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RESPONSE TO RECOMM:ENDATIONS FOR FEDERAL _SUPPQRTOF ANTI~-SMOKING EDUCATION, CESSATION'CLINICS, AND BEHAVIORAL RESEARCH During a series of "forums" regarding smoking and public policy conducted in 1977, the American Cancer Society heard numerous recommendations that federal support of smoking,cessation programs, anti-smoking education~and behavioral research is needed to control smoking in the United States. Whether behavior modification of U.S. citizens by these means is a legitimate avenue of governmental activity remains a significant question for debate. Evaluation~of Cessation Programs Smoking cessation programs are run by various voluntary health associations, religious groups, and commercial clinics. The American Cancer Society has an extensive program of free "quit clinics", which have enrolled more smokers than any other program except the Five-Day Plan sponsored by the Seventh-Day Adventist Church. If the forum recommendations are implemented, the federal government would begin paying for these programs. Such funding would be ill-advised for several reasons, including their long-term ineffectiveness. Only a relatively small number of smokers have been assisted by such programs. "[0]f the 35 million adults who:have stopped smoking the National Clearinghouse estimates that 95 percent quit

V If 95 percent of the nation's 35 million ex-smokers stopped "cold turkey," it would seem irrational for the federal government to pour billions into programs which have been strikingly unsuccess- ful. Accordingly, we are left with the question raised by Dale Houghland, Chairman, California lnteragency Council on Smoking and Health~: "Should smoking-cessation be publicly financed, or is it 12 strictly a matter of individual responsibility?" Dr. Peter Bourne, Special Assistant to the President for Health Issues, recently addressed this very point: ". .. federally funded 'I Quit' programs may be too costly and the diversion of already too scarce federal research funds may cost us lives as well as dollars. These programs may3best be left up to private citizen~groups. 1 Anti-Smoking Education Some of those who testified at the ACS forums advocated government intervention in the educational process in order to present anti-smoking information to public school students. Such a plan is neither practical nor desirable. First of all, government interference in public education has never been popular with American~citizens who feel that parents, teachers, and administrators should exercise control of the educa- tional process on a local level. Senator Birch Bayh addressed the issue at the ACS Chicago forum: "We have had problems when the federal govern- ment has tried to mandate a curriculum. That leads to thought control and all of the con- cerns we have had about the national govern- ment's controlling the thought processes of our children."14

A contrasting and disturbing point of view was offered by a witness at the Atlanta forum: "Hitler did a good job. He browbeated [sic] everybody. They believed in him at age 12. We need to use the same tactics."15 Testimony presented at the forums indicates the funda- mental lack of agreement among the "experts" about the effectiveness of anti-smoking education. Some witnesses felt that anti-smokingg education is not working. Charles Howard, Minneapolis attorney and President of the Association of Nonsmokers' Rights, said, "I would feel that educational efforts at kids are probably not worth the dollar return."16' If this is so, it is questionable whether govern- ment should spend additional tax monies on such programs. Other witnesses indicated that children already have sufficient smoking information available to them:' "Students of today are well-informed about the dangers of smoking. The cigarette packages all carry their own warning and-the media--radio, TV and newspapers--do a good job of informing!."17 Additional support for this contention may be found in smoking parents' repeated indications that their children are the most vociferous critics of their smoking. Another basic disagreement exists over the age at which students are most receptive to anti-smoking information. Daniel Horn, Director of the National Clearinghouse for Smoking and Health, said: "I question the trend toward concentrating our efforts on the very young. It is easy to brain- wash youngsters but when the hormones start to flow and self-images start to change at ages 12 -5-

C and 13 and l4, and~continue through the next few years, there is a whole new problem that needs to be facedlEight then, when the issue is most salient." Sidney Ottman of the California Congress of Parents and Teachers believes that education should start earlier. He comments: "The problems primarily are identified at the secondary level and I really feel as some of the evidence given to you today that the prob- lems really are at the elementary levil and that's where our emphasis should be." 9 In Atlanta, Dr. Richard Marks commented, "Once they're 12, 13, 14, 20 15, it's too late . . . . It has to start in kindergarten." A witness at the St. Louis forum~, Dr. Rabert Bruce, believes that Horn, Ottman, and even Marks would be approaching young people too late. He said~, "I'm not sure that the seventh and eighth grade is necessarily the place to begin . . . . I think we need to start earlier, need to start before nursery school."21 The educational establishment in the United States is already under fire for failing!to teach reading and basic mathe- matics. In many areas of the country the educational system is suf- feringfrom serious financial problems. School tax levies have failed~in countless school districts. Teaching positions have not been filled and thus curricula, including reading programs, have been cut back to the detriment of students. It would seem inadvis- able to place yet another burden on the system--especially, when the = 0 anti-smoking education issue is so clouded by uncertainty and dis- ~ ~ agreement. ~ O -6-

BIBLIOGRAPHY [1] American Cancer Society, National Commission on Smoking and Public Policy, Draft Report, p. 1. [2] Schwartz, Donald, "No Butts About It, It's Tough to Quit", The Pittsburg Press, May 27, 1976, p. B-1. [3] Premack, David, et al., "Mechanisms of Self-Control", Learning Mechanisms of Smoking 0(0): 107-108, 1970. [4] American Cancer Society, supra, p. 2. [5] Thompson, E. L., "Educational Programs to Change Smoking Behavior", A Review of the Literature: 1960-1976, The American Cancer Society Public Education Section, 51 pp:., 1976. [6] Ibid. .[7] Zack, Albert, Principal [ACS Member); Duckworth, Ken, student; Ochalek, Jill, student; Bentley High School, Livonia, Michigan~, Statement Before the National Commission on Smoking and Public Policy, Chicago, Illinois, May 25, 1977, p. 1. [8] Schwartz, Jerome L., Chief, Health Care Research, California Department of Health, Statement Before the National Commission~ on Smoking and Public Policy, Los Angeles, California, March 22, 1977, p. 5. [9] Maher, Brendan"A., Professor of Psychology of Personality and Chairman, Department of Psychology and Social Relations, Harvard University, Cambridge, Massachusetts, Testimony Before the National Commission on Smoking and Public Policy, Boston, Massachusetts, June 2, 1977, Tape 1, Side 2, Rev. 969. [10] Hartelius, Jonas, "Nicotine Dependence and Smoking Cessation Programs: A Review", World Smoking and Health, Vol. 2, No. 1, p. 5, Summer, 1977. jll] Hammond', Ann, Executive Director, Health Education Center, Palo Alto, California, Statement Before the National Commission on Smoking and Public Policy, Los Angeles, California, March 22, 1977, p. 6. 03745141 [12] Houghland, Dale, Chairman, California Interagency Council on Smoking and Health, Statement Before the National Commission on Smoking and Public Policy, Los Angeles, California, March 22, 1977, pp. 1-2.

c [13] Bourne, Peter, Special Assistant to the President for Health Issues, Speech before the American Cancer Society Ad-Hoc Committee on Tobacco and Smoking Research, November 10, 1977. [14] Bayh, Birch, U. S. Senator (D-Ind.), Testimony Before the National Commission on Smoking and Public Policy, Chicago, Illinois, May 25, 1977, Tape 1, Rev. 322. [15] Marks, Richard, Jr., Department of Radiation Therapy, Medical University of South Carolina, Charleston, South Carolina, Testimony Before the National Commission on Smoking and Public Policy, Atlanta, Georgia, June 14, 1977, Tape 2, Side 2, Rev. 144. [16] Howard, Charles, Minneapolis Attorney and President, Association of Nonsmokers' Rights, Testimony Before the National Commission on Smoking and Public Policy, Chicago, Illinois, May 25, 1977, Tape 1, Side 2, Rev. 553. [17] Patterson, Pat, ACS Volunteer, Statement Before the National Commission on Smoking and Public Policy, Chicago, Illinois, May 25, 1977, p. 3. [18] Horn, Daniel, Director, National Clearinghouse for Smoking and Health, Statement Before the National Commissi=on Smoking and Public Policy, Los Angeles, California, March 22, 1977, p. 4. [19] Ottman, Sidney, Santa Barbara, California, Congress of Parents and Teachers, Testimony Before the National Commission on Smoking and Public Policy, Los Angeles, California, March 22, 1977, Tape 4, Rev. 306. [20] Marks, Richard, Jr., Department of Radiation Therapy, Medical University of South Carolina, Charleston, South Carolina, Testi- mony Before the National Commission on Smoking and Public Policy, Atlanta, Georgia, June 14, 1977, Tape 2, Side 2, Rev. 106. [21] Bruce, Robert, Assistant Professor of Medicine, Washington University School of Medicine, St. Louis, Missouri, Testimony Before the National Commission on Smoking and Public Policy, St. Louis, Missouri, May 19, 1977, Tape 2, Side 2, Rev. 1018. [22] Helms, Jesse, U. S. Senator, North Carolina, Statement, Hearings Before the Subcommittee on~Health of the Committee on Labor and Public Welfare, United States Senate, 1976, page 74. [23] Premack, David, supra, pp. 116-117. 03'745142