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RJ Reynolds

Health Vs. Cigarette Smoking. Report of the Governor's Advisory Committee on Cigarette Smoking and Health.

Date: Nov 1964
Length: 163 pages
501877543-501877705
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Referenced Document
Cigarette Smoking and Health, by State Department of Public Health, 630000. California Penal Code Section 308. List of Footnotes. Surgeon General Report, 640111. List of Laws. Report of the Royal College of Physicians, 620300. Teachers Guide on Smoking an
Date Loaded
07 Jan 1999
Named Person
Ca, S.T. Board, O.F. Health
Us Surgeon General
List, O.F. Advisory Comm Members
Brown, E.G.
Merrill, M.H.
Ama
Danish Cancer Society
Hammond, E.C.
Pearl, R.
Fda
Ca Governors Advisory Comm
Barron, M.
Hew
Univ, M.I.
Royal College, O.F. Physicians
Terry
Iceland Cancer Society
Neuberger, M.
Fcc
Us Public Health Service
Ca Interagency Council Cigarette, S.M.
Tuberculosis & Health Assn, O.F. Ca, B.U.
Ca Dept Education
Ca Medical Assn
Dept, O.F. Commerce
Dept, O.F. Agriculture
Ejrup, B.
Meyner, R.B.
Frick, F.
Allen, G.V.
Teens Against Cancer
British Ministry, O.F. Health
Spivak, J.
Leverenz, J.W.
Cramer, T.
Carthew, A.
Kotin, P.
Hailsham
Day, C.
Printers Ink
Green
Delape
Pritchard
Salber, E.
Horn, D.
Brecher, E.
Brecher, R.
Borhani, N.O.
Hechter, H.
Breslow, L.
Goldman, E.
Buka, M.
Welsh, B.
Macmahon, B.
Harrison, S.
Reed, R.
Green, J.
Rochman, J.E.
Graham, E.
Univ, O.F. Ca
Roswell Memorial Park Institute Can
Peeples, W.J.
Rossi, A.J.
Capron, R.
Hill, P.
Klumb, J.J.
Burch, V.
Currie, W.R.
Baker, R.
Miller, D.
Laughlin, M.F.
Tucker, S.
Hanson, R.
Thompson, I.
Byes, B.
Yale
Center For Alcoholic Studies
Rutgers
Childrens Bureau
Us House, O.F. Representatives
Ca Heart Assn
Surgeon General Advisory Comm
Alliance Combating Tobacco Infectio
Natl Automatic Merchandising Assn
King James, I.
Exchequer
Swedish Tobacco Monopoly
Tobacco Leaf Magazine
Uk House
Us Senate
Ca House
Attorney General
Secretary, O.F. St
Harper
James
Lartigue
Ca, S.T. Director, O.F. Public Health
Nih
Natl Clearinghouse, O.N. Smoking & Hea
Uk Natl Health Service
Ymca
Ywca
Modern Medicine
Acs
American
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Liggett
Lorillard
Ti
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Ca Govenors Advisory Comm
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-15- will also reinforce the total educational experience so important during Lthe formative period. The Committee recommends development of seven pilot recreatfonal programs in California. Adults must also have the benefit of special educational techniques, sapplemented by clinical programs for those vho have medical or other rea- sons to stop smoking. Adults should be made aware of their role in setting an example for young people. Industries offer a fertile field of approach to the adult employee in curtailing cigarette smoking. Specialized education for physicians should be developed, for physi- cians have many roles to.perform 3n advancing this program. "A Committee of One '+'housan3" is being mobilized to recruit a staunch group of physicians ready to assurr,e active participation in many phases of program development. Re -~::arch Altering the present practice of cigarette smoking clearly depends on a thorough understanding of how cigarettes affect the human system and of the behavioral and social phenomena which condition acceptance -- and change. Scientific research must, therefore, be one component in a comprehensive rr:,gram of action. Research will also enrich man's understanding of other health-predicated behavior patterns. Committee proposes a plan of research embracing two types of ctivity: (i) basic research in both the medical and behavioral sciences; and (2) applied research -- evaluation, demonstration and training -- to test techniques in cigarette smoking control. The latter' activity would also serve to train personnel essential to staff educational, counseling The extent of investigation yet needed in the basic sciences remains formidable, despite the numerous studies which have been conducted to date. ,
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-.:U- BLaic studics in cpidcm.iology, c,Y:c•nzstry, physi.olosy, and patho:%fy will refine the current state of knovief:ge regFrding the effects of cigarette smoking on the system. Ansk•ers might be found to some of the more baffling questions: What produces harm to the system? Could harm be averted by other than abstinence from smoking? Is smoking addictive? Bea:£ivior8,'l and social research on th~s form of habituation is very modest. Here, cor:sidera.bi.e scientific activity should be generated to unders tyr.d how ir.divi.ouul Pnd gr^ ;p beha.vior influences the practice of cigarette smoking. Basic research, opsr`stional research and evaluation of prodrams designed to c?-.u:.:xe smosang habi.ts are all essential. To fuiii.li tY.f .•ezssx^h -:;:.;,er,tia.l necessary to support a broad program of action, of a coordinated Research °rogrsm in ?'ch:.G.:.co S;,ud-' e.s. Tr_e pr: ncips', flznction, by the activity of a research adv-sor y conLTrdt -Let, -vould be to :,tir.-Lt ste research through awarding of graYits. Tr:e t?::... : ,asponNib:1'• ty for this function be delegated to the atr;.e Dz,,•~Yrt•rr.e:' o. rt~b_'-_:. aeait:n. The coordination of relevL-nt resesrc}: evuluat.ion, f,ublicstion and &.-pl.icatior, of findings woulc s=s:; te Pdm:.r_s-Lr•r::d tt:~ R:.;`_arch ?rcg:am. :s~:y a.~~~czs oi - - r~= ::°r~k~ ~=or, ncmo::str a.t_on and tra:nirk3 can be handled :.:ost ef fectl've_y ia a university seT.Y•:irig. 1.^.e t+o2''.:.'71iLY+ee reeommerd':i th&'t uTs:ts be estc-ODii s}:ed unC'Ler university 4LaSYices, from kriic:: consui.tat, .io:: to a;.l ot~:er p2a.ses of action can be ger.erated a.nd train::Z of qu~",i_ied staff undertaken. Consumer +.CitUd..C s Z`Ze role ;,f the coT:sux:f:r _:, .. -r?purt.'=.ra, one in ths ciga'rett•e smoking- health ~:Vcc dec.sion to or r.ot pur:;hcse cit,t:rcttcs be- corr:es an !:,diviau~_-_ exercise ,:: personx"i he:::th.
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-17- Taking heed of the sales produced by effective advertising, the Governor's Adv;sory Committee recommends thAt consumer practice studies be initiated to indicate specifically how consumers come to spend their money on cigarettes or alternative items and What types of media presen- tations influence their purchases. Consumer practice studies could be conducted by independent market researchers, receiving grants from the Research Program in Tobacco Studies. ; ~Tr.e immense market potential of California means that the tobacco / ~ industry will be alerted by any consumer behavior which adversely affects I ; sales. This wil.l help activate company research toward producing a safer ; ; product from tobacco. 'Tae industry has ay rEady shown signs of moving in i the direction of consumer protection, and consumer behavior may well sccelerate this trend. .
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-18- PROPOSrD Rr^.GOA5'tE.'NDATIONS GOV'ERNOR'S ADVISORY COMMITTEE ON CIGARETTE SMOKING AND HEALTH In consideration of the foregoing, the Governor's Advisory Committee on Cigarette Smoking and Health therefore recommends that: 1. THE STATE DEVELOP A COORDINATED PROIRAM OF ACTION TO INFORM CALIFORNIAN`s ~ OF THE HEALTE HP.ZARDS OF CIGARETTE SMOKING AND TO CONTROL THE USE OF CIGARETTES. THE PRO3RAM SHOULD INCLUDE EXTENSIVE EDUCATIONAL ACTIVITIES FOR BOTH YOUTH AND ADULTS; BASIC AND APPLIED RESEARCH; EVALUATION, DEMON- STRATION AhrD TRAINING ACTIVITIES; ESTABLISHNZ-NT OF WITHDRAWAL CLINICS; AND STATUTOR!? CHANGES TO STRE!w'1'HEN EXi.STING CODES AND LEGAL INTERPRETA- TI ON RELATED TO CIGARETTE SHiOKI I:G . 2. FUNDS FOR Ti-PJ' PROGRAM BE OBTAINLD BY AN INCREASE IN THE STATE CIGARETTE TAX, WIri DESIGNATION OF A SPECIAL. FUND SUFFICIENT TO FINANCE THE ACTIVI- TIES PROPOSED. 3. EDUCATIONAL EFFORTS BE CONCENTRA'TED PRIt~`:ARILY ON YOUNGSTERS WHO HAVE NOT YET STARTED TO SMOKE CIGARETTES. IN PFRTICULAR, a. The State should develop an Fxtens~ve educational program, with suitable inaterials and specially trained teaching personnel, focussed primarily on young people. The program should also include those er:gaged in or training for the health and teaching professions, and adults general3y. b. The entire State health education program should be strengthened to enhance the effectiveness of specific efforts on cigarette smoking and health. A Framework in Health Instruct~on, providing continuity for all health instruction, would enabl.e thee teaching of health principles to be improved generally.
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c. Action should be taken to strengthen the teaching of health in- struction in California scY:ools, and to 'enlarge the scope of persons to Vnom it should be taught. In particular, existing sections of the Education and Administrative Codes should be amended,as follows; 1. Education Code section 9309 should be amended to substitute the words "health hazards" for "eu~ls" with reference to alcohol, drugs and tobacco. 2. Education Code section 7852 should be.arrnded to include in- struction about the effects of smo:iing. 3. Education Code sectior: 7604 should be amended to require health instruction in a} i eler:: n;,ary gr ades as vas required until 1961. 4. Education Code 7700 shou:d be aminded to require health instrue- 5• tion in secondary grades. .A.dministrative Code, T~t"_e 5, section 6:30 should be amended to :eq~airE all teacr:ers qualify,ng for a tza.chir.g credential with speciaiization in elerr:entaxy educe.z,on to be prepared to teach stat-.+.o:y subjects, whicn include hea:.th, alcohol, narcotics and saf Lty. N d. The State should stirr.uip-tc: s.nd financial3.y support organized, recrea- tional activity in the after-school hours when youngsters are n,ost apt to be idle. The recrca-tC.:onal program. should be closely inte- brated with classroom content in health instruction. e. The State should sponsor Eva.:.ua.tion, Demonstration and Training units to develop and evaluate specific education e.i materials and methods for teaching the, adverse eff rcts of cigs.re tte sm-oking and to train personnel skilied in teuchirk;, counseling ar,d recreational activities. These units would function most effectively under university auspices.'
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-20 - f. The Governor should establish pcriadfc California Youth Congresses on Smoking and Health, followed by regional or community youth conferences on the subjec: in State colleges, universities and secondary schools. 4. THE STATE ESTABLISH AND FINANCIALLY SUPPCRT A COORDINATED RESEARCH PROGRAM IN TOBACCO AND HEALTH, INCLUDIN.G INVESTIGATIONS IN MEDICINE, EPID:'~iIOLOGY, CHIZIS•TRY, PHYSIOLOGY, BEHAVIORAL SCIENCE AND CONSUMER PRArTICES. r.DMINISIkP2IVE RESPONSIBILIW SHCULD BE PLACED IN THE STATE DEPARTINE'NT OF PUbLIC NFALT:-i, WITH A AErI;S TO AWARD GRANTS TO INVF,STI- GATORS IN PRIVATE AND -PUBLIC AIENCIES TO COND'JCT hTEDED RESEARCH. THE FROsRAM SHOULD SERVE AS A TRAINING RESGJ'c.CE FOR EDUCATCRS, PHYSICIANS, HEALTH PERSONNEL AND OTPERS WCRKING ON THE PR03LEM; AND IT SHCIJLD FACILI- TATE APPLICATION OF FINDINGS TO ALL PHASES OF THE STATE PROGRA14 ON CIGA- RE`1'TE SMOKING. 5. THE ST!-_TE ESTABLISH AND FINANCIALLY SUP PC:RI• CO:%F~!LsNIT+ SERVICE CENTERS, IN WHICH CIGpR.:'i~E WII'HI)RAWAL CLINICS, P?OF FFSSIONAL AND COhg&JNITY ED'J- CATIC%.R, AND Cv^NSULTxTI01 SERVICES TO ITdD'.7Si'it`! FTTTJ A:JENCIES COULD BE C^vCitDIN!-~'LD. FJVAi:UATI0II OF CLINICS SHC".TLD BE INCORPORATED II3I'0 T'^:EIR Dr;VELCPi~ENN'I'. HOSPITALS, DEFrR`l~t>TvT:, OR VOLUNTARY hZE ALTH fsGENCIES MIGHT BE USED AS THE BAZE FOR SUCH SERVICE CENTERS. 6. ST:ICT Ei?FCRCEI-::..'IvT OF PENAL COD:: SECTION "zOS BE UIv'DER'!'AIC1I'I, PROHIBITZNv ACCESS OF T:INCRS TO CIGARETTr,S. UiE SECTION SHOJLD BE A.MENDED TO SPECIFICP.LI.,Y INCLUDF, VENDING MPL:iINES AS A SO'~RCE OF SALES TO MInORS, AND RESPONSIBILITY FOR INFRACTIOPdS BE S'IZFJLP-TED. 7. LEGISLATIGN SHOULD BE ENACTED: a. To ubulish the two defenses of contributory negligence and assump- tion of the risk, and impose on c:ga.rette manufacturers a duty to
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-21- warn of the health risks, in order to make civil suit s against tobacco companies by lung cancer plaintiffs more actionable. b. To extend the implied warranty prevailing between the cigarette manufacturer and the consumer, as a tr,eans of stimulating research toward producing a safe cigarette. 8. "NO SMOKING" REGtTLATIONS, WHE-:ZE ESTABLISHED, . BE ENFORCED. 9. INDUSTRY ENCOURAGE EDUCATIONAL ACTIVITIES IiND WITHIDRAk'AL CLINICS FOR EMPLOYEES IN ORDER TO COrf3AT THE ADV"r.RSE EFFECTS OF SMOKINv ON THEIR HEALTH. 10. HE1,LT'ri AND EDUCATION INSTITUTIONS -- SOSPITALS, MEDICAL SCHOOLS, HEALTH DEi'ARTVCENTS, PRIVATE AND PUBLIC EDUCATIONAL INSTITUTIONS -- BE ENCaJRAGED TO RE:dOVE CIGARETTE VENDING MACHINES AND OTiirR SOURCES OF CIGARETTE Sh.'r^ FROM THEIR PREMISES. .
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-22- CI:AI'TI:R 2 'TRODUCTION Much of the course of history, it is said, has been written in the quest and use of tobacco. Since its first traceable use by American Indians in the 15th century, tobacco has been a focal point of piracy, wars, costly trades and comMercial ventures, financial coups and taxation. Tobacco has won a colorful place in the history of Western man, just as betel nuts have assumed tremendous importance in Eastern cultures.- In 1921, a curious discovery was made by a young pathologist at the University of I•iinnesota. There Dr. I•ioses Barron observed that the inci- dence of lung cancer appeared to have increased amazingly. He cited this finding as an "epidemic of lung cancer." Since that first awareness, the evidence has been mounting. Lung cancer has certainly reached "epidemic proportions," being the principal cause of death in 1963 of more than 41,000 Anericans. This particular fo:rm of car.cer now exceeds all other types, and is becoming one of the most co:=,on killers of American men. T'i:e "epidemic" was long submerged both in its strength and the public's N awareness of it. lne country recovered from a depression, embarked on a war, and after the intensity of global strife, settled back to domestic mat- ters. 1'he "epidenic" of lung cancer thrust forward insidiously; by the late 19I:0's it could not fail to be noticed. Epidemiologists, reminded of Raymond Pearl's findings in 19381 and spurred by the interest of thoracic surgeons, began seeking the reason why lung cancer should have increased so remarkably. Whatever the factor might be, it was fairly recent in human experi- ence -- widespread perhaps no more than a few decades. Moreover, from studicc of carcinogenesis it appeared that exposure took place over long periods of time, rather than incnediately prior to onset of the disease. The
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-23- epidc.~tic was not localized to one city or region; it was increasing in coun- tries other than the United States. And the carcinogenic agent did seem to have affected more men than women. Among the agents under scrutiny were: atmospheric pollutants, industrial and other environmental irritants, and tobacco -- or several of these in combination. E'pidemiologists and other investigators studied many types of exposure which might adversely affect the lungs. Research yielded steadily increas- ing knowledge of the effects which cigarette smoking has upon the human body. Time after time, in study after study, one fact recurred. Those persons who smoked cigarettes sustained not only more lung cancer but more other ill effects than those who did not smoke. During the 1950's and early 1960's, studies -- conducted both retrospec- tively on the experience of individuals already sick, and prospectively on changes in the health of persons followed over a period of time -- kept pro- ducing the same result. The health of those persons who smoked cigarettes compared unfavorably with those w'no did not. Each study was greeted by a wave of skepticism and "controversy." To accuse a familiar, comfortable habit of having deleterious health effects sounded almost "un-American." . People would listen, read, discuss _ir.dings and go riUht on smoking. Support was rallied by voluntary health wgencies, and statements admonish- ing the public to reevaluate the practice of cigarette smoking punctuated the scene. But more teen-agers every day, living in a culture that defi- nitely encouraged cigarette smoking, began testing a habit which would soon become so difficult to break that they would not even try. Surely if ciga- rettes were really harmful, the government that protected food, water and other things we take into our bodies would initiate appropriate action. '!'o a number of Covernments outside of the United States, which is the principal Crc•.rer and processor of cigarettes, the knowledge of adverse effects
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-21E._ led to more than "controversy." By 1962, when the Royal College of Physicians of London addressed its report to the British Ministry of Health and the citi- zens of Great Britain, a number of other nations had already taken some action: scientific investigations flourished from Denmark to Ceylon (10 countries); information on the harmful effects had been disseminated by governmental and lay groups in 21 countries; Australia and West Germany had levied increased tobacco taxes; tobacco product advertising had been outlawed in Sweden, the Soviet Union and Italy; restrictions as to where cigarettes could be smoked or who could purchase them had been imposed in 5 nations. What had begun as a"controversy" now became a universally recognized health problem -- and it, was being attacked by a number of methods. In Iceland, for example, the Parliament passed an increased tax of ~ cent on each pack of cigarettes to be given to the Iceland Cancer Society "to be used to urge people, and espe- cially teen-a;ers, not to smoke..." In the United States, the government and citizens watched. Voluntary health agencjes initiated educational campaigns, especially directed at teen-agers vfno might forego cigarette smoking. Finally, in June 1961, the voluntary health agencies which had started the campaign alone urged then . President Kennedy to form an official commission to study the "widespread implications of the tobacco problem." In the ensuing months, m.any voices indicated that the situation had become a serious public health problem. On April 16, 1962, Surgeon General Terry sent a detailed proposal to the Secretaa-y of Health, Education and Welfare, calli ng for formation of an advisory group and for a reevalua;,ion of the position,taken in 1959 by Surgeon General Burney in the Journal of the rxlericar. Medical Association. Particularly, he noted a number of significar.t developments: 1. I~cw studicc indicating that smol-;inS has r..::;;or adverse health effecEs. 2. Representation from national voluntary health agencies for action on the part of the U.S. Public Health Service.

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