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The most successful health campaign in modern history

How one number explains how we’re winning the 60-year war on smoking

How old am I? Old enough to have flown on planes that had ashtrays in the armrests. Old enough to remember restaurants with smoking sections separated from the nonsmoking section by, essentially, nothing. Old enough to remember when “smoking or non” was a question the restaurant host actually asked you. Old enough that in the year I graduated high school — 1997 — more than a third of high schoolers smoked.

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I’m 47 — not ancient, even if I sometimes feel that way — and yet the America I grew up in the 1980s was still so saturated with cigarette smoke that these memories feel like dispatches from another civilization. In 1980, roughly a third of American adults still smoked. The smoking mascot Joe Camel, whom critics would later accuse of being designed to appeal to children, debuted the year I turned 10.

How a fix for smoking sparked a new crisis

Now here’s a number from 2024: 9.9 percent. That’s the share of American adults who smoke cigarettes, according to data from the National Health Interview Survey analyzed in a paper published this month in NEJM Evidence. It’s the first time the rate has fallen below 10 percent in the history of the survey. In the language of public health, smoking in America is now officially “rare.”

How do you quit cigarettes when willpower alone just won’t do?

This decline — from 42.4 percent in 1965 to 9.9 percent, over about 60 years — is one of the great public health achievements of the modern era. It didn’t happen because of a single breakthrough or a miracle drug. It happened because science, policy, litigation, and sheer collective will chipped away at the problem for six decades against the fierce resistance of one of the most powerful industries on earth. If you’re looking for evidence that large-scale, long-term progress is possible — even when the odds seem impossible — there are few better examples than the story of smoking.

The smoke got in your eye

The scale of the change is hard to appreciate now. At the peak, Americans consumed more than 4,000 cigarettes per person per year, or more than half a pack a day. Roughly half of all physicians smoked. Cigarette companies spent billions on marketing........

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