The Big Answer

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While cigarette smoking has decreased overall in the U.S. population, alcohol use and abuse has not.

The clearest trend, of all substances, has been in tobacco use (Statistical Abstract of the U.S., 1988, 108th ed.), with 25 percent of the U.S. population smoking in 1987, down from 37 percent in 1970. By 2010, 20 percent of U.S. adults smoked. Anyway, the good news is that the rate of decline recently is much sharper among adults 18 to 29 than among those 50 and older. This may reflect a decline in smoking among teens and other minors—the ages at which a lifetime of smoking often starts—and, in any case, increases the likelihood that smoking rates will continue to fall in the years ahead.

Worldwide, although smoking is decreasing, there are some opposing trends. In at least 19 countries more girls than boys smoke. And it has been suggested that nonsmoking education should begin with under-11-year-olds because, in Europe in 1988, by the age of eleven, 30 percent of boys and 20 percent of girls have tried smoking. And by age thirteen 48 percent of boys and 43 percent of girls smoke at least occasionally. By age 18, 30 percent of both sexes smoke daily ("Nonsmoking: Begin with Kids Under Age 11," World Health, December 1988, p. 30.).

In East Germany, smoking declined 16.5 percent among men between 1960 and 1980 and increased in women by 60 percent. In Asia, where smoking rates are generally low, in Andhra Pradesh (India) in 1987, 67 percent of women smoke, as do 40 percent in some rural areas in Thailand. Women are subject not only to the health risks that apply to men, but to other risks that are specific to females. Women who smoke have a higher overall mortality than women who do not, making greater demands on health services and losing more time from work or school (Eileen, "Women and Smoking," World Health, December 1987, pp. 28-29.). In the developing world, tobacco consumption continues to rise at the rate of 3.4% in 2002 (WHO/WPRO-Smoking Statistics; World Health Organization Regional Office for the Western Pacific).

What is important about the incidence of smoking is the 500,000 lives that it claims in the United States every year, with total deaths in industrialized nations of over one million a year from tobacco (World Health Organization). Second hand smoke kills 53,000 people per year in the U.S. (20/20, November 1991) and causes 603,000 deaths a year worldwide (More than 600,000 people killed by 2nd-hand smoke. The Washington Post, 26.11.2010). Male and female smokers lose an average of 13.2 and 14.5 years of life, respectively (MMWR April 12, 2002 / 51(14);300-3). At least half of all lifelong smokers die earlier as a result of smoking (BMJ, Am J Public Health 1995:1223-1230).

Second hand smoke kills 53,000 people per year in the U.S. and causes 603,000 deaths a year worldwide

Estimates claim that smokers cost the U.S. economy $97.6 billion a year in lost productivity, and that an additional $96.7 billion is spent on public and private health care combined (Smith, Hilary. "The high costs of smoking". MSN money.). This is over 1% of the gross domestic product.

The tobacco industry, in complete disregard for the health of Americans, uses its power by lobbying at the state level to preempt healthy local initiatives that would protect nonsmokers from the ravaging effects of tobacco (Sylvester, Kathleen, "The Tobacco Industry Will Walk a Mile to Stop an Anti-smoking Law," Governing, May 1989, pp. 34-40.).

And if the U.S. government's policy is to reduce cigarette smoking in the U.S., its efforts to open Asian markets to American tobacco products have roused criticism. Exported cigarettes have no health warnings and they often contain higher levels of tars than the brands sold in the U.S. In countries where cigarette advertising was virtually nonexistent, and after some arm-twisting under Section 31 of the Trade Act of 1974, Korea reversed its ban on advertising and in one month American tobacco companies saw a thirty-fold increase in their cigarette exports there. In 1987, formal trade understandings with Japan and Taiwan were reached and cigarette exports to Japan tripled in one year. Cigarette exports to Taiwan increased 2400 percent between 1986 and 1988.

Overall American cigarette exports almost doubled between 1986 and 1988, from 64 billion to 118 billion units. A great deal of the advertising targets children who do not yet smoke, with promotions encouraging the habit. In Taiwan, teens who want to go into a disco are told to bring three empty packs of Winston cigarettes.

In 1989 Philip Morris sold 138 billion Marlboro cigarettes in the U.S. and more than 180 billion abroad. This brand is the world's best seller. Those numbers add up to about 60 cigarettes for every man, woman, and child on earth (Friendly, Fred W., "Hard Drugs, Hard Choices.", and "Fascinating Facts," University of California, Berkeley Wellness Letter, August 1990, p. 1.).

Asian Countries used to consume about 50 percent of America's overseas tobacco a few years back, but cheap tobacco from Brazil, Argentina, Malawi, and Thailand lowered that considerably. Asian consumption has been increasing about 5.5 percent per year. In 1988, Philip Morris projected that tobacco sales for the whole industry would increase 35 percent by 1999, to 2.3 trillion cigarettes a year. In China, which is the biggest producer and consumer of cigarettes in the world, American cigarettes are very prestigious. According to C. Everett Koop, if 40 percent of the 500 million people under the age of 20 begin smoking, 25 percent of them (i.e. 50 million people) will eventually die of smoking-related diseases ("An Unhealthy Trade," World Press Review, July 1988, p. 47.).

16 of the world's 20 most polluted cities are in China—and yet a big percentage of Chinese are smokers!

Chinese people often wear masks in public to help with breathing

A billboard of the Marlboro man stands as a sentinel to East Berlin where Checkpoint Charlie used to be; and East German shops' walls and umbrellas are covered with cigarette names. In the former Soviet Union, after riots for cigarettes, the government asked western manufacturers to give them a quote for 4 billion cigarettes (The Economist, September 15, 1990.).

One in six deaths in America is due to smoking (National Cancer Institute). And though ex-drug-addict smokers claim that giving up heroin was easier than giving up cigarettes ("Heroin, Cocaine, and Cigarette Users," Internal Medicine News, No. 22, 1989, as cited in the Edell Health Letter, March 1990, p. 4.), over 90 percent of smokers manage to quit cold turkey with 25 percent quitting on the first try, and over 73 percent finding success by the fourth try (HeartCorps, January/February 1990, p. 12.).

Cigarette smokers, because of their habit, are more prone to certain diseases like strokes, heart attacks, and lung cancer. And it has been found that smokers are less likely to take care of themselves. They drink more alcohol, don't eat well or regularly, and don't take vitamins (National Health Interview Survey of Cancer Epidemiology and Control.). They are less likely to have a friend or relative they can call on for help, and they have less medical tests. Former smokers, however, become very careful about their health habits (Waldrop, Judith, "It's Bad," Smoking & Other Tobacco Use: United States, 1987, National Center for Health Statistics, American Demographics, February 1990, pp. 12-13.).

So who starts smoking and why? The answer is certain identifiable teenagers—junior high-schoolers 12 to 14 years old. And because smokers are starting at earlier and earlier ages, the latest data show that the average male smoker is 22 times more likely to die from lung cancer than a nonsmoker—double the risk difference found in earlier studies between 1959 and 1965. Teens are influenced by their peers and by massive advertising in magazines, newspapers, stores, and gas stations. Smoking is one of the few socially accepted forms of rebellion for teenage girls. The lower the academic grades for male or female teens, the higher the smoking rate. High school drop-outs have the highest smoking rates—as much as 75 percent according to some studies.

The Journal of the American Medical Association reported a recall and eye-tracking study of adolescents viewing tobacco advertisements. Although the health warnings on cigarette advertisements are intended to educate the public about the health risks of smoking cigarettes, the study showed that the warning on the label is not an effective public education tool. The score for recognizing the health warning was only slightly better than random guessing. Eight percent of the viewing time was spent looking at the warning. And the warning was not viewed 43.6 percent of the time. After viewing the ad, the participants were practically unable to recognize which warning had been displayed (Greydanus, Donald E., "Routing a Modern Pied Piper of Hamlin," Journal of the American Medical Association, January 6, 1989, pp. 99-100.).

Since 1971 when cigarette commercials were banned from radio and television, cigarette advertising has increased eightfold to $2.5 billion a year. If you ask teens about smoking data, they believe that about twice as many people smoke as actually do. They do not believe they are vulnerable to the health hazards or addictive properties of cigarettes. They believe they will be able to feel it if they get addicted, and then they'll stop. If smoking doesn't feel bad, they think it can't be hurting their bodies. And they believe that society doesn't think smoking is really so bad, because if it did it wouldn't allow them to be inundated by cigarette advertising (Glazer, Sarah, "Who Smokes, Who Starts—and Why," Editorial Research Reports, March 24, 1989, pp. 150-162.). (Think hard about this last belief.)

Anyone watching television or movies in the U.S. in the 1990s can easily observe how the tobacco industry does its "real" advertising. It's obvious that the tobacco industry, by probably legal means that one can easily imagine, has managed to cause a major character in some TV shows and movies to be a smoker, like the two stars at the end of Boston Legal, or more recently, America’s Next Top Model—a teen-targeted show. A study by the Office of National Drug Control Policy found that 20 of the 73 episodes of the most popular teen-targeted shows were rated TV-PG (“parental guidance suggested”), and 60% of them had at least one tobacco depiction. In contrast, among the 53 shows rated TV-14 (“parents strongly cautioned”), 32% of episodes had at least one tobacco depiction. In other words, the stronger the parent cautioning the less smoking and the lighter cautioning shows have MORE smoking.

Unfortunately, this type of "advertising" is much more effective than is purchased magazine, television or radio ads because its influence is far greater on young people. When a young person sees his/her "heros" smoke, smoking becomes acceptable, and even desirable. The studios seemed to cave in to public pressure, a few years back, when they at first gave higher ratings (such as PG-13) to shows with lots of smoking or with protagonists who smoke, but the moment the public turned their backs, the ratings reversed so that younger, more vulnerable teens would get the most smoking encouragement. If you don't think Big Tobacco had a role in this somehow, you don't know how big corporations think. Since May 2007, the Motion Picture Association of America is supposed to give a film glamorizing smoking or depicting pervasive smoking outside of a historic or other mitigating context a higher rating. But the researchers discovered something quite different. One can only wonder how such a "mix-up" could have happened. Not!

Note: The good news is that both Google and Microsoft have policies that outlaw the promotion of tobacco products on their advertising networks, and back in 1990 the Tobacco Institute pledged $10,000,000 to a campaign to discourage smoking by minors. And new 2010 regulations prohibit tobacco companies from sponsoring sports, music, and other cultural events. Also, tobacco companies can no longer display their logos or advertise their products on T-shirts, hats, or other apparel. However, bad news is that the estimated profit that U.S. tobacco companies earned in the same year from sales of tobacco to minors was $250,000,000 (Harper's Index, Harper's Magazine, 1991.). In addition, the Tobacco Institute spends $18,000,000 per year looking for evidence that smoking isn't harmful (CNN, September 17, 1991.).