Fifty years ago, almost half of Americans smoked cigarettes—at work, in restaurants, schools and even in hospitals. Then came a landmark warning that changed everything.
The Surgeon General's report on smoking and health, issued January 11, 1964, was the first of its kind to alert the public that cigarettes caused lung cancer and other fatal tumors.
The contents of the nearly 400-page report made headlines across America. And while not everyone heeded its call to cut tobacco out of daily life, within a decade smoking was slowly but steadily on the decline.
Today, 18 percent of Americans smoke, down from 42 percent in 1964.
The change in smoking habits has saved eight million people from dying prematurely over the last 50 years, according to research released this week to coincide with the report's anniversary.
Lung cancer rates are down, and men and women are living longer than ever before.
"In the past half century, nothing else has come close to this contribution to the health of Americans. Nothing," said Ken Warner, professor of health management and policy at the University of Michigan.
"I firmly believe that when 20th century historians look back on the last century they are going to conclude that the rise and fall of the cigarette constituted one of the most important public health stories of the century," he told reporters in Washington.
But as experts held press conferences and scientific journals published research on the changes in American health and longevity since 1964, some warned that significant challenges remain.
For instance, while smoking rates are down globally, the actual number of smokers is on the rise in the world as cigarettes gain popularity in places like China and India, according to the Institute for Health Metrics in Washington.
Globally, the number of smokers has climbed from 721 million in 1980 to 967 million in 2012, it said.
Smoking is still the leading cause of preventable death in the United States, killing some 400,000 people annually.
"One out of every five deaths is a completely preventable smoking-produced death," said Warner.
On the flip side of the eight-million-lives-saved figure is a more harrowing one: nearly 18 million people in the United States have died from tobacco since 1964.
"It is a horrible statistic," said Michael Terry, the son of the late Luther Terry, the surgeon general who issued report 50 years ago.
"He would be disappointed," Terry said. "He would say, 'What have we been doing?'"
Studies show that new products like mini cigars that come in fruit flavors, as well as electronic cigarettes are gaining in popularity, particularly among young people.
Every day, about three thousand youths try cigarettes for the first time, and 700 get hooked, according to the Campaign for Tobacco Free Kids.
"The primary reason we haven't accomplished more is the same today as it was in 1964. It is the behavior of the tobacco industry," said the group's president, Matthew Myers.
"Cigarettes today are every bit as deadly, every bit as addictive and even more appealing to our nation's children," said Myers.
He added that the tobacco industry spends one million dollars an hour on marketing, "much of that in ways to make tobacco products more appealing and more accessible to our kids."
However, David Sylvia, a spokesman for Altria, the parent company of tobacco giant Philip Morris USA, said cigarette advertising is way down, due to a major legal settlement in 1998 led to dramatic changes in marketing.
No longer can cigarette ads be emblazoned across billboards, taxi cabs, branded merchandise or sports stadiums.
Today, much of tobacco marketing is done one-on-one to adult consumers who ask to receive money-saving promotions, and via retail establishments where cigarettes are sold, he said.
"We want to market to adults that currently use tobacco products," he told AFP.
"We don't want kids to use tobacco products," he said, adding that efforts are made to limit the reach of tobacco marketing to "unintended audiences."
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