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he phnrnmcalogieJ b:ais of addiclion n hiphiivk srnukcrs, lie cl lccls of wtuuiug luhdti; und (k)public policy aspccts of dcaling svilh high lisk smokcrs. Work Group 3: The Role of I I(fsililals in Rcducing Smokinl; r must hmpil:d mLninisrralulx, lising 116 carc c'osh anJ inuc:uiug Guvcln- .IItJ wguLdion are lup pi iol ilics. Itetluc- Slllllkirlg is 11t)1 Lf110n616Ci1 :naJur CoO- us. Thtu, Icle hn>piclls Iry lu discouraga .d.iug. ICvcn iu Ihmc huspil215 whcrc ismuking pnlmcs do cnisl, tuo siuglc iu~ itlual trr GloiP in respumi6lc tirl imiile- nling Ihcln. lhi> has Icsuhcd iu inc((cc : clluils lu IcJuce nmoking. . (llhcr ubslndcn Io cuullnlliug smnkin Irospu,dc induJc couccnl (ul Ihe in- idmJ liphls uf vlinkcrs, Ihcnltitudcs;md iesiur ul sla(I Inclobcls wllu Ju smukc, tlcullies in culirrcing smukiug resUio us, '.Ind Ihe eoml enJ limc neccssary lo plcmcnl nnlismukiag pnlicros and pro- uus. Yet smokiug is iucougruous widl Ihe insuy wis+iun o( u hnspiluC lu prosidc Iq Ligh qualily hc:dlh calc and reLtluJ allh caltlclltitnl. Iluspilnlo (lu Ituvc !I irt- ons6ilily lu iisrtiel vmrking if esPucurc luhaa) smokc inarascs 16c heullh ris r pnlicnls or adve:acly n(leels Ihe ImAdl ILLlr1•.IUOkCr]. Whilc it may Iwl iniliully bc possiblc r Lu.piuJs ru cliinin;ac srnul.ing cnlirciy, cy c:m Ibcus nn tcJucing Ihe level of noking. I'urlhcnuolc, huspilal sl:rff clnbcls eue rulc uuoduLs lu Iheir p;ulenl9; qL(13t7yE.n conu:picnlly. cunailmcnl of slaff smnking will cncowot;c ulhcrs lo qIliL. Wilh Ihesc issucs in wind, thc Wulk Gloup made Ihc lulluwing sLllenunts: 1. Ilc:nusc sruoking is Ihc siuglc moa prc- vcnlabk cinsc u( illncst and tw ly tlydh, :md is Illc mosl flcqueul c:u:sc of huspittll Incs, hospitals h:roc rt lespon- si6ilily In reJuce smuking, encuwuge nousluot,ing, and plotccl Ihc righls of nunsmnkns. 2. Ilinpitals shouW Icsnita smuking ill uldcr to plovitlc nn excrnplnly, .sufc, hcallh plonloting cnvironlncnl for p.r licrus, enlplnyccs end visitors. ). ~ru implemcul these, Ihe group recom- mcutlctl lh:u cach hospilal ttevelop x fur- rnal poli.:y lo pruhi6lt srnoking cxcept in spcaiully designxrcJ, wdl-vculiluled plllccs. ~17:c hospil:tl should fusl ublOin Lnuld :Ippluv.d, ns wcll us mcdio.d Imd udnrinislralivc suppoll. A nlldli- disclplinnly Ictntl willl hospittd-widc reprceenletluu .shotdcl dcvclop tile I:ulicy; onc ndmiuislrtuiou-Icvcl cmploy,:c should 6c Icshuusiblc (ur ovcrsaring nnJ implcmculing il. l1te policy shoulcl be cxpl:tiucd to all clnpluyces. P:Ilicnts und visilurs_ J. Ilospilals shoulA pravidc eduauiunal prot'rtuns :md aclivillcs Iu hclp pctrple quit snwking, cilhcr dircclly or in trop- erution wilh cominunily Ilgenuies. I'or exanlplc, Ihe hospilal conltl provide spacc for snlnkiog cessalion pla6rams, or dcvclop plny.l mns lo bc conductcJ by Ihc hospil:J sttdf. 5. IlasplLds shnuld assumc IeaJcrship in hlinl(ing logclhcr eonummity Itl;cnclcs and punups enmrniltctl lu Icdueing moking. 6. Ilospiluls should initiulc, advncalc or suppnrt pu611c policies dcsigncd lu rrcdacc or r.liwinnte smoking (csl'cci:dly iu metJical ;mcl henllh cnre Ihcillties) anJ Icgislalioll Ihnl providrs incenli<cs t~~: inJividujis In slop sm:~kiilr. 7. 13rc4usc vnnking ls' iI Itlcvcmahlt- liw ;md x:drty II3rnJ, husl'ilA til .'mbl a~-r thCil iulullu~i1: iul I,,iL.li ... p:emiunt cuslS ifsmnkirp i;.,,I~,.J ~nliail Icrloced or climinlncd. In atldilinu Iu arlwlls I'md i I11(xn hy inaividn:d Ir.,..l,.'Inls, I1 el'. 91n1e hosl'illll acsi'di:Ri"sr, >Irrnl.! pul,liu mllisinakiuP.. InJ,ici, ~.l :Iho devclup Ilnd dlsv-Inin.il" n~,atnr. hmv lu :nluce snl'.l~~n" ~~.n I,~,~..~ .. BIitUlinus. Work Group 4: Smoking C(lnlr(>I Through (lie Workpl;)ce C mhloycrs can have n grca inlpacl on Ihe sulukiug bchrtvior olcwployas and cm- ployccs' Limilics tlirougll workplacc smokingconlrnl policies and progremv. Thcse bcuc(il both employer anrl employce. They mccl cnlployec heallh needs whilc reducing Ille cnlployel's smokingrclatcd expenscs- fhec elrc fvc main 6nrricrs lu inl rodudug such prugrmns ~Ind pnlicles: • Pmployors' Inck of knnwlcdgc u6out smoking isuus .utd smuking conlrol, • Pcrccived conllicts ill Iabor/wnnsigc- rnent Iclutions, , • Luck o( eviJnlcc of progr,un cffco- IivCILL'SS, • Innctequntc resourccs, • t-ack of infonualinn about cosls end cost-elTcclivcucss. llic follnwing recomrrmcndnlions can help nvcrcomc Il:rsc b:urlcls: L Crc:llc :r mudrl tuipl,nll" I.,.... smnl;ing cunhul, v.iut, Ihrsr I;ui,lr!i (~~)I?nll•Inycr: (nl cmli~, , lallvcs, sucll as wcnns) sh,~~lll 1ic11snle In Ihi tl;cirrt ~,uJ int[ tion of thc I'nlicy (b)11 sllould hc ullaplahlc lo d liaus. (c) Ilshouldtakcinlouc~~nunl IL,aI vm1lic.t: isndSirlivc,andu I I '.._i -! lin.,.o ~ aic urta6lcnr tulrrillinp lu slup sumkiip~, culircly. (tl)II sLnlJd hc sni'I°1:"i hv nli I:acis of IrtBltlll!t]uonl . (c)'Ilic Isrillcy thnidd nnl rnlilli.l rr,ll1 ui suhstitute (or Illc cnmpnny's „hlip.alinn Irt moirllnin:l sltlr r:nlLpl:lir (f) l I:c Irstliclinuv Ilol'.,I~Lf by ILr p~il~tv will bc c~llniccd- I I:rsr •,I~nldd ;n.luac

iI~l"rAlt pac4.ngt4pnd;ulvclllscmculslodcscribc tlre huinrds uf .urol.inl:; ;mJ - cliulosutg Ihc yu:rntiry aud icicnrily of IJI adJiliccs lounct in cig.:ucrtes. Ihc cig;u cue indusu y shuu!d 6c Im!d re.pun- sib!e for demonslnuing tlre salrry of lobncco [rdditivcs. Slrcngdlen, cxpand, anJ ;tJcyualely fund Pcdnul plugr;uns of prcvunion, eJucaunn ;rnd inlbnnaliun, iududiug: Ihc Office rm Snruking unJ I Irulllt ;urd ils activities: • scicnrilic Infunnation, 6¢iudlrg Ihc SurGcou Gcnct:J's mmnnl repurl; • advcrlising and mnli;l inilialivcs litauint; un Ligh I isl, P,~uups; • rnaiuluining nJcqunlc dala b;ucs nnd swvcYs nl' pub!ic atvnr uress, hchaviur :nrtl hcdlll +I.uus in Idulian w snwk- ulg, ineludinlt infurwauuo Guin Ihc N:rliun;J Gmccl !oslilulc:mJ Ihe Na liuual ('aucr lur I lcelllr Slalinlics; Ischuol IrcnIIL cdnruiun piograws rcl:rlcJ tu 5nwkiug tmtl hc:dlh; ~ ulllcr cduc,uiou:d :rclivilics, suah as: • an nppruprialc puslaBe slwup on thc liu/urds nf smukiug; • Irre lilennure in huvumncn( uflic:ei for di.lribllliun to t6e pu611c; • a urollu lix guvcrnmatl liqws Nn(1 slw iuua y: "Srnu6ing is I)unEeruus lo Yuur llca!Ih." I~liminac crup pr ira xuppur Is fur lobuc- cu aud renlorve luba<cn frulu Ilrc Pood fnr I'cnte I'roglam. 12cquire IhW nll cigurcllcs m:ukclctl irl tlrc Unilcd Slalcs ur sold by IJ.Sl numulirnurcts be sdl-calingulslriug ta rcducc 6urn injury, (lisubi!ily and Jcalh. 6. Approvca"SenscofCoogicss"resulu- (iun on smo4.ing and hadrh. 7, (111'cr lo.c iocunivcs lo iuduslry lo develop smokc-lice work :ucns, and smoking prcvcnliun and ccss;llion pro- grmrs, aiincd p:ulleuI;uly tut oCdrpn- liolyd exposule la su6slnnces Ihat in- rlunc dre risk Irom srnoking, 7hr l;Arrume f7rtrnrlr I. llle Ilcpminrcnl nf I lcallh nnd I luman Sci viccsshouitl monirnrlhe nwn6er and (I u,dily uf pr evculive Ircuhh scrvices pru- videJ hy the slares unt!cr Ihe block grunt prugiam, especi:dly Ihoso rcluling lo smol.ing. If, iu Iwu ycnrs. Ihcrc is II notice,rlile decrcase, speclllc Fecleral fnndln(; sFtoult! Ix ratoiec!, 2. lltc I)cpurlmeul nf I IcJlh and I Innran Snviccs anJ Ilre Ikl'arlmcnl nf Iiduur liun shurJJ rc(Iuirc Ih:u tdl Grimlec anJ coulaa iustiwliuns adupl Ihc I)IIIIs slunJalus luf Ihc plolcclion of nuu- suwkrrs (cg,. Prohibll smokin8 in clcvutois, cnnfcrtncc ruorns end ulhcr Iwbllc arc;ts) ;md assurc Ihe nvuilabilily nf nonslnoklug nrr.ts in cafclerias. 3. Ilic Ucparllnenl uf Ucfnrscshuuld nol scll cignrclles ul o price lower Iltan Ihe evcrlrgc prcvalling rnlc of Iha sunound- iug ure;l, 4, lineir br;mch nflhe f eder,d governrrmcnt ---cxeculivc, Icgislativc and judici;ll - should scl ;m example ns an ernpluyet by prolccriug IIiC ri;;hts ttlnunsmnkerx; guaranleeing snwke-flee pnb!ic pluces; And pluviJing snuI king prevenllun, edu- cnliOll urIIl CC)saliull 1IIp(fl1r119. Wc)rk Group 6: Priority State ari(I 1Ocil Governnient Initialives M;my aclions simi!tu !o Ihose suqgesleJ hy Work CrnupS can hctakcn byslmcund lucal govcrmnents to recluce clgaretlc smnking• lllc proh!crns of cn;rcting ncthliog Icgislnlion are somewhal sinti!ar lo Ihosc fnund :u Ihc nalicnrd level; for Ihis rcavur, Ilre volunl:uy hut!I!t ngencics nwet finrrt 9nle cn0lilinus wlrich mlrrnr Ihe nnlinnal cou!iliun dcscri6cd 6y Work Group 5. 'lhrsc vlalc cu;dilions nmdd bc triloiul lo bual polilical rclJilics :rnd coulJ fnws on Icgitlaliun musl Irp!nopiiNlc In (aud in('sl likely (o be aplnoved iu) Ihnt arca. nnc af Ihc frst nctions of Ihcu loenl cuallliuns shordc! be In pall al t resiclcnlt oil lie ne<d fnr stronger smoking limirn- lious. Sincc Ihe Inajurily of vuICls :uc fnonsnlokcrs !wd wnny /trc hccnminl! cnm ceruccl about Ihe effecls of pnsnive srnok- iug, Ihc resullsof this poll Could Ilc uscd lo iulJueuce Iegis!alors irrlo supportiug an- tismoklug mrrsures. 'I'he coalilions Can Ihen work In enncl Ihe fallowin,G: I. Isgiskrliuu Icr limil lohnccu srnokinn in the tvol k plnce nnd nll places visi!etl by Ihc gcrrer.d public. linforccnrcru of Ihis lcgislolion shardd nol be hmsh, hut shou!tl ullnw anyone abgneved hy a viulnlion lu iuslllutcaivil action, 2. 1 cgisl:uion lu permit Iho r.tle only of sell-exlinguishiug eigmelP_s. A public eclueniun eampaign shuuld enq;lmsire Ihe ccunouilc, sucial mJ Lre•6h ',i qucutcc of fires r eigarcltes- J. Iiccluirrn'•arls to '.r.•I'cntr '~. Ihrou-pL !21h p :!tL• 1~ ..,.. .., !I~.c cnnscqucnccs nf mrt~t.l~•ip. d. Rclpil;ilionvioannhcl~.ll.l;irc•'.nJla~-il pnv.r nl ni p.rn i .: ,. nrnllin <n Ihc h~ rll ,<<li i,.c• „I snmkiug, nnd In Ollci sinu4,iir•' Ie•,',a- tion progrnnw lo h n cir',I'J,r,cc,. 5. luncitccl sl•rlc. r;ncs nn cl.pnirl:r;, LI !)CICLnIn(tP Clu~nLnl1 .r~.~I . . I eduenlion antl rracmrh nu Inharcr, ref•tltd disc;rus, 6. Heslil .iont m: ~...rrn m!rr.. (c',I~tiriP)' in IiubLc Ir;ul.ltin un publ lc pi ol icl I)'J. 7. Limiluliunv nn Ihr.nb0 nf rilla1cllrs n.,,rt cnloi .ncil ui~lT , il,~liti. IIIC S1uC ol ii[SmcIICS Iq niirc.i 8. Il:wn'n,.g 16< di~.!iil••..:C.,.I cr CirarcUCS. ond Ilcallh innu~wrc la nnmiur IU.I r!~ielslinn mLidr es,,,il.l n:!ie I~~b;u n srnukc, I k,~ Ihal LL mipld I~C u.i. u I :I 1!J. i I lun p~rr . 1 in nm t I l;.r•, In ; L~ I Con$rrss.'Ihr hdoiinnlimi ianl,l i I,rn hc nmJc iL~^•iil;iIde icv.ion ~ri;l,~.

I,,. P7 (Pr1) ~efL `f 71ar ll t r r v r 0 ~ ~~ t rR,y I t~l*~fir r~f R,~f t.+t ILF 'y Y r I/ ~ r m ~ l t' I r~~~-a(tr rx~;,r~~~ il -~ i(•,us autl lubbying cl foi u lu cnacl Inws yllihiuug sucll smnking. huuls1hould mtlkc aspcciGc elfnrl to :ulvc parcnu nnrl yuulh gluups in uwiup, iinplcnKnting:md suppulliug ;it nuusu!ukinl; Lnd conlprehcusive nhh cducuion plugtnuls. :eq' tehuol t1isLliA shuuld cnlpluy a y11:diFictI hcullh educariou specialist to iududc :mlismokiiig infurrn;llion in tlistlicl-tviJc schoul hc:rllh plofrr,lnls. 8. AlI sthlnrl-rchllcJ prufcssion:d nnd vulunlcn org:mituliuns shuulti issue stlung pu.ilinu stalcmenlv cnllint, fur nonsuwking and cumploheusivc schoul hmdlll ctlucuuuo ptugl;lrrls. p:uicnts svilh respiratory nnd car- diovascular dlscnsc. 2. Adopl bl:uldnrds nf pratlice fnrJculing wilh snrolCecs ul Iligh rislt due In ucrupu- tion:J csptuuru. These should culphnsize: (:t) Ihe harinl'ul illlel;lclirnl hchveerr snlnk- lug nnd specified necuhnliuntll ex- porllres; . (b) rnlucing occupnlional exposure and/or con!rntling s!noF:ing by thnze prescnlly exl)otit'd; 01,a (c) finding uncl helping pcrsons alrelldy saf- fCring clswage as a resull of irltclnclivc C%ht1S111 C. 3. 1'mpll:lslic balL the Prarlilirrnrr's "dm Ip lu irtform" :Inrl Ihc palieN's "duly In undcrsl:mtl r,nd :ICI." 'Ihe risks ;Issociuled wilh smnking shoutd bc expl:lined so Ihnl Ihey ;ve unJerslarldnblc ta p:rlienls; infnl innllnn nbout discasc, umltality autl Ihc socinl ;Intlecnnonliccffectsofsnokingshonld 6e heronalirecl. Special connnunicu- ' tlonsshould6cdevelolrcdfurmiuolity ;ultlicnces. "Infarmcd cnnscnL" matcril(s should 6c given to Ihose wilh occup;rtinn;d expovwc. Infnnunlion on smnking slalus and hipll risk exposlur. I sholdcl Ire enlcrcd inlo , II niedical recnrdv. , q. bevclop prucetlures for self-assessmcn( uf higll-rislt smula6lg. 'Ihcsc shuulci be developed 6y rnlnldmy hc;dth :Igencics nnd olllcrs invnlvcd in srnuking cunlrnl, nnd dislri6utcd IhlnuFh u!cdic;ll ppsonrlcl, industry anJ thc luedia. 5. I'raviJr tusisLlnt'e hl smukLlgcessullurl. I)cvclop Irnl6 sclf-hclp;InJ ugcncy 1'to- , glllnlw lu rlid high-lisk smokcrs, for cx Work Group 2: The High Risk Concept in Smoking Control Iain snlukel s:ue ul copccielly higll risk :CI nlllur[ fllOrluliq' afld CscCisive mur- y'. Ihuse t. llh conJiliuns Illat arc cilhcr uh.ned by or mlclzcl teuh cigalcue king Io raioc uwl6iJily ;rnd nluu:dily ..'1 hcsc iudutk: Icdicnl conJitious, auc6 us: ng dlstnsc (csprci:qly t61 nuic obsu uc- v< pulinon;uy Jischsc); ,I ipha al al lci y Jisentie; xon;uy hcllrl diumt; Incen of Ihe cip:ucue-as.wcinlell sires; culiolisw; _uulC plcclispnsuion lu, or I;Inlilitd islury ol, wioking-raluteJ discau; rc}m:mey. rCCllplaiufl!d 1i111i11iUUS C).pOEUr[ lo ,bcs!os, ur:mimn, wul, cortun Just, :utiiulalc m,rucr, wlpluu tlinxltlc ,mtl .u6oi1 munoxidc. ifcstylc: iph tlnspge suwking (tldlnc,l by lolal I'c'Ihnc drtie-Ihe nwnbu uf cil~urUlcs ulnkrd p<r J:ry, Ihc noulbcr of ycars of moAing, Isr:luJ wc,aine eoltlrnl ut lhe igIocncs slunkcd, inlcnsily of pldlwg, nunlbel uf puffsl; • urcllpal luns In tvhich I here is n higll pre- ralcurc of smoking (mrsing, b;lrtend- iup, Icslaln;tul I:Jdc-wniling, hail' slyl- iuR); • dlugnbuse; low rconomiC sl8lus; • rnclnbelsllip in u minolily group. We Ilulsl (ind w:1ys to ConviOce these sluokers tu quit. One of Ihe mosl Gusunung plublcrlrc confronliug public 6callh teakers is Ihc opp:ucnt Inek nf Icsponsivcnc:s uf "h;ntl core" snlakcrs to brhlvinral approudles, us well its the disindlnnuun of many smokers lo quit dc,pilL cvitlcuuu nf Ilcldlh irnpairmcnt-'ru do ILis, lvc nmsL: ' I. Adupl sl:lntl:lyds of pruclicc fur dc;dillg tcilll smoker, :d high risk tlue In Ihe rurvislenee nf ulhrr metlic:d cuuditinns. 'I Letic wuuld hclp I'hysici;uts and ulha' IIe:JIh plnfestiionnls lu idenlify hihh-rLtik slnnkcis, untl givc ILcm infnnnnliun nn hutv to clr,J tvllh Ihese palicnls;md whal Icnrnuccs ;irc :IVailuble It+ hclp. I'riolily shuulcl lie givcu to prcBn:ml veouurn nnd v1.ISn9f;0 nmplc, hlzek lub:m inulu.; I iu tlic mcdiirll munlty shuulJ h:cuinc iuinl pror floul' Ice'ci., cs-r1t,a.. rrlodclc ;InJ n stq,lwll nalvr..'il: II cs snlokcrs. G. I'Itlmutc edut'ulinu un Ilir rnuirpl n hil~IrliJt snlnLing nnd il. n,moquuur, "ILt' veurr:ll I vl.lit +I,1 ~:.. in bulli Irniin,iic r:ue ~Iud :.p liipn, inc!udlop, 1~, .1 .Li prarlicc; n ... I,lilmun'u'y:ultl ,1 I lt'ull li Innrrr;inn:dY rmhc Iruc lird vre wcJi:ul;nl,!:"..,.I .~,I I~„ W Ililmtv y r:u c ~,i~,:., .~.,i.ilI ~,n, nn,l psychul(w.ic,il nr,i ;IYSUCiulinnS. 7. I'runlule rescarth nlt 1!n• ,~ rohD.r, high-li.i: swnl,iup. Invcsligulc (:) imlm:nolugir-ul eia!m; Icvcrsing Ihc hitth riA n(amrf.ii~.s~: (b)bluloy;la[il Innlstl. !''1 ~1...;v., stlcccpllbillty; (c)binlnSical (csl'.r'r,ll!y :~~~!I Inechnnisnis invnlvcd iisk nf sinokinE; (rl)Ihellnssihlrlo!rnflrlinnidsiirr~,luriu![ Ihc liskof sr.~okin{r; (e) imptucccl lucllnrdi hn r u,.r.cy'iir-hC"r- nmlion lo I'erlp~c :l! h'I_r.l, tnL:. :n.. I I,.r niulh~u(Irlr 11•,~"n !.. sn•.,rking; ~. (I~Ilic bt'Inivinitd ui,pinI sluoking; (F.)tlle IISk slalnc nl v;nlons ~ihim- IIIi1lUlltiLs; (hJloup.lcirrl<If:~cknl i ,. .r i .r.l nftcr Inr'pu:mcy;

yr.l ~j~ Gl~irop f s efr: ~~. 4"'1Vrl~•(r~rFj~~liJAll~~~~l'~?l!~i•f~~l~'J~~~./ 7f,eYY--~~~llr vl...r.....r y Y ..JSU.IIU.b ...-~ -. r Work Group 7: Tobacco-Rela(ed Research . spi10 uf seidrsp:ead ucccplanct Ibal ;ucue smoking is Ilrc nulion's uu:nhrr e puhlic hcallh praldem, Ihere is no con- Icd,naliuunlelfoll lodclunlinetlrepro- ,scs by s,hich smoking causes dixasc, .nbiliry ;urd dcallt. Ilrcla is inAdtquulc ppun I'ur 6oilJll:g Ihe cpitIcwiuloglc;rt sc of vnoAiug anJ its rtlnlecl Jlu.ucs; in- cquale uuiuing in ILe cpiJennology. :,rm:rcnlugy rrnJ p'dlhnphysiulogy of I;uelte slnuke; iuuJequalc pru(osiun.rl ucetion rcgnrding:ill :upcns of smoking; d Iin:dly, un irmJtyunlc baae nf Imowccs :dudwg Pcuplc spna• :rnrl hudgcls) lo :el rhtl IcfUrrdr llceJ9. Cwrcul rrle:oclr is wudully lacking, anlrnrcJ tvillr Ihe m:rgnlwde of Ihc proh- n, in n nu:nhnof ;urus: ) dre irael:ruiou of gcnclic, cuvi:au:ncn- lal nud other fuclo(s svilh cig,uellc srnul.ing; 1) dm efkcls u( iuvohmttuY muoking; I)Ihc mcchanisms Ly ,'hich diseascs ;uc proJucccl as a rotdl of ng;otllc snwF,- ing; :wd 1) Ihc elfcets uf the couliuually clumgiug lo6acco pro.L:<I. In orde lo hulh dcac:ue Ihc numhcr I ncw swuker s owd w iucleuse Ihc uumhcr iro yml, il is t+scnli:J In Ln,'c rdiablc, :;rnd:udlrcd J,na un swoAiug hubils htli- .Ides ;mJ Ilsks. "ru clo Ihis, we musl 1lprovc lhe queIlly ;rnJ inacasc Ihc u:mlity uf d:rla Icgarding smoklug ill Ihis cuwrl:y. lhueforc, n national "bh:cprint for ucliuu" shurdd hpve Ihe fullowing com- poneuls in Ilre ;uebi nf tohaccnrelaleJ t<sc:udc (I) II iscssculi;d to crcntc;r nationul. Pomcf- ful, polilical focus lo spcnk for tobacco- rdeted Iese;uch in Coogress, in lite Itx- c:utive Ilrallcll, ill univcrsilics nnd to olhcr inlcl'eslccl groups (sce Work (jrotqi 5). 'Ib acurn:plish Ihis gu;rl, [I "n9liunal cno:dio31i0g CMUlnitlee oil smuking rescarch aud control" should he esluhlishcJ. 'Ihis comnrillec shnuW lol:by Ibr long-Inm aJuqnnle supporl lor Ihc of lice on Snwkiog anct I Ic.illh. (2) I.iulr It:orhrclivc rescarch hachccu donc on Ihe heh;lviorol und socio-ccanu:nic aspccls ,rf cig,rrcue swokiog; rcFativcIy fcw p:ofcs.ionuls mc Ir:rincJ to (1011 lis. Ihc n:rlinwd coordin;tling commillcc shuuld r,rke dlc lentl in mecting with Ihe IvaIessioual suhocdsund sociclics locn- cuurugc rhe clevelopment of cul'rieula. and manpowcr iu drese nrcas. (1) Ulrln is collectcd on snroking by dif- furnl invclic'.ulnrs In diffelcnt w1ys. CrilwLt for descllhing ealcgorics of smul.vrs n.s Iif,h1, he;nry or cx-smokrrs h,:ve uol hvtin vitndarJized or quun- IilicJ. Ihcsc crileria should be dcvclupcJ hy lhc coonllnuling cowlnit- tcc, so Ihm claul cnllcacd frorn dili2rcnt somces can be courparcd. +.µµ ,~~ d4 t{ ~°t!a ~11.if-1,IJ,h Work Group 13: Countering Cigarelfe /1(Iverlisin}; 1 hc one billion Jollar advctising cnnr p:tigns of Ihe cigarelle induslry mislcad cansumas by olniuing infornuuion nboul tlte fhcallh risksof swoking. Twcnl y hcrcc•nt of the Awclicnn publlc do nol know Ihnt cignrcllc smnking cnuses canccr; 30 pcrc'cnt ;ve un:tw:uc of Il:e rclalionship bclwcal smoking and hcurt disease. With Ihis in nrind, Ihe wrn k group Oil mms:'tedla ce- ;unlucd wlrys to pleveul suu kurg, hclp iuclivldn:Js lo quit, and prolccl Ihe righls nf nonsnrokcrs. II matk llrc fullowing pru- posnls: I. AViIrning Slntcmcnl Ivll suppolt shordd be Kiven lo Ihe U.S. Peclctal Tr:rde Convnissiou's recoln- mcndmion rhal Ihc currcnt warniog stNenlcnl should he rcplaccd with a tougher, more 5uccinaf wurning. A scrlcs of rmuling st:dc:ncnts rclnting to lung ctmcer, hGrrt rllsrae, emphyse:ua, fetal dunrnge, ela., shoold be con- sidcred, basccl oo the experiences of ~ Pinland and Swcden. A new design for the w;u niug slaleurenl shoulcl usc colors Ih;tl will makc il morc nuticeahle. 2. I'uldic Relalioru Campnign Vcrsrrs Ihr•. i "Ibhuccu htJuslry I 'Ihc funcllon of thc volunlnry hcalth ngeucies shoulcl Lc lo etlucale the pub!ic ~nhoutlhe:isksofsmokillgtrndthebene- Ins of quiuing, and rlol to eugagc in debnles or confronl:rlians with Ihe cig;rlcllc induslry. Ycl Ihc induslry spends n substanlial n:nounl of monoy Io counlclucl Ihcsc publlc cduc:ainn canrpait;ns. to offsct Ihis 111,11 ional organivalion of concerncd cilimns tµininsl sn:nki:q•, slmtdd 6c fn: rncJ; il s funcl ian s,rn:ld bc lo cllampion Iire lighls of uoumtol.els and to crrunlcr Ihc nrlivili,~s nf Ihc 'I-ohncm lusti'ule (Ihc Iniblk : rrI::IFmv urnr nf ILc iud~N:~'1 Snr6 .n: oir. Iiun,vnnLl:n~,:;lhn.,ml.:l. • ,,: Ihcul~rbli:,hal, q n :_s..utI rl r '_...- iug Iranl laictrt i'-,•J.. liuns I ri nrh,c: 1. I„t c:Nlty, it wunld hm~c',he ilcxibllily lu .:cl in IS the righls of non;nu:fs:;- ,l. Rcurl:ing Aliur:rir~;f.rnnl~.~, I.illle hus boeu d,mc ;n i,ilr,:rn: L,.,.. , Ili':prlr_s aT.:l : ! ~.'.u•.:i!. :,:.,...~.: lhc hcnllh piublau; in,uned Ly rr .: rcllc s:nuking. (~nnnn::n,r.tllrm sl,cei,:l- isl.s flunl the vnl,ml:ny hcahh :,:•o.,.,i,~~ shuuld tlcvclop n c n:.i'::ic,'r u: wL!•.:lt for Ihcsc grnups. This',vnu;,4 cut::,l t.. usc o( I,ress, raJio a:e! Ici,o-i•,i,m , tions. 4, Pdilnri;J Covernge Nitcglvincs tuc 1101 p:o erlilrrtiLl(wplJgaul Il~cri.V, ul, ir:u,'Ir snloking. A`.'ilh Ic:v cvcchtimm ~:lr-. and Ihc Nrrr )":uF.ri1. c~'o, •::::r: :uagneines c:rny esle::+ivc rit•..::c~ne ndvcrlisiug, sIhich nl:1y inllu' :r - editolial policy. Sincc gnvunn:cnl l in Il:is arr.l iI invr, mcrlinp shntdd hc h<-IJ „iih tL< :. cculive cornrni:lcc nl Ihr Ani,:::•:m ,incicly nf V,:y,vin, ~ I~J~I~_. Ihcncrdluinloi:n~onswnris.d" ri::k nf smnl.inv; hnLli.b.~; ~~

;Ulrl'ORIAI. I ,etting Away With Murder I I.ll I I II H I I HKY, M I 1 Ile 'Iirbac<u Iuslilule Ohe puhlic lufa- Ins hnu of Ihe wajur ll.S. luhnccn dom- ruicl) Ilas I:rAen ILV ol fensivr iu the bnl I Ic ~cr slnoking cuNtul- for luo lolrg, a haccu iuJuslry Sptrkelanau d:rlms, Ihe Imiswukiug briF."do" has "8ullcn aw;ly u6 mulJcu." , 'ILe nwsl recull Imizcl of (lie tub:leco nnpauia' .nwck is dre 19A21 LS Sulgeon enel:J's Itcpoll, 7hc• 11c,dIH Cn7nc- urna') nJ.S'rnuFfug: ('rrnrrr.' VVhrn Ihe :poll Was lclc;IsvJ, Ihc lulsl<cn iu(hlslly aS "leluly IU lld--Ilol IGIfI." ~l Ilelr IrCI: ublishing a Icbullld, "Snlukiug luld 'anccr: A Siiculilic I'uapcdiec" rchich hlCs Illal Illa[ We "uhcious prnhlonl9" nd "siL/uliulul dcficieucics" iu the vidcu¢ liuking ilciucllc sln(rking autl ancn, lhe Illallllltc Inlcuds lo use ILi, nauncul lu IilAc "a mrrtc visilrlc xn(I Iq; res',ivc Inlc in Ille bmllc 111111 anli IuI):rc<u urccs," , cLurJiug tu uu cdilolial in Ihe lubur('u Hrpun('r, :I I"drlc jounral. Aunlhci pronp In the allack is un ccouanclic sWCly of lobo¢o's cnnlri6u- l iuu lu I hc U.S. ecouon!y, concluGed by the Iluiveully of 1'ennsylvuniiu's Wharlon Ap- pllal Itusr:uch ('cnlrl, Imd paid rOr by Ihc Luv Illnl Cuvinglou uud Ilwliug, which Itplcscnts Ihe 'li)huxo Inslilwc. It limnd Ihill lubaccn tonlri6ldcs $57.fi billiun lo Ihc I).S- ceornorlry cauh year. 'Ihc bcnertls inl- pWCJ by Ihc sluJy ulc nol surplising, since Ihe uulhulz uckrlusvlaly,c Ihal Illey iliunled "Ihe ccuuourieinrpliealiuusof hcalllt issucs ;runcinluJ wilh Inbuccu cnnsumpliull." Irl olhtr wutJs, Ihc study Intdtiplicv unly Ille 6cncfils, not lhc cosls, of /ohaceo pludutls. It Inn hceu usrd exlensively hy Ihe lbbncco I nslinrle iu u selics of p:II1lPlllels ol icnled to individual stulcs hl culubitl cfforls al slnok- irlh CWr1101. lllc fobaccu inslilule hns also plcpalyd u sclirs nl' aJvclliscrncm5 lo be Id:ICCJinNerrSlrrrk, linle, I:V.Gudrand olhcr nuliowrl I I.S. maC,a<ines. 1hese plo- mnle a hnoklol Ihal purVorts to answcr "I6c most asked questions aboul ciFilrclles." Ihe ads urge readers lo "wcigh bulll sldes bcfore yuu lakc sidcs" run7inurd on/xlgr N CONTENTS Ill)f I-OItIAI. CellingAwlly 11'i16Mnrder ..................... . I.Nhn lnry.ILS.A. RI?I'ORT 'l~hr NaliumJ Conference un Smn6ing (1K Ilrnhlr; . . . . . . . . A Suummry Itrpurl . . ...... . ..... 1 I IYSIOI-OGY Aulismaking Actiuns in Frnncc: I~ivr S'car ftruullc . . . .. . . . . . .. .. . . . . . . . . . . . . . .. . . . . ~NI Jcumhturllu Cohrrr9<.Ixl. linncc Snroking in AfrinC .. . . . . . . . . . . . . . . . .75 'Illr ('nminl; ICpiJemic ..... AluncJ I.rL;r.md I:virlr 16r11. ( Irnr Ilriluin I Inve'Ihr nnd Niculinr ), 'irl(Is nf ('igarrllrc Chnnl!rd2 ..__. 11 I_Ymr T. Ruilrmsk' 1'1 S. Itlrtrrl, I(' Ib~bh!.. s l `L., cu r r I IJ.S.A. 1)ues Cigurrlle Adverlisinl; Mollvule ('hildren'! )5 SmmnChanru.m,nrrw:m2 ('ll;nrellr Smoklug mld Ilctvin/; L(rsc . . Arrr:J S. Ibr:rhirn:u!J AlrmcJ S.I'xn bi. I'YYPr NLWS Clabld News .... . ....... ... . ...... . ..... . .. . . . . . . . 11, ANNOI.INCILMf1MP fif1111YmldCarlrerenccanSmnldngnndlfenllh... '1 ! CUVI_It: "Gnulr. nun rurnu" (IhnnL 5m,, I dm!'I s,uu6c") Vnslcr wns doli ntd Ioy r,lrs. 1r,dnr ('nn.rrd rnr p.r. I.~po IIUl6urr, Prr lu Lallu C'unlro I liun~~d, IlrtiGlr, Lr,rllin, Ilrrly. V.rrl ,.111, prnnhJmr. -_ WnId1.USSl1r)I:IN(,.41117AI:1'll Allr'q4mmur d t'urrprreh~ i,.I n.r vr.l.7, No.2,-Swnrnru, I942 rr~nrrlrv~,rr_ Pra~l'ulrcd ISrrr rirrn, rr,rr Ivh,i.~.~. Lu'. I'uLlrhrd by rhr Anrrrlrurrr C:vrcerSuc'mry.lna NnvanhcrE disbibulcJ Lcc m rLC Ihu!rd Siairs nul 717 I IuN Accnrrc, N.w York, N.Y. IIY)17 ;rbrmrl. ISSN:OIM1I~7672 Ibr inlurnertinr, nnJ iJr:r, in i1!rsr aiu.l„ ero nr~.r rd Ilm rrmhurs, rr,n rr,cu,.u,ynl !hc,~'r,j CnpydgW r9 1942 Arncricnn CnnccrSncicly,lnc. Socicly.lnc. __ AAtI:II1CAN UAN('I•:It SO(ll:ll', IN('. (IIII(l'.II4 Rohrn 1'J'. 18rrlrv, Al 1). .1h,n K. Junue Lr,r, II'.:Ir/nm, rrrrlrlnn (~/mirr,r,or s,rr_ li~ r l+r,rdr~rr I"111I1/11IAt. AIIYI4t111v IIr1AItU /'nJ 7. 4lrbn 7),.1l. C Mr, Nrno.,..d IL. G.OuAhrv Pr 1 xl llem,n..nr fq~.n..Sr~n;rNnnA N1(,f/_V.A. fbnrhridRr•.U.h'i tirordlrrJnr.1.,ed.n Ur. A". llp,ur,v Ur. R. Alu,nuni 7)r. N. N.b.,.. ./r (7do,Nur vv Crnr , S'r~rrr.r7und "' ..S1.rre"rl.,,rJ AnG, "I""p, Pilbor: W;dra S. Ituss PruJuoi~rn: M1tarsin lurrL, N6rJ I'. I Lo-olr. Al.rnnaing I'Jiruo P.Ilcn Bus<n Gdlrmial rAssislann I.vuueuc I Luvll AtcJinJ Advisor Ndrolxs Ci. Ilouiglivrl, Ivt.l), I)wlyrc Cmul 1 clue Surrhriaal ('nrnulrurl: I lrwance(I:uGukcl Cnpy'. %I.mrcur liodd:rrJ Irrtrmerlounl, GurY S dc Ilmvcn C'vcrJam.'r Ibru:dJ I)ndd.,r

silf~'~V~ll!rytr.vlA~S!Ylll~4~h~!JIf rftcd to devote a fail nrnount ol~ sVacc o anusnwAinE utessoges; antllhc Ullice tn SInoV,ing nnd I le,dlh zhunld provide ill wtlh Inulc inlolnl!niun lln Illis upic. Irlevixiun anJ Ihulin Cucrraige Ihe nwnbcr of anliatnnking uclvir- ixwanls bluakhjul duriug lu imc I iwc is _onvdcrably loss'tr th;ut when ciH,ucllc tdvnlising was:Illuwcd ou Ihc Itit. ~ILe vulumu!y hcnllh .Igencies shnlJtl umr 6inc Io I'cvctsc Ibls du1nswing. In ndJluon, thcsc allcncic4 shoultl mect wll6 rcpiascnlalives nf ILe Screeu r\c. lors <n!ild, Ihe Sclccu \\'i ilcn C1uiIJ unJ othcr suc)t giunps to discuss ways lo im d0dc infunnWlou Abunl lbe Iisks of s!uoking :rnd Ilte lighu ol notu!oukers in lihus uud tclrs'i~iun pIogr ams.l~elcvl- siou suics willl lar6e. Ic6ular iwJicuccs ',ue pnnlcula!ly good schide for ddrvcliuil tbc nnlu!nr,V.inH wi~.s~upe. 6, Impmi of ('ignrclle Arlvcrlis'ing h1;my rese:udters Cl,tinl Ihal cigurelle ntivellirlug is deigncd lo lure lcenagus into tLe hnbil and cncournge snokers to w>utin Iheir hablL As ycl, hosvcve, vahd ~cu~uch lo mnlinn these hypo- lltcscs hus nol hero unila Iqkeo. lhe (1f- lice nn Smoking wtJ Ilcnhh should mouintr und eollcd reseu'dt on Ihe cf- fcclsul t'it_mcllcadvcllising, valshoold enudocl uonlcul ;inaysesof Ihese adver- liscntents. Ako, Ihe cigmcile intlnslry shuolJ be Icquirecl to prnve Iltsl their adveli'ing dues nol nffcct Iecuuge smokiuH habils. 7. C'Igarellc Mudcls -Illc vohmlary hc',dllt uqultlles shuldd Ncck m cod lo II!e use ofhinnan modcls in cigolctle mlvcrtising. This is nol nmanl lo climinale ci6areue aclvertising per se, bW In slinwlWe public c'onccrn nboul Ihc nrlulc ol'such ahrorlising. Work Group 9: Motivating and Assisting Smokers to Quit on Tlrcir Own ! is IJw"'rl Ilial UbCl llinelfi111'1 UI tI1C a,!II nu!nbcr ufs!nukas sclhu ;ucc1sslully til Jo so sN~i!hont hclp; tuud Ihnt ovcr H(1 :I<cua nl eurrein s!uul.en want it) slop nu6ing. A priwury cv:ry lo Zu,isl ILcsc nukns "uul.l lie (o dteclup und prulnmc ~ILhclp piog!wns Ihnl cntphasirc: 1)Ihe vngcn nl quilling (dceidiog lo yull, piepanug lu tptit. Iwd tLeu stnying ull cip:ucnnl. ;uld 2)fuaors ;usnciakd svilll succcsslul,;tl~ Icmpls ti) quil- '1lLCSC haoois include: A quiller is ntmivnlcd by n hcnlt6 Ilsk only If il secros pnsnnnlly rclevn!!I; mnsl sutokcrs cluim to he nuiliv,urd by posittve inccwives (e.g., wolc slnnnmQ rall!cr Ihum ucEalive iuccn- lives I( .g., lisk uf nmcer); h<nllh xnd !n:ulcry are (hc p!inrny goal) of people who socce.ssfully yuil; physical nntl psyrholutaicnl alress nrc Ihe wnin swrnbling LlucFs ill s!noAc!s who dn nul soccceJ in sloplthigI cac6 smokcr htu nn uplimal Icvcl ill fcul :uuus:d, beyontl svltich he will time ~ %h il k~-t i aa~-IT iza j4i~ ;'<[l~~Oj *,,#1'n I 1-111 1! . w ~ ~ ~ _ out comrnunicnlions; hnd expcclntion of success predicls success. Many ssnokcrs wunl lo know altoul Ihe spcciGc relaliousbip belwecn 5ntoking cncn!iou antl wcighl gain, rntl wlcn lo clo lo uvoid obeaily. Tbis Infotmulion shntdq bc includcd ill any.sclf-Itrlp IxoV,inm. The Wolk (uotlP recommencletl: I. Sclf-help progtarns sltould expl;lin that slopping smoking is a nmlfrslagc pro- ce,ss, not u single evenl; one slip is nol overall Inilure, nnd there arc conactc ways to mnnnge strcss nutl cnulrol svelqhl. Sntokers shoJtl he laut;ht whal to expect wlten quilling; Ihe imhurlnnce of spcuficily in srlling d,nc, Inclltod, etc, II!c procedures used by hcople whu successl1111y quit cold-lorkcy, ;mcl how Io an;dyzc an unsuccessftd allclnpl, II is import.ml lo refule the notion thw smokcrs cnn'l qniL Proglo!rns .shuuld idcntlfy silualinns ill whieh ntnsl peoplc encoonlcr difllcuhy aod duunusuu!c how ill oVecoloon' Iftont. Only Ihe media cmt ptesent wn~lt Ivu 4t:lmslnlltcr,nmltVit,:1 oL1~lr ...._. mcssaprs sli~~uld Lc r,!II snwl.cls, but lu ;h.'ii ! r IS icnds;n wcll. cinl>It,r,iiln/~, Ihc nrr~d ho cr:cnutnltnnrnl nrld Siqppuil. 2- I'hysleulne :md nlbct Itr.rlli I,c!.,mnd shntJd hc iufn!wcJ tolu tn h~b:.!g i 11 , .,~p, ('tmllnuinl; !mahnd rd, ir,tlinn t'!:tli!•. sholAtl bc nflc!rJ I'n ailcnJl'••l, u s!r11' s!nUkiog Irrng!d!u. ]. I'ubilc liln"nies r., . nllnking infnnl:;ainrt- I' IelCVhnne wcst il c uud ri:1nnr1l Idc/ tatr ,,,.•. I r —, fut!ncJ to dittlii,nly d,n1 !,.r.n.P.i bclp ptuptmn;. 5. I:cu!u:ni,qi 1,, afpccl uf il~•• ~" ~IfL, ~l Wt)rk Group 10: Fulurc Strategies (or lhc Changing Cigarctte Doring tFte pasl Ihtee dttndes, Ihe make- up of cig!uctlcs Ilus chuuge(I dltmwlicr!Ily. Qscr `X)pcrcenl nf Ihc ugarctlcs nowsnhl in Ihe Unnnl Slales me lilter-lippetl, com- pared wilh 1.4 pcicenl ill 1952. 'har und nicotine yields hnvn decrcascd signifcunlly-in 1952 the avcrnpc Inr con- lent of US. cig;ucltcs wns below 14 mg. mtd motc Ihno 6U PVrccnl of ull eign1eucs solcl yicidel IS mg, nr Icss Inr. C:nbun Inonnxide ylcltls hnve also becn rcduced. uvtrr 20 Ing_ of I.II. !I:. ,I.. i,.• niculi!n~ o' t ic1l (! I t! ''.iid i'ir linncloo(cot)acuIrlO_t(ct,~,. f1r_ m:mJ :uul salrt rnuip~ ~iiinn. In attlit Itt rc:oat I~to:r'! )irl,,l„ti nirOlinc an51 c:nhnn moniosidr. cinzictlc manufaeluius !r' ~:J Ibc :unl lobLlem usecl in p;tltcr bns hrrn locv-tar Iohycnt is unnl.'•md I'ar n!nwc nml

% The National Conference on Smoking OR Health - A Summary Report wo hundrrd lweuty-Ilve experls Gom ross Ihe Unired Slures gancCre[I in a work- ; conl'erencc in New Yot L. City in Novcur r 1981 to develop e"blucptint for lion" aguiosl srnokiugl'ha Naliomd Conlcruuc tnt Snrok- ; OIt I Ie:dlh, cospousotcd by 21 nn- tual orgrwizWions, was inilillled '.mJ p,wized by Ihe Ann•ricau C:In<cr Socidy. ior to Ihe conferenee, e planning min- II Ice, coiuposed of rep esentatives o f endt Ilie 21 organiz:nions,ehnseten keyi.vsucs be uansidcred. I'osition papers were ~velopcd on ezc6 ;md Jisllibulttl in ndmcc of the confert:nce to participants. mong Ihesc wcre: vnoking conttol in Ihe orAplace, in hospitals anJ t6ronglt :hools; sntoking coutrol in high-risk .tpul:nions; priorily gocernmcnlal milia- ves (local, slate and Federal); coootel Ing gareue advctlizing; and tile need li>r rbacco-rcLned resenrch. (_onfcrence parIicipana wae dividcJ vo tcn work grouf+s accorolug lo lhcse Ipics; tltcx groups wcre given a Ihrcc-pat I .nk: lo sluJy currenl informztion and ntdcrials, to iJentify olunrcles inhi6iting rtogress, and 10 make specific recmrwtcu- lalions for action, iucluding methods for -arrying it otrt.'Ihoc tccouunwndations arc nnnnarizad in the following pagcs. llie doninant and ntost frequently rcpc.ncd tcconunendation by many work groups was a call to the major volwrtary Ilgencies-dte Amerlcnn Cancer Society, tile Ameuicm I-ung Association and tire Anreticnn Ilcarl Associalion-lo coor- din. Ic ILcir cffols in svnoking control. A resolutiun, ndopled at Ilte conference, oullincs tile n<ed 12x such action: RPSOI.VIio, lhol tile Conference rccontntcnds thal thc nnlional voluntary agencies recognize Ilte nced to pool substnnl Inl resources aud utlcnt to effeclively promote tile tighl of nonsmokers and clixouagc tile smokiug of tobacco, to ctenle n nalional coalllion otganimlion whose sole purpose will be lo discouragc hoth active - nnd passivc sntoking Ihrough polilicnl aulion; 11II(RNfORG, LHT fP 11I3 PUK"I~III?R Rf_SOI,VI3U, that tile Conlclcncc reconrmnrds that tile nationol volunt«ry agencies usc lheir inlluence to sltongly eucoutnCe Ilteir state aud local afrdinles lo crrUC nncl/or signifcandy supporl simllar coalilion organizntious al tile state zud local level. UTyWIf.0 A response tn this was no[ long in coming. "Ihe piesldents of the Amcllcan Cnncct Society, Ihe Alncrican I-ung Assoclnlion and Ilte Ameticun llc;ut Associutinn joined together al Ilte um- fernnce to Illedge Ihcir sollUnll to "a con- linuing, unitccl apl"9ach...lu uc tlcn d:c n:nlnncd blu. ~ln inl b,..„n:, . a:,.,I'I._.. IrrcclLtgin Ncsv Smk in Jhnu9:y lig],.IiicY Inid tile LPauuJrvuiA Ln a i liuli ng0ir1915f1lolling. Work Grouh 1: Prevention of Snulkint; I Ilrltllt,h Comprehensive School Health Ellut-aGon Cigarelle sntoking is mosl apt to begin thtring clenrcnlnry and high school ycars. "lIlctefore, seLools huvu lhe oppurlunily-- us svtll ax the obligation-lo l!clp prcvcut Ihe stml and enconutge the n~ssnlion of cig:naltc snroking among stmlcnts. A comprehensive schcrol smoking ccssalion ptogrtnl should begin in kinclcr- gnrlen and continue through Irigh school. "Ihcre arc.sone banicrs lo Ihis: • Schools arc gcncrully reyuircd to pro- vide only a rninimunt of hcallh education, •'fhcrc is no cons'ensus on tile su6jccts to 6c covcled in hcnlth cdocntion, and • No wiiform st,m 1 uds exist f.:r t•.,:,r. Ig hcnllh education Instructors. These bnrriers can be overcome. The Work Croup proposed three gcncral strtnegies: • Kindeagnrten Ihrough grade 12 healllt ecluclllion cmphasizing slooking and olhcr Ligh ti.sk hcLaviots should be ntatr datory in all schools. • All Ire:dlh inslruclors slrould be nde- tptatcly liaiued lu latch about smol,infq and other high ri5k behaviors. • A poitivc, hcalth-ptomoting environ- mcnt nnul bc ae,Ued in lhcsunounding Cuminllnily. 'I'o implcmcn tl:ac p ~:.R grouprccnnunaldcd!6ut I. ~Il~.e Fcdunl go.:arn li~-cs fcr cfi7iva ;11ic 1, li.nn I""L-J11In5 il: lin,' tions. (hd:lrliro"r Lv Ih,~ funds shoultl 6c ma,'.e hy II, Ucpt:rlrrmcnt uiiG-lur.dh~n n- t , ~ Publlc I Icrllh Stnire. 2. Ilcdth cduatian sJro.wi•.1 !.. - kntt oftiulncutolpts:n I,re; uucl a mcc~illd tr,p,' ~.:,~i, .~.. .. claty Icuchma tvlv~ IrI: Ih.-I10 3.'fe a. . ..., .. . . _... ~ prcp;nc fcut!~c:s .,f It_ .,L nccoldinR to nulionl:liy I,•.i, slnndurds. 4. Stalc G.ducaliuu 11ro,,:lin,~nls a tenehu" L,iui,~g ;~:,a asscss the qnIlil IcueltwanJ p: ptnl;tlma lut Ihuu t.L„ urc.l 5. .Sntokin,r, tihatJ,l l r prnl:llI, t ln..~ .:.....I ......, .... ~ Scllool plopctly r.: :r s: .,,. .. ..., , Ihncln:,, Sl:u, I ..,,. , _. ~..I ollicialti amrl I:h.uu!dhcrhrl:v b,•L~..l:r.-t~ .. vmvsi.:'~A7T'n'T'~

~. . .r, ., r.r ` _ , ' .., I /,I~~.,jl t f .!.~ . . . Y I r g t, U i 09 .~~~~I~ Pr y~ k t7lltaf-Iltdt?~~II~7ilYrl;q/1~~ I i G•~~~~, uily of aJdilivcs h;rvc chtmgeJ. Sincc :xact nalwe uf addilivic elumkce is cnn- tcd luopridnry inforln;uiou Ity lite rcuc contp:min, IhL'y lite nol Iully wn by cithcr rcncardt scicntlisls ut lit he:Jth ofliiinls. Couscyucudy, Ihe ive ri>ks pox-J by t6cse ch;mges nie uol hilly undct~luorl. lLcre Nre, as , ecty slrong imlianiunc Ih;u sntokus dtoc cigzt clles dif fecndy - lakc utnre Iccpcr pulls, smo{.e nwtc cig:uclles, or ngc 11te way Ihcy sntoAc lite riy;uclte in uoc Ihc dclicuy uf tat :wd nicotiue. Ndwuyh lite wicnllGc cvidence lo luntf IUwl;u Clg;n'i iti Illnllcd, Ilte I Surpeou Gcucl;d's Rcpotl wimned up il we du Auow: Ihcre is uo .s;db cit.:ueue nnd uo eufe Icvd of consurnptiun. Sruul.ing dgnrellcs leilh loo-cr yields of iur und lucollua tc<htccs Ihc risk ul lunt; LII/leCr alltl, lu ]oOIG LAICOI, impluvC] IhcMmuAcr'scL;tncc fut Innger lilc, Pro- vIJcJ Ihac ii nu inmpcnb;rtul Y inei ense in ILe nrniuwn SntoA<J. I lowever, Ihe bcnclils :ue mwgin:d eowp;veJ lvilh gtcwg op cig,llctlc~ entir<ly. It u nol olear lvhM tcduaiots in riak mzy oco.u wltlt luw wr/nic,uiue yidJs in discaxti nlhcr lll:w Imtg [.mCer. llte atrdiov;lsailar cviJcu:c i, Inu limilctl lo leutt;wl a coucltuiun, nor is Ihnc cnourh lululnt;nion on tlhidl Io 6 tsc a judkntcnl ;tLool diiuuic ubsbuclive luur tliu;nc. Thcl c Is no cvidcnrc lo wg. Ecsl I IGLL ;t wnmau'S Soildiing In low-11u at;;uel Ici has any d lal uu t uducing Ihe risk lo her Iclus nt 16e uc,6utn_ 'llte PeJet,il guvcloluenl :md Ihe unt:iry hcnllh otp,miialiuns httvc cn- n;tgcd ILc mc ot low riuond nicmine 0Sq9vyC0 q ~ ~ ' ~ r ~,v .r- t f lµ 11 Ay GTifftti~-~'~ "j ciglucucs by those smokers who cannot yuil, and ILe lohacco cnmpsnies hnve dcvolcd an hiu c.uinply largc pcrcdnl~tgc of lhcir cnonnnus ;nhaliiing oullays lo luo- mule lite osc of Ihuec ucw bl tmds, lhe ef- Iccls have solnaimcs hccn confusiug lo eousumcls; at'enrding to a snrvey con- duqcd lon lite 'I'ob;icco Instilulc, nwny swokcrs 6Llicvc Ih,ll low tnr cig;trclles rtrntuvc uuy r6As Itorn snloking. Ihc Wut k(n uup cx;mlincd Ihc Issucs alising ftom Ihe drunnlic chaugcs in cly:ucllcti In cnutidn nhal concspanrling dmnl;es ntuy bc needed iu pu6lic hcdlh policics, Ptugtunts aud rese;uclt. 'I-Ite lnllowing rcr:unnncndalions wcrc ntadc: I. Cicale e nou govcnmwnltJ nalinoal CClller On Slnokinb to conduct sttrvell- ktncc ;tnd caordin;Ue rescatch nn Ilte cLanging cigllrclte, mld to develop a na- tlunal pu6lic Informalion program lo in- lotnt sntokns uf Ihe rcl/uivc rinks of Ihese ciglnclles. 2. Dcvclop realistic paralnclers for utcasuring Itnd luotliloring lite cuusll- luctns of cig;ucllc stnoke 16rough both InaJlinc nmasuraueuts and hornan ex- posmc. ]. Lllilize these ncwly develuped IrorunctcrY fur mrrsuring cig;trette slnakc dclivcrcd lo cslablish goveru- mmII l;d t~r vnlouvny agcncy guitlellnes lor rcduuug lite rlclivery of selected vmokc conslllualls wilhuW endorsing lite lpvCiGed level as an Ideal or accep. t;ihlc Icvcl. J, Couduct qwdiLHlivc ;malyscs of Ihe Iar dcliacicJ by Iltc chnnging cigarcltc. 5. I)cvdop;t tcfcicncecigaretlewilh lower lur jutd nir.'otine Ievels for usc in tnc,uth, I G. Placc nlnjor entpltmis in all smoknlg research ou the hcallh effecls of Ihe changing cignrelle, p,trliculatly thnse wilh very low l;u yields. 7. Rcsc;uch dm.intetty, Phnrmokinctics, pltysiologic anrl mctabolic cffcds of ILe c'Imuging cigarellc. Monitor and scl slanrlards for Lhe redoctioo of sirlcslrr,lrn vmoke cmissinus liorn thc clringing cigarcllc. 8. Cive Itiglt prioily to epiJcntioingical sludics of Ihc carcliovoscular nnJ pldntunal5' Jix;i.,` cl li . h al tL. .~ illg cignrcllc. 9. Ruquilc Jhdusrnt in ur.an I.c ,i. iug;tntl ou pnck.lgcs ul Ihc yi<IJti uf /,u, nicolinc nnd cnrbun monuxWr. 10. Rcquilc tulalinm',I a"d;uu;;l oti. Ing nnd oll paakugiuti- IL f.ncoortgr plty.ici,tn. In 6rcunlc mntrv incuhul wiflt n~•nliu", 16L ii p.irur, !- gtvc up snwking:utP 11111 ,iniinl~ ihriu I ~i thc tclnlivc ti~ks ol tlte , iciuI .iut•, Ui(,;u cl l c_ !9 SMOK(-I PI.C NV 2 000 Last ycur, the Representative Iloelyof the Norwqiau tvtcdicol Assnci lion passcrl the following reso!wion: The f2cpresentative 6ody of Ille Nor.vegian tifedical Aseo.i;tlir~il tlrges Ihe Govenuuent to work lownrdsr,ulking Mot wny n 4mnke- ftce snciely by tha year 21XX). "Ibhacco is a heallh h;v;trd bolh for sntokcts mtd Ihcil roandings. Conlinuous usc d:unal'cs Ihc hcal l, tbloo'.I ,_.." .t.: ,.,,. culnloty syslcnt, luogs nnd respiralory h acl, mtd anscs c.u:i rrz: f lite lung, Ihrn;tl ;tnJ urin;lry hladder, ;ts wcll as clone.uv.c lo Ih, fc(ns. Phasing out llle conwinpliun of lobnu:u is tn iinl,.,:l.ull slep towatds iioproving tlw Lcahll nf the nalion. I'assit;e of Ihc resolulinn luts rcccivecl cxlensive putilicity ill Il~c Nor lvcgiall press aod has hclpcd to foau5 al;cnlion on lhc I~ ~~pe ot I.hc lobacco prohlem.

wt'cllog Ihc ug61s of uuoswnkcrs. Ile conseyucuces ol unncunlpliance IouIJ be dcwly uuduslaud- hc cosl olIhcsc paliciu shnulJ uot cx- nsivcly burdul Inc:d mmo;lguncnl aud, clcc, Icduct u,mpliunce. . valicly of stup-vnoknlg prugl;mis Buuld be uffered lu 211 mnploy'c" ;wd, Vhcncrcr possi6lt, lo rly+crJcnls 'md eIIIlLS. 'mIiap;rliun iu Ihoc ptuglams shouW Ic ulcouragcJ, bul vnlnolnry. f smokingtessatlun prugrams are uf- ccd uu comp;my lime, they should be thcdldcd to f;lcililale p;ullcipalion rilhoul impctliug pluducuau. 'nvotve urgtudi:dluuul ll~adcrs hl smuk- ng CUplrtll trclltlries. , Plllplnycrs lue ulosl likely to suppoll allol.ing corll«il ptnµllunls if dlcy wc ;)IUAYII tJ be CJ,I CtfRllAY- IlCllce, l1 lonmda Inusl be dcvd'ipcJ lul nnnlyr- ing Iht euols und bellelils I+f smol.nlg contiol. Oucc Ihis fonnulu is plq+mcd, it shuuld bt JislubuleJ to business, iuJmlry antl laburlcadtn. Iucrense and Inlprure Ihe resuurces urniLdJc Llr anrksilc prugrarns. 'fhe "Codc of I'IUCticc:wJ 6v;llualioll ({wddines " Jcvdupcd by Ihe In- IcraBcncy I'tel Itevicw (-mm~lill<c for NfuiounlSwoklugCtss.aiun 1'loglwns, sholdd be divlibulc,l lo bluincss, io- Juslry and I:d,t,r gloups- I'mpluycrs eun Isc Ihcce yuidclines lo dccdap ailcria (sucL as succcss rlllcs mlcl cosl-pcr- 9a',S9b94:0 yuiller) fur :Innly+ing and sclceling slnuking trssW iun plurr,uns. -0. I)cvdup pr r5unal iuculllvrs forrnlpllq- ees lu qull snwking. (:I)Cusc sludio ,II luccrllivc prugr7mIs shnIIIJ Ilc di;o Ibulyd lo cmpluy<rs :md cmpluycCs. (6)Goup hc:Jlh insulancc policies shnuld bc chaugcd lu rew,utl nonsmnkiug. 5. Smukiug coulrol prugnuns shmdll lie pllrl ol prccrnlh'e mcdicfuc. (u)Slnoklug cuntrol progr.uns linked lo IIIIIL'~Y, IIIIIIi11011, SIIe55 rll[11111g[IIICIII und utciluunlcutal pruleclion erc rnore sueresslill Ihnn IhoNe proviJtd nlunc. (6)Infawclliun Ilnd nctlcti;ds on sntnkillg catllul shaldd clnph:niic Ihis facl. 6. ralcuurugc Idl Icvels af guvcrnnlrnl to fnrililnle wurtnile polluies nnd pno- grnms. (;q I u'tli,rn Icinlhnl sclncnl fonvtlhwsspru- glulns shoulJ nol bc mxaMc incomc. (6)l-ob;¢co smoke, Ilndcr ccrlein cnnrli- linns, should be declured a hr:tllh hauud. (e) (lnvcl luncul, us rnle Inodel, slwuld pto- viJe ils elnployccs wilL n comprrhensive hcdlll eJucutinn progllml, induding Slmlklug contrul. 7. lncrrasee tlle awart•nns of pussive 51nuk- ing I)s n wtrrksitc hcnllh issuc. - (n) A Inmcl of expcrts sholdd review Ille scicntilic cvidcuce on Ihc Ilculdt cffxls of passivc smnking, tu wdl as Ihc legul iulplicaliuns uf tmd cnlployce rc[nrlions to snrokulg reslrictiuns, r:e i~~IS}~lS'y(~~i +Illlla~::!I iP I;..t." Work Group 5: Priorily Federal Goverrlmcnl Illili,ltivl•s Tlle 6est uppulhmily in nlurc Ih;m n dcc;IJe now cxiels liir major l-cJclal iu- iLlntives to conll'oI smoking, ycl ncilhcr Cnngress nnr thc flxecullve ISnmch \Al act unless Lhe major voluntul y hcalth orgrmiin- lions nlqkc .I sonng cumrniLlncnl lo pulhi- c;J zction. Arllollg Ilresc inilinlivcs nrc: • nn increncc in Ille 1'cclcl;d excise tnx on cig;vclles; • ch;ingeslnthesnvninglabeloncigare!te puckagcs and in odvcrtising; • iucreo-tsed Federul suppon for eJucalion and Icsearch on smoking t'olllrol; • reduUions in lobucco plicc sullpolIS; • Ivlcdicarc/tvleclicaid reilnbursenlenl lor smoking Ce59fllinll plOgrtlnl5. "Ille Work Group set priorilies and recommended aclinns whicll could be taken by Ihe voluttlmy hcnllh ugcncics, Gingrrss and dlc lixcculive Ilrmch. Thc PbhulLuy l9callh il gmlrics I. "I'he rnnjor vohmlary health orgfmim- tious (ILe Anwrican CanccrSocic(y, ILc Amcricnu Ilcvt Acrociition nnd Ihe Anlclicml I_.uug Association) sholdd cvablish a coalition wilh mhcr grnups (heallh, church, cldclly, yulh, Iaor, puIIGc ir,lncs't, bc:iress, etc.) tc coot- clinale both uutiuwil .md local action, including lohbying, petitions, &nd Icsli- fying bcfurc Congress, tlle fcrlcnd cum Is ond I cgulnlnl y agrncies. 'ILis will Ielluirensuha;mli:d inerensein lirlincinl suppolt fnd staflnlg for Ihcse activitics frum all organi[ulions ilrvolved. Its m,iin objeclivcs .hould bc: (a)crcaling a uationnl rtclwork of gl acslaols suppull for smoking conlrol, nnd iclallifyinµ pcuiilc :•.. twlk aL10 h.lc[ 'Ir- i:ll key Inembcrs nl (~tlnFJa.; (b)dcvel~lliugpl:,usl,lilh~rna.l _i'I~;in,l nrul phplol" ialiam. nIJ I, nll,"~I' , jndlcinl c:¢s :unl I cculatul N (c)I,I'gnniringIcpnl anll IrvicLuivcrvpalim lou:ulynm:ulcl~ (~I)lohhyir~g ~cpcluli(Ic,l Ly{~'.=;; (c) oNilysls of k'P.i.}aiicc I,I, sl'CCirJU rclonllurn,l;lli,nn f indirndu"d,,nn,lr,ll Ili r.,! ,.., nl~ Illt nchenl l; mul (f)csl;lblinhlnenl of :I nrl,l . I alguing mrans ot rn•.,.n".l,,,~ 16c mculbcl.s nf Ilm nttwoi k. ('nngrl:cc 'I hf US. Collplt>> sholll~l cn ktlinn dcsigncd lu: I. Mullildy thc 1odrlal ceci<r Ins o!I cigplCtlCs lo t6rcc t t Wrl I I: Selll II•Vfl (pOw UI III . II; pI I n 6.1. sehich sv;lt esluLli.6r'I iu lotl t~h . I. crCLIsC\vtcllll lclly.. ._~ri.ri Ihepnsl 11)yeors, A<uhtilanlilll+nltionl uf tllc Fcdetul .In,~.. I,, :!.. , polt rmlislno6lnt~. Llluf•J:IIU;. 2. Allprocclb: "(-ouq~i,lelni 19tvaltiml Ail" (\',.,:... 1957 and Ilntr' I I I,::~Lod Ril,l. ,, 1929), which wuulrl reqliilc: (a)muinlaillingldlH~livilil•snllhc(III'r .. Snloking nud Ilcallh oI tLa U.S. Ucpmlrnc¢tufllcl4!I:u,~.l1n, VICCs; (fl)rUtaiog Illc wnllrilq, IIb"-la. nn fiv,ln~n,•