INDIANAPOLIS (AP) — A lot can happen in 50 years. Half a century ago, man hadn't walked on the moon, the Internet hadn't been invented, and more than 40 percent of Americans smoked.
Then, in January 1964, the U.S. surgeon general released the first government report saying smoking leads to disease and death. Many might have thought that during the following 10 years — if not, then 25 or 50 — the habit would basically disappear.
But a quarter of Hoosiers still smoke despite an avalanche of scientific studies that link smoking to heart problems, lung disease, breast cancer and other health problems, The Indianapolis Star reported (http://indy.st/K78fqj ).
The surgeon general is expected to release a report Friday reviewing the past 50 years and making recommendations for the next half-century.
"I don't think a lot of people would have expected a 50-year timeline at the end of which we still have 43 million people smoking in this country," said Dr. Stephen J. Jay, a professor of public health and medicine at the Indiana University School of Medicine and the Richard M. Fairbanks School of Public Health.
Luther Terry was the surgeon general who released the 1964 report. He would have been surprised at how many people still smoke, his son Michael Terry said last week at a news conference in Washington, D.C., held by Tobacco Free Kids.
Luther Terry, the country's ninth surgeon general, long had railed about the dangers of smoking, said his son, who was in high school when the report appeared.
"He would be disappointed," Michael Terry said of his father, who died in 1985. "He would say ... we clearly have not done enough."
About 19 percent of U.S. adults smoke. Nationally, Indiana ranks in the top 10 for the percentage of smokers. More pregnant women in Indiana smoke compared with the rest of the country.
There's no easy explanation for why smoking has proved such a hard habit for the state to kick. Numerous factors play a role, such as the highly addictive nature of nicotine, combined with the efforts of tobacco companies to ensure their product maintains a foothold in the American consciousness.
Indiana, like other states with high smoking rates, has a history of tobacco production and a culture that embraces individual rights.
Still, public health has scored myriad victories in the war against cigarettes. In 1970, cigarette ads were banned from television. In 1984, warning labels on cigarette packs expanded to cover pregnant women and youths.
In fact, some argue the story of cigarettes over the past half-century is a tale of a glass half full.
About 42 percent of American adults smoked in 1964 when the surgeon general's report appeared. A report last week in the Journal of the American Medical Association estimated that tobacco-control efforts in the past 50 years had prevented 8 million premature deaths.
"The public health campaign against tobacco use has been one of the greatest public health advancements in our history," said Dr. Richard Feldman, director of medical education and family medical residency at Franciscan St. Francis Health and a former state health commissioner. "As we go on, further reductions are going to get more and more difficult."
For Indiana, the task may be even harder.
The state was late to the game compared with many in banning smoking in the workplace and other public areas, and state taxes on tobacco are much lower than in many other states.
All of this makes us a darling of the tobacco companies.
Tobacco companies view Indiana as a perfect test market for new products and pump about $270 million a year into advertising in Indiana, said Miranda Spitznagle, director of the Indiana Tobacco Prevention Cessation Commission, part of the Indiana State Department of Health.
In comparison, Indiana spends $5 million a year on tobacco cessation, far less than the $78 million the Centers for Disease Control and Prevention recommends.
"You can see that we're up against a tough battle," Spitznagle said. "This is far from won. It's still a problem for our state."
Indiana's government has not helped, either, say critics such as IU's Jay.
In 2011, the legislature dismantled the Indiana Tobacco Prevention and Cessation Agency after a 10-year run as a separate entity. It was placed under the umbrella of the state health department. That decision came after a decade of steadily decreasing funding for tobacco prevention, Jay said.
Nor is Indiana strong on tobacco taxes. Higher taxes tend to track with lower smoking rates, Jay said. Here, the tax on cigarettes is just less than $1 per pack, while other states, including neighboring Michigan, have taxes that are double that. New York's tax rate is quadruple Indiana's. For every 10 percent increase in the cost of cigarettes, smoking rates go down by 5 percent to 6 percent for youths and 4 percent for adults, Jay said.
Convincing Hoosiers of the need to quit smoking, however, presents a challenge.
"Hoosiers are the best people in the whole world, but they aren't the healthiest, and our culture supports the continuation of smoking," Feldman said. "We have a stronger tradition and a persistent tradition in Indiana for unhealthy lifestyles. ... Why that is, I can't answer."
Dr. Arden G. Christen, a professor emeritus in the Department of Oral Biology at the Indiana University School of Dentistry, knows the power of cigarette advertising. He smoked for 10 years, starting when he was in his second year of dental school at the University of Minnesota. He can recall dental conventions where so many participants smoked that it was difficult to see the screen.
"You wanted to be just like the Marlboro Man, the idea of being independent and autonomous and in charge of life," he said.
Two years after the surgeon general's report, Christen quit after one of his daughters caught him smoking. Then, he devoted much of his career to detailing the havoc that tobacco can wreak on oral health.
Now, he works on helping people quit smoking.
Anti-smoking advocates hope more people get the message to give up their cigarettes. The American Heart Association, the American Lung Association and a number of other health advocacy groups have banded together to propose a "10 in 10" initiative, bringing smoking rates down to under 10 percent by 2024.
As for what the goal should be 40 years after that? Only time will tell.
Information from: The Indianapolis Star, http://www.indystar.com