
On January 11, 1964, the Surgeon General of the United States released a report concluding that cigarette smoking was hazardous to health. This report was the first in a series of steps to reduce the impact of tobacco use on Americans' health. In 1965, the Federal Cigarette Labeling and Advertising Act was passed, requiring tobacco companies to place health warning labels on cigarette packages. This was followed by the Public Health Cigarette Smoking Act of 1969. In contrast, it wasn't until 1988 that the Alcoholic Beverage Labeling Act was passed, requiring alcoholic beverages to carry warning labels. Despite this, alcohol warning labels continue to face opposition from the alcohol industry, and there are ongoing calls for stronger and more effective health warnings on alcoholic beverages.
| Characteristics | Values |
|---|---|
| Date of first Surgeon General's report on smoking | 11 January 1964 |
| Surgeon General who issued the report | Luther L. Terry, M.D. |
| Number of articles consulted | More than 7,000 |
| Conclusion | Cigarette smoking causes lung cancer and is the most important cause of chronic bronchitis |
| Federal legislation | Federal Cigarette Labelling and Advertising Act of 1965 |
| Warning label | "Caution: Cigarette Smoking May Be Hazardous to Your Health" |
| Location of warning label | Side panel of cigarette package |
| Year of first anti-smoking measures | 1965 |
| Recent legislation | 2019 amendment to the Food, Drug and Cosmetic Act |
| Effect of the report | The percentage of Americans who smoke dropped from 42% in 1964 to 18% |
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What You'll Learn

Cigarette health warnings began in 1965
The 1964 report, led by Surgeon General Luther Terry, was a landmark in public health and the first to receive widespread media and public attention. It was based on the conclusion that cigarette smoking causes lung cancer and is likely a cause of heart disease. The report also found that smoking during pregnancy reduced the average weight of newborns.
The committee's findings were based on the review of more than 7,000 articles relating to smoking and disease. The report stated that cigarette smoking was a cause of lung and laryngeal cancer in men and a probable cause of lung cancer in women. It also concluded that smoking was the most important cause of chronic bronchitis and pointed to a correlation between smoking and emphysema, as well as coronary heart disease.
The release of the 1964 report was a pivotal moment in changing the perception of smoking in America. It marked a shift from viewing smoking as a glamorous habit to recognizing it as a dangerous activity with deadly consequences. The report sparked a series of anti-smoking measures and public health initiatives aimed at reducing the impact of tobacco use on the health of Americans.
The Federal Cigarette Labelling and Advertising Act of 1965 required the warning "Caution: Cigarette Smoking May Be Hazardous to Your Health" to be placed in small print on one side panel of each cigarette package. This was the first step in a long journey to address the health risks associated with smoking and encourage smokers to quit.
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Alcoholic Beverage Labeling Act of 1988
On January 11, 1964, Surgeon General Luther L. Terry released the first Surgeon General's report on the health risks of smoking. The report, titled "Smoking and Health", was based on more than 7,000 articles relating to smoking and disease and concluded that cigarette smoking causes lung and laryngeal cancer in men. This report marked the beginning of a series of steps to mitigate the harmful effects of tobacco use on Americans' health.
In 1965, Congress passed the Federal Cigarette Labeling and Advertising Act, requiring a warning label on cigarette packages stating, "Caution: Cigarette Smoking May Be Hazardous to Your Health." This was a significant step in acknowledging the dangers of smoking and providing consumers with information about the potential risks associated with cigarette consumption.
While the focus of this query is on alcohol, it is worth noting that the Surgeon General's warnings and reports have addressed various topics over the years, including smoking, TV, and safer sex practices, demonstrating their broad scope of public health concerns.
Now, turning to the Alcoholic Beverage Labeling Act of 1988, this legislation was enacted as part of the Anti-Drug Abuse Act of 1988. It mandates that alcoholic beverages sold or distributed in the United States carry labels with specific warnings. These warnings include the following:
- Women should refrain from consuming alcoholic beverages during pregnancy due to the risk of birth defects.
- Alcohol consumption impairs one's ability to drive a car or operate machinery.
- Alcohol consumption may lead to health problems.
The Act defines an alcoholic beverage as any beverage containing at least 0.5% alcohol by volume intended for human consumption. It is important to note that this requirement for health warning statements does not apply to beverages bottled in a foreign country before November 18, 1989. The responsibility falls on the importer to provide evidence that the beverage was bottled before this date if requested.
The Alcoholic Beverage Labeling Act of 1988 amended the Federal Alcohol Administration Act, empowering the Secretary of the Treasury with enforcement. The Act also establishes civil penalties for violations and authorizes the Secretary to compromise liability upon payment for each offense.
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Current fetal warnings are ineffective
On January 11, 1964, Surgeon General Luther L. Terry released the first report on the health risks of smoking, marking the beginning of a series of steps to mitigate the impact of tobacco use on Americans' health. The report, based on over 7,000 articles linking smoking to various diseases, concluded that cigarette smoking causes lung and laryngeal cancer in men. This pivotal moment changed the perception of smoking from a glamorous habit to one with deadly consequences.
Secondly, the current warnings may not adequately emphasize the range of conditions that can lead to fetal distress. For example, non-reassuring fetal status can result from various obstetric, maternal, or fetal conditions, such as maternal cardiovascular disease, anemia, diabetes, hypertension, infection, or placental issues. By not explicitly mentioning these specific conditions, the warnings may fail to provide pregnant women with comprehensive information to recognize potential risk factors.
Furthermore, the current warnings may not sufficiently highlight the importance of prompt action in response to warning signs. Fetal hypoxia, for instance, can have severe short- and long-term complications, including encephalopathy, seizures, cerebral palsy, and neurodevelopmental delays. However, without urgent and proper evaluation and intrauterine resuscitation, the fetus may suffer irreversible damage. Therefore, it is crucial that fetal warnings emphasize the time-sensitive nature of fetal distress and the potential consequences of delayed intervention.
Additionally, the current warnings may not provide clear guidance on fetal movement monitoring. While decreased fetal movement can indicate potential fetal impairment or risk, there is a lack of consensus on the most effective monitoring techniques. Some women may be more vigilant in monitoring fetal movement than others, and certain methods may not be feasible or accessible for all pregnant women. It is essential to offer a range of evidence-based monitoring options that consider individual variability and provide clear instructions on when and how to seek medical attention.
To enhance the effectiveness of fetal warnings, it is necessary to develop standardized guidelines, ensure comprehensive and specific information, emphasize the urgency of prompt action, and provide clear, accessible instructions on fetal movement monitoring and seeking medical care. Addressing these gaps will help improve maternal and fetal health outcomes and ensure that warnings are informative and actionable.
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2025: Calls for cancer risk warnings
In 2025, there are growing calls for cancer risk warnings to be included on alcoholic beverages, as a direct result of the Surgeon General's 1964 report on smoking and health. This landmark report, released on January 11, 1964, by Surgeon General Luther L. Terry, was the culmination of research by an advisory committee that reviewed over 7,000 articles on cigarette smoking. The report concluded that smoking was a significant cause of lung and laryngeal cancer, as well as heart disease, and it sparked a series of anti-smoking measures over the following decades.
The impact of the 1964 report was profound, not only in raising awareness about the health risks of smoking but also in shifting the public perception of smoking from a glamorous habit to one with deadly consequences. The report's findings led to the Federal Cigarette Labeling and Advertising Act of 1965, which mandated the first warning labels on cigarette packages. This was followed by the Public Health Cigarette Smoking Act of 1969 and various other anti-smoking measures, including smoking bans in public places and on domestic and international flights.
The Surgeon General's report and the subsequent anti-smoking efforts have had a tangible impact on smoking rates in the United States. The percentage of Americans who smoke has dropped significantly, from a peak of 42% in 1964 to 18% in recent years. This success in reducing tobacco use has inspired similar efforts to address the potential harms associated with alcohol consumption.
Calls for cancer risk warnings on alcoholic beverages are driven by similar concerns for public health and a desire to inform consumers about the potential dangers of alcohol use. Research has linked alcohol consumption to an increased risk of various types of cancer, including breast, liver, and colorectal cancer. Proponents of warning labels argue that consumers have a right to know about these risks, enabling them to make more informed choices about their alcohol intake.
While the alcohol industry has resisted these calls, citing potential negative impacts on their business, public health advocates remain steadfast in their efforts. They draw on the lessons learned from the anti-smoking movement, recognizing the importance of scientific research, public education, and policy interventions in mitigating the harmful effects of substances like tobacco and alcohol. The push for cancer risk warnings on alcohol products is a testament to the ongoing commitment to improving public health and empowering individuals to make healthier choices.
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Surgeon General's reports on tobacco
On January 11, 1964, the Surgeon General of the U.S. Public Health Service, Luther L. Terry, released the first report of the Surgeon General's Advisory Committee on Smoking and Health. The report was based on more than 7,000 articles relating to smoking and disease already available in the biomedical literature. The Advisory Committee concluded that cigarette smoking causes lung cancer and laryngeal cancer in men. The report was the first in a series of steps to diminish the impact of tobacco use on the health of Americans.
In 1965, the Public Health Service established the National Clearinghouse for Smoking and Health, which was later succeeded by the Centers for Disease Control and Prevention's Office on Smoking and Health. This office has been responsible for numerous reports on the health consequences of smoking over the years. In 1968, the Office of the Surgeon General was abolished, and the position became an advisor to the Secretary of Health, Education, and Welfare.
In 1987, the Office of the Surgeon General was reestablished. Since then, the Surgeon General has continued to release reports and take actions to protect Americans from the dangers of tobacco and nicotine, including preventing youth from using tobacco products. For example, in 2012, a report was released on "Preventing Tobacco Use Among Youth and Young Adults," which detailed the factors that lead young people to initiate tobacco use and the devastating health and economic impacts. Another report in 2016 focused on "E-Cigarette Use Among Youth and Young Adults," highlighting the rapidly changing patterns of e-cigarette use and assessing the health effects of these products.
The Surgeon General's reports have had a significant impact on public perception and policy regarding tobacco use. The annual per capita cigarette consumption in the United States had increased from 54 cigarettes in 1900 to over 4,000 cigarettes in 1963 when the first research linked smoking to cancer. It took the 1964 report and decades of effort to change the perception of smoking in America from a glamorous habit to one with deadly consequences. As a result, tobacco use in the United States has significantly decreased, but it remains a high priority for the Office of the Surgeon General as it is still the leading cause of preventable death.
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Frequently asked questions
The Surgeon General of the U.S. Public Health Service, Luther L. Terry, released the first report on January 11, 1964.
The report concluded that cigarette smoking is a cause of lung and laryngeal cancer in men, a probable cause of lung cancer in women, and the most important cause of chronic bronchitis.
The report led to a change in public perception of smoking, from a glamorous habit to one with deadly consequences. It also prompted Congress to pass the Federal Cigarette Labeling and Advertising Act of 1965, which required warning labels on cigarette packages.
The warning labels stated: "Caution: Cigarette Smoking May Be Hazardous to Your Health".
Yes, in 1987, the Office of the Surgeon General was reestablished, and smoking was banned on all domestic and international flights by 2000. In 2019, the Food, Drug, and Cosmetic Act was amended, raising the minimum age for tobacco sales from 18 to 21.








































