o _95 _u_ler Golds_ein Bs Ross l_. Cigarette smoking in pregnancy: its influence on birth weight and

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)

Food and Agricultural Organization (Branch of the U.N. that leads efforts to defeat hunger)

Food and Drug Administration (FDA)

Gallup Organization (Polling firm)

formerly known as Gallup & Robinson, Inc. (1975)

General Counsel

George Washington University

Health Examination Survey (For the National Center for Health Statistics)

Indian Health Service

Institute of Psychiatry (London)

International Union Against Cancer

Karolinska Institute

Lancet

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

Los Angeles Times

Merit Systems Protection Board

Ministry of Health (Located in Singapore)

National Bureau of Economic Research

National Cancer Society

National Center for Health Statistics (Keeps statistics on health-related matters)

Plaintiff

National Health Service

National Heart Lung and Blood Institute

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 Interagency Council on Smoking and Health

National Science Foundation

New Jersey Bell Telephone Company

New York Times

Office on Smoking and Health

Responsible for creating reports on the health effects of smoking. Created by the Public Health Service.

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.

Preventive Medicine (periodical)

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)

Response Analysis (survey conductors located in Princeton, N.J.)

Roper Organization (Consumer Research/Public Relations Org.)

Interested in finding out what drives consumer behavior; surveys consumers on their prime areas of concern; assists corporations with reputation-building and public image based on its findings.

Royal College of Physicians (Monitors the quality of Canadian/U.K. medical education)

Sacramento Bee

San Francisco Examiner

Senate

Southern Illinois University

St. Paul Hospital (Dallas, Texas)

Standard Asbestos

Statistics Canada (Federal Statistics Canada)

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).

U.S. Department of Agriculture

United Nations

United States Tobacco Company (Producers of Copenhagen/Skoal chewing tobacco)

Producers of chewing tobacco

University of Arizona

University of British Columbia (Located in Vancouver, British Columbia, Canada)

University of California Los Angeles (UCLA)

University of California San Francisco

University of London

University of Manitoba

University of Massachusetts

University of Miami School of Medicine

University of Oslo

University of Pennsylvania

Veterans Administration

Wall Street Journal

WHA

World Conference on Smoking and Health

World Health Organization (Concerned with global public health)

International organization concered with public health worldwide

WRA (Worldwide Regulatory Affairs - branch of Philip Morris corp.)

Worldwide Regulatory Affairs

WRO (PM's Washington Relations Office (1994))

1994 PM's Washington Relations Office

Yale Law Journal (periodical)

Named Person

Bailey, William E.

Banzhaf, John F., III (Exec. Dir. Action of Smoking & Health (ASH))

Executive Director of Action on Smoking and Health (ASH).Professor of Law at Georgetown. Banzhaf succeeded in using the Fairness Doctrine to get cigarette commercials off television in 1968. See Banzhaf FCC, 405 F, 2d 1082 (D.C. Cir. 1968) (affirming FCC ruling that radio and television stations must devote a significant amount of broadcast time to case against smoking). His telephone number is (202) 659-4310. The big focus in past years has been to force OSHA to enforce smoking bans, per Matt Bars. ASH publishes Smoking and Health Review bulletins. "A leading anti-smoking activist" (Chic. Sun-Times 6/23/93). Action on Smoking and Health is located at 2013 H Street, N.W., Washington, D.C. 20006. (Castano Expert List) See Action on Smoking a Health, TTLA Almanac - Names.

Button, Dee

Carnes, Betty

Coate, Douglas

Colle, Royal

Court, Paris

Dow, Merrell

East, Robert

English, Barbara

Fair, Russel

Fairbanks, Leland L.

Field, Marvin

Friend, James

Garner, Donald W

Plaintiff

Gerace, Terence A.

Glantz, Stanton

Glantz, Stanton A.

Greene, Bill

Grefe, Ed

Grossman, Michael

Hall, Lawrence W., Jr. (RJR Marketing)

Worked for RJR Tobacco Co. as a Sales Representative, MR Analyst from 1968- , Director of Marketing Development in 1980, Vice President of Brands Marketing in 1981, Vice President of Marketing Development in 1982, and for RJR International Inc. from 1977-1980. (Source: RJR Who's Who NMLRP)

Harris, Jeffrey Earl, M.D., Ph.D. (Associate Prof, Harvard Medical School)

Harris went through company documents and old medical-journal articles regarding the scope of the tobacco companies' early knowledge about the hazards of smoking. He testified regarding media and scientific state-of-the-art about smoking.

Heller, Julia

Ill, F. Banzhaf

Jarvik, Murray E., M.D. (Nicotine expert)

Plaintiff

Jenkin, Patrick

Labs, Leo

Larson, Hal

Leathar, D.S.

Leu, Robert E.

Looman, David

Loveday, Paul L.

Mah, Russell

Mai, Russell

Mann, Allison

Mar, Russell

Mcdowell, Jack

Miller, George

Miller, Gus

Number, Grant

Padberg, Eileen

Patel, U.A.

Defense

Pfeiffer, Paul N.

Rabkin, Simon W.

Raphael, Adam

Raw, Martin

Rhoads, Jonathan

Rubin, Sylvia

Samson, Yolande

Schneider, Lynne, Ph.D. (Researched effect of anti-smoking campaigns on smoking behav)

Schneider, Nina G.

Schwartz, Jerome L.

Scott, Kenneth E.

Shannon, Michael E.

Shields, Brooke (Actress, featured in anti-smoking ads)

Shimp, Donna M.

Steinfeld, Jesse

Tarrance, V. Lance

Terry, Luther Leonidas, 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).

Tuchman, Barbara

Woodward, Richard

Worthington, Paula

Young, George

Yu, Peter

Master ID

TI08350674-1466
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o ~95 ~u~ler ~, Golds~ein Bs Ross l~. Cigarette smoking in pregnancy: its influence on birth weight and perlnatsl mortality. Br Hed J [Clln Res] 1972 ~pr l: 127-130. Ferguson DH, Hor~ood LJ~ Shannon FT. Smoking during pregnancy. NZ Hed J 1979; 89: 41-43. Baric L, MacArthur C. Health norms in pregnancy. 1977; 31: 30-38. Br J Prey Soc Med Don.van JW. Randomised controlled trial of the anti-smoking advice in pregnancy. Br J Prev Soc Med 1977; 31: 6-12. Danaher BG, Shisslak CM, Thompson CB, Ford JD, A smoking cessation program for pregnant women: an exploratory study. Am J Public Health 1978; 68: 896-898. Baric L, HacArthur C, Sherwood M. A study of health education aspects of s.moklng in pregnancy. Hygie 1976; 19:1-17 (supplement). Bernstetn DA. Modification of smoking behavior: an evaluative review. Psychol Bull 1969; 71: 418-440. T108351072

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REED TO KNOW #endy J. Moreton, B.Sc. Robert East, D.Phil. ~ingston Polytechnic School of Sociology Penrhyn Road, Kingston upon Thames Surrey KTI 2EE, England N~nat should we be saying to smokers in mass communications? Do we need to change our message for different target groups? A study conducted by the authors has explored the process of giving-up smok- ing by measuring the beliefs and feelings of reluctant smokers about quit- ting; the subjects were clients at a clinic. By using repeated measures, evidence was obtained of the changes in these beliefs and feelings during the process of stopping and remaining abstinent. This paper will discuss that part of the study which looked at changes prior to stopping smoking. There is ample evidence that the beliefs and feelings that people have are closely related to their chosen behaviour (I). People consider the expected outcomes of their possible options and weigh up the associated gains and ~osses. An understanding of a smoker's beliefs about giving-up should therefore be a good guide for new initiatives in persuasive and support .iterature. This theoretical perspective (2,3) has formed the basis of the :.ew national report on smoking cessation attitudes prepared by the Office of Population Censuses and Surveys in London (4). Notice that it is giving-up s~oking not smoking itself with which we are concerned. This means we highlight the short term negative outcomes which tend to be forgotten when general issues of smoking are investigated. Some smokers are better prospects for cessation than others. Those who are most likel~ to be receptive to m~ss communications should be studied, but it is difficult to define such a ~roup. It was assumed that those enrolling in a clinic would contain a large proportion of dissonant or reluctant smokers who would be prepared to listen to facts and methods about stopping. Such a group should provide a better ~uide for designing effective communication than the ~eneral population of smokers which contains many people who are unlikely to chan~e. It is recognised, however, ~hat clinic populations may contain more people who are heavily dependent on nicotine, highly anxious or strongly socially oriented and these biases may affect the generality of our Address for correspondence: Wendy J. ~oreton, Bealth Education Department, North East Essex ~ealth Authority, Central Clinic, High Street, Colchester CO1 IUJ, England. T108351073

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results. The annlyses were subdivided by sex as it was suspected that there might be a cognitive basis to the differential success rates often reported for men a.d wo~en. There are two types of influence that can be expected to impact on the beha- vlour of reluctant smokers {2,3,5). Firstly, personal attitudes, i.e. expec~ti0n~ "'a&ou~ giving-up such as, 'Would I gain a sense of achievement~", and the consequent gains or losses - "How good would a sense of achievement beT". Secondly~ perceived social pressure, i.e. normative pressure from significant others, from close relatives, close friends and These:-~'~£afluences would be expected to combine to influence smoking cessation. In our findings, an indication of this combined influence, which al$~"'~e~k~ duration of abstinence, was personal obligation, i.e. "I ought:tb g~Lup smoking". Contrary to other published work (3), we did not find that. a self-prediction measure of the likelihood of giving-up ("I will give up smoking"} was as successful at predicting outcome as personal obli- gation ..... .: ...... : These ~fl~enoes were ~easured twice before the smoker quit; when partici- pants registered for the group and three weeks later, just prior to their Target Q~ittlag date. The cessation group was designed to enable partici- pants to e~plore their expectations about stopping and the gains and losses of dolng.so, and to provide social support. Participants were also encourag- ed to look. for suppor~ from their daily contacts. There was therefore ~mple oppor~unlty for change in cognitions and consolidation of the attitude towards glving-up smoking. There is evidence that these changes were taking place. indicators of this: There are two Firstly at reg~$trati0n, measured cognitions did not relate to future dura- ZiOn O~ .~.~.~ee, ~ut ~y the Tsrge~ Quitting Date it was possible to predict OutCome. frOm these cognitions. Secondly, $ame~of the attitudinal changes that ~ook place were correlated with leugt~of abstinence. The relationships between cognitions and behaviour for women and men are shown in Figure I, It can be seen that for men the length of abstinence may be predicted from personal obligation ... what a man feels he ought to do. Personal obligation seems to relate ~o personal attitude in men. ~ut for ~mmen, the m~or infl~ence appears to be through perceived social pressare~ ~t abe perceives other people think she should do. ~en appear to have taken i~to consideration what others think when forming their attitttde, b~t ~a there is ao direc~ c~rr~l=r~ ~.f ..... 4,,~ -~-~ -:~zY~ a~tit~eS ~t ~e[~ ~rceived $oc£ai pressures. N~n on the other ha~ ~ not sem to I~ ~£vi~-up ~a~ns and losses to pressuve from o~her people. T108351074

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FIGURE I. CORRELATIORS BETWEEN COGNITIONS AND BETWEEN OcJ~RITIO~S ~tA~D BEHAVIOUR. 0.5~ A 0.60 0.56 0.6~ A 0.57 0.4"7 I 0,56 h~. In the multiple correlation of A and P on O, P is not NB. In the multiple correlation of P, A and O on behaviour, . ~s Slg~.tcant. TI0.~'.351075

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Their behavlour is therefore related to a generalised response to do what other people ~hlr, k they ought to do. These paths of influence are corroborated by the evidence from measures of specific beliefs. A su~ative measure of those beliefs which are relevant for givlng-up smoking would ~e expected to relate to attitude and this was found; for men in this study it also related to the measure of perceived social pressure. This relationship did not exist for women. Thus,..w~er~aa_men.are acting in line with their personal attitudes, women are re~pgnding to perceived external support. Women who, immediately prior to stopplng~ feel under more social pressure, remain abstinent longer. Those women, who are less successful appear to suffer a loss of perceived social pressure. Just prior to quitting they believe that close friends are less likely ~o think that they should give-up. This difference in.influence between the sexes may help to explain differen- tial succ~ss~rates. ~ Social support is more changeable than beliefs about the medical consequences of smoking and one might therefore expect women to be less successful.than men if they rely on social support. DIRECTIONS FORHEALTHEDUCATION MESSAGES? The evlden~ suggests that men and women must be considered separately. For men, personal attitudes must be changed in a more positive direction and in order to do that, beliefs which are both relevant to cessation and change- able must be identified. Our evidence showed that a higher proportion of more successful men think about being miserable when they stop, than less successful men; also, avoiding heart attack is definitely an issue only for the more successful men. Health education for men might therefore stress even more the specific health issues, especially heart disease. Interest- ingly, it was found that for both men and women some unpleasant outcomes which deter stopping are taken most seriously by those who are most success- ful. This odd finding appears to be because those who are most successful substantially re4u,ce their perceptions o~ how bad or how likely these things will be during attendance at the cessation group, perhaps because they learn methodsof copi~t~. This suggests that presenti~ the stark realities abo~t quitting may be a 9ound way to promote cessation as long as this is support- ed by info~ti@m for reduc~mg the .egative consequences of quitting. For women several approaches are applicable. Significant people in their lives could be imfluenced directly, getting them to encourage smokers to stop and to support them ~n their attempts. When dealing with the personal attitudes of women, the implications for others of their giving-up could be drawn oot in a. attempt to increase their perceptions of social pressure. Rather than reinforcing the current thinking patterns of women, an effort ~ .................. ~ %~,=~ co cake seriously their personal attitudes to stoppimg a~d ~ develop them, that is to develop a pattern of cognition more similar to men. Perhaps the most challenging of these approaches is the third. Like men, the starting point for influencing attitudes to giving-up smoking depends upon relevant and changeable beliefs. The best ways of ensuring that women T108351076

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401 hold their own attitudes in mind throughout the process of quitting must be considered. One of the beliefs which was relevant for ~oumn, but not for men, was '%~eing m~re ~acomfortable tmder stress"; reductlous in the likelihood of ~his ~rior to cessation were related ~o longer ~bs~i~nce. lhis fi~ing suggests that ~n my reed to feel c~fldent that they will be able ~o cope with i=terperso~l sltuaKio~ if ~h~ are ~o ~ su=eessful quitters. It is a~so ~rth ~zinE that so~ specific health issues were not relevant for worn: avoiding heart atZack, avoiding bronchitis and having more energy. This division into mle and female target groups is only one way of direct- ing communications so that they are more effective. Another and so far neglected way is to aim communications at different stages in the quitting process. Our work is also concerned with the 'staging' of communications and we hope to report on this matter in due course. The authors would like to acknowledge financial assistance from the Cancer Research Campaign. ,t. Ajzen I, Fishbeln MF. analysis and review of 84(5): 888-918. Attltude-behavior relations: a theoretical empirical research. Psychol Bull 1977; Fishbein MF. Consumer beliefs and behavior with respect to cigarette smoking. A critical analysis of the public literature. Federal Trade Commission Report to Congress pursuant to the Public Health Cigarette Smoking Act for the year 1976. Appendix A. 1977. Ajzen I, Fishbein MF. Understanding attitudes and predicting social behavior. Englewood Cliffs, New Jersey: Prentice Hall, 1980. Marsh A, Matheson J. S.m~king attitudes and behaviour - an enquiry on behalf of the Department of Bealth and Social Security. London: Rer Majesty's Stationery Office. ¥ishbein MF, Ajzen I. Belief, attitude, intention and behaviou~. An introduction to theory and research. Reading, Mass: Addison-Wesley, 19.75. T108351077

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Judith g. Ockene*, Ph.D. Director, Division of Preventive and Behavioral Medicine Department of Medicine University of Massachusetts Medical School 55 Lake Avenue, North Worcester, MA. 01605, U.S.A. Stephen B. Hulley, M.D., MPH Professor of Epidemiology and Medicine UnSversity of California Medical Center 211Gough Street San Francisco, CA 94102, U.S.A. Terence A. Gerace, Ph.D. Associate Professor of Epldemiology Department of Epidemlology and Public Health University of Miami School of Medicine Miami, Florida 33101, U.S.A. For the MRFIT Research Group IRTRODUCTIOH The Multiple Risk Factor Intervention Trial (MRFIT) was a National Insti- tutes of Health (NIH) supported, primary prevention clinical trial whose participants were men aged 35-57 at high risk for Coronary Heart Disease (CHD) and free of overt CHD on entry. At the termination of the trial, every participant had been followed for at least 6 years. The primary objective of the M~FIT was to determine whether reduction of high blood pressure and blood cholesterol, and cessation of cisarette smoking would result in a significant reduction in ~ortellty from ClID (i). The main purpose of this paper is to provide an overview of the smoking cessation program, the cigaretCe smokin~ cessatio~ outcomes achieved by the Special Intervention and Usual Care smokers, and the relationship of the cessation outcomes to mortality from CHD. * To whom reprint requests and correspondence can be addressed. A list of the names of the principal investigators and senior staff of the c!ini~ e~,~dl.~c~ng ~nd support centers, the IW~LBI and members o~ the MRFIT Policy A~viaory ~oard and Mortality Review Committee is also available. T108351078

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Following screenln~ of 361,662 men in community and industrial settings by 22 ~IT clinical centers throughout the United States, 12,866 men recruited and randomly assigned to a Special Intervention (SI) or Usual Care(~C) group {2). l~ne men selected ~ere in the upper IO to 15% of risk CflD death, as calculated by levels of serum cholesterol, diastolic blood pressure, and n~mber of cigarettes smoked per day using a risk score distri- bution based on data from the Framingham Heart Study. Eligibility criteria specified that each participant agree to participate in the program for 6 years and that each smoker state his willingness to attempt smokin~ cessa- tion. Reasons for exclusion included DBP ~ 115 mm Hg, serum cholesterol 350 m~/dL, evidence of CRD, (including angina pectoris), diabetes mellitus, expected geographic mobility, diets incompatible with the MRFIT food pattern, and/or other problems which could impair participation in the trial. Of the 12,866 men randomized, 63.8% (or 4103) of the SI and 63.5Z (or 4091) of the UC participants were smokers at entry, and smoked an average of 33.9 cigarettes/day (I). No intervention program was offered to the UC men who were referred to their usual source of medical care; they were however asked to return once a year for a medical history, physical examination, and laboratory studies. The results of the screening and annual examination were sent to their personal physicians, who were also informed of the scientific objectives of the study. Participants randomized to the SI group also underwent yearly examination and returned to the clinical center every 4 months for data collectlon, and more frequently as was necessary for risk factor modification. METHODS The Smoking luterventlon Program The initial phase of cigarette smoking intervention probably began with screening itself~ although during the first two screening visits (SI and S2) there was no direct effort to encourage participants to discontinue or decrease ¢iga, rette ,mkin~. The questions of $I and S2 coupled with the heightened concern about heart disease in these ~n may have acted to make some men decide to quit, The for~1 cigarette smokin~ cessation e~fort began i~ t~e latter part of the thi~ screening visit, after the par~icipan~ had been randomized into the ~p~ei~l Inz~e~ti~ group (3). Followi~ randomization, an an~i-s~king message was delivered by a physician who oullined the e~fects of ~king on che cardiovascular and respiratory systems, strongly emphasized ~he potential benefits of cessation, and advised the participant to stop s~klng. At this time ~he s~ker also ~ with a s~ki~g ~ci~list ~t the clinical center (an individual ~ would carry out the s~ki~ cessation program) ~o determined with the participant ~ether he would st~e~ the initial Intensive Intervention a~ut stoppi~ cigarette ~ki~g a~ his previous efforts at cessation ~re al~ assess~ by ~be s~cislis~. T108351079

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The initial Intensive Intervention Program for risk factor modification for SI participants began at the first visit after randomization and consisted primarily of ten weekly group seslons in which the concepts of heart disease and "risk" were discussed, an~ modification of nutrition and smoking behavior were carried out sim~Itaueously. Individual counselling was available to participants who did not desire to or could not participate in the ~roups, and as a supplement for some group participants. At the time of randomization, approximately 87% of the SI smokers elected to participate in the groups (3). A second stage, Extended Intervention and Maintenance, provided a specific Extended Intervention Program for participants not achieving the desired changes, as well as a Maintenance Program for partici- pants achieving satisfactory risk reduction during intensive or extended intervention (4). The decision to use behavioral assessment, self-monitoring, gradual change, stimulus control procedures, behavioral contracts, and relaxation techniques in the intensive intervention program was based upon findings in the literature which suggested that a variety of approaches yielded comparable long-term smoking cessation rates and that different smokers respond to different procedures (3,5). Participants were instructed in the use of substitute activities incompatible with smoking (e.g., exercise) to help them deal with short-term problems of strong urges to smoke. Aversive tech- niques were not used, in part because of the high risk status of the MRFIT participants. Extended intervention efforts included the aforementioned methods utilized in intensive intervention, although there was greater flexibility for scheduling sessions. Smoking intervention no longer had to be integrated with the nutrition component. Once cessation was achieved in either initial or extended intervention the maintenance program was begun. A key item in both the Extended Intervention and Maintenance Programs was a specified minimum number of contacts. Participants who maintained smoking abstinence over an extended period of time were eventually seen for smoking cessation only at the regular 4 month follow-up visits (3). The goal of the M~FIT smoking program was to achieve early cessation for SI smokers. Some changes in smokin~ were anticipated for the UC participants as well. It was expected that a certain degree of recidivism would occur over the 6-year course of the trial with twice the relapse in the first year as in each of the subsequent 5 years of intervention. An inverse relation- ship between cessation and the number of cigarettes smoked was also expected. Measurement of ~kimg Cessation Serum thlocyanate (SCN) and carbon monoxide (CO) levels provided objective measures of smoking and a check on the validity of the self-report measure. Serum SCN is generally elevated in cigarette smokers due to minute traces of cyanide which are present in tobacco smoke and which are metabolized to ~ ....... ~ ('~ ~- ~ ...................... ~iy ig tion is affected by inhalation habits and in addition serum SC~ levels appear to be raised by the use of diuretics. The use of pipes and cigars also raises these levels. When these additional factors which exert an effect on SCN levels are taken into account, the levels for quitters at 6

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~b~) ,-~tch ~ore closely the levels for the MEFIT baseline micro mole/L). ~ ~ .a ~ltiple regression model which takes factors affecting a~m~m£ ¢o "adjust" ~he re~r~ da~a on cessation (7). For each ~, r~ ~pec~ed S~ levels are co~p~red from the ~gress~o. ~._assu~i~ no cigarette s~king, ~he other assuming the ~~" for ~e population ~s assu~d to be a mixture of the two ~ribu~iogs, and the mixing proportion is computed ~sing least .~ p~opor~ion of the observed distribution which is due to the ~ribu~ion for s~kers ~s used as the esti~te of the percent of ~i£~e~ ~o are s~ill smokinE. ~ecause the dose-response curve ~s ~~. flattens out beyond 30 cigarettes per day, SCN levels have ~y to adjust cessation rates and not to verify c~garette smoking ~-~~e s~k~nE cessation rates and "=h~ocyanate adjusted cessa- ~'.a~.~e~ermined at baseline and annual exams 1,2,3,4,5, and 6 for" ~he present report. ~~ingCessation Rates co~tservative assumption that individuals who missed a visit are according to their entry smoking level even though some had r~.cessation at a previous v~s~t, SI smoke=s achieved a 43% rate of ~s~a~ion (42% adjusted) and UC smokers a 28% rate of reported ~(26% adjusted) at the sixth annual examination. A greater number ~i~ ~king than was expected from the desiEn of the ~FIT (I); al~ true for UC smokers. In sp~te of the higher than expected UC rate, the difference between the two still exceeded the trial difference ~n the SI-UC SCN adjusted cessation rate was about ~ut ~he trial. At each annual examination the SI-UC d~fference ~i~ r~te is statistic~lly s~gnif~cant (p<O.O01). For ~he SI ~ ~s a difference (p<O.O01) between reported and adjusted z~z,es ..til year 6 and for the ~C smokers this difference ~t~! year 3. Thus ~he accuracy ,of self-reported data ~rov,ed t~e trial progressed, althou~ there is a consistently greater ~ted ~t~e~ t~e S, CN adjusted data and the self-reported data f~~ ~n then for the UC secular trends in smoking cessation for the general popula- Participants quit smoking at year I than would be expected in sample of middle-aged men. Without intervention, about 2 the general population quit s~king on their ~ each year ~ibs~i~. el~nts to the ~reater cessati~ rate for UC partici- ~ th~ ~er=! ~~on a~ year i ~y incl~e: factors ~£~1 (e.g.~ ~i~ identified at high-risk, and the screening i~1~s ~estious about smking and cardiovascular fitness); ~1~teer" effect in which individuals volunteering for a ~rogram ~y ~ ~usually health conscious a~ ~tivated to ~ssibility that illness in this high risk group ~y have led to T108351081

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