Surgeon General C. Everett Koop produced a significant report detailing the addictive properties of nicotine, highlighting its severity by comparing it to substances such as heroin and cocaine. As a prominent public health figure, Koop used this report to cement his legacy of advocating for life-saving health measures and anti-smoking campaigns. The release of this report was timely, occurring amidst a national anti-smoking movement partly spurred by the 1986 report, which warned about smoking-related illnesses. Specifically, Koop's findings underscored how nicotine acts on the brain, stimulating dopamine release and leading to a cycle of addiction resembling that caused by harder drugs. Koops used stark comparisons to drive public awareness and mobilize efforts towards more rigorous tobacco regulations.

The report was pivotal in shaping the discourse around smoking in America. During the 1980s, smoking had seen a face-lift in public perception; the glamorization of smoking was challenged by increasing studies linking it to significant health conditions, notably lung cancer, heart disease, and a myriad of other life-threatening diseases. Koop's call for stricter tobacco control began to resonate with both the public and lawmakers, pressing for stricter advertising regulations and labeling laws, culminating in the eventual passage of the Family Smoking Prevention and Tobacco Control Act in 2009, which granted the FDA the authority to regulate tobacco products.

Koop's report went beyond mere statistics; it was part of a larger movement toward comprehensive tobacco control strategies. This included smoking bans in public spaces, education campaigns in schools, and inclusion of nicotine addiction in medical curricula. As public health initiatives gained momentum, many began to view tobacco addiction through the same lens as other drug addictions, which forced a shift in both policy and perception surrounding smoking in America.