Tobacco Documents Online

5 3 1 PURPOSE 2 SEC. 3. It is the purpose of this Act to provide a new 3 strategy to educate and provide information to the American 4 public that will allow individuals to make informed decisions 5 concerning smoking. 6 SMOKING RESEARCH, EDUCATION, AND INFORMATION 7 SEC. 4. (a) Title XVII of the Public Health Service Act 8 is amended by adding at the end thereof the following new 9 section: 10 "SMOKINO AND HEALTH 11 "SEC. 1711. (a) The Secretary shall establish and carry 12 out a program to inform the public of the dangers to health 13 from cigarette smoking. In carrying out such program, the 14 Secretary shall- 15 "(1) coordinate all activities of the Department 16 which relate to smoking and its effects on health, in- 17 cluding research and demonstration projects and educa- 18 tional activities; 19, "(2) through the Interagency Committee on 20 Smoking and Health established under subsection (b), 21 coordinate the activities referred to in clause (1) of this 22 subsection with all other activities of the Federal Gov- 23 ernment which relate to smoking and its effects on 24 health; S. 1sx9-ie

COMPREHENSIVE SMOKING PREVENTION EDUCATION ACT OF 1981 HEARING BEFORE THE COMMITTEE ON LABOR AND HUMAN RESOURCES UNITED STATES SENATE NINETY-SEVENTH CONGRESS SECOND SESSION ON S. 1929 TO AMEND THE PUBLIC HEALTH SERVICE ACT AND THE FED- ERAL CIGARETTE LABELING AND ADVERTISING ACT TO IN- CREASE THE AVAILABILITY TO THE AMERCAN PUBLIC OF INFORMATION ON THE HEALTH CONSEQUENCES OF SMOKING AND THEREBY IMPROVE INFORMED CHOICE, AND FOR OTHER PURPOSES MARCH 16, 1982 Printed for the use of the Committee on Labor and Human Resources U.S. GOVERNMENT PRINTING OFFICE Db-077 O WASHINGTON : 1982

4 2 1 FINDINGS 2 SEC. 2. The Congress finds that- 3 (1) cigarette smoking is the largest preventable 4 cause of illness and premature death in the United 5 States, and is associated with the unnecessary deaths 6 of over three hundred thousand Americans annually; 7 (2) smoking is the primary cause of lung cancer 8 and emphysema in the United States, and is associated 9 with other cancers; 10 (3) heart disease accounts for nearly one-half of 11 the deaths in the United States, and one-third of the 12 deaths attributable to heart disease are associated with 13 smoking; 14 (4) the risks of miscarriage, stillbirths, premature 15 births, and child weight deficiencies for pregnant 16 women who smoke are higher than for pregnant 17 women who do not smoke; 18 (5) certain occupational hazards, in conjunction 19 with smoking, increase substantially the risk of disease 20 and death; and 21 (6) present Federal, State, and private initiatives 22 have been insufficient in conveying to the American 23 public the information contained in clauses (1) through 24 (5) of this section and other information regarding 25 smoking. S. 1929-is 5 3 1 PURPOSE 2 SEC. 3. It is the purpose of ti 3 strategy to educate and provide infc 4 public that will allow individuals to 5 concerning smoking. 6 SMOKING RESEARCH, EDUCATIO 7 SEC. 4. (a) Title XVII of the I 8 is amended by adding at the end t' 9 section: 10 "SMOKING AND H 11 "SEC. 1711. (a) The Secretar3 12 out a program to inform the public 13 from cigarette smoking. In carryin 14 Secretary shall- 15 "(1) coordinate all actiN 16 which relate to smoking and 17 cluding research and demonsti 18 tional activities; 19. "(2) through the Intc 20 Smoking and Health establis: 21 coordinate the activities referr 22 subsection with all other actiN 23 ernment which relate to sm 24 health; O W ~ O ~ C11 S. 1929-ie W N

9 7 1 "(C) 'WARNING: The Surgeon General has De- 2 termined that Cigarette Smoking Causes Heart Dis- 3 ease.'. 4 "(D) 'WARNING: The Surgeon General has De- 5 termined that Cigarette Smoking by Pregnant Women 6 May Result in Miscarriage, Premature Births, or Child 7 Weight Deficiencies.'. 8 "(E) 'SMOKERS: No Matter How Long You 9 Have Smoked, Quitting Now Greatly Reduces The 10 Risks To Your Health.'. 11 "(2) The labeling statements specified in paragraph (1) 12 of this subsection shall be rotated on the packages of each 13 brand of cigarettes and the advertisements for each brand of 14 cigarettes in a manner that assures that each of such labeling 15 statements appears an equal number of times on each brand 16 of cigarettes and all such advertisements within the fifteen- 17 month period beginning on the effective date of this subsec- 18 tion and each succeeding fifteen-month period. 19 "(3) Any labeling statement required under this subsec- 20 tion shall be located in a conspicuous place on every cigarette 21 package and in each advertisement for cigarettes, and shall 22 appear in conspicuous and legible type in contrast by typog- 23 raphy, layout, or color with all other printed material on the 24 package or advertisement.

6 4 1 "(3) through the Interagency Committee on 2 Smoking and Health established under subsection (b), 3 coordinate the activities of the Federal Government re- 4 ferred to in clauses (1) and (2) of this subsection with 5 similar activities in the private sector; 6 "(4) conduct research and develop new methods 7, for informing the public of the effects of smoking on 8 health, either independently or in conjunction with the 9 private sector, for use in a national effort; 10 "(5) collect, analyze, and disseminate information, 11 studies, and other data related to smoking and its ef- 12 fects on health; 13 "(6) make available, through specific publications 14 and bibliographic and reference materials, information 15 on research efforts relating to smoking and its effects 16 on health; and 17 "(7) undertake any other additional informational 18 and research activities which the Secretary determines 19 necessary and appropriate. 20 In carrying out the requirements of this subsection, the Sec- 21 retary shall seek to develop methods of communication with 22 Federal, State, and local entities, as well as with the private 23 sector. 24 "(b)(1) To carry out the activities described in clauses 25 (2) and (3) of subsection (a), there is established an Inter- 7 5 1 agency Committee on Smoking and Heq 2 shall be composed of- 3 "(A) representatives from ai 4 and agencies of the Department, 5 the National Heart, Lung, and Bloc 6 tional Cancer Institute, the Nationt 7 Health and Development, the Heal 8 istration, the Health Resources Adn 9 Center for Disease Control; and 10 "(B) at least one representatiN 11 Trade Commission, the Departmen 12 Department of Labor, and any otl 13 designated by the Secretary. 14 "(2) The Committee shall meet at lf 15 year. 16 "(c) The Secretary shall transmit a 17 not later than January 1 of each year wl 18 "(1) current information on thc 19 on health; - 20 "(2) an overview and assessme 21 ities undertaken to inform the publ 22 smoking on health; 23 "(3) information regarding th 24 private sector with respect to the ef 25 health; and S. 1929-1a r7 S S. 1929-ie

CONTENT Text of: S. 1929 ........................................................................ CHRONOLOGICAL LIST OF COMMITTEE ON LABOR AND HUMAN RESOURCES ORRIN G. HATCH, Utah, Chairman ROBERT T. STAFFORD, Vermont DAN QUAYLE, Indiana PAULA HAWKINS, Florida DON NICKLES, Oklahoma LOWELL P. WEICKER, JR., Connecticut GORDON J. HUMPHREY, New Hampshire JEREMIAH DENTON, Alabama JOHN P. EAST, North Carolina EDWARD M. KENNEDY, Massachusetts JENNINGS RANDOLPH, West Virginia HARRISON A. WILLIAMS, JR., New Jersey CLAIBORNE PELL, Rhode Island THOMAS F. EAGLETON, Missouri DONALD W. RIEGLE, JR., Michigan HOWARD M. METZENBAUM, Ohio GeoaGe W. Parrrs, JR., Chief Counsel Rnvrr M. PATet[, Staff Director and General Counsel LAwasxcE C. Hoxowrrz, M.D., Minority Staff Director cnl TUESDAY, MARCH 16, Packwood, Hon. Bob, a U.S. Senator from the State Brandt, Edward N., Jr., M.D., Assistant Secretary Service, Department of Health and Human Serv Everett Koop, Surgeon General, U.S. Public HeE Luoto, Acting Director, Office of Smoking and Hf Pollin, William, M.D., Director, National Institute, Holbrook, John H., M.D., associate professor, Un Medicine ........................................................................ LeMaistre, Charles A., M.D., president, Universit_ Hospital and Tumor Institute, on behalf of._the Health .....................................................................:...... Horrigan, Edward A., Jr., chairman and chief exec Tobacco Co., on behalf of the Tobacco Institute, iard, assistant professor of marketing, Ohio S senck, professor of psychology, Institute of London; Sheldon C. Sommers, scientific directo search ...................................................................:........ STATEMENTS American Cancer Society, the, prepared statement American Heart Association, John A. Oates, M.I on smoking, prepared statement ............................. American Lung Association, prepared statement ... Brandt, Edward N., Jr., M.D., Assistant Secretary Service, Department of Health and Human Sen Everett Koop, Surgeon General, U.S. Public He: Luoto, Acting Director, Office of Smoking and H Prepared statement ............................................... Eysenck, H. J., Ph. D., S.Sc., professor of psycholc University of London, prepared statement........... Hawkins, Hon. Paula, a U.S. Senator from the statement ............................................................::....... Holbrook, John H., M.D., associate professor, Un Medicine ....................................................................... Prepared statement ............................................... Horrigan, Edward A., Jr., chairman and chief exec Tobacco Co., on behalf of the Tobacco Institute, iard, assistant professor of marketing, Ohio S senck, professor of psychology, Institute of London; Sheldon C. Sommers, scientific direct< search ........................................................................... Prepared statement ............................................... Huddleston, Hon. Walter D., a U.S. Senator frc prepared statement .................................................... am

2 cigarettes. It causes chronic disease, premature death, and billions of dollars of lost productivity every year. In fact, this legislation enjoys endorsement from virtually every major health and medical professional organization concerned with public health. I am not interested in legislating health, in telling people how to live their personal lives. I am particularly not interested in having the Federal Government step in if a problem can be solved in the private sector, as it usually can. But I am convinced that the health consequences of smoking are of such magnitude, and that the public is sufficiently unaware of these problems, that we need another major national effort to help our citizens make informed choices about their health. It is not Government regulation, but more public education, I have in mind. I agree with former Assistant Secretary of Health, Dr. Ted Cooper, when he said, "We will achieve the greatest good not through absolute bans, but by giving our people the knowledge nec- essary to make rational and informed personal decisions." That is why Senator Packwood and I have introduced the Com- prehensive Smoking Prevention Education Act. Senator Packwood, of course, is with us today, and I am grateful to have him here. He is chairman of the Senate Commerce Committee. We introduced this bill on December 9, 1981. This bill is designed to stimulate a cooperative effort with the private sector to provide health education on smoking. We would -like the Federal Government to continue the activities of the Office of Smoking and Health, which does a commendable job in coordi- nating and disseminating smoking related information. The stimu- lus and support that this legislation can provide will further aug- ment these admirable efforts. In addition, our bill asks the tobacco industry to rotate the mes- sages on the warning labels already mandated by the Federal Ciga- rette Labeling and Advertising Act. These new labels would inform our smoking population not only of cigarettes' causal link with cancer of the lung, but also with emphysema, a chronic lung dis- ease which causes a slow and agonizing death and disables over 1 million Americans. Other labels will indicate that cigarettes cause heart disease, and may cause miscarriages or premature births. To- bacco manufacturers will also be asked to provide information re- garding the chemical additives used as flavor enhancers so that our scientists can determine if these chemicals aren't possibly as cancer-causing as tobacco itself. [The text of S. 1929 follows:] 3 97TH CONGRESS 1ST SESSION S*1929 To amend the Public Health Service Act and the Feder Advertising Act to increase the availability to the mation on the health consequences of smoking and choice, and for other purposes. IN THE SENATE OF THE UNIT] DECEMBER 9 (legislative day, NoVEMBEE Mr. HATCH (for himself and Mr. PACItx'oOD) introduced was read tw-ice and referred jointly by unanimous co on Commerce, Science, and Transportation and Labo A BILL To amend the Public Health Service Act Cigarette Labeling and Advertising Ac availability to the American public of ii health consequences of smoking and th( formed choice, and for other purposes. 1 Be it enacted by the Senate and Hot 2 tiaes of the United States of America in Cc 3 That this Act may be cited as the "Compr 4 Prevention Education Act of 1981".

CONTENTS I Text of S. 1929 .................................................................................................... ..................... Page 3 CHRONOLOGICAL LIST OF WITNESSES ' TUESDAY, MARCH 16, 1982 Packwood, Hon. Bob, a U.S. Senator from the State of Oregon ............................. 13 Brandt, Edward N., Jr., M.D., Assistant Secretary for Health, Public Health Service, Department of Health and Human Services, accompanied by Dr. C. Everett Koop, Surgeon General, U.S. Public Health Service and Dr. JoAnn Luoto, Acting Director, Office of Smoking and Health ........................................ 6 Pollin, William, M.D., Director, National Institute on Drug Abuse ...................... 48 Holbrook, John H., M.D., associate professor, University of Utah College of Medicine .................................................................................................... ..................... 71 LeMaistre, Charles A., M.D., president, University of Texas M. D. Anderson Hospital and Tumor Institute, on behalf of the Coalition on Smoking OR Health .................. :................................................................................................... ....... .......................................... 81 Horrigan, Edward A., Jr., chairman and chief executive officer, R. J. Reynolds Tobacco Co., on behalf of the Tobacco Institute, accompanied by Paul Min- iard, assistant professor of marketing, Ohio State University; Hans Ey- senck, professor of psychology, Institute of Psychiatry, University of London; Sheldon C. Sommers, scientific director, Council for Tobacco Re- search .................................................................................................... ......................... 36 STATEMENTS American Cancer Society, the, prepared statement .................................................. 121 American Heart Association, John A. Oates, M.D., chairman, subcommittee on smoking, prepared statement ............................................................................... 109 American Lung Association, prepared statement ..................................................... 99 Brandt, Edward N., Jr., M.D., Assistant Secretary for Health, Public Health Service, Department of Health and Human Services, accompanied by Dr. C. Everett Koop, Surgeon General, U.S. Public Health Service and Dr. JoAnn Luoto, Acting Director, Office of Smoking and Health ........................................ 6 Prepared statement ................................................................................................. 30 Eysenck, H. J., Ph. D., S.Sc., professor of psychology, Institute of Psychiatry, University of London, prepared statement ............................................................. 155 Hawkins, Hon. Paula, a U.S. Senator from the State of Florida, prepared statemen t .................................................................................................... ................... 18 Holbrook, John H., M.D., associate professor, University of Utah College of Med icine .................................................................................................... ..................... 71 Prepared statement ................................................................................................. 74 Horrigan, Edward A., Jr., chairman and chief executive officer, R. J. Reynolds Tobacco Co., on behalf of the Tobacco Institute, accompanied by Paul Min- iard, assistant professor of marketing, Ohio State University; Hans Ey- senck, professor of psychology, Institute of Psychiatry, University of London; Sheldon C. Sommers, scientific director, Council for Tobacco Re- search .................................................................................................... ......................... 36 Prepared statement ................................................................................................. 14 0 Huddleston, Hon. Walter D., a U.S. Senator from the State of Kentucky, prepared statement .................................................................................................... .. 20 (III)

10 11 8 9 1 "(4) In accordance with the provisions of section 553 of 2 title 5, United States Code, the Federal Trade Commission 3 shall establish by rule a system to ensure that labeling state- 4 ments required under this subsection are rotated in accord- 5 ance with the provisions of paragraph (2) of this subsection, 6 and that at any time each of the five labeling statements 7 appears on at least 15 per centum of all cigarette packages 8 and advertising. 1 Health and Human Services a complete 2 additive used in the manufacture of suc 3 quantity of such additive. 4 "(2) The Federal Trade Commissi 5 ment of Health and Human Services an 6 ployee thereof shall not disclose to any 7 Commission or the Department any infori 8 suant to paragraph (1). 9 "(b)(1) It shall be unlawful for any person to manufac- 9 "(3) For purposes of section 552(b)i 10 ture, import, or package for sale or distribution within the 11 United States any cigarettes, the package of which fails to 12 disclose the level of- 13 "(A) tar; 14 "(B) nicotine; and 10 States Code, and section 1905 of title 11 Code, any information received by the I 12 mission and the Department of Health a 13 pursuant to paragraph (1) shall be consi 14 secret.". 15 "(C) carbon monoxide, 16 contained in such cigarettes. 15 16 PREEMPTION SEC. 6. Section 5(a) of the Federal 17 "(2) Such tar, nicotine, and carbon monoxide levels 17 and Advertising Act (15 U.S.C. 1334(a)) 18 shall be based on the results of the most recent tests of ciga- 18 (1) by striking out "statement' 19 rettes by the Federal Trade Commission. The Federal Trade 19 pears and inserting in lieu thereof 20 Commission shall perform such tests at least on an annual 20 (2) by inserting before the pe ~ ' 21 basis. 21 . "or in any cigarette advertising 22 ."(e)(1) It shall be unlawful for any person to manufac- 22 EFFECTIVE DATE 23 ture, import, or packagee for sale or distribution within the 23 SEO. 7. (a) Except as provided in 24 United States any cigarettes unless such person has provided 25 to the Federal Trade Commission and the Department of 24 provisions of this Act shall take effect or 25 ment. ~ W ~.r:~ S. 1929-is wr 95-077 0-62--2

COMPREHENSIVE SMOKING PREVENTION EDUCATION ACT OF 1981 TUESDAY, MARCH 16, 1982 U.S. SENATE, COMMITTEE ON LABOR AND HUMAN RESOURCES, Washington, D.C. The committee met, pursuant to notice, at 9:30 a.m., in room 4232, Dirksen Senate Office Building, Senator Orrin Hatch (chair- man of the committee) presiding. Present: Senators Hatch and East. Also present: Senator Packwood. OPENING STATEMENT OF SENATOR HATCH The CHAIRMAN. The committee will be in order. It is a pleasure for me to welcome you here today to these full committee hearings devoted to the Comprehensive Smoking Pre- vention Education Act, S. 1929. As chairman of the Labor and Human Resources Committee, I have had the opportunity to learn a great deal about the health needs of our citizens. Over the past decade, there have been numerous Federal initiatives intended to meet these needs, all of which have worthy motives, but with a price tag which has proven to be more costly than the taxpayers can afford. Consequently, Congress is slowly but surely rediscovering a lost virtue. It is called prudence. And so now, in cooperation with Presi- dent Reagan, we are trying to target our resources and activities where they are likely to reap the most benefit, where they will give us the "biggest bang for the buck." In this regard, I have consulted with scientists and health profes- sionals within the public and private sector_for their recommenda- tions. I am impressed with their strong consensus favoring more emphasis on preventive medicine and health promotion. We simply cannot afford to spend the lion's share of our Federal health dollar on the treatment of disease, particularly when so many of the ill- nesses which cause death and disability are preventable. I speak here not only of the dollar costs but also of the human costs. Our Government's commitment to health prevention must therefore become more than sentimental lip service. Our comment should translate into action. The health of the American people de- pends on it. Our Nation's preeminent health experts agree that the mos worthwhile single effort we could make to improve the health o our citizens is to convince them of the harmfulness of smokin ' (1) .1 ~., ~ ~