Tobacco Documents Online

10 1 2 7 achieve their stated purposes or that there is a failtzre to comply substantially with assurances provided under sub+ 3 section (b) with respect to the.receipt of such grant, the 8 Secretary shall notify the State that further payments will not be made t'o it under such grant (or in his discretion thatfurther payments will be reduced), until he is: satisfied that the program or programs will operate effectively or there will no longer be such a failure. Until' he is so satis - g fled, the Secretary shall make no payment' or, in his dis- 16 17 18 19 20 21 22 23 cretion, reduce payments to the State from such grant. "(d) (1) The totaU amount of grants received by a State under subsection (a) to assist States in planning for preventive health services for the fiscal year ending Sep- tember 30, 1980 shall be determined by the Secretary, except that it may not be less than the product of $0:20' and the population of the State. "(2) The total amount of' grants received by a State ttnder subsection (a) to assist States in providing preventivee health services' for any fiscal year shall be determined by the Secretary, except that it- "(A) may not exceed the lesser of- "(i) the product' of' $0.75 and the population of! the State, or 24 "(ii) in the case of the fiscal year ending Sep- 25 tember 30, 1982, 5 per centum of the amount of 1 1 2 3 4 6 7 8 9 10 8 State and local: ex services supported within the State ii ended on or before fiscal year ending centum of the amo. State's fiscal year 1 1982; and, in the c, tember 30, 1984, such expenditures befor d d on or e 11 en 12 13I 14 "(B) may not be h the population of the & " (3) The total amour. 15 under subsection (a) to a: 16 of operating the health cotr 17 preventive health services p 18 be determined by the Secrc 19 less , than the product of S, 20 21 22 O 23 W 24 © C.~ 25 W State. luotwithstandixig par for any fiscal year the am, year under subsection (1) to make grants for that fisc paragraphs to all States, th fiscal year for a State shalll i

V Page a U.S. Senator from the State of Kentucky________ Hon. Wendell H. Ford 94 11 , , Food Marketing Institute, Dennis M. Devaney, counsel; prepared A ' statement --------------------------------------------------------- 884 )r Page Foote, Emerson, former vice cha;rman of the board, American Cancer Society, prepared statement_________________________________________ 214 410 Georgia Department of IIealth, Joseph A. Wilber, M.D., director for adult prepared statement_________________________________ health services 526 ie I; , Giant Food Inc., Janet E. Tenney, nutritionist, office of consumer affairs, prepared statement------------------------------------------------- 690 .Ie. id Green Dolmatch Advertising, Inc., New York, N.Y., Paula Green, president, preparedi statement------------------------------------------------- 192. id 'd, al -_ 00 Haas, Ellen, director, consumer division, Commun_ty Nutrition Institute; Robert O. Nesheim, Ph. D., vice president of science and technology, The Quaker Oats Co., representing the Grocery Manufacturers Association ; Michael F. Jacobson, Ph. D., executive director, Center for Science in4he he 39 Public Interest ; Ira I. Somers, Ph. D., executive vice president and director of laboratories, \ationaliFood Processors Association; and Janet E. Tenney, nutritionist, office of consumer affairs, Giant Food, Inc., accompanied by H. Edward Dunkelberger, Jr., counsel, National Food cts Processors Assoc:ation, a panel_____________________________________ 600 --- 208 Prepared statement'----------------------------------------------- 608 Ird 514, Hanneman, Gerhard J., associate professor of communications, Annenberg School of Communications, University of Southern California_________ 398 )H ___ 836 Hart, Hon. Gary, a U.S. Senator from, the State of Colorado, prepared statment ---------------------------------------------------------- 305: _-- 854 Health Education Foundation, Morris E: Chafetz, M.D., president, prepared D. statement --------------------------------------------------------- 538 , 221 International Foodservice Manufacturers Association~ prepared statement 918 or Kellogg Company of Battle Creek, prepared statement (with attachment) 881 , _ 218' Lazar, Dr. J. Brett, health officer, DiontgomeryCounty Healt'h~ Depart~ment, ive representing the, National Associ'Qtion of Counties and the American Public Health Association 374 -_- 372 __________________________________________ D:, 685 Leffall;, Lasaile D., Jr., M.D., president-elect, American Cancer Society, accompanied by Donald Young, M.D., member, American Thoracie So- ion, _ 08 ciety, and former medical director, American Lung Associationq Robert, M. Daugherty, Jr., M.D., Ph. D;, cha^rman, subcommittee on smoking, ical American Heart Association; John S: Banzahf III„ executive director and chief counsel Action on Smoking and Health a panel 198 lof , , , ------------ Prepared statement 208 Aor s E. 10 _______________________________________________ Manoff, Richard' K., chairmany Richard K. Manoff, Inc., and president, Manoff International, Inc___________________________________________ . 83' _ 412 Prepared st'atement----------------------------------------------- 390 Jr., -- 915 McGinnis, Michael, 'M.D.,,Deputq Assistant Secret'aryfor Health for Special Health Initiatives; accompanied by Donald Millar, Center for D'sease Ired ---- 3'-'0' Control; and Taylor Quinn, Bureau of Foods, U.S. Food and Drug. Administration ---------------------------------------------------- 328 Prepared stat!ement_______________________________________________ 339 National Association of Broadcast'ers, prepared stat'ement______________ 844 rli__ llifi National Food Processors Association, Ira I. Somers, Ph. D., esecutivee vice president and director of laboratories, prepared statement_________ 717 17!) President's Council on Physical Fitness and Sports, C. Carson Conrad, !aooI EaecutiR•e, Director, prepared statement_____________________________ 412 - :{71) Public Communications Center, Pelhazn~ Manor, N.Y., James %V. Swinehart, +lrll Ph. D., director, prepared; statement_________________________________ 187 U.} !2i; Quaker Oats Co., Robert 0. \esheim, Ph. D., vice president of science and technology, prepared statement______________________________________ 676 rn Richard K. AIanoff, Inc.,,Richard K. Manoff, chairman, prepared statement 390 1Niil Steen, Lowell H~, M.D., representing the Amer`c•an~ Jledicall Association, aceompanied by Harry N. Petersonl director, department of legislation, Ameriean Medical Association______________________________________ 368 129,

Page es and ient as House ------ 93 Lent___ 8'0 icology Dedical ~nt---- 315 ------ 240 --- 887 ,fessor ------ 179 epared' 900 Jlartim • High~ anei__ 159 rssional 690 ,he \ a- 736 iter fbr ---- 499 by- '.versity, 178-_-- 466 )rtzllity istitute utes of )c'ated 3chatz, ------ 98 ' - 5599 avid: I. Tomm Health --- -- 62' Water ,tectiou iary of --- 31 )'vaui:r :.heard >1.\dm, - 37 .Y., Lv „~ nf 11,77 .13".." 'nnt I.;i -17s ~ VII Articles, publications„et cetera-Continued Guidelines for Preparing Nutrient Statements for: Page Canned asparagus-------------------------------------------- 738 Canned cut green beans-------------------------------------- 742 Canned beans (waY)---------------------------------------- 747 Canned beans (lima) ---------------------------------------- 750. Canned beets------------------------------------------------- 753' Canned carrots..---------------------------------------------- 756 Golden creami style corn______________________________________ 759 Canne&yellow whole kernelicorn_______________________________ 763 Canne& sweet: peas------------------------------------------- 771 Canned spinach--------------------------------------------- 775: Canned sweet potatoes---------------------------------------- 779 Canned tomatoes--------------------------------------------- 782 Canned stewed tomatoes-------------------------------------- 785 Canned tomato juice----------------------------------------- 788 Canned tomato paste----------------------------------------- 796 Canned tomato puree----------------------------------------- 799 Canned tomato sauce----------------------------------------- 803 Apricot halves----------------------------------------------- 807 Apricot nectar----------------------------------------------- 813 Canned fruit cocktail_________________________________________ 816 Clingstone peaches------------------------------------------- 821 Freestone peaches-------------------------------------------- 826 Canned tuna------------------------------------------------- 832 Health Education Foundation, description of organization----------- 575 HEF News, Voh 1, No. 11I, from the Health Education Foundation„ Washington. D-C----------------------------------------------- - 5~7 Ineffective Filters in Reducing Carbon 1lonoside Through Filtration__ 118 lfortality in Selected Cities with Fluoridated and Non-Fluoridated Water Supplies, by J. David Erickson, D:D.S., Ph. D., Chronic Diseases Division„ Bureau of Epidemiology, Center for Disease Control, Atlanta, Ga., from the New England Journal' of' DZedi- cine. May 18, 1978---------------------------------------------- 446 NA's Survey Result's: What Consumers Want (And Don't Want), To See on Food Labels, from, Nutriti'on~ Action: June 1978------------ 692' Overview-Heait'hi Consequences of Smoking, from the U.S' Department of IIealth, Education, and tiCelfare; Public Service, Cent'er for Disease Control, 1975___________________________________________ 313' President Carter Expresses Personal and Administration, Support for Fluoridation„ telegram to Dr. Frank Sheler, president, American Dental Associatlion, Miami, Fla., October 1077____________________ 996 Proposed Label by the National Food Processors Association-___---- 734: Proposed Labeling Under S. 3117__________________________________ 735 Public Health Service Smoking and Health________________________ 124 Reid Brothers, a partnership, 1977 crop year net income------------ 97 Research Shows \oi Mutagenic Effects: From Fluoride, by the ChiefS Laboratory of Developmental Biology and Anomalies, \ ational In- stitute of Dental Research, National Institutes of Health, September 1977 ---------------------------------------------------------- 495 Safety of Water Fluoridation, by Ernestl \ewbrun, D.M.D., Ph. D.,, professor of oral~biology and cha'rman of the section ofbiologicali sciences, University of California, school of dentistry, San Francisco, Calif., from the Journal of the American Dental Association, Febru- ary 1977------------------------------------------------------- 427 Selectedi Corporations and Public Authorities Conducting Employee Heaith/FithessProgTams, from the President''s Counc?1 on Physical Fitness,and Sports--------------------------------------------- 595 Statewide Antifluoridation Initiatives: A\ew Challenge to Health \Vorkers; by Caswell A. Evans, Jr., D.D.S., .ILP:H. ; and Tomm Pickles, D.M.D., M.P.H.,, from AJI'H; January 1978______________ 472 Surveilltinee of Nutrition Labeling in the Retail Packaged Food Sup• p1P, by Raymond E. Schucker___________________________________ 619 "Tar" and Nicotine Content of C'garette Smoke in Relation to Death Rates, by E. Cuyler Hammond, Lawrence Garfinkel, Herbert Seid. man, and Edward A. Lew, department,of epidemiology and statistics, American Cancer Society, New York, \.Y------------------------ 2261

CONTENTS Text of : Page S. 3115---------------------------------------------------------- 4 S. 3116---------------------------------------------------------- 52 S. 311'8---------------------------------------------------------- ---------------------------- usylvania it ansylvania t CHRONOLOGICAL LIST OF' WITNESSES MAy 25, 1978' Ford, Hon. Wendell H.,, a U.S: Senator from~ the State of Kentucky______ 94 Foege, William H., \IID., Director, Center for Disease Control; \orman Kretchmer, M.D., Director, \ationali lnstitutes of Child Health and Human Development ; and Johni Pinney, Director, OfHce of Smoking and Health, Department of Heaithj Education, and Welfare, a panel__ 109 Wolfe, Theresa and Moira Reilly, Immaculata High School; Jiartin O'\Ialley, Mark Adams, and Charles Grif6th„ Gonzaga College High School; and James Valeo, Bethesda-Chevy Chase High School, a panel__ 159 Evans; Richard I., Ph. D., professor of psychology, University of Houston, Houston~ Tex., accompanied by James: W. Swinehart, Ph. D., director, Public Communications Center, Pelham Dianor, \.Y. ;, and' Paula Green, president, Green Dolmatch Advertis=ng, Inc.,, New York, N.Y., a panel__ 166'. Leffall, Lasalle D., Jr., M.D;, president.elect, American~ Cancer Society, accompanied by Donald Young, M.D., member;, American Thoracic So- ciety, and former medical director, American Lung Association ; Robert M. Daugherty, Jr., JLD:, Ph. D:,, chairman, subcommittee oni smoking. AmericalrHeart AssociaVon; John S. Banzahf fII, executive director and chief counsel; Action on Smoking and Health, a: panel_________________ 198 Jv:Nn 7, 1978 McGinnis, Michael, M.D., Deputy Assistant Secretary for Health for Special Health Initiatives, accompanied by Donald Millar, Center for Disease Control; and Taylor Quinn„ Bureau of Foods,, UIS. Food and Drug Administrateon ---------------------------------------------------- 328. Fielding, Dr. Jonathan E:, commissioner of public health, Commonwealth of Uiassachusetts--------------------------------------------------- 364 St'een, LocvelL 11, M.D., representing; the American Medical Association, accompanied by Harry N. Peterson~ director, department of legislation, American Medical Association_______________________________________ 368 Arnold, Dr. Charles B., president, the American, College of Preventive Medicine ---------------------------------------------------------- 372 Lazar, Dr. Js Brett, health officer,, Montgomery County Health Department, representing the National Association of Counties and the American Public Health Association------------------------------------------ 374 Farquhar, Dr. John, SV., professor of medicine, Stanford Univers: tw School of 3ledicine-------------------------------------------------------- 379 Jianoff, Richard K., chairman, Richard K. 'Manoff, Inc., and president, Manoff International, Inc___________________________________________ 383' Hanneman, Gerhard J., associate professor of communications, Annenberg School of Communications, University of Southern California--------- 398

4 93TH CONGRESS 2D sEssioN St 3115 1 FORMULA dR.AT 2 SEC. 102. Eff ' 3 by adding after s INTH E SENATK OF THE UNITED STATES heading theret'o : MAY 19 (legislative day; MAY 17), 1978 4 Mr. KENNEDY (for hlmself,.jfr. WILLIAWa, Dfr..CxAFEE,.Air..RANDaLrx,,Mr... 5 "FORMULA GRAN PELL, Mr. RiECLE, Mr. McGbvEaN, Mr. HART, an&Mr. LEAHY) introduced the following bill; which was read twice and referred to the Committee On Human Resources 6 7 SEC. 315. (: A BILL To establish a comprehensive disease prevention and health promotion program in the United States. 1 Be it enacted by the Senate and House of Representa- 2 tizes of the United States of America in Congress assembled, 3 That this Act may be cited as the "Disease Prevention and 4 Health Promotion Act of 1978". 5 TITLE I-FORTMULA AND PROJECT GRANTS 6 FOR PREVENTIVE HEALTH SERVICES 7 SEC. 101. Whenever in this title an~ amendment is es- 8 pressed in terms of' an' amendment to a section or other pro- 9 vision, the: reference shall be considered to be made to~ a ~.. 10 section or ot'her provision of the Public Health Service Act: 10 11 12 6. 13 (b) No gr:~ 14: unless an applica 15 16 17 18 19 20 21 22 23 O 24 W ~ O W 8' States to assist t: g costs of providing or contracts or boi subdivisions of' th entities) preventi- approved by, the such form and be shalll by regulattiof in an application f, "(,i ) for reduce, throuk causative conc of the five ler "(;2)the' obligated by

15 individual th a grant -h individ- 1i informa- discl'osure lorisre- of a State, m may be ; or to an provisions: vhich are .vice pro- ;rams as, ident for , and' on ie ext'ent onditions on (b) , 12 1 on the amount of funds obligated under grants under subsec- 2 reception room, conference room, or hearing, room in any 3 operating programs: to prevent the diseases and conditions 4 referred to in paragraphs (1) and (3) of subsection (b) ; 5 and on the effectiveness of the programs assisted under 6 grant's under subsection (a) in preventing such diseases and 7 conditions. 8 "' (k) (1) For purposes of paragraphs (1) and (3) of 9 10 11 subsection~ (b), the term 'primary prevention of causative conditions' means the prevention of the development of the conditions in healthy individuals. 12 "' (2) For purposes of paragraphs (1) and (3) of sub- 13 section (b) ,`secondary prevention of causative conditions' 14 means the early detection of the condit'ions in~ asymptomatic 15 individuals. 16 "'(3) For purposes of'paragraph (d) (1') (B), the.term 17 'State and lbcal expenditures for preventive health services' 18' means expenditures by State an& local public health authori- 19 ties for preventive health services supported by grants 20 under subsection ('a) but excludes expenditures by such 21 authorities- 22 "(A) spec:ificalNy required by Federal statutory 23 law as a condition to the receipt of Federal financial 24 assistance, or

23 proceedb onnection it of that'~ by ot4er r effective 'eneral of !presenta- exa.mina- ds of the pertinerIt individual _i a grant iu individ- formation closure is or is re- 4 a State, ;ratn may 1, or anv such 20 1 "(h)~ Nothing in this section shall limit or otherwise 2 restrict the use of ftimds which are granted to a State or 3 to an agency or a political subdivision of a State under 4 provisions of FederaL law (other than this section) and 5 which are available for the conduct of~ preventive health 6 service programs from being used in connection with pro- 7 grams assisted through grants under subsection (a) . g "(i) The Secretary shall submit to the President for 9 submission to the Congress on January 1, 1981, and on 10 January 1 of each succeeding year a report on the estent. 11 of t'he problems presented by the diseases and conditions 12 referred to in subsection ( j); on the amount of funds obli- 13 gatied under grants under subsection~ (a) in~ the preceding 14 fiscal year for each of the programs listed in subsection ( j); 15 and on the effectiveness of the activities assisted under grants 16 under subsection (a) in controlling such diseases and 17 conditions. 1s "(j) (1)~ For payments to States under grants under 19 subsection (a)' for establishing and maintaining programs 20 for the screening, detection, diagnosis, prevention, refer- 21 ral for treatment, an& followup on compliance with treat- 22 ment ofhypertension, thene nre authorize& to be appropriated 23 $30;000,000 for the fiscal year ending September 30, 1980; 24 $35,000~,000~ for the fiscal year ending September 30, 1981,

loubled. Among ore than~ a pack itane of teenahe >ut at, a disturki- of these y oung will be marred rlier they start i at age 16, and rrlierthan their he lung, mouth, )re emphy.sema, cart attacks and ire catastrophe. o a habit which generates for a re a number of ; or encouraging h programs are ning. Deterring in dealing with ly hazardous to ivironmental or ~e in death and heard extensive cing debate. «'e fourth has sttb- ,e cListinb i'shed zed the bulk of ewed! all of the ~ett~e smokinh is )cen raised from ence concerninnal problem. The iScouu•a~ing cig. hildren are pri, >ae aclear role kerh tlicilr clril- "ountlr~sOther railroacl f liik f„r dnig ~ nsake cr•rt,lin ~~„f tli1• al„. Today ws will explore the phenomenon, of childhood smoking, and we will examine some potential strategies for dealing with it. I am confident that with the'help of the kind of witnesses we will'hear from, today, we can organize effective, acceptable and noncoerciv.e programs for blunting the epidemic of childhood smoking in thiscountiry. Before proceeding, Iwouldlil:etoexpress myregi•et that the tobacco industry was unable to provide a witness to represent its point of view at this morning's hearing. When S. 3115 was introduced 6 dayss ago, we invited the Tobacco Institute and'several tobaceo companies to appear at this sessionL They informed us that this was not sufficient warning, and that they coukU not find a single individual from the Institute or from any of the companies who could appear today. I would only point out that among the witnesses we have with us today are several who~ were not told until 3 or 4 days ago that we wanted them to attend. Senator Ctr A M-E. I am cosponsor of this bill which we are consider- in« today, -whichdeals with the area of prevention. It seenas to me that there is something off-kilter in our whole system of expenditures for medical care in thejTnited States in that we pour billions of dollarsinto, taking care of people who are illa--andthat is proper and right- but 'wepour about 2 percent of that amount iiitotryingt'o keep people healthy, in the whole area of preventive medicine. And so this bill,, which Senator Kennedy was the primary sponsor of and which I am a cosponsor of, deals with this particular area. The bill has several see- tions. The area we will be considering today deals with the subject of deterring, smoking amongst our children and relating, to thezvhole problem of cigarette smoking. Now, over the years this subcommittee has heard testimony on hundreds of healt~h issues, but it seems tomefezvof them liaveconcen- trated in the area of preventive medicine. What we are considering today, is the subject of cigarette smoking and its damaging effect~s on, the health of our entire citizenry, and wearepart'~icula-rlyconcerned no.cwith the young people who are smokingin, increasing numbers. tiVefirst have a statementlfrom Senator Schweiker, and then we will proceed with our first distinguished witness. Senator ScFrwErt.En. Thank you very much, Mr. Chairman. I am not a sponsor of thispartieular bill. Idid agree to sponsor the billi on t'hehealth education, program on which anotherheamng will be hel'd,, so I«ould like the record to show that I did not cosponsor S. 3115, thee c.oinprehensive bill, or S. 31117 or S. 3118, because I have some unre- solved problems on both bills. I amia sponsor of S'. 3116, aa bill which expandsformula grants and project grant programs, andcreat'es a new program on health promotion and diseasee prevention. I come here with an open mind and will be glad to heart'hetesti- mony: today. Thank youi very m2uh, llr: Chairman. [The texts of S. 31115; S. 3116, and S. 3118 follow :]

13 d for such nount ap- .mt needed such fiscal ~ made for ,ar period ning, after :nd'er such limates or s justment's d in such~ he Seere- 'h a ants. , hich is=a -duce 'the or equip- nd truWl ernmeat ny ot~ter ofpieer ` o r tli e 10 1 detail of such an officer or employee is for the convenience of 2 and at the request of such State and for the purpose of pla.n- 3 ning or carrying out a prograan with respect to which the 4 State grant under subsection (a) is made. The amount by 5 whi& any such grant is so reduced shall be available for g paymentl by the Secretary of the costs incurred inn furnishing 7 the supplies or equipments or in detailing the personnel, on g which the reduction of such grant is based, an& such amount g sli,all be deemed as part of the grant and shall be deemed to 10 have been paid to the State. 11 "(g) (1) Eu.ch State which is a recipient of a: grant 12 under subsection (a) shall keep su& records as the Secretary 1,3 shall by regulation prescribe, including records which fully 14 disclose the amount and disposition by such State of the 15 ,, proceeds of such grant, the total cost of the undertaking in 16 connection with which such gra,nt was made, and the amount 17 of that portion of' the cost of the undertaking supplied by 18 other souxces, and such other records as will facilitate an 19 effective audit. 20 ." (2) The Secretary and the Comptroller General of 2j. the United Sta#es;.. or *Ay of,their duly authorized representsi- 22 . tives; shsill have a+oce.ss for the purpose of audit and egamicuti- 23 tion to anvy books, doc=ents; pa.pers, and records of each 24 State which is a recipient of a grant under subsection ('a). 25 that are pertinent to $u<sh grant.

12 9 1 bears the same ratio to the amounts determined for such 2 State in accordance with this section as the amount ap- 3 propriate& under subsection (1) bears to the amount needed 4 to make grants in accordance with this section for such fiscal 5 year to all States. 6 "(e) Each grant! under subsection (a) shall be made-for 7 costs.for preventive health services in the one-year period 8 beginning on the first day of the first month beginning after 9 the month~ in which the grant is made. Payments under such 10 grants may be made in advance on the basis of estimates or 11 by the way of reimbursement, with necessary adjustments 12 on account of underpayments or overpayments, and in such 13 installments and on such terms and conditions as the Secrie- 14 tary finds necessaryy to carry out the purposes of such grant,. 15 "(f~) The Secretary, at! the request of a; State which is~-a 16 17 18 19 20 1 detail of such an officer or e 2 and at the request of such ~ 3 ning or ca.rrying out a pril 4 State grant under subsecti 5 which any such grant is. 6 payment by the Secretary 7 the supplies or equipment g whioh the reduction of su,1 9 shall be deemed as part c 10 have been paid to the Stat~ 11 1° ('g) (1) Ea,ch Sta under subsection (a) sha shall by regulation pres, disclbse the amount an •proceeds of such gran't,. recipient of a grant under subsection (a), may reduce Ihe 16 amountl'of such grant by- 17 "('1) the fair market value: of any supplies or equip- 18 ment furnished the State, and - "(2) the amount of the pay, allowances, and travel 19 2fj 21 expenses of any officer or.empioyee of the Governmei~t 22 when detailed to the State and the amount of any o&r 23 costs incurred in connection with the detaili of such officer 24 - or employee, 25 when the furnishing of' such: supplies or equipment or 'tke 21 the Uaited States,-or A s connection with which of that portion of the other 'sources, and suc: effective a.udit. "(2) The Secret; 22 . tives, sha]1 have apcess 23 tion to any books, dc O 24 State which is a reci ~ 25 that are pertinent to s W W U1