(Photo by Andrew Burton/Getty Images)

Last week, CVS announced it would no longer sell tobacco products. The White House commended the move, asserting that President Obama "has made creating a tobacco-free generation a top priority."

An Associated Press article earlier this year heralded the predicted end of smoking in America.

In just the past century, smoking cigarettes was associated with every desirable trait from rugged manliness to glamorous (and svelte, natch) womanhood. It's hard to believe how far smoking has fallen.


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ABOVE: Cigarette ads marketed to men and women. CREDIT: Stanford Research into the Impact of Tobacco Advertising


The turning point for smoking came in 1964, when the Surgeon General bucked pressure from tobacco companies and issued a 387-page report detailing the link between tobacco use and disease and mortality. Since then, cigarette smoking rates have decreased by more than half in the United States: From 42.4 percent of adults in 1965 to 18.1 percent of adults in 2012.

That's a steep decline, but that means at least 56 million Americans were still smoking that year. Today, anti-smoking groups are grappling with the complications inherent in convincing the remaining one-fifth of Americans who still light up to give it up for good.

Certainly, proactive measures have been taken: Obama was criticized during his first election for his own bad habit, but he has since quit, citing the bad influence on his girls and a healthy fear of his wife. Though it hasn't been widely publicized, the president has taken several legislative measures to help other Americans stop smoking: He signed a bill that gave the FDA the authority to limit the amount of certain chemicals in tobacco products, added smoking cessation coverage to health insurance plans with the Affordable Care Act, and increased the tax on tobacco products in the 2009 Children's Health Insurance Program Reauthorization Act.


Three major media campaigns are encouraging people to quit: The Centers for Disease Control's "Tips from Former Smokers" campaign, the FDA's "The real cost of smoking" ads, and the recently launched #FinishIt campaign from thetruth.com.

So what will it take to snuff out smoking for good in America?

Vince Willmoore, the vice president of communications for the Campaign for Tobacco-Free Kids, outlined some of the steps that need to be taken, as prescribed by the Surgeon General's report from earlier this year.


"First of all is to continue to conduct national media campaigns that encourage smokers to quit and prevent kids from starting," he told Fusion. He cited the various campaigns as effective, but said they still lack visibility, adding that the Surgeon General's report called for more media exposure.

"Second, we need significant increases in tobacco taxes at the state and federal level," Willmoore said. Studies have shown that making cigarettes more expensive does deter people from smoking.

Willmore said about 49 percent of the population is protected by various state and local laws, as well as rules that ban smoking in restaurants and other places. "We'd like to see every state fund stop-smoking programs at the levels recommended by the CDC."


Fusion spoke to three cigarette smokers about these steps. None had seen any of the ad campaigns. Rising prices weren't much of a deterrent either โ€” "even when I had no money I found a way to smoke," said one โ€” and they weren't bothered by laws that forced them to move further away from entrances.

All said they've tried to quit smoking in the past, and were able to stop for a few months or years at a stretch before starting again. All of them began smoking when they were teenagers.


"Eighty-six percent of people (who currently smoke) start smoking by the time they're 20 years old," said Robin Koval, the president and CEO of Legacy, the anti-tobacco organization that runs thetruth.com.

She said teenagers' brains are inherently more likely to take risks and believe they will be immune to consequences.


"Unfortunately, tobacco has the best marketing tool: They're selling an addictive product," Koval told Fusion. "Young people start, they experiment, many think this is something they don't plan to do for a really long time, and unfortunately it's very hard to stop."

Fortunately, teen smoking rates have declined faster than in the general population: After peaking in 1997 at 36.4 percent, it has gone down to 15.7 percent as of 2013, according to the CDC. Since the grand majority of smokers start as teens, prevention is key to long-term dereases in smoking rates. But that still leaves us with a lot of adults who already smoke.

ABOVE: Rates of smoking among teenagers has declined in the past 20 years. CREDIT: Campaign for Tobacco-Free Kids


Nearly 70 percent of all current smokers say they want to quit, and every year, about half of them attempt to stop smoking for good. Koval said it takes the average smoker 11 tries to successfully quit.

So who still smokes? Overwhelmingly, communities that are marginalized, such as the poor, Native Americans and African-Americans.

In recent years, cigarette companies have found a new population to advertise to: The LGBT community. Gay, lesbian, bisexual and transgender youth are particularly susceptible to the stress-reducing appeal of smoking, according to the DC Center for LGBT Youth.


ABOVE: A cigarette ad from a 2005 copy of The Advocate. CREDIT: National LGBT Tobacco Control Network

"It is a crisis for the LGBT community," Koval continued. "They've been very, very heavily targeted by the tobacco industry, promoted to over and over again, so it becomes a more culturally accepted behavior. This is a pretty shocking statistic, but if you really look at the numbers, more people are going to die from tobacco-related illness than โ€” from this point with all the advances we've made โ€” than are going to succumb to AIDS."

Koval said public education, clean air laws, and price increases were the keys to ending smoking for good. But what these efforts lack is a way to tackle the nebulous thing that keeps people smoking: Addiction.


"Why do junkies shoot up even though they know it's killing them? I don't know the answer to that, other than human imperfection," one smoker told Fusion. "All addicts operate under a veil of cognitive dissonance in order to continue."

While anti-tobacco campaigns have made huge strides in decreasing smoking rates, the last people who smoke will be the hardest to convince to stop. But with 480,000 annual deaths from smoking in the United States (at an annual healthcare cost of roughly $289 billion), it's difficult to deny the real-world consequences of lighting up.