Tobacco Documents Online

MliiUTES Place: The Ualdorf-Astoria ,vew York, P'ew Yor.k-- Meeting: TuFsday, February 1, 1977 First :leeting of the ratio;ial Conmission on Smol::in~, and 1'uhlic Policy Co-nraission :.embers Present David t,;altimore, Ph. D. Dr. I)enn=s Chamot :terlin K. DuVal, M:D. Charles E. Eberso). Dr. Rcbert Y.ol.ley Alice S. Huang, Ph.D. Tirs. Robert W. Huff Allan K. Jonas George Kneeland Baldwin Maull J. QutKg Newton C-Ornelius W. (T.aens Mrs. Marlin Perkins 11. Marvin Pollard, `I.D. Harvey C. Russell Robert Shank, M.D. Scott Simonds, Dr. P.R. Mrs. Marietta Tree Kerr White, M.1). ` Coc ;nis:iion Members Excused Benjamin F. Byrd, Jr., M.D. :Iarshali Evans Phili p Lea, Pt. D. Dr. Salvador E. Luria William H. Wendel y Guests Present Ms. Ruth Cl.ark Cuyler Hac;mond, Sc. D. Dr. Luther Terry ACS Staff Present A1an Davis Allan Erickson Institu`e of Public Affairs Ms. Eileen McCormack Dr. Frank R4uscher Dr. Jesse Steinfeld Thomas Ulmer . Irving Rimer Zis. Carol Warner Victor Wetngarten

2 M.=t. UL`i!:R 1delco:r:eJ the Co~rmi.ssion on behllf of the ACS board and pledged the full resources of the Society to assist it in i ts work. He described the importance the Society attaches to the Co:n-iission's work in view of t!:e or~ani.zation's major comrnitmznt to the Target 5 antt--smoking campaign. He said the Society looked to the Corr,nission to gather new evidence in tLie field of the success or failure, to date, oL that campaign, to weigh the data it collects carefully, and to recommend possible new approaches on smoking and public policy. He extended both the Society's appreciation and his own to the Cor.unission members for agreeing to undF:rtake this ' task, and emphasized thlt the effort will have the full support of the Society and- its man.bers. :iR. hEI?:GaRTE\ Restated for the Commission the extend of the problem caused by cigarette smoking, which the 1975 Public Health Service report to the Congress said was "the largest single unnecessary and preventable cause of illness and early deat;l". The most recent Public Health Service figures indicate that 89,000 persons died from lung cancer in 1975, niid 250,000 other ILmericans died from coronary heart dj.sels~-, v:+r.ious other forms of cancer, and respiratory diseases largely attributed to excessive cigarette smoking. He reported the Society's most recent stirdies which indicated more than 90 percent of all cigarette smokera wure fully aware of the dangers of excessive smoking yet, despite this knowledge and awareness: s in 1975, the tobacco industry produced .601 bil.lion cigarettes - an all-time high. In 1976, that fiPure was increased to 670 b:llion - more than 3,000 cigarettes for every man, woman and child in the United ;:tctes. 0 of that number, less than 12 percent was of the low-tar, low-nicotine variety. lie reported that the tobacco industry's aulvertisin!; ex- penditures in 1971, the last year cig:.re:t*_e ldvurg tisang wzs permitted on radio or TV, exceeded $200 million. In 1975, the figure was $300 million, and for 1976 it was estimated that expenditure was $321 million. r 0

`;R. lie tlien. reoorted the r.e:ults of the new National Clearing contd. Nouse s,.Irvoy which indicates that A:nericans favor increasec2 social action against smoking. For example: 0 70 percent want greater restrictions on smoking in public places; 0 56 percent believe all cigarette advertising should be banned from all inedia; 40 percen.t of smokers af;ree with this : 0 73, percent believe management should-have the right to bar, smotiing in the work place; o more t^an 75 percent believe that teachers, nurses, and physicians should set an exai,iple by not scaolany, and 60 percent of smokers agree with thi.s. . . It is evident from the above that there is a new clirlte of . . public opinion that affords the American Cancer Society new opportunities to lift its anti-smoking camp:3ign to new height.s. ACS has an ambi tiou5 f ive-year program to reduce sn:oking a::ion, adults by 25 percent -• 12-1/12 million men and wu,aen - and among tean-agers by 50 percent - approximately 4-1/2 million youngsters. This is a formidable goal. One purpose of this new Nationa]. Comiaission .is to find oxit on a regional basis what is being done, wi;at ir r.o': beir; don?!, and possibly what should be clone to help move tiii:, thorny public health problem along desirable public l:ines. He described the methodology being used i.n organizin.y for the Regional forums at which testimony will be taken, and said that f ive Regional. Planninl; Councils had already been formed - Los Anfielec:, Denver, Seattle, St. Louis and Chicago - and that Councils would be forotied in Boston, Philade lphia, and Atlanta within the next two weeks. The function of the Regional Planning Council is to a;on an agenda forr that region's Forum, identify the wicnasses who can testify to each oZ thF agenda items, secure th1~- participation of that witness, and al;:o be responsible for the actual logistics of the Forum. I:ach of the f iva regi.ons to date, the host cities of which are Los Angeles, 1),--nver, Seattle, St. Louis, and Chicago, h:we resPonded exceptionally well to this responsibility. Agendas have been a,;recd itpon which conform almost ideuti.c::Illy with that proposed in the original prospectus, and as m.any as 60 and 70 potential witnesses have been identified in each region. J ~ ~ ~

4 As it no:4 appears, there willl be witnesses from virtu.all.y :t;t. I:STNGARTE:N contd. every state that will include: Governors, U.S. Senators, mentiers of the Congres:; concerned with tcib.u.r.o lcf;ir.lat-ian, State Le~,ist<<tors who have bcen aetive Sn intrculucinf; anti- snoking lebis.lation, a]ar.f;e number of physicians with special expertise in hrub]e:ns of prc•m.ature birth:; chic to cigaret.e s-,oking, epi.deeiioloT;ists, Stzte Conunissioners of Health, dentists who have been involvccd with oral cancer due to smo'.<ing, footbnlll and basket.~oall c:ozches, educators, and students who have been involved in anti-smoking campaigns (some from the fourth grade level), restaurant owners who have banned cigarette smoking in their establishments, and a number of entertainment industry and sports celebrities who have had personal experiences with various aspects of the smoking problem and wlio will appear not as celebrities but peo?le who have an interest in the subject and something . to co:a.:~unicate. On this 1.ist, for example, nr.e Roger Staubach, quarterback of the Dallas Cowboys whose mother died of lung cancer, Vicki Carr who will not appear in a night club which pernits smoking, Sl.ick Watts of Seatt]o who is very active ic: the anti-smoking campaign, Bill Russell, and Donnie and 11,I::rie Osmond, who have a particular message for young people. It now appears that each Forum will bear at least 30 witnesses. Each city is hosting a reception for Commission members and will use that occasion to involve new groups of public officials and othars who might be helpful in the anti-smokincc., effort. In addition, we anticipate very extensive niedia coverage, not only of the Forums themselves, hut in the form of intervie•ws with me:abers of the Commissioll as well as many of the witnesses.l As of the present time, there are'no negatives to report. The Planni;,g Council meetings have gone exceptionally well, and enthusiasm remains unusual]y high. ' DR. S'=EI2:FELD Outlined the "Health Consequences of Smoking" as stated in Iten `:o. 4 of the agenda. He stressed the point that, while the results of passive smoking - ths exposure to nicotine of adults in public places, or even by embryo in n smoking mother' womb - had not had sufficient epi.demioloy,icall prooF as a cause of cancer, the possibility should not be taken .l:i,htly. A recent study in London, h-- said, showed that babies of smokin mothers are often stunted and frequently premature. As a • reason, he advanced the theory gained from laboratory tests with ani:aals that carbon dioxide in the blood of babies born to s-mo king mothers was ten timcs as high as that in babies born to non-smoking mothers. Children of smoking parents, he added, ..+ ~ 0 %0

S DR. STI:INYELU are 1ikc:Jy to be, accordiur; to tests, more suscccptibic to contd. respiratory infection and pneumonia than the offspring of non-::mokcr s . TiIC::;e ta'lllc;('.nti11 (lililin.(!rs to health c%III:;C'd by Sm(lkli) g and stnokcrs have not been emphasized strong.ly enough, Dr. Stein- feld felt. - The recent industry emphasis on the low-tar, ]ow-nicot.ine .cigarettes may raise awhole new set of questions. Has the reduction of one or more dangcrous components in a_cil;arette, in fact, decreased the risk and danRcrs from other possibly unknown components? If cigarettes Were cate--orized as food, they could be banned on the basis of the danger of their additives. Since there is not legislation of this kind governinp, the tobacco industry, cigarettes are not controlled . by federal agencies on the- basis of their ingrndi.ents, and little is known of.their exact components. If the carcinogenic hydrocarbons were to he removed frorm cigarettes, we would still be faced with the pos~ibili',;y that there art, other disease-causing agents within c igarc:ttes. For example, the number of people who die of heart disease far exceed those who die from ].ung cancer. Contrary to the popular myth that cigarette smoking takes many years to show its harmful effects, it has bncome evident that even high school students who smoke can show effects of pulrr.oriary disease. Ci.narette smoking is carcinogenic for both men and c•:omen, and lung cancer has become more prevalent znor:g women than in the past. Among cancers, in men, it is the number one cause of death and in women, it is number four. I ripe and cigar smokers are not ir,unune rom cancer. ~u7 i chances of developing oral cancer are high. The c;eath rates fron oral cancer are equal to those of lung cancer. There is i also an additional danger for pipe and cigar smokers who in- hale because they have sho:•m a pronounced susceptibility to I cancer of the bladder or pancreas. ' • Out of the 1,000 or more components of a cigarette, nicotine and carbon monoxide.may be the greatest cause In the develop- ment of cancer, and certainly carbon monoxide has bcen iden- tified as a major factor in the cause of heart disease. It is dif f icult to measure the e::tent of c.lrbon lnonoxide, and this obstacle ha&made it almost impossible to control it. Al.though ~ .r 0

i)1:. STf:::i ELll a smo :er w;to "yui ts" decreases hi s chance . of heart attack contd . to the I evel of a non-smoker in a f ew months, this does not hold true <:s far as the continued developmentt of cancer is concerned. Cancer, unfortunatcly, is influenced by the 1en;th of time a person has smoked, the number.of cigarettes smoke~ an_-~ the amount of smoke inhaled, and, depending on the gro,ath and expansiori of cancer cells, nott only in _the lungs, but to othcr parts of the body, sncir as the larynx and lrharyn:c, take aT-reat deal longer before the affected parts can be re- habilitated, if ever. I In surmation, Dr. Steinfeld noted that the "safc<st" cigarette ( is the one that isn't smoked, and the time has come to protect lll not only the smoker from himse.lf, but to protect all soc:iet:y. ~ . DR. TER: `' Revie:•red the events since his famous 1964 Surgeon General's report on the dangers of smol:ing and thc subsequent rtiling in 1970 ••chich banned cigarette advertising on radio and television, effective in January of 1971. One unfortunate by-product of this much desired radio/TV ban, said Dr. Terry, was the corg reshondinl; ban placed by th:.• networks on any and all public service anti-smoking n,tssanc- which had been previously accepted on an "equal t:L;re" basis. Because of this, such anti-smoking agencies as the Amcrican Cancer Society and others were forced into a passive, rzt,hi:r than a:,ili:ant, role and denied the opportunity, t'nereaf.ter, to obtain any significant broadcast time. Although the 1970 law required the inclusion of a::tron~^r version of the Surgeon General's warning ori e•ach pack of cigarettes •- saying smoking is harmful rather than the original mav be - Dr. Terry fclt that efforts should be niide to make the c•:arning still stronger today. He noted that several bills have been Introduced in' past Congresses and a number or state leoisl•atures concerring smokina in recent years. But lie also noted that mcst of them had died be_ore the Congress or legislatures adjourned. Dr. Terry is not now aware of any significant anti-smol:ing legislation that has been introduced in the n.:c•/ Congress but stressed the point that, in the face of the strong pro- cigarette and tobacco lobby, it would take a strong concerted effort by the anti-smoking forces to obtain passage of any desirable laws. He expressed the hope that the puhlicity given to the work of this Commission at its many Regional. Forucs could contribute to the desired goal if effectuating meaningful change. Ln 0 . ~ ~ ~

7 DR. Dr. Terry pointcd out that progress weis being nade and contd. cited the fact that before 1970 there %•:cre if nny sUIte or federal l.aw:; about ::moki.nf;. A,,;ainst this, he cited 1975 statisLics, wherein 48 stILCS had introduced and health and that, at least, 423 bills relatin; to smoking 60 statutes in 31~ states had been cnactea covertnb a wide variety of matters, including effective limitations on - smoking in public places, cigarette advertising, sales zu mittors, and insurance costs. 0ne of the more exemplary of these. lat-.,s, passed in Minnesota in 1975, states that "the UePartmcnt of Labor and Industry shall establish rules pro- hihitin; smoking in places of work wheree the close proximity of workers, or the inadequacy of ventilation, causes pollution detrimental to the health and comfort of non-smoking employees". One of the FTC's roles in the smo':ini; problem has been to ' determine from the tobacco industry why people smoke. The agency has attempted to obtain market research studie:; from the cigarette manufacturers and has subpoenaed their rec.ords, but this action is now being challenged in the courts, :^•::d it T-ay be years before a decision is handed down. Another area of FTC regulation is billboard advertising by ciSarette manufacturers. Court actions are now in process again;tt scn•.ie cigarette companies because the mandatory health warning is no longer being displayed in the type-size or promincncs required by law. Another governmental agency, the Interstate Co.-nrerce Commission, is playing an important role in the anti-smoking battle. It.has, in recent years, required.that all trains must provide a non-smoking area equal to 50 percent of the passenger space available with the proviso that the facilities may not be mixed. If there is only one car, it must be a non-smoker. Smoking is not pernitted in dining cars, but it is allowed in bar cars under ICC rules. On buses, the ICC has ruled that bus campanie: may prohibit smoking but, if smoking is allowed, it is restrtcte to the rear 30 percent of the bus. The Civil Aeronautics Board now requires airlines to provide non-s»o':cing seating areas. There has been a running controversy about the amount of space to he allocated to smokers and non- smokers. The CAB is now consider inF, special f tiF;lits forr non- smokers, prohibiting smoking on airplanes entirely, limiting non-smokers to minimum space on the plane. The toblcco industr) in an effort to solve this dilemma, is now soliciting the signatures of smokers and non-smokers at airports to protect ..~ ~ N

8 DR. 'fGl:la their respectivc rights on airpl.lues. To date, petitions contd. signed by smokers outnumber the non-smokers by about f.our to one, due larFc:ly to the intensive paid campaign by the industry now under way at many airports. Dr. Terry citc!d the case of the Pontiac Stadium in Mic:hic;an which, by the nature of its construction, dehends on positive- air pressure to keep its collapsible ruof in place and tlws - is unable to adequately dispose of smoke through its air circulation equipment. Many of the people attending events in the Stadium have complaincd about smoking in the Stadium and retained a la4ryer in their defense. By measuring the density of the smoke and the pcrcent:age of carbon dioxide present in the Stadium, the complainants proved that, because of smo:ang, visibility was reduced' by virtual.ty 85 percent before the end of the first half. Upon presentation of this and other evidencc, the Court ruled that smoking should be prohibited in the Stadium's stands for the good of the players and spectators. • v Employces'rights are another area gradually affecting regulation of smoking in public places. Recently a woman in Jersey brought her employer, Bell Telephone, ir•to court arid won a decision in herr favor wNich required the employer to provide a non-smoking work area for non-smol:ing employees. NS. CLAI',K Presented the findings and views expressed in her recent statistical study of teen-age smoking. The anti-smoking message has been heard by this group but not heeded, because teen-agers believe that everyone smokes except doctors and athletes, and because the incidence of smoking in their peer group is so heavy, they resort to the con- venient rationalization e•:hich says, smoking is addictive and thus difficult to stop. Both of these myths must be laid to rest before a lasting incentive to stop smoking can be created for these young people. The problem, IIs. Clark added, is not helped by school.a which provide smoking rooms for teen-age students. Where such rooms are provided, one out off every two students smoke and there Is always the danger of the non-smolcc:r being converted. Where no smoking roums exist, the lack of facilities and the inconvenience tend to reduce the amount of smoking substantially. These facts should not be overlooked as a contributing cause of the teeO-age smoking problem. .,~

9 MS. C;.:•.Z= In a recent study of the American fruoily, about 50 per- contcc cent of the children between ages 6.1nd 32 admitted to having a friend who scnokes, wlrich shows how e1r].y thc smoking hibit.can become intrenched in our children. As reasons for the up-surge in youth smoking, Ms. Clark citc:d : - The "do your own thing" philosophy that now prevails anong the young. - Peer pressures to do what the others are doing. - The emotional well-being (or ].ack of nervousness) that smoi:inb is supposed to generate. - The general lack of militancy of today's youth by comparison with thosc off tLe 1960s. - The diminishing scare-effect of the 1964 Surgeon . General's report. _ - The removal of cigarette advertising from TV in 1971 and the attendant elimination of the very effective anti-smo'<ing television spot announcements at that time. r One means of combatting the smoking problem of our yo::ti: as well as its general apathy to the dangers of smoking .,c~sld be to r.!ount a campaign, said Ms. Clark, that would makc the drive against smoking a real cause - a crusade, if you :~il.l - against one of the most prevalent purveyors of death knoan to man. A 30-ninste discussion followed, which elaborated on sonic of the above topics, as follows: DR. D~_VAL Few messages have gotten across as clearly as the ant.i- smokinfi messages, and, yet, it: appears obvious that young girls have opted for slim figures rath:r than longer lives. The issue of self-image and self-esteem is bound to be a lot r.iore important to young pcople than the question of health, slnd for that reason, smol:in; should b~- pre:;ented to them as a socially unacceptable habit that is damaging to the general impression they present to society. MRS. PFD:I\S Smoking rooms in schools can do nothing but set a very poor - example to our youth. This is completely alien to the im- portance of educating them properly nrainst the dangers of smoking. The very young, from kindergarten age on, should be reached in an effort to combat any desires they might develop in later life to start smoking. It could be presented to them in a "good-guy, bnd-guy" fashion in their .r ,.r a

:(f;S. story boo!:; or cartoons. The pod-,;uy, of course, contc:. being the nnn-smol:r..r, ;ind the bad•-f;uy being the Fmuke.r. The adu1t s:;oker should be vn-3tten off acs they arc: already set in thc:i.r habits and are not i;oinl; to quit. We nwst start no:•r to educate our youtig children in school on the dan, er. s of smoking so that they will not hecotie the lost adults of tomorrow. DR. Agreed with Mrs. Perkins on the importance of educating our very young and sugs;ested the possibil.ity of riaki•ng the tobacco industry our allies instead of our enc:my. llIt. SI`;v`:DS RaisLid the question of the non-smokers bearing the brunl for the s-mokers-as evIdeuced by insurance premiums. i`ER: RUSSELL Stressed his concern that the Commission should be careful . not to be viewed as a group that patrols the l:tves of other people. We can regulate many things, he.suggested, such as the amount of tar, the avai]ahility of cig=irettes to minors, etc., but he is opposed to legislation uhich would control smol t•7e should not be prohibitionists. DR. 1' L•::0`rl) Opened the af ternooa session wi th a slide presentatio:: on the 1960-1972 study of male and female cigarette sr.iokers by category of tar and nicotine content of their cir,arettes (low, nediuM, and hifih). Further on this subjcct, he stated that the problem is not to 'develup the "safe" cioarette hut to find out if we have already do;~e so. To date, we don't have a completely satisfactory system for this purpose. Dr. Hammond then anscaered questions, and a lengthy discussion ensued among the Commission members about the following: a.) effects of inhaling/not inhaling while smoking cigzr--ttes; b.) scoking pipes and cigars vs. cigarettes; c. ) chec-.,ing tohacco; d. ) illnesses of children c<<uscd by passive smoking; e. ) the possibility of the elimination of tar/nicotine from cigarettes and the retention and development of other agents ehat could be just as dangerous. The full text of Dr. Hammond's published report, which he summarized at the meeting, is attached for your information.