RJ Reynolds
Health Vs. Cigarette Smoking. Report of the Governor's Advisory Committee on Cigarette Smoking and Health.
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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.
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- 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.
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- Allen, G.V.
- Teens Against Cancer
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- 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
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- Childrens Bureau
- Us House, O.F. Representatives
- Ca Heart Assn
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- Natl Automatic Merchandising Assn
- King James, I.
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- Tobacco Leaf Magazine
- Uk House
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- Attorney General
- Secretary, O.F. St
- Harper
- James
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- Ca, S.T. Director, O.F. Public Health
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- Natl Clearinghouse, O.N. Smoking & Hea
- Uk Natl Health Service
- Ymca
- Ywca
- Modern Medicine
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studies in which death rates were compared is that of Dr. E. Cuyler Hammond,
conducted on over 35,000 "matched pair" subjects. These were persons physio-'
logically and psychologically similar in many ways but different in their
smoking practice. Hammond's latest findings reinforce the conclusion of a
causative relationship between cigarette smoking and disease and death.
The facts concerning the ill effects af cigarette smoking are just as
conclusive, and just as depressing as those concerning poor sanitation or
poor food. Reducing the use of the cigarette is clearly in the tradition
of preserving the public's health.
Legal Facts: Statutes Relating to the Use or Sale of Tobacco
Tc;:ucco's role in affecting history can also be seen in the laws govern-
ing its sale and use. In California, the Legislature has adopted statutes
relating to tobacco to protect minors, to protect the general health, safety
or welfare of California citizens, and to produce revenue.
Under present California law, Penal Code section 308 makes it a misde-
:~:c:acr to furnish ami.nor under age 18 with "any tobacco, cigarette or ciga-
rette papers...." Violators, those supplying minors, are subject to fine
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or imprisonment. Education Code section 1C6C2, by contrast, is directed at
ninors themselves, prohibiting minors from having or using tobacco products
on school premises. The teaching about tobacco is also written intolaw,
Education Code section 9309.
Statutes mentioning tobacco and designed to protect the general health,
safety or welfare of citizens are primarily concerned with insuring cleanli-
ness and permitting the blind to sell cigarettes in licensed vending stands
on State-owned premises.
Since 1959, a tax of 30 per package has been levied on cigarettes in
California, although the State was among the last to establish such a tax.
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It yields substantial revenues to the State General Fund but is still less
than the tax in many other states.
In the past decade, a number of bills have been proposed to alter the
existing framework surrounding tobacco products. None has been passed.
In the field of private law, of the five well-known cases in which a
lung cancer plaintiff or his heirs sued a~tobacco company, not one has yet
recovered damages. Plaintiffs have found it difficult to prove in court
that cigarettes caused their particular cancers, among other reasons be-
cause cigarette smoking is not the only cause of cancer. In the future,
plaintiffs may fare better, since the Florida Supreme Court in the case
of Green vs. the American Tobacco Company declared that recovery on the
theory of implied warranty is possible, even though at the time the ciga-
rettes were sold the manufacturer could not have known that users would be
endangered by inhaling smoke from his cigarettes. Private law in this
direction is bound to expand.
Fiscal Facts: Taxation and Revenue from Sale of Tobacco
Historically, tobacco products have been a major source of revenue in
Western countries. At present, only six states have not levied taxes on
cigarettes in addition to the Federal tax. Since California levied the 30
tax in 1959, revenue has risen from $64 million to over $70 million.per
year.
The existence of the tax has obviously not influenced cigarette sales
to decline. In fact, until the subject of cigarettes being harmful to
health reached its present momentum, sales of cigarettes in California were
on the upswing.
Though the practice of placing cigarette tax revenues into the General
Fund is followed in California, the Legislature may earmark funds for special
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purposes: e.g., automobile registration fees go to the Department of Motor
Vehicles for highway improvement.
The Advisory Committee considered the fiscal aspect of the problem only
as it related to providing a state action program. As Governor Brown stated:
health comes first; revenue second.
Federal and state taxes in the United4States.on tobacco yield over $3
billion annually; export sales of tobacco and cigarettes bring in another
half-billion dollars in sales which are taxable. The tobacco industry is
severely troubled by the threat of sales depletion or more stringent methods
of limiting sales; several states base-their education budgets on tobacco
production taxes. The industry has been criticized because of the dispro-
portionate sums expended on research and product promotion. The annual
promotional expenditure of the tobacco companies exceeds $200 million, but
until the recent grant to the American Medical Association, only $6.25 mi1-
lion had been allocated to research outside the industry. How Mich of the
private, undisclosed research within the industry has been to make the con-
sumed product safer is unknown. It appears,that much of the industry re-
search has been aimed at developing filters or new brands containing
essentially the same tobacco.
Educational Facts
The teaching of health in California's public schools is constantly
being modernized. However, one somewhat archaic statute does exist re-
quiring that instruction be given in the "evil effects ofalcohol, tobacco
and other narcotics on the human system." Education specifically on the
health effects of these products has been limited.
Informal polls conducted in California indicate that about half of the
students in high schools smoke cigarettes by the time they graduate. The
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fact that section 308 of the Penal Code has not been enforced (no prose-
cutions have ever been recorded) has permitted youngsters to purchase
cigarettes quite easily with no apparent penalty to themselves or the
persons dispensing them.
Educators, physicians and now the government are concerned about the
apathy of young people in not observing the law, and the apathy of adults,
parents and vendors alike, who do not discourage its abuse. A number of
studies have been conducted to try to determine why youngsters begin to
smoke, the prime motivations for their continuing, and whether some char-
acteristics of temperament distinguish the smoker from the nonsmoker.
Youngsters tend to reflect the smoking practices of their parents and
siblings as well as their peers; intelligence and achievement tests indi-
cate that nonsmokers tend to perform better; nonsmokers are more inclined
to participate in sports and other activities.
Additional investigations of youth behavior are needed, including
the development of means to discourage young people from adopting the
habit in the first place.
Behavioral Considerations
The behavioral science disciplines may assist in ascertaining how
health habits persist and how new health practices become established.
Studies, demonstration projects and evaluation are needed to determine
how prevailing ideas and customs related to cigarette smoking may be changed
effectively. These would include longitudinal studies'of the natural his-
tory of smoking to reveal those psychological, social and cultural determi-
nants favoring the adoption of the practice as a normal activity; studies
of personality traits displayed by smokers and nonsmokers; analyses of
factors influencing cigarette smoking and of means designed to change the
practice; and evaluation of curative and other action programs.
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Consumer Considerations
Among the important behavioral considerations are those relating to
the responsiveness of individuals as consumers. One question to be answered
is: to what extent does the protection of the public's health require gov-
ernmental participation in controlling the use of cigarettes? In meeting
other health problems created by changing ~-z- often improving -- conditions
of life, the government has played a central role in reducing health threats
produced by environmental hazards, such as air pollution and food contami-
nation.
Our present way of life has produced a remarkable change in health:
instead of succumbing to diseases due to unhealthful conditions of the past,
such as fatigue and poor sanitation, Americans now become ill and die of
"modern" conditions -- overindulgence in food and drink and insufficient
exercise, for example. Consumer behavf or in the quest of life's "better
things" largely influences patterns of disease and death.
With respect to cigarette smoking, the cause of improving the public's
health has been thwarted by promotion on many sides, bombarded by messages
to buy, buy, buy cigarettes. About five percent of what the consumer spends
on cigarettes comes back to him in advertising and promotion -- to keep on
smoking.
Research is badly needed to determine how to reach the consumer before
the act of purchase. The role of the government in protecting our health
has been distinguished. In this matter, also, it is needed.
PROGRANiS OF AC'IION
Health Plannina and Withdrawal Clinics
Preserving and'improving the health of people has been the motivation
for phenomenal changes in the conditions under which men live. In present
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times, as in the past, it is the conditions of life which determine the
disease patterns of men and which suggest directions for improvement.
Cigarette smoking is clearly one of the conditions of the "more abundant
life" of modern times which has resulted in needless disability and pre-
mature death from a number of chronic diseases.
Prevention of this particular condition can be accomplished most
readily through.intensive education of those who have not yet begun to
smoke, especially young people. Further preventive strength can be
generated by education of adults, particularly physicians and other health
personnel and teachers. -
At present, there are few cures for the conditions which cigarette
smoking produces. Persons with lung cancer seldom live more than a year
or two; coronary artery disease takes a great toll; and the progress of
emphysema and chronic bronchitis cannot easily be arrested. However, some
success has already been achieved in combating cigarette smoking. Tested
and relatively effective are the withdrawal clinics for those individuals
who want to give up the habit but seem unable by themselves to do so.
Initiation and evaluation of such clinics sliould be encouraged as part
of any statewide program against cigarette smoking.
Withdrawal clinics would be but one of several activities which-the
Committee recommends be consolidated into community Service Centers. In
addition, professional education, community education and consultation to
industry and agencies would originate here. Existing facilities, such as.
hospitals, voluntary health agencies or-health departments, could accomo-
date Service Centers.
Lep,al Implicutions Governriental activity with respect to tobacco consumption and health
is a subject presently well-publicized and fraught with emotion. In.
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addition, the subject has only recently developed, and legislative guide-
lines are therefore few. With these observations in mind, the legislative
recommendations of the Committee may be summarized as follows.
In order to prevent uncontrolled access to cigarettes by minors, exist-
ing legislation should be fully enforced and new legislation proposed to
strengthen it. Penal Code section 308 might be held to apply to vending
machine sales to minors, but ambiguities in the present statute make it
unclear as to which person is actually responsible for infractions result-
i
ing from vending machine sales. The Committee therefore proposes amending
section 308 to specifically include vending machine sales, designating
pa
no
to
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rties responsible for infractions. The suggested language should be
broader in scope than necessary to prohibit the minor's present access
vending machines.
Statutory changes could be enacted to give cigarette-lung cancer plain-
tiffs a better chance of recovery from cigarette manufacturers. Abolition
of the defenses of contributory negligence and assumption of the risk, as
well as an imposition on the manufacturers of a duty to warn, would make a
negligence theory more actionable. Also, d new and more specific implied
warranty, independent of and in addition to existing implied warranty, could
make the implied warranty theory more helpful to the lung cancer plaintiff.
There are few areas of human conduct which can or should be regulated I
by the Federal government. None of the conduct which would be governed by
the proposals made so far, with the possible exception ofthe labeling
statute, falls within exclusive Federal authority. However, several Federal
agencies are contemplating the adoption of policies which would have an
impact on the areas under discussion. The proposals for California action
should complement contemplated Federal government action and delineate the
role that California should adopt as a state in action against,cigarette smoking.
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It is desirable that the State work expeditiously along lines proposed
by the Federal agencies directly concerned with the cigarette smoking-health
issue. These agencies include: the Federal Trade Commission, the Federal
Communications Commission, the Federal Food and Drug Administration, the
Department of Health, Education and Welfare, the Department of Agriculture
and the Department of Commerce. The first-..four mentioned began working on
programs or reevaluations directly after the Report of the Advisory Committee
to the Surgeon General was issued January 11, 1964. The other two have not
yet indicated any plans to seek other uses or other markets for tobacco, to
assist in improving the quality of the product now being manufactured, or to
impose any new restrictions upon tobacco.
Fiscal Considerations
As cigarettes have been historically subject to taxation, fiscal con-
siderations are inroortant. Unlike most countries which operate tobacco
monopolies or which depend heavily upon the revenue accrued from taxes, in
the United States tobacco production and distribution are conducted by free
enterprise with relatively low taxes levied.by Federal and state governments.
~
The Federal tax is presently eight cents or roughly 31 percent of the cost
of a package of cigarettes.
The present State tax on cigarettes in California is among the lowest
in the nation: three cents (about 13 percent). The State tax is so rela-
tively low that it would be feasible to initiate and maintain a State program
for protection of health against cigarettes by raising the present tax.
Earmarking these funds, or part of them, for a cigarette smoking control
program would place the cost upon those involved in the problem. This is
not without precedent in California fiscal practice. For example, a por-
tion of the alcoholic beverage tax is used for alcoholic rehabilitation,
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and funds appropriated from motor vehicle*registrations support highway
improvements.
One cent per package out of an increased cigarette tax would yield
25 million dollars. While this a sizable amount, it should be noted that
it is not disproportionate with California's share of the cigarette in-
dustry's annual, national, promotional cost of 200 million dollars. It
is also not large in relation to the amount of'money lost each year in
California by the expenses (medical care, work loss, public assistance,
etc.) resulting from cigarette smoking.
Selective taxation, for example, according to tar and nicotine content,
has been suggested by some. However, it seems to offer little promise of
being effective either from a health or fiscal point of view. Licensing
vendors or vending machines is similarly not considered feasible; the tre-
mendous cost of enforcement and administrGtion could not be balanced by
expected reduction in consumption. Licensing could only apply, at present,
to prohibiting minors from purchasing cigarettes illegally.
~ Therefore, the Governor's Advisory Committee proposes an increased
f/ State tax on cigarettes, a portion of which should be used to support a
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comprehensive program to combat the adverse health effects of cigarette
moking.
Education Needs
Education is one of the most important means of changing the present
attitudes and practices of people with respect to cigarette smoking. Just
as cigarette smoking gained ascendance in the last decades, the evidence
now suggests it should recede in the coming years. Through education, both
youth and adults can be conditioned to think and act differently about smok-
ing cigarettes.
Education in California cocicerning cigarette smoking has been laigely
limited to modest teaching in public schools under an outmoded section of
the Education Code which calls for instruction in the "evils" of smoking,
alcohol and narcotics. The current state of knowledge about the health
hazards of cigarette smoking is sufficien+t to warrant great:.= i,.".c;nsified
instruction with a more factual orientatior}. Thc.Interagency Council on
Cigarette Smoking and Health, of which the Department of Education is a
member, has supported preparation of teacher's resource kits containing
guides for elementary and secondary school teachers and a variety of cur-
rent reference materials on the r:eaith he.zards of smoking.
The school program alone, however, cannot be expected to be the sole,
source of information and guidance on the subject of smoking. Supplemental
activities will strengthen the content provided in the classroom and affect
the social milieu. One'tecrnique is to conduct conferences -- a form of
inservice training - for yout'rh leaders.
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h;ore dlrectly, the health education program in schools needs to be
strengthened so that materials on smoking will be based on scientific evi-
dence and health interes;.. T::a Ccr=dttee eavors devel opment of a Framework
for i:4alth Instruction, providing continuity and guidance, to be tested and
then introduced fully throughout the school system. Amendments to the Edu-
cation and Administrative Ca3.es,,to enlarge the scope of teaching health
education, are also recommer.ded.
Related to improved health instruction is development of an improved
recreational program. ihe latter should extend the structured day during
which classroom content is integrated to the actual application of health
principles. Not only will a sound recreat;ior,al program enhance the well-
being of youngsters, especially those from deprived backgrounds, but it
