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NCAB -RECOMMEtJDA1TIGNS FOR FEDERAL-GOVERNME!'vT RELiULHItUR ur NfAXI[~;~t q~;~tq CIGARETTE YIELDS OF NOX°IIDUS SMOKE G0:'1PONENTS APPROVED AT THE NOVEMBER 19, 1974 MEETING WHEREAS: 1. A very low incidence-of primary lung cancer is observed i-n - non-smokers-, but the overwhelming majority of the nearly 80,000 current annual deaths in the United States alone is observed among habitUal cigarette smokers. A dose-response relation-ship between the number of cigarettes smoked and .-incidence of cancer of the lung has been established beyond -doubt by numerous epidemiological studies in man. (Notable examples are: A study by Hammond-and Horn - see Appendix-l- Reference=4l-1 - where, compared to non-smokers, the risk of dying of lung cancer is eight times more for- habTtue.l-smdkers of-lass than 10 cigarettes a day; >-0.5 times for 10 to 20 cigarettes, and 23.4-times for_smokers af over 20 cigarettes daily. Similarly, Doll and Hill - see Ap-pendirx 1-- Reference #4 - found that in Englan4_-the- same risk is 18.4.time; -higher for ha-b+tual_smokerd of 1 to i4 cigarettes daily, 19.86 times for 15 to 24 cigarettes, and 23.43 times higher for smokers of over 25 cigarettes daily. The_differences among t-hese and other studies are to be found in the different populations-studied,- different cigarettes consumed and different survey times, but a similar dose-response trend is conf"irmed by the scientific evider.ce available, as summarized and highlighted in Appendix 1.) -2. Carcinoma of the larynx and oral cavity, and certain respiratory and cardiovascular diseases also have shown- a dose-response relationship with smoking of cigarettes_, and evidence for less-pronounced cigarette smoking dependence has also been found for cancer of the esophagus, of the-bladder, of the pancreas, and other forms of disease. (See Appendix 1) 3. Epidemiological studies in ex-smokers indicate-that a diminution of risk of lung cancer takes place- after cessation of the habit, and cantTnues to diminish with time.

(2) (A notable examp°l e of evi dence i s-the study by Gol l and Hill = see Appendix 1 Reference #4 s- where, compared to non-smokers, the risk of-dying of lung cancer for - continuing smokers is 18.29 times, decreasing to 9.57 -times for those that have quit smoking for over 5 years, 7 times for those between 7 and 9 years_, 2.57 times= between 10 and 20 years and 2.75_iimes for over 20- years afte_r-cesfation,of smoking. =0ther pertinent references ate given in Appendix 2.) Toxi c components are found i n both -the condensate and- - the gas ---phase ofeigarette smoke. But the primary sources of toxicity-so far identified are tar and nicotine and-probabiy carbon mondxide-, nitrogen oxides and hydrogen cyanide. (See Appendix 3) - 5. The experience -o-f the- 1ast- 20-years indicates 'that the -_cpnsumer -c-an be accustomed to the--use of- mi 1 der -ci garettes without causing appreciable ma-rketing- changes. Tne- sales-weight-ed approximate average cigarette yield of- commercia_l cigarettes markeied-in the United--States- doring 1, 973 was-19.2 mil.ligrams-of tar and 1.3 milligrams of-nicotine (FTC standards), reflecting current consumer demano-and acceptability. Nowever-several popular brands are still being marketed with tar content-of 28 to 30.5 milligrams and nicotine content-as high as 2.2 milligrams according to FTC reports. (See Appendix 4) THEREFORE: The NCAB recommends legislative_and/or-regulatory action by the Federal Government as follows: 1. A Government agency should be empowered to-set-maximum cigarette-levels of tar and nicotine that will become progressively lower than the 1973 averages of 19.2 milligrams and 1.3 milligrams respectivety.- Such decreases should be undertaken slowly enough to insure that no important increase in the number of cigarettes consumed does occur. These actions should insure that a range of cigarettes including some with very low tar and nicotine contents continue to be available.

( 3 ) 2. Because smoking has a severe impact on oardiovascular and respiratory di_seases,-the Government agenoy empoKered to regulate ~naxirr~um emission of undesirable smoke components should get appropriate teehrical_advice=from the National Heart_and Lung Instltute. 3. Pending the accomplishmer,t of the foregoing recommendations through changes in the existing law, the President of the United ~tates might-consider making a public-personal appeal to the to~acco and ci-garei:te industry for=voluntary, and- rapi d_ effort towards preferenti al marketi ng of l ew- tar and l ow ni co-ti ne ci garettes , and towards reducti on of other smoke- components that_ may be recogoi zed- as _-hazard-ods . 4. The pubb - c must _be i nfprmed =that -there- i s currentl y- no known_-formula for a safe cigarette-, and that the restrictions here su-ggasted are likely to produce, out-carirot guarantee a reduct,-on of hazards from smoking. For health protection, the safes"I., course i s not to smoke. at a l l.= It is parti ci~l arly important that education-in the schools fie continued and improved to prevent_future generations from acquiring smoking-related diseases. In making these recommendations the NCAB also recognizes that total cigarette banning in the current cultural, economic and political setting is impractical. The regulatior of maximum yields of noxious cigarette components in a gradual way would permit the cigarette industry a reasonable time for utilization and modification of existing inventories, and development of less hazardous products. The NCAB also notes that other factors, notably asbestos inhalation and urani:um mini-ng conditions, have been shown to increase the susceptibility of cigarette smokers to lung cancer. I