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STATEMENT BY JOSEPH A. CALIFANO, JR. SECRETARY OF HEALTH, EDUCATION, AND WELFARE BEFORE THE SUBCOMMITTEE ON HEALTH AND THE ENVIRONMENT OF THE HOUSE INTERSTATE AND FOREIGN COMMERCE CONLtiiITTEE February 15, 1978

The most troublesome aspect of the problems related to smoking, in my view, is the fact that so many Americans start~smoking at a very early age, as a result, in part, of expensive cigarette advertising campaigns. In fact, each day of the year approximately 4,000 children become cigarette smokers. Seventy-five percent of American adults who smoke started before they were 21 years old. Ninety percent of today's smokers started smoking before age 25. These startling statistics indicate that to a very considerable degree, smoking inAmerfca is a problem of young people. Indeed, teen-age girls are now smoking more heavily thanever in the past. Since 19'68, the percentage of teenage girls who smoke has more than d'oubled, so that the difference in smoking rates between teenage girls and boys has virtually disappeared. In 1969, 10 percent of all teenage girls who smoked used at least a pack a day. Now, 39 percent of the teenage girls who use cigarettes smoke at least a pack a day. Thus, more teenage girls are smoking ~ now and they are heavier smokers than ever before.

Moreover, the rate of teenage smoking is apparently on the rise -- and teenagers are starting to smoke at even younger ages. Teenagers and children who make the decision to'smoke are often not doing so with the benefit of a fully informed perspective about the hazards of smoking. They are often responding to a half a billion dollar advertising campaign which portrays smoking as attractive and mature. When those young people become adults, they discover that smoking is neither adult nor sexy. It is extremely difficult to quit because smoking can often be addictive. Fully 80 percent of the adults who smoke would like to quit if they could find an easy way to do it, and over half have tried unsuccessfully to quit. Finally, health authorities have demonstrated that the increased mortality rate for smokers is significantly higher for those who start smoking as adolescents than for those who acquire the habit later in life. Let me underscore the great danger smoking poses to teenagers by describing four 16 year olds -- a boy and girl who start smoking at that age and a boy and girl who do p not: `1 ~ Ut N ~ . .A~

c o The two who smoke (assuming a pack a day) ~ will have a 1 in 20 chance of developing lung cancer over their lifetime; the boy and~girl who do not smoke will have only a 1 in 200 chance of suffering from the same disease. o The two who smoke will have 6 chances in 10~ of having a heart attack; the two who don't smoke have only 3 chances in 10. The 16 year old smokers are doubling their lifetime risk of heart attacks by smoking. o The two who smoke have 1 chance in 20~of developing chronic bronchitis or emphysema; the two who don't smoke have only 1 chance in 200 of suffering from the same diseases. Thus,*over their lifetime, the 16 year olds who smoke will have a 1 in 10 chance of developing a serious lung disease such as lung cancer, emphysema, or chronic bronchitis, providing they manage not to have a heart attack. By contrast, the 16 year olds who do not smoke will have a 1 in 100 chance of contracting a serious lung disease over their lifetime.

9 Most strikingly, the life expectancy of the 16 year old make smoker is 65 years (at one pack a day) or 62 years (at two packs a day); the life expectancy for the 16 year old male non-smoker is 71 years. Similarly, the life expectancy of a 16 year old female smoker is 72 years (at one pack a day) and 70 years (at two packs a day): the life-expectancy of a 16 year old female non-smoker is 78 years. Thus, at the heart of the anti-smoking effort is a deep concern about smoking health effects on young people. 0 W ~ CJT N ~ C:

-10- The Program Let me now describe the principle components of the HEW program in smoking and health. Education In order to provide a central coordinating focus to Departmental and government smoking activities -- especially our educational 'rnitiatives -- and to give this effort the prominence it deserves, I am establishing an Office on Smoking and Health in the immediare office of the Surgeon General. Mr. Chairman, the legislation you sponsored -- the National Health Information and Health Promotion Act of 1976 -- makes it possible for this office to carry out important functions. This office will be responsible for providing leadership in the area of smoking and health by expediting the development of educational materials which can be used in the programs of states, municipalities, and voluntary organizations; by working to establish behavioral and biomedical research priorities; by serving as a clearinghouse for requests fcr public and technical information related to smoking; by serving as a liaison between the Department and other government and non-governmental organizations; and by facilitating the cooperation of the Public Health Service and the Office of Education in identifying school health education curricula

which wi1L inform young people. C I would like to elaborate briefly on this last point. I am convince6that if we are to provide young people with the perspective they need to make a truly informed choice on smoking as well as other health problems, we the health education programs offered in our have to improve schools. I have therefore asked the Office of Education and Public Health Service to help in the identification and demonstration of improve6health curricula. I have also asked the chief state school officers of each state and 16,A00 school district superintendents to concentrate as well on~these important issues. We must provide teens and sub-teens with~information to balance against the advertisements which appear in newspapers, in magazines, at sporting events and on~billboards and which portray smoking as glamorous. The Office on Smoking andiHealth will also serve as the principal focal point for the drafting of a new Surgeon General's Report on Smoking. This Report will provide a comprehensive review of the biomedical and behavioral research~ , which has been conducted since 1964,. It will note opportunities for future research, and will review efforts available to assist in smoking cessation. A major emphasis will be placed on young,people and smokers at speciaL risk.

G' -13- $30 million FY 1979 smoking and health budget will be devoted to research. An important element in this research program will be $4 million identified for use by the National Institute on Child Health and Human Development to investigate the childhood developmental determinants of smoking behavior. This work should help us to understand better those factors responsible for a child's decision to start smoking, or to adopt other behaviors which may ultimately be detrimental to his or her health. Other behavioral research will be directed at studying the addictive properties of nicotine, as well as the efficacy of various smoking cessation methods. We will continue or accelerate biomedical and epidemi'ologic research into the heal~th consequences of smoking, the reduced risk in smoking lower tar and nicotine cigarettes, and the interaction of smoking with other drugs and with occupational and physiologic risks. There will also be research into a much-debated and very important problem -- the effects of smoke on non- smokers. Additional Elements In addition, I have requested that all states examine their laws on smoking in public places and in health facilities, with the aim of ensuring, where possible, the rights of non- smokers to clean indoor air. Similarly, in order to protect r

C homes. We are encouraging other states, and indeed government agencies, to consider the appropriateness of these provisions as they mount their own efforts to discourage smoking and protect the rights of non-smokers. As you know, most federaL offices currently have no policy protecting non-smokers. In short, the program I set forth in my speech~last month does not go nearly as far as programs some have urged and some jurisdictions have enacted. But our balanced program of education'andiresearch is appropriate at this time. It is also appropriate that we take under further study more far-reaching measures that wouldiestablish neww regulations or incentives to discourage smokl-ng or protect the rights of non-smokers. We believe our anti-smoking initiative will succeed. People are ready to quit. And the most significant drop in smoking occurred during another period of widespread public debate and concern when the highly visible counter-advertisements appeared on television and radio from~1968'to 1970. Finally, our greatest concern is to reach children. I know of no responsible parent who wouldencourage a child to smoke, yet we have not been able to reverse the trend:of smoking start-up in this vulnerable group. I am convinced that we can, but it will take a concerted effort not only by r

-18- this Department, but by parents, teachers, employers, physicians, health agencies, voluntary associations, and state and local governments. It is clear that an important measure of the success of the program will be a reduction in the number of teen-agers and pre-teens who Awwacgn start smoking. The anti-smoking initiative is a sound investment that can real~ize a priceless divi4iend -- a healthier future for the nation. Thank you very much. .