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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

54 and why ehe is, bccauso peer group p_essn: e sseems to have 2 3 4 5 6 I 8 10 11 12 14: 15 16 17 1F3 19 20 21 22 23 24 worked in complotely contrary r®alms, and you are obviously geared to th.3t, so that would be part of your survey, I would Yssta~sa . One of c:y questions is--s4sucturally, with your asw of- fice in HEw that mr. Pinney is going to hmad up, is that cor- rect? Mr. Pir.r_ey. Yes, sir. Senator Schc,reil.os. Fioc; wf.ll you integrate, though, with the Na_iosswS *_aetitutc of Child Bta.lt2:, because they have very e,oparate prc _edures on p:rrr r.:views of proj3cts like this, acd I am all fo_ tho in:cyrzt=o_--but isn't that a prob- lem? Ms. Pinasay. It is not a problem, Senator. The philosophy! on which ths, offic: is bascd is oae of project managns.:.nt. In esseaca, tha Secrstany felt tha.t thoro v+as *aot enough attFSn- tion at his level on the prcb2a of s=king and health. Thera was a lot going on in each of the Institutes, but the ques`cion was: aro ke directing what resourccs we have to the best pocsiblo reaas an3 emda? An d, for examplo, with the National Institute of Child Esalth as.d Bums.n Dsvclop=sxt, my role would be ons of discuss:.ng with Dr. F.ra`.c1*ner What his progr<n. .P.-mounc=ent would say in terms of eliciting good sound ro- eaarch in the areag that wa have ida-m-tified as top priority. The actuc;. cont3nC: of tho resezrcb proposn.'.s and tr.c pasr

56 I 2 9 4 8 10 11 12 13 14 15 16 17 16 19 20 22 23 24 25 STIi'i'E.11Mh'TS O!" A PAi.EL OF $I6E SCSOOL STUDZiTS: ^aHEEBSu W0LFF AND b:OIRA REILLEY, INL+fI:CULATA HICH SCSOOL; MARTIN O'h:ALLEY, MARX ADF.NLS, Ab1D CI3AP.LES GRFFI'i'3, GOhZAGA COLLEGE HIGH SCSOOL; Ah'D .TANMS YALfiO, BE':cirSDA-CHa"VY CHASE HIGH SCHOOL Sonator Keanscy. Wo will bave a panel of high school stu&ont3 from GonWaga College High School, ImMaculat.a School and th3 F,e4.kcsda-Ch_vy Chace Bigh School. Through-an over- sig!`.t, the Sra.T,a.culata and Bn;;hcs3a-Ch,svy Chas3 High Schools wrrc now ncatiioncd on the fcraa3l witnQSs list, but thzy have bza:: s:^.orrcusly cooparative as thc young stud= ts havs. We want to uolcoca you to th6 Co!:nitts3. I think ths Cor.grCss of t2 e Uniaed StaEs3 geta its informalon from a variecy of so-sc,es. W= bave in this legislztion that ws have before na noa--xe a=a tryinc to ds-al with an is3u_ ar.ich I think is of enarnous co_-cern to paremts all ovaz this country, porhaps all aver tt:o rorld--paron°.s vhosa perhaps first in- teTeat is tho good bralth of their childrea, paro3ts who are f,u^raasir:gly concornrdd about t.h:, esplosion in S.c-nas of tho co..r.:vmpticn of cigarat;:es. As so many scicntiists a,-.d research- ers and family doctors hr-,,a poi:,t,~ci out, the ecieatific infor- maticn is very cl~ar that rcs a.ro rcally heads3 for a typa of hcal;,h c-?as:rophc in this nation if tha kinds of proj®c'cions fiha: hava ta:esn placu r::iezza 2°58' ard 1974 among young peoplQ,

57 I ~ - 2 3 ~-~ A 5 7 8 9 10 11 12 3 I4i 14 ~ ~ ~ 15 16 17 1s 19 20 21 22 • 23 24 25 ers , g irs s~ Coatinuo s. teena o hia g asr.ong I think all of you must have baan inpressa3 by what some.of our distinguishad researchers and doctors have poiated out to this Committee. And wo aro trying, as we shou, d, to f i=sd ways and msans of working with local commuaitios and working with you and your aosociatss in the schools to try aad find out if tbere ia some way wE can work in partcnarship to re2iava this gonera- tioa, this younger guoration, of the burd¢n of smoking. We realizo it's complezj xo r'®elizs it involves a vari©ty of di'frerent guQ3tioas that affact young paopio--and we want vQ:y much this morning to h$ar from you, whay'you think is ' the nature of the problem and thp Kays and mEans that we can 1~oest deal wit-.h it. So we are v©rh, vcry grateful to have you join us h"e 4 t}as morning. IIoaa ma.ay of you hsve ever testified bGforC? UiEll, it's nothitg to be concarmc•S about, we Wa`t just to hear from you in yoc3 o•an words. I cisatw your att:~:.ti.oa to thu cha.rL•s that we have ever here that show in t.'^_osa four di,fo-rc.:t se-3sea:c3 arezs ths vcry eigrificantt growi:!-, in the nzmt„rss of regular smokers a2tw_3n 1960 and 1974 by various age, categorias. And we can ses; in thn youxgest age, from 12, 13, aszd 14 year old, an eightfold inort;asa; ccrrestoading increases, perhaps aat p3resntagcwisc, b::t cQZ"caiz?.y from the numbers dramatically J

al1 ~ ~a 58 continue in the 15 aand 16 and 17 to IB--and this is, as we can see in «-ho*chart that ic just behind it, at this point ' the girls are virtually even with tho boys in tems of use of cigarettes. 5 8 9 8ut nonmthaloss it has besp doscribed as an explosion in torms of the uso of cigarettes, aad'Y® would like to try and sort of gain your views about the iESuQs. We would liks to h:as from you your own views about smo- king. We are aot trying to makv any noral jiu!gmcnts obvious~- ly, but 4re are trying to find out about--you can s.`.art off with your nazaas, your ages, and whsrQ you go to achool, and thc n we would like to ask you about trhethe r you s:ok© and wh= did, you star-, rs.d soma other a_uestions. I thir'c wE will gct start€c maybe over hssro with Thtsrese. 16 17 18 19 20 21 23 24 TzY k into the mikcs, if you xould, aad giva us your aa=, age, and rshe_d you go to school, ju3t initially wo will introduce oursalv6s. I - Tod hc,.r.a3y from f:assachuse'cts, Senator Chafao from Rtiodo Island, and Sonator Schwaikarr fron Ponnsyl- vania, and we ar© all iFsmb`,3 of t.h0 ges?th SuL-com.vitte@ that is conc, rnad with Vsis lcgislation. So juct give us your ni=e, your age, your sc2rc.l, and tFlos,. wo %-•il:l come to sonz! of tha questions. Fii sn Volff. I un T:.erf.er3 Wolff, I am 17 ycara old, and 3 plan on gcing to Wast Virgin+F z'aslayan next year. Senator Chafss. A.^..d you just graduaWd fsVp r'-`.rrE?

0 2 3 4 5 6 C 59 lS.is s Wo 1 f f. I-culata. Miss Railley. My rtiase is Moira Reilley, I am 17, and I have just graduatsd from Immaculata Ligh School. 14r. O't3al10y. I am Martin O'I+.a?le_v, 15, I am a froshce,n af Gonzaga Coll©ge High School. Fs. Adams. I am Mark Adams, I aa 15, I am also a frash- ma•n at Gonzaga. Mr. Griffi4:h. I am Charlos Griffith, I am 17, I am a 11 12 13 14 15 16 17 18 19 20 21 22 23 24 ju_ior at Gonzaga. fir. Va2o.o. I am Jam=? Va?oo and I amgradue.ting fromBct;hesda-Cr.SV.y Chaso aic_rh Schoc,l. Senator renr:edy. Cou2d you tcll us, maykr by just a show of hands, hoVi many of yuu smo}:e? MP.yba we could start with you, TrercEe and Hcira--whan did you start? Miss Wolff. A-ror.ud 14 or 15. Senator Ecnnesy. i?hat about you, Moira? Miss z3i11ey. 15. Senator r~-,_nrdy. Jazoes? Mr. 1.'alco. Yes, I was 13. Senatior l:anacdy. . I,arlc? Na'. ACTa=3. I was 13. Saaetor Itenn:djP. I kaGk' t_+aL's a few y€ars ago, but do you thin}: you could try and rsaybe trcll us about why you da- c:dcd to sf:a:.'t to smo!ss or not to eaoF:c? Was it sort of a

t 3 oonsoiC s decision? C 60 lliss Roilley. Well, basically r•hen people start smokiag csgarettes, it is because of peer prsssura: your friends start to saokc. And then it i© a choiee of whethEr you wrant to ba 5 6 7 B 9 10 11 12 13 14 15 16 17 Ss 19 20 21, 22 23 • 24 sort of left out, you know, by people of your own agetif you don't start snroking, you know, thoy aort of look down on you. Senator Chafeo. fthat psrcaata.ge of the girls in your class smok®, would you azy? Miss R=illay. In my cle.sc Iwoul;d say aboLt 85 pares.nt. So:.ator KFSmsdy. Mhaf f.bout you, Thernss, whon you starte3 to eso3:c? K:irs 1:olfF. I slaaxvtea s.ao'•.ing mostly bscauaa I like it. I tioald say I sta=2.:.d s:.o}:ir.g probably to fit in with tho crowd. So.-:atcr IC.dv. Let me Ls2: the ones wno do smoke-- cou? d I j sst seuo your hands again? snoko? Eoih yozLr parcui.s tr:okfl? Mr. Valea. Ono cf mins. Sosc many of your parents Saaator Frr.nady. On9 cf yo;n: parents. How about th3 oncs that don't smo;ce, do your pare.hts smol.e or not rmoko? i-:ritin,, what abo4t that? Kt:. O'Valley. Os:e of tay par= t.s sTMokGs, but bo is not a cons3stCat Moko,.rF ha just has eo=. ec,a.ry onca in a while. Mr. Griffith. So•;:h of :aioo aaoLo. su.^:atG_ i;ar ociy. F.:,:! ycu don't en.cke. Mark, Waa-t about

I 2 3 4 5 6 6 9 10 ti 12 13 14 15 16 17 1 is 19 20 21 22 23 25 C you.• r 61 Mr. Adr,mg. N®itha.r of my parents smokes. My aaother used to, but sho Qu.it. Senator FennE dy. Do your frieads think at all about the health iraplications of smoking, or do you sort of think about it and think it is not going to happen.to me? What kind of •a sense do you or any of your friends have about whether it really is go_ng to make much of a diffcranco in t~~s of your health or not? Both your oL•n vieci and whati you hea^ scmo of your friends talk ahout. l2r. 0'I•?alley. k~ll, I vould say that kids my age aren't really conccrnt.d wi-th the health issues, you knor; thay talk about it maybe. But the aain e.f.aq that thay are doing it for is, you Y.now, just to fit in c•rith the crowd. Smo]•.ing is someth{ng that most adults do. So I Y.2',.in3: the roason why the k..idt do it is justi so thay can get a feeling of, you know, Piiss Re-illsy. t;aruraty. tlr. 0'c:a.llcy. Yssa, maturity. But I don't tdiic:k they arv really ccncernan3 tihs.t mv.ch with tho hEalth ir.enes. SLaGror i.cnr.e3y. h'haC abaLt it, Jim? Mr. Valso. f?tll, %:hcn I fire:t tstarted to smo;c, you know, I usc:R to th=al; it coUdg't hzppsm. to au3, I couldn't g9t ill from it, w was icn:uao to it or soMOishisg. But no~ 0-.at I am o2d3r, I have bca thxn.':Sng--I cM eez how it has affected

V 1 2 4 5 7 9 10 11 12 1k 15 15 17 18 19 20 21 - 24 25 .C C 62 my ability to run any leng`.h of distanco, you know, my wind. Senator Kennedy. Are you an athlete? • Mr. Valeo. S?sll, I used to run track, I usxd to sprint. When I sprinted, it didn't maka a diffo.rence, because, you know, a hundred yards--thzt's nothing. But I am talking abon going out to ran two or threo miies--I'don't know wDothar I could do it anymore without huffing and pnffing at thQ and of it. But now, you know, I have made a vow to myself that I am going to quit smoking, b3causo I can etc th^ effeot that it has had on me as far es that goos. SF=ator SchFraiker. Are you going to gui t cold turkey, or ho;: are you going to qui_, Jim? A:r. vzlec. t+'all, I Aaveti tried to cut down, and:it just doa3n'r ffor}:, bacauge tb?.re are too mezy t3.mes wbsn a cigarett tastes good--that's what it boils Coaa to. But I am just goin to go all t_h9 way, quit cold turkny with it, wh.= I quit. Senator Chzfee. Charles, I noS:.i.co that you don't spoke and both your parr-nts smakQ. No4, arfi yoL involved in athle- tics or what particula:z r¢ason do you not sraota? F1r. Grifritb. I didr't saol:O--a lot of ay frieads starta to eno'.o br.cl; in 7tFt and 8;. gra&_s, and my parents =o1:od, ar.3 I just vaate3 to be diffCZc_-,t. I a.ike to ba irz3apendaat. S; uatcr F'.e:x.cdy. Let m3 as:r you ab3ul.: the attiL•uie of thr, schools t.boutt tIh3 s•saking. Do your schoals p.y.-n<_t it, do

. • 63 C 2 3 4 5 6 7 9 10 11 - 12 l I 17 18 19 20 21 23 thay'discourage it? Does that ra1:e any differanco? What about it, Moira? Miss Reilloy. Woet Catholic high schools, I would say, allow it for saniors. Our high school didn't allow smokieg at all. Geaeraliy, most pubiic high schools,'there's so msc2 s=a1:ln3 tharois nothing you can do about it.- But I oroulu gencrally say that most schools allow it; there's not much you can do, so mauuy g-aoplo saok6. Ssnat.or rev=1y. What about thio hcalth issue, 'lha.resa? Do you trir.k that many of the youn3sr people that get started givQ that very a_+.ch atti=, tion or much thought, or do you. fiad cut when they got a little oldsr that t:-qy bcg3.n to give ~~ it aore and then ar6 they hooked on it, or uha4? i :S Misfs Wolff. When you fir,:t start smoking, it doesn't-- at least wit.h me, it didn't tako effect unti],.like m couple of yezxs afC:mr, lihe.now I can s¢3 that I csm't ren as sauch or par':ic_pato as much in activi::.as. I don't thi_Zk they roay ly lcol: into 1t., thra health conditicas of it. I ~ St A eneoroar.e42y. Iht d thini? Mar:, Yao you.. D you thik on ticv ti.ink muah a.bout ths health factors in ths s:.-~oking? . ~ Mc. P.rie.ms. Y.hzr, I first sta_4:ed, yes, Z. thouabt about tlat, b'At I f:.v_-uTCc3, yoe know, that I seoul3.Z 't be smUking my whol4 litot I figured lf.}ui c•:he:a I turnad 18 I would stop or something like that. Bst now, as timm goea by, you know. 25 ~

s C C 64 &anstor PCsnrredy. You axe thiaung more about it, about 3 9 10 it 12 13 14 15 16 17 iB to 20 21 - 22 23 24 25 w5cthez to stop? What do aay of you think would be-have some of you thought about stopping s:aoking? Lxt ma sea a show of bande. How saany of you thcugbt about stopping smohiag? Jia, you thought about it. Sanator 6chwoiker. Be's going to do it. ' Scaaltor Kenae-1y. Iio'B going to do it. What do you thin: are roally the factors that vsould make a diffsr2nc® in whethe: you can s3top or not? It it agai.n what is happeaing with your fri.end ,, your colleag': es? Or do you think tho fact that you r.r.ow aorc tbout thu health itcplicatioa3? Dccs that help you or a..~cc-a-rage you to stop emokiag? Ph:at do you th_a", _ are the things that ca^n help the rsost in texcas of getting tc-Un4gars to stop? Hiss pzillcy. Most t;G;.nagcrs aroa't re_lly well iSai`orm¢fl about the health problemc. You Eee co=_rcials and ads that tscy, you know, in tv:enty ysaxa you might develop luuq cancer or somctF iag liko that. Sut when you are young aad you start smoL-iag, you don't th`nh ot the long-tcs:cm effectss you are juct th...infiing about acw and you arc thinking about--I will jus;- try sroking for a while ind thea quit. But you woLld bavo to e;;art at tho schools probably, bo- catise r-hat is wh;,re r.osL p2oplCt start. And if you can stop pFop13 from sTMo3:icg ct Echocl, th.-c thzy are just not going to = M~h ~=-

k I 2 4 5 6 7 8 9 10 11 12 ~ - 13 14 15 16 17 i6 19 20 21 22 24 25 .C C 65 dsvelop a habit. t+nd thrn it wouldn't be as hard to stop. Senator Kenaedy. I thint: you put your finger really on the key quostiors, and that is, you know--are tbere things that can ha done to pr6vant youn3 paople from gQtting startec What suggestions do you have on that? Maybe we rill str._ t wi th Jim. Mr. Valco. I havc thought about it, aad it would have to start ro,lly at sa early aga. t?'naa I was young I was totally against s:no!:ing and I got my father to qaiti smot-.ing. . ~ 6raator Ktsn::,edy. Etow youcg was that? lir. Valoo. I s.ritzlk3s:g about 9 and 8, in that area. Bscause I hadd teachera back ths:zt also that would say baw bad srsoking is, and, you kmcv, what itt could do to you as you got oldex, and so on. But the.,, as I got into jun.ior high school, the eznpbzsis on si'+.okirg--tho only thing wo L.aard was you cr.: 't smo :3 ic school; that was it. Hut Fa nHve:; heard why. And so it al- most lzca=- --just to defy autho.S.ty, a;a would smol:e. ]Lnd if thoy kepL thh:a cmph&sis uF, bcrcasso, you know, it's a prett_v imprescionaa3.ts asa, eFz. throu3h high school also--if the czaphasis frzs kopt up on frhy you Ehou?dn't Emoks, not just tlsr.t you oar't smokE, I thi^1c thzt it wuuld raako a big diffcr- ezct. Senator 8chwaiker. Jim, bot+ did you gct the scney to support you: habit? In othw words, that can run 63veral

C 66 !"- t bundred Aucks a year. Did your foll:s give you your money? Didn't that get a littlc expensive aftar a while? 3 34r. 'Valso. I don't like to take an allosva.nce from my C22. pa_•e.Rte unless I have to, when I am aot working. I fr.ry to 5 work at ski shops, whotever, as oftGn as I can, because I 8 just think I would rathe,r, you kaow, be able to support my- self, at least as far as spending money goos or anything along thooe lines. 10 Sonator Chafea. Cculd eca just have a show of bands-how many of you have ever Erca ir. yot,r s3choo13 educational films on the bad effE^ts of - o}:itg? Sut you are in tho sas.e 11 12 achool. 13 A'.iss R.zilloy. fliffnrent classos. 14 Sanator Chafe:.. Different classcs. What did you ace, a 15 fila? 16 Miss Psilley. A film, in physiology; it vis on the body, 17 things 1t3:c that. An.d occssionally thay w7txld have topics in 18 the science ccurse where they roTisw cancer and srroF,ing and 19 thir_gs likc that--that's just one :rimwster, out of the whole 20 year. 21 Ser.ator Chtfe--. pmd if you did.n't happen to take that 22 course in pS:ysiology; you wouldn't see t'am f ilm? 23 Misa F;cillGy. Right. 24 S-Mator Chaf-a:~. And nona of the rost of yau had any edu- = 25 cat?on2.l--ia asss-mblias or r-n1Wiag iiko tI::.t--on --- .. V:k. U1 N ~ ~_

I 3 4 5 6 7 8 9 10 , 12 r 13 ~ I 14 15 1G 17 1s 19 20 21 22 23 24 25 1: .C c. Sanator Schwaiker. Or phya. ed. or boalth classes? Mifls Re.illey. No. Sasatcr 1C®ansdy. Let c* ask you--what would be your reaction to sort of the school providing this iaformation? Would you consider it, well, they don't want us to aralce, so therefore tj%oy are ja=fag it dovm our throat, you know, a ccntiruod plo'_ of th3 foress of aut.hority in our lives; or do you thint young paople would really, if this health mas- sag© w,aro provided in a sciEnti:ic ar13 kind of no-nonseas® way, really laid out the facts in tcrsas of young people, do I you think it vr•ouZd mahe a difference in torms of their doci- sions? Mark, ehat do you thir-k? Xr. Adams, holl, I think that would saka a big differ- ence, recause nc+st pzcplo who start suo}:isg don't really know what cance;. is liko, anG if they were givon s: za ts:amp:es, showing fiL-as at an ca+-lier age tt:an jun:ior high school, I think that that hou18 really pre:vent a lot of smoking. Senato;- P.~nned.,r. ChzL:ldt<? t-;r. Crif.it.h. Wc11, I thiulc if you had films or soasthizg ot p_c.?lo c:i:o arc maybe in their 20`s or so, •Hh<_ch is not far off from cur ac?c--and, 1-ou k, cw, eos ths effects that it has had on Chr--- already, l±lce c:c3.ra and Thrireso had trouble running, ior Ja..Cs--ass saes the lozg•-term eficc_c, thoy are there, bnt the short:-fcorce effects are therE, Atoo. You know, it's not that

s 1 2 4 5 6 7 8 9 10 11 12 tg 14 15 16 17 18 19 20, 21 22 far'off bofore you will start to fesl the effects of it. And I think if you saw a young person not much old3r than the effect it has on him, it would have taoro impact than body who is sixty years old ar,d has cancer. Scnator Sch-.mS1cer. I would like to asY of the paopla x smoke, rhen your parents found it out,•what was their reacti Did they try to talk you put of it? Did they say it's your docision? Or did you have an srgusat with thccn? idbat raac• tion did your parents giva? Jim? Mr. Qaleo. Wa11, my parents novar told me f1Gt out I can't smo?ce; and I r.evzr Kept it from them oittxir. They en- couragR3 me not to B.Tol:e r and they fi.ep't using the examplo, ~ well, you Ft:oppsd nc frc.-a swokiny, why ars you smoking now? j Eut thzy just told no what it could do to aie, but I didn't really pay Much attcn:•ion to it. But they didn't just put tu ii iroa hand dou-n and say ao, I can't. S=ator SchcMi;cer. Mark? tL . Adaras. When my parents first found out, thoy really , kind of said, it's your dE•cision; if you wr.a;, to hurt yoursslf you know, you can do ^:. But they 4ncouragc3 me not to, aot to startt. &anator SchF:eiker. .Th•aresa? lHiEE Wolff. They emcourage3 =a zot to definitoly. My ~: 25 11 p&rante aenen't picased at all,

I 2 3 5 6 7 8 9 10 11 12 13 14 15 16 21 22 23 24 25 C I Senator SchweiAer. Moira? 69 Hiss Reilley. well, tny paxants--thare's not much you can say Khen you smake, you know--you are.setting a bad example yourself. I rrean, thoy can't t$l.l you not to do it if they do it. So all they can say, you know, is it's your decisionj.yeu make the choico. But it•is not what vo would w-a.nt you to do. Bs:.ator Schwott.e•_. Gottiag back to the question that this panel is really asking up hsra--w'hat is the most effac- tive way that wo cpn ivput on that dECision? I gather if wro were to ass you ttis question who:.her an input from your parents, wLo ciould tai.e a strozg stand, verass education and films a=d input fron the school, what is your anvwor as to which kosld bc moct offcctive in your judgmcnt for all kids to stop sxo:cing? Miss RRail?6y. I would say that it would have to come from the school and c,d;;aation aa3 tho media sourcos, thirr,3 like that. I naasz, your parCs.'1t5 will play A=ole in your c=king or noL ss:oY.iag, but even if tuey say aot to, there aro so aany tinss t1•~at you c= just go alz2ad and do it any- way. Sena•tos ScLwz:.}:er. P.i,ht, and that is usLally an invitz- tion to do it amyray, r:ght? Miss Roiliey. Yos. Senatoy Keasztdy. On tbic p=int, what do you think is the do" C~

1 3 4 5 6 7 9 10 11 12 13 14 15 16 17 18 19 20 21 22 24 25 .c C 70 most cffectivA in Faeso:Iting this massaga to the studgnts in th3 schools. l+ro ycu better g©tting it from your peeers, your colleagues, your classiaatos? Are you bsttar gatting the mossage from a teacher? Are you more impressed, do ~you think if you got it from an ar.hlete that is kind of Wall-kacrwn? k'uat do you ttiink really taakes tho moet iznpression? Or a doctor? Miss Reilley. I would say your pe3rs, and somacna with a little authority, you kno•ic, a little o1d.^•.r, maybe could set an e.tiamplo. Sut, you know, somoorse who has gona through tmo- k::ng and has E::peri ~~s: c3d it and can rela :a those sspericnce3 to you, sc:one that is more your agm--you would b:, more apt to list.sn to thcm. 6enatcr F:zz.tisdy. ha:a't about the rest? trr. Valeo. Well, I feeI it would really be a combination j of all of ti':c--. I ara iu:p:.eseC--d by athletes; and when I was ycLrg, if I hed 2cad: an a4:h:.c4o ccmo up and s4y, you know, cor:z on and bc like ms, don't sm*~-a--that would mal:e a big improsE,esz. But I k•oi1.d also aet.d tiio s•..prort of my frionds atd whatever; if I did smokE, I would read th-_~ir cepport to hclp ras stc= , you l:n-ou" to 3:c_•p me off of thcn for awhilo-- becausz it's a hard habit to braLk. And tcacizers aad paronts both also. 5:•erybody'y input h:ilps_ 6erptor Kennedy. This is a good point bore--and I would ju: t an _st_r;>atcd in the roactior. of the rest of you to it- r

l 71 Jim"m::ntioning that you nesd the support of your parsnts, 2 3 h 5 8 9 10 11 12 t:. 13 14 15 16 17 18 19, 20 21 23 24 25 you need the support of the school, you npsd the support.--_ som.s health messages within the schoolt I suppose what you arc also talking about is other kinds of comnunity activity that you are involvod ia as well, whether a boys club or a girls club or various kinds of organization, that they ara conscious and thay a.ra vorkina on it. I supposo some young people would L-- inpreas;,d by those activities as wQll. Y7hat you are talking about, Jim, I sugposo, is a really pretty ecnsitizad cc=unity acd local effort about the health hnzasds of ssr.okir.g. Would you all agrca with that as a thought? Lot r:e asi you just finally: what is the impact of tcls- vision? You sae, you know, all the advartci.ging-6::cuse me, it's not oa tclevisiou, but you see the other advertising in magazf.nes and neerspzp,;rs--do-3s that havQ much of aa imract? You arE alumays sss:.ag a big rugged rwn or woman lighting up a cigaxQt-t-0 Mr. Adamo. I don't think the z.dvcrtieing on TV is eerioufs encuorh to get p^sopG e to stop? I thini: if they mako it more scrioLS. S2r_ar_or K=:Lc3y. Do you tFii.^.k if you bad counter- adver.°.ising on eithur radio or tal®vision, that that would be of soLa vaiue, too? Probably a tough question. Srna4:or Sch:*3_U%e_. Lst me zsl:, hoil much of tho

0 2 3 4 b 6 7 8 9 11 12 c=~== 13 14 19 16 17 •iB 19 20 21 22 23 24 25 1 ` 72 advsxtiing about pro-smoking t.hatlyou see in aewspapars and magszinss and biliboards--hoW much do you figura that is a factor? I mean, doGs that u=}ce it glazsorous? boe3 that look like it's a mature grown-up th:.ng to do? Eow much of an impac would you say--what you might seo in an ad in a newspapor or magaziu3 or billboard? Miss Roilisy. The ads tl=sQlves azts pretty ridiculous as far as making you start to smore. Bu2 just ths fact that you s-3 ads Bve.:ywksre for smoking--Qverywhero; it's impossibl ~ to gEt away frora it. It raminds you of sr+oking, it makee you waat to have a cigzretto--ttdYgo like that. Ttare's just so much of it, you can't got away frcm it. SGaator Chateo. Jim, what prompter3 you to try and per- suada your fathsr not to smoka? Kr. Valoo. t:a31, I could seo then what it was doing to hiu. I aaan, he just wasn't agilc; he couldn't run aaymore, ho cculdn't run upstairs or anything liko that. H3 just couldn't load a rcally activc life until he stopped smoking. 1Sud my :esacher thw had said, if your parents smoke, you should try to got tham to stop, brcauso it is rezlly bad for ;.ham a=d so oa. BS2twc,~,n those reasons, that pro••~p:r.d m: to hclp--'to try and help aayntay. Senator Xacaa3y. i,'eI1, v: tha.ek you for b3;.ag wiL.h us this m:iraiag and for your answers. Is there aartt.ir.g any of you e,uln l•ika to say to us?

: . r 3 6 8 .C C STATEFXt.'TS OF RICCkIARD I. EVA?:S, PH.D., PROFESSOR OP PSYCHOLOGY, UNIVF.3SITY OF BOUSTON, 60USTON, TE2CP.S : Jf,BMS 19. SR'ILXfiART, PH.D., DIRECTOR, PUBLIC COMA-W2dZCATIO?;S CnVER, PBLHA.*i MANOR, NE NEW YORR: AND PAU*.•.A GR.%EN, PRIiSIDENT, GR=, N DOLFIATCH ADVERTISING, INC. , IRE'w YORR, N.:iI YOItK . 75 Scn3Yar 2Cear,edy. Wo hrm got our aoea panel, I believe, I 10 11 12 1* 14 15 16 17 18 19 201 21 22 23 24 with Richara Evaas-4::. Evans, Mr. 6wiaehast, and Paula Gresn. -Dr. Evaar.s? Dr. Svans. Yes, first of all I wauld like to comm;ad thp Senators on thei:r q-~aautioas of the teea`gr33rs. I would like to invite you all to join our researca staff, hscause we are doiag exaatZy the sarao thiag. Senator Kaanedy. I just thought of a good one after they 1c3Ft: how massy of thea would have not star~.ad if they knew Erbat they 3Cnz-W Lo;v? Ds. Scans. Wal!, I an not going to rGad a formal state- a:cat horcr bscaus-z I a aL~Isr of things have coLe uF whicii I c:.uld rGspacd to thc2 migti: be e; nora effe=tive use of my ts:. Pirs;, of all, Iwould like to point aut that I am currcu?t- ly the director of tho Smokiag Scction of ti:o Baylor College of FS_:dfciA,-^ .. hatio.^.al $¢art and ftZood VCi+88l RtiSE3arctl and

I 2 3 4 5 6 8 9 10 11 12 13 C 14 15 16 17 1s 19 20 21 22 23 ( C 76 Dt•_mo3retration Center. I am principal i.nveotfgator of a Heart and Lung-supportod project which is really directed at dotcrring the onget of amoking in children. And happen also to ba acadesatcally professor of psychology at the University of Houston. ~ Wow, working with Dr. DaBakko [phonetic] 8aart Ceztar and trying to look at soma of probably the most well- establishsd risk factor number of diseases, I began to realizt that dealing with the addict.ivc s:noker is probably a lot lctss of a payoff than probably going into zn area that has becn ~ nntyplorad ralatively and trying to deter the onset of amok- iag. How, what wo found isz th:ough our research by inter- viowing large grczpa of pre-tec:::ag®=-s and teea.agors, and looking at thG whole range of smoking, a model b:gaa to w~.~ergA which, int~reatinyly enopgh, is pretty tr31l supportod by tl^..? fesnnagcrs What you just intrrvimksd. It se=a tsat by the time tcc chil6sen roach the 7th grade, virtually all of ::6zm beliera smoking iu dangerous. It se=9 that bofore their Y.c"a years thcy t?3co this vcry concr©taly, so they ).:terally Ch_nk it can i:ill Ro=cc_e and t,`uy try to do things like per- suade their parents not to emo's0. Lu: on roachir•g 7th grade, di`.fercr.t things bagin to happtn, thoy become vary prssent- orientEd. For exarples nessagss which say you aze going to get c~s,ce,r wh:,n you ara qutte old don't mesa much to ths=n--

77 F I 3 E:::== . 4 5 8 9 10 i 11 I 12 13 14 15 16 17 ~ 1s 21 22 23 24 25 thC aro living in th,a prasssitt. Thoy ao.e other kids smoki.a that aren't dying off lmmcQiataly. Also they t:ow becooa influenced by paar prossure, whicl was brought out by these youngsters oxtre=ly Wo2l. This poar pressure is very important. For examplp, we have pro- duced samo tilms vrhich actually chow what these pres3ures ar like and how, for exanpls, eosae youngsters learn how to say no to tham--for ax.arplo, they aight mml:e an v:cu3e like I have got an allQrgh not to smoko, bnt the pressure can ha vez high sua very iat_nsivot they want to balong, they w*r.nt to be acccpLud at this aga. Also, as was a3.-eady poiatGd out, we fouLd--trhich coafir;as a lot of ot,%cr data--thati if both parent.s sisokQ ths likelihood of children smolciug is obviously very high, and only one Esnokae it is sorewhai:t less but still fairly high, if awii:Izer smoF;e it is sonEwhat loss. AaothEr thing that carma out, which I think is very isa- porta°+t: ovartly, cousciously, they usually are not really arrarE of hou f:h9 a:dia aff6cts th=, hoH the cigaratCo ado work. For example, we produced some information, gave the:a ~ sort of a sbor',: course, ?:ir_d of an early Marshall HcLuhan, i tryin i to ga4 tham to uL3tzs!.and how in f act the mcdia M orked, how i;ho_a rsc ripp~d off by tho ir.€dia-•-this is part of our i filrs. AA.d most of t:nw. conscicusly say, well, eo know t hey are foaling: us, and so oa--but, as a na;;;:r..r of fact, there's ;no doubt ahoi;{: it, E.haTe iB a coverYt irflueacoF collactiv,?y

2 3 4 5 6 8 9 10 11 12 13 14 15 i5 17 i6 19 20 21 22 23 24 25 and o( r tiraa the esame skills W'hCs advertising agencies can offectively use in s013:ling -alsogt any product--and often selling the produot without the consumer really knowing bow t1ay are bain.g influonced--obviously can work in the area of initiating smo?:ing. Now, what va have dono and ythat wa azo currently doing is engaging in a long-term investigation in the 8ouston, Texas, school district. Ve~are following children, beginning in the 7th grade--anci va will be following thsxa thr6Lgh high school--and lssvm producad some films and rressages which in fact are directed at training tho children how to resist those pr*ssures. Rathar tcha,^. 1a-ving adult authority figures preach- !ng to tho:.~ in ti:ese films, we have child_--s.2 ths:nsclves pre- senting the infor-ruat.ionn. We actually have learned from the chii:iron haw thay say no, for. =znple, how t3+tiso inflLeaces wcrk--ar.d we att;_~de; to transmit this saGerai times during the year. liaother- thing h.h-et as found is very, vo,.ry imgcrtaat--and it was intorcviting that it was brougilt out in tctia tcstizaony from the childrea--is that if you can make a=-ssaoe indicato Co the child that thrsc is an i=sd4iste phys_olegi.al effe:.t of the r_mo3;is:g. ra4:her than c.mphasizo that at some later point t.h: y arQ going to got camcer or hzest discasa or what have you, that tt-tu-as to be gc=,^thing that is not only effective, but our study shocrs that :t.Y: gradr-rs, for c::e,zple, wou].d prefer I