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C Smoking or Health: It's Your Choice A report by the American Council on Science and Health

The American Council on Science and Health (ACSH) is a national consumer education association directed and advised bya panel.ofscientistsfrom avarietyof.disciplines. ACSH is committed to providing consumers with scientifi• cally balanced evaluations of issues relating to food, chemi- cals, the environment, and health. ACSH is a nonprofit association exempt from federal income tax under Section 501(c) (3) ) of the Internal Revenue. Code..All contributions are tax-deductible as provided by . law. Individual copies of this report are available at a:cost of$2.00. Prices for 10 or more copies are available on request. January,1984 This reporton smoking and health waswritten byCathy Becker Popescu, M..S.,.a.Research Associate for the American Council.on Science and Health. ACSH gratefullyacknowledges the comments and contribu• tions of the following ihdividuals who reviewed this report: Stephen Barrett, M.D. Lehigh Valley Committee Against Health Fraud Alan Blum; M.D. New York State Journal of Medicihe Nancy Doyle, M.A. American Lung Association Berton D. Freedman, M.P.H. American Lung Association Lawrence Garfinkel,.M,A. American Cancer Society William Havender, Ph.D. Consultant, Berkeley; California Howard Maccabee„Ph.D., M.D. Radiatiom.OncologyCenter, WalnutCreek,California. CGVer yM41u hY e. Martlp Paul Magnus, M.D. National Heart Foundation of Australia Kathleen Meister, M.S. . American Council on Science and Health Dade W. Moeller, Ph.D. Harvard School of Public Health Sidney Shindell, M.D., LL.B. Medical College of Wisconsin, Ronald T. Stanko, M.D. Ghiversity of Pittsburgh School of Medicine Fredrick J. Stare, M.D., Ph.D. Harvard School of PubiicHealth Stephen S. Sternberg, M.D. Memorial Sloan-Kettering Cancer Center O Ellzabeth M.. Whelan, Sc.D., M.P.H. WAmerican Council on Science and Health Q Larry White, J.D. Berkeley, California W ra C11 C11 N The opinions expressed in ACSH publications do not necessarily represent the views of all ACSH Directors and Advisors. . I

Although it can he difficult to quit smoking, the more than 33 million ex-smokers.in the United Statc.s today prove that it can be d'one. . If you want t'o "kick the habit", and would like some tips on quitting or informatiomabout smoking cessation programs, contact thefollowing;organizations: Office on Smoking and Health r U.S..Department of Health and Human Services 110 Park Building 5600 Fishers Lane Bockville„MD20857. AmericanCancerSociety' 777 Third Avenue New York, NY 10017 American Lung Association' 1740 Broadway New York, i\'Y10019 AmericanHeartAssociation' 7320 Greenville Avenue Dallas, TX 75231 The.follosving organizations can provide.information on nonsmokers' rights andlreiated subjects: 3 Action on Smoking and Health (ASII)2013'H Street, N.W. - 44'ashingt'on, D.C. 20006 E 1 0 Group Against SmokingPolhdion (GASP) ~ P.O. Box 682 College Park, MD 20740 ! o . ~ ~ SMOKING OR HEALTH: IT'S YOUR CHOICE FM m g • American • Council on Science and Health Yes, I will join ACSH! Annual Membership Rates: O~BENEFACTOR: $5,000 O INDIVIDUAL: $35 7TPATRON: $3;000 (OVERSEAS): $50' O SPONSOR; $1,000 O!STIJDENTOR O INSTITUTIONAL: $500 . SR. CIIiIZEN: $15 0 ACSH NEWS & VIEWS S UBSCRIPTiION ONLY: $10 (ACSH NEWS & VIEWS O VERSEAS): $16' 'All'overseas subscrip tions must be prepaid. 0 I wishito contritiute $ _~ in addition to membersh ip dues. All contributions are tax-deductible as provided by law. Please make all checks payable to American Council on Science and Health and'mailto: 47 Maple Slreet, Summit, New Jersey07901 PLEASE PRINT Name Address City State Zip Telephone Affiliation AcsH members receive: 03734565 • ACSH News & Views, abimonthlypublication with scientific articles on health andsafety;d book reviews; guest editorials; and updates om current issues being researched by ACSH. • Copies of latest ACSH reports, summardes,.annual reports, and other materials. • Information on national and local conferences and seminars.. • . Please send.membershipinformation to: PLEASE PRINT 'Or contact your local chapter, which should be lis•tcdin tlre telephonedirectory. Name Address City State._- - Zip Telephone Affillation

• People who quit smoking decrease their risk of dying fromheart disease. Tenyears after giving up smok- ing, the risk approaches that of alifetime.non- smeker. Other lung diseases • Smoking is the major cause of emphysema and chronic bronchitis. • Eighty-five percent.of all chronic.bronchitis.and emphysema deaths are related to cigarette smoking. • In 1982, there.were more than 46,000smoking- related emphysema and chronic bronchitis deaths. • Smokers have an increasctI incidenoe of less serious respiratoryy problems, such as influenza. • The lung function of smokers ismeasurably impaired. Peptic ulcer disease • Smokers have a peptic ulcer diseasecleath rate which is twice that of nonsmokers. • Evidence suggests that smoking retards the healing of peptic ulcers. - TABLEI: QUANTIFYING THE RISKS OF S,'*IOK- ING Bywhatpercent'rge Selected do smokers increase disease category .. their risk of dying?` Lung cancer. 700 % - I,500 % Laryngealcancer 500% -1,300% Oral cancer 300 % -1,500 % Esophageal cancer 400% - 500% Bladdercancer 100%.- 300% Pancreatic cancer 100% Kidneycancer 50%, . Coronary heart disease 70%- 300% Emphysema andether chronic airway obstructions - (excludingasthma) 1000%- 2000% Peptic ulcer disease 100 % •Aperson who sinokes one pack of cigarettes or less per day would be assumingrisks at the lower end of the.apectrum., Those smoking more than a.pack a a day would assume risks at the hiGher end. Most important, the smoker assumes all these risk.s at the same time. I'M NOT A HEAVY SMOKER. DO THESE RISKS APPLY TO ME? Yes. The risks which have been cited refer to those incurred by the average smoker, except in cases where "heavysmoking" has been indicated. There is a definite dose-response relationship between smoking and disease, i.e., the more cigarettes one smokes, the greater the risk of disease. Smokingjust a few cigarettes a day is certainly less harmful than smoking a pack a day, but for all practical purposes, there is no safe level of smoking. Betty Grable, a cigarette smoker, died of lung cancer at the age of 56. DOES CIGARETTE.SMOKING CARRY THE SAME RISKS FOR WOMEN AS FOR MEN? 03'73455*7 While some of the earlier epidemiological studies indi- cated that women were less affected by smoking than were men, this.vas largelyrdue to the fact that.comen had not been smoking for as long as men when these. studies were conducted. (As mentioned previoush; men began smoking in large numbers after l\brld War I, but women did not take up smoking in full f'orceuntil the 194os. ) ~ The effects of smoking omwomen can be seen bv exam- ining their lung cancer rates over time. In 1950,, women accounted for only one of 121ung cancer deaths..In subsequent years, the age-adjusted lung 10, ... 1 . 11~ .

C risks associated with oral contraceptive use and occu- pational exposure to certaimharmful substances. Smok- ing during pregnancy poses a significant threat to the unborn child. Smoking is also.responsible for increased rates,of absentecism and disability among workers and is the major cause of residential fires: Parents who smoke may jeopardize their childten's health. The AmericamCouncil on Science and Health warns nonsmokers not to begin smokingand!urges smokers to. "kick the habit." This isone issue.where the choices are clear: smoking or health. . A BRIEF HISTORY OF THE CIGARETTE Tobacco is a native American.plant that was first used as a smoking suhstancein the religious ceremonies of priests in coastallreginns of Central and South Amer- ica. It was introduced into Europe in the late 1500s, but was not well received by all. King James I of England published what maybe considered the first anti-smoking tract in 1604,.describing tobacco smoking as "a custome loathesome to the eye, hatefull to the Nose, harmfull to the braine, dangerous tothe Lungs,, and in the black stinking.fume thereof necrest resem- blingthc horriblc Stigian smoke of thepit that is bottomlesse."Despite King James' efforts, tobacco use, in the form of snuff dipping and pipe smoking, spread in England and then quickly throughout the world, serving as a profitable export for the newly formed Colonies. It was not'until the 20th century that.large numbers of people began to usetobacco in a much more deadly f'orm: the cigarette. While cancers of the mouth, lips, throat andnose.had already been linked with the usc of snuff, cigars and pipes bya.few astute physicians, these forms of tobacco didnot seriously affect the rest of the body: With the developmcnt of the blended cigarette, however,.tobacco users were able to inhale.smoke into their lungs, exposing the entire body to many of tobacco's harmful substances. The great cigarette advertising campaign Cigarette sales rose.sharplyin the early 1900s, boosted by World War D and the great cigarette advertising , campaign. , - Before the.war,.cigarettes were not exceedingly popu- lar; cigar and pipe smokers eonsidered them somewhat sissified. The war changed allrthat, since cigaret!tes could besmoked so much moreconvenient!lc in the trenches than could pipes and cigars. Millions of doughbovs thus took upcigarette.smoking during the war and brought the habit homeaftenvards. The great 20th century cigarette advertisingcampaign began right after \Vorld War I, capitalizing at first on the.patriotism that went along with the war effort. The advertising was clever, original, brazen, alllrring and extremely high-pitched. The ads often featured testi- monials bymovie stars, athletes and even doctors, who went so far as to suggest that good health and good looks were the rewards of smoking. Some cigarette manufacturers made particularly bold health claims for their products, advising that thcir brand could steady the nerves or even cureamokers' cough. The ad4ertising campaigns were so effective.that by 1939, a Fortune.survey showed that 53 0 of adult American men smoked cigarettes. Sixty-six percent of men under 40 smoked cigarettes. The widespread use of cigarettes among women lagged some 25 to 30 years behind that of men. Although afew daring,women had smoked cigarcttes even before Wordd:War I, women did'not take up smoking in large numbers until the 1940s. The First clues Unbeknownst to the.smokingpublic, an impressive amount of speculation - and some hard scientific ~ evidence - linking smoking:with disease had appeared in the periodbet'ween 1920 and 11940. Tobacco com- panies chose not to acknowledge this evidence and continued to promote cigarettes heavily. Cigarette ad which appeared in 1944 By today's standards, the medical evidence gathered against cigarettes b~ 1940 would have been enough to stimulate a thorough investigation of the matter and extensive coverage inthe popular press. But un• fortunately, this was not the case at'the time. 5

whose parents smoke. Recent studies have suggested a relationship between parental smoking and changes on l ung funet'ion tests among child ren. Some studies have indicated that'long term exposure to other people's cigarette smoke is associated with detri- mental lung changes in adults, but more study is neededito confirm this. . There have been four.epidemiological studies pub- lished:.which examined the relationship bctweem"pas- sive .smoking;' and lung cancer. One of these was a . small stUdydonein Greece whichshovved that non- smokingwomen.who had lung cancerwerc.more likely to have.had husbands who smoked than were women without lung cancer. Another,.much larger study con- ducted in Japan indicated that nonsmoking vomen whose: husbands smoked were at significantly greater risk of developing lung cancer than those whose hus- bands.did not smoke. In a third study of more than 175,000 nonsmoking Americanwomcny researchers found little or no increased risk of lung cancer among womon marriedIto smokers. A fourth study,, of nearly 4,000 Louisiana residents, indicated a relationship ' between exposure to a spouse's cigarette smoking and the development of lung cancer. . Each of these sludiessuffered from limitations and weaknesses which might have artificallyinfllated'or obscured a possible association between passive smok- ingand lung cancer. Some authorities believe that, taken together, these studies provide adequate evidence to indicate an increased risk of lung cancer for "passive smokers." Further research is needed to confirmthis,, however. ARE TIIERE ANY OTHER HAZARDS ASSOCIATED WITH CIGARETTE SMOKING? In addition to being a.health hazard, cigarettes are also a major fire hazard. In 1981, an estimated 2,000 Americans lost their lives and more than 3,000 were injured in cigarette-ignitedfires. The victims included smokers, nonsmoking family members and occupants of the smokers' hotels and apartment buildings. A study conducted in the.Balt'imore.area.indicated that:t over a three-year period, more#han half of all house fire deaths w.ereattributable to:fines caused by smok- ing. Thirty-nine percent of those who died in these fires were n otsmokers themsebves. Thc.number of cigarette-related fire deaths could be substantially reduced by the widespread use of "fire- safe" cigarettes .vh ich would either extinguish when not puffed upon or burn in such a way so as not to ignite other materials... Manufacturers have resisted the development' and marketing of such cigarettes, how- ever,.even though they are technically feasible, WHICH SUBSTANCES IN CIGARETTES ARE HARMFUL? More than 4,000 different substances have been identi- fied:in tobacco smoke..Scientists believe that carbon monoxide,.nicotine and "tar" are most likely to con- tribute to smoking's ill effects. ("Tar" is the name given to the particulate matter contained in cigarette smoke.) There are,, however, many other substances in cigarette smoke which may be harmful. These include nitro- samines, naturally occurring radioactive compounds, phenol and benzene, to name just a few. The National Cancer Institute has identified dozens of compounds in tobacco smoke which are carci nogens or tumor promoters. IS THERE ANYTHING IN CIGARETTES BESIDES TOBACCO? Yes. In fact', much of the flavor in the lbw-tar and nico- tine cigarettes which are so popular today comes from additives, rather than from the tobacco. • Cigarette manufacturers boast that they have more than 1,400 additives to choose from. In addition to flavorants, agents are also added to moisten the tobacco and to prevent cigarettes from self- extinguishing. U3'73[,}561 These additives are not listed on cigarette packages;, nor are.they approved for use in cigarettes by the Food and DrugAdministration (FDA), which regulates ingredientsin manufactured foods, beveragesand drugs. No government regulatory agency has any control over the.additives used in cigarettes. In 1983, the tobacco industry finally provided the Department of Health and Human Services with a partial list of additives used in cigarettes. This informa- tion is of limited value for the immediate future, how- ever, as there are few data to indicate whether manv of these additives are safe when burned. The data which we do have suggest that at least some of these additiN es are not safe.when burned4 Cocoa,, for example, is a cornmon cigarette additive svhich4s innocuous whemeaten. Animal tests indicate that it! may be carcinogenic xehen burned, however. Certain sugars which are.often used to flavor cigarettes produce a substance called cat'echol «hen heated. Catechol is a major co-carcinogen in tobacco smoke. I 19 18

C .. .,° I °oo _ .. ~ E E ~_ E 6 C N y I ~ o c a o` - - " t '~ 9 e en ` m I v ~r . ~ r7y= . n l _ ~ C U a j ~ F a U ° ~ e z . ~E 2 C E E :C O F 9 n ~ I o cc O4 ~ 0 v 00 ~ ~ ' ~ - U . . . Z i - ~ . C< o :9 z T7 '~~~~ ` sm a T q = ° o Z I S ? I J . 8 - o $ c ' a „ a c , 6 . F~ o VrJS f cc ~ WHO ARE TODAY'S SMOKERS? Although the rate of.smoking has declined significantlye since the.mid-1960s, there are still sume 55 million smokers in the Cnitcd States - abuutthe same nunibe as 20 years ago:. Current]), about 37 % . of American men and 29 % of American women smoke cigureltes. These figures rcp- resent a signrficant'.drop in:tbc rate of smoking among men, from a m eximum rate oF over 59°0 .'phe smoking rate for women hasdeclinert by only a few percentage points oaer the ycars, however, ftom a peak of 33 < in 1965. - Among nren, smoking is invcrsclyrelatEd tnincomc and occupational level. )fen in professional and techni- cal occupations and who earn relativelyhigh solaries are less Ilkrly to smoke than arc 61Le-collar workers or those whobavc relativelylhw incomes. Itr 1975,47% of male bluu-collar •vorkers smo4cd, as comparedlwith only 36% of male white-collzr workers. . The relationship bett.veen occupational and income level and smoking is recersed among womeni Female white-collar w'orkers and womcn earningsalndas in the upper-middle income range are more likely to smoke than are women in bl4e-collar occupations and hcLL.ewives. Educational level seems to.be another important factor related tosmokc rg l ehavior The more highls educated ay rsonis.thelec Ikelvtleorsheislosmuke, although the relatLo uhip itist rnger for me than for women. Accordrngtoonesuneg morctha t',•.uthiids of Ihwyerc;,judges, business eaecuhi'es, phy 'ians, dentYSts, engineers and m anagerrwho were once smok- ersh.~d quit, presumahk because they were aware of and'understiwd the risks assoclated w'ith smoking. ARE SOME TEENAGERS MORE LIKELY' TO SMOKE THAN OTHERS? It appearsso_ Astudvnf hiyh school senorscnnducted by the National Institute on D ugAbuse (NIDA) mdtcated th d students who did not perfor r well academicallremorelikelytosmokethan ss'o .academically cuc sd 1 student Sh I t, Nhosmol.ed crc alsomn likelyto.be enrolled ocat[onal ses, rafhcrthani rcollcgep eparal urncul O er all the educatm al and o- ~ p t n 1 asprrat' of hi}~h schoal studtnts w Iw smokcd tended to bc luwer Ihn n thaw o[ ~mnsmokin~ students_ Teenaqerr.vho lis-rd in sing~e parent homes or w hove parents. siblinef . or frlrndssmoked wcre foundto hemore apt eatake up smoking. ~ 1 23

C ":.:...• TABLE OF CONTENTS ~' .::.:.... ...... ... IntroducHon............................. .. 3 ~ PositionStatement........................ 3 ~A Rrief History of the Cigarette ............. 4 TheLongTermEffectsoFSmoking.......... 8 .. Riskstothe AvcrageSmokcr.......... ........ . 11 ~. ~Women and Smoking ..................... ... 11 Prcmatnre Deaths Due to. Smoking .......... 12 . ' SmokingDuringPtegnancy ................ 12 Interaction of Smoking N,ith Other Agents ... 13 The Smoking and Hcalth "Controversv'...... 14 , . PassiveSmoking.......................... 17 .,:. FiteHazard ............................. 18 ~ilarmfulSubstancesin Cigarettes............ 19 Cigarettes'Secret'.Ingredients............... .. 19 Pipe and Cigar Smoking~................... .20 Smokeless Tobacco ..... . .................. ...20'. Economic Costs of Slnoking................ .. 21 TodavsSmokcrs...........:....:............ 23 Teenage Smokers .............•............. 2.9 Addiction ............................... .24 Low-Tar, Luw-NicotineCigarcttos .........~. 258enefitsof Quittin ~ g ....................... 20.. Smokin g Cessa tion ........................ ..25. INTRODUCTION. ^ - The year 198-5 marks two Important'annoersariu in the historyy of the cigarette. On April 30, 1884, the modern cigarette was born in thet{orth iCarolina factnrv of R{ Duke and Soms. Onn that d6te, the new bonsack cigarette-rolling machine . passed its final test, operatingsucce.ssfully for a full work day, 1'his marked the end of'the inefficienfband-rofling era, and lallo.vedlcigarette manufaoturers' out- put - and the number of smokers - to inerease suG- stantially.The dramatic, but ultimately tragkq success story . of the cigarette was about to be written. On Jynuarc 11,:1964,. the cigarette's Golden .kgc unof- ficielli came tuan endl a'ith the release of.the Grst U.S69urgion GcncraPsReport on Smoking andl Health. Scientificevidenee ofIIhe hazards of cigarette smoking had 6enn acoumulatin,~, for decadcs, but never before had ihe facts been summed.up so concisely and effectivelk . In light nf tnday;s knowledge, the report: seems mildbut in 1964 it shocked the counlryy, authori- tatively csiablishing the I ink between smoking and discase in the public aonsciou.mess for the first time. Today, 20 years after the first Surgeon General'sseport, we knmathat smokfng is even more dangerous than wasbelieved in 1984. The impact which the cigarette hasfiad on Amcricani healthbasbeen fkr groatCr -- and mnre deleterious- than anyone could havc imagined. Yet many peoplb are not fullraware of:the magnitude and specifics of the effEc•ts which cigarette smoking hrss omhealth. Thismeport.Hc the American Council on Science and Health (ACSH) is intended to emphasize to .. smokers and nonsmokers the enormoustisks which they, or their friends and Inved ones, are thking when theylight up. - . ,. , POSITIWSTATEMENT. ... ° The American Counoiliun Sclenre and Health joins withdhe U.S. Public Health Service, theRorld Health Organization, the Arne.rican Cancer SociCty; the Amer- ican Lung Azmciation, the American Heart .Assoriatinn anU cauntlrss other organiiations concerned rvi th pub- lic health,in condemning cigarette smoking as a major heal th ha,.srd. The sclentific ertd6nee indicules une- quivncallA'that cigarette smokinpis the mostamportant singlccuuseuf;prerentablb dcutllm IheUnitedStztes, being responsible for more than300,0017.premature . devt hseaah year. Cigarette smoking is addictive andlncreasesahe risk of developingand dying from cancer. heart~di.8aw an& chronic lung dliease. It greatly Lncrcasrs the health 2 3 ~ ~ ~ ~ w `~

C 'There is even evidence to suggest that manufacturers c»ntinuedlo add a substance called roumnarin to oiga- rettes after the FDA had banned it in foods because it eausedliverandutherorgandamage. Judging from the limited amountaf information which we have about cigarette additives, it appcarsth at there h ample cause for concern over their unrestricted use. ' ARE PIPE AND CIGAR SMOKING DAN= GEROUS TO HEALTH? " Although there are definite heallh risks associated with . . thesmokingofcigarsandpipes,thcyappeartobr.dess dangernus than cigarettes. This is largely due tn the . fact that'.eigar and pipe smokers smoke less than ciga, rette smokers and generally.do not inhale the smuke. The harmful effects.of pipeand cigar smoking are c-on- centrated at those body.sites directly exposed'rtb the smoke. Pipe aii smokers have as high a risk as cigarettesnrokersofdy'ing~of'.canceroflthemouth, larynx, throat and esophagus: Pipe and cigar snickers have somcwhat'liigher death rates from other smoking- ,..re[ateddiseasesthandononsmokers,butlo+verrates _. : than cigarette smokers. . The Surgeon General has concluded that "some risk exists from smoking cigars and pipes, as currently used in the Uhited States, but for most dlseases, the risk is small rel9tive to the enormous risk of smoking, cigarettes.- There fs; however, no evidence that either pipe or cigar smokc per.se is any lecs dangerous than cigarette. , smoke.Amongpoprdatiunswhic&vnholeoigarsmoke;. available scientific evidence suggests that the overall health risks are similar to those incu rred by cigarette smakers. .. . . . : IS SMOKELESS TOBACCO (SNUFF OR - CHEW.ING'TOBACCO)SAFE?, ' No.Theprolungeduseafsmokclhcstobaccnh:rsbeen associated with an increased risk of oralicancer.partie- ularly at the site where.lhe tobacco is heldl It i.c also a . factorinthcde•elnpmentofnon-oancerousoral!disor- ders, such as leukoplakia and certain periodontal dis- ease. ' lntermsofcancerriskatotherbodesitesandicardio- vamular disease risk, smukcless tobacco is much safer thansmnkingcigarettes. . C WHAT ARE.THE ECONOMIC COSTS OF SMOKING-RELATED DISEASE? It is estimated that smoking-relateddlness accnunts for nearly8% of all direct hcalth,earecostsand more than 11 % of the tcrtel leconom ic cost nfdimase (dlrect and indirect costs) in the United States. (Ibdirect eests indhde earnings lost d6e to smoking-related illness and premature death.). . As indicated in Table 2(1'age 22), more than $11 billion werespent in 1980 in medical carecosts for smaking- related diseases..Lost earningsduc to cigarette smoking amounted to $36 billiamin 1980. WHO PAYS THESE COSTS? . All Americans, smokers and nonsmokers alike, pay the crutr of smoking. BundA collected from public taxes are used to pay.hospital and disabilih benefits to smokers disabled by smoking-related diseases and to support the survivors of those who die prematurely due to cigarettes. . Health and life insurance companieswhietl charge equal premiuos to smokers and nonsmokers also shift the burden of smoking-related disease to nonsmokers. Athough smokers and nonsmnkers pay equal prenri- ums;;smokersand theirfamilies are more llkelvtn erol: lect insurance bencfits i due to the increased rfsk of diseasee and early death. Smokers alto charge theirmedical bills to nonsmokcrs through h ighcr prit~es on consumer yoods. In 1980, smokers spent zmesttirnated 1547million moredecsoff; thejnh nnd8t'millinn more dars in bed than did non- smokers. Theii job-related accident rate i.c douHle that of their nonsmokingco-workcrs. In addition to losses in prnduciv[ty„emplnyers must bear theeegenses of more &equent cleaning and repoir of nf ficc furnCchingsand ineremud costs of aib conditioning to Lilter smoke Irom the uir-.]'heemple.er, of couae; then pasiesthcseeesls nn to all coruumers io the furm of increasud prices., 20 - , 2L

Not unly doo the data on cigarettes conform to all the acceptedcriteriaforestablishingcausationlbutthe ' association h s been demonstrated over andover by ` thousands of'studies. Autopsies and clinical and lexperi: mental data also corroborate the epiderniological find- .f inp. .. .. ..... Tobacco industryplny: If cigarette smoking causes ' cancer, themwhydon't all smokers get canuer? , Faco Those warning nf the dangers of smoking openly acknowledge that't not everyane who smokvs will develop cancer, heart disease or chronic lun g disease. There are obvious differences in susceptibilitr to all types of di'sease_ Leu than 2%'0 of persons infected with the polio virus develop paralytic polio. Not everyone . exposed to.the tuberculasis microbedevelops the dis- ease. Yet, noone wnnlddi,rount the role of these agents in causing illneas. No[ everyone who rides in or drives a car is killed in an ' auto aucidAnt; however, the:risk iucreasesdepending on the manner of driving, the number of miles and thee type of car driven. The same holds true for cigarettes. - Not everysnmkerdies of cancer or cearbdisease, but - the.riskincreasesdependingonthcmannerofsmoking . andthenumberandtypeofcigarettrssmoked. Tobacco indmtryploy: II ciGarette smokinghasn~t been . shownto.causediseaseinanimak,tfsanitcouldnll caused"ucaseimman. - Factt Althou gh tesearch has.sho.vn that mbacco "tar" - fs earcinogenic when painted on the skin nf mice, there are not many dataon the effects of actual smoking on, animals. Largely: this is due to the f act that it isroery difficult to get animalS to smoke oigarettes in the same waythat humansdo: Even sot.in nne stud}' where researchcrs trained beagles lo,'smoke" tNroughlulLs cut in their throats, caneerouslungchangcs were observed! . It is usuallyy the case that animal data prnvide leads fon epidemiblbgfcal studies on humans. In the.case of ciga- rettes, we began to see cancen in humans we11 before . therewas:ewughsuspicinntobegjne.etensivcanimaf .. testing. At this point, given whatlwe alrcady.knowy about the effects of smoking on Humans, it would seem unnceesvary to:revert to studying(ts effects on animals. Tobacco industry plny:?hcre are so manys health hae- srds to which we are exposed, whoy should anyone worry about cigarettes? Faet:44e live in a wurld where new"hcalth hazards"seem to rturn up.dhily. Many of these "hazzrdSare , merely hykothetical„overrated, or have heensuqgested bv onlv one or two studies. Cigarettes, on the other hand, are knmwo to kill more than 30Q000Amcricans each year. The risksof ciga- rette smoking have tucndemonstrated;in thousandsof studies and areunquestibnably.far greater than those associated with most other commonly, feared "health hazardE." IS IT DANGEROUSTO BE AROUND OTHER PEOPLE WHO Sil1OKE CIGARETTES? CAN THEIR S,OKING HARM MY HEALTH? A burning cigarette releases many noxious chemicals, such arcarb©mmonoxide and hydrogen cyanide; into the air. Someof these chemicals are present'.in h(orer cancenfratiuns in sidcstream smoke (the smoke released directly into the air by the burning cigarette); tha n.in the mainstream smoke which is drawn into the smok- er i lungs. Many nonsmokers are annoyed hy cigarette smoke and. may experience unpleasant symptoms suchas vvatery eyes and headache: Certaiit indicidlrzls, sttch ac thuse with heart ur lu ng diseases, contact lens wearers, and'~d allergic or asthmatic persons m as' be more sensttive to cigarette snjoke than others. They may espedeneea worsening ofd'sease sym ptomv or other problems when, esposedRo ambient tobacco smoke. TLcreisgrowingevideneethatparentaluiGare)te - smoking can be barmf ul'to children'shealkh. Babies nP purcuts ..'ho,amoke h'ave bccn s-huan tu be mnre Gkdy lo decclup bronehit is and pnenmoniu than a rehabies witlfnonsmoking parents. Respiratory and rar infec. tions may.Lr rnnre.common amon¢ older children 16