Tobacco Documents Online

-6- hrough i ences the :.sals, .. noting " sible The Health Organizations Act. As this alarming data began to accumulate, it became clear to the American Cancer Society and to other national organizations that the time had passed for accumulating evidence -- now was the time for action. On June I, 1961, a joint letter was dispatched to President John F. Kennedy over the signatures of the Presidents of the American Cancer Society, American Heart Association, National Tuberculosis Association (now the American Lung Association), and the American Public Health Association, asking that appropriate action be taken. The voluntary agenci~e, the letter pointed out, had used £heir resources to uncover the health risks of smoking. Now, it was up to the government to take a stand and to respond accordingly. icome Ochsner wing ~e and :bse- I .~y the ~ 1950's, ~ epid- ~ S ]~rette >icians iduals a find- the ate ted The Sur~eo~ General's Report On June 7, 1961, Dr. Luther L. Terry, Surgeon General of the ~nited States Public Health Service, announced that by direction of the President, he was establishing an expert Advisory Committee to undertake a comprehensive review of all data on smoking and health. On January II, 1964, the Committee made its report titled "Smoking and Health", the famed document which became known throughout the world by the title "The Surgeon General's Report". The two most significant conclusions were: "Cigarette smoking is a health hazard Of sufficient importance in the United States to warrant remedial action. Cigarette smoking is causally related to lung cancer in men; the magnitude of the effect of cigarette smoking far outweighs other factors. The data for women, although less extensive, point in the same direction". The report produced shock waves. There was an immediate public reaction, and a sharp, albeit short-lived, drop in cigarette sales. But there were other more long-lasting results. With this ammunition in hand, the American Cancer Society and its allies launched intensive programs of Public Education, through the schools and community groups of all types. For the Society, this constituted an expansion and intensification of a program which had been going on for at least ten years, and which had already reached most high schools throughout the country. The Surgeon General's Report provided incentive and ammunition also for a nationwide campaign by the American Cancer Scciety and its allies via the press, radio and television. T107581584,

-7- Conqressional Action Congress reacted to the Surgeon General's Report by enacting the first national law regulating the labeling of cigarettes and requiring specificall. that all cigarette packages carry the warning label: "Caution - Cigarette Smoking May Be Hazardous To Your Health". Simultaneously, the Government established, under the Public Health Service, the National Clearinghouse on Smoking and Health to conduct research, provide scientific reports, and give education and information to the public on trends in smoking and on the health hazards involved. The voluntary agencies were mightily disappointed with the outcome. No restrictions had been placed on promotion and advertising of cigarettes. Instead of undertaking a massive government program of public education to warn the American people about smoking, Congress had sidestepped the issue by appointing a Clearinghouse on Smoking and Health; instead of a strong, effective warning of the kind that is placed on bottles o~ poison, Congress had required only a very weak, innocuous warning. Nevertheless, a vital breakthrough had been made. Th~ government had finally committed itself to an official position declaring smoking to be harmful to health, and had at least undertaken some measures, however limite consistent with this position. However, the task of carrying on the battle through Public Education and the mass media was left to the voluntary health organizations, a respon- sibility they discharged with great faithfulness and vigor. pe~capita consumption Drops The cumulative impact of all these factors proved to be great. The per capita consumption of cigarettes, which had reached an all time high in 1963, began to fall immediately after the issuance of the Surgeon General's Report in 1964. The following year, this figure rose slightly and remained on a plateau for 1966 and 1967, but at a level considerably under the 1963 mark. While there was disappointment that the per capita consumption curve did not continue to fall, there was still considerable satisfaction that it had not resumed its rise. This was proof that the anti-smoking activity of the health organizations was proving powerful enough to counteract the advertising of the cigarette companies. Had this not been the case, the consumption curve would have, without a doubt, continued to rise in sharp ascent after 1963. T107581585

=irst :ically .~ tte ;e and ~.. NO ;. ~ to ;sue I ess The "~ai~ness Dpctrine" Then, in 1967, an event of great importance took place. The Federal Communications Co~ission ruled that the "Fairness Doctrine", hitherto applied only to political campaigns, should apply also to cigarette adver- tising on television and radio. Broadcasters who used "spots" advertising cigarettes were required to give a "significant amount" of free time for anti-smoking messages. This was the signal for launching a massive, intensive campaign on television and radio warning about the dangers of smoking, an effort in which the American Cancer Society and other large voluntary health organ- izations joined. Simultaneous with this saturation campaign, per capita consumption of cigarettes began to drop. It ~ontinued to decline sharp.ly through 1969, 1970 and part of 1971. Midway in 1971, it began suddenly to point upward again .... l.~.d mi ted, ,: pon- ,. per :.ed _3 'it of CiBarette Ads Banned On Radio And TV In 1969, .the Federal Trade Co~ission, supported by the voluntary health organizations, called upon Congress to ban all cigarette advertising from television and radio as had been done in eleven other countries including Great Britain, Norway, Sweden, Italy, Switzerland, the Soviet Union and Poland. Congress responded by passing, in 1970, a "Public Health Smoking Act" banning cigarette advertising on radio and television after January 1971. The act also ordered a stronger warning label reading: "Warning - The Surgeon General Has Determined That Cigarette Smoking Is Dangerous To Health". While this law was .hailed as a victory for the anti-smoking forces, it could not be foreseen that it would also produce a serious drawback. Since the broadcasters could no longer advertise cigarettes, they no longer were required to carry anti-cigarette messages. How powerful these messages had really been was demonstrated by what happened when they were no longer there. By the end of 1971, the per capita consumption curve for cigarettes had begun to point upward again; then it continued to move up gradually through 1972, 1973 and 1974. But, in 1975, the upward trend was halted, and that year, the figure remained about level with that of 1974. Whether this slowdown was temporary, or whether it will continue, no one knows. There is also a question as to what this really means. Does it mean that inflation and unemployment are cutting into the purchase of cigarettes? Or is the anti-smoking idea beginning to take hold, resulting in a growing taboo against cigarettes? T107581586

Smg~.n~.Restricted in Public Places While the former is a reasonable explanation, there is strong evi- dence in support of the latter. After the enactment in 1973 by the Arizona legislature of a statewide law to restrict smoking in public places, many other states have followed suit. In 1975 alone, 15 states passed legislation regulating smoking areas In addition, there are federal regulations in effect restricting smoking i~ airplanes, inter-state buses and trains. A number of organizations have come into existence making 9uite vocal their antagonism tosmoking. The psychological effect of these measures and activities has been to place smokers in the position of being different or an unpopular minor- ity. This, we believe, has worked synergisticBlly with the continuing campaigns of Public Education and. Public Information to cause many more smokers to give up cigarettes. While some television programs still feature stars with cigarettes in their mouths, the overwhelming trend, reflected in "family type" programs and in educational and news broadcasts, is in the other direction. This is certainly also true in the newspapers and magazine: Smoking is becoming more and more unpopular, Con~inue~ .DeGline~IE_Eercentafle~ Of Smokers This is borne out by the report "Adult Use Of Tobacco - 1975" issued by tBe U.S. Department of Health, Education and Welfare and based on the study of the National Clearinghouse on Smoking and Health. Some dramatic changes have occurred between 1970 and 1975. Namely: - the proportion of male smokers 21 and over dropped from 42.2 percent to 39.3 percent - the proportion of women smokers dropped from 30.5 percent to 28.9 percent the proportion of male and female smokers was down in every age category with the exception of a slight increase in women 21-24, women over 55, and men over 65 - the most impressive decline was recorded for men 21-24, a drop from 49.8 percent in 1970, to 41.3 percent in 1975 Going back to 1964, the year of the Surgeon General's Report, and com- paring the figures then with the figures today, the gains stand out even more dramatically. In 1964, 52.2 percent of all adult males ~ere smoking. In ]975, the figure was 39.3 percent; In 1964, 31.5 percent of all adult women were smoking; in ]975, 28.9 percent. T107581587

-n Fes. -1 O- ~ttitudes Unfavorable To Smo~nq Corresponding to these actual reductions in cigarette smoking are some very significant indications of future declines, based on present attitudes and assuming these are properly exploited by the health agencies. Fifty-six percent of those surveyed believed that cigarette advertising should be banned completely. Those voting this way included two out of every five smokers. Seventy-eight percent, including two out of every three smokers, felt that teachers, doctors and other health professionals should set a good example by not smoking. Most current smokers, th~ report also disclosed, have made at least one serious attempt to stop smoking. Overall, nine out of every ten say they have either tried to stop smoking or would probably do so if there was an easy way. The message from this survey, so far as the American Cancer S~ciety is concerned, is sharp and clear. Whatever the Society and its allies have been doing to persuade people to stop smoking, or not to take up the habit, has had a deep, long-range impact. The anti-smoking campaigns have produced substantial, impressive results. A_ Numb_er~O_f G~n.eral. P~r.~_p__o_sals The Task Force on Tobacco and Cancer would, therefore: make these general observations: - educational efforts -- through Public Education, Public Infor- mation and Professional Education -- should be intensified and expanded. - since most smokers want to stop, a greater proportion of the Society's anti-smoking resources ~hould go into measures which will help them quit. - since anti-smoking efforts have had greatest impact among educated white males resulting in decreased rates of cancer of the lung and larynx, these disorders are now becoming increasingly diseases of the poor. Special efforts must, therefore, be directed toward these susceptible segments of the population. - since it is evident from educational research that firm attitudes on health are formed in the early years of childhood, a larger proportion of the total effort should be devoted to influencing children starting at the age of 5 or 6. There should be, however, no reduction in efforts directed to teen-agers, nor of the efforts directed to adults. T!07581588

- young women contemplating pregnancy are an especially important target. The life and health of a child is a very powerful incentive to stop smoking. - the importance of involving the medical, dental and allied prof- essions as exemplars and as activists is paramount. - encouragement should be given to popular efforts aimed at bring- ing reasonable restrictions on smoking in public places for the benefit of both the smoker and the non-smoker. Since most smokers want to stop smoking, the majority would welcome regulations which restrict the times and places where they can smoke, and help to support a wavering resolution. Th.e Low Tar-Nicotine _Ciq~re~tt_e A point which has not yet been fully discussed is the "low tar" and "low nicotine" cigarette. Considerable scientific evidence has been amassed demonstrating the "dose-response" relationship between cigarette smoking and cancer, respiratory and heart disease. Tar, nicotine and carbon monoxide have been identified as the causative factors. While pretending to ignore this evidence, the cigarette companies have been reducing the tar and nicotine content of their products steadily, year after year. In 1954, 95 percent of all cigarettes sold in the U. S. fell in the range between 35 milligrams and 53 milligrams of tar per cigarette. By 1960, a decided shift had taken place across the board with 90 percent of all cigarettes sold fall~ng between 19 and 35 milligrams of tar. The downward trend had gone much further, and in 1975, 90 percent of all cigarettes sold fell between 12 and 25 milligrams. Beyond this general downward shift in tar for the regular cigarette brands, there has been an eruption of "low tar" brands. In 1967, cigarettes with 15 milligrams of tar or lower (these are classified as "low tar") constituted only 2 percent of the market. Today, this figure is between lO and 15 percent. The movement, in the industry, is definitely toward the production of less hazardous cigarettes, by reducing tar and nicotine content, and even- tually, by reducing carbon monoxide as well. While this trend to reduce the noxious elements in cigarette smoke should be encouraged, the issue should remain quite clear. While some cigarettes may be less hazardous than others, no cigarette is safe. The efforts of the American Cancer Society should continue to be "d~oted to bringing about total abstention from smoking for as many people as possi61e. T107581589

-12- Importance Of Keep.in~ Tb~ Public Informed Another question which has been raised in the course of the deliberations of the Task Force has to do with the necessity of continuing to "convince" the public with evidence. Some have felt that "all the evidence is in" and "everyone is convinced". "Therefore, our efforts should not be dissipated in telling the same old story to people who know it". Since the time of the Surgeon General's Report, many important epidemi- ological studies have been made with respect to the relationship between smoking and heart disease. Foremost among the researchers have been Dr. William B. Kannel of Framingham, Massachusetts, and Dr. Jeremiah Stamler at North- western University in Chicago. These studies have not only reconfirmed the disastrous effect smoking has on heart disease and other circulatory ailments, but have produced evidence also that .those who stop smoking reduce their risk of suffering a heart attack. Similar results have been produced by Dr. Ernst Wynder. Furthermore, a significant new area of research -- the relatiofi~hip between smoking and pregnancy -- in which area Dr. Neville Butler of Bristol, England, has made o'utstanding contributions -- has established that the rates of miscarriage, stillbirth and infant mortality are higher for mothers who smoke during pregnancy than for mothers who do not. It has also been estab- lished that infants born to mothers who smoke have lower weight at birth, on the average, than do the infants of mothers who de not smoke. This factor is significant since it has been further demonstrated that low weight at birth is related to the later development of physical and emotional disability. In the area of noxious substances in cigarette smoke, recent research has disclosed that the carbon monoxide in cigarette smoke is a very important causal factor in circulatory ailments, and that its presence in the atmosphere where many cigarettes are being smoked is much higher than is acceptable under safety standards. This new evidence should be brought to public attention with as much force as was used to publicize findings of the Surgeon General's Report..Nor should there be any slackening of effort in publicizing the old evidence. A new smoke-vulnerable generation has emerged since the time of the 1964 Report. They must be given the facts, the old and the new. Furthermore, memory ha~ a way of fading, especially when the memory stands in the way of something the individual would like to do. Therefore, even those who know the facts quite well, should have them reinforced through repeated exposure. Now, to conclude this section of the Task Force report. T107581590

S!Decific Five-Year Goals The gains which have been made in the fight to combat smoking are many and they are impressive. The outlook for further and much greater gains is extremely favorable. We believe that it is entirely feasible, based on what has been achieved to date, and based on our evaluation of the strength and determination of the American Cancer Society, its Divisions, its Units and its two million volunteers, to set specific five-year goals. In order to reduce tobacco-related disease and death, we propose the following goals to be achieved by 1982: To reducEthe number of~du!ts who smoke by at least. 25 percent ~.cgd~ s~okinq amo~nq younq oeople b_~ at least 50 ~ercen$ (In quantitative terms, this means reducing the total number of smokers by approximately 16 million persons as follows: 4.5 million teenTagers; 22.5 million adults -- of the 50 million who now 'smdke)' (3) To encourage ~overnmen~a~dindu~trv to reduce the toxic ~.l.e~.~q.t@ in ci~acettE.sm@kEbY a~ 16ast 50 Percent by com~a~i~dn-t6~ ~'he averaRe leve]s~of today, as a step toward the'it ~'l eli~at~X And finally, to reiterate a principle enunciated over a~d over by the /knerican Cancer Society. It is our belief that effectiw implementation of these proposals and achievement of the five-year goals depends on each of the 68 ACS Divisions and more than 3,000 local Units. Unless the Society, at all levels of organization, takes this program to heart, these r~co~nendations will remain just recommendations. We add our voices to those of national leadership in the American Cancer Society in a plea for the speediest, fullest, and most wholehearted action to bring this new anti-smoking program to life, and thus to preserve life for millions of our fellow-Americans. T107581591

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