Tobacco Documents Online

November 21, 1972 MEMORANDUM TO: W. T. Hoyt CC: Henry Ramm Dr. R. C. Hockett FROM: Leonard S. Zahn W. Kloepfers Jr. SUBJECT: American Public Health Association, Atlantic City, N.J. Nov. 12-16, 1972 There was a considerable amount of anti-smoking activity at the APHA.meeting, both organizational and in individual pre- sentations.,APHA's Srhoking.)arid;;Health Project conducted a 5- day stop smokiaag program; there also was a Smoking and Health Desk in the registration area to provide literature and informa- tion. There was a good turnout of writers but press attention to smoking was minimal, at least in the general press, because most of the material was non-sensational or old. However, we may see further pickup in some of the medical and paramedical journals. 1. The APHA Membership Smoking Survey convened five speak- ers to report on the survey conducted by the organization. It was a 2Y2-hour session and the audience never totaled more than 30-35 persons. A. "Methodology and study background" -- Raymond Nelson, Chilton Research Services, Philadelphia. Every fifth APHA mem- ber was sent a mail questionnaire -- 5500 and 3747 responded. There were 1795 non-respondents and 350 were interviewed by telephone in a manner to represent all non-respondents. B. "Smoking characteristics of APHA members" -- John Mul- doon, Daytona Beach, Fla. This included age, sex, marital sta- tus, smoking habits, etc. Comparing present cigarette smoking to a year ago: 66% smoke about the same amount, 10% smoke more and 20% smoke less. "These figures should be somewhat depress- ing to a public health educator." Other data were included a- bout those who stopped, expected or hoped to stop, etc. C. "Analysis of attitudes expressed in the sia'r..vey" -- Dorothy Green, Bethesda, Md. (National Clearinghouse). In one part of the questionnaire, respondents were asked to reply to 15 statements on smoking. There were four "answers" to each ranging from Strongly Agree to Strongly Disagree. In general, members viewed smoking as an important problem in which they have some responsibility for taking action. Smokers are more reluctant to do anything than are nonsmokers. Those who have stopped are more optimistic than those who have been unable to quit;,current smokers believe it is futile to try to do any- thi.n about the problem. eona ahn PUBUC RELATIONS COUNSEL andAssociates,lnc. P. 0. BOX 523 • 13 LINCOLN ROAD • GREAT NECK, N.Y. 11021 •(212) 895-7445

2. D. "The relationship of membership responses to health re- lated facts in the survey" -- Leonard Schuman, Minneapolis (a member of the Surgeon General's 1964 committee). He discussed the responses to the opinion questions on the relationship of smok- ing to various diseases. He prefaced virtually every section by referring to the data reported by the Surgeon General and/or others. In substance, he was sorely disappointed at the general failure of members to find overwhelmingly that smoking was re- lated in a causal manner to many diseases. He blamed this on "deficiencies in information among professional groups." He did note that a "high score" in fixing the blame on cigarettes came from members of the APHA's Epidemiology Section. This was an ex- pected result and conforms with the current judgment of the sci- entific community. E. "Smoking control -- the challenge to public health work- ers" -- Daniel Horn.y. Bethesda. Since 1964 there have been many changes in beliefs about and attitudes toward cigarette smoking. There were 49-million adult smokers in 1966. In the next four years more than 60/ tried to stop and more than a third did suc- ceed -- over .10-million. There was an increase of 8-million in the adult population during the four years, leaving a net re- duction of 4.5-million in the number of cigarette smokers. But since then the sharp reduction in smoking has leveled off and the total number of smokers has increased along with the in- creasing population. Now, however, the problem is of a different character than existed five or six years ago. Nearly half the smokers in 1966 had little concern about the health effects of smoking and did not consider quitting. By 1970 this proportion had dropped to less than 20% and may now be as low as onefout of six. Also, about 20% of the 1966 smokers had considered quitting but never actually tried. By 1970 this group had increased to become one- third of the smoking population. A third group of 1966 smokers were those who had tried to stop at least once without success. Formerly a third of the smoking population, they now constitute over a half. This group is now split about 50-50 between those whose problem is stopping and those whose problem is staying off cigarettes. From 1968 to 1970 there was "a tremendous onslaught of mass communications on the effect of cigarette smoking on health." If the present problem no longer is to convince people of the adverse effects but that they should do something +positiue, then health workers must become more involved. We need to ls:n.ow more in the stop-smoking area but even with the "gaps in knowledge," we know more than we are using. It's unlikely further inroads into the problem will be made without the aid of health profes- sionals.

3 2. The APHA Governing Council adopted a resolution on small cigars which called them as potentially harmful as cigarettes. The resolution deplored advertising of small cigars as violating the broadcast ban on cigarettes and urged Congress and govern- mental agencies to consider steps to eliminate the advertising and tax advantages of the small cigars. Interestingly, the Governing Council returned for revision a "Position Paper" on "The local health department -- services and responsibilities" that contained this paragraph: "Chronic disease control and medical rehabilitation -- This activity should aim at the development of methods for prevention, detection, treatment, and rehabilita- tion in heart disease, cancer, diabetes, arthritis, neurological and sensory disease, including stroke and kidney disease. In the light of data now available, it is clear that an active program aimed at the re- duction of the number of cigarette smokers, and mini- mizing the numbers of new smokers, should be a part of each local health program." No reason was given for the action and the paper may come up again next year. Of course, APHA is undergoing a serious financial crisis and the Council spent most of its time debat- ing a budget for the coming year. Also of interest is the fact that the Western Branch of APHA (there is also a Southern Branch) had submitted a lengthy paper dealing with smoking and health. This never came to the floor of the Council. 3. E. Cuyler Hammond of the American Cancer Society re- ceived the second annual Edward W. Browning Achievement Award, awarded by APHA for the New York Community Trust, to recognize an individual for "excellence in the practice of public health in the rendering and delivery of services related to prevent- ion of disease, the prolongation of life, and attainment of health." The citation noted that Hammond's work in "elucidat- ing the cause-effect relationship between smoking and cancer is reflected in Congressional action which required the health warning on cigarette packages and the banning of their advert- ising from television." With the award went a $5,000 check. Hammond was co-author of a paper with Iriving Selikoff on "Epidemiological perspectives in environmental cancer research." This was a re-hash of their work in occupational cancer, includ- ing asbestos workers, roofers, etc. Complementing this work is the one-million persons study begun many years ago by the ACS. 4. President's Committee on Health Education. This was cre- ated in September 1971 by President Nixon to find ways to de- velop a sense of health consumer citizenship and to determine

4. the different kinds of health education needs of each major population group, such as ghetto residents, mothers, youths, and the aged. Fact-finding hearings were held last January in several cities, and some committee members were at APHA to present con- clusions and recommendations. However, such was not the case. Several of the members, at a press conference, said they could not really disclose anything until they had met with the President. They expect to do so in December. Victor Weingarten, president of the Institute of Public Affairs, New York, said there is no single.,:focus, in or out of government, on the major causes of sickness and death which can be affected by individual behavior. Health education is neg- lected, under-financed and fragmented. There are no long-range objectives. "Packaged" information lack relevance and has no pre-testing. There seems to be more concern in meeting the needs of the providers of information than those of the consumer. (The press conference was wide-ranging with committee mem- bers responding to questions with comments that apparently did not fall within the scope of their committee responsibilities. Some examples follow.) Irving Shapiro, Ph.D., director of health education, Health Insurance Plan of Greater New York. In response to a question a- bout the ACSt smoking-health program: it's probably both educa- tional and informative. Where local educators work with the ACS, itts educational; where there's a broad dispersal of facts, itts informative. Yet very few people can name four of the seven danger signs. Most smokers know the harm of smoking but have a terrible time trying to stop. Weingarten -- discussing cost-effect studies involving auto seat and shoulder belts: Let's extend this idea to smoking. What should be done when statistics indicate more people are start- ing to smoke than are stopping? The hazards may be clearly es- tablished but therets no clear way to determine motivation. It is essential to find out about motivation and behavior. Shapiro (picking up on the above): A problem is created when people stop smoking and begin to gain weight. We need to learn more about attitudes and behavior in order to effect great- er persistence over a longer period of time. Weingarten (later): it's hard to tell a 15-year-old kid that if he starts to smoke heFll get lung cancer at 55 or 60. But sick people in a hospital tend to listen "better." With the exception of pediatricians and obstetrician-gynecologists, doc- tors have too little time, training and incentive to informa and educate their patients. Also present were Clarence E. Pearson, director for ad- ministration and planning, health and welfare, Metropolitan Life Insurance Co., New York, and Scott Simonds, Dr. PH, professor of

5- health education, University of Michigan School of Public Health. 5. "Lung cancer mortality of uranium miners in relation to cigarette smoking, age and radiation exposure, October 1960 through September 1968" -- Frank Lundin, Jr., Bethesda. Study population was 3366 white uranium miners followed for a 10- year period ending Sept. 30, 1960. Mortality was available through September 1968. Two major findings related to cigarette smoking: light and heavy smokers had about the same level of radiation lung cancer, and nonsmokers had a much. lower level of radiation lung cancer. These findings, when considered with earlier (pub- lished data) are consistentwith two hypotheses: lung cancers were initiated by radiation independent of any cancers initiated by cigarette smoking, and cigarette smoking promoted the develop- ment of the lung cancers initiated by radiation. Heavy smoking seems to initiate many more lung cancers than does light smoking, but both have a powerful promoting effect on cancers initiated by radiation. If smoking acts as a cancer- promoter, as this study strongly suggests, one would expect the latency period for nonsmokers would be longer than for smokers. Lung cancer is now becoming "prominent" among Indians in the study who smoked very little. 6. "Relation of alcohol and tobacco to cancer of the mouth and pharynx" -- Win YtuitLee, New York. The study was undertaken to test the previous (published by Keller and Terris, 1965) findings that heavy alcohol use and heavy smoking are independ- ently related to cancer,of the mouth and pharynx. Using a some- what different approach than that of Keller and Terris, the present study confirmed the previous finding. However, it failed to replicate another finding of the previous study -- that the association of mouth and.pharynx cancer with tobacco use is in- dependent of alcohol consumption. Further work is planned in order to answer questions raised. 7. "Fetal, infant and maternal mortality during periods of economic instability" -- M. H. Brenner, Baltimore, Md. In- creases in U.S. infant mortality correspond directly to periods of economic decline, however small. Data on vital statistics and economic conditions from 1915 to 1968 show that infant mortality increases in direct proportion to unemployment. There is a con- stant relationship between deaths and economic decline when ex- amining fetal deaths, deaths occurring up to one day of age, one month, and one year. The relationship is evidence even dur- ing short periods of economic distress. There are time lags between economic downturns and the on- set of increased mortality. For example, rises in fetal deaths and deaths of infants less than one day old occur within one year after an economic downturn. Increases in mortality of infants less than one year old occur from three to five years after the

6. economic decline. Lack of prenatal care, the physical and emotion- al state of the mother, alterations in her diet, excessive smok- ing, and hypertension may contribute to a child's death in the first day. (He was citing other work for most of these factors.) After the first month of life, an infantfs death is more likely to be caused by environmental factors such as accidents, infect- ions and respiratory and digestive diseases. All these factors may result from economic stress -- unemployment might make it impossible for a family to afford routine maternal and infant care. -0- A great many abstracts and texts, including papers for the above items, have been obtained for the CTR library. L.S.Z. LSZ:hg