LET’S MAKE THE NEXT GENERATION

TOBACCO-FREE

Your Guide to the 50th Anniversary Surgeon General’s 

Report on Smoking and Health

A NNIVERSARY

U.S. Department of Health and Human Services
50 Years of Progress

A Report of the Surgeon General

Rear Admiral Boris D. Lushniak, M.D., 

M.P.H., Acting Surgeon General

NOTE FROM THE ACTING 

U.S. SURGEON GENERAL

I am pleased and honored to release The Health Consequences of Smoking: 50 Years 

of Progress, the 50th Anniversary Surgeon General’s Report on Smoking and Health. 

This new report:

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looks back at the important gains we have made in reducing tobacco use over 

the last half-century;

catalogs the devastating effects smoking and exposure to secondhand smoke have 

on the human body; and 

looks at the work still to be done to achieve our goal of a society free from 

tobacco-related disease and death. 

Because the report itself is written mostly for a scientific and medical audience, we have 

created this consumer guide to explain the report in language we can all understand. 

This guide details devastating effects of smoking including nicotine addiction and 

serious disease. It shows that 5.6 million of today’s children will ultimately die early from 

smoking if we do not do more to reduce current smoking rates. And it shows that 2.5 

million nonsmokers have died from secondhand smoke since 1964. 

It also contains important facts on the benefits of quitting smoking and free resources 

that are available to smokers who want to quit. The guide is meant to motivate as well 

as educate, because the best thing all of us can do to protect our bodies and live long, 

healthy lives is to say no to tobacco use. If you are an educator, a health care provider, 

a parent, or just someone who is interested in healthy living, we hope this guide will be 

helpful in your efforts to learn more about the dangers of tobacco.

We are at a historic moment in our fight to end the epidemic of tobacco use that 

continues to kill more of our citizens than any other preventable cause. The good news 

is that we know which strategies work best. By applying these strategies more fully 

and more aggressively, we can move closer to our goal of making the next generation 

tobacco-free.

As the Nation’s Doctor, the Surgeon General provides Americans with the best scientific information available on how to improve their health and 

reduce the risk of illness and injury. Some of the Surgeon General’s most important tools are comprehensive scientific reports on specific health 

issues, such as this report on smoking and health. To read the full report and its related materials, go to SurgeonGeneral.gov.
 

1 A PERSISTENT EPIDEMIC 

Introduction 2

The Killer Cigarette 4

The Power of Nicotine Addiction 6

2 DISEASES AND HEALTH PROBLEMS 

LINKED TO SMOKING 

Cancer Trigger 9

Breath Blocker 10

Heart Stopper 12

Smoking and Reproduction 14

Smoking and Diabetes 16

Smoking and the Immune System 16

Smoking and Eye Disease 17

3 THE NEXT 50 YEARS

Saving Millions of Lives 19

Ending the Tobacco Use Epidemic 20
2

A PERSISTENT EPIDEMIC

BUT A WINNABLE PUBLIC HEALTH BATTLE 

Every adult who dies early 

because of smoking is 

replaced by two new, young 

smokers, one of whom also 

will die early from smoking. 

Introduction 

We have known for the last 50 years that people 

who smoke cigarettes are much more likely to 

develop—and die from—certain diseases than 

people who don’t smoke. More than 20 million 

Americans have died because of smoking 

since the first Surgeon General’s Report on 

Smoking and Health was issued in 1964. 

Most of those deaths were of adults who 

smoked, but 2.5 million were of nonsmokers 

who died because they breathed secondhand 

smoke—air that was polluted by other people’s 

cigarette smoke.

Adults are not the only people who suffer 

because of smoking. Today, about half of all 

the children between ages 3 and 18 years in 

this country are exposed to cigarette smoke 

regularly, either at home or in places such as 

restaurants that still allow smoking. 

For decades the tobacco industry has been 

encouraging children to start smoking. 

Images that make smoking appealing to 

children are still highly visible in our society. 

TIMELINE:

50 YEARS 

OF PROGRESS 

IN TOBACCO 

CONTROL 

 January 11, 

 First Surgeon General’s Report 

on Smoking and Health. 

1964 

Forty-two percent of American 

adults smoke. 42%
50 Years of Progress

A Report of the Surgeon General

They are found:

l

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l

In movies and on TV 

In video games

In retail advertising, including in 

convenience stores

Online

As a result of tobacco industry marketing and 

other influences, more than 3,200 children 

younger than the age of 18 smoke their first 

cigarette every day. Another 2,100 youth and 

young adults who are occasional smokers 

become daily smokers. Nearly 9 out of 10 

smokers start before the age of 18, and 98% 

start smoking by age 26. Every adult who dies 

early because of smoking is replaced by two new

young smokers; if current risks hold, one of the 

two also will die early from smoking. 

3

, 

5 — — .6

MILLION

CHILDREN ALIVE TODAY 

WILL ULTIMATELY

DIE EARLY FROM SMOKING

IF WE DO NOT DO MORE 

TO REDUCE CURRENT 

SMOKING RATES

THAT’S EQUAL TO

1 CHILD 

OUT OF 

EVERY 13 

ALIVE IN THE U.S. TODAY

OR

2 

OF 

THE27

CHILDREN

IN THE AVERAGE 

3RD GRADE

CLASSROOM

1966 

The United States becomes the first country 

to require warning labels 

on cigarettes.

1967 

U.S. Fairness Doctrine requires public service 

announcements about smoking’s health risks to 

counter tobacco ads on radio and TV.

1969 

The National Association of Broadcasters 

agrees to phase out cigarette ads on TV 

and radio.
4

37%

SMOKING RISKS ARE 

MORE DEADLY NOW 

THAN 50 YEARS AGO

LUNG CANCER

RISK FOR SMOKERS

—COMPARED TO—

PEOPLE WHO

NEVER SMOKED

0

5

10

15

20

25

30

Nonsmokers

Relative Risk

Male Smokers 

Female Smokers

1959–1965 1982–1988 2000–2010

The Killer Cigarette 

In the first half of the 20th century, cigarettes 

were simpler than they are now. They had 

no filters, no vent holes, and fewer added 

chemicals. By the time the first Surgeon 

General’s Report on Smoking and Health came 

out in 1964, cigarettes were much more 

complex. Today’s cigarettes are even more so, 

and the risks from smoking have become more 

deadly over time. 

Between 1959 and 2010, lung cancer risk 

for smokers rose dramatically. Among female 

smokers, risk increased tenfold and among 

male smokers, risk doubled. These increases 

occurred even though smokers in 2000 through 

2010 smoked fewer cigarettes a day than earlier 

smokers. The risk for lung cancer in people 

who never smoked stayed about the same 

between 1959 and 2010.

One possible explanation for the higher rates 

of lung cancer is that the filters and vent holes 

in most modern cigarettes may lead smokers 

to inhale more deeply, pulling dangerous 

chemicals farther into their lungs.

Why Smoking Tobacco Products Is So Deadly 

The danger of smoking comes from inhaling 

chemical compounds, some in the tobacco 

and some that are created when tobacco is 

burned. The tobacco in cigarettes is a blend 

of dried tobacco leaf and tobacco sheet made 

1970 

Thirty-seven percent of American 

adults smoke.

1970 

Congress passes the Public Health Cigarette Smoking 

Act, which bans cigarette ads on TV and radio, and 

strengthens the Surgeon General’s warning label on 

cigarette packs.

1971 

Last cigarette ad airs on U.S. TV, on The Tonight 

Show starring Johnny Carson.
50 Years of Progress

A Report of the Surgeon General 5

AZ

2.5 

MILLION HAVE DIED

FROM SECONDHAND 

SMOKE

from stems, ribs, and other tobacco leaf 

waste. The process used to make modern 

cigarettes includes the use of many chemicals. 

In all, scientists have identified more than 

7,000 chemicals and chemical compounds in 

tobacco smoke. At least 70 of them are known 

specifically to cause cancer.

All cigarettes are harmful, and any exposure to 

tobacco smoke can cause both immediate and 

long-term damage to the body. There is no safe 

level of exposure to tobacco smoke, and there is 

no safe cigarette. To reduce cancer risk, quitting 

smoking entirely is an important strategy that 

has been proven to work.

Since 1964, more than 

20 million Americans have 

died because of smoking. 

Of the 20 million who died, 

2.5 million were nonsmokers 

who died because of 

secondhand smoke. 

CIGARETTE

SMOKE CONTAINS 

MORE THAN 

7,000 

CHEMICALS AND

CHEMICAL

COMPOUNDS

1972 

Surgeon General’s Report discusses 

secondhand smoke as a health risk.

1973

Arizona becomes the first state to restrict 

smoking in some public places.

1975 

Army and Navy stop providing 

cigarette rations to their troops. 
About three out of four

teen smokers become adult 

smokers, even if they plan 

to quit in a few years.

The Power of Nicotine Addiction 

Many smokers say they choose to continue 

smoking despite knowing the health risks. 

The reality is that smoking is not usually a 

choice. For most smokers, tobacco use is an 

addiction, and nicotine is the primary drug 

in tobacco that causes addiction. It only takes 

10 seconds for the nicotine from one puff of 

smoke to reach the brain. This rapid delivery of 

nicotine from the lungs to the brain is one of 

the reasons that cigarettes are so addictive. And 

once it gets there, nicotine causes cells in the 

brain to release dopamine. One of the effects 

of dopamine released in the brain is to create a 

heightened sense of alertness and contentment. 

Over time, the brain cells of smokers are 

changed to expect the regular bursts of extra 

dopamine that result from smoking. When a 

smoker tries to quit, these brain changes cause 

strong cravings for more nicotine. 

Some of today’s cigarettes are more addictive 

than those from earlier decades. In part, this is 

a result of chemicals added to today’s cigarettes 

that cause the nicotine to reach the brain more 

quickly. In addition, menthol reduces the 

harshness of the smoke and makes it easier to 

smoke—particularly for children and teens. 

Research suggests that children and adolescents 

may be sensitive to nicotine and can become 

addicted more easily than adults. The younger 

smokers are when they start, the more likely 

they are to become addicted, and the more 

likely that they will become heavily addicted. 

Many young people underestimate the power 

6

1980 

Thirty-three percent of American 

adults smoke. 33%

1981 

Surgeon General’s Report examines changes 

in how cigarettes are made and what they 

contain.

1984 

Surgeon General’s warning on cigarette 

packs replaced with four health warnings that 

appear on a rotating basis.
50 Years of Progress

A Report of the Surgeon General

of nicotine addiction. About three out of 

four high school smokers will become adult 

smokers—even if they intend to quit in a 

few years. 

In addition to causing addiction, nicotine that 

is rapidly delivered by cigarettes can affect 

the body in other ways. For example, a rapid 

increase in nicotine blood levels can raise the 

heart rate and blood pressure and narrow 

arteries around the heart. Nicotine may also 

result in premature births and low birth weight 

babies in women who smoke during pregnancy. 

At very high doses, nicotine is toxic, and 

nicotine poisoning can be very dangerous or 

even cause death. But the most common and 

most serious effect of nicotine is addiction. 

Nicotine addiction keeps people smoking 

longer, and the longer they smoke, the more 

damage they do to their bodies.

7

NEARLY

1 IN 5

ADULTS AND

TEENAGERS

SMOKE

You Can Beat Nicotine Addiction

Quit rates for smokers are on the rise 

and today, there are many ways to 

beat nicotine addiction. More than 

half of all smokers have already 

quit. People who talk to their doctors 

about quitting or call quitlines for 

advice are more successful than 

those who go it alone. FDA-approved 

medications and nicotine patches, 

gum, or lozenges, along with coaching 

support, can double or triple your 

chances of success.

If you are a smoker and you want 

to quit, free help is available at 

1-800-QUIT-NOW (1-800-784-8669) 

and at smokefree.gov. 

1986 

First Surgeon General’s Report dedicated to the 

health effects of secondhand smoke is released.

1988 

Proposition 99 passes in California, 

first tobacco tax to dedicate 

funds for a state tobacco 

control program.

1988 

Surgeon General’s Report concludes 

nicotine is addictive.
8

26%

DISEASES AND

HEALTH PROBLEMS

LINKED TO SMOKING

CANCER

DEATHS

C O U L D B E 

PREVENTED

1OUT

OF3

LUNGS l TRACHEA

BRONCHUS l ESOPHAGUS

ORAL CAVITY l LIP

NASOPHARYNX

NASAL CAVITY l LARYNX

STOMACH l BLADDER

PANCREAS l KIDNEY

LIVER l UTERINE CERVIX

COLON AND RECTUM

AND CAUSES LEUKEMIA

SMOKING

CAUSES CANCER

—IN THE—

Smoking can cause cancer 

almost anywhere in the body.

LUNG

KIDNEY

PANCREAS

LIVER BLADDER COLON

1990 

Twenty-six percent of American 

adults smoke.

1990 

R.J. Reynolds ends a marketing test targeting 

African Americans in response to protests 

organized by Uptown Coalition.

1990 

Congress makes domestic airline 

flights smokefree.
50 Years of Progress

A Report of the Surgeon General

Smoking—The Cancer Trigger 

Cancer is a serious disease that happens when 

cells grow uncontrollably in the body. These 

cells grow into tumors that damage organs 

and can spread to other parts of the body. 

Smoking can cause cancer almost anywhere 

in the body. Nearly all lung cancer—the 

number-one cancer killer of both men and 

women—is caused by smoking. If no one in 

the United States smoked, we could prevent 

one out of three cancer deaths. 

DNA Damage

DNA is the “blueprint” for every cell in the 

human body—the cell’s “instruction manual.” 

DNA controls a cell’s growth and the work 

each cell does. When tobacco smoke damages 

DNA, cells can begin growing abnormally. 

Typically, the body releases special cells to 

attack and kill cells that are growing out of 

control. However, toxic chemicals in cigarette 

smoke weaken this process and make it easier 

for the abnormal cells to keep growing and 

dividing. 

Lung Cancer

Today, lung cancer is the number-one cause 

of cancer death for both men and women. 

Nearly 9 out of 10 lung cancers are caused 

by smoking. In fact, smokers today are much 

more likely to develop lung cancer than 

smokers were in 1964, when the first Surgeon 

General’s Report on Smoking and Health linked 

smoking to lung cancer. 

Smoking Linked to Two Additional Cancers

Evidence now proves that smoking causes 

both colorectal cancer, which is the second 

deadliest cancer after lung cancer, and liver 

cancer. Studies suggest a link between smoking 

and breast cancer, but the evidence is not 

as firm. Studies also suggest that men with 

prostate cancer who smoke may be more likely 

to die from the disease than nonsmokers.

Cancer Treatment

Cigarette smoking keeps cancer treatments 

from working as well as they should. People 

who continue to smoke after diagnosis raise 

their risk for future cancers and death. They’re 

more likely to die from their original cancer, 

secondary cancers, and all other causes than 

are former smokers and people who have 

never smoked.

9

1990 

San Luis Obispo, California, passes 

first smokefree restaurant law.

1991 

National Cancer Institute launches the 

ASSIST program, supporting tobacco control 

programs in 17 states.

1992 

U.S. Environmental Protection Agency classifies 

secondhand smoke as a Group A carcinogen.
10

COPD DEATHS

8 10 OUT 

OF

NEARLY

ARE A RESULT OF 

SMOKING

THERE IS NO CURE 

FOR COPD

1 10 OUT 

OF

HIGH SCHOOL 

STUDENTS HAS

ASTHMA

SMOKING 

SLOWS DOWN

LUNG GROWTH 

IN CHILDREN 

AND TEENS

Smoking—The Breath Blocker

Respiratory Diseases

The chemicals in cigarette smoke cause 

immediate damage to cells and tissue in the 

human body, including those on the path 

from the mouth to the lung’s air sacs—the 

final target of the smoke. Delicate lung tissue 

damaged by chemicals in cigarette smoke 

doesn’t have a chance to heal if it is exposed 

to these chemicals in large amounts day after 

day. The result is a wide range of deadly 

lung conditions.

Chronic Obstructive Pulmonary Disease

Smoking causes chronic obstructive pulmonary 

disease (COPD). COPD includes several 

underlying lung diseases, such as emphysema 

and chronic bronchitis, in which the airways 

are damaged and can never completely heal, 

and the lungs lose their elastic properties. 

People with COPD suffer from shortness of 

breath, coughing, difficulty exercising, air 

trapped in their lungs, swollen airways, and 

scar tissue. As a result, they may even have 

trouble with routine activities such as walking 

and dressing. Their quality of life can drop 

significantly. Over time, COPD causes low 

oxygen levels in the body. People with COPD 

are at high risk for many other serious diseases, 

including lung cancer and heart disease. The 

disease has no cure. 

1993 

The White House goes smokefree.

1994 

Mississippi files first state lawsuit against 

U.S. tobacco companies to recover 

Medicaid costs for smoking-related illnesses.

1994 

Seven tobacco company executives 

testify to Congress that they believe 

nicotine is NOT addictive.
50 Years of Progress

A Report of the Surgeon General

Women are now dying from COPD in about 

the same numbers as men, and women appear 

more susceptible to developing severe COPD 

at younger ages. Women smokers are up to 

40 times more likely to develop COPD than 

women who have never smoked.

Tuberculosis

Tuberculosis (TB) is a common infection 

worldwide that usually attacks the lungs. TB 

is spread through the air when people with 

the disease cough or sneeze. It was once a 

leading cause of death in the United States, but 

advances in public health have made TB far less 

common here. However, it remains a serious 

health issue elsewhere in the world. According 

to the World Health Organization, TB caused 

1.4 million deaths worldwide in 2011. There 

is now enough evidence to conclude that 

smoking increases a person’s risk of getting TB 

and dying from it. 

Other Respiratory Damage Caused by Smoking

More than 11% of high school students in 

the United States have asthma, and studies 

suggest that youth who smoke are more 

likely to develop asthma. Breathing someone 

else’s smoke also triggers asthma attacks in 

nonsmokers. Children exposed to secondhand 

smoke have more respiratory infections than 

children who are not exposed. 

11

Women smokers are up to 

40 times more likely to 

develop COPD than women 

who have never smoked. 

Although the body has ways to prevent or 

lessen the severity of injury caused by agents 

inhaled into the lungs, these defenses are 

overwhelmed when the body is exposed to 

cigarette smoke over and over again. After years 

of exposure to the chemicals in cigarette smoke, 

lung tissue becomes scarred, loses its elasticity, 

and doesn’t work as well. People who stop 

smoking begin to breathe easier, regain higher 

levels of oxygen in the body, and lower their 

risk of respiratory disease compared to those 

who continue to smoke. 

1995 

California passes first statewide 

smokefree restaurant and 

bar law. 

1996 

FDA makes first attempt to regulate 

manufacture, sale and marketing of 

tobacco products.

1998 

Forty-six states and four tobacco companies sign 

Tobacco Master Settlement Agreement which 

requires tobacco companies to reimburse a portion 

of state Medicaid costs resulting from smoking.
12

SAVE YOUR

HEART

AVOID THE SMOKE

Smoking damages the heart and blood 

vessels very quickly, but the damage is 

repaired quickly for most smokers who 

stop smoking. Even long-time smokers 

can see rapid health improvements 

when they quit. Within a year, heart 

attack risk drops dramatically. Within 

five years, most smokers cut their risk 

of stroke to nearly that of a nonsmoker. 

Even a few cigarettes now and then 

damage the heart, so the only proven 

strategy to keep your heart safe from 

the effects of smoking is to quit.

Go to cdc.gov/tips to see how 

heart disease motivated one 

smoker, Roosevelt, to quit. 

Smoking—The Heart Stopper

More than 16 million Americans have heart 

disease, almost 8 million already have had a 

heart attack and 7 million have had a stroke. 

Cardiovascular disease (CVD) is the single 

largest cause of all deaths in the United States, 

killing more than 800,000 people a year. 

CVD includes narrow or blocked arteries 

in and around the heart (coronary heart 

disease), high blood pressure (hypertension), 

heart attack (acute myocardial infarction), 

stroke and heart-related chest pain (angina 

pectoris). Smoking is a major cause 

of CVD. 

Even people who smoke fewer than five 

cigarettes a day show signs of early stages of 

CVD. The risk of CVD increases when more 

cigarettes a day are smoked, and when smoking 

continues for many years. 

Exposure to secondhand smoke can increase 

the risk for a heart attack or stroke. More 

than 33,000 nonsmokers die every year in 

the United States from coronary heart disease 

caused by exposure to secondhand smoke. 

Peripheral Arterial Disease 

Blood vessels are found throughout the body 

and carry oxygen to every organ. The oxygen 

makes it possible for organs to do the work 

needed to keep the body healthy and working 

correctly. Cigarette smoke makes cells lining 

blood vessels swell so that the vessels become 

narrower, reducing the flow of blood. Even 

smoking every now and then, or inhaling 

someone else’s smoke, damages blood vessels. 

1998 

Surgeon General’s Report examines tobacco 

use and disease among racial/ethnic 

minority groups.

1999 

U.S. Department of Justice files lawsuit against 

major U.S. tobacco companies for deceiving 

Americans about health hazards of smoking 

and secondhand smoke.

1999 

Centers for Disease Control and Prevention 

(CDC) launches the National Tobacco Control 

Program, supporting tobacco control programs 

in 50 states.
50 Years of Progress

A Report of the Surgeon General

Atherosclerosis, or hardening of the arteries, 

occurs when artery walls thicken and the 

opening inside the artery narrows. Peripheral 

arterial disease (PAD) or peripheral vascular 

disease (PVD) occurs when arteries that supply 

the legs, feet, arms, or hands become narrow, 

reducing blood flow. Without normal blood 

flow, people with PAD may have pain when 

they walk, and cells and tissue can die from 

lack of oxygen. In extreme cases, gangrene 

can develop and the infected limb may have 

to be removed. Smoking is the most common 

preventable cause of PAD.

Coronary Heart Disease

Components in the blood, called platelets, stick 

together along with proteins to form clots. 

Clotting prevents blood loss and infection after 

an injury. Chemicals in cigarette smoke cause 

blood to thicken and form clots inside veins 

and arteries, even when clotting isn’t needed 

to prevent bleeding or infection. Smoking 

also promotes the formation of plaque in the 

walls of arteries and clots can form where there 

is plaque. This is especially dangerous when 

arteries are already narrowed from smoking, 

because the clots can easily block those arteries. 

When arteries are blocked, the oxygen to 

nearby organs is cut off. Coronary heart disease 

occurs when arteries that carry blood to heart 

muscles are blocked by clots. This blockage can 

lead to a heart attack and sudden death. 

Stroke

A stroke is loss of brain function caused when 

blood flow within the brain is interrupted. 

Strokes can occur when arteries that carry 

blood to the brain become blocked from 

narrowing or a clot, or when a blood vessel 

leaks or bursts inside the brain. Strokes can 

cause permanent brain damage and death. 

Smoking increases the risk for stroke. Deaths 

13

23%

from strokes are more likely among smokers 

than among former smokers or people who 

have never smoked. The more cigarettes a 

person smokes per day, the higher his or her 

risk of dying from a stroke. Even exposure 

to secondhand smoke can cause strokes 

in nonsmokers. 

Abdominal Aortic Aneurysm

The aorta is the body’s main artery that carries 

oxygen-rich blood to all parts of the body. 

Smoking is a known cause of early hardening 

of the abdominal aorta, the part of the aorta 

that supplies blood to the abdomen, pelvis, and 

legs. Autopsy studies have found that smoking 

during adolescence can cause this dangerous 

condition as early as young adulthood. 

Hardening of the abdominal aorta can lead 

to an aneurysm, or a weakened and bulging 

area. A ruptured abdominal aortic aneurysm 

causes life-threatening bleeding and is often 

fatal. Almost all deaths from abdominal aortic 

aneurysms are caused by smoking and other 

tobacco use. Women smokers have a higher 

risk of dying from an aortic aneurysm than 

men who smoke.

1999 

Tobacco Master Settlement Agreement bans 

outdoor and transit billboard 

ads for tobacco products.

2000 

Twenty-three percent of American 

adults smoke.

2001 

Surgeon General’s Report calls smokingrelated disease among women a full-blown 

epidemic.
Babies whose mothers 

smoked during pregnancy 

or who are exposed to 

secondhand smoke after 

birth are more likely to die 

of sudden infant death 

syndrome (SIDS) than are 

babies who are not exposed. 

Smoking and Reproduction

For many reasons, men and women who 

want to have children should not smoke. 

Studies suggest that smoking affects hormone 

production. This could make it more difficult 

for women smokers to become pregnant. 

Pregnant women who smoke or who are 

exposed to secondhand smoke endanger 

their unborn babies, as well as their own 

health. Babies whose mothers smoked during 

pregnancy or who are exposed to secondhand 

smoke after birth are more likely to die of 

sudden infant death syndrome (SIDS) than 

are babies who are not exposed. More than 

100,000 of the smoking-caused deaths over 

the last 50 years were of babies who died from 

SIDS or other health conditions. Deadly 

chemicals in cigarette smoke reached these 

infants before they were born, or when they 

were exposed to cigarette smoke during infancy. 

Pregnancy Complications 

More than 400,000 babies born in the United 

States every year are exposed to chemicals in 

cigarette smoke before birth because their 

mothers smoke. Smoking is known to cause 

ectopic pregnancy, a condition in which the 

fertilized egg fails to move to the uterus and 

instead attaches in the fallopian tube or to 

other organs outside the womb. Ectopic 

pregnancy almost always causes the fetus to 

die and poses a serious risk to the health of the 

mother. Another possible complication from 

smoking during pregnancy is miscarriage. 

14

2003 

World Health Organization adopts the first 

international tobacco control treaty, 

the Framework Convention on 

Tobacco Control.

2004 

New York passes first fire-safe cigarette law, 

requiring cigarettes to have fire-retardant 

bands in the paper wrapper that slow burn 

rates and prevent accidental fires.

2006 

A federal court finds major U.S. tobacco 

companies guilty of deceiving public on dangers 

of smoking and secondhand smoke.
50 Years of Progress

A Report of the Surgeon General

Mothers who smoke during pregnancy are 

more likely to deliver their babies early. Preterm 

delivery is a leading cause of death, disability, 

and disease among newborns. Mothers who 

smoke during pregnancy are also more likely 

to deliver babies with low birth weight, even if 

they are full term. 

Birth Defects 

Smoking during pregnancy can cause birth 

defects. Women who smoke during early 

pregnancy are more likely to deliver babies with 

cleft lips and/or cleft palates—conditions in 

which the lip or palate fails to form completely. 

Both conditions interfere with an infant’s 

ability to eat properly, and both must be 

corrected with surgery. 

Carbon monoxide in tobacco smoke keeps the 

fetus from getting enough oxygen. Smoking 

during pregnancy can cause tissue damage in 

the fetus, especially in the lungs and brain. 

This damage can last throughout childhood 

and into the teenage years.

Male Reproduction and Sexual Function 

In the United States, 18 million men over 

age 20 suffer from erectile dysfunction (ED). 

A man with ED can’t have and maintain an 

erection that is adequate for satisfactory sexual 

performance, which can affect reproduction. 

Recent evidence concludes that smoking is 

a cause of ED. Cigarette smoke alters blood 

flow necessary for an erection, and smoking 

interferes with the healthy function of blood 

vessels in erectile tissue. 

Men need healthy sperm for fertility. Smoking 

damages DNA in sperm, which can lead to 

infertility or early fetal death.

18

M I L L I O N 

MALES

—OVER AGE 20—

SUFFER FROM ERECTILE 

DYSFUNCTION (ED)

SMOKING IS A CAUSE OF ED

Cigarette smoke alters blood flow 

necessary for an erection.

15

2009 

The Family Smoking Prevention and Tobacco 

Control Act, directing the FDA to regulate 

the manufacture, marketing, and sale 

of tobacco products, is signed into law.

2009 

Congress authorizes the biggest 

federal tobacco excise tax in U.S. history. 19%

2010 

Nineteen percent of American 

adults smoke
Smokers are 30% to 40% 

more likely to develop type 2 

diabetes than nonsmokers.

Smoking and Diabetes

Diabetes—a disease that causes blood sugar 

levels in the body to be too high—is a growing 

health crisis around the world. In the United 

States, more than 25 million adults suffer from 

diabetes. We now know that smoking causes 

type 2 diabetes, also known as adult-onset 

diabetes. Smokers are 30% to 40% more likely 

to develop type 2 diabetes than nonsmokers. 

The more cigarettes an individual smokes, the 

higher the risk for diabetes. 

16

Diabetes can cause serious health problems, 

including heart disease, blindness, kidney 

failure, and nerve and blood vessel damage 

of the feet and legs, which can lead to 

amputation. A person with diabetes who 

smokes is more likely to have trouble regulating 

insulin and controlling the disease than 

nonsmokers with diabetes. Both smoking and 

diabetes cause problems with blood flow, which 

raises the risk of blindness and amputations. 

Smokers with diabetes are also more likely 

to have kidney failure than nonsmokers with 

diabetes. Diabetes is the seventh leading cause 

of death in the United States.

Smoking and the Immune System

The immune system is the body’s way of 

protecting itself from infection and disease. 

The immune system fights everything from 

cold and flu viruses to serious conditions such 

as cancer. Smoking compromises the immune 

system and can make the body less successful at 

fighting disease. Smokers have more respiratory 

infections than nonsmokers, in part because 

the chemicals in cigarettes make it harder for 

their immune systems to successfully attack the 

viruses and bacteria that can cause respiratory 

infections. In fact, smokers generally are much 

less healthy than nonsmokers. Their overall 

health is worse, they need to go to the doctor 

more often, and they are admitted to the 

hospital more often.

Smoking also causes autoimmune disorders. 

Autoimmune disorders occur when the 

immune system attacks the body’s healthy cells. 

For example, in rheumatoid arthritis, or RA, 

the immune system attacks the joints and tissue 

around the joints, causing swelling and pain. 

As a result, people with RA have a harder 

2010 

Half of U.S. states and the District of Columbia 

have adopted comprehensive 

smokefree laws.

2012 

Surgeon General’s Report concludes that 

tobacco marketing causes smoking among 

youth and young adults.

2012 

CDC launches Tips From Former Smokers, 

the first federally funded national tobacco 

education campaign.
50 Years of Progress

A Report of the Surgeon General

time getting around and doing normal daily 

activities. We now know RA can be caused 

by smoking, and smoking makes some RA 

treatments less effective. More women have 

RA than men.

Smoking and Eye Disease

Chemicals in cigarette smoke restrict blood 

flow to important organs by causing blood 

vessels to narrow. The eye has many tiny 

blood vessels that keep it healthy and working 

properly. Chemicals in tobacco smoke damage 

these blood vessels and prevent them from 

carrying enough oxygen throughout the eye. 

Smoking causes damage to delicate cells in the 

eye, and exposure to cigarette smoke over long 

periods of time means the cells do not have a 

chance to heal. These effects from smoking can 

cause serious eye diseases.

Age-related macular degeneration, or AMD, 

is an eye disease that causes loss of vision in 

the center of the field of vision. The retina is a 

delicate tissue that lines the inside of the eye. 

It is sensitive to light and sends visual images 

to the brain. The macula is the most sensitive 

part of the retina and is the part of the eye that 

gives you sharp vision. Age-related macular 

degeneration damages the macula over time 

and can lead to loss of vision in the center of 

the eye. AMD is common in older people and 

is the leading cause of vision loss in people over 

age 65. Smoking is now known to cause AMD. 

Studies show that quitting smoking may reduce 

that risk, but it might take 20 or more years 

after smokers quit for the risk to go down. 

In addition to causing AMD, smoking causes 

cataracts. A cataract is the clouding of the eye’s 

lens. Cataracts cause loss of vision because the 

17

18%

RETINA

MACULA

IRIS

PUPIL

CORNEA

LENS OPTIC NERVE

A LOOK AT YOUR EYE

Smoking causes age-related 

macular degeneration. 

clouding prevents light from passing through 

the lens to the retina. Cataract disease is the 

leading cause of blindness but can be treated 

with surgery. Cataracts usually occur in older 

adults.

2014 

50 years after the first Surgeon General’s Report on 

smoking, 18% of American adults smoke, 

compared to 42% in 1964.

We’ve made a lot of progress, 

but there’s still more to do.
THE NEXT 50 YEARS

IF WE COULD HELP EVERY SMOKER TO QUIT SMOKING AND KEEP

YOUNG PEOPLE FROM STARTING IN THE FIRST PLACE, THE RESULTS 

WOULD BE STAGGERING. 

18

1/2

MILLION

PREMATURE DEATHS

could be prevented every year.

5.6

MILLION CHILDREN

alive today who ultimately will die early 

because of smoking could live to a 

normal life expectancy.

AT LEAST

$130

BILLION

in direct medical costs for adults 

could be saved every year.

MORE THAN

16

MILLION PEOPLE

already have at least one disease from smoking.

We could prevent that number from growing more.

Despite all our progress, there is 

more work to be done. Every day 

3,200 youth under 18 smoke their 

first cigarette, and another 2,100 

youth and young adults who have 

been occasional smokers become 

daily smokers.
50 Years of Progress

A Report of the Surgeon General 19

AT LEAST

88

MILLION AMERICANS

who continue to be exposed to the dangerous chemicals 

in secondhand smoke could breathe freely. 

OUT 1 OF 3

CANCER DEATHS

in this country could be prevented.

AT LEAST

$156

BILLION

in losses to our economy—caused when 

people get sick and die early from 

smoking—could be prevented.

Saving Millions of Lives

There are many ways to reduce smoking rates quickly and dramatically. 

Among the strategies proven to work are:

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Affordable smoking cessation treatments that are easily available to people who want to quit;

Comprehensive smokefree and tobacco-free policies in public places that protect nonsmokers 

and make smoking the exception rather than the norm;

Higher prices on cigarettes and other tobacco products that discourage young people from 

starting in the first place and that encourage adult smokers to quit;

Continued mass media campaigns that inform people of the dangers of smoking and tell 

them about resources to help them quit; and

State and community programs that help integrate tobacco control into medical, retail, 

education, and public health environments that reach groups of people who might not 

otherwise be exposed to tobacco control initiatives.
Ending the Tobacco Use Epidemic

Smoking has been the number-one cause of 

preventable death and disease in this country 

for decades. Although we have cut smoking 

rates in half since 1964, the current rate of 

progress is not fast enough. The death and 

disease from tobacco—which claims nearly 

500,000 lives each year—is overwhelmingly 

caused by cigarettes and other burned tobacco 

products. To stop these deaths, we need to 

rapidly eliminate their use. 

We can break the cycle of sickness, disability, 

and death caused by smoking if we: llll

Extend proven programs and policies to 

more states and cities to make smoking less 

accessible, less affordable, and less attractive;

Help everyone who wants to quit by 

providing cessation resources that are readily 

available and affordable;

Make cigarettes less addictive and less 

appealing to youth by using federal 

regulatory authority; and

Work to rapidly eliminate the use of 

cigarettes and other forms of burned 

products.

These steps can save millions of lives in the 

coming decades and eliminate smoking as the 

leading preventable cause of death and disease.

20

TOGETHER 

NEXT GENE
 WE CAN MAKE THE 

RATION TOBACCO-FREE

A N

NIVERSARY
A NNIVERSARY

Your Guide to the 50th Anniversary Surgeon General’s 

Report on Smoking and Health

For more information on tobacco use and health, visit BeTobaccoFree.gov.

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To read the full report and its related materials, go to SurgeonGeneral.gov.

To learn more about tobacco control and prevention, visit CDC’s Smoking & Tobacco 

Use Web site at cdc.gov/tobacco.

To download copies of this booklet, go to cdc.gov/tobacco.

To order copies of this booklet, go to cdc.gov/tobacco and click on Publications 

Catalog or call 1-800-CDC-INFO (1-800-232-4636); TTY: 1-888-232-6348.

To access a telephone quitline serving your area, call 1-800-QUIT-NOW (1-800-784-8669).

For real stories from former smokers, visit CDC’s Tips From Former Smokers Web site at 

cdc.gov/tips.