CLEVELAND, Ohio -- Is it possible that we're nearing the end of tobacco road?

In the nearly half-century since the U.S. surgeon general proclaimed that smoking cigarettes will lead to cancer and early death, our view of smoking has been steadily spiraling downward.

Smokers have fallen from the heights of ultra-cool (think Humphrey Bogart or James Dean) and into the depths of foolish (consider 5 million tobacco-related deaths).

So today, on the 35th Great American Smokeout, some health officials might hope we're nearing the end of our longtime affair with smoking, pointing to a steadily declining line on a graph as proof.

The fact is, about a third fewer Americans smoke today, about 21 percent, than in the late 1970s (34 percent), according to the U.S. Centers for Disease Control and Prevention.

In other words, we've come a long way.

Maybe.

Certainly, tobacco use is far from over. Some studies figure that there are still some 1.2 billion smokers throughout the world -- one-third of which are in China.

However, these days, few question that cigarettes kill. Nearly one of every five deaths in the United States is related to smoking, the American Cancer Society says. They kill more Americans than alcohol, car accidents, suicide, AIDS, homicide and illegal drugs combined.

The Smokeout, sponsored by the Cancer Society since 1976, is the annual event in which health officials and cancer-prevention groups encourage smokers to quit for at least one day, hoping that it might challenge them to stop permanently.

"The single most important thing you can do to reduce your risk of cancer -- by 33 percent -- is to stop smoking," said Alexandra Vukoder of the Cancer Society's office in Cleveland. "We are all hoping for the day, even if it seems far off, when smoking is no longer an issue."

Clearly, we're no longer the nation where not so long ago there were cigarette lighters in every car, ashtrays on every restaurant table and where smokers were expected -- welcomed, even -- on airplanes, in hospitals and in schools.

No, we're now almost completely a culture where cigarette, cigar and pipe smokers are just no longer accepted. There's actually a Facebook page titled "I hold my breath when I see a smoker come near me." More than 30,000 people have clicked on the "like" button.

And frankly, the smokers among us aren't really even among us -- at least not publicly. They're on the fringes in Ohio and many other states.

This, not even a half-century from the time when cigarette smoke hung in the air inside any office building or business. And no wonder: Cigarettes were cheap at 46 cents a pack.

Ask anyone of the smoking generations about their first job and they'll often as not tell you stories of how workers smoked at their desks in the early days of haze. Or watch an old movie. Heck, even Santa Claus turns in for the night in a smoke-filled room in the original "Miracle on 34th Street."

Now, smokers have to pay more than 10 times what their parents paid for the same pack of cigarettes. They're left to cluster in their own hazy, leperlike colonies several hundred feet from the door of most buildings.

"There's no doubt that there's a lot of stigma attached to using tobacco products now," Vukoder said. "Even so, the smoking rate in Ohio is still 23 percent, and we'd be satisfied for the Great American Smokeout if we can get a few of those to commit to give up smoking."

Vukoder's modest expectations for incremental gain in the long-running war against a product some 5,000 years old shouldn't be surprising.

"I call the Great American Smokeout a 'rehearsal,' " said Iyaad M. Hasan, a certified nurse practitioner and director of the Tobacco Treatment Center at the Cleveland Clinic Wellness Institute. "It's not easy to quit, but if we can get people to look at their life without tobacco for one day, maybe we can help them."

The worst thing to happen to smokers might seem like exile as communities and companies consider even more-restrictive rules for tobacco users. The Cleveland Clinic's recent decision to rescind job offers for applicants who test positive for nicotine is an example.

But the best thing to happen in the last decade or so is that real help is available, Hasan said. That's the real difference today, not that smokers are isolated.

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"The culture change came first, but when the Smokeout began 35 years ago, smokers didn't have the choices for cessation treatment they have today," Hasan said. "It's no longer just 'cold turkey and good luck.' There's even the chance of a vaccine down the road."

A vaccine? Certainly that could be the most deadly development yet for tobacco -- ashes to ashes, in the end?

Not likely.

"We've seen a lot of attempts through the years to stop people from doing something that they enjoy doing, but as long as there is a market for something, someone is going to produce it," Roger Quarles, president of the International Tobacco Growers Association, said by telephone Wednesday.

Quarles was in Uruguay to meet with officials from the World Health Organization about proposed restrictions on tobacco additives for flavored cigarettes and cigars.

"I think even health folks realize that even though they've put smokers outside and they're going to put more graphic warnings on the labels, that people will do what they want to do in free countries," Quarles said.

He said that even though U.S. percentages have dropped from 34 percent to 21 percent since 1978, population growth has meant that there are just as many smokers as ever.

"They've made smoking more inconvenient for people, but I don't see smoking going anywhere."

Of course, no one would be surprised to hear a leading tobacco advocate say that.

But Hasan and Vukoder also cautiously admit they face a still-strong opponent that may never be eliminated -- even with the declining percentages and the clear changes toward an anti-smoking culture 3 1/2 decades since the first Smokeout.

"Tobacco is hooked up to so many mental, habitual and emotional links that it's very hard for people to see there's hope to get past it," Hasan said. "We know there is, but they can't always see they're being controlled by it."

Vukoder agreed and said that as long as smoking is still cool for teens (and until recently as long as tobacco companies could market mint chocolate chip flavored cigarettes and the like) and legal, people will still choose to smoke.

"Here's the bottom line, though: We care about smokers or we wouldn't do these things," she said. "The world has changed a lot over the last 35 years and it may seem like smokers are the enemy, but they're not.

"We're the ones trying to help smokers -- and everyone around them -- from the effects of the smoke that can kill them."

Computer-assisted reporting editor Rich Exner contributed to this story.

To reach this Plain Dealer reporter: mscott@plaind.com, 216-999-4148