The success of the anti-cigarette campaign

Probably the biggest public health success in America over the past half century has been the remarkably effective long-term campaign to reduce cigarette smoking. The percentage of adults who smoke tobacco has declined from 42% in 1965 (the first year the CDC measured this), to 12.5% in 2020.

It’s difficult to disentangle the effect of various factors that have led to this stunning decline of what was once a ubiquitous habit — note that if we exclude people who report having no more than one or two drinks per year, the current percentage of alcohol drinkers in the USA is about the same as the percentage of smokers 60 years ago — but the most commonly cited include:

Anti-smoking educational campaigns

Making it difficult to smoke in public and many private spaces

Increasing prices

Improved smoking cessation treatments, and laws requiring the cost of these to be covered by medical insurance

I would add another factor, which is more broadly cultural than narrowly legal or economic: smoking has become declasse.

This is evident if you look at the relationship between smoking rates and education and income: While 32% of people with a GED smoke, the percentages for holders of four year college degrees and graduate degrees are 5.6% and 3.5% respectively. And while 20.2% of people with household incomes under the $35,000 smoke, 6.2% of people with household incomes over $100,000 do.

It’s also worth noting that, if we were in the same situation today as we were in the mid-1960s, the contemporary incarnation of the Republican party would make it completely impossible to undertake any of the government measures that, in combination, have over the past half century so successfully reduced the leading cause of preventable death in America.