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FRAMEWORK FOR THE PUBLIC POLICY ACTIVITIES OF THE COALITION ON SMOKING OR HEALTH FOR 1993 TABLE OF CONTENTS Page Overview 1 Background 2 Public Policy Objectives for Freedom From Tobacco 10 Advertising and Promotion of Tobacco Products 10 Sale and Distribution of Tobacco Products 12 Tax and Pricing Policy 13 Clean Indoor Air and Environmental Tobacco Smoke 14 Regulation of Tobacco Products 16 Government Tobacco-Use Prevention and Cessation Activities 18 Governmental Support for Tobacco 20 Agriculture 20 Trade 21 Coalition uo Smnkiog OR Health Fnmewurk for Public Policy Activiliea 1993

9 The federal government has promoted the export of tobacco to Thailand, Japan, South Korea, and, most recently, Taiwan. It has been exercising its trade leverage with these nations to force them to open their doors to U.S. tobacco products and to require them to weaken health-based restrictions on tobacco marketing. Forcing U.S. tobacco products and U.S. marketing techniques for those products on foreign nations at a time the U.S. Govemment has declared war on drugs like cocaine is particularly ironic. Many more people die each year from tobacco than from heroin, cocaine, and all other illegal drugs combined. To continue the efforts begun in 1982, the Coalition on Smoking OR Health will be pursuing the following objectives at the federal and state level in the coming year:

FRAMEWORK for PUBLIC POLICY. ACTIVITIES of tlee COALITION ON SMOKING OR HEALTH 1993

11 State The Coalition on Smoking OR Health recommends: • Enactment of legislation to prohibit or limit the ways and places that tobacco advertising can be used, particularly that which appeals to children and teenagers, including: J banning brandname promotional practices, including sponsorship of sporting events, concerts, jazz festivals, and the like, that include the use of product names and logos; and / banning advertising in publicly owned or controlled space, such as public transportation, municipal stadiums and arenas, and billboards. • Enactment of legislation to limit or eliminate the taxpayer subsidy of tobacco industry advertising and promotion through the business tax deduction. Cudilion on Smo6ng OR HuIEa Fmmerork for Public Policy Activities 1993

~ American AMERICAN ~ LUNG ASSOCIATION' ~ AEAN ~ Heart = ea,.e~el y Association ' SOCIETY6 Coalition on Smoking OR Health FRAMEWORK FOR THE PUBLIC POLICY ACTIVITIES OF THE COALITION ON SMOKING OR HEALTH FOR 1993 Overview This nation's three largest voluntary health organizations, the American Cancer Society, the American Heart Association, and the American Lung Association, are united as the Coalition on Smoking OR Health. The Coalition was formed in 1982 and since then has been working to educate public policy makers about issues related to tobacco and disease prevention and health promotion. The Coalition has been successful in such projects as banning smoking on domestic airline flights; revising warning labels on cigarette packages and advertising, and obtaining warning labels on smokeless tobacco products. In addition, the Coalition is active on the state level, and has achieved several successes in clean indoor air and limiting youth access to tobacco. Tobacco use continues to be a major public health problem in the United States. The Coalition on Smoking OR Health believes that strong efforts should be made to discourage tobacco use in all segments of the population, including youth, women, and minority populations who increasingly are targeted by the tobacco industry. To accomplish this goal, and to continue working towards the Surgeon General's goal of a Tobacco Free Society by the Year 2000, the Coalition has identified seven major policy areas for action: • Advertising and Promotion of Tobacco Products • Sale and Distribution of Tobacco Products • Tax and Pricing Policy • Clean Indoor Air and Environmental Tobacco Smoke • Regulation of Tobacco Products • Government Tobacco-Use Prevention and Cessation Activities • Governmental Support of Tobacco

3 infections per year in children under 18 months of age, resulting in about 7,500 to 15,000 hospitalizations. Exposure to ETS also exacerbates and aggravates symptoms in children with asthma. There is some evidence that ETS exposure also causes asthma in children who have not had the disease previously. Chewing Tobacco and Snuff Tobacco-use includes chewing and sniffing, as well as smoking. Although less popular than smoking, use of other forms of tobacco is a growing public health concern. Chewing tobacco and snuff can cause oral cancer, lead to the development of oral leukoplakias (white patches or plaques) and other oral conditions, and cause addiction to nicotine. Use of these substances is also associated with coronary artery and peripheral vascular disease, hypertension, peptic ulcers, and fetal mortality and morbidity. Smoking-Related Deaths Tobacco-related diseases cause more than 434,000 deaths annually in the United States. This toll would be higher if deaths related to ETS were included. More people die each year in the U.S. from smoking than from AIDS, suicide, alcohol, cocaine, crack, heroin, homicide, car accidents, and fires combined. Based on current smoking rates, recent estimates predict that in the next 20 years more women than men will die from tobacco-related diseases. Among women, lung cancer has surpassed breast cancer as a cause of death. Already, U.S. women, who account for 5 percent of the females in the world, have half the world's female deaths from tobacco-related causes. True health care reform, focused on preventive health as a means of reducing death and disease and empowering people to manage their health, must deal with the issue of tobacco use. The ability to prevent hundreds of thousands of death caused by the use of tobacco products is within our grasp. Dramatic reduction in the use of tobacco can end the tragedy of death and disease that has been allowed to perpetuate for too long. Smoking Prevalence Since the Surgeon General's 1964 call to action, government and private organizations have moved to eliminate the health hazard of tobacco. Progress has been made. In 1965, 43 percent of adults in the U.S. were smokers. By 1990, the adult smoking rate in the U.S. had been reduced to 25.5 percent. About half of all people who ever smoked have quit. But close to 50 million Americans still smoke. Coelition on Snwking OR Health Fnmework for Public Policy Activitics 1993

4 While this news is generally encouraging, other evidence shows clearly that the epidemic of tobacco-related death and disease is far from over and is likely to continue for many years. While overall smoking rates have declined, smoking among young people under the age of 18 has remained relatively steady since 1981. Overall smoking rates for high school seniors have remained level at about 18 to 21 percent. Moreover, those who do not plan to go to college have a significantly higher smoking rate about 30 percent. Also the smoking prevalence among high school females is higher than for males. One recent survey found that among high school students (grades 9-12), over 25 percent smoked cigarettes monthly or more frequently. This rate was up from 23 percent the previous year. The rate for junior high students (grades 6-8) was over 13 percent for monthly or more frequent smoking, up from 11 percent. This trend does not bode well for the future. Today's smokers are tomorrow's casualties in the war against death and disease. Prevalence of Chewing Tobacco and Snuff Use Approximately 15 percent of the population over age 12 has used chewing tobacco or snuff at least once. Young boys, in particular, are attracted to chewing tobacco and snuff by watching sports stars use these products. Some teams are beginning to recognize this problem by banning their players from using these forms of tobacco. Use of snuff and chewing tobacco is reported by over 19 percent of male high school students. White male students report a significantly higher rate of almost 24 percent. Use of chewing tobacco and snuff varies by sex and race. Among the population age 18 and older, 4.2 percent of white men use chewing tobacco compared to 3.4 percent of black men. Almost no white women chew (0.1 percent), while a small percentage of black women (1.7 percent) do. Similar disparities are found in snuff use, with 3.3 percent of white men using it, compared with 1.1 percent for black men; only 0.3 percent of white women use snuff, compared to 2.2 percent of black women. Chewing tobacco consumption has declined from its peak in 1980, but appears to have stabilized. On the other hand, snuff consumption has increased each year for the last five years. Cost to Society Tobacco use costs the U.S. economy approximately $72 billion, based on 1990 data, in direct health care costs and lost productivity. The cost to Medicare and Medicaid alone in 1991 is estimated at $7.2 billion. Other federal health care programs such as the Indian Health Service, CHAMPUS (for military dependents and retirees), and veterans health care also incur high costs. These estimates do not include the emotional toll on families and friends as loved ones suffer Coalition on Smoking OR Health Fnmework for Public Policy Activities 1993

12 2. SALE AND DISTRlBUTION OF TOBACCO PRODUC75 Forty-eight states and the District of Columbia have some restrictions or prohibitions on the sale of cigarettes to minors. Nonetheless, tobacco products remain readily available to young people because of virtually nonexistent enforcement efforts, unrestricted free sampling, the availability of tobacco products from vending machines, and the paucity of rules and regulations designed to discourage tobacco sales to underage young people. National leadership is needed to provide a consistent and effective way to control access by youth to tobacco products. F eral The Coalition on Smoking OR Health recommends: • Enactment and enforcement of nationwide policies to restrict the distribution of tobacco products to minors, including / enforcement of an amendment to the Alcohol Drug Abuse and Mental Health Administration Reauthorization Act, introduced in the 102nd Congress by Rep. Mike Synar, to require states to enforce their age restriction on the sale of tobacco products or lose a portion of their federal block grant funds; r enactment of bans on free sampling, sale of tobacco products through vending machines, and licensing requirements for sellers of tobacco products; and • Enactment of a requirement that tobacco products sold on military installations be priced at levels comparable to prices charged in civilian stores. State The Coalition on Smoking OR Health recommends: • Enforcement of laws setting age restrictions for the sale of tobacco products, including requiring licenses for retail sellers of tobacco products, with revocation as a penalty for violation of minimum age laws; • Enactment and enforcement of bans on free sampling and the sale of tobacco products through vending machines. Coelition on Snqking OR Hubh Fnmework for Public Policy Activitiea 1993

5 through their addiction, illness, and death due to smoking. Tobacco Taxes Tobacco taxes have a significant impact on tobacco consumption, and are especially effective in discouraging children from smoking. In 1989, the General Accounting Office reviewed research on teenage response to cigarette price increases and concluded that a 21 cent increase in the price of a pack of cigarettes at that time would result in about a 12 percent decrease in the number of teenaged smokers and a concomitant decrease in the number of premature deaths due to smoking. Adult smokers are also sensitive to price increases. Since the California excise tax was increased by 25 cents in 1989, smoking in the state has decreased by 17 percent. As of January 1, 1993, the federal excise tax on a package of cigarettes is 24 cents, a four cent increase from the tax that had been in effect for the previous two years. In 1991, the federal government collected $4.8 billion in taxes on tobacco products, state governments collected $6.1 billion, and local governments $198 million. The average retail price per pack is $1.735. State taxes range from 2.5 cents per pack in Virginia to 51 cents in Massachusetts. In contrast, Canadian provincial taxes range from $2.89 to $3.90 (US$) per pack. When state and federal excise taxes on tobacco products are combined, they are much lower today in constant dollars than they were before the release of the 1964 Surgeon General's report. At its peak in 1965, the tax share of the price of a pack of cigarettes in the U.S. was just over 50 percent. By 1990, that share had dropped to just under one-fourth. Among the world's industrialized nations, only Spain has a lower cigarette excise tax rate, and most - such as the U.K., Australia, New Zealand, Canada, Germany, Denmark and Ireland - have much higher rates. Marketing, Promotion, Sales and Distribution The tobacco industry spends almost $4 billion a year to advertise and promote its deadly products. In contrast, the federal office responsible for coordinating federal tobacco-use education, prevention and research efforts had a budget of $7.3 million in fiscal year 1992 and will receive $10 million in 1993. To look at this another way, every da_y the tobacco industry spends the equivalent of the entire year's budget for the federal Office on Smoking and Health. As cigarette sales decline in this country, expenditures on advertising and promotion increase at a rate far exceeding the rate of inflation. In 1981, sales peaked at 636.5 billion cigarettes, or nearly 32 billion packs. Advertising and promotion expenditures that year were $1.5 billion. By 1990, domestic sales were down to 523.7 billion cigarettes, but advertising and promotion Coalition on Smoking OR He.hh Fnmcwork ror Public Policy Activities 1993 ~ ~ ~ Cn N N N N

6 expenditures were $3.99 billion. Tobacco companies spend a great deal of money to keep people smoking and to entice new smokers. Forty-eight states and the District of Columbia have some restrictions or prohibitions on the sale of cigarettes to minors. Nonetheless, tobacco products remain readily available to young people because of virtually nonexistent enforcement efforts, unrestricted free sampling, the availability of tobacco products from vending machines, and the paucity of rules and regulations designed to discourage tobacco sales to underage young people. National leadership is needed to provide a consistent and effective way to control access by youth to tobacco products. Current military tobacco pricing policies encourage tobacco use by military personnel by subsidizing the cost. In military stores, tobacco products sell for 10% to 60% less than in civilian stores. Effects of Tobacco Advertising The 1990 report of the National Commission on Drug-Free Schools found that tobacco advertising and promotion clearly influences young people to take up smoking. It glamorizes and legitimizes tobacco usage, increasing social and peer pressure among young people to use tobacco products in order to be accepted, and creating the false impression that tobacco products pose no significant health risk. Tobacco advertising and promotion overwhelm the efforts of the public and private sector to educate this nation's youth about the health effects of tobacco; create a climate that increases peer pressure on young people to use tobacco; and, trivialize and diminish the significant health hazards of tobacco use. The tobacco industry also tailors its advertising to play on the public's concerns about health and addiction, including the concerns of women about weight gain if they stop smoking. Advertisements that emphasize the low tar and low nicotine properties of certain brands imply that these products reduce the health risks associated with smoking. Other brand advertising, aimed at women, implies that use of the product will suppress appetite and help control weight. In 1964, the tobacco industry assured the Congress it would not only develop, but also rigidly adhere to voluntary advertising and sampling codes. The industry created the codes but has never adhered to nor enforced them. Enforcement provisions in the original code were eliminated in 1970. The voluntary advertising code includes standards stating that cigarette advertising will not indicate that smoking is essential to success or sexual attraction or use models for smokers who are younger than twenty-five. Athletes are not to be depicted, nor are smokers who have just participated in rigorous physical activity. Coelition on Smuking OR Hulth Fnmework for Public Policy Activitics 1993

17 ./ prohibit the use of implied and or direct health claims for tobacco products (i.e. low tar, low nicotine) that have not been substantiated; and J require tobacco manufacturers to disclose to FDA all research they have conducted or are aware of which bears on the health and safety of their products. • The FDA to use its existing authorities to regulate tobacco products under its drug authorities when advertisements, labeling, or other promotions for these products make explicit or implicit health claims. State The Coalition on Smoking OR Health recommends: • State-level action that seeks to classify low tar, low nicotine products as "drugs" under state food and drug laws. These laws often are identical to federal law, thus opening up new opportunities for the states to crack down on misleading and deceptive health claims that have no other purpose than to encourage smokers to keep smoking, or potential smokers to take up the habit under the belief that the products are safer and less addictive. In addition to seeking action directly from state agencies who regulate prescription drugs (i.e. State Pharmacy Board, State Department of Health, etc.), the Coalition encourages state attorneys general to bring action against these products as drugs. Cwlition on Smoking OR Health Fnmework for Public Policy Aclivities 1993

15 State The Coalition on Smoking OR Health recommends: • Enactment and enforcement of legislation and regulations to reduce the exposure of non- smoking adults and children to environmental tobacco smoke, with emphasis on facilities and activities that expose the greatest number of people to ETS for the longest periods of time, such as workplaces, schools, daycare centers, and healthcare facilities. Possible mechanisms include: / comprehensive clean indoor air legislation, based on the Coalition's model law, which would also allow localities to enact stronger legislation; and / legislation banning smoking or requiring no-smoking policies in selected facilities and activities. Coalition on Smoking OR Health Fnmework for Pablic Policy Activities 1993

+ American ~ Heart Association sfaHn.C.mm.le. Alan C D..n. Ceam an Amenean C- 5uciei, xul D. e,um. Amenean Hean A-ian Fran Du Melle Amercan LunF Aaf¢ia- AEmInlfVafw. Fahral loues lm Ssl.n Eyenm Awnlnufr.ra..SU/riwe, Peur FisMr Cwnsel WnMw L Nrm A.mn.lunm S}f.en LeR.lati,e AE ri.on lnu-l Amercan Acailemv of Famil, Mr~K~an. AmerKan Acnlemr M PeEninc. Ame/Kin Af Wc~llpn lor ke.P,ram, ea/e Amerran fdlepe uf Camianp~ Ammcan PuELr HoIN Aa.muunn Amerran Sarei, nf Imemal MM~tinc A,n nnlSU,earMTem-a Neap~ Wrql. wrtn nl Dmm, 6mA Delen. Foumaimn AMERICAN LUNG ASSOCIATION ` ~ AMERICAN t , e.n,lma, al Pen,e. y CANCER •' SOC.IETY• Coalition on Smoking OR Health The Coalition on Smoking OR Health is pleased to present its FRAMEWORK FOR PUBLIC POLICY ACTIVITIES FOR 1993 to Federal and State legislators and policymakers, health advocates, and the public. The Framework will guide the public policy activities of the Coalition as we work towards the Surgeon General's goal of a Tobacco Free Society by the Year 2000. This document has been developed by the American Cancer Society, the American Heart Association, and the American Lung Association, united as the Coalition on Smoking OR Health, in collaboration with the Legislative Advisory Council of the Coalition.* The members of the Legislative Advisory Council are: American Academy of Pediatrics American Academy of Family Physicians American College of Cardiology American Association for Respiratory Care American Public Health Association American Society of Internal Medicine Association of State and Territorial Health Officials March of Dimes Birth Defects Foundation. The implementation of the recommendations in the Framework would be a giant step in the improvement of the health of all Americans. * In addition, approximately 150 additional health, consumer, and religious groups support Coalition initiatives on an ad hoc basis. I 15p Connecticut Avenue. NW. Suite 820. Washineon. DC 2IX136 Telephone: (?0?l 452-1184 FAS: s?02l J5'_-1117

19 J providing reimbursement through Medicaid programs and private insurance for cessation services, including nicotine replacement therapy. • Opposition to any legislation providing smokers special protection under civil rights or equal employment statutes Coalition on Smuting OR Hulth Fnmework for Public Policy Activities 1993 m ~ ~ CR N N W ~

10 PUBLIC POLICY OBJECTIVES FOR FREEDOM FROM TOBACCO I. ADVERTTSING AND PROMOTTON OF TOBACCO PRODUCTS The tobacco industry spent $3.9 billion in 1990 on advertising and promotional activities. Tobacco advertising and promotion overwhelm the efforts of the public and private sector to educate this nation's youth about the health effects of tobacco; create a climate that increases peer pressure on young people to use tobacco; and, trivialize and diminish the significant health hazards of tobacco use. Federal The Coalition on Smoking OR Health recommends: • Enactment of legislation to prohibit all tobacco advertising and promotional practices. The following can be considered as interim steps in the absence of a complete ban: J limiting tobacco advertising to tombstone advertising, with text only and no representation of humans; J banning brandname promotional practices, including sponsorship of sporting events, concerts, jazz festivals, and the like, that include the use of product names and logos; J enforcing, through codification or other means, the provisions in the tobacco industry's own so-called "voluntary advertising code"; • Enactment of legislation to limit or eliminate the taxpayer subsidy of tobacco industry advertising and promotion through the business tax deduction; and • Regulation of health-related claims in tobacco advertising. • Repeal of the federal preemption on state regulation of tobacco advertising, which limits states' ability to enforce their deceptive acts and practices statutes Coelition on Smuking OR HcaUh Fnmewort for Public Pulicy Activities 1993

21 b. International Trade The federal government has promoted the export of tobacco to Thailand, Japan, South Korea, and, most recently, Taiwan. It has been exercising its trade leverage with these nations to force them to open their doors to U.S. tobacco products and to require them to weaken restrictions on tobacco marketing that have been imposed for health-based reasons. Forcing U.S. tobacco products and U.S. marketing techniques for those products on foreign nations at a time the U.S. Government has declared war on drugs like cocaine is particularly ironic. Many more people die each year from tobacco than from heroin, cocaine, and all other illegal drugs combined. Federal The Coalition on Smoking OR Health recommends: • Modification of trade policy priorities, including J ceasing use of trade leverage to promote the export of tobacco and tobacco products in contravention of federal health policy; and ./ including consideration of health information from federal officials in trade deliberations. State The Coalition on Smoking OR Health supports: • Research into crops offering an alternative to tobacco on land that has been used for tobacco and using growing and marketing skills developed by tobacco farmers; and • Gradual reduction of technical and other assistance to tobacco farmers by state agricultural agencies. Coalition on Smoking OR Hea11A Fnmework for Public Policy Activili<a 1993 ~ ~ ~ t:lt N N t.~ OD

18 6. GOVERNMENT TOBACCO-USE PREVENTION AND CESSATION ACTIVITIES The Office on Smoking and Health (OSH), the federal office responsible for coordinating federal tobacco-use education, prevention and research efforts had a budget of $7.3 million in fiscal year 1992 and will receive $10 million in 1993. To look at this another way, every day the tobacco industry spends the equivalent of the entire year's budget for OSH. Federal The Coalition on Smoking OR Health recommends: • Strengthening and expanding the federal government's role in tobacco-use education, prevention, research, and cessation efforts, including J an adequately funded public education advertising program aimed at informing young people about the dangers of tobacco use and the role of marketing in encouraging tobacco use; J requiring the availability of smoking cessation services in all health care programs serving pregnant women; and J providing reimbursement under Medicaid and Medicare for cessation services, including nicotine replacement therapy, and encouraging private insurers to provide similar coverage. State The Coalition on Smoking OR Health recommends • Strengthening and expanding state health department activities in tobacco-use education, prevention, research, and cessation efforts, including J public education advertising campaigns aimed at young people; J inclusion of tobacco in all health education and drug abuse prevention curricula; J requiring the availability of smoking cessation services in all health care programs serving pregnant women; and Cuelition on Snwking OR Health Fnmework for Public Policy Activities 1993

2 Background Tobacco As A Cause of Death and Disease Since the 1950's, scientific evidence has proven the link between smoking and disease and mortality. In 1964, the United States Surgeon General published a landmark report officially recognizing smoking as a cause of cancer and other serious diseases. The clear message of the report was, "Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action." Among the diseases researchers have concluded are caused or exacerbated by tobacco use are lung and laryngeal cancer, coronary heart disease, atherosclerotic peripheral vascular disease, oral cancer, esophageal cancer, and chronic obstructive pulmonary disease (emphysema and chronic bronchitis). Infants born to mothers who smoke are at higher risk of premature birth, low birthweight, having birth defects, and dying before their first birthday. Cigarette smoking is considered a probable cause of unsuccessful pregnancy, increased infant mortality, and peptic ulcer disease. It is a contributing or associated factor for several other forms of cancer. Furthermore, nicotine, a major constituent of tobacco, is highly addictive. Tobacco use has been recognized as a serious drug abuse problem by the World Health Organization and the U.S. Public Health Service. The National Institute of Drug Abuse has described cigarette smoking as the "most widespread example of drug dependence" in our nation. The 1988 Surgeon General's Report dealt exclusively with nicotine addiction, establishing nicotine as a substance comparable in its physiological and psychological properties to other addictive substances that are abused. Environmental Tobacco Smoke or Passive Smoking Scientific evidence is mounting that non-smokers are adversely affected by exposure to the toxic smoke produced by other people's tobacco use. The U.S. Environmental Protection Agency (EPA) in the review draft of the risk assessment called "Respiratory Health Effects of Passive Smoking," estimates that 3,000 lung cancer deaths per year in non-smokers are caused by environmental tobacco smoke (ETS). According to the American Heart Association, ETS is also responsible for between 35,000 and 40,000 deaths yearly in the U.S. from cardiovascular disease. Young children are particularly vulnerable to the effects of ETS. The EPA estimates that exposure to parental smoking is responsible for 150,000 to 300,000 lower respiratory tract Cwlition on Smoking OR HeaLh Fnmework for Public Policy Aclivities 1993

16 I 5. REGULATTON OATOBACCO PRODUCTS In spite of the well-established health hazards of tobacco, tobacco products have been exempted from regulation under all major health and safety laws enacted by Congress. It makes no sense for the U.S. government to require health and safety standards for other legal products, such as food, drugs, and cosmetics, and fail to regulate adequately the manufacture, distribution, sale, labeling, advertising and promotion of the one addictive drug that causes death and disease. In addition, the Food and Drug Administration has not exercised its existing authorities over deceptive advertising claims, and, as a result, unwarranted deceptive health claims have proliferated. The Coalition on Smoking OR Health will continue to pressure the FDA to act on a number of Coalition petitions that would classify these "low yield" products "as drugs" under section 201 of the FDC Act. Federal The Coalition on Smoking OR Health recommends: • Enactment of federal legislation to require that tobacco products be regulated by the Food and Drug Administration (FDA) as other legal drugs, devices, foods, and consumer products are regulated. At a minimum, Federal regulation of tobacco products should require the FDA to: d apply the same regulatory standards to the advertising and promotion of tobacco products that it does to other legal prescription drug products (particularly other nicotine containing prescription drugs); ,/ require that all additives added to tobacco are tested for safety in a comparable manner to the way additives used in foods are tested; ./ require that tobacco products are fully labeled to provide the public with complete and adequate information on additives and constituents (i.e. benzene, arsenic) in tobacco smoke; additional warnings such as addiction, increased risk of stroke and the effects of environmental tobacco smoke on nonsmokers; other contraindication warnings such as increased risks for persons with preexisting medical conditions, use of tobacco with birth control pills, etc.; / use its authorities to ensure enforcement of federally mandated minimum age of sale and dispensing laws; Coelifion on Smuking OR He.lth Fomework for Poblic Pdicy Auldties 1993

13 3. TAX AND PRICING POLICY Tobacco taxes have a significant impact on tobacco consumption, and are especially effective in discouraging children from smoking. In 1989, the General Accounting Office reviewed research on teenage response to cigarette price increases and concluded that a 21 cent increase in the price of a pack of cigarettes at that time would result in about a 12 percent decrease in the number of teenaged smokers and a concomitant decrease in the number of premature deaths due to smoking. Adult smokers are also sensitive to price increases. Since the California excise tax was increased by 25 cents in 1989, smoking in the state has decreased by 17 percent. Federal The Coalition on Smoking OR Health recommends: • Enactment of legislation to significantly increase the price of tobacco products to discourage initiation and continuation of tobacco use, with primary emphasis on a significant increase in the federal excise tax. Consideration could also be given to imposition of an ad valorem tax, or a direct assessment on manufacturers, in addition to the corporate income tax; and • Consideration of establishment of a trust fund or other mechanism to designate revenues from tobacco taxes for such purposes as offsetting health care and other costs incurred due to tobacco use, supporting health education programs, assisting tobacco farmers in shifting to other crops, or similar uses. State The Coalition on Smoking OR Health recommends: • Enactment of legislation to significantly increase the price of tobacco products, with primary emphasis on a significant increase in the excise tax; and • Consideration of establishment of a trust fund or other mechanism to designate revenues from tobacco taxes for such purposes as offsetting health care and other costs incurred due to tobacco use, supporting health education programs, and assisting tobacco farmers in shifting to other crops; or similar uses. Co.lirion un Smnking OR Heelfi Fnmework for Public Policy Aclivitiea 1993

7 Since the establishment of the voluntary advertising code, the tobacco industry has continued to dodge legislative action to regulate its advertising. The industry hides behind the curtain of the First Amendment in its attempts to justify its resistance to regulation. Despite the tobacco industry's claims to the contrary, the Supreme Court has ruled that certain restrictions on commercial speech are constitutionally acceptable. Prescription drugs, food products and many other consumer products are similarly regulated in both their labeling and advertising. Government's Failure to Regulate Not only is tobacco the most harmful product sold in the U.S. today, but it is the least regulated. No federal agency regulates tobacco products for health or safety purposes. In spite of the well established dangers associated with tobacco use, Congress has exempted tobacco products from regulation under numerous health and safety laws designed to protect consumers from dangerous products. Tobacco is exempted from regulation under the Consumer Product Safety Act, the Fair Packaging and Labeling Act, the Federal Hazardous Substance Act, and the Toxic Substances Control Act. In addition, the Food and Drug Administration has taken the position that there is no specific authority to regulate tobacco under the Food, Drug, and Cosmetic Act or the Controlled Substance Act. Unlike all other products, particularly those which we consume, no federal regulatory agency has jurisdiction over the manufacture, distribution, sale, or labeline of tobacco products. Thus, unlike foods, drugs, cosmetics or other consumer products, tobacco products are virtually given carte blanche to manufacture and market their addictive wares free from the intervention of an agency like the Food and Drug Administration or the Consumer Product Safety Commission - agencies established to protect the public from dangerous consumer products. No agency oversees the safety of the chemical and other additives in these products. Tobacco Farming In contrast to its reluctant position on tobacco product regulation, the federal government does take an interest in tobacco farming. To administer the price support program, the federal government spends about $15 million a year, fifty percent more than it spends on the Office on Smoking and Health. In addition, the U.S. Department of Agriculture spends about $13 million each year for crop insurance, $9 million for research and extension services , and $1 million for miscellaneous activities related to tobacco. The tobacco price support program includes such tasks as controlling the amount of acreage planted in tobacco and setting minimum prices for raw tobacco. The Department of Agriculture also provides general advice and support to tobacco farmers. Growers and manufacturers pay Coalilion on Smoking OR Health Fnmework for Poblic Policy Activities 1993

14 4. CLEAN INDOOR AIR AND BNVlRONMENTAL TOBACCO SMOKE Scientific evidence is mounting that non-smokers are adversely affected by exposure to the toxic smoke produced by other people's tobacco use. The U.S. Environmental Protection Agency (EPA) in the review draft of the risk assessment called "Respiratory Health Effects of Passive Smoking," estimates that 3000 lung cancer deaths per year in non-smokers are caused by environmental tobacco smoke (ETS). According to the American Heart Association, ETS is also responsible for between 35,000 and 40,000 deaths yearly in the U.S. from cardiovascular disease. Young children are particularly vulnerable to the effects of ETS. The EPA estimates that exposure to parental smoking is responsible for 150,000 to 300,000 lower respiratory tract infections per year in children under 18 months of age, resulting in about 7,500 to 15,000 hospitalizations. Federal The Coalition on Smoking OR Health recommends: • Enactment and enforcement of legislation and regulations to reduce the exposure of non- smoking adults and children to environmental tobacco smoke (ETS), with emphasis on facilities and activities that expose the greatest number of people to ETS for the longest periods of time, such as workplaces, schools, daycare centers, and healthcare facilities. Possible mechanisms include: J comprehensive clean indoor air legislation; J legislation banning smoking or requiring no-smoking policies in selected federally funded programs or facilities; J regulatory action by appropriate federal agencies, provided such action does not restrict the ability of state and local governments to enact more comprehensive protections, if needed. • Undertaking of a risk assessment of the cardiovascular health effects of ETS by the Environmental Protection Agency to complement the risk assessment of cancer and respiratory health effects already completed. CoalLLwn on smnkipg OR Health Fntnework for Public Policy Activities 1993

20 7. GOVERNMBNTAL SUPPORT FOR TOBACCO a. Aariculture To administer the tobacco price support program, the federal government spends about $15 million a year, fifty percent more than it spends on the Office on Smoking and Health. In addition, the U.S. Department of Agriculture spends about $13 million each year for crop insurance, $9 million for research and extension services , and $1 million for miscellaneous activities related to tobacco. The tobacco price support program includes such tasks as controlling the amount of acreage planted in tobacco and setting minimum prices for raw tobacco. The Department of Agriculture also provides general advice and support to tobacco farmers. Growers and manufacturers pay a levy on their tobacco to cover any loss in principal on loans made as part of the price support program. Under the current program, the government does not subsidize tobacco farmers the way it does wheat and other farmers. But during the 1980's the government spent about $1 billion to bail out the tobacco program. Federal The Coalition on Smoking OR Health supports: • Efforts to eliminate federal financial support for the growth of tobacco while assisting farmers who wish to stop growing tobacco. Possible mechanisms include; J eliminating or reducing the use of federal funds to pay for, administer or otherwise support the tobacco price support program, allotments, and quotas; J supporting research into crops offering an alternative to tobacco on land that has been used for tobacco and using growing and marketing skills developed by tobacco farmers; and J creating a federally-funded program - perhaps using the federal excise tax on tobacco products, user fee revenues, tax credits or similar means - to provide financial assistance to tobacco farmers who voluntarily elect to stop growing tobacco. Tobacco allotments owned by farmers who participate in the program would be retired, thereby decreasing the overall number of such allotments and the acreage devoted to the growth of tobacco. Coalition on sawting OR Hulth Fnmeworlc for Public Policy Activiti<s 1993

8 a levy on their tobacco to cover any loss in principal on loans made as part of the price support program. Under the current program, the government does not subsidize tobacco farmers the way it does wheat and other farmers. But during the 1980's the government spent about $1 billion to bail out the tobacco program. The percentage of imported tobacco used in domestic cigarettes has increased almost threefold since 1969, currently accounting for more than one-third of the tobacco used in this country. The acreage devoted to growing tobacco in this country is about 80 percent of what it was in 1974. Domestic growers attempt to make up the reduced domestic use of tobacco by selling their tobacco overseas. In 1991 the overseas market was up slightly, increasing 3 percent, but the prospects for expansion are poor. Although tobacco remains a very profitable crop for farmers, their interests and prospects would appear to differ from those of the manufacturers. Tobacco Manufacturers Despite the drop in domestic consumption, tobacco remains a highly profitable industry. The largest of the six domestic tobacco companies made a profit of $6.6 billion on sales of about $24 billion from its tobacco business in 1991 -- a profit of 28 percent. Retail prices of tobacco products increased about 8 percent in the last year. Since January 1980, manufacturers have raised cigarette prices 31 times, three times in the last year alone. Manufacturers are taking a greater share of the consumer's dollar now than in 1980, while farmers, and excise taxes are taking a smaller share. Wholesalers' and retailers' share remains the same. In 1980, manufacturers took 37 percent of every dollar spent on cigarettes; in 1991 that share increased to 50 percent. At the same time, the farmers share went from 7 percent to only 3 percent. The tax share has also decreased from 34 percent to 25 percent. International Tobacco Epidemic The tobacco epidemic is not confined to the U.S. The 1992 Surgeon General's Report on Smoking and Health in the Americas says that smoking-related death and disease is increasing in Latin America and the Caribbean. The report says there is a continuum of smoking and disease that is related to economic development. As a country grows economically, its people gradually increase their smoking rates. As smoking becomes entrenched, it leads to major loss of life. The U.S. government has been playing a disturbing role regarding the worldwide epidemic. The Department of Health and Human Services recognizes as incontrovertible the health hazards of tobacco. But, the U.S. Trade Representative and others promote the export of tobacco. Coalition on Smuking OR Hmllh Fnnwwork for Public Policy Ac[ivilies 1993