Social movements may be precipitated or
strengthened by events that “dramatize a glaring contradiction between a highly resonant cultural value
[such as health] and conventional social practices [such
as smoking]” (McAdam 1994, p. 40). Rarely in social
history, however, can a single such event be identified
as a key source of social change. The publication of
the 1964 Surgeon General’s report on smoking and
health might qualify as such a rarity. The Surgeon
General’s report consolidated and legitimized 15 years
of growing evidence of the dangers of smoking to
health (USDHEW 1964). Its publication “marked the
beginning of a revolution in attitudes and behaviors
relating to cigarettes” (Brandt 1990, p. 156).
“Beginning” should be stressed, because abandonment of
cigarettes was not precipitous. Smoking prevalence
did begin a persistent but hardly precipitate decline
in 1965 of 0.5 percent per year (USDHHS 1989).
Cigarette sales kept increasing and would not peak
until the late 1970s. Although per capita cigarette consumption reached its highest level in 1963, the year
before the report’s publication, it did not begin a steady
year-to-year decline until 1973 (USDHHS 1994).
Thus, the Surgeon General’s report was certainly
a pivotal event, but it did not change smoking patterns overnight. Why this was so—why people did
not, upon learning of the report’s findings, immediately cease either beginning or continuing to smoke—
is a complex phenomenon, even if one disregards the
major role of nicotine addiction. On the one hand,
a change in behavioral norms can be precipitated by
a change in what people generally believe. On the
other hand, people do not always act in their own
best interests, even in response to clearly stated facts
(Schudson 1984; USDHHS 1989). The outcome in a
conflict between cultural mores (in this instance, beliefs instilled through the social, behavioral, and physiological habit of smoking, reinforced by marketing)
and scientific fact (as represented in the widely publicized findings of the Surgeon General’s report) often
depends on how the latter is diffused—that is, on
whether new information can become so broadly and
effectively transmitted and received that it becomes
accepted knowledge that then supplants habit.
As one
sociologist has observed, “The diffusion of new knowledge is a major cause of collective searches for new
norms in the modern world” (Davis 1975, p. 53).
A Stubborn Norm
In the case represented by the Surgeon General’s
report, the diffusion of new knowledge was impeded
by the entrenched norm of smoking, a widespread
practice fueled by the persistent and pervasive marketing of cigarettes (see “Advertising and Promotion”
in Chapter 5). During the decade preceding the
report, many social norms were established or
strengthened through the dominant new mass
medium, television. Whatever effect television advertising had on cigarette sales, the constant presence of
cigarettes both in advertisements and in the real and
imaginary lives of the medium’s “stars” was a strong
force in reinforcing smoking as a norm. Furthermore,
TV-related marketing coincided with, and helped bring
to the public’s attention, the availability of the filtertipped cigarette—thereby not only reinforcing the
40 Chapter 2
Reducing Tobacco Use
smoking norm but also helping screen the imputed
health hazards of smoking (USDHHS 1994).
The smoking norm could be found in the most
unlikely settings and thus gave rise to considerable
cognitive dissonance. The first significant government
response to the report was the FTC’s 1964 ruling that
warning labels be required on cigarette packs and that
tobacco advertising be strictly regulated (see “Attempts
to Regulate Tobacco Advertising and Packaging” in
Chapter 5). The resulting legislation that was passed,
however (the Federal Cigarette Labeling and Advertising Act of 1965 [Public Law 89-92]),
undermined
much of the original proposal’s strength by requiring
a more weakly worded warning label than the FTC had
proposed (USDHHS 1994). Furthermore, the act not
only preempted the FTC’s ruling but also prohibited
the FTC or any other federal, state, or city authority
from further restricting cigarette advertising until
after the expiration of the law on June 30, 1969. In 1969,
former Surgeon General Terry would refer to the 1965
act as a “hoax on the American people” (U.S. House of
Representatives 1969, p. 267, citing Dr. Terry).
This dissonance between legislative intent and
legislative action was detectable, in more than one
sense, in the smoke-filled congressional hearings at the
time. In 1967, for example, when Dr. Paul Kotin,
director of the Division of Environmental Health Sciences, National Institutes of Health, came to testify
about the health hazards of cigarette smoking, Senator Norris Cotton (R-NH) asked, “Is it going to prejudice anybody if I smoke my pipe?”
Dr. Kotin replied,
“I trust it won’t prejudice anybody any more than my
smoking my pipe will” (U.S. Senate 1968, p. 14). Dr.
Kotin’s smoking was a topic of conversation again in
congressional hearings in 1969. Dr. Kotin along with
Surgeon General William H. Stewart, Dr. Kenneth Milo
Endicott (director of the National Cancer Institute), and
Dr. Daniel Horn (director of the National Clearinghouse on Smoking and Health) came together to testify in favor of stronger health warnings on cigarette
packages and legislation requiring similar warnings
in all cigarette advertising. At one point, Representative Dan H. Kuykendall (R-TN) asked Surgeon
General Stewart, “Isn’t [Dr. Kotin] one of the most
knowledgeable men in this field?” When the Surgeon
General replied affirmatively, Kuykendall returned,
“Why doesn’t he quit smoking?” Kuykendall then
directly asked Kotin whether he was sure that smoking a pipe did not cause lip cancer; Kotin responded,
“A risk I am willing to take, sir” (U.S. House of Representatives 1969, p. 167).
The next day, Representative
Tim Lee Carter (R-KY) observed that, in fact, all four
of the men in the delegation, including the Surgeon
General, were smokers (U.S. House of Representatives
1969). Actions undermine words, and scenes such as
these were symbolic of a strong wish not to believe in
the health consequences of smoking. Given that the
nation’s chief health policymakers did not, or were not
able to, apply to their own behaviors the very evidence
they had gathered, the strength with which the smoking norm persisted among the general population is
more easily comprehended
