CDC A Report of the Surgeon General

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CDC A Report of the Surgeon General

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Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Office on Smoking and Health

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NYSA numbers: 0398 B1793 02C
Named Organization: ADAMHA (Alcohol, Drug Abuse, Mental Health Adm.)
Alcohol, Drug Abuse, and Mental Health Administration; Addiction Research Foundation of Toronto; Addictive Behaviors (Journal); Advertising Age (periodical); Alcohol, Drug Abuse and Mental Health Administration; Alliance for Health, Physical Education, Recreation and Dance; American Academy of Advertising; American Academy of Family Physicians; American Academy of Pediatrics; American Board of Family Practice; American Cancer Society; American Dental Association; American Health Foundation (Health Research)
Plaintiff; American Heart Association (Voluntary health organization that focuses on cardiac health)
Voluntary health organization that focuses on cardiac health and stroke. AHA occasionally teams with tobacco retailers to engage in promotions/fund-raisers (see http://www.smokefree.net/doc-alert/messages/247136.html and http://www.rawbw.com/~jpk/stand/Pictures.html).; American Journal of Cardiology (scientific periodical); American Journal of Epidemiology (scientific periodical); American Journal of Public Health (periodical); American Lung Association
Voluntary health organization concerned with fighting lung disease, promoting lung health and advocating clean air, indoors and out.; American Medical Association (physicians group)
Professional trade group representing American physicians.; American Psychiatric Association (Psychiatric professional group)
Trade group for psychiatric health professionals.; American Public Health Association (Public health organization)
Professional organization for people working in public health; American Stop-Smoking Intervention Study (Six year effort to reduce smoking rate in 17 U.S. states nat)
ASSIST was funded with approximately $114 million over six years in the early to mid 1990's by the American Cancer Society and the National Cancer Institute for a period of approximately 6 years.; American Tobacco Company; Americans for Nonsmokers' Rights (Anti tobacco organization)
Concerned with clean indoor air.; Anderson Cancer Center (M.D. Anderson Cancer Center); Archives (National Archives and Records Administration); Arizona Department of Health Services; Arizona State University; Army; ASH (Action on Smoking and Health)
Action on Smoking and Health; Associated Press (AP) (National Uniform Press Service); Association for Consumer Research; Association of State and Territorial health Officials (ASTHO); Aurora University; Boy Scouts of America; Boys and Girls Clubs of America; British Journal of Addiction (scientific periodical); British Journal of Cancer (scientific periodical); British Journal of Pharmacology (scientific periodical); British Medical Journal (BMJ) (scientific periodical)
scientific periodical; Bureau of the Census; Cable News Network (C.N.N.); California Department of Health Services; CBS (Columbia Broadcasting System); Center for Consumer Research (Located at Florida State University); Centers for Disease Control and Prevention (CDC); Chapel Hill; Clinical Research (scientific periodical); Coalition on Smoking OR Health (public action arm of the National Interagency Council on Smo); Cold Spring Harbor Laboratory; Committee on Energy and Commerce; Congressional Budget Office (CBO); Consumer Reports (magazine that tested tar content in 50s); Consumers Union (Publish Consumer Reports); Cosmopolitan (Woman's Magazine); Department of Commerce (DOC); *Department of Education (use United States Department of Health, Education & We; *Department of Health and Human Services; Department of Health and Social Services (British governmental dept.); *Department of Health, Education, and Welfare (HEW) (use United States Departmen (use @hew_dept); Department of Labor (DOL); Doctors Ought to Care (Activist physician group on tobacco)
Founded by Alan Blum M.D; Emory University; Environmental Protection Agency (EPA); European Journal of Respiratory Diseases (periodical); Family Course Consortium (Industry-created "youth anti-smoking" front group); Federal Register (publication); Federal Trade Commission (Enforcement agency for laws against deceptive advertising)
Enforces laws against false and deceptive advertising, including ads for tobacco products. Ensures proper display of health warnings in ads and on tobacco products;collects and reports to Congress information concerning cigarette and smokeless tobacco advertising, sales expenditures, and the tar, nicotine, and carbon monoxide content of cigarettes.; Federal Trade Commission (FTC); Firestone; Food and Drug Administration (FDA); Fortune; Gallup Organization (Polling firm)
formerly known as Gallup & Robinson, Inc. (1975); General Accounting Office; General Counsel; Girls, Inc. (Jackson, Mississippi); Government Accountability Office (GAO); Government Printing Office (GPO); Harvard Business School; Harvard College (Harvard Collge is the undergraduate branch of Harvard Univer); Harvard Medical School; Harvard School of Public Health; Harvard University; *Health and Human Services (HHS) (use United States Department of Health and Hum (US); Health and Welfare Canada; Health Education Authority (British group; keeps statistics on business nonsmoking polic)
Located in England and keeps statistics on companies with nonsmoking policies; Health Examination Survey (For the National Center for Health Statistics); Health Resources and Services Administration; Health Services and Mental Health Administration (U.S. Public Health Service); Home Testing Institute; House of Representatives; Houston Post (newspaper); Imperial Tobacco Co. (Determined optimum nicotine levels for cigarettes)
Did testing pre-1972? of U.K. smokers and concluded that the optimum nicotine delivery for the cigarette, and that stepwise reductions in delivery caused progressive rejection by consumers (see Project Wheat); Imperial Tobacco Ltd. (Cigarette manufacturer in United Kingdom)
Cigarette manufacturer in United Kingdom; Indian Health Service; Indiana University (Located in Bloomington, Indiana); Institute for Social Research (University of Michigan); Institute for the Study of Smoking Behavior and Policy; Interagency Committee on Smoking and Health (Congressional committee); International Agency for Research on Cancer ("IARC") (International Agency for Research on Cancer ("IRAC"))
International Agency for Research on Cancer ("IARC"); International Journal of Epidemiology; J. Walter Thompson (Advertising agency); John Wiley & Sons (Publisher); Johns Hopkins University; Journal of Consumer Research; Journal of Epidemiology and Community Health (scientific periodical); Journal of Physiology (scientific periodical); Journal of Preventive Medicine (scientific periodical); Journal of Public Policy and Marketing; Journal of the National Cancer Institute (scientific periodical); Journal of the National Medical Association (scientific periodical); Ladies Home Journal; Lancet; Leo Burnett (Advertising/PR)
Defense; Liggett & Myers Inc. (Pioneer in the generic cigarette business)
Cigarette manufacturer; Pioneer in the generic cigarette business; L&M is the manufacturer of Chesterfield, Decade, Dorado, Duke of Durham in 1958, Eagle, Eve, L&M, Lark, Pyramid and Stride cigarettes; Lord & Thomas; McGraw-Hill; Medical Journal of Australia (scientific periodical); Memorial Hospital; Michigan Department of Public Health; Michigan State University; National Academy Press; National Association of Broadcasters; National Association of State Boards of Education; National Automatic Merchandising Association; National Broadcasting Company; National Bureau of Economic Research; National Cancer Institute NCI
Division of Cancer Prevention and Control, National Cancer Institute located in Rockville, MD; National Center for Chronic Disease Prevention; National Center for Health Statistics (Keeps statistics on health-related matters)
Plaintiff; National Clearinghouse for Smoking and Health (NCSH)
NCSH was created in 1964 by the Public health Service. Forerunner of the Office on Smoking and Health. Responsible for creating reports on the health effects of smoking.; National Football League; National Health Survey; National Heart Lung and Blood Institute; National Institute of Child Health and Human Development; National Institute of Education; National Institute on Drug Abuse (An addiction research center in Baltimore, MD)
An addiction research center located in Baltimore, MD; National Institutes of Health; National Institutes of Health (NIH); National Research Council; National Science Foundation; Navy; New England Journal of Medicine; New York State Department of Health; New York State Journal of Medicine (periodical); New York Times; New Zealand Medical Journal (scientific periodical); Newsweek (Weekly News Magazine (U.S.A.)); Nonsmokers Rights (California anti-smoking organization created by Stanton Glan); Northwestern University; Office on Smoking and Health
Responsible for creating reports on the health effects of smoking. Created by the Public Health Service.; Ogilvy and Mather (Advertising Firm Located in New York); Ohio University; Oxford University; Philip Morris & Co. Ltd. (Cigarette manufacturer, incorporated in U.S. in 1902)
Philip Morris & Co. Ltd.., was incorporated in New York in April of 1902; half the shares were held by the parent company in London, and the balance by its U.S. distributor and his American associate. Its overall sales in 1903, its first full year of U.S. operation, were a modest seven million cigarettes. Among the brand offered, besides Philip Morris, were Blues, Cambridge, Derby, and a ladies favorite name for the London street where the home companies factory was located - Marlborough.; Philip Morris Companies Inc. (Parent company of Philip Morris USA, Kraft, Miller)
America's seventh-largest industrial enterprise in 1993, owns Kraft, Miller Brewing, General Foods, and more.; Playboy; Plenum Press; Preventive Medicine (periodical); Printers Ink (Advertising Trade Magazine); Psychopharmacology (scientific periodical); Public Health University (Located in Bangkok, Thailand); R.J. Reynolds Corporation (second tier subsidiary of RJR Industries); R.J. Reynolds Tobacco Co. (Cigarette manufacturer (Camel, Winston, Doral))
Cigarette manufacturer (Camel, Winston, Doral); Reader's Digest; Research Council; Response Analysis (survey conductors located in Princeton, N.J.); RJR Nabisco Inc. (Delaware corporation, subsidiary of RJR Nabisco Holdings)
Subsidiary of RJR Nabisco Holdings Corp.; Robert Wood Johnson Foundation (Foundation, funds tobacco control and health projects); Roswell Park Cancer Institute; Royal College of Physicians (Monitors the quality of Canadian/U.K. medical education); Royal Statistical Society; San Diego State University; Senate; Simmons Market Research Bureau (Advertising auditing company); Smokers Rights Association; Society for Public Health Education; Sports Illustrated; Stanford University; STAT (Stop Teenage Addiction to Tobacco)
Stop Teenage Addiction to Tobacco - anti tobacco group started by Joe Tye.; State University of New York; Stop teenage Addiction to Tobacco (STAT is a anti-smoking group (1994))
STAT is a anti-smoking group (1994); Student Marketing Institute; Subcommittee on Health and the Environment; Subcommittee on Transportation, Tourism and Hazardous Materials; Substance Abuse and Mental Health Services Administration; Surgeon General's Advisory Committee (SGAC); Tennessee Department of Health; Tobacco Institute (Industry Trade Association)
The purpose of the Institute was to defeat legislation unfavorable to the industry, put a positive spin on the tobacco industry, bolster the industry's credibility with legislators and the public, and help maintain the controversy over "the primary issue" (the health issue).; Tobacco Observer (periodical); U.S. Department of Commerce; United States Congress; United States Tobacco Company (Producers of Copenhagen/Skoal chewing tobacco)
Producers of chewing tobacco; University Medical Center; University of British Columbia (Located in Vancouver, British Columbia, Canada); *University of California (use specific branch); University of California at Berkeley; University of California at San Francisco; *University of California Berkeley (use University of California at Berkeley); University of California San Diego; University of California San Diego School of Medicine; University of Florida; University of Houston; University of Illinois (at Champaign-Urbana); University of Illinois At Chicago; University of Maryland College Park; University of Michigan; University of Minnesota; University of Nebraska; University of New Mexico School of Medicine; University of North Carolina; University of North Carolina Chapel Hill; University of North Carolina Press; University of Sydney; University of Texas; University of Texas Health Science Center; University of Vermont; University of Virginia; University of Wisconsin; Wall Street Journal; West Publishing Company; West Virginia University; World Health Organization (Concerned with global public health)
International organization concered with public health worldwide; Yankelovich (Consumer Research Organization)
Specializes in analyzing consumer trends, "critical understanding of consumers, brands and trends, insights into consumer behaviors, attitudes and motivations." (per its web site, 1/02). Heavily relied upon for decades by the tobacco industry.; Young & Rubicam (New York-based advertising agency.)
Was awarded the assignment for advertising Philip Morris' Dave's low-priced cigarette brand. Y&R lost RJR Reynolds' Camel cigarette brand account in 1991 when two Y&R Executives resigned to form Mezzina/Brown, which remains Camel's ad agency (1994) (WSJ 9/13/94).
Named Person: Agee, Victoria; Aitken, P.P. (Youth Smoking Researcher)
Co-Author of "Children's Perceptions of Advertisements for Cigarettes"; Alexander, H.M. (Researcher on Youth Smoking, Newcastle, New South Whales); All, Bell; Altman, David G.; American Brands, Inc.
Defense; Anker, Deborah; Ary, Dennis V.; Bauman, Karl E.; Baumgarten, Von; Bennett, Glen L. (National Heart, Lung & Blood Institute)
Wrote "The Effects of Passive Smoking and Day Care on Respiratory Illnesses in Children"; Benny, Jack (Entertainer, Advertised for Luckies Cigarettes); *Bernays, Edward (use Bernaise, Edward)
Plaintiff; Bishop, Joey (Comedian, Advertised for Newport); Booth, Michael; Botvin, Gilbert J., Ph.D. (Funded by PM & BW; Addiction Psychologist, Cornell U.)
Developed a Life Skills Training Program; Bowling, James; Brubaker, Robert G.; Burner, Leo; Burns, David M.; Burton, Dee; Byrd, Robert C.; Byrne, Kelly L.; Camel, Joe; Carter, Lee; Chaloupka, Frank J., IV, Ph.D. (Economist, U of Illinois at Chicago, Anti-Tobacco Expert); Chang, Michele; Chassin, Laurie, Ph.D. (Psychologist, Arizona St. U. )
Researched advertising effects. Editor of "Nicotine Tobacco Research, Official Journal of the Socienty for Research on Nicotine and Tobacco".; Chrismon, Jeffrey H.; Christen, Arden G.; Coates, Thomas J., Ph.D. (Psychologist, U of CA, San Francisco)
Li VC, Coates TJ, Ewart CK, and Kim YJ published "The effectiveness of smoking cessation advice during routine medical care: physicians can make a difference" (1987).; Collins, Robert J.; Connolly, Gregory; Coulson, W. R., Ph.D. (ACS Psychologist, United States International U.)
Author of "Helping Youth Decide: 'When the Fox Preaches, Beware the Geese.'"; Cowan, Anita; Cummings, K. Michael; Dane, Doyle; Dean, Jimmy (Country Singer); Derrick, Susan R.; Dorsey, Tommy; Durbin, Richard J. (U.S. Representative in 1994, anti-tobacco voice)
Richard J. Durbin was a United States Representative in 1994 (D-IL). He was a leading anti-tobacco voice and a leading antismoking advocate in Congress (LAT 7/18/94; U.S. News 4/18/94). Durbin is concerned about reducing the number of young smokers (U.S. News 4/18/94). He proposed an amendment, with Reps. Synar and Wyden, which would give FDA authority to regulate the manufacture, sale, labeling, advertising, and content of tobacco products, circa 6/94 (AP 6/13/94). Durbin appeared for the 3/25/94 Waxman subcommittee hearing and stated that "Tobacco companies are our nation's number one drug pushers." In May 1994, U.S. representative Martin Meehan wrote a letter to U.S. Attorney General Janet Reno signed by six other congress members (Hansen, Stark, Viscols, Durbin, Synar, Foglietta, and Meehan signed). The letter suggested DOJ investigate whether the tobacco Executive violated RICO laws or committed perjury before the Waxman subcommittee (1994) (BN TLR 6/29/94; DJ 5/27/94). The contact in 1994 was Melissa Narins at (202) 225-5271.; Eckl, Elizabeth D.; Elder, John; Elders, M. Joycelyn, M.D. (Former Surgeon General)
Plaintiff; Elders, M. Joycelyn; Eriksen, Michael P., Sc.D. (Center for Disease Control, Director of Smoking & Health)
Plaintiff; Factor, Rick; Fiore, Michael C., M.D., M.P.H. (Director of Tob. Research and Intervention Program, U of Wis)
Plaintiff; Fischer, Paul M., M.D. (Physician, Georgia Med. College, Plaintiff & Expert)
Plaintiff; Foresman, Scott; Forster, Jean L.; Frank, Erica; Gallup, George H.; Garrett, Levi; Gelb, Betsy; Gfroerer, Joseph; Gifford, Frank; Gleason, Jackie (TV Comedian); Gloria, Donna; Glover, Elbert D.; Glynn, Thomas J., Ph. D.
Plaintiff; Goodman, Benny; Gore, Albert (Vice- President); Greenblatt, Janet C.; Gritz, Ellen R., Ph.D.
Plaintiff; Harris, Louis; Harris, William A.; Headen, Sandra W.; Heart, Stanford; Henningfield, Jack Edward, Ph.D. (Pharmacologist, Johns Hopkins U, Anti-Tobacco Expert)
Plaintiff; Heyman, Richard B.; Hill, David; Hill, George Washington
Defense; House, Chelsea; Houston, Houston; Houston, Thomas; How, Al; Hughes, John Russell, M.D. (Addiction Psychiatrist, U of Vermont, Plaintiff's Expert)
Plaintiff; Hull, Frederick L.; Ill, Jacob P.; Ingraham, Gwendolyn A.; Johnson, Doreen; Johnson, Jeffrey C.; Johnston, Lloyd (Principal Investigator, University of Michigan researcher); Jones, R.T. (BATCO GR&DC)
R. T. Jones was with BATCO-GR&DC. (Source: NM Tobacco Companies Personnel List); Joseph, Steven C.; July, June; June, May; Kann, Laura; Kayser, Kay; Keeler, T. E. (Researched relative effects of cigarette taxes vs. anti-smok); Killen, Perry C.; Knowlton, Sarah; Land, J. C. (B&W); Landry, Jack; Lane, Lois; Lang, Peter; Lasker, Albert D.
Defense; Lautenberg, Frank R.
Plaintiff; Leathar, D.S.; Lee, Philip R.; Leech, Mark J.; Lichtenstein, Edward; Lloyd, Douglas S.; Lloyd, Gayle; London, Julie; Long, Al; Lung, Al; Lynn, William R.; Lytton, Peggy; Magnuson, Warren G. (Senator from state of Washington); Mah, Russell; Mah, S. Russell; Manley, Marc W., M.D., M.P.H. (Medical Officer at NCI, Rockville, MD)
Marc W. Manley M.D., M.P.H. was a medical officer and acting chief of the Public Health Division of Cancer Prevention and Control for the National Cancer Institute in Rockville, MD in 1993. (Orleans & Slade). He was also contributor to Orleans & Slade Nicotine Addiction in 1993.; Manning, Bonnie L.; Manning, Willard S. (U of MI, Plaintiff's expert)
Plaintiff; Marcus, Stephen E.; Mcarthur, John D.; Mccloud, Karen; Mcginnis, J. Michael; McGinnis, J. Michael, M.D.
Plaintiff; Mckenzie, Ed; Mclaughlin, Daniel F.; Mcneil, Ann D.; Merlo, Ellen (PM Corp. Affairs VP)
Marketing Services prior to 1986. Understood use of nicotine addiction in selling PM products.; Merritt, Robert K.; Michaels, Jennifer A.; Miller, Glenn; Miltenberger, Nancy A.; Miner, Kimberly J.; Mon, Philip; Morrow, William; Mouse, Mickey; Mowrey, Paul D.; Murray, David; Myers, Dr.; Nelson, David E.; Neuberger, Maureen; Novotny, Thomas (Plaintiff's expert, health care costs)
Plaintiff; O'Connell, D.L.; Office on Smoking and Health, Centers for Disease Control and Prevention
Plaintiff; Orlandi, Mario; Parcel, Guy S.; Patterson, Joseph; Pechacek, Terry F.; Perry, Cheryl Leigh, Ph.D. (Behavioral Scientist, U of Minnesota, Anti-Tobacco Expert)
Plaintiff; Pertschuk, Michael (FTC Commissioner (c. 1984)); Pierce, J. P.
Sales Administration; Pierce, John P., Ph.D. (Epidemiologist, U of CA, San Diego, Anti-Tobacco Expert); Pindborg, J.J., M.D. (Studied the effects of smoking on Leukoplakia); Pinney, John M.; Popper, Edward T.; Press, Ronald; Randolph, Mary Babb; Ray, Richard; Remington, Patrick L., M.D., M.P.H. (Epidemiologist, Wisconsin Dept. of Health, Anti-Tobacco Expe)
Plaintiff; Richards, John W., Jr.; Richmond, Julius B., M.D. (Former Surgeon General)
co-author of "Health and Growth"Plaintiff; Rigotti, Nancy A., M.D. (Internist, Harvard Med. School, Anti-Tobacco Expert); Robey, John; Rothenberg, Richard B.; Salem, Winston Hedges; Samet, Jonathan M.; Satcher, David, M.D., Ph.D.; Schelling, Thomas C.; Schroeder, Kathleen L.; Sciandra, Russell; Severson, Herbert H. Ph.D.
Plaintiff; Shalala, Donna E. (Clinton cabinet member, now president of U of Miami, Florida)
Plaintiff; Shaw, Artie; Shelby, Maggie; Shelton, Dana M.; Shopland, Donald R. (NCI Public Health Advisor)
Plaintiff; Siegel, Michael B.; Sieving, Renee E.; Sinatra, Frank (Singer); Smith, Vivian L.; Steinfeld, Jesse; Stevens, Tim; Sussman, Steve; Tee, Robert; Teeter, Robert; Terry, Luther L. M.D. (Surgeon General, 61-65, U of Pennsylvania, Anti-Tobacco Expe)
Luther Terry was former Surgeon General of the United States Public Health Service from 1961 to 1965. Terry was emeritus professor of Research Medicine at the University of Pennsylvania School of Medicine in 1984 (E. Whelan 1984).; Van Dyke, Dick (T.V. Host); Wallack, Larry; Warner, Kenneth E., Ph.D (Plaintiff's expert, health care costs)
Plaintiff; Warren, Charles W.; Wasserman, Jeffrey; Weiss, Scott T.; Weissman, George (PM Chairman & CEO '79-84)
Vice President of Philip Morris from 1954 to 1956. Vice President and Assistant to the President in 1957. Vice President of Marketing from 1958-59. Executive Vice President of Marketing in 1960. Exec. VP Overseas in 1961, Exec. VP PM International 1962-66. President from 1967 to 1972. President and Chief Operating Officer in 1973. Vice Chairman from 1974-78. Chair and CEO from '79-84 and on the Board of Directors from 1959-84. "Mastermind" of Philip Morris' direction.; West, Virginia; Whiteman, Paul; Wik, John; Wiley, John; Wilkenfeld, Judith P., J.D. (Attorney, FTC, FDA, Anti-Tobacco Expert)
Plaintiff; Williams, Laura; Winn, Deborah M., Ph.D.
Plaintiff; Wolf, Rebecca B.; Worden, John K.; Wright, John; Wynder, Ernst L., M.D. (Epidemiologist, Sloan Kettering, Anti-Tobacco Expert)
1993 First scientist to report in 1950 on the carginocencity of cigarettes in rats painted with tar. Assistant at Sloan-Kettering Institute for Cancer Research Directed the American Health Foundation (AHF) from 1984 to his death in 1998.; Young, John Orr; Zhu, Bao Ping
Date Loaded: 27 Jan 2005
Box: 6521. PAD: Carol Hrycaj 1993-94 Tax Issues
Folder: Cigarette Taxation and the Social Consequences of Smoking by W. Kip Viscusi September 29, 1994
Division: Public Affairs

Page count mismatch (files 322, split 139)

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CDC A Report of the Surgeon General U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Office on Smoking and Health T113950312

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Tobacco Among Young People A Report of the Surgeon General U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Office on Smoking and Health T113950313

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Suggested Citation U.S. Department of Health and Human Services. Preventing Tobacco Use A~nong Young People: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control'and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994. For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C., 20402, S/N 017-001-00491-0. Use of trade names is for identification only and does not constitute endorsement by the Public Health Service or the U.S. Department of Health and Human Services. T113950314

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THE SECRETARY OF HEALTH AN{.) HUMAN SERvI{_E$ The Honorable Thomas S. Speaker of the House of Washington, D.C. 20515 Foley Representatives Dear Mr. Speaker: It is my pleasure to transmit to the Congress the Surgeon General's report on the health consequences of smoking entitled Prev@nting Tobacco Use Amonq Younq People. This report is mandated by section 8(a) of the Public Health Cigarette Smoking Act of 1969 (Public Law 91-222) and includes the health effects of smokeless tobacco products as mandated by section 8(a) of the Comprehensive Smokeless Tobacco Health Education Act of 1986 (Public Law 99-252). The report was prepared by the Centers for Disease Control and Prevention's Office on Smoking and Health. This report focuses on the vulnerable adolescent ages of I0 through 18 when most users start smoking, chewing, or dipping and become addicted to tobacco. It examines the health effects of early smoking and smokeless tobacco use, the reasons that young men and women begin using tobacco, the extent to which they use it, and efforts to prevent tobacco use by young people. Smoking kills 434,000 Americans each year. Adolescent smoking and smokeless tobacco use are the first steps in this totally preventable public health tragedy. The facts are simple: one out of three adolescents in the United States is using tobacco by age 18, adolescent users become adult users, and few people begin to use tobacco after age I~. Preventing young people from starting to use tobacco is the key to reducing the death and disease caused by tobacco use. This report documents that intervention programs targeting the broad social environment of adolescents are both effective and warranted. A great opportunity lies before us to prevent millions of premature deaths and improve the quality of lives. This report points out the overwhelming need in public health for efforts directed toward stopping young people before they start using tobacco. Enclosure T!13950315

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THE SECRETARY OF HEALTH AND HUMAN SERVICES WASHINGTON. O The Honorable Albert Gore, President of the Senate Washington, D.C. 20510 Dear Mr. President: Jr. It is my pleasure to transmit to the Congress the Surgeon General's report on the health consequences of smoking entitled P;@v@n~in~ Tobacco Use Among Young People. This report is mandgted by section 8(a) of the Public Health Cigarette Smoklng Act of 1969 (Publ±c Law 91-222) and includes the health effects of smokeless tobacco products as mandated by section 8(a) of the Comprehensive Smokeless Tobacco Kealth Education Act of 1986 (Public Law 99-252). The report was prepared by the Centers for Disease Control and Prevention's Office on Smoking and Health. This report focuses on the vulnerable adolescent ages of I0 through 18 when most users start smoking, chewing, or dipping and become addicted to tobacco. It examines the health effects of early smoking and smokeless tobacco use, the reasons that young men and women begin using tobacco, the extent to which they use it, and efforts to prevent tobacco use by young people. Smoking kills 434,000 Americans each year. Adolescent smoking and smokeless tobacco use are the first steps in this totally preventable public health tragedy. The facts are simple: one out of three adolescents in the United States is using tobacco by age 18, adolescent users become adult users, and few people begin to use tob&cco after age 18. Preventing young people from starting to use tobacco is the key to reducing the death and disease caused by tobacco use-. This report documents that intervention programs targeting the broad social environment of adolescents are both effective and warranted. A great opportunity lies before us to prevent millions of premature deaths and improve the quality of lives. This report points out the overwhelming need in public health for stopping young people before they efforts directed toward start using tobacco. Donna E. Shalala Enclosure T113950316

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Foreword This Surgeon General's report on smoking and health is the twenty-third in a series that was begun in 1964 and mandated by federal law in 1969. This report is ~he first in this series to focus on young people. It underscores the seriousness of tobacco use, its relationship to other adolescent problem behaviors, and the responsibility of all citizens to protect the health of our children. Since 1964, substantial changes have occurred in scientific knowledge of the health consequences of smoking and smokeless tobacco use. Much more is also known about programs and policies that encourage nonsmoking behavior among adults and protect nonsmokers from exposure to environmental tobacco smoke. Although con- siderable gains have been made against smoking among U.S. adults, this progress has not been realized with young people. Onset rates of cigarette smoking among our youth have not declined over the past decade, and 28 percent of the nation's high school seniors are currently cigarette smokers. The onset of tobacco use occurs primarily in early adolescence, a developmental stage that is several decades removed from the death and disability that are associated with smoking and smokeless tobacco use in adulthood. Currently, very few people begin to use tobacco as adults; almost all first use has occurred by the time people graduate from high school. The earlier young people begin using tobacco, the more heavily they are likely to use it as adults, and the longer potential time they have to be users. Both the duration and the amount of tobacco use are related to eventual chronic health problems. The processes of nicotine addiction further ensure that many of today's adolescent smokers will regularly use tobacco when they are adults. Preventing smoking and smokeless tobacco use among young people is critical to ending the epidemic of tobacco use in the United States.. This report examines the past few decades' extensive scientific literature on the factors that influence the onset of use among young people and on strategies to prevent this onset. To better understand adolescent tobacco use, this report draws not only on medical and epidemiologic research but also on behavioral and social investigations. The resulting examination of the advertising and promotional activities of the tobacco industry, as well as the review of research on the effects of these activities on young people, marks an important contribution to our understanding of the epidemic of tobacco use in the United States and elsewhere. In particular, this research on the social environment of young people identifies key risk factors that encourage tobacco use. The careful targeting of these risk factors--on a communit,vwide basis--has proven successful in preventing the onset and development of tobacco use among young people. Philip R. Lee, M.D. Assistant Secretary, for Health Public Health Service David Satcher, M.D., Ph.D. Director Centers for Disease Control and Prevention T113950317

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Preface from the Surgeon General, U.S. Department of Health and Human Services The public health movement against tobacco use will be successful when young people no longer want to smoke. We are not there yet. Despite 30 years of decline in overall smoking prevalence, despite widespread dissemination of information about smoking, despite a continuing decline in the social acceptability of smoking, substantial numbers of young men and women begin to smoke and become addicted. These current and future smokers are new recruits in the continuing epidemic of disease, disability, and death attributable to tobacco use. When young .people no longer want to smoke, the epidemic itself will die. This report of the Surgeon General, Preventing Tobacco Use Among Young People, delineates the problem in no uncertain terms. The direct effects of tobacco use on the health of young people have been greatly underestimated. The long-term effects are, of course, well established. The addictive nature of tobacco use is also well known, but it is perhaps less appreciated that early addiction is the chief mechanism for renewing the pool of smokers. Most people who are going to smoke are hooked by the time they are 20 years old. Young people face enormous pressures to smoke. The tobacco industry devotes an annual budget of nearly $4 billion to advertising and promoting cigarettes. As this report so well describes, there has been a continuing shift from advertising to promo- tion, largely because of banning cigarette ads from broodcast media. The effect of the ban is dubious, however, since the use of promotional materials, the sponsoring of sports events, and the use of logos in nontraditional venues may actually be more effective in reaching target audiences. Clearly, young people are being indoctrinated with tobacco promotion at a susceptible time in their lives. A misguided debate has arisen about whether tobacco promotion "causes" young people to smoke--misguided because single-source causation is probably too simple an explanation for any social phenomenon. The more important issue is what effect tobacco promotion might have. Current research suggests that pervasive tobacco promotion has two major effects: it creates the perception that more people smoke than actually do, and it provides a conduit between actual self-image and ideal self-image--- in other words, smoking is made to look cool. Whether causal or not, these effects foster the uptake of smoking, initiating for many a dismal and relentless chain of events. On the brighter side, a large portion of this report is devoted to countervailing influences. We have the justification: there is a substantial scientific basis for primary prevention of cigarette smoking and smokeless tobacco use. A number of successful prevention programs, based on the psychological and behavioral factors that create susceptibility to smoking, are available. We have the means: the report defines a coordinated, effective, nonsmoking public health program for young people. And we have the will: schools, communities, legislatures, and public opinion all testify to the growing support for encouraging young people to avoid tobacco use. T113950318

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The task ks by no means easy. This report underscores the commitment all of us must have to the health of young people in the United States. Substantial work will be required to translate the justification, the means, and the will into a world in which young people no longer want to smoke. L for one, relish the task. M. Joycelyn Elders. M.D. Surgeon General iu T113950319

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Preventing Tobacco Use Among ~2ntn.~ People Acknowledgments Th,s report was prepared by the Department of Health and Human Services under the general direction of the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. David Satcher, M.D., Ph.D., l~irector, Centers for Disease Control and Prevention, Atlanta, Georgia. Jeffrey P. Koplan, M.D., M.P.H., Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Richard B. Rothenberg, M.D., M.P.H., Associate Director for Science, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Michael P. Eriksen, Sc.D., Director, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. The editors of the report were Cheryl L. Perry, Ph.D., Senior Scientific Editor, Professor, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Gayle Lloyd, M.A., Managing Editor, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Frederick L. Hull, Ph.D., Technical Editor, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Contributing authors were David R. Arday, M.D., M.P.H., Preventive Medicine Specialist, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Dennis V. Ary, Ph.D., Research Scientist, Oregon Research Institute, and President, Oregon Center for Applied Science, Eugene, Oregon. Michael Booth, Ph.D., Lecturer, Department of Public Health, Universi ,ty of Sydney, Sydney, Australia. Dee Burton, Ph.D., Associate Director for Media Research, University of Illinois at Chicago Prevention Research Center, School of Public Health, Chicago, Illinois. Frank J. Chaloupka IV, Ph.D., Assistant Professor, Department of Economics, The Universi ,ty of Illinois at Chicago, Chicago, Illinois. K. Michael Cummings, Ph.D., M.P.H., Director, Smoking Control Program, Roswell Park Cancer Institute, New York State Department of Health, Buffalo, New York. Joseph R. DiFranza, M.D., Director of Research, Fitchburg Family Practice Residency Program, Fitchburg, Massachusetts. Ro~elyn Payne Epps, M.D., M.P.H., Expert, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. Jean L. Forster, Ph.D., M.P.H., Associate Professor, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Gary A. GiovLno, Ph.D., Chief, Epidemiology Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Elbert: D. Glover, Ph.D., Director, Tobacco Research Center, Mary Babb Randolph Cancer Center, West Virg'.mia University School of Medicine/Robert C. Byrd Health Scionces Center, Morgantown, West Virginia. Jack E. Henningfield, Ph.D., Chief, Clinical Pharmacology Branch, Addiction Research Center, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland. Lloyd Johnston, Ph.D., Program Director, Institute of Social Research, University of Michigan, Ann Arbor, Michigan. Laura Kann, Ph.D., ChieL Surveillance Research Section, Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. R. Monina Klevens, D.D.S., M.P.H., Epidemiologist, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Edward Lichtenstein, Ph.D., Research Scientist, Oregon Research Institute, Eugene, Oregon. T!13950320

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Surgeon General ~ Report Marc Manley, M.D., M.P.H., .ChieL Public Health Applications Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. Robert K. Merritt, M.A., Behavioral Scientist, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. David E. Nelson, M.D., M.P.H., Medical Epidemiologist, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Donald Nutbeam, Ph.D., Professor, Department of Public Health, University of Sydney, Sydney, Australia. Mario Orlandi, Ph.D., M.P.H., Chief, Division of Health Promotion Research, American Health Foundation, New York, New York. Cheryl L. Perry, Ph.D., Professor, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Richard W. Pollay, Ph.D., Professor of Marketing and Curator, History of Advertising Archives, Faculty 6f Commerce, University of British Columbia, Vancouver, British Columbia. Edward T. Popper, D.B.A., Professor of Business • Administration and Marketing, Dean, School of Business and Professional Studies, Aurora University, Aurora, Illinois. Jonathan M. Samet, M.D., Professor of Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico. Herbert H. Severson, Ph.D., Research Scientist, Oregon Research Institute, Eugene, Oregon. Dana M. Shelton, M.P.H., Epidemiologist, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Charles W. Warren, Ph.D., Sociologist, Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. John K. Worden, Ph.D., Research Professor, Department of Family Practice and Office of Health Promotion Research, University of Vermont, Burlington, Vermont. Reviewers were David G. Altman, Ph.D., Senior Research Scientist, Stanford Center for Research in Disease Prevention, Stanford University, Palo Alto, California. Karl E. Bauman, Ph.D., Professor, Department of Health Behavior and Health Education, School of Public Health, University of North Carolina, Chapel Hill, North Carolina. Richard F. Beltramini, Ph.D., Associate Professor, Department of Marketing, Arizona State University, Tempe, Arizona. Glen Bennett, M.P.H., Coordinator, Smoking Education Program, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland. Neal Benowitz, M.D., Professor of Medicine, University of California at San Francisco, San Francisco, California. Gilbert J. Botvin, Ph.D., Professor and Director, Institute for Prevention Research, Cornel.[ University Medical College, New York, New Yorl¢ Robert G. Brubaker, Ph.D., Professor, Department of Psychology, Eastern Kentucky University, Richmond, Kentucky. David M. Burns, M.D., Professor of Medicine, University, of California, San Diego School of Medicine, San Diego, California. Laurie Chassin, Ph.D., Pr(~fessor, Arizona State University, Department of Psychology, Tempe, Arizona. Arden G. Christen, D.D.S., Professor of Oral Biology, Department of Oral Biology, Indiana University School of Dentistry, Indianapolis, Indiana. Robert J. Collins, D.M.D., M.P.H., Chief Dental Officer, Public Health Service, Indian Health Service, Rockville, Maryland. Gregory Connolly, D.M.D., M.P.H., Director, Massachusetts Tobacco Control Program, Massachusetts Department of Public Health, Boston, Massachusetts. K. Michael Cummings, Ph.D., M.P.H., Director, Smoking Control Program, Roswell Park Cancer Institute, New York State Department of Health, Buffalo, New York. Dorynne J. Czechowicz, M.D., Associate Director for Medical and Professional Affairs, Division of Clinical Research, National Institute on Drug Abuse, National Institutes of Health, Rockville, Maryland. Michael M. Daube, Public Service Commission, Perth, Australia. vi T!13950321

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