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A half-century ago, the surgeon general first outlined health risks associated with smoking.

More than four in 10 American adults were smokers — and so were a lot of kids — 50 years ago when the surgeon general first announced that smoking kills. The report "Smoking and Health" said bluntly that smoking cigarettes causes lung cancer and is linked to other serious diseases.

In the half-century since that report came out on Jan. 11, 1964, an estimated eight million deaths have been prevented by stop-smoking efforts, according to a new study in the Journal of the American Medical Association.

About 42 percent of American adults smoked in 1964, and that number has plummeted to about 18 percent. The reduction in tobacco use is believed to account for a substantial portion of gains made in life expectancy in America, which has risen by five years since that first report on tobacco dangers.

But despite widespread knowledge of these dangers, along with increased taxes, advertising bans, warning labels on tobacco products and laws limiting smoking, some haven't quite managed to kick butts. That fact bothers a coalition of anti-tobacco nonprofits that this week called for renewed, vigorous efforts to reduce tobacco use.

One of the groups, The Campaign for Tobacco-Free Kids, points out that nearly 44 million American adults and 3.6 million adolescents and children smoke. The four conditions most linked to tobacco use — heart disease, cancer, lung ills and stroke — are still the top causes of death in the United States.

There are two things blocking progress, said Dr. Les Beitsch, chairman of Medical Humanities and Social Sciences for the College of Medicine at Florida State University. First, nicotine is incredibly addictive to those who use the product. Second, corporations are addicted to the massive profits they make off that first addiction, he said.

"We’ve made enormous progress, but we can’t declare victory when tobacco is still the No. 1 cause of preventable deaths in the United States," Vince Willmore, the spokesman for The Campaign for Tobacco-Free Kids, told the Deseret News. "We know how to win this, and it cannot take another 50 years. We cannot afford another 50 years of death and disease caused by tobacco."

The toll

The vast majority of smokers began at or before they were 18 years old. Tobacco-Free Kids notes that each day more than 3,000 American children try cigarettes for the first time.

Recent Centers for Disease Control and Prevention statistics reported that about 443,000 Americans die prematurely each year from smoking-related causes. Tobacco use costs about $96 billion in the United States in health care bills and $97 billion in lost productivity.

Worldwide, tobacco is believed to kill almost six million people a year.

"Tobacco is, quite simply, in a league of its own in terms of the sheer number and varieties of ways it kills and maims people," Dr. Thomas Frieden, CDC director, wrote in a JAMA Commentary. "Images of smoking in movies, television and on the Internet remain common; and cigarettes continue to be far too affordable in nearly all parts of the country."

A coalition of organizations believes implementing proven programs and policies can end tobacco's stranglehold on smokers. In a joint statement Wednesday, they asked for "bold action" by government to achieve three goals: Reduce smoking rates to less than 10 percent within 10 years; protect all Americans from secondhand smoke within five years; and "ultimately eliminate the death and disease caused by tobacco use."

The groups in the coalition are the American Academy of Pediatrics; American Cancer Society Cancer Action Network; American Heart Association; American Lung Association; Americans for Nonsmokers' Rights; and Campaign for Tobacco-Free Kids and Legacy.

Experts would also like tobacco companies to cough up the money to fund anti-tobacco efforts, or at least stop contributing to the toll. The coalition highlighted Federal Trade Commission data showing that the tobacco industry will spend the equivalent of $1 million each hour this year to market cigarettes and smokeless tobacco products. The companies, it said, fight efforts to limit marketing, design their products to appeal to kids and aim to create and sustain addiction to nicotine.

Some progress has been impressive, but efforts to curb tobacco use have been hampered by tobacco manufacturers, Beitsch said, adding that it earlier appeared the tobacco industry "was going to work with us, even with the master settlement of the 1990s. But they never really honored commitments to tell the truth and work in an honorable way."

It is hard to make progress, he noted, when a "so-called partner doesn't really intend to collaborate."

Bright patches

Beitsch sees definite bright spots in anti-smoking efforts, though. Very few health practitioners smoke. Some states, including Utah, have already met goals set for 2020 in terms of reducing tobacco use. Florida is an example of a state that reached goals for reducing tobacco use in middle schools and high schools.

The high school smoking rate peaked at 36.4 percent in 1997, but was down to 18.1 percent in 2011, according to the Youth Risk Behavior Survey conducted by CDC. The recent Monitoring the Future Survey found smoking among high school seniors cut in half since 1997, down to 16.3 percent in 2013.

American adults have also cut the number of cigarettes they smoke. Adult per capita consumption has gone from a high of 4,345 in 1963 to 1,232 in 2011. A study in the American Journal of Public Health estimated that without the anti-tobacco efforts of the past 50 years, per capita cigarette use would have been five times higher in 2011 than it was.

Researchers say smoking by men declined an average of 25 percent in 187 countries from 1980 to 2012, and by 42 percent among women. But with population growth, the raw number of smokers globally has grown, and rates remain high in some countries. For men, smoking is very common in Russia, Indonesia and Armenia, for instance, while women smoke in higher-than-average numbers in Chile, France and Greece.

While the United States was first to sound the alarm about tobacco dangers, it lags behind many countries, Beitsch said.

"We were the first to take concerted action. We took the lead, but other countries have in many ways surpassed us in terms of how they deal with smoking," he said.

Proven strategies

Tobacco-Free Kids wants the Food and Drug Administration to use the authority it received in 2009 to regulate manufacturing, marketing and sale of tobacco products, including electronic cigarettes.

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It wants Congress to give the federal tobacco tax a hefty bump. And it wants more media campaigns that motivate smokers to quit and prevent others from picking up the habit.

One such campaign is "Tips from Former Smokers," that the CDC recently credited with helping more than 100,000 Americans kick the habit for good. The ads generated more than 150,000 extra calls to quit lines and sparked 2.8 million additional visits to the website, said the CDC, which created the campaign. The federal health agency listed it as one of its five top accomplishments of 2013.

EMAIL: lois@deseretnews.com, Twitter: Loisco