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TESTIMONY OF ROBERT M. DAUGHfRTY,, 1R:, M.D., Ph..D. CHAIRMAN SUBCOMMITTEE ON,SMOKING AMERICAN.HEART AS80CIATION Before the SUBCOMMITTEE ON HEALTH AND SCIENTIFIC RESEARCH COMMITTEE ON HUMAN RESOURCES . UNITED STATES SENATE MAY' 25, 1978

13. Evans RI; Smoki'ng in Children: Developing a Social-Psychollogicall Strategy of Deterrence. •J. Prew. Med. 5: 12'2-1'27„ 1976. 4.

C consequences from cigarette smoki.ng. Therefore, we support the following proposed initiatives: 1. The i'nstitution of a di~fferential': federal tax oni ci~g,arettes accordiing to their tar and nicotine content. Since the current trend among smokers is to purchase lower tar and nicotine cigarettes (12), such a system wouldi not only aid smokers in selecting a less hazardous cigarette but would provide a financial'. incentive for them to, do so. 2. Utilizing the strongest possible statement.regarding the health risks of smoking,,consistent with scientific evidence, as a warning label to be placed.on cigarette packs., This could include the "°revol,ving label""' which ilss being used in Sweden. 3.Support for epidemiolog,ilcal studiies.to determine the relative risks associated with the varying levels of tar and ni~cotine and other.sub- stances commonly added to commerically prepared.cigarettes. Continued biomedical research i's needed to gain a better undprstanding.of the mechanism through which cigarette,smoking contributes to the develop- ment of cardiovas.cular disease. 4. The establishment of programs. designedto deter smoking among children and adolescents. Since the onset of smoki'.ng,, specifically "experimental' smoking"', is occurring at increasina7y earlier ages (13), this initi- ative is right on target. As smoking continues to decline in the adult population, there is a growth. in the number of smokers am,ong this nation's youth, es~pecialily teenage girls. Therefore, we are partil- cularily pleased to see the special emphasis om pre-teens and teen- agers,. A revisw, of th.e evidence to date linkingici'garettesi to coronary heart disease„ peripheral arterial disease and chronic obstructive,pul~monary disease indicates that smoking is a major and preventable cause of each of these diseases. Gains against this man-made hazard have been modest consi'deriing the vilgorous and effective actions being taken against other man made environmental hazards, often based on less evidence of adverse health consequences. Effective actfon is cleariy required. The American Heart Association stands. ready to assiist this Subcommittee and the Department of Health, Education and Welfare in your efforts to improve the health of this nation. - - . 9. Thank you.

1'.. The Health Consequences of Smoking. U.S. Department of Health, Educati'on and Welfare. PHS, CDC, US Government Printing Office, 1975. 2. Kanneli WB',, Shurtleff D; The Framingtiam Study: Cigarettes and the Dev- elopment of Intermittent Claudication. Geriatrics 28:61-68, 1973. 3. Fei',nlieb M, Williams RR;, Relative Risks of Myocardial Infarction, Cardiovascullar Diseas.e and Peripherial Vascular Disease by Type of Smokin~g. In Proceedings of the 3rd Worl,d Conference on Smoking and, Health, 1975, .p.2,43. - 4. Hammond EC, Horn~ D; Smoking and Death Rates - Report on 44 Months of:ollow-up of 187,783 Men:I. Total, Mortality. JAMA„ 166:1159-1172, 1958. II. Death Rates. By Cause. pp., 1294-1i308'. 5. Kahn HA, The Do:rni Study ofSmoking and Mortality Ahiong, US Veterans., Report on 8ll years, of Observation in Epidemiologi'calStudy of Cancer and Other Chronic Diseases. W. Haenszel, Edl. National Cancer Institute, ; Monograph 19: 1-125, 1966. 6. Doll R, Hill AB; Mortality in Relation to Sinokingi: Ten Years Observations of British Doctors. Brit. Ji. Med. 1:1399-1410; 1460-1476, 1964. 7. Proceedings of the 3rd World!Conference on Smoking and Healtth, 1975. Vol. 1: Modifying the Risk for the Smoker. US Department of Health,. Education and Welfare. PHS,,NIH, (DHEW Publ. No.(NS.H). 76-1221). 8. Gordon T, Kannel' WB, McGee D; Death, and Coronary Attacks in Men After Giving up Cigarette Smoking. Report from,the Framingham Study. , Lancet 2':1345-1'353, 1974. 9'. Aronow WS, Kaplan MA', Jacob D:; Tobacco: A Precipitating Factor in Angina Pectoris. Ann. Intern. Med. 69:529-539,,1968. 10. Astrup P, Kjel:ldsen K, W'anstrup P; Enhanciing Influence of Carbon Mbnoxide on the Development of Atheromatosils in Chol'esterol-fed Rabbits. J. Atherosc]erosis Res. 7: 343-354,. 1967. . #6 11. Shurtlleff D. Some Characteristics Related to. the.Incidence of Cardio- vascular Disease and' Death; The Framingham,Study, 18 Years Fol'low-up.. DHEW Publ. (NIH.) No. 74-599-1974.. W 12. A National Dilemma: Cigarette Smoking or the Health of Americans., Report of the National Commission on S.noking and,Public Policy to ~ the Board ofDirectors, American Cancer Society, January 31, 1978. O, w

Mr. Chairman and' members of the Subcommfttee, my name is Robert M. Daugherty, Jr. , M.D., Ph.D. I am presently the Dean. of the Mediicall School at the University of Wyomingiand!Chairman of the Subcommittee on Smoking of the American Heart Association. Althoughi the smoker can reduce the health risks of smoking by smoking fewer cigarettes, switching, to filltered low tar and nicotine cilgareti:es., taking fewer puffs and not inhaling, the only sure way is to abstain from smokfng serious j'eopardy (11). chronic bronchitis and emphysema, diseases whilch are in turn the chi'ef causes of pulmonary heart,disease and aggravate other types of heart disease. The risk of'cardiovascul,ar di.sease increases in proportion to the number of cigarettes smoked and-the duration of exposure to the habit. The effect of cigarette smoking on cardi~ovascular disease risk i's inde- pendent of the other maj,or risk factors and; the risk is greatly aggravated when such: factors as high blood pressure, high.bloodicholesterol or di,abetes ,~ are present. Such hilgh risk persons who also smoke place themselves iln ` i pheral arterial disease (2)'. Smoking is also the principal cause of both American Heart Association is a non-profit voluntary health organization consisting of some 40',,000 scientists, 65,000 other key membersand some = 2,000,000 citizen volunteers who are dedicated to the reduction of pre- mature death, and disability resulting from cardiovascular disease. Cigarette smoking has been held,responsible for many thousandsof prema- ture deaths eacli,year. Total mortality is twice as high among cigarette smokers as among, nonsmokers., Many of these smokers d'ie of'coronary heart disease. In fact, cigarette smoking greatly increases an individual's risk of developing cardiovascular disease. Since the first Surgeon General's Report on Smoking in 1964, the contri- ; but:Aon of'cigarette smoking to the dlevelopment of'heart attack and coro- n:.~;~ ti_-:rt disease mortality has been further confirned and strengthened by additional' epidemiological, clinical and anatomical evi'dence (1-7). Cigarette smokiing has now been firmly connected with.th.e onset of peri- I appreciate the,opportunity to appear before this SubcomniiteQ o:n behalf' of the American Heart Association to testify in support of the National Disease Prevention and Health Promotion Act of 1978. As you may know, the entirely. A shift to ci'gar and pipe smoking i's not effective if the former cigarette smoker continues to inhale (3)., O In vi:ew of the evidence linking cigarette smoking to card5ovascutar disease o which I have summarized'r for you, the Ameri'can, Heart Association applauds 0 W you, Mr. Chairman, for introducing legislation aimed at reducing,the health W ° ~-