When Diane Phillips' parents started smoking cigarettes, they had no idea how bad it was for them.

As a result, the Dillsburg resident said, her mother had chronic respiratory problems for the last 10 years of her life.

Phillips' parents were already smoking before the first Surgeon General's Report on Smoking and Health scientifically linked the habit to lung cancer and heart disease 50 years ago.

"It was very sad to know that that information didn't reach them in time to be able to avoid getting involved with tobacco use," said Phillips, who serves as senior director of state policy for the American Cancer Society Cancer Action Network.

This year's report, the 32nd one of its kind, flags smoking as more dangerous than initially reported. It affects nearly all organs of the body and causes illnesses from impaired fertility to colon cancer, the report says.

When the initial report came out in 1964, the country's smoking rate was 42 percent. By 2011, it dropped to 19 percent, according to the Centers for Disease Control and Prevention.

But it remains the leading cause of preventable death and illness in the United States.

County progress: York County has a 22 percent rate, which has been stable over the past 10 years, according to the 2012 York and Adams County Community Health Needs Assessment.

In 2006, Memorial Hospital, WellSpan Health's York and Gettysburg hospitals and Hanover Hospital adopted tobacco-free policies. In 2008, YMCA of York and York County adopted a tobacco-free policy for the county's four Y campuses.

Eat Play Breathe York is focusing on education and making more large organizations tobacco-free, steering committee co-chair Cori Strathmeyer said in an email. The organization tries to promote changes in health through nutrition, exercise and reducing tobacco smoke in and around York City.

"We have been quite busy working to decrease tobacco use and exposure in York," she said.

Prior to Eat Play Breathe's creation in 2010, Bring On Play and York City implemented a tobacco-free park policy in 2008, Strathmeyer said.

In 2012, the York Housing Authority adopted a smoke-free housing policy for all low-income housing in York County, she said. Last year, smoke-free living policies were implemented in about 90 York City apartment units.

Eat Play Breathe created its first tobacco-free PSA last year and will roll out more videos on March 19, Kick Butts Day, Strathmeyer said. It is also planning cessation events and tobacco-free policy drafts for higher education institutions, she said.

State progress: In Pennsylvania, 21.3 percent of adults were cigarette smokers in 2011.

More aggressive state legislation could curb that number, Phillips said, adding Pennsylvania still needs to work on three issues: protecting all workers from secondhand smoke, funding tobacco prevention and cessation services and increasing the price of cigarettes.

The state earned a C, F and C in those areas in the American Lung Association's State of Tobacco Control 2014 report.

Although Phillips applauds the state's Clean Indoor Air Act of 2008, which bans smoking in certain public places and workplaces, the law doesn't protect all workers from cancer-causing secondhand smoke. Pennsylvanians who work in certain bars, for example, can spend eight-hour shifts in a smoke-filled environment.

As a society, our attitudes about smoking have changed drastically: 50 years ago, many people didn't want to believe the Surgeon General's claims that smoking was linked to cancer and other illnesses, she said. Now, she said, we know cigarettes are even more dangerous than initially reported.

"We're in a different place today. We're in a better place — but we still have work to do," Phillips said.

— Reach Mollie Durkin at mdurkin@yorkdispatch.com.