Tobacco Documents Online

T E S T' I MI G IW: Y' OF ROBERT M. DAUGHERTY, JR'., M.D1., Ph.D. CHAI'RMAlW, SUBCOMMITTEE ON SMOKING AMERICAN HEART ASSa'CIATION', Before the SUBCOMMITTEE ONi HEALTH AN,D' SCIENTIFIC RESEARCH' COMMITTEE ON HUMAN R'ESOURCES, ~UNITED~ STATESIS~~EINATE~~ MAr' 25, 1978 '

-4- T3~., Evans RI; Smvk~i ng, i'nChil1 dren::~ Developing a So~~cia~l:-P~sycho~llogicall Strategy of Deterrence. J. Prev. Med. 5: 122-127, 1976.

Mr. Cha~i'rman~~ and members~~of~the~~ Subcommittee, my name~~ i~s~Robe~rt~M. Daugherty, Jr., M. D. ,, Ph. D. I' am presently the Dean, of the Medhlcal School at the Wni versi ty of Wyoming and Chai rman of the Subcommil ttee on Smoki ng of the American Heart Association. I appreci ate the. opportuni'l ty, to appear before thi's Subcornmi ttee on behail f of the American Heart Association to testify in support of the National Disease Preventi'on and Health Promotion Act of 1978'. As you may know, the American Heart Association is a non-profit voluntary health organizationi consisting of some 40,000 scientists, 65,000 other key members and some 2',000,000 citizen volunteers who are dedicated to the reduction of pre- mature death and~ dfsabili'ty -resulting from cardiovascular disease. Cigarette smoking has been helid responsiblie for many tfiousandtof prema- ture deathis each, year. Total mortality is twice as high among cigarette smokers as among nonsmokers. Many of these smokers die of coronary heart disease. In fact, cigarette smoking greatly increases an individual''s risk of developing cardiovagcul'ar disease. Since the first Surgeon General's Report on Smoking in 1964, the contri- bution: of cigarette smoking tothedevelopmentofhezrt, attack and coiro~-nary heart disease mortal'ity, has been forther confirmed and strengthened by addi!ti'onal epi'demioliogical, cl'ini cal' and anatomi cai' evidence (1-7). Cigarette smoki'ng, has now been fi rmly connected wi'th the onset of' peri- phet^al arteri al dy sease (2)1. Smoki ng i s a1 so the pri nci pal cause of both chronic bronchiti~~s'~, and'~ emphysema, di~sea~ses~ wh~ich, are~~ i~n, turn~ the~~ chief, causes of pulmonary heart disease and aggravate other types of heart disease. The risk of cardiovascular disease increases in proportion too the number of cigarettes smoked and the durationlof exposure to the habiit.- Thie effect of cigarette smoking on cardiovascuT ar disease risk is inde- p~enden~~t o~f' th~e~~ oth~~er~ maj~,o~~r~~ risk factors and the~ ri~~sk~~ i~s~ gre~atly, ~ aggravated w~h~en~ s~~uch~ faetors~ as~ hilg,h~ bloo~dJ press~ure~~,, high ~~ blood cho~iles~~teroll~~, o~r~ diiabe~~tes~~ are present. Such hi.gh risk persons who a]so, smoke place themselves in serious jeopardy Al though the smoker can reduce the heal th ri sks of smoking by srnaki'ng fewer ci garettes , switching° to fi l tered' l ow tar andi niicoti ne ci garettes , tak ing fewer puffs and not i nhal iing, the only sure way iis to abstai n from smoking enti rely. A shi ft to ci gar and pri pe smoki ng i s not effective if the former cigarette smoker continues to inhale (3I). In view of the evidence 1!inking cigarette smoking to cardiovascular disease w'hi'ch: I hav~esummarized for you~, the American, Heart Association appl'iauds you, Mr. Chairman, for introducing legisl atton, ai'med'l at reducing the healthi

I s consequences fr= cigarette smoking. Therefore, we support the following proposed Initiatives: The~ i:nst~itu~ti'on~ of~ a di'~~ffe~rential' federal taxon~ ci~ga~re~ttes~, according:1 to their tar and nicotine content. Since the current trend among smokers i s to purchase lower tar and ni coti ne ci garettes (12), such a system~ woulid not only aid smokers in, selecting a Iess hazardous cilgarette but would provide a, fi'nancial incentive for theml to do, so. Utililzingi the strongest possible statement regarding the health risks of s~mok~ing,~ consistent with scientffilc evidence, as~~ a wa~rn~inq labe~l~, to, be~ placed on c~~i~garettte~ pack~s~., Thi'~~s, couId~ include th~e~ "revo~lvi'ng~ label" which is being used in Sweden. 3'. Support for epidemiological studies to determn'ne the relati've risk associated with the varyinq l'evels of tar and nicotine and other.sub- stances commonly added to commerical'ly prepared cigarettes. Continued bli omedi cal research i s needed to gai n a better understanding of the mechantsm through whi ch ci garette smoki ng contri butes to the develop- ment of cardi ovascul ar di sease. 4. The establ'ishment of programs designed to deter smoking among chil'd'ren, and adol'escents. Since the onset of' smoki ng, speci'fi cal 1'y "experiimental, smoking", is occurring at increasinaly earlier ages (13),, this iini'ti- ati ve is right on target. As smoki ngi conti nues to declli ne in the adul t populati,on, there is a growth in the number of smokers among this rtationi''s youth, especially teenage girls. Therefore, we are parti- culiari1y pleased to see the special emphasis on preLteens and teen- agers. A revi'ew of the evi dence to date l ilnking cigarettes to coronary, heart disease, peripheral arterial, disease and chronilc obstructive pulmonary disease i ndiicates -that smoki ng is a major and preventabl e cause of' each of ' have beenimodest these di seases . Gai ns agai nst this man-made hazard considering the vigorous and effectiveactio~nsbei ng taken against other man-made envi ronmental' hazards, often based~ on less evi dence of' adversee heallth consequences. Effective action is clearly required. The American Heart Association stands ready to assist thi's Subcommittee and the Department of HeaIth, Education and Wel fare inyo~ureffarts to . improve the heal,th of' ttii s nation. Thank you.

REFERENCES. The Health Consequences of Smoki'ng,. U.S. Department of Health, Education and Welfare. PHS, CDC, US Government Printi ng Offi ce, 1975. ICamnell WB',ShurtleffD; The Framingham Study: Cigarettes and the Dev=el opment of Intermi ttent Cl audication. Geri atri cs~ 28:fi1-68', 1973', Feinlii'eb M, Williams RR; Relative Risks of Myocardiial' I!nfarctiion, Cardiovascul ar D'isease and' Peri pherial Vascul ar Disease by Type of Smoking. In Prviceedings of the 3'rd' Worlid Conference on Smo king and Healith, 1975, p.243. Hammond' EC, Horn D'; Smoking and Death Rates - Report on 44 Months of :ol'low-up of 187,783' Men:I. Total Mortality. JAMA, 1i66:1159-1I172, 1958!. II. Death Rates By Cause. pp. 1,294-1308. Kahn HA, The Dorn Study of Smoki ng and! M'ortal i'ty Among US Veterans . Report on 81-2years of Observatilon i n Epi'demiologi ca1 Study of Cancer and'~ Other Chronic Diseases. W. Haenszel, Edi. National Cancer Institute, Monograph 191: 11-12'5„ 1!966. 6. Doll R, H'i. l'i1 AB; Mo rtal i ty i n Re] ati o to Smoki ng : Ten Years Observati ons of' British Doctors. Brit. J. Med. 1:1399'-14'10;. 1460-1476, 1964. - 7.Proceediingsafthe 3rdWorT4 Conference~ on Smo(cingi and Healith,1975.uo!i. 1: Modifyi'ng the Risk for the Smoker. US Department of Health, ' Educati on and~ Wel fare. PHS, NIIH, (OHEWi Publ . No.(,NIH), 76-1221).. 8. Gordon T„ Kannel'l WB, McGee D; Death and! Coronary Attacks in Men After Giving up Cilgarette Smoking. Report from the Framingham Study. Lancet 2:1345-1353, 1974. 9'. Aronow WS, 1Capl an MA,, Jacob D;, Tobacco: A Preci pi tati ng Factor i n. Angina Pectoris. Ann. Pnterni. Med. 69:529-539, 1968. 101. Astrup P'„ Kjlel'dsen K, Wanstrup P'; Enhancing Influence of Carbon Monoxide oni the Development of Atheromatosi's in Cholesterol-fed Rabbilt§., J. ' 11. Atherosclerosz s Res. 7: 343~-354, 1967. OHEW' Pubil. (NIH~)~~ No~,.~ 74~-599'-1974.~ Shurtl eff D. Some Characteristiics Rel'ated to the Inci d'ence of C'ardi o- vascul~a~r~ Di~seas'~e, a~nd~~ De~ath~~: Th~e~~ F~ramingham~ Study, 18 Years Fo~llow-upi. 1I2'. A National Dilemmal. Cigarette Smoking or the H'ealth of Americans. Re~po~rt~ of~~ the National Commi~ssi.o~~n~, on S;noking~ and Public~ Pollicy~ to the Board of Directors, American Cancer Socilety, January 31, 1,978.