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SUBCOMMITTEE ON HEALTH ANI) SCIENTIFIC RESEARCH • l. . .. . ., :. ..- . . .. .. COMMITTEE ON HUMAN RESOURCES . HEARING ON DETERRING CHILDHOOD SMOKING - - - Washington, D. C. F1ay 25, 1978 HOOVER REPORTING COMPANY, INC. E}fcial Reportcn Wasbington, D. C. $46•6666

1 I 2 3 C O N T E N T S S1ATE's•'~'_a'I' PAGE The Aonorab2e Wandell H. Ford, Dmocrzt, Xe.ztacky 4 A panol rcpres=t:Lig thE admia± etratioz : William 8. Posge, M.D., Director, Ccntor for 6 7 Disease Control; Norma? Kretchmer,'M.D., Director, National Ine titute of Child Evaltch rA, e.^_d Emz.a DsvPQIopmc3;:; and John Pinn,Qy,- Director Oiffcc of Smoking and Health, Departm:nt oi !ID 11 F:Ea:`h, Educatioa, and ti3olfere 27 , A pa=31 of high QchooZ s Ludonts : , 12 13 j1, i5 16 17 iQ 19 21 P2 23 2A 9 4:- ~-: ~- w + .. i l T: eras2 Wolff and Maira Rci? 1 Sy, 1'trr=ca1 atz E{ch School; Ila..:tin C~'I:z11^Y. Ma.rk Aca~~, and ChariEs Grif.fith, Gor~zzga Co??eS3, E:.gh School; and Ja-Mas Valeo, B~ h,cda-ChEry Chasa'Ei.gh fic} 001 56 R pe..~I consf.stg ng of : Rjichaxd T. 1+;vans, Ph.D. , Pro.fasQor of PEychology, IIu:.ressi;>y of Houston, Ecuzt.z, Texas; James t7. Swi=--hart, PS.D. , 7irE_tcr, r ublic Cc=-_:aicatioas CEatr^rr Fe'cazi tiarr.or, how Fork; azd Pat.:.Ia Cre:5in, FresiC,,nt. Gman Dolradch ~;c vcrtisi ng e In.^.. , *?~•T:: .o_-1;, i~trcc York'

B CONTENTS (contd) - - - - - -T - STAt ELHEw"i' A pa.nel con2isting of : -A: 4 LaSallo D. Laffa11, Jr., M.D., Pr®sidaut-clect, 5 Amorican Cancar Scrci©ty; Dor.ald Youpg, l4'.D. , 6 ltmbsr, Amesican Thoracic Socisty, *and Former 7 i Mzdical Directar, American Lung Agsaciation; Ftob6rrL- M. Daughcrty, Jr., M.D., Ph.D., Chair- 10 11 12 13 1 15 16 17 18 19 20 21 22 23 25 man, Subccmn.S.t~a on S=kin.g, &mzrf cam ticart Association; Joivl S. Bznca.hf, IIY, Executiv8 DirectCr and ChiO Counsal, P.ction oa Smoking and H©z1 th PAG$ I l05

: Barham 8 4 5 6 7 8 9 10 11 12 13- 14 15 16 17 18 LAY IN 19 20 21 22 23 C HEARING ON DSTERRING CHICd00D SN,OKING THUP.SDAX, MAY 25, 1978 United States Senate, .Subcom„ittee on Health and Scientific Ressarch of the Co:naittea on Human Resources, Washington, D. C. The Subcommittee met, pursu_nt to call,-ic Room 4232 of the Dirksen Senate Office Building, at 10:14 a.m., the Hon-._ orablb Edward M. ,1Cennedy, Chairstan, presidi'ttg. PrEsar.t: Seaators Kennedy, Schweiker, and Chafee. Senz6or Chzfee. Ladies anC gentle:^sea, we will now start our hearing. Senator Kennedy is unable to be here until later on, but he has a stater.Ent. l (The following was receiroE:.i for the record: L^ ~..7

I C 6TATO-MA"S' OF A PATqEL REPP.ESENTI2iG TEE AD- MINISTRATION: YfILLIAM H. FOEGE, li.D., DIRECTOR, CENTER FOR'DISrASE COa'TROL; HORFiM PCRL-TCY.MER, M.D., DIRECTOR, DiATIOHAL INSTITUTES OF CiiILD HEALTH AI?D HUMIaN 6 8 9 101 11 12 13 14 15 16 17 12 19 20 2! 22 LkY I:. 24 e?- L. DEVcLOPPiEW; AND JOBTJ' PlhidE?, • D?RECTOR, O£FICE OF &KORItyG AIMliVaS.T.H, DEPART-e-EST OF SEA:.TFi', EDliCATIOn AND F'P-LrAItL 27 Senator Ctufes. The ner.t pauel will b3 nade up of Dr. Ylilliac Foe;:., Dito.:yor of tho Cen.`.a= for Dissaso, Control in Atlanta, Pund Dr. Norman nroticYmor frcm the National Institutbs , of Child Health ars3 Sim-at: DEvelopment, and Jc+llm Pini-tey, Director of tihm Of:ico of Smoking a.d itealth in HEW. W:Bll, ga.rtlcnsn, hm :aelcome you haro. It is my privi- lcags to have known Dr. FoEge and sesn him b2fore. And why don`t us start off with Dr. FoQ;o, and then we will take the otaE.rs. Dr. Foage. Trsi.:: you, ts. Chairman. With your psrmiesion we k•anld irsort Ghi; fo_ thA rccc_d and read only aelacted por- Lios:s of oa.r tcai:LMony. Soz:atos Che.fe.3. r in3. [T"~ fo? 3.osai,.g uras rc:cn;rcd for thQ record: 25

37 I 1t 3 4 6 7 8 9 10 1I 12 13 14. 15 16 0 18 19' 20 21 22 23 24~ respon4ibility. The ten soparatc4 warning tressagos woukd attract greatar interast, through both novelty and variety, than tho single message now usAd. 6overal of.the-m--for exa,mple, the one on da,-naSa to tho unborn child--would have the further advantage of calling atteztion to spscif s c threats that may not yet bo vidaly r®cc,7nizod. - . If the decision is nade to reguire a variety of smssages, thc spccif ic w'or ding of each nee-ds to bo carefully considered. I would hope that tho condii:io_al •nay be' could be avoided, an3 that in every case rhe.re the. cvidGace is supportive that the force of the statsmant 'is 'da.ngaTous' could bu retaincd. I would ea:phasf.zc that wrarnings should be required in adver- tising as vrell as on packages. Section 10, Mr. Chzir^..an, is the portion which is to us the hcart of the 2Egislation. This is the area of greatest concern to the Dopartmant. It is also th3 area in which wo have bcen the least successSul in the past. 1k© can point with soae prid.- to gicnificarl:: deGrazst!s in smoking am oag adults-- first s-mong n:ales a;:3, rece^tll•, among females. But with chilS.rez smdi youth, the pl.ct,= i€ d? €f eze.at. p3'745110 Syo::i :g ariang boy s has hardly chang3d in the last derr.do. ou_ most rsccat fiRiras C wrich 'wil:. b.^~ upda,c3d during the coming Summar, shcw that five porc:erit of boys boUTec•n 12 and 14 moko; jLst un.zer 20 perceseL of boys 15 ar.d 16 =-oke; and

36 n 2 3 4 5 6 7 8 9 17 i t3 19 20 21' 22 23 24 25 so.nf:xhat more than 30 percent of boyo 17 and 18 sm.oke. By ag0 18, the habit of emoking is wo?3;-estr.blishcd, and ws think this is unfortunzte and sho_king. MeanWtii.le; smoking among girls has increased d.•anatically. In the 1960's about twice as many boys as girls smokcd; now at Bvnry age lovel girls are smoking at the same rate as boys. Senator 6chtic•sikor. Doctor, do we have any information or evidenco at all to indicate rrhy, Nhat's the reason fo'r the upsurge among teenago girls? Dr. Po:ega. We are not certain of this, but we think that this is due partially to the now equality of the sexes that wo 8ra sa2ing, and ka are hoping, tiwer.cfora, that now that they are equal they uill both go dawa togetheL. 6enator Schwoiker. 8q+za1 right to get lung cancer to- qether? Dr. Poogz). That's right. Tbs lcsgislatfon which you have introduced recogaiz_a r;:e impor4:,ancc of reecarcb in directing our efforts. k:o nrs2d to learn more about smoking behavior than we know now, pa.rticulz.:ly rc-ga`dir.g smoking bA_-.havior among caildran. In the President's budget for PY '79, wo are requesting $4 million for thz~ ilationr.l Instzt:ute on Child Sealth and Hema= Devclopment to invesL•igato t.`~a childhood determinants o: srohing bai,arior. At this point, let 'ao em-phas;ze tr':at tho primary goal I

2 3 4 ~ 6 9 10 11 12 13 14 15 1G j 17 18 19 20 21 22 i~ff 23 24 25 39 of our prsvention programs with children, as vrall as adults, is to provide education and to conduct rasaxsch that will enhancE, noti reduco, p=rsonal choice. We must underatand that an 1S-year-old smokur dces not n3caesarily repres¢at free will. That amofiQr may wQil be the representation of bondage due to insufficieut information to mak= s dolibarate informed choice. Do our te=agers truly understand, as emphasized by Secretary Califaao, that cxokir,g is i.adc;r3 slok-rootion sui- cide? One of tha: tiosfi effective ways we havs fouad to inform children and ycuLg pcople is through health education in the scy.ool_. Sono e:cc1lE:.t school curricula have already bean drvelor::d and test:d for olc:c.nta=y school children. There is aa pa#3c-alarly urgent nasd to devulop education- al programs fcr toon3gcrs. braism wa are gatrsring neH know- lEdgo, wa rLsL a:.eo arply what u'e already know about teonage at;:;t-u_as toisard s?not:ir:r,, auri rbout how tes.^.agers learn. Sa.rv;:ys SsvQ s2'ac;.~z, for insta=2, tha :: --3i5hty-fcur p;,rc.;n_ of CecrzgQ s-so krss adm3t that f smoY:iag is babit-formir.g, ---Sixty-nisse perc°,a* rca 1s ta that s:~oki:g slows thsM dov:n in sports, --Ttira-t.hirds baliev8 that sn,acing is just as.har7aful as their doctors aae! tcEc?^crs and par6:,ts aal, --And half of th<<..T hope that k*huz they havee c..l.idren,

C 40 2 8 4 6 7 10 11 12 13 t= : 14 15 16 17 18 19 20 21 22 23 24 25 their children won't Emok®. The final s9ction of S. 3118 calls upon t.`o Secretary to study and report back within two years on the rrala`ive hsalth risk associat.d with ssot:ing cigssattas of varying levcls, and the relationship of tar, nicotine, and various additives to health risks. Tteso two qu3stions, in.o•ar opinion, aro among'tho most im:ortant public hcaltb qucstions of our tim_. W3 are now beginning work on tho 1979 Surg®on Cf3n,,ra1'ts •Report:' This •- will bz the rxost impori.z.:.t raview of 3nfosaatioa on czaoking si.ece the L.ublicalwioa of thE original report nearly fiftecn yo :rs agj. As part of this effort, ttsa aa_cm-ci'os will ba loohing at the chaages %+rnich have taJ:l.•a place in the cigr.rette itself, and will attr-r-pt to evalu4t4 tho health sic,**r+ificance of these changes. On the basis of this i.nfozsation, HEF9 will focus at:e_nt:ios on many e3p`cta of the questyons pos&d iat 3118, and it is our hope that thia informatfon will be availabia, before ~ th0 end of two ye?_r3. Senator Scci!;:i'c,2r.. Aiay 1 ir.t3rrup` jurr one minutc? He just markad up the Lsbor-USrti bill. ycsC}, day, a.an on. ths I h_a1th ac:u:.•ation rrao3.'ag sect{on I;hi~: the Ad:.~inistration-- Lot on child health, but tte otti_r--wo took it from 8 mil.lion t.k,:~ T_dainistra.tiors's rc74uest abov€~ the 12 a.ill+ors the Housfl guti in to 20 million. So wa did put 20 mi.ll{on iz the

6 I 2 3 4 5 8 9 10 11 12 13 14 15 16 17 18 19 20 21 P2 24 25 C C 53 avidenco, our policy and ot:.r position has bean very defiaite- ly to encourage people to staoke lower-tax lower-nicotine ci- garettes. San3tor Kennedy. Okay. Scnator Chafee? Sonator Cha`ez. Dick, do you have any gu.astions? Senator SchwEiker. Just a coupla.,'Firat. I do want to comment CDC and 1M-Fi for their w.ork in this area. I am strong- ly suppcrtive of the bill eehare wa talkr.: about clean indoor air aad non-kars' rights. I think this is long overdue, and whilo I have sos3 problems with other sections of the bill, I don't have anyy prob2e:s with that aad I strongly sup- port it. I assure you that in te_-zns of the appropriations aspects, we will give you the money to do the job. I would like to ask one or ttiro cuestiona. Dr. Poege, you mentionEd on page 12--or you ask the question, which is a dz,n good one: 'My docs it appear tl:at fewsr coZlege- bo.sa yoa.:gstcrs su:oY.® tLaa those who do not plan to go to collcgC?" I was actounaacd rocEn.ly to sc3 a survey at Princeton, a- the ama3.l percrr.-.'-agss of co.l _go guys who smoked comprsed to w::en I cras in collc3c; I just couldn't believe the statis- tics, but apparEntly thsy are truo. A..zd th: question I guoss I havU' is, it seems to =- tr?r© is a:n awful lot to 2carn about the p3e= group pressuro of the college maZo and why he isn't smoI:::ng, and tae p3ar group pressure of tha young 4e:.aage gal k