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DEPARTMENT OF HEALTH. EDUCATION. AND WELFARE ~ . . FORr RELEAS E: AT _ 10 : 30 A c Mt . EST ...: .AHN, BLAMPH I N(202 ) 245-6343.. THURSDAY, JANUARY 11, 1979 REMARKS OF SECRETARY JOSEPH A. CALIFANO,. ON THE.RELEASE OF THE SURGEON GENERAL'S REPORT ON SMOKI NG AND HEALTH' WASHINGTON, D. C. JANUARY 11, 1979

THIS REPORT'S 1200 PAGES OF FACTS AND ANALYSIS ARE .TOO VAST TO BE SUMMARIZED IN.A FEW WORDS. BUT I DO WANT TO POINT TO FOUR OF THE HIGHLIGHTS WHICH DISTINGUISH IT FROM ITS PREDECESSOR OF FIFTEEN YEARS AGO: • FIRST, WOMEN AND SMOKING. BECAUSE INFORMATION . ON WOMEN AND.SMOKING WAS NOT WIDELY AVAILABLE IN 1964, THIS SUBJECT WAS NOT TREATED IN DETAIL. BUT TODAY WE KNOW MORE. THERE IS DISCRIMINATION AGAINST WOMEN'IN SOME SECTORS OF OUR SOCIETY -- BUT CIGARETTES. IN THEIR DEATH-DEALING EFFECTS, DO NOT DI-SCRIMINATE: LUNG CANCER RATES AMONG WOMEN HAVE INCREASED FIVE-FOLD IN THE LAST 20 YEARS, WOMEN'WHO SMOKE LIKE MEN DIE LIKE MEN WHO~SMOKE, AND WOMEN WHO SMOKE DURING PREGNANCY FACE THE POSSIBILITY OF CREATING LONG-TERM IRREVERSIBLE EFFECTS ON THEIR BABIES,

• SECOND, THIS REPORT SHEDS NEW LIGHT ON SMOKING IN CERTAIN HAZARDOUS OCCUPATIONAL SETTINGS. WORKERS IN THE ASBESTOS, RUBBER, COAL, TEXTILE, .URNAtUM AND CHEMICAL INDUSTRIES, AMONG OTHERS, FACE INCREASED RISKS FROM SMOKING. WE ARE ...P.ART I CULARLY DI STURBED BY E1/I DENCE -THAT - SMOKING RATES --.AND'SMOKING-RELATED DEATH. RATES -- AMONG SOME GROUPS, BLACK MEN AND. BLUE COLLAR WORKERS, FOR EXAMPLE, ARE DISPROPORTIONATELY HIGH. THE SMOKING RATE AMONG BLACK MEN, FOR EXAMPLE, WAS ABOUT 10 PERCENT HIGHER IN 1976 THAN~AMONG WHITE MEN. WE DO NOT KNOW WHY. BUT WE ARE DISTURBED BY FINDINGS LIKE THESE, AND INTEND TO TRY TO FIND OUT WHY. • THIRD, THIS NEW REPORT, IN KEEPING WITH THE NEW EMPHASIS OF OUR SMOKING-AND-HEALTH EFFORT, TAKES UP THE QUESTION OF SMOKING AMONG CHILDREN. WE KNOW, FOR EXAMPLE, THAT THE PERCENTAGE OF GIRLS AGE 12 TO 14 WHO SMOKE INCREASED EIGHTFOLD BETWEEN 1968 AND.1974. AMONG THE AGE GROUP 13 T0 19,

THERE ARE AN ESTIMATED SIX MILLION REGULAR SMOKERS. ONE HUNDRED THOUSAND CHILDREN UNDER AGE 13 ARE.REGULAR'SMOKERS, THIS IS'THE REAL .BURDEN THAT THE CIGARETTE INDUSTRY, WITH ITS MORE THAN HALF A BILLION DOLLARS IN ADVERTISING.THIS YEAR, MUST'BEAR. NO.PARENTS I KNOW WANT THEIR : CHILDREN.-TO. SMOKEI f THE REPORT CONFIRMS THE LINK BETWEEN CIGARETTE' SMOKING AND A HOST OF.D,ISEASES WHICH IN THE 1964 REPORT WERE NOT CITED AS CAUSALLY RELATED TO SMOKING: LUNG CANCER IN WOMEN, FOR EXAMPLE; tANCERS OF THE MOUTH, ESOPHAGUS AND BLADDER; AND MANY KINDS OF HEART DISEASE, I WANT TO EMPHASIZE ANOTHER LESSON THAT GOES BEYOND THE ACTUAL CONTENTS OF THIS REPORT: A LESSON GAINED FROM THE ORIGINAL REPORT IN 1964; FROM FIFTEEN YEARS OF EFFORT BY PHYSICIANS, VOLUNTARY HEALTH AGENCIES, SCIENTISTS AND GOVERNMENT AGENCIES IN THIS FIELD, /

SEVERAL CHAPTERS OF THIS REPORT DEAL WIT.H POSSIBLE REASONS FOR THIS. SEVERAL OTHER CHAPTERS DESCRIBE THE CONSEQUENCES, BOTH TO THE WOMAN SMOKER AND TO THE BABIES OF MOTHERS WHO SMOKE DURING PREGNANCY. IT IS A SHOCKING FACT THAT,,IF PRESENT TRENDS CONTINUE; CIGARETTE SMOKING WILL BRING AGE-ADJUSTED DEATH RATES FROM LUNG CANCER AMONG :WOMEN IN THE-NEXT DECADE TO HIGHER LEVELS THAN THE DEATH RATE FROM B.REAST CANCER.. THIS IS. ESPECIALLY. TRAGIC .BECAUSE 85 PERCENT OF LUNG CANCER IS.RELATED TO SMOKING, AND THUS IS PREVENTABLE. ANOTHER ENORMOUSLY TROUBLING PROBLEM CONCERNS SMOKING AMONG CHILDREN, OF THE ESTIMATED 54 MILLION AMERICANS WHO STILL SMOKE, SOME 90 PERCENT BECAME SMOKERS BEFORE THEY REACHED THE AGE OF Z5; 75 PERCENT BEFORE AGE 21. THE FIGURES WE HAVE INDICATE THAT SINCE 19304. WHEN ONLY HALF AS MANY GIRLS AS BOYS WERE SMOKERS, TEENAGE GIRLS HAVE BEEN CATCHING UP WITH TEENAGE BOYS IN SMOKING RATES, tJl

- WE HAVE PROVEN -- IN THE -LAST FIFTEEN YEARS AND~ Ii~ THE LAST YEAR -- THAT WE CAN SUCCESSFULLY PERSUADE SMGKE:.S TO QUIT SMOKING$ BUT THE WORK OF THE NEXT FIFTEEN YEARS -- AND A CENTRAL PURPOSE OF THE NEW EFFORT I ANNOUNCED LAST JAN UARY-=- 'I S-TO 'PERSUADE 'M I LLI ONS' OF' YOUNG 'PEOPLE N!EVER ' TO START IN-THE FIRST PLACE. A CONSIDERABLE PART OF THIS'SURGEONIENERAL'S REPORT CONCERNS ITSELF WITH CRUCIAL QUESTIONS ABOUT HOW TO ACCOMPLISH'THAT. I USE THE WORD "QUESTION" ADVISEDLY--- BECAUSE OVERALL, WE KNOW MORE ABOUT THE HEALTH EFFECTS OF SMOKING THAN WE DO ABOUT SMOKING BEHAVIOR. WE DO NOT KNOW WHY APPROXIMATELY ONE-THIRD OF OUR YOUNG PEOPLE ARE SMOKERS BY THE TIME THEY ARE 18 AND THE OTHER TWO-THIRDS ARE NOT. WE DO NOT KNOW AS MUCH AS WE SHOULL ABOUT THE DIFFICULTIES OF STAYING OFF CIGARETTES, ONCE 0'J!&c_ HAS QUIT.

OUR NEW INFORMATION AND EDUCATION PROGRAM -- MUCH OF IT BASED ON FACTS IN THIS REPORT -- WILL BECOME HIGHLY VISIBLE TO THE AMERICAN PEOPLE ON'TELEVISION, ON RADIO, AND OTHER MEDIA ALL ACROSS THE NATIOtr.- WE INTEND TO REACH EVERY:EXPECTANT MOTHER IN THE NATION WITH A MEDICAL WARNING ABOUT THE POTENTIAL RISKS POSED TO HER BABY IF SHE SMOKES. • THE DEPARTMENT'S BUDGET REQUEST FOR SMOKING AND HEALTH, TO AL`LOW FOR THESE AND OTHER EXPANDED EFFORTS, WILL BE INCREASED. IN THE PAST OUR EFFORTS HAVE GONE FORWARD -- AND HAVE BEEN EFFECTIVE -- WITHIN OUR AMERICAN TRADITIONS OF FREE, VOLUNTARY CHOICE.