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WORKING DRAFT hCAB RECO'-1~•1Et•,OATIONS FOR FEDERAL COVE-RNr1EN T REGULATION OF MAXIMUh1 CIGARETTE i IEEOS OF NOXIOUB SMOKE COMPONENTS _ WHEREAS: 1. - A-very low i nci dence of pri ma r y- l unc3 cancer i s observed _i.n non-smokers, bu t the overvrhel ~:i ng major : ty of the- r.earl y ~l , r sF_~r,.e among ab Iua ~`` 80,000 e.~t rent annual °"r_~ s% --r`w -s is co ~ . ci garet+e s~r~ekers . The dose-respen~e re i ati-onshi p bet~~reQn-~''"f the number -ef ci garettes smoke-d and i nc-i denca of cancer of the l ung`- has been es tabl i shed beyond doubt by -numerous c'.pi demio1^g'. c? l s±Ld ies 1 n :ran. (Notable-examrles are: A stud~ by Hammond and ltorn ~ see Appendix- I Reference fl1 -iifhere, compared to non-smokers, the ri&k-_of dying-of lung cancer is eight times.more for habitual smokers of lo-ss than 10 cigarettes a day, 10.5 times for 10 to 20- ci gzrettes , and 23.4 times for_ s=miokers of over 20 ci garpttes dai ly. Sim i l ar-ly, -Dol l- and Ha l l- see Appendix 1 Reference #4 - found that in England-the same risk is 18.4 times higher for habitual smokers of 1 to-14 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-these 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 confirmed by the -scientific evidence 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 t6kes place after cessation of the habit, and continues to diminish with- time. I f

(A notable example of evidence is the study by Doll and Hi l l--'see Append ix 1:_RefQre=nce p4 - where, compared -to- non-smokers-, -trie ri sk- of dyi-ng of lung _ cancer f-or- - eontinuin~ 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-i0 and 20 years and 2.75 times for over 20 years after cessation of smoking.- Other pertinent references_= are given in Appendix 2. ) 4. Toxic components are found in both the-condensate and- the gas phase of cigarette smoke.- But the_primary - sources of texicity so far-identified are tar and nicotine and probably carbon monoxide, nitrogen oxides and hydrogen- cyanide.= - (See, Appendix .33) 5. The experience of-the last 20 years indicates that the- consumer -c.an be accustomed to the bse -o€ m i l der ci gare ttes without causing appreciable marketing changes. The sales-weighted approximate average cigarette yield of commercial-cigarettes marketed in_ the United States during 1973 was 19. 2 mi 11 i gr-ams of tar and 1. 3 m i 11 ; grams -of nicotine kFTC standards), reflecting current consumer demand and acceptab~lity. Ho~aever several popular brands - are still being marketed with tar content of 23 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 tharn the 1973 averages of 19.2 milli- grams and 1.3 milligrams respectively. Such decreases should be undertaken slowly enough to insure that no important increase in number of cigarettes consumed does occur. These actions should irsure that a range of cigarcttes including some with very low tar and nicotine contents continue-to be available:

(3) 2. Because smoking -has a=severe impact or. card i ovascAil ar and -respi ratory , diseases, the Goverrment- agencyempotivered to _ - regulate_-maximuq, emiss ibn of undesirable smokz- components -_should- g_et. appropriate techrricaL advice from -the- National tleart and Lung Institute. 3. --Pending the accomplishment of the-foregoing recommendations through changes in t!ie existing law, the President of the United States oight consider making a public personal appeal to the tobacco and ciaarette industry for voluntary, and rapid effort towards preferential marketing of low tar and low nicotine cigar-ettes, and towards reduction of other smoke components that may be recognized_as -hazardous.- - 4. The public must be informed that there is currently no known formula for a safe cigarette, and_that the restrictions hFere - suggested_are l i kely to prcduce s- but--cannot guarantee a reduction of hazards rrom smoking. For hQalth protection, the safest_course is not to smoke at all-. -It is particularly importan-t that- education in the schools be 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 regulation of maximum yields of noxious cigarette_ components in- a gradual way would permit the cigarette industry a reasonable time for utilizat-on and modification of existing inventories, and development-of less hazardous products.

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