Tobacco Documents Online

2 3 4 6 "7 8 9 10 12 13 14 16 17 20 21 ~. 22 ~ 23 80 telephone interviews. In the first survey, we used face to face interviews in households %;here there are no telephones, and we found that it did not make any difference, so we did not go to that trouble again. And anyway, the number of househoids with telephones is rapidly increasing. There was a lette~ to the editor of the ~ashington Post just the other day from the Vice President of C&P Telephone Company, and he said that in the Washington 9tea 95.3 percent of the households have telephones. That is just to tell you a little bit of the methodology. It really works very well, because you can collect the data so quickly. Sihce the first survey, in 1968, up to the present, 1974, what has happeneh. I do not think is discouraging. Some people think it is. Smoking among teenage boys has remained almost constant. Smoking among teenage girls has risen every time. However, up until 1968 the increasein cigarette smoking among teenagers was accelerating ~t a very rapid rate. So if you can slow it down just a little bit, it is something to be ve~l much encouraged about, I think. Now, I brought a few slides along. Bob, maybe you better go back there and punch them up. As I say, there are a lot of findings that I am not even going to talk about, because you have th rep~But I think this might give you some insights. First.slide, please. T[06652365

1 2 3 4 5 6 7 8 9 10 11 15 81 That just gives you an example of the kind of art work that DCCI can do. ~ext slide. There you are, with boys. You can see that among boys there was very little change in the percentage of cigarette smokers over the four surveys. You can see that it is almost flat across the four surveys, 1968, 1970, 1972, and 1974. That funny thing among 17 and 18-year-old boys in 1970 -- Statistical] it says it is significant. M~ guess is that it is some sort of aberration, because it went right back to where it was, and stayed there. So I think that i~ is safe to say that among boys, smoking has not continued to accelerate over this period, and it looks like it has leveled off. The next slide shows the girls. I think you can see that the acceleration has stopped. Among 17- and 18-year-old girls,-it iooks like a trend towards slowing down in the rate of taking up smoking, when the girls get to be 17 and 18. ' Now, what'this has-done, by the increase in smoking among girls and the decrease in smoking among-boys, is that there is no longer any difference between boys and girls. They are both smoking at the same rate. A few years ago, twice as many boys as girls were smoking. At the Third World Conference on Smoking and Health, I think the question I was asked =nst Tl08652366

1 2 3 4 5 6 7 8 9 .10 11 12. 13 14 15 16 17 18 19 20 21 82 often is, "~, are girls caught up with boys? h~y are girls ~ore like bo~,s?" I do not ~now. ~hy are girls and boys alike in so many ways now. I think it ~would be funny if they were not getting to be alike. I think we need to be concerned, though The next slide gives us a little indication of what effect the p~rents have on the children. The first bar shows what happens if both parents smoke, by age. You can see that that is the highest, just about, all the way through. The yello~ line is if only the father smokes. The next line is~ if only the mother smokes. You see, the mother tends to have a little bit more influence on the smoking of the child than does the father. And the blue line, which is the lowest in all cases, is where neither parent smokes. You can see, too, that this influence is more pro- nounced at the younger age groups, 15- and 16-year-olds, than it is as they get older. Incidentally, older siblings have the same sort of influence as parent~. Next slide. selves. So we looked at some things about the teenagers them- One was if they worked outside the home~ Now, "worked outside the home" could mean part time, full time, part of the year, all of the year. And w~ found that most boys do work, and really, most girls do work at some time. The ones that do not work are very few, and the ones that did n~t work at TI06652367

1 2 3 ,4 6 7 8 9 10 11 13 1.5 16 17 18 1.9 20 21 23, 83 all are not very likely to be smokers. They are much less l~ely than those who worked. There are a number of possible explanations, one of which could be that they have no money, and the other of which could be that that green line of children are really pretty protected. They have not even worked outside the home. But we do not really know. The next slide shows us a little bit about aspirations their educational aspirations. This is based on just those who are in high school. We asked them, "If you are in high school, what kind of course are you taking?" If you are taking a colleg~ preparatory course, you are less likely to be a smoker than if you .are taking any other course besides college preparatory. This we also found gets borne out in our 18-year-olds. The 18-year-olds are divided pretty much into three equal groups, those who are still in high school, those who are in college, and those who have dropped out. Those in college have the lowest smoking rate. Those who are out of school hive the highest, and the high school students in between. So it is becoming a socioeconomic thing, insofar as we can measure that by education. The next slide shows us the education of the parents, and again, this bears out the fact that'the better educated the parents, the less likely the child is to smoke. I think that. this is not just a matter of education. X think what we are talking about is a socioeconomic phenomenon where ~moking is- Tl06652368

1 2 3 4 6 7 9 10 "11 12 13 14 15 16 17 18 19 20 21 no longer accepted among the well-educated. You will find lots of other data in the report, but I thinh the main thing that I would like to say, finally, is that we do ~ow that these teenagers are aware that cigarette. smoking is a health threat. About 93 percent of them say that cigarette smoking is harmful to health. And this implies, to me, that we stop telling them that cigarette smoking is harmful • "Oh you mean you do not want to health Now, somebody says, , us to educate them any more?" Well, yelling at them about "harmful to health" when t~ey already know it is not educating them. I think we have to move away fro~ just saying, "Oh, you have to quit smoking", to "This is what smoking does to you." .... .... I.think that is probably all there is time for, unless you have some questions. DR. MURPHY: Perhaps we could defer the questions until all the speakers have spoken. Thank you very much. MR. OGDEN: Thanks, Dorothy. I would now iike to ask Dr. David Burns to talk a little bit about the 1975 report on Health Cons'equences of Smoking, and fn particular the chapter on involuntary smoking. Dave? DR. BURNS: I would like to start by simply running through some of'the high points of this year's report.. Carbon monoxide has continued to develop as a major factor in cardio- vascular disease, both in etiology and also in the pathophysioloc of cardiovascular disease, showing a marked tendency to aggravate T106652369

I 2 3 4 5 6 7 9 10 11 12 13 14 15 16 17 18 19 20 21 85 people with angina, shortening their exercise tolerance, and also has been shown to have a negative inotropic effect on the diseased heart. Cigarette smoking has been shown to be the major source ofcarbon monoxide absorption for most smokers in the country, and that is well ahead, running three to four times the level that is absorbed due to industrial exposure, even in people that are industrially exposed. In other wor~s, the magnitude of the increase in carbon monoxide absorption is three times as great in people smoking cigarettes as it is in people who are industrially exposed to carbon monoxide. For the new evidence in the cancer chapter, smokers who have switched to filter cigarettes for over lO years hay& been shown to have a lower risk of developing lung cancer than those who continue to smoke regular cigarettes. Cigarette smoking and exposure to radioactivity by uranium mining have bee~ related to the cytologic changes" in respiratory tract epithelium, but cigarette smoking again has a much stronger association than simply exposure to radioactive radon daughters by mining. In one very interesting rgport from the Soviet Union, chrysotile asbestos has been shown to contain traces of the carcinogen, benzoate pyrene, which may have implications for the reason why asbestos workers have a very marked increase in lung cancer incidence, but that. lung cancer incidence is almost entirely contained in the smoking asbestos workers. T106652370

1 2 3 4 5 6 7 8 9 10 1 I 17 86 Smohing after first primary oral cavity tub.or predisposes to a second respiratory tract or oral cavity tumor. The evidence on aryl hydrocarbon hydroxylase ha~ con- tinued to develop. This is an enzyme which metabolizes some of the compounds that are considered to be carcinogenic. In one study, a group of patients with lung cancer were examined for what was felt to be a measure of the genetic capacity to produce this enzyme~ and it was found that substantially more of the lung cancer patients had an ability to produce high levels of this enzyme than did either other tumor controls or the normal population. However, in the light of the we~l-established fact that l~ng cancer does not have a genetic predisposition, or at least a strong genetic predisposition, certainly more evidence in this area is going to be needed before we can really make sound judgments on that. In the pulmonary area, tests of small airway dysfunctio seemed to be abnormal in a large percentage of asymptomatic smoke~s, and autopsy studies have shown a very good, strong dose-response relationship between cigarette smoking and the microscopic changes of chronic bronchitis and emphysema. One study has shown that bronchiolitis is much more common in smokers who died at an early age due to accidents than in nonsmokers. Finally, there is a chapter on involuntary smoking, or what has been called passive smoking in the past. We have chosen to call it involuntary smoking, due to the fact that it Ti08652371

1 2 3 4 5 6 7 8 9 10 11 13 14 15 16 17 18 19 20 21 87 is s~o~:ing due to the e:~osure to many of the same constituents that are present in cigarette smohe, and it is involuntary, due to the fact that it occurs as a result of the necessary act of breathing in a smoke-filled room. A number of studies have determined levels of carbon monoxide in various situations, both experimental and environ- mental situations, and substantial levels of carbon monoxide have been d~termined due to cigarette smoke; levels anywhere from 3 to ll0 parts per million have been recorded in situations. The higher levels occur only in those situations where there is very heavy smoke pollution -- i.e., a large number of cigarettes smoked -- and very poor ventilation. But these situations occur; a room such as this does not really have adequate ventilation ~o remove the smoke. This is also of major concern at this point due to the fact that because of the energy costs of drawing in air from the outside, ventilation systems are now being designed to draw in less and less air from the outside, and use recirculated. air. And today, the technology does no~ exist -- and I repeat, it does not exist~-- to adequately remove the smoke contaminatior due to cigarette smoke. There are other forms of dust which can be removed. Certain forms of pollen can be removed. But neither carbon monoxide northe solid particulate matter due to cigarette s~oke can adequately be removed from the ~efiltered air. So therefore, in the buildings that are now being designed, TI06652372

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 ~. 22 88 we are faced with a situation ~ere the indoor environmental quality is being compromised due to the energy costs of drawing in outside air. In addition, there are two other areas where the effects of involuntary smoking have been studied. On &ircraft • and busses it has been shown that a substantial percentage of the nonsmokers are annoyed by cigarette smoking. It was also worth noting that segregation of the smokers was felt to be an adequate solution to this problem. And finally, in two studies, one that was not quite adequately controlled, from Israel, and one that was quite well contr611ed, from England, studied the incidence of bronchitis ~nd pneumonia in infants within the first year of life. The English study continued for the first 5 years of life, but was only able to show an increased incidence of bronchitis and pneumonia in infants of smoking parents during the first year. This increased incidence persisted when the birth weight of the baby was controlled for. It also persisted when socioeconomic class was controlled for. And very interestingly, it increased with increasing numbers of cigarettes smoked in the house. The one aspect of this area that needs to be further studied is that what was not controlled for was factors that may be related to cigarette smoking, such,as parenta~ neglect~ In the study from Israel, infants who were admitted for poisoninc also more frequently had parents who were s~kers. So that it TI06652373

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 ~ 25 89 is not Clear yet that the incidence is due to enviroruT.ental pollution, but it is clear that infants of smoking ~.others do have a higher risk of developing bronchitis and pneumonia in ~he first year of life. I thinh that about sums it up. ~R. OGDEN: Thank you, Dave. I would like Roy Davis now to talk briefly about some of our contract activities', and then we wi~ all collectively be available for some questions. Roy. DR. DAVIS: First, I will acknowledge that it is about 2 minutes past the time that it is all to have ended, and I know that you have to return at 1 o'clock, so I will be just extremely brief. First of all, this year's fiscal year budget in the Reimbursement Agreement is in the general vicinity of $900,000, and the first thing I want to report is that the Bureau of Health Education has allocated from its funds something in t~e vicinity of $1.5 million or perhaps $2 million for the conduct of the same kinds of activities. I think it is important that we recognize that fact. The second thing is that it has already been noted that the major thrust of the smoking control program has been contin- ued in this year's agreement, but it has been extended to in-. clude a little bit more of health education, but I would like to say not general health education but health education that T106652374