Tobacco Documents Online

DISEASE PREVENTION AND HEALTH PROMOTION ACT OF 1978 HEARIN GS BEFORE THE SUBCQMMITTEE' ON ~ HEALTH AND SCIENTIFIC RESEARCH OF THE COMMITTEE ON HUMAN RES'OURCES UNITED STATES SEI ATE NINETY-FIFTH CONGRESS SECOND SESSIOAT. ON S. 3115 TO ESTABLISH A COMPREHENSIVE DISEASE PREVENTION AND HEALTH PROMOTION PROGRAM INI THE UNITED STATES AND RELATED BILLS MAY 25 ; JUNE 7 AND 9, 1978 Printed for the use of the Committee on Human Resources U.S. GOVERNIVIE\T' PRI\TING OFFICE' 30-536 WASHINGTON : 1978

2 FORMULA GRANTS FOR PREVENTIVE HEALTH SERVICES SEC. 102. Effective October 1, 1979, title III is amended 3 byy adding after section 314 the following new section and 4 5 6 7 heading thereto: "FORbtULA GRANTS TO STATES FOR PREVENTIVE HEALTH SERVICES SEC. 315. (a) The Secretary shall make grants to s' States to assist them in planning for and in~ meeting the 9 oosts of providing (through such States and through grants 10 or contracts or both with public health authorities of political 11 subdivisions~ of the Stat'es, other public entities, or private 12 entities ) preventive health services. 13 "(b) No grant shall be made under subsection (a) 14 unless an application therefor has been submitted to, and 15 approved by, the Secretary. Such an application shall be in 16 such form and be submitted in such manner as the Secretary 17 shall by regulation prescribe and shall provide (other than 18 in an application for a planning grant) - 19 "(1) for a detailed plan of' a program designed to 20 reduce, through the primary or secondary prevention of 21 causative conditions, the mortality rates for one or more 22 of the five leading causes of' death in the State; 23 "(2) the amount of Federal, State, and other funds 24 obiigated by the State in its latest annuaL accounting

( Text of : S. 3115------------------ S. 3116------------------ S. 3118----------------- CHRONOIA COMMITTEE ON HUMAN RESOURCES HARRISON A. WILLIAMS, Js., New Jersey, Chairman JENNINGS RANDOLPH, West~ Virginia JACOB K. JAVITS, New York CLAIBORNE PELL, Rhode Island RICHARD S. SCHWEIKER, Pennsylvania EDWARD 1L KENNEDY, Massachusetts ROBERT T. STAFFORD,, Vermont' GAYLORD'NELSON, Wisconsin ORRIN G. HATCH, Utah THOMAS F. EAGLETON, Missouri JOHN II. CIIAFEE, Rhode Island ALAN CRANSTON, California S. I. HAYAKAWA, California WILLIAM D. HATHAWAY, Maine DONALD W. RIEGLE, JR., Michigan STEPHEN J... PARADISE, c3eneraL. CounselandStagDirector MARJORIE M. WHITTAKER, Chier, Clerk DON A.. ZIMMERMAN, MinorityCounael GaEaoRY Fusco, Minority Staff Director SUBCOMMITTEE ON HEALTH AND SCIENTIFIC! RESEARCH EDWARD M. KENNEDY, Massachusetts, Chairman CLAIBORNE' PELL, Rhode Island RICHARD S., SCHWEIKER, Pennsylvania GAYLORD NELSON; Wisconsin JACOB K. JAVITS, New York WILLIAM D: HATHAWAY,,bfaine JOHN H. CH'AFEE, Rhode Island HARRISON A. WILLIAMS, JR., New Jersey (ex o8'icio) LAWRENCE HOROWITZ,. ProJesaionalStaff Member DAVID WINSTON, Minority Counsel Ford, Hon. Wendell H., a U.S. Foege, William H.,, M.D., Dirt Kretchmer, M.D., Director, Human Development ; and and Health, Department of! «'olfe, Theresa and Moira I O'Malley, Mark Adams, an,~ School, and James Valeo, Be Evans, Richard I., Ph. D., prof~ Houston, Tex., accompanied Public Communications Cent president~, Green Dolmatch ALeffall, Lasalle D.,, Jr., M.D., accompanied by Donal& Youl ciety, and former medical dir M. Daugherty, Jr., M.D., Ph, American Heart Association ; chief counsel, Action on Smo, AIcGinnis, Michael, \LD., Deput: Health Initiatives, aecompan Cisntrol'; and Taylor Quinn, :ldministration ------------- I'ielding; Dr. Jonathan E., comi of JPassachusetts___-__-____- Steen, Lowell H., M.D., repres( accompanied by Harry N. Pe American Aiedical Associatiol Arno)d! Dr. Charles B., presid Medicine ------------------- Lazar, Dr. J. Brett, health office representing the National A~ Pulilic Health Association___ 1'.Irquhar, Dr. John W., profess( of Medirine_________________ Manoff, Richard K., chairman, -1Ianoff rnternational, Inc____ Hanneman, Gerhardi J., associat Schooli of Communications, U

1 2 3 4 5 6 7 8 19 20 21 22 23 24 6 3 period for the provision~ of eachi program described in paragraph (1); a description of the preventive health services provided'by Ghe State in each such program.in such period; the amount of Federal funds needed by the State to continue providing such services in each such program, if the State proposes changes in the provision of the: services in any such program, the priorities of such proposed changes; the reasons for such changes; and, the amount of Federal' funds needed by the Statee to make such changes; (3) for, at the option of' the State, a detailed' plan of a program designed to reduce, through the primary or secondary prevention of causative conditions, the bur- den of illness associated with~ the five leading causes of morbidity in the State ;. "'(4) the amount of Federal, State, and other funds obligated by the State in its, latest annual accounting, period' for the provision of each program described in paragraph (3) ; a, d'escriptioit of the: preventive health services provided by the State in each su& program in such period; the: amount of Federal funds needed by the State to continue providing such services in each such program; if the State proposes changes in the provision of the services in any such program, the priorities of such 1 2 3 5 6 7 8 9 10 11 12 13 14 proposed change: amount of F'edei such changes; " (5) that t and (3) - ta (A) ~, tion prograj cable, all re "(B) r program or particular a: /( (C) , relevant rai of'morbidit, 15 " (D). 16 reduction i~ 17: where app, 18 «(E) 19 tions com? 20~ 22 shall incluc how the cc tronic med~ poses of th( "(F).

8 I 2 3 5 tity in the~ State that will be responsible for ac- complishing through contracts with privateentities~ and other means the requirements of paragraph 4 (E) ; and 5 6 7 "(G) shall contain such other information as the Secretary may by regulation prescribe; "(6) for assurances satisfactory to the Secretary that the preventive health services which will be pro* vid'ed' withi funds under a grant under subsection (a) will be provided in a manner consistent with the State health plan in effect' under section 1524 (e) ; "'(7')for assurances satisfactory to the Secretary that the State will provide for such fiscal controll and fund' accounting procedures as the Secretary by regula- tion prescribes to assure the proper disbursement of and accounting for funds received under grants under sub- section (a) ; "(8) for assurances satisfactory to the Secretary that' t.he:State will make such reports (in such form and containing such information as the Secretary may by regulation prescribe) as the Secretary may rzasonaltly require and keep such records and afford such access thereto as the Secretary may find necessary to assure the correctness of, and~ to verify, such reports : c E " (9)' for assurancE that the State will con imposed by this section, " ° (10') for such ott may by regulation presc "' ( c ) (1) The Secretar} 1 2 3 4 5 6 7 ties undertaken by each St, under subsection (b) to d, grams are operating effecti 8 9 10 poses, and if the State comF with the application. The 11 application submitted undei tary determines- "'(A) that the pr effectively to achieve tl " (B) that the Str vid'ed with a prior ap 12 13 14 15 16 17 18 tion ('b ) , an& 19 20 21 "(C) that' he is ply with the assurant under consideration. "'(2) Whenever the 22 23 and opportunity for a heai 24 to funds paid to it under ; 25 the program or program~ 3U-36 (1i- -,8 - 2'

VIII Artieles, publications, et cetera-Continued Trends in U~rban Mortality in~ Relation to Fluoridation Status, by Eugene Rogot, A. Richey Sharrett, Dlanning,Feinleib, and Richard R. Fabsitz„lldational Heart, Lung, and Biood Institut'e, Bethesda,1Id., Page from the American, Journal of Epidemiology, February 1978L------- 484 Two Days in January, an explanation of the 300,000 deatll, statistics,, from the Tobacco Institute_____________________________________ 278 Communications to : Blumenthal, Dr. David, staff member, Subcommittee on Health and Scientific Research, from Wali~am DL Kane, executive director, Asso- ciation for the Advancement ofHealth Education, Washington, D.C., June 15, 1978-------------------------------------------------- 406 Califano, Hon. Joseph A. Jr., Secretary, Department of Health, Educa- tion, and Welfare, from Michael Pertschuk„Chairman, FederaLTrade Commission, Washington, D.C., May 24; 1978--------------------- 113 Kennedy, Hon. Edivard M., a U.S. Senator from the State of .iias- sachusetts, from : Biemiller, Andrew J., direchor, Department of Legislation, American Federation of Labor and Congress of Industrial pr- ganizat'ons, June 1, 1978----------------------------------- 405 Kornegay, Horace R., president'4 the Tobacco Institute, Wash- ington, D.C., July 12, 1978------------------- 239 Soloman, Joel W., Adiuinistrator, General Services Administration, from Hon. Joseph A. Califano;,Jr.,,Secretarg, Department of Health, Education, and Welfare, January 7, 1978_________________ Selected tables: --- 11G Carot'ene„Ascorbic Acid„Thiamine, Riboflavin,111iac'n; and Pantothenic Acid Contents of Selected Canned Foods, by the National Canners Association -------------------------- --------- 737 DISEASE PREVENTIC A( THIIRSE Si'BCO]r_IIITTEE O,_\ HE=1I:- OF' TIM C( The subcommittee met, pur. sen Senate Office Building, a nedy (chairman of the subcom Present: Senators Kennedy Committee staff present : Da J.D. majority staff; Davicj minority. Senator CtI AF"EE. Ladies an ing. Senator Kennedy is unal statement that I will insert in [The opening statement of OPF, NING STATEMENT 0 Senator KEV:vEDY. Today tific Research opens hearing: vention and Health, Promoti week with the cosponsorship lation proposes & series of pr, for the first time in its histor prevention of disease and tbi zens. Today's session, focuses ~ to cigarette: smoking,, and p:smoking among our children. Over the years this subcom of health issues, but none ha turbs me more deeply, than th of parents in this country- for one t.hing, above all other cal health will permit them beinb . For many American, parer hopes may never be realized. disease, but by an epidemic of From 1968 to 1974, there of 12 to 14 year old girls wh(

, byy d R. J1d., Page _ 484 ties, --- 278 and _sso- ).C., ---- 406 uca- -ade 4as- 113 enic ners 737 DISEASE PREVENTION AND HEALTH PRO'1I0TION ACT OF 1978 THURSDAY, MAY 25, 19"78 U.S. SE`ATE, StiBCO-MJCITTEF: ON HE:ILTII A\I) SCIENTIFIC RESE.IRCII OF THE CobIDiITTEE OY HUMAN RESOURCE3,, tiVash,ington, D.C. The subcommittee met, pursuant tocalli, in room, 4'232of the Dirk-sen Senate Office Building, at 10:14 a:m., Senator Edward AI. Ken- nedy (chairman of the subcommittee) presiding. Present : Senators Kennedy, Schweiker, an& Chafee: Committee staff present :David Blumenthal, M. D., Robert Wenger, .I.D. niajority.staft; David Winston and AIai•yFrances Lowe, minority. Senator CHAFEF. Ladies and gentlemen, we will now start our hear- ing. Senator Kennedy is~ unabieto be here until later on,,but he has a statement that I will insert in the record at this point. UThe opening, statement of Senator Kennedy follows :] OPENTIIrG STATEMENT OF SE\ATOR FiDNVARm M. KE.'v,NEDY Senator KExxEDY. Today the Subcommittee on Health and Scien- tific Research opens hearings on S. 3115, the \Tat'~ional Disease Pre- vention and Health Promotion Act of 1978; which I introduced last week with the cosponsorship of sev eral of my colleagues. This legis- lation proposes a series of prob ams which would provide our Nation for the first time in its history -with a comprehensive strategy for the prevention of disease and the promotion of health among our citi- zens. Today's session focuses on the provisions of S. 3115 which relate to cigarette smoking, and particularly, on provisions for d'eterring smoking;among our children. Over the years this subcommittee has heard testimony on hundredss of health issues, but none has more personal relevance to nae, or dis- turbs me more deeply, than the topic on which we focus today. liillions of parents in this country-and I count myself among them-wish for one thing above a1L others. They hope that their children's physi- cal health -will permit them to realize their full potential as human beings. For many American parents and'formanyof our c'hildreny those hopes may never be realized. They are endangered not by war or by disease, but byfln e.pid'emic of'another sort. From 1968to1'974, there was an eightfold increase in the number of 12 to 14 year old girls who smoke cigarettes. During that time, the 1! (1)

ure to r sub- it, the ts will -retion tisfied ?ly or satis- s dis- t. by a g for Sep- 'tary, 30:20 State: ntive d by atloll Sep- it of 1 2 7 20 21 22 23 24 25 1,1 8 Stat'e and local expenditures for preventive health services supported by grants under subsection (a)' within the State in the State's fiscal' year which ended on or before July 1, 198'1; in the case of' the fiscal, year ending September 30, 1983, 7~ per centum of the amount of such, expenditures in the State's fiscal year which ended on or bef'ore July 1, 1982; and, in the case of the fiscal year ending Sep- tember 30, 1984, 10 per centum of the amount of such expenditures in. the State's fiscall year which ended on or before July 1, 1983; and "(B) may not be less than the prodnct of $0.50 and the population of, the State. "(3) The total, amount of grants received by a State under subsection (a) to assist'~ States in meeting the costs of operating the health communications component of their preventive health services programs for any fiscal year shall be determined by the Secretary, except that it may not be less thaa the product of $0.10 and the population of the State. Notwithstanding paragraphs (1) , (2), and (3) , if for any fiscal year the amount appropriated for that fiscal year under subsection (1) is less than the amount needed to make grants for that fiscal year ini accordance witlu sucIi paragraphs to all States, the total amount of grants for that fiscal year for a State: shall not be less~ thani an amount which

9 tor ac- 2ntities igraph ion as retary e pro- will will health, retary 4 and :~gula- )f and ' sub- etary :1 and y by ialily ccess t'1ie C 6 1 "(9) for assurances satisfactory totheSecret'ary2 that the State will comply with any other conditions g imposed by this section with respect to grants ; and! 4 (10) for such other information as the Secretary 5 may by regulation prescribe. g "(c) (1) The Secretary shall review annually the activi- 7 ties undertaken by each State with an approved application 8 under subsection (b) to determine if the program or pro- 9 grams are operating effectively to achieve their stated pur- 10 poses, and if the State complied with the assurances provided 11 with the application, The Secretary shall not approve an 12 application submitted under subsection (b)' unless the Secre- 13 tary determines- 14 "(A) that the program or programs are operating, 15 effectively to achieve their state& purposes, 16 "(B) that' the State complied with assurances pro- 17 vided with a prior application submitted; under subsec- 18 tion (b) , and 19 "(C) that he is assured that the State wiII com- 20 ply with the assurances provided with the application 21 under consideration. 22 "(2) Whenever the Secretary, after reasonable notice 23 and opportunity for a hearing to the State, finds wit'h respect 24 to funds paid to it under a grant under subsection (a),, that 25 the program or programs are nit operojZg-*ctivelg to 9©-aa6 0 - 7. N -_ O W ~ © Cn Cj N

7 lescribed in itive health program in Aed by the each such e provision ,riorities of' i changes;. . the State bailed plan e primary , the bur- causes of :her fun& ecounting -cribed in ti-e health ogram in 'd bv the N'h such r,rovi.ion ~ Of snch 4 1 proposed changes; the reasons for such changes; and„ the 2 amount of Federal funds need'e& by the State to make g such changes; 4 "'(5) that the plans described in paragraphs (1). 5 and (3)- g "' ('A ) shall describe a comprehensive preven- q tion program which utilizes, to the extent practi- 8 9 10 11 12 13 14 15 16 17 18 19: ' 20 ft I'. cable, all relevant professional disciplines; "(B) may, at the option of the. State, describe a program or programs that are targeted toward's a particular age group ; "(C) shall set forth quantitatively the current relevant rates of mortality andy where appropriate, of morbidity in the State; "(D) shall set forth the quantitative goals for reduction in the relevant rates of mortality and, where appropriate, of morbidity in the State; "(E) shall have a separate health communica- tions component in the program or programs: which shall include, but not be limited to, a description of how the communications media, inoluding, the elec~ 22 tronic media; will be utilized' to effectuate the pur- 23 poses of the programs; 24` '' "'(F) shall identify -a specific" instith.itional en-