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! • . 1 DOCTORS AND SlSOKIIiC (IV) Th.ir Smokia= 1labits, Tbair Adviea to Fatien:s on thoking, and Tbair Vi.vs on tb: Cors.latien f.twaa Cisar.t:• Smokia; and Luaj Cancer and on RaaarscE Conducted Thereon A Study of T.iE tlA2:OtLlL TkfY3ICIAh'S' ADVISORY ?AfaL Conducted by T g L H L D I H L T L I C I 11 f T I T U T L Pr.sant.d Lxclusivaly to ltill 4 Ihovlton, sc. for tb. T0L1CC0 DtDL"STRY T.LSLAI4:B CCMSITTLC Dat• o! ftudyt Auruat 1939 Dat• of L.port: Octobas 1959 Li,,u.. . .. . . r: . X~;~.1: 1 W; : ROGERS C 1 R00217?E 5-y C~°R Hh~ 0~~~ ~ ~

THIS DC+CUMENT SUBIECT TO AUG. 20, l?i85 Nvil •DI~SE#VflrtA1I0N ORDER IN RDGERS AND DU tE CASES. IIiTRODUCTION The p.esent stucy ie che fourth of ita kind conductad by The ?fediretric Znatitute for The Tobc.:co I: wstry Research Co®ittaa. The Study, as those before, is based upon the t~rr.ional Physicians' Advisory Panel, a probaD!.lity aample of all gar.erc= -practit.ioners and part•time specialists under sixty•five in private practice in the United States. The present stuc'y was incorporated as part of the monthly " Trenda in Cencral Practice" survey for the month of August, 1959. The findings are based on the retu.-ns of 369 physicians which have beea statistically weighted so as to represent ae closely na possible the distributions that would have been obtained had a census been taken. Comparative data from April 1958 and March 1957 have been included wherever appropriate. t ROC,ERS C 1 R0021 777 CTR HN 028613

HA;ZDM IOLERAPICES 90% C.mfidence 1.*ve1 THIS DOCUMENT SUBIECT TO AUG. 20, 1985 Nvd•J,»E..iii+afiJN ORDER iN Rj.L,,., h-0 U:1,~E t;;6E.a Number of Tolerance* Phraitiaas Jtacponding percentagec of the Phyaiciane Aeapondina to the Queition to the _Quention 10 or 90 20 or 80 30 or 70 40 or 60 50 ' x z z •c ~ 1,000 ± 1.6 t2.1 t2.4 t2.5 t2.6 800 1.7 2.3 2.7 2.8 2.9 750 :.8 2.4 2.7 2.9 3.0 700 1.9 2.5 2.8 3.0 3.1 600 2.0 2.7 3.1 3.3 3.4 550 2.1 2.8 3.2 3.4 3.5 500 2.2 2.9 3.4 3.5 3.7 450 2.3 3.1 3.6 3.3 3.9 400 2.5 3.3 3.8 4.1 4.3 350 2.6 3.5 4.1 4.3 4.6 300 2.8 3.8 4.4 4.6 4.9 250 3.1 4.3 4.8 5.1 5.2 200 3.5 4.7 5.3 5.7 5.7 150 4.0 5.4 6.2 6.6 6.7 125 4.4 5.9 6.7 7.2 7.4 100 4.9 6.6 7.5 8.1 8.2 75 5.7 7.6 8.7 9.3 9.4 S0 7.0 9.3 10.7 11.4 11.6 25 10.0 13.2 15.1 16.1 16.5 * Tolerance is equal to the absolute error in percentage unitc. ROGERS ctR0021778 CTR HN O2-6614

THIS DOCUMENT SURIECT 70 AUG. 29, 1985 NuN-DiSSEM;i+At10N ORDER IN ROGER~ AND DJKE CASES 5Ui•:i1ARY Sr.olcinR Habits of hvsicians (lables 1- S) Slightly more than half the pbysiciaos were tmokers in August 1959. Almost the same percentage of physiciazs irc.'.icated that they were smokers in 1pri1 1958, bovever, in Marsb 195? tvo•tbirds of the pbysicisas were sm:cers M•1a 1). Oi the pby:;.'.ciane who do s©oke a).most tvo-thirds smc'•r3 or` c:gare:tes, thia was also troc in April 1958. In t:ai:b 1957 s:igutly more than two-t`sir3s of the ph5s:.ciezs smokcj ~, cigarettes. There does not seen to be any cbanp,e in rhs "t;pe" of smking done by physiciana in ougust 1959 vhec comoared vitb April 1958. Tae ratio of "cigarette only" scokers to "cigar only" smokers to "pipe only" smDke:s bas re:.a.ined the sa=e (Tab1= 2). Table 3 indicates tbt t there has been a decrease in the nuaber of physicians smoking tw , three, four and five pipefuls i.n l.uguat 1959 and an increase in t' sse smoking one and six-ten pipefu1s per day. The average nuaber of pipefuls bas increased to 6.1 in August 1959 compared to 5.0 in April 1958, the s,edian nuober has also increased from 3.8 to 6.1. ROGERS c T R0o21 779 CTR HN 026615

1::IS DDCU:.tENT SUf3tECT 10 t._,;, :G1985 HuN•DISSUAINANpH CRD,R lN RDGERS AND UKE CASES ii The average number of cigars saoked per day by physicians in August 1959 vaa 3.5, in April 1958 the average vaa 4.1 and to hirch 1957 the average vas 3.1 (:iD1e 4). Approximately tvo-thirds of the physicians vAo smoked cigarettes smoked one or s+ore packs per day. This was also true for the tvo other survey periods. In addition to the percentage of cigarette smokera remeining constant, the am»t smoked, on the average, has reraitted constant - slightly more than one pack per day (Table 5). Of the physicians who amoke, more than one-fifth have cut down on their smoking during t~.: past year and =re than one-tuarter have chaa~;ed to filter tips. In trying to compare this to the percentages obtained in April 1958 and March 1957 it muat be remembered that maay physicians vill not be able to remecber the date they changed to filter tips. As a result many physiciana who chasged to filter tips tvo yeara ago have probably answered the question a.ffirmatively craating an overlap of affirmative responses from the previous survey period (Table 6). ROGERS C t R00217s0 CTR HN 026616

TII!S DOCUMENT SU9fE:T 70 A;;G. 20, 1g85 NUN•D,3SEc,t,NATION ORDER IN.FOGERS AND UKE CASES iii Of the physicians who indicated that they did not smoke, alff,st the same number indicated that they had never been smokers aa those who specified that they had given vp swkins (Tahle 7). Approximately 50 percent of those who bad given it up did so within the past seven years and of thasa the largest group were soderate smokers. This compares very closely to the results obtained in April 1958 (Tables 8• 9). In this question definitions of :floder- ate, heavy and light were left to the respondents. However, for other purposes in this report a"beavy asoker" is defined u those who daily smoke more than one pack of ci8aretta , more than four cigars, or anre than six pipefuls; "moderate smoker" is one who smokes from one-half to one pack of cigar- ettes per day, three to four cigars, or five to six pipefuls; a"litht sanker" is one who smckss a half of a pack of cif ar- ettes or less, ona to t.o ciears, or four or less than four pipefuls per day. edvice on Smokins, (Tables 10 - 22) Pbysicians' advice to patients with variour conditiona in Au8.at 1959 was sinilar to the advice given in the last ROGERS E1 Roozi 7s1 CTR MN 01-R6 1'7`11

THIS DOCU'.1ENT _,: '-~ =I- 1985 MiN•DiSSEMiNATiON ORDEZ iN,g_OGER? AND UKE CAS:SV iv tw survey periods. There does not seem to be any significant shifts from the previous survey periods. I.n the "o" patient aad the "no answer" line there baa been a shift but this ia priIDarily due to a cbange in coditD4 procedu:es. Patients vitb cardiovascular and respiratory conditions are tivea advice on smokini more than those vith taatrointeetinal conditions. ApproximatelT three-fifths of the physicians in August 1959 adviaed a patient or patients vith a cardiovascular condition to give up smokl.nt and tw •tbirds of the pbysiciana Save this same advice to a patient or patienta with rnpiratory conditiona. Ona-half bave this advice to a pitiant or patient.a vit.h C.I. conditione. The advice to "cut down on smokiar' vu given by more than half the physicians to at leaat one cardio- vascular patieat. Tdia aLso holds trua for respiratory conditions. Tvo-filtba of the pbTaicians jave this advice to one or mnra patients vith a C.I. condition.. ?av pbrsiciana advised patients vith tneaa conditiona to cb.aaje to f ilter tip ciWettes, or to a pipe or cijar (Tablaa 10 - 13). ROGERS c t Roozi -18z 0 CTR ~N O*2-6616

i '~ DDCU"ENT SCP5!E:T TJ :.JG. :1 lbg5 Nv'i•DiS'jE!4iNATiDN ORDER IN RDuER~ AND DJ~E CASw v The heavy smoker physician jrvup, on the tvera=e, advise fever patienta to give up smoking than any othe r group. This group also is the eoat likely to advise patiente to change to filter tip cigc=ettes, or to a:pipe or cigar. bovever, cbaagin8 to a filter tip or to a pipe or cigar is not adviaed by maqy pbysiclacs (Tab:ea 14 - 17). One-tenth of the phytit iana have recomeeaded tmol•.in:~ a*: some tire and of t;3oce vho have, one-third are heavy Lmol.er;.. The heavier the phytician smolcer the more likely be is to have recocxnded bQOkiag to a patieot at some ti=e (Ta*1e 18). Approx:matei;, e.hree-fifths of the ph;Psicir-s :'ave aot changed tbeir recomme--sdatiotu to tbetr cardiera,culir patients concerning smektn,g during the paat year. Of tboee vhoae ad- Kce has csaaged, ainety-five perreat curtail s=king w2XI oftea vbi1e five percent evrtail amoki.4 jLg1 oftea (Taale 19). tbre than half the pbysiciaa+ have not eLaaged their aaokin8 to patianta with reepiratory eoaditiona dusinj the paat ysar. Of those vboae advice haa cbjegid alonat all bave aQv1s.A cartatltnlt smoktng .nrv often (Table 20). The ROGERS C 1 R0021 753 CTR HN 02"66 19-

i::IS DOCL'MENT S:VECT T1 RJ:,. 13, 1985 NUN-DISSE;dINATION ORDER lH OGERS AND DUKE CASES& vi freauency of recommendations to cardiovascular and respiratory patist• also holds trse for patients with sasr.:ointettinal conditions (Table 21). b nior~ On Cigstette Scnkint sr.c' Sour,ges„Qf Infozretion (T3Dlea 23 j(). Two-thirds of the physicians are of the opinion that "in the preseat state of knowledge, cigarette scoking can be considered only one of the several factors aasociated in the etiology of lung cancer." Of tseme fifcy-seven per- cent are oro1:ers and for r•-three aren't. Fou:teen percent of the physicians feel that the case for cigarette smoking is conclu:;ively proven - almost two-thirds of these are non- scokers. Of the thirteen percent of physicians who are of the opinion that "the caee againat cigarette tbking has not been conclusively proven` more than three-qus:ters are scokers (Table 23). rbre pnysicians place reliance on infora+tion concerning •anking and disease from the American Cancer bociety than lrom any other group. iiore than two-thirds of the physicians rated this aource u a good one. With the exception of "re- aearch cnnd•rr.-A 4n 1whoaav,rf.a of tobweco companiei" a11 ROGERC C T R0021784 C T R 1' 1 N 02 B G2 0

vii THIS DOC'htE';' SJ°IECi 1^ RU1;, ?01985 GRGER lN ROGER: :yJ D1KE CASES sources were rated higher in Augwt 1959 than tbey vere in April 1958. Almost thrae-fiftbs c•' the physicians feel that research conducted in laboratories of tobacco companies is a poor source an•' half feel that I:dependent research sup- ported by funls from the Tobacco Industry Research Comittee is a poor source (Tabla 24). Tvo•fiftho of the physicians rate "gasoline etoine and dieael exhauat• fuoes" u a very la,ortaat envircameatal factor to :iccu increared research attention on. Phyaicia:a feel that increased research is needed on most of the en•riroamental fectcrs (:able ;S). Approxicately seven•tenth-, of the pbysiciaaa feel that a combination of exogenoue and eadogc:ous fa:tors is cost important in ltag cancer causation. In t,pril, 1958, tvo- thirds of the physicians were of this opinion (Table 2:). ;2nclusion There is a close rel ationahip between the findinas in this study and the one of April 1958. This rel ationahip re- lat.s to tbs physiciaa's own smokinj babits, the nuaber of ROGERS C 1 R0021 7 55 C~9R HN O~'~~~ 1