The popularity of cigarette smoking in the United States first took off in the aftermath of World War I, when soldiers brought the habit home with them. By 1944, during World War II, 41 percent of all American adults were smokers, according to Gallup.
The medical community had long speculated that cigarettes caused lung cancer, and in 1964, U.S. Surgeon General Luther Terry publicly confirmed those concerns were valid. He issued a landmark 387-page report that led to the 1965 Federal Cigarette Labeling and Advertising Act, which required health risk warning labels on cigarette packs sold in the U.S.
While the labels may not have led to an immediate decline in smoking, historians say they were an important first tobacco regulation step that helped spur other efforts to reduce smoking—including advertising restrictions and smoking bans in public places and workplaces.
Cigarettes Become Cool After World War I
Chewing tobacco and pipes were more popular than cigarettes at the turn of the 20th century, with many people associating cigarettes to “boyhood, adolescence, rebellion,” says Allan Brandt, professor of the history of medicine and public health at Harvard University and author of The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America.
“Cigarettes were really thought about as being a very sort of denigrated form of use of tobacco,” Brandt says. “Gentlemen smoked pipes and cigars. Women shouldn’t smoke at all.”
World War I soldiers picked up the habit in droves as a distraction from the harsh realities of war. That helped change perceptions of smoking cigarettes “from a dirty boys’ habit to being a source of gratification,” Brandt says.
Smoking was glamorized in movies featuring characters who smoked, and movie stars became celebrity endorsers of cigarette brands while newspapers and magazines were filled with cigarette ads.
Smoking Linked to Rising Cancer Rates
As lung cancer cases worldwide rose rapidly by the mid-20th century, a landmark 1956 study in England surveyed the smoking habits and health outcomes of 34,400 British doctors—and linked smoking to lung cancer. A Reader’s Digest article “Cancer by the Carton” shared similar results from recent medical studies.
The powerful U.S. tobacco industry worked fervently to contest the research. In 1958, the Tobacco Institute was established to cast doubt on health research linking cigarette smoking to disease, communicate the industry’s standpoint on health and economic issues to the public and lobby against cigarette regulations.
The path to cigarette pack warning labels started after Terry established his committee to explore smoking’s health impacts. After analyzing more than 7,000 medical articles, the panel—made up of half smokers and half non-smokers—released its “Smoking and Health” report on January 11, 1964. It linked smoking to lung cancer, throat cancer and chronic bronchitis.
The Politics of Cigarette Warning Labels
The report urged government action to reduce smoking and generated intense public interest.
“There is a question of, what is that going to look like? What is going to be the entity to regulate this problem that’s been clearly defined by experts?” says Sarah Milov, associate professor of history at the University of Virginia and author of The Cigarette: A Political History.
The tobacco industry, Milov says, wanted regulation to come from Congress, believing lawmakers would protect the sector’s interests.
But the Federal Trade Commission (FTC)—the independent U.S. government agency charged with protecting consumers—entered the fray. In January 1964, the FTC proposed warning labels saying smoking is dangerous to health, may cause cancer and that the Surgeon General found it “contributes substantially to mortality from certain diseases and to the overall death rate,” as the committee’s report had found.
The mortality rates and death references worried the cigarette companies, which responded with more lobbying and a public relations campaign highlighting the economic importance of the tobacco industry. By June 1964, the FTC changed course, announcing it would instead require warnings where cigarette manufacturers could come up with their own language, so long as they clearly stated that smoking can lead to death from cancer and other illnesses.
Congress ended up intervening on the issue before the FTC could proceed with its final proposal. The congressional debate over labeling “was the first time people began to understand the political significance of political lobbying [and] special interest groups,” Brandt says.
Landmark U.S. Tobacco Law Passed
Congress passed the Federal Cigarette Labeling and Advertising Act in July 1965, requiring that all cigarette packs include the statement “Caution: Cigarette smoking may be hazardous to your health." Warnings for cigarette ads were not included in the legislation, though it charged the FTC with monitoring the ads for deceptive claims.
“If we really look back at it, those regulations were very weak,” Brandt says. “But at the same time, it showed that our political processes could really support population health by regulating very big and powerful industries.”
In a nod to the tobacco lobby, the law prevented federal, state and local government bodies from enacting any other cigarette labeling or advertising requirements for four years.
“Legislative preemption of agency action became the overall strategy of the tobacco industry because Congress was more friendly to the industry than the agencies,” Milov says.
While the tobacco industry succeeded in weakening the warning language, the sector saw the labels as beneficial, to some degree, because smokers were now informed their health could suffer because of cigarette use, potentially reducing the risk of lawsuits from smokers who developed health problems.
How Tobacco Regulation Has Evolved
U.S. cigarette smoking rates didn’t drop below 40 percent until the late 1970s.
But the legislation was the first of many anti-smoking efforts, and historians say it played a pivotal role in the anti-smoking crusade.
“What this led to was a very aggressive grassroots tobacco-controlled movement that, over time, has really had a big impact,” Brandt says. “We went from a society that celebrated smoking to it being an often discredited behavior.”
By 1970, Congress passed legislation to strengthen warning labels and ban cigarette ads on radio and television.
As the health hazards of secondhand smoke became clear in the mid-1980s, public health and environmental activists focused on curbing smoking and cigarettes at the state and local levels. This drive led to smoking bans in airports, bus stations, public parks and beaches, restaurants, bars and workplaces.
In 2009, the Food and Drug Administration gained the authority to regulate tobacco product manufacturing and marketing. That year, Congress mandated the FDA to require graphic warnings on cigarette packs featuring disturbing images of people with tobacco-related health problems, spurring an ongoing legal battle between the FDA and the tobacco industry.
According to Gallup, by 2024, only 11 percent of the population said they smoked cigarettes in the past week.
