After decades of smoking two packs of cigarettes a day, George Cocking finally quit in 1999. But he's not really breathing any easier.

He's breathing through his neck. The 56-year-old Toms River man lost his larynx to cancer. The laryngectomy rendered useless his nose and mouth in terms of breathing; his trachea, or windpipe, is now connected to a hole in his neck. Forty years ago today, when U.S. Surgeon General Luther Terry issued a landmark report linking smoking to cancer and other diseases, Cocking didn't pay much attention. By then, he had been hooked on cigarettes for four years. "I was Superman," said Cocking (pronounced CO-king). "That didn't mean me." But many other people did heed Terry's report, which was a "courageous first step" in the war on smoking, said Lillian Pfaff, media and marketing manager for the state's Comprehensive Tobacco Control Program. Attitudes toward smoking have changed tremendously since 1964, with milestones big and small -- from banning tobacco advertising on TV to leaving out the pipe accessory in the Mr. Potato Head toy kit; from the historic tobacco settlement agreement to NASCAR's Winston Cup Series being renamed the Nextel Cup. "Smoking in New Jersey is becoming an unacceptable social behavior," said Albert Petroni, community organizer for the Communities Against Tobacco coalition in Ocean County. At the same time, the country has seen a kind of backlash from the smoking minority, who are frustrated by what they feel is an infringement on their right to publicly enjoy a legal product. One thing is certain: The surgeon general's report of 1964 wasn't just a warning to smokers; it was a warning to American tobacco companies of the battles that lay ahead. Where we were The 1964 report was not the first to link smoking with health risks. The American Cancer Society issued similar studies in 1954 and 1959, but they did not receive the publicity that Terry's report did. The report came at a time when nearly 52 percent of American men and 34 percent of women smoked, according to the American Lung Association. A year after Terry's report, Congress passed the federal Cigarette Labeling and Advertising Act requiring the surgeon general's warning on cigarette packages. By 1969, Congress had banned tobacco advertising from radio and television. But the smoke was still too thick for Regina Carlson. In 1974, the New Jersey woman helped to create the Group Against Smoking Pollution, or GASP, based in Summit, Union County. At that time, said Carlson, people smoked in hospitals, grocery stores, airplanes, movie theaters and college classrooms. So GASP started working to enact tobacco control laws. As the nonsmoking movement gained momentum, the federal Food and Drug Administration began approving a variety of smoking cessation aids, starting in 1984 with nicotine gum. Nicotine replacement therapy -- including items such as Nicorette gum and the NicoDerm CQ "patch" -- has since become a $1.6 billion market worldwide, according to GlaxoSmithKline, which manufactures the products. In 1988, Surgeon General C. Everett Koop classified nicotine as an addictive drug. By 1990, Americans could no longer smoke on domestic airplane flights. Then in 1994, the attorney general of Mississippi filed a lawsuit seeking reimbursement from tobacco companies for smokers' Medicaid expenses. Tobacco executives initially fought the suit -- and others that followed -- and even testified before Congress that nicotine is not addictive. Yet four years later, tobacco companies signed the mam-moth $206 billion Master Settle-ment Agreement with 46 states, the District of Columbia and five U.S. territories. New Jer-sey's share was $7.6 billion, to be paid out over many years. In addition to paying the mon-ey, the companies agreed to further restrict tobacco market-ing and advertising. One year after the settlement, in 1999, George Cocking lost his larynx. "My last cigarette was at the door of the hospital," Cocking said. Where we are Statistics from the American Lung Association show that to-day about 25 percent of men and 21 percent of women in the United States smoke -- roughly half of the percentage that smoked 40 years ago. In New Jersey, 274 local gov-ernments have passed ordi-nances regulating tobacco use, sales and marketing, according to GASP. Out of Monmouth County's 53 municipalities, 11 have enacted laws on tobacco use and 24 have ordinances on its sale; about one-third of Ocean County's 33 municipali-ties have such laws. But that's not good enough for the American Lung Associa-tion, which issued a national report card last week on the State of Tobacco Control. New Jersey received an "F" in the categories of smoke-free air, youth access and spending on tobacco prevention and control. One of New Jersey's major fail-ings, according to the report, is its lack of a smoking ban in bars and restaurants, similar to ones in California and New York City. A proposed ban sponsored last year by Assem-blywoman Loretta Weinberg, D-Bergen, went nowhere. "It is a very contentious issue," Weinberg said. Part of the opposition comes from the New Jersey Restau-rant Association, which oppos-es any legislation that exempts certain establishments -- casi-nos, private clubs, alumni halls, golf courses, bars -- from a smoking ban, said president Deborah Dowdell. Lawmakers had amended Weinberg's bill to exempt certain venues. As it is, Dowdell noted, many restaurants have chosen to go smoke-free on their own be-cause "the marketplace drives this issue." "Over the years, smoking sec-tions have gotten smaller and smaller and smaller," she said. "That has occurred without any need for a law." At the I Cavallini restaurant in Colts Neck, management tried to cater to smokers and non-smokers but found the space was too small. Guests who were seated near smokers "didn't ap-preciate it, and they let us know," said manager Kathy Ha-berstroh. "We decided it would be in our best interest -- in the interest of all the customers -- to go non-smoking," Haberstroh said. "If we had room where we could separate the guests, we would have offered smoking because we like to accommodate every-one." The Garden State's one good grade on the lung association's report card was an "A" in ciga-rette taxes, which at $2.05 per pack are the highest in the na-tion. New Jersey collected about $740 million in excise and sales tax on cigarettes in fiscal year 2003, according to the state treasurer's office. Yet Carlson of GASP noted that the costs of tobacco in terms of health care, lost productivity and smoking-related fires far exceed the revenue generated from taxes. Smoking-related health care costs in New Jersey totaled nearly $2.5 billion last year, and smoking-related productiv-ity losses were $2.2 billion, ac-cording to the National Center for Tobacco-Free Kids. Meanwhile, smokers' perceived assault on their lifestyle through cigarette-tax increases and anti-tobacco laws has led to the creation of smokers' rights organizations. For example, the Web site MySmokers-Rights.com, sponsored by to-bacco giant R.J. Reynolds Co., offers information on how much money smokers are pay-ing in cigarette taxes and which legislators to contact if they are upset about it, ex-plained John Singleton, RJR's director of public affairs. "Smokers have a right to have a voice," Singleton said. George Cocking no longer has his voice -- at least not the way it used to be. He speaks in short, guttural bursts because of his missing larynx and vocal cords. He probably should have seen it coming. His mother died in 1959 of lung cancer after years of exposure to secondhand smoke. His dad, a heavy smok-er, had a laryngectomy in 1965. But the warnings that Cocking ignored have not been lost on his own son, who was a smoker until four years ago. "He quit the day that I came home from the hospital," Cock-ing said. Where we're going Anti-smoking activists still see much work to do, and are dis-appointed they do not have enough money to do it with. New Jersey has borrowed against the next 25 years of tobacco settlement payments. While some money was spent on anti-smoking and health care programs over the past few years, most of it was used to balance the 2003 and 2004 state budgets. Regina Carlson of GASP is up-set that more money did not go to tobacco control and preven-tion. She and others, including Lillian Pfaff of the state's Com-prehensive Tobacco Control Program, are especially con-cerned about funding for youth anti-tobacco programs such as Reaching Everyone By Expos-ing Lies (REBEL). "We'd like to see more teens never start to smoke," Pfaff said. "Ninety percent of all cur-rent smokers started in their teen years." On the legislative front, a state-wide anti-smoking bill will be reintroduced in the new ses-sion, which begins Tuesday, said Assemblywoman Wein-berg. Stricter local laws are unlikely because municipalities cannot pass workplace smoking bans without special enabling legis-lation from the Statehouse, Weinberg said. Lawmakers have refused to pass that. "If municipalities are really in-terested in this, they should be asking us to (pass this legisla-tion) a little more often than they do," she said. On the marketing front, Leslie Terjesen, senior field represen-tative for health education in Ocean County, wants to see more graphic warnings on American tobacco products. Starting about three years ago, Canadian cigarettes began car-rying warnings accompanied by graphic images. "Cigarettes cause mouth diseases" reads one warning, illustrated by a photo of teeth whose gums are riddled with sores. The words-only warnings in the United States pale by com-parison, said Terjesen, who compared them to "background music." But the "shock value" of Canadian labels -- and the fact that they must cover 50 percent of a cigarette pack -- might jolt smokers out of their compla-cency, she said. On the personal front, George Cocking, who used to work at the water treatment plant in Toms River, now spends his days speaking -- as best he can -- to schoolchildren in Mon-mouth and Ocean counties about the dangers of tobacco. The hole in his neck, called a stoma, is covered by a plastic filter that looks like a plug. That seems to make the kids pay a little more attention to his anti-smoking message than they normally might. "It's not hard to see the effect on me," Cocking said. "It's right there in their face."

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