Tobacco Documents Online

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