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SUBCOMMITTEE ON HEALTH ANt} SCIENT'IR'IC RESEAIRC H COMIVITTTEE ON HUMAN RESOURCES HEAR~INa'~ ORDETERItIING ~~ CHILDHpCD~~ SMOKING Was}iington., D. C. May 25, 1978 HOOVER REPORTING' COMPANY, INC O~'icial Rtponters W:shiagton, D. C. S4i6-6666

I 2 C0 NTENTS STAM~N:' ' PAGB The Honorable ti:andeZl H. Ford, Democrzt, Iti;e.a2ncky A pa'r 3I roprea=ting th!o Ad.mini etration: William. H. Foage, M.D. , Director, Center for Disease Contro2.: Nornva, Rretchmer, ' ri. D. ,. Direct.or, National Xnstitufi.e of Child fiva2ti,h ~ni, - Pund 13~*Tuan Devolapmrnt; and' Jahn Pianey, pirector Of f ic:: of Smok3.ng s;~d Health, tepartme:nt of 1c 11. 12 j3 I 15 16 17 1i9 2'1 Rezith, cdc:yat'~on, and, ~Te3.fara A pan,31 of b{ gh QC:tQOZ studanLLs : i ~ ~ Ua E?3'a;2 H.{gh! Scizoo? , Martsn a:'I:a1Z!°y, L~arrc?'~:~,r,,,M~, and 4 27 ChariEs Griffith, Goraa'ga Co? lege High School; and' Ja"as Va-leo, sel.:hardu-Checy Chase High Sc}oo2 56. Apt:.~l consist:.ng of s Richaxd T., E`vans, Ph.D., Professor of Psychology, Uuy.vcxsity of HGu:4on, I?ou3toz, Texas, 3ames 1-7. Swin`liary, Ph.D., D:rectcr, rubIic Cc=-e.ni:c ations CE`a ~`~"-~'r ,"-~'r, FCa't?c'u~1 ~ia.*io"', I~o:.' YOL_lia c~a^L iLi PZ'~::I' ~'~ Ci~Z~, FrGsidept,. Grti Dolrad: h Znw. ,. ~?t s Yo~-1;, F:~v YQi ti; 75

C O N T E' Ni T S (contcl) S:TA'aEMUT PAGE A paTZe1 cfln3istiAg of'r 01 LaSa11o D. E.effall, J€. , K.D. , Presidont-@lect, &marican CancAr Society;Donaad Yota.Qag,, M'.D., Plcxnbsr, America'n Tb.oracic Society, 'and Formar t+edical Dir+actor, American Iy::na Association; Robert Mi., Uawg;hQrty, J'r., R.D., Ph.D., Chair- man, Subccmmitteo on Smokia.g, Prms-rican Hcart Association; JoiL3 S. Banzahf', IIS', Execut; ve 1'1'~ Directar and Chief Couzxsel, Action on Smokfing 12 and Haalt..*r 105. 13 1E 15 16 17 18 19 20 ~ 21 O ~ 22 CD 23 ~ 24 ~ 23

Barham 1, 2 4 7 8 9 10 1T 12 1S- 14. 115 1s 1'7 LAY IN 18. 19 W 21' 22 >'1EARI.NGOh1 DET~,'FL12, IiiiG CHIIirDHDOD SI+;OKING THURSDAY, MAY 25, 1978 United States Senzte, Subcommittee on~ bealth and Scientific Ressarch of the Co:nmittee on Human Resources, . . YJashington, D. C~. ~ The Subcommittee met, pursuant to call,-ia Room 4232 of the Dir3:sen Senat+e Oxfice Building, at I0 :14 a.m., the Hon- orable orab26 Edsaard M. Kennedy, C'hairman,, presiding. PzEser,t: Senators Kennedy, Schweiker, and Chafee. Senator Chafee. Ladies and' gentle-me:a, we will now start our hearing. Senator Kennedy is unable to be here until later on, but he hais a statement. { ['^he followi'r.gwas rieceiw~.~-a for the record:: ~:-~ 25

27 , STATEMENT OF APA_'~EZ REE'P,E'SENTIN6 TdE AD- } MINISTRATT=: R*ILLIAM',W. F'OErE,.A.D. , 4 4 5 DIRE :TOR, CENTER FOR DISEASFs CONTROL; NORMM KRETCRMiER, M.D. , DTR'ECTOR, NATIONAL INSTITUTES O7CIiILJ HEALTH AVD H'i1MFiU DEV£LOPIAENT~ AND JOEM PllkidSY, ' DTF3,^I,'OR,, OrFICEOF SMOKING AM RE_a:IT.13, DEPARTIKEh"X ON HEc~;?.,TKi, EDO.C••r IOK AND S!E.IFA= i.F:Y I:~ Senat!or Chaf~.~. Tn© ne.vt panel will be made up of Dr. 10 William Foega, D3.rs:to_ of tho Canter for Dissws':Control in 111' Atlanta, and pr. ."rSUrman KrntcY~;s frcm thc Nationml I3sititu'tras I ~ 12' of Child Hcalt,h and Suau Dev6yoprctints and' Jollin Pinz-key', ; ~ I ~. ~ 13 Diractor of the Offzce of Smaking and Realth in HEW. 14 Fell, gentlemen, x,.: w2lcome you hero. It ir my privi- i5 lQge to have known Dr. Foe:e and €ceen him before. And why i6 doa`'t wa stB-rt off with Dr. Fofzge, and t,Y.en ti-e will take the t'7 others. I 19 Dr. Feage. Ehanu, ycu, t':'r:. Cha~.-mman. With you.rr permi8sion uW wo:Ld Yv+serS: tL•ie for th:a rccord and read only, s®locted po_- 20 V 22 24 25 tj.OnE aE our taa1:':17T1Ll1!. I N Q monai toY' Ch~ f~::._ ~f~::. L in3. N ~ jThz fel lowi^g x.*as rC:ce3ved for t}Q records ~ G11 ~. 0 ~ U

37 11 2 7 10 11 12 13 14 15 16' 17' 1a 19. 20 21 22 23. 24 25 respon4ibility. j The ten &eparatowarning reessages would a_tract greaterr interast~, through both novelty and varie_y, t.ban tho single message now used. SeRaral of. thezyn--for example, the one osa da.,-naga to the unborn child--would have tr.+s further advaai of c$Ilang attention to apecff{c threats that may not yet bb. Wid.6ly r+acr.gnizod. If the decision is aade to requira a variety of smassages, the specif ic wording of each nee-ds to bt3 carefully considered. I would moge~ that the conditional "kiay bz" cou3.d' be avoided, zz3 that in every caaa r.here the Evidcn :e is supportive that the force of the s`atement "is 'da.nge-rous" could bu ret.ained., ~' I would em-pbasizc that inrar.nf.ngs should be requfsred in adver- tising as well as on packages. Scctioo 10, I+ir. Chair-^...an, is the portion which is to us the hcart of th€ 2egislat=on. This is the area of greatest concerc to the Dop3rtn ,nt. It is also the, area in which we have been the least successful in, the past. W© can point witit: someAridr to eiCnixica:nt decreases in smokiag amoag.adults-- fsrst tmo:z g n*.cales ar:3, receTMtly, a'mong, fcmaaies. But with chiZ':~ren and youth, thepicttira is di€f ezesat. Smo'.i::.g a.AOrg bo, s has h+ard].y chang3d i~n tah~o last d+srrAo. (1u- most re.^.es*+t fice;.es, wh3czh 'wi.il be upda.,ad', riurizg, rher coming su=.:r, sh:,w that five rsascent of boys betweon 12' and 14 mmokot just undpr 20 percent of boys 25, ar,d 16 smoi:e: and

38'. 1 2. 33 8. 9 t0 17' 18 19 20 21 22. 23 24 25 sozmwhat mo1ei than 30 percent of boyo 17 and 18 smcke. ago 18, the habit of smoking is wo, l-establishcd, and we think this is tnnfortunate a:nd' shocking. MeanWhile, smoking among~ girls has incr+aased' dramatically. In the 196 0' s about twice as many boys aa g ir ls smoked': now, at evacy age, Yavei girls are smoking atthe same rate as boys. S3+snator Sch"ikQr. Doctor, do we have any in€ormation or ovidenco at all to indicate why, what's the reason for the upsurge among fceenagn girls? D=. Eo;aga. We are aot c3rtQin of this, but we thi.nic that this is duo partia? zy to the now equality of the sexos that we arasaoi''x:g, an<3' wa ar=* hoping, theareioro, that now that they are equal they will both go down together. Senator SchwoikAr. Ecrnzal right to get lung cancer to- gether? Dr. Foaga. xhat`s riaht. Tha lagislaWion which you have introduced recogzizos the imporfrance of' reEOarch in d'iroc: itzg our efforts. k1ansed to learn more about smoking behaviorr tha:n we know now, particularly rrc-g;arding smoking behavior alIIong' c;laldrt3a. In the Prosident's budget for FY '79, wo are requesting $4 m3Z!lion for t'hzi r3 :tionai Inst itute on Child Hi3alth and' Hum.an Development to f.nvesuigatG the childhood ds:Y.ermi.aants of sJoking baiis;rior. 1'~t this point, ].!et me em-phasiz® that the primary goal I 1~

I 4 6 1i0 11 12 14 15 16 17 18 20 21 22 23 24 39 of our pr+evention prograraa with childrOn, as well as adults, is to provide eduvetion and to conduct resaa:rch that will onhancet not reduce, pyszsc,nal choice. We must understand that am13-ynar-old smoksr dces not necessarily represent free will. That,smokc3r may well be, the rfc:pTesientatf.on of bondage due to insufficion.t information to makm a delibt3rafce informed choice. Do our te=agrjrs truuly understa.nd, as emphasized by Secrstary Caliieno, that smokiF-g is inde:td sZQa•-motioa sui- cide? One of the riosL affective ways we have found to infiorm chiidren and young people is through health educati.on in the schoo? s. Sozo e=cc13 ent schooZ curricula have alroady been dv=lalop::d and t3slZ:~d' for ©lc-.~fiary school ch=_ldren. There is a part'ic-s].arly urgent nasd to dQvelop Educati on- al prograAs for taer,3gc:.s. bT'hilm we are gathering new know- led7o, wa rust aiso a:aly, wti.at we alrewdy lasow about tecnag6 at;:it-u?ats toward smoking, and about how te~ag~srs learn. SurV;:y$ Li3'tT;'ir,t .9'h1vva, for •.,5tr.~~..°L'cai L'haa,: --W$rhty-Fcuz pvrc.-n_ of teenage, mo ,ers aci*eit that smoking is haitt-forring, ---E:i.xt;y-nfsn.e Frarcen¢ Leal{ to ; h~.t suotiing slows thsm dov.n in sports, --Two-th3.:da baix*va that smoka.Mg is just as harmful as thcxr doctors and tra-acb-ars an& parsr.:s szy, --And half of them- hope that khez they have. children, I

40 their children tvon "t EsoKe. The final section of S. 3115 calls upon the Secretary to study and report back wit.b{ n two years on the relative health risk associatl*d with smaking cigazcattes of varying Levols, and the relaticnship of ta.r, nicotine, and variouss 10. 11 12 13 14 15 ' 16 17 18 19 20 21 22. 23' 25 additivQs to health risks. These ttmp qu3sfiions, in ojr opinioa, are asong "tho most 'am: orta'at public health guestions of our tihe. Y143 are nowl be3iam-1.ngvo.r3: on the 1979 Surgmon General "st -Report: Thi.ss will be. the most i,apcri.a.r,t ta%vic5w of informaia:onon smo3ting sirace the j<ubL*.ca'~.:ioa of t~'~e, or~.gi•nal r~sport nearly fiftecm yflars ogj,. As part of this efLort, th« zacacias will be Ioo~~ing att the changes c4laich have ta):en! place in thr3 ci;arette itself,, and will attexapt tio evaluate th0 2ealth sig'-nificanr.e of these charegcs. On fiahebasis of this ir_forrnatioa, KEili will focvs attenwios on many aspcc3;s of tye cuestions pcsa: in, 3118, r.nd it is our hope that this information will be available bafore. !I . thc' c*zd o€' two year's. Se,nator Jcbz.M:i'•:Lr.. May T_ intorrupt just one minaao? We just m&rl.ad up tho L&bor-HvW bi1?: yWsz:a..:day, amd on. the ,:aalttu t2:ucation. t.raoSzi:g :~cllAon I think, the P.c3.mi.-Astratron-- not cn child health, but the oth-;:r--wc took it frcn 8 million, re,_uost absrae the 12 a:ia.lion the House p•at in to 2E11 million. S-3 wa did put 20 miLlion in th.e

2 3' 9 11 12 14 t5. 5I3 evidence, our policy and our po6xtion has beesa very definite- ly to encourage people to szno3:e lowAr-ta:r lower-nicotine ci- garett4s. Sezaator Kennedy. Okay. Scnator Chafee? Soaa:or ChaRw. Dick, do you have any cjuesti'mns? Senator Schwsikar. Jus t a coup? :. ' Firat, I do: want to coument CDC and HEWfor their work in~ this area. I am strong- ly supportive of' the bill xhar.e ~ra talk-.44 about clean indoor air ar:d noa-s-p okers' rights. I thin}c this is long owordus, and whilo I have sose problem-s wit!h other scctions of the bill, I don't have any probZems with that and I strongly sup- port it. I assure you that in tarms of the appropriations aspects, we will giva you the money to do the job. I would like:4:o ask one or two questions. Dr. Foege, you ineMtioned on p3ge 12--or you ask the question, which is 16 a darn good one: "Whyy docs it appea;r that fewer college- I 17 i I bouad youngstors srr.aYa: than. thosa who do not plair to go to : " 18 ~ colloga? 19 i was ast-oun5e3 rocently to sag a survey at Princeton, 20 at ths%: small pPScas-:3go of co'.l!rgo guys who smoked compa-red 21 to w. Qn I was in collrag;e: IjLst coul:da't believe the sta2is- N O ~ As uoss th9 are trua uestion I tios d t but a arentl h : ~ ~~. , g y . , pp y . , .q CD 23' I hava. is, it seems to ma trt:r® is s.n awful lot to learn about ~ tt;e pae_ group pressure of the coiiegc male and'why he isn't ~ 24 C11 2'5 smoking, and. the paeT group pressure of tha young teenage g,al