How does a culture of health change? Lessons from the war on cigarettes

This paper focuses on one of the most dramatic changes in the culture of health in the U.S. since World War II: the reduction of adult cigarette smoking from close to half of the population to under 20 percent between the 1960s and the 1990s. What role does culture play in explaining this shift in smoking from socially accepted to socially stigmatized? After surveying how culture has been used to explain the decline in smoking in the fields of tobacco control and public health, we argue that existing concepts do not capture the complex transformation of smoking. We instead suggest a micro-sociological view which presumes that culture may change in response to spatially organized constraints, cajoling, and comradeship. By reviewing two major drivers of the transformation of smoking - the Surgeon General's Reports and the nonsmokers' rights movement - at this micro-sociological level, we show how culture works through social spaces and practices while institutionalizing collective or even legal pressures and constraints on behavior. This conclusion also seeks to explain the uneven adoption of non-smoking across classes, and to reflect on the utility of presuming that a uniform “culture” blankets a society.