TIME health

Smoking News to Make You Cringe

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Stephen St. John—Getty Images/National Geographic Creative

Read TIME's reports from the era when the medical community thought it was O.K. to smoke

Thursday marks the American Cancer Society’s Great American Smokeout (GASO), a nationwide event encouraging smokers to kick the habit.

We know today that cigarette smoking causes serious diseases in every organ of the body, including lung cancer, diabetes, colorectal and liver cancer, rheumatoid arthritis, erectile dysfunction, age-related macular degeneration, and more. Tobacco use rakes up more than $96 billion a year in medical costs, and it’s estimated that 42.1 million people, or 18.1% of all adults in the U.S. smoke cigarettes.

This year marked the 50th anniversary of the historic 1964 Surgeon General’s report that concluded that smoking caused lung cancer, and should be avoided. Before then, smoking messaging was depressingly inaccurate. Despite concerns — initially from a small minority of medical experts — the tobacco industry boomed in the U.S., and even doctors considered the effects of cigarettes to be benign.

Here are some examples of tobacco-related beliefs that appeared through the years in TIME Magazine:

1923: In an article about a recent compilation of smoking-related data, TIME was mostly concerned with whether smoking made people more or less brainy: “The outstanding fact of this survey is that every man in the literary group smokes, and the majority of the literary women. Moreover, most of them consider its effects beneficial, and claim that their literary and imaginative powers are stimulated by it.” And later: “From the laboratory data, the author concludes that it is impossible to say that tobacco smoking will retard the intellectual processes of any one person, but in a large group it may be predicted that the majority will be slightly retarded.”

1928: Some experts tried early on to warn about the effect of nicotine, but were met with resistance. In an article about a researcher presenting data on nicotine and the brain, TIME writes: “Many U. S. doctors have contended and often hoped to prove that smoking does no harm. In Newark, N. J., five children of the Fillimon family have been smoking full-sized cigars since the age of two. The oldest, Frank, 11, now averages five cigars a day. All of these children appear healthy, go to school regularly, get good grades.”

1935: Questions began to be raised about the effects on infants, though uptake was limited: “Physiologists agree that smoking does no more harm to a woman than to a man, if harm there be. According to many investigators, the only circumstances under which a woman should not smoke are while she has anesthetic gas in her lungs (she might explode), and while she produces milk for her baby. Milk drains from the blood of a smoking mother those smoke ingredients which please her, but may not agree with her nursling.”

1938 Even if there might be adverse health events for some smokers, not all physicians agreed it was a universal risk: “In step with a recent upsurge of articles on smoking, in the current issue of Scribner’s, Mr. Furnas offers several anti-smoking aids for what they are worth. Samples: 1) wash out the mouth with a weak solution of silver nitrate which ‘makes a smoke taste as if it had been cured in sour milk’; 2) chew candied ginger, gentian, or camomile; 3) to occupy the hands smoke a prop cigaret. For many a smoker, however, this facetious advice may be unnecessary, since many a doctor has come to the conclusion that, no matter what else it may do to you, smoking does not injure the heart of a healthy person.”

1949: By the late 1940s, smoking had become a contentious debate in the medical community: “Smoking? Possibly a minor cause of cancer of the mouth, said Dr. MacDonald. But smoking, argued New Orleans’ Dr. Alton Ochsner, can be blamed for the increase of cancer of the lung. Surgeon Ochsner, a nonsmoker, was positive. Dr. Charles S. Cameron, A.C.S. medical and scientific director, who does smoke, was not so sure. For every expert who blames tobacco for the increase of cancer of the lung, he said, there is another who says tobacco is not the cause.”

1962 More evidence was linking tobacco to cancer, and some groups were trying to get pregnant women to quit out of potential risks to the child, but still: “Some doctors, though, see no direct connection between smoking and prematurity; they argue that the problem is a matter of temperament, that high-strung women who smoke would have a high proportion of “preemies” anyway.”

1964 In a historic move, the 1964 Surgeon General’s report officially stated that cigarette smoking causes cancer, giving authority to anti-smoking campaigns. TIME wrote:

The conclusion was just about what everybody had expected. “On the basis of prolonged study and evaluation,” the 150,000-word report declared, “the committee makes the following judgment: Cigarette smoking is a health hazard of sufficient importance in the U.S. to warrant appropriate remedial action.” More significant than the words was their source: it was the unanimous report of an impartial committee of top experts in several health fields, backed by the full authority of the U.S. Government.

Read TIME’s full 1964 coverage of the Surgeon General’s report, here in the TIME Vault: The Government Report

TIME Cancer

Young Smokers Put Millions at Risk, CDC Says

Kid Smoker
Diverse Images/UIG/Getty Images

5.6 million young people under age 17 could die early

Over 1 in 5 high school students use tobacco products, and unless rates drop significantly, 5.6 million young people under age 17 will die early from a smoking-related illness, according to a recent report from the Centers of Disease Control and Prevention (CDC).

Among young people who use tobacco products, over 90% are using nicotine vectors like cigarettes, cigars, hookahs and pipes. The vast majority of smokers try their first cigarette by the time they turn 18. The findings were published Thursday in the CDC’s Morbidity and Mortality Weekly Report.

The CDC analyzed its National Youth Tobacco Survey and report that in 2013, 22.9% of high school students and 6.5% of middle schoolers said they had used tobacco in the last 30 days. Those rates are slightly down from 2012, where 23.3% of high school students and 6.7% of middle schoolers said they’d used some form of tobacco in the last month. Unfortunately, the new numbers still show that close to 50% of all high schoolers and almost 18% of all middle schoolers have used a tobacco product at least once.

What about e-cigarettes? They’re still less popular than the traditional products: 4.5% of high schoolers and 1.1% of middle schoolers said they used them in the last month. How great of a problem e-cigarettes are for public health is still debated, but the products do contain nicotine, so therefore considered unsafe for kids.

One item of particular concern to the FDA are cigars, because they are taxed at a lower rate and often made to look like cigarettes, even having fruity flavors. Some are not regulated by the FDA in the way cigarettes are, which experts cite as a major concern.

Cigarette smoking kills more than 480,000 Americans every year, and for each death, there are about 32 people living with a smoking-related illness. It costs the U.S. economy billions in medical costs and loss in productivity. One strategy to make smoking less appealing to young people (besides the long list of terrifying health risks, like lung cancer) is by hiking up the price of tobacco, and launching more youth-targeted social campaigns, the CDC says.

Smokers can get free help quitting by calling 1-800-QUIT-NOW.

TIME tobacco

Here’s the Best Way to Get Someone to Quit Smoking

Antismoking messaging works differently depending on who's watching, a new study shows

For years, the U.S. government has gone back and forth about whether or not it’s legal to force tobacco companies to use images of cancerous lungs and other graphic pictures on their cigarette packaging. The assumption, of course, is that the images will terrify any smoker into kicking the habit.

However, a new study published in the journal Nicotine & Tobacco Research shows that the graphic tactic might not work on all smokers. The effectiveness of antismoking messaging depends on the attitude of the smoker.

Researchers from the Georgetown Lombardi Comprehensive Cancer Center studied 740 smokers to figure out what type of antismoking campaigns worked best. They discovered that messages that stress the benefits of quitting, like “quitting smoking reduces the risk of death due to tobacco,” were more effective at getting smokers to quit if those smokers thought that quitting would be very hard. The more graphic and negative ads like “smoking can kill you” tended to work best for smokers who thought they could quit whenever they wanted.

One of the reasons motivating messaging worked best among smokers who viewed quitting as a challenge could be that they’re already well aware of the health risks. On the other hand, the researchers speculate that loss-framed messaging — the kind that focuses on the negative consequences of continuing a behavior — worked better for smokers who felt they had more agency in their cessation because the negative ads built up motivation to stop.

Ultimately, the researchers believe that having a mixture of various messaging strategies is the best way to appeal to a broad range of smokers, and that currently there are far more negative messages than positive ones.

That’s not to say that scary ads don’t work. For a couple years, the Centers for Disease Control and Prevention (CDC) has poured resources into an intensive ad campaign called “Tips From Former Smokers” which features real former smokers who have experienced serious setbacks from their habit, like no longer being able to speak properly or having a baby too early. During past campaigns, the CDC has said that their quit lines experience 80% more activity when the ads are running compared with the weeks before.

Terrifying ads aren’t going away anytime soon, but mixing in more motivating messages might appeal to would-be quitters of all kinds.

TIME Retail

CVS Quits Selling Tobacco 3 Weeks Ahead of Schedule

Changes corporate name from CVS Caremark to CVS Health

CVS announced Wednesday that it has yanked cigarettes and other tobacco products from shelves at 7,600 stores nationwide, beating its original goal for ending cigarette sales by almost a month.

The retailer also changed its corporate name from CVS Caremark to CVS Health, a name the company believes “reflects our broader health care commitment.”

CVS pledged tobacco products would be off its shelves by Oct. 1 when it announced its plan to stop selling cigarettes in February, but they’re gone three weeks early.

“Every day, all across the country, customers and patients place their trust in our 26,000 pharmacists and nurse practitioners to serve their health care needs,” Helena B. Foulkes, President of CVS/pharmacy said in a statement posted on the company’s website. “The removal of cigarette and other tobacco products from our stores is an important step in helping Americans to quit smoking and get healthy.”

“We’re the first national pharmacy chain to step up and take this action,” CEO Larry Merlo said in a video accompanying the original statement announcing the halt in sales. “Tobacco products have no place in a setting where health care is delivered.”

Merlo also said the company plans to launch a “robust smoking cessation program” next year, to help the 7 in 10 smokers who say the way to quit achieve that goal.

The move comes as CVS is increasingly trying to rebrand itself as a health-care company, with in-pharmacy clinics and partnerships with hospitals. Now that cigarettes have disappeared, customers can expect to see new signage and an “enhanced selection” of nicotine replacement products.

First Lady Michelle Obama, who has made public health a key priority during her time in the White House, thanked CVS in a Twitter message.

TIME Addiction

WHO Urges Tighter Regulation of E-Cigarettes

A woman smokes an "Blu" e-cigarette in Washington, D.C., on Sept. 25, 2013.
A woman smokes an "Blu" e-cigarette in Washington, D.C., on Sept. 25, 2013. Jim Watson—AFP/Getty Images

The United Nations agency acknowledged both the "promise and threat" of the $3 billion industry

The World Health Organization recommended countries adopt a raft of tighter regulations over the sale and use of e-cigarettes Tuesday, including a ban on sales to minors, a ban on “vaping” indoors and tighter controls over advertising and flavored products.

The United Nations agency released a report on Tuesday that acknowledged both the “promise and threat” of the e-cigarette market, Reuters reports. The authors cast doubt on e-cigarette makers’ claims that the devices could help smokers kick the habit. Until those claims had been substantiated by a stronger body of scientific evidence, the U.N. health agency recommended that countries adopt regulations that would “minimize content and emissions of toxicants.”

Suggested regulations include restrictions on advertisements promoting e-cigarettes as a healthy alternative to smoking, prohibitions on sales to minors and sweetened flavors that might appeal to minors and a ban on using the devices indoors. The Food and Drug Administration proposed similar restrictions on sales to minors and advertising of e-cigarettes in April, but stopped short of banning television advertising or sweetened flavors.

The report comes amid a widening divide in the scientific community as to whether e-cigarettes constitute a help or a hindrance in the battle to stop people smoking. A group of 53 scientists signed an open letter to the WHO earlier this year urging officials to resist any measures that might suppress sales of e-cigarettes, calling them “part of the solution” in the fight against smoking.

[Reuters]

TIME E-Cigarettes

Toronto Bans E-Cigarettes From City Workplaces

An e-cigarette on March 05, 2013 in Paris.
An e-cigarette in Paris on March 05, 2013 Kenzo Tribouillard—AFP/Getty Images

Mayor Rob Ford reportedly voted against the ban

The Toronto City Council voted 36-2 in favor of banning e-cigarettes from all city workplaces on Monday.

According to a Toronto Sun reporter, Mayor Rob Ford was one of the two votes against the ban.

The vote was part of a marathon session for the city council which could last several days and will address some 400 items from e-cigarettes to traffic lights.

Toronto is not the first major city in North America to issue a prohibition on e-cigarettes. In March, Los Angeles became the third city after New York and Chicago to outlaw e-cigarettes at the office, and Philadelphia followed soon after.

But the L.A. ban extended further than city workplaces with bans in place for bars, restaurants, and parks. In New York, e-cigarette smokers cannot vape anywhere where conventional smoking is also banned, and in Chicago, there’s an indoor smoking ban in place. Smaller cities have also taken up the issue, and it’s expected that more cities will consider similar bans.

Health Canada, the government’s public health department, advised Canadians not to buy e-cigarettes as long ago as 2009, CTV News reports, but there are no formal prohibitions on the sale of e-cigarettes unless they are “expressly intended” for nicotine delivery. That allows many retailers to circumvent a crackdown by regulators.

Earlier this year, the FDA said it would increase its regulation over e-cigarettes, and on Sunday night, the American Heart Association called for stricter oversight, especially when it comes to marketing to kids.

TIME Heart Disease

E-Cigs Should Be Last Resort for Quitters, Heart Group Says

A salesman waits for customers as he enjoys an electronic cigarette at a store in Miami, Florida on April 24, 2014.
A salesman waits for customers as he enjoys an electronic cigarette at a store in Miami, Florida on April 24, 2014. Joe Raedle—Getty Images

The American Heart Association calls for tighter e-cigarette regulations, but gives the OK for a small amount of smoking cessation use

Electronic cigarettes should be used to help smokers quit only if proven cessation methods like nicotine patches fail, the American Heart Association said late Sunday.

The AHA acknowledged that e-cigs haven’t yet been proven to be good tools for quitting smoking, though some research has suggested they may be about equal to or slightly better than nicotine patches. The new recommendation is part of the AHA’s policy statement on e-cigarettes. The AHA calls for more regulation of e-cigs, which is something the FDA has promised in the past. The AHA says it fears any further delay in these regulations could have serious public health consequences.

Specifically, the AHA calls for new and stronger regulations for how e-cigarettes are marketed, especially to young people. It recommends a ban on sales to minors, since some research has shown that young people consider using e-cigarettes as a convenient method for smoking. Public health experts have long worried that e-cigarettes could serve as a gateway to other tobacco products, like the much unhealthier conventional cigarettes.

The group says some research suggesting e-cigarettes could normalize smoking are troubling, especially data showing youth exposure to e-cigarette advertising has spiked 250% from 2011 to 2013. “These disturbing developments have helped convince the association that e-cigarettes need to be strongly regulated, thoroughly researched and closely monitored,” AHA CEO Nancy Brown said in a statement.

Whether e-cigarettes are just another vector for nicotine exposure to American youth is a hotly debated topic among public health experts. Some hold the belief that pushing smokers toward lower-level nicotine carriers could ultimately help people quit, while others say there’s no space for more addictive products in the U.S. market.

TIME

‘Marlboro Boys’: Photographing Underage Smoking in Indonesia

While smoking rates are declining in many western countries, the opposite is happening in the Republic of Indonesia, where over 60% of the male population regularly smokes and uses tobacco. When Canadian photographer Michelle Siu heard about this alarming statistic, she felt it was something she needed to document.

Smoking has become ingrained in Indonesian culture where some children are having their first cigarette by the age of four, Siu tells TIME. “Tobacco consumption in Indonesia is a complex issue as it is intertwined in the country culturally, politically and economically. You can’t take 10 steps before seeing a tobacco advertisement or someone smoking.”

Indonesia’s economy is dependent upon the tobacco industry, which has proven to be extremely profitable. Many Indonesians make their livelihood through tobacco farming, and are surrounded by cigarettes from an early age. Smoking regulations in Indonesia are few and far between, and it is not uncommon to see children smoking cigarettes on public buses on their way to and from school. “It’s hard for the government to really want to regulate the industry,” says Siu. “It’s something that they make a lot of money off of.”

As a daughter of immigrant parents, Siu says she is drawn to stories that shed light on “threatened cultures and vulnerable people.”

In Marlboro’s Boys, Siu examines the loss of innocence that these young smokers exhibit. “They inhale and exhale like old men that have been smoking for years – some of them have been smoking two packs a day since they were little kids.”


Michelle Siu is a documentary photographer based in Toronto.

Adam Glanzman is a contributor to TIME LightBox. Follow him on Twitter @glanzpiece


TIME tobacco

E-Cig Benefits Outweigh Their Harms, New Research Says

A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014.
A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014. Nam Y. Huh—AP

That doesn't mean you should hop on the bandwagon

The debate over e-cigarettes—now a$2 billion industry in the U.S. and growing—is constantly up in smoke.

The primary problem is that we simply do not know what e-cigarettes’ long-term health impacts are, with some people heralding it an effective smoking cessation while others say it’s just more nicotine products on the market—and not smoking, no matter what you inhale, is your best bet. Some early research found that adolescents smoking e-cigarettes will also smoke regular tobacco products, and that there’s an increase in e-cigarette related calls to poison centers around the nation.

But this week, a new paper looking at over 80 studies on e-cigarettes’ safety and their effects on users plays devil’s advocate.

The researchers found that based on the evidence, e-cigs are much less harmful to smokers and bystanders compared to conventional cigarettes. They are becoming more popular, but the numbers—so far—don’t suggest that they are being regularly used by non-smokers or kids. Finally, the researchers found that e-cigs can help some users cut down on their use of regular cigarettes and even quit. As regulating bodies around the world make decisions about how to deal with e-cigs, the researchers conclude that letting e-cigarettes compete with traditional tobacco on the market might actually decrease smoking morbidity and mortality.

“Health professionals may consider advising smokers unable or unwilling to quit through other routes to switch to [e-cigarettes] as a safer alternative to smoking and a possible pathway to complete cessation of nicotine use,” the Queen Mary University of London researchers write in their study, published in the journal Addiction.

When it comes to the question of what’s safer, e-cigs or cigarettes, no one is in disagreement. E-cigarettes win. While they still provide smokers with nicotine, which is highly addictive, users do not inhale the toxic smoke and chemicals from regular cigarettes.

Public health experts are split on what role e-cigarettes will play in the nation’s health, but more evidence and further research from both sides of the debate will hopefully keep policy members informed about where the current science stands.

TIME tobacco

$23.6 Billion Lawsuit Winner to Big Tobacco: “Are You Awake Now?”

Cynthia Robinson with her attorneys Willie Gary (left) and Christopher Chestnut (right) as she speaks during an interview on July 21, 2014 in New York City.
Cynthia Robinson with her attorneys Willie Gary (left) and Christopher Chestnut (right) as she speaks during an interview on July 21, 2014 in New York City. Bebeto Matthews—AP

The widow who won a $23.6 billion lawsuit against R.J. Reynolds talks to TIME about the suit and what she hopes the victory will accomplish

“Are you awake now? Do you hear what the jury is saying? You have to stop,” Cynthia Robinson wants to tell the tobacco industry. The Florida widow recently won a $23.6 billion lawsuit against tobacco company R.J. Reynolds, one of the largest recent judgments on the industry, and in an interview with TIME, she says she hopes they listen to the jury’s message.

Robinson’s husband Michael Johnson died in 1996 at age of 36 from lung cancer, and in her lawsuit against R.J. Reynolds, she and her attorneys argued that the company was aware that cigarettes were addictive and caused lung cancer, but was negligent in telling smokers like Johnson about those risks.

Johnson got hooked on cigarettes when he was just 13-years-old, and eventually smoked up to three packs a day, often lighting his next cigarette with the burning end of the one he just finished. “He was a quiet person. He read the Bible every day, he took the kids swimming, he mowed the yards of all the elderly neighbors,” Robinson says. He was diagnosed with lung cancer in 1995 and lived for almost a year in constant pain. “The pain [from the cancer] was always there. When you’re on oxygen and you have to step outside for a cigarette, you can’t stop. You’re addicted.”

Johnson tried multiple times to stop smoking with no success. During one of her husband’s hospital visits, Robinson knew something was wrong when he began sweating and one of his eyes started to droop. The doctor said he would live for only a couple of months, but he survived for 10 more months. “He suffocated and died for so long, it was awful,” says Robinson, recalling how hard it was for her husband to breathe in the months before his death.

The day Johnson died, he could not stop coughing up blood. His brother tried to hold him up, and Robinson wanted to get him into an ambulance, but his mother told her that he was already gone. “The blood was everywhere, it was awful. Only 36 years old and he was already gone,” says Robinson.

Ten years later Robinson filled her lawsuit. It’s one of many Florida lawsuits referred to as an “Engle progeny,” stemming from a 2000 $145 billion verdict in a class action suit led Dr. Howard A. Engle, a Miami Beach pediatrician who smoked, and eventually died of chronic obstructive pulmonary disease. The case was overturned in appeals court, and it was ruled that smokers could not make up a class. But the Engle case established that the tobacco industry had deceived Americans, by knowingly putting addictive and cancerous products on the market, and paved the way for thousands of individual Florida cases to take on Big Tobacco. On Friday July 18, Robinson did, and won her bittersweet victory.

“It was justice. It was time, and it had been a long time,” Robinson says. “I thought, oh my God, we did it. We may have to keep fighting, and will. It’s for Michael, and anyone who lost their lives to lung cancer. There are thousands right now dying of lung cancer. Michael died so young, he missed graduations and weddings.”

“We expected every dime and more,” says Robinson’s attorney Willie E Gary. “Johnson started smoking when he was a teen. How aware of the risks can you be at that age? But [the tobacco industry] would market and target kids. To this day they are going after our youth, stuffing their pockets. It’s all about the profits and it’s nothing about the health and safety of the people.”

As TIME reported earlier this week, R.J. Reynolds plans to appeal, and based on the industry’s track record with lawsuits, the damages will likely be lowered. Gary isn’t deterred: ” We expect to win. Winning is not about getting everything that you want. We know that we made a difference.”

It’s small consolation for losing her husband, but Robinson is satisfied that her time, effort, and daily prayers were enough to topple Goliath, at least in court last Friday. “We had to go all the way no matter how many years it took. Life has been lost,” she says. For the thousands of other pending lawsuits, she urges plaintiffs to persevere. “Don’t give up no matter how much they try to discourage and belittle you, you fight them to the very end, and you’ll succeed,” she says.

 

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