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Tobacco Institute

[On Tobacco: 21 Questions and Answers [TI publication] with references]

Date: 1981
Length: 550 pages
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1 How many cigarettes are sold annually ~. , in the U.S.? Approximately 630 billion cigarette~ were purchased .... in 1980, an increase of 17 percent in the l~st decade. Government survey~ indicate the average smoker smokes about a pack a day, men averaging a little !?: more than women. 2 Nearly 60 million Amerieans--ab~ut one third of the adult population. ~ Are more women and teenagers smoking • today? Because of population growth, the number of adult American women who choose to smoke is apparently women-- the rate or percentage-- is lower. The 1980 womensmoker~ peaked between 1965 and 1976, and estimated that 28.2 percent of the adult female pop- ulation were smoker~ in 1979. .... Smoking has declined among teenager~. According . " to the American Cancer Soeie~, smoking is down ~ third to the Iowe*t level since 1964. In young a .... women, the smoking rate has decreased 17 percent .-_- since 1974, .... -:~:;.. : Z~• Are smokers different from nonsmokers? .... Some researchers conclude that smokers, in general, • : have b~havior pattetms different from nonsmoker~ . They report that smokers tend to be more com- municative, creative, energetic and assertive. They - are also said to marry" more often, move more often, " more often change jobs, prefer spicier and saltier foods and participate more in sports. ,nd children " they were more likely to have been independent. As ~" adults they tend to be more outgoing--living, so 0129170 °Oooo sse TIEX 0007588--
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physician r~ ~che~ ha~e call~ a "pauci~" of time ~ i~el~." - ~nd international minor cl~i~catio~ h~ve .,. come re~ of an incr~ing propo~ion of a " "~ ,~ ~nd of lung cancer not traditionally ~iated - • -~. ~ ~ with cigare~e smo~ng. :~ Did the 1964 Surgeon ~ne~'s repo~ '" ~ est~Hsh that smo~ng ~ses ~ncer • Science hm b~n unable in more than 40 vca~ .. ~ ~ and o~er dis~esF of r~carch to pr~ucc human ~-pc lung c~nccr in la~to~ animals with tobacco smoke ' -.,~ No. The re~--a~uallv that of ~e Adv~oD" inhalation. . ~: Comm~ to the Su~n Gcnc~l on Smoking -.:-: and ~ealth--d ~d n~t ~tablish cause-and-effe~ rclatiomhi~ bc~v~n cigarc~c smoking and any ,~.~~ dise~e or ~nd tion, I~ conclusiom, the comm(~ ~ ~ ~at about h~ disease? ": . .'.~ said, were a "matter of judgment." ~enfially a .(: s~dv. of numb<~, the 1964 repo~ w~ a selective In ~rlv. 1981, a pint pr~ident of the Amebean ... . r~,iew of ~pulation smdi~ comparing dis~e rat~ Hea~ ~iation said it ~t when he told a New among smoke~, nommoke~ and~-~moken. It York re~er, "We have yet to uncover what ca~ ~ated clearly that "stati~i~l metho~ cannot ~ab ather~cler~is, r~nsible for hea~ attack and lish p~f da ¢au~l relation, hip in an ~iation." stroke." The admi~ion ~me only mont~ aker a .. ;~ Ha~'ard rm~rcher wrote in ~4m~Mn Hea~ " 6 thatthereisno~ablishedpr~fthatcigarette ~~~ ~at ar~) some of the questions le~ smoking ~ causally related to corona~ heart disc~e ~....~ ~ un~swered by the 19~ ~po~ ~d others (CHD). " cigarette • .'-.~:~.-: issued since~ Manv scicnt~ comider smo~ng to be a Now, ~ in 196,-, there are ~ed star,till CH~ ~k factor, that ~, an element or chara~edstic . rclatiomhi~ bc ~ccn smoking and ce~ain h~th found in common, singly or in combination with the smoking co,~trove~. ~y, for ~pl~ do non- ~ ea~ nor do ~ beli~e that their elimination ~ smoke~ d~elop h~n dis~e, lung ~n~r and will ne~ari~ prevent illn~. The 1979 Surg~n ~ :.~ "....~.,~ :. o~er d~ ~:~uently ~atcd with smoking~ ~ ~ner~'s rc~ ~inted out that mere ~iation of lung ~ncer, 'uhy do the v~ majo~ of "henW" r~her~ who not~ "seHous qu~tiom" abou~ ~' smoke~ never d~elop the d~ Why haven't interpretation of ce~in h~ data, ~ncluded that . scient~m b~n able to prove that any one or any no consistent cllni~ or =~fimcntal data in anima~ . ~mbination of the thomas& of com~nen~ m found or man c/early sup~ what he called "the leap from in ei~r~e smoke ~m~ h~an dise~e? ~ation to en~ncemen~" Clearly, a g~ deal needs to be l~ed about CHD. But ~ H~t of other evid~ce~ ho~v ~n • ~one ins/st that a ~usal coast/on h~ Have scientists dete~in~ the cause . of emph~emaF " ' ~'Lt~:~ Becau~ at l~t three ~o~ m~e s~ods qu~tiom No. Emphysema ~ a fo~ of lung damage ~pically ' .~.~1'" a~ut any such :oncl~io~ :~:<..7~ " ~" ' * ~e~ed , ~und in older ~on~ R~arche~ in the area have "~ lung cancer monaliw rat~ can't be ~ ~a~ ~ ~ndcrcd the ~ibl¢ role of~ch ~cto~ ~ smoking, ~-~<'5~ patterns, h,~ or in other countfi~, abno~aliti~, childbed dise~, adult infections ~:'~,;'~ and genetic disordem But that this ~ still just ..~~ 01 9171 TI KU 00000'3663 0007589
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speculation is demonstrated by astatement from the 19' Hasn't carbon monoxide {CO)in • , : government it~stit'ute responsible for lung research ... ~.1. cigarette smoke been implicated in that "we do n.t know the cause of pulmonary" em- heart disease? physema, how to stop its progress even if detected . .: earl)', or how io prevent heart disease caused by Some do believe it might e_,cplain the statistical • , emphysema." " association between cigarettes and GHD. A tasteless, - colorless, odorless gas produced by many natural and " .~ In their efforts :o determine what eames emphysema, man-made sources, it has been sl~own, "in large .: scientists and r~earcher~ have exposed ~xperimental amounts, to decrease the supply of ox3'gen in the animals to various substances, including tobacco blood. However, it has never, in the le~'els found in ~rnoke. But as far as tobacco smoke goes, even the cigarettesmoke, been demonstrated to cause heart or ~ most recent S, rgeon General's report on smoking <~- any other human disease. Even the 1981 Surgeon and health not,:d that"there are no published studies ~ General's report pointed out that "judgments" on . that acceptably show in an animal model that the the role of CO in heart d sense ar based on ' '~ development cf emphysema is induced by cigarette ' scanty information." .: ' .-.~' smoke." .... . .'..: Obviously, emphysema is poorly understood and 1 "~ • "~ answem about its origins and development can only 1 ~.~ Does tobacco smoke endanger • , '~ " • nonsmokers? • .-'.: be found thro, gh further scientific research. • : It can certainb' annoy some people from time to ~ time, but there is no convincing evidence that "" "' "1 ~'~ tobacco smoke causes disease in nonsmokers. In fact, "/ 1 ~J. V, qaat are tar and nicotine? the 1979 Surgeon General's report, the last to con- sider the subject, states explicitly, ~Healthv non- -~ . : Nicotine, ace] 9rless substance found in tobacco smokers mxposed to cigarette smoke have l~ttle or no '. '" leaves and smoke, is eliminated from the blood • ~ . physiologic response to the smoke, and what response • ~ rapidly. Research has shown that there is little eum- does occur may be due to psychological factors." The ' ... ulative effect. ":?at is a substance, minus water and • nicotine, obtai, ted by super-cooling and condensing report furthersays,"The existence ofa tobaccosmoke tobacco smoke under special laboratory, conditions, allergy in humans is unproven." Studies on this :. " This method ol collecting tar beam little resemblance question continue but have not confirmed that tobacco smoke presents disease risks for nonsmokers. • :. • , to the way cigarettes are smoked. - " . • -~ • help resolve the smoking and health ": "" ." :" - ":~ ,) "sa~er-'? ... . . .,-~ controversy.) • ' ~:~.~,Z~.~'~ Despite all the research that has been done over the " • i'. ".Y :~-'<,: ' 8o far, the tobacco industry has committed more ..~:~.:?: ~: 'c." years, no one h:~ demonstrated that milligram num- than 591 million for i~dependent research on smok- • . ; .... z: ~ f~, ~.~ hers have any I ~ealth significance. • . .... .¢ .., ing and health questions. In many years, indust .ry :' " "; Many varieties of low tar-niootine cigarettes are now awards exceeded that of any government depart- "'". . ,.... ,....:~._~ on the market in response to comumer preference ment, They have always far ~ceeded the smoking ....... k..~_ trends. In 1980, the average cigarette sold in the and health research funding of all voluntary health • . ...... . .. .'c,. ". U.S. yielded I~s than 14 mg~ tar, a level generally. [ associations, which regularly spend more of their • ' " "','. :~ categorized as ! 3w tar. ~ donated funds for administration and public relations "' ?:.. "~. ;~d, .~...,.. ..:::. r: campaigns than for research. The tobacco industry .:,. " - ~- }~ remains committed to advancing scientific inquiry ~ into the in in the smoking knoxvledge ;~; ..... - 5k'..'~. • 4 5 "' "- TIMN 0129172 TIEX 0007590--
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5 Do the tobacco companies control the ~[ore than half of tobacco's contribution to • reseat'ch they sponsor? collections resuhm from ripple effects, a~ indust .ry employees, their bosses and major suppliers buy the Absolutely not. Independent scientific advisors goods and services of other, nontobacco, industries. evaluate and fund research proposals by individualz .' and institutions. Awards are made with no strings " attached and etch researcher is free to publish study • 0 results, whatev,:r they may be..t O. What is the tobacco subsidy? There is no tobacco subsMy program. There is a .. • ":~ '~/~ VChat is the economic contribution of tobacco price support program, which limits the • tobacco? amount of tobacco grown domestically and insures • farmers a fair return on their investments. Money The tobacco industry contributes mightily to the expended under the program isn't a gift. It's a loan ~ U.S. economy. Leeris grown in 20 states on an from the federal government, repaid with interest. estimated 276,£00 farms. It is the sixth largest U.S. Similar programs exist for 12 other commodltie~ ' ; cash crop. The U.S. is also the leading exporter of grown in this country. • ".i tobacco and th,: third largest tobacco importer. The result is a positive net contribution of more than Unlike mc~ other agricultural price support $l.7 billion pei' year to the U,S, international programs, however, in mc~t years the tobacco pro- balance of pa.vt cents. Americans spent 521 billion gram repays the government more than the farmers for tobacco prcclucts in 1980. have borrowed. In its 47 year~ of existence--with loam totaling about $5 billion--the program has produced a net 1o~ to taxpayers of approximately 7 $56.7 million, or about one tenth of one percent of -.- , What's the effect of tobacco taxes? all losses for all commodity, price support programs. While losing the $57 million, the government has . Federal, state and local governments realize some collected ~72 billion in the cigarette tax alone. $6.5 billion ammally in direct taxes on tobacco products, helping to pay for such thing~ as road -. building and s¢heol lunch programs. The U.S. 1 ~'~ Doe~ ci~arette advertlsha~ cause young Treasury colic, ts 8 cents on every pack of cigarettes / 7 • people to stat't smoking? sold. individual state~ from 2 to 21 cents and at least 369 municipali :its from 1 to 10 cents. Since the As one knowledgeable government official has said, first federal tax on tobacco in 1862. nearly 5138 ~Advertising is certainly not the culprit." Cigarette billion has been collected by all levels of government, advertising is brand advertising. Its purpose and, Tobacco is the most heavily taxed consumer more significantly, its effect is to divide the already' product, existing market by promoting brand identification. t~ . and loyalty among ind~ividuals who are smokers. The roughly 4~0,000 persons employed in all phases " • :~" of tobaccO and their employers and essential sup- Research on the injection of smoking among young .. : "' pliers also pay ~axe~. people reveal~ compl~ i:~. chological, cultural and ..... socioeconomic faetom No one favor~ smoking by -,~ According to a pioneering industry study by the young people. Smoking is an adult custom to be -.' ..' J -.~ University of Fennsvlvania's Wharton Applied . ....,...~ ¢.~ . ' decided by adults based on a mature and informed ...,.~ .. ..'-. ~.,. Research Ccnt.:r in 1979, tobacco and it~ ripple ". individual freedom of choice- ...::" :~; ~, effects generatc ~22 billion a year in taxes. The • . . ..:..;.. federal share is more than $14 billion, paid in personal o .'-" ..~: and corporate 'ncome, social security ~nd other " ~:J taxes. Total st.~te and municipal taxes, including '"': ...~ sales and prop(rty t~.xes, is more than $7 billion. ;~: :" " ~?'~-" TI KU 000003665 ~ TIEX 0007591___
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THE OBACCO INSTITUTE 1875 l STREET, NORTII~NEST AX~,E I1. I)[ I'I"IN 2021457-4}R)0 * 800.'424-9876 _(1~ 457-,;~74 April 1, 1981 Patrick Sirridge, Esquire Shook, Hardy & Bacon 20th Floor, Mercantile Bank Tower Ii01 Walnut Street Kansas City, Missouri 64106 Dear Pat : Herewith the promised marked-up copy of "On Tobacco." Changes from what Alfred sent you March 20 are indicated in italic type for fast identifica- tion. Sources are, as well. You will note that all except tobacco statistics, SG report excerpts and one great new CHD statement I found just this week is material that has been cleared previously. For simplification in clearing publications such as this in future -- those dealing with the health controversy~ I shall indicate sources this way from now when submitting draft copy to Alfred. May I hear from you, please, Monday at the latest? Our field guys are waiting for it. Thanks and best regards. Cordially, AHD/pam Enclosure cc: Alfred Pollard, Esquire Rhonda Goldberg Susan Stuntz William Kloepfer, Jr. TIEX 0007593
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D R A F T ON TOBACCO: 21 QUESTIONS AND ANSWERS I. How many cigarettes are sold annually in the U.S.? Approximately 630 billion cigarettes were purchased in 1980, an increase of 17 percent in the last decade. Government surveys indicate the average smoker smokes about a pack a day, men averaging a little more than women. ~.S. Cigaret~Consumption. i900 to Date; Ad~It Use of Smoking, 1975, p. 17) 2. How many people smoke? Nearly 60 million Americans -- about one third of the adult population. (TI estimate) 3. Are more women and teenagers smoking today? Because of population growth, the number of adult American women who choose to smoke is apparently larger than ever, but the incidence of smoking among women -- the rate or percentage -- is lower. The 1980 Surgeon General's report said the proportion of between 1965 and 1976 women smokers peaked ~/~//~#//~}/]/~7/~/ and estimated that 28.2 percent of the adult female population were smokers in 1979. (SG '80, p. 2) Smoking has declined among teenagers. According to the American Cancer Society, smoking is down a third to the lowest level since 1964. In young women, the smoking rate has decreased 17 percent since 1974. (World Smoking and Health magazine editorial, Autumn 1980). 4. Are smokers different from nonsmokers? TIEX 0007594 Some researchers conclude that smokers., in general, have behavior patterns different from nonsmokers. Smokers tend to be more
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ON"TOBACCO - page two communicative, creative, energetic and assertive. They marry more often, move more often, more often change jobs, prefer spicier and saltier foods and participate more in sports. As children they were more likely to have been independent. As adults they are more outgoing -- living, so to speak, in "over- drive," more aware of what two physician researchers have called a "paucity of time itself." (Cigarette Controversy, p. 9; independent children, 1969 Cig. Controv., p. 30; Continuing Controversy, p. 124) 5. Did the Surgeon General's report establish that smoking causes cancer and other diseases? No. The report -- acutally that of the Advisory Committee to the Surgeon General on Smoking and Health -- did not establish cause-and-effect relationships between cigarette smoking and any Any about "causality" disease or condition. I~ conclusions///~//c/~i~/~J/~i~F, were the "considered oiudament of the Committee. " '~dX~/d/~,~t{~/./'/ Essentially a study of numbers, the 1964 report was a selective review of population studies comparing disease rates among smokers, nonsmokers and ex-smokers. It stated clearly that "statistical methods cannot establish proof of a causal relation- ship in an association." (SGAC, pp. 19, 20) 6. What are some of the questions left unanswered by the 1964 report and others issued since then in Washington? Now, as in 1964, there are reported statistical relationships between smoking and certain health problems, and a number of suggestions about cause-and-effect~ but no definitive and final answers in the smoking controversy. What, for example, causes heart disease, lung cancer and other diseases related statistically TIEX 0007595
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O~t TOBACCO - page three to smoking -- in nonsmokers? If it is true that cigarette smoking is the major cause of lung cancer, why do the vast majority of "heavy" smokers never develop the disease? Why haven't scientists been able to identify any one or combination of the thousands of components found in cigarette smoke as the cause of any human disease? (Continuing Controversy, p. l) 7. But in light of other evidence, how can anyone insist that a causal connection has not been proven in lung cancer? Because at least three factors raise serious questions about any such conclusion. o What some have called an epidemic of lung cancer in this century -- created largely by important diagnostic advances and perhaps more apparent than real -- can't be satisfactorily explained by cigarette consumption patterns, here or in other countries. o With changes in diagnostic capabilities and international tumor classifications have come reports of an increasing proportion of a kind of lung cancer not generally associated with cigarette smoking. o Science has been unable in more than 40 years of research to produce lung cancer in laboratory animals with tobacco smoke inhalation. (Continuing Controversy, pp. 8-9, 87-99). TIEX 0007596 8. What about heart disease? In early 1981, a past president of the American Heart Association said it best when he told a New York reporter,. We have yet to uncover what causes atherosclerosis, responsible for heart attack and stroke. " (Newsday, 3/1/81)
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ONTOBACCO - page four ........... ~ discussing smoking and cardiovascular disease, ~td//~f~¢~MY~Y~F~fFJ' In January 1981,/the Surgeon General's n~est report /~/~~/~/~/~/~/~//~//~s/~//~hz~./ pointed out that "correlation is not synonymous with causation. " (SG '79, p. 4-65) Many scientists consider cigarette smoking a CHD risk factor, that is, an element or characteristic found in common, singly or in combination with other variables, in a number of persons developing CHD symptoms. A 30-year study of the population of Framingham, Mass., one of thebest known projects on heart disease, identified as CHD risk factors elevated cholesterol and blood pressure, smoking and obesity. Yet the director of that study wrote recently of the "skepticism about the role of risk factors in cardiovascular disease and the preventive and therapeutic efficacy of modifying them." (Continuing Contreversy, pp. fig, 132) Responsible scientists do not regard risk factors as causes, and do not believe that their elimination will necessarily prevent illness. 9. Have scientists determined the cause of emphysema? No. Emphysema, which makes breathing difficult, is a kind of lung damage typically found in older persons. Researchers ponder whether, among other things, it might be caused by inhaling some substance, whether it might result from some blood circulation occupational exposure, l~ng structure ~bnormalities, childhood diseases, adult infection or difficulty, and what role/genetics .may play in its development. Despite speculation that smoking is involved, the .Surgeon General noted in 19~i that "it is uncertain which of the many ingredients in cigarette smoke has a role in production of chronic obstructive lung disease" -- to which might be added if anX, since science - TIEX 0007597
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OF..TOBACCO page five has been unable to duplicate emphysema in animals with long-term inhalation of cigarette smoke. (Cigarette Controversy, p. 3; B&w book, paras 173-190; SG '81, pp. 135 and 142) I0. What are tar and nicotine? Nicotine, a colorless substance found in tobacco leaves and smoke, is eliminated from the blood rapidly. There is little cumulative effect. By the time the cigarette is finished much of the nicotine is already metabolized. Tar is the solid matter, minus water and nicotine, collected by super-cooling and condensing tobacco smoke under special laboratory conditions. This method of producing tar has little to do with the way cigarettes are smoked. (On Smoking, pp. 2-3) ii. Are cigarettes with low tar and nicotine "safer"? Despite all the research that has been done over the years, no one has demonstrated that milligram numbers have any health significance. Many varieties of low tar-nicotine cigarettes are now on the market in response to consumer preference trends. In 1980, the average cigarette sold in the U.S. yielded less than 14 mgs tar, a level generally categorized as low tar. (On Smoking, p. 7; TTO, 2/81, p. l) 12. Hasn't carbon monoxide [CO) in cigarette smoke been implicated in heart disease? TIEX 0007598 Some do believe it might explain the statistical association between cigarettes and CHD. A tasteless, colorless, odorless gas produced by many natural and man-made sources, it has been shown,
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O~°TOBACCO - page six in large amounts, to decrease the supply of oxygen to the heart muscle. However, it has never, in the levels found in cigarette smoke, been demonstrated to cause heart or any other human disease. The 1981 Surgeon General's report pointed out that "judgments" on the role of CO in heart disease "are based on scanty information." (Continuing Controversy, p. 127; SG '81, p. 123) 13. Does tobacco smoke endanger nonsmokers? It can certainly annoy some people from time to time, but there is no convincing evidence that tobacco smoke causes disease in non- smokers. In fact, the 1979 Surgeon General's Report, the last to consider the subject, states explicitly, "Healthy nonsmokers exp6sed to cigarette smoke have little or no physiologic response to the smoke, and what response does occur may be due to psycho- logical factors." The report further says "The existence of a tobacco smoke allergy in humans is unproven." Studies on this question continue but have not confirmed that tobacco smoke presents disease~risks for nonsmokers. (SG '79, p. 11-28 and p. 10-5) 14. What is the tobacco industry doing to help resolve the smoking and health controversy? So far, the tobacco industry has committed more than $91 million for independent research on smoking and health questions~ In many years, industry awards exceeded that 6f any government department. They have always far exceeded the smoking and health research funding of all voluntary health associations, which regularly spend more of their donated funds for administration and public relations campaigns than for research. The tobacco industry TIEX 0007599
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0i4'TOBACCO - page seven remains committed to advancing scientific inquiry into the gaps in knowledge in the smoking controversy.(S~H Research- Fiscal laB0; Tobacco Industry Research on S&H) 15. Do the tobacco companies control the research they sponsor? Absolutely not. Their research grants are based on judgments by independent scientific advisors. Awards are made with no strings attached and each researcher is urged to publish study results, whatever they may be. (Tobacco Industry R~search on S&H) 16. What is the economic contribution of tobacco? The tobacco industry contributes mightily to the U.S. economy. ' Leaf is grown in 20 states on an estimated 276 000 farms. It is the sixth largest U.S. cash crop. The U.S. is also the leading exporter of tobacco and the third largest tobacco importer. The result is a positive net contribution of more than $1.7 billion per year to the U.S. international balance of payments. Americans spent $21 billion for tobacco products in 1980. (USDA reports; Tobacco Industry Profile 1980) 17. What's the effect of tobacco taxes? Federal, state and local governments realize some $6.5 billion annually in direct taxes on tobacco products, helping to pay for such things as road building and school lunch programs. The U.S. Treasury collects 8 cents on every pack sold, individual states from 2 to 21 cents and at least 369 municipalities from 1 to i0 cents. Since the first federal tax on tobacco in 1863, nearly $138 billion has been collected by all levels of government. TIEX 0007600
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OF! TOBACCO - page eight Tobacco is the most heavily taxed consumer product. (AGL Natl edition, p. 8; Tobacco Tax Council) The roughly 400,000 persons employed in all phases of tobacco and their employers and essential suppliers also pay taxes.(AaL Natl., p. 2) According to a pioneering industry study by the University of Pennsylvania's Wharton Applied Research Center in 1979, tobacco and its ripple effects generate ~22 billion a year in taxes• The federal share is more than $14 billion, paid in personal and cor- porate income, social security and other taxes. Total state and municipal taxes, including sales and property taxes, is more than $7 billion. More than half of tobacco's contribution to tax collections results from ripple effects, as industry employees, their bosses and major suppliers buy the goods and services of other, nontobacco, industries. (AGL Natl., pp. 8-9) 18. What is the tobacco subsidy? There is no tobacco subsidy program. There is a tobacco price support program, which limits the amount of tobacco grown domestically and insures farmers a fair return on their investments. Money expended under the program isn't a gift. It's a loan from the federal government, repaid with interest. Similar programs exist for 12 other commodities grown in this country. Unlike most other agricultural price support programs, however, in most years the tobacco program repays the government more than the farmers have borrowed. In its 47 years of existence -- with TIEX 0007601
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ON',TOBACCO - page nine loans totaling about $5 billion --the program has produced a net loss to taxpayers of approsimately $56.7 million, or about one tenth of one percent of all losses for all commodity price support programs. While losing the $57 million, the government has collected $72 billion in the cigarette tax alone. (USDA reports; there is no Tobacco Subsidy) 19. Does cigarette advertising cause young people to start smoking? As one knowledgeable government official has said, "Advertising is certainly not the culprit." Cigarette advertising is brand advertising. Its purpose and, more significantly, its effect is to divide the already existing market by promoting brand identi- fication and loyalty among individuals who are smokers. Research on the initiation of smoking among young people reveals complex psychological, cultural and socioeconomic factors. No one favors smoking by young people. Smoking is an adult custom to be decided by adults based on a mature and informed individual freedom of choice. (John Pinney, quoted in 4/81 TTO Q&A, also in ICOSI briefing paper, Adv. Restrictions Do Not Have the Intended Effects, p. MlO) 20. What motivates anti-smoking groups? Despite health warnings that have appeared on all cigarette pack- ages for many years, a small number of persons remain dedicated to prohibition of smoking. In the 1950s and 60s, their attack was against a tobacco product -- cigarettes -- and led to the package warning label and other restrictions. Now it is the users of the product who are the targets as the anti-smokers attempt to subject them to public disapproval and ridicule. TIEX 0007602
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0~7OBACCO - page ten The anti-smokers -- a smsll minoritv of the nonsmokers -- lobby for laws to restrict the use of tobacco, seeking to convert a custom into a crime. 21. Are the tobacco companies preparing to market marijuana if it's le~lized? No! Logic alone would demonstrate that cigarette makers, already faced with a controversy involving a fully legal product, would not enter an area with the legal and ethical sensitivities of marijuana. Despite rumors to the contrary, the companies do not own land on which to grow marijuana. Nor have they registered any marijuana trade names, such as "Acapulco Gold". The Tobacco Institute recognizes that there are differences of opinion concerning smoking and health. This booklet is presented in the belief that full, free and informed discussion of the smoking and health controversy is in the public interest, and in the conviction that the controversy must be resolved by scientific research. The Tobacco Institute 1875 I Street, ~./~/v/ ~o~thwe~t Washington, D.C. 20006 TTEX 0007603
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I).$. Cigrette Consumption, 1900 Date Per Pal' Capita Capita Billions 18 Year $oid Over Year Sold Over 1900 2.5 54 1 ~00 369.8 3.552 01 2.5 53 51 397.1 3,744 02 2.8 60 52 416o0 3,886 03 3.1 54 53 408.2 3,778 04 3.3 66 54 387.0 3,546 05 3.6 70 55 396.4 3,597 05 4.5 ; 86 56 406.5 3,650 07 5.3 99 57 422.5 3,755 08 5.7" 105 58 448.9 3,953 09 7.0 125 59 467.5 4,073 1910 8,6 ' 151 1960 484.4 4,171 11 "10.1 173 61 502.5 4.266 • 12 13.2 223 62 508.4 4,266 13 15~ 260 63 523.9 4,345 14 18.5 267 64 511~ 4,194 15 17.9 285 65 528.8 4,258 16 252 395 66 541.3 4,267 17 35.7 . 551 67 549.3 4,280 / 18 45,6 697 68 545.6 4,186 / 19 48.0 727 89 528.9 3,993 / 1920 44.6 665 1970 536,5 3,985 !' 21 50.7 742 71 555.1 4,037 / 22 53.4 770 72 566.8 4,043 23 64.4 911 73 589.7 4,145 24 71J) 982 74 599.0 4,141 25 79.8 1,085 75 807~ 4,123 26 89.1 1,191 76 613.5 4,092 27 97-q 1~/9 77 617.0 4,051 28 106.0 1,386 78 616.0 3,967 29 118.6 1~04 79 621.5 3,861 1930 119.3 1,485 19~0 531.5 3,851 31 114.0 1,399 81 640.0 3,840 32 102.8 1 ~45 82 634.0 3,746 33 111.6 1,334 83 600.0 3,494 34 125.7 1,4~3 84" 593.0 3,411 35 134.4 1,564 37 1~,8 1~47 38 153.4 1,830 38 172.1 1,900 1940 181.9 1~76 44 296.3 3,039 45 340.6 3,449 46 344.3 3,446 47 345.4 3,416 ';'~-~ l~e l'ob~©o In~|ltute 49 360.9 3,480 ~t~_~ Washington, DC 20006 TIMN 0053661 TIEX 0007604
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ADULT USE OF TOBACCO - 1975 .J T~LES U.$. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEAI.TH SERVICE CENTER FOR DISEASE ~ONTROL ATLANTA, GEORGIA TINIIN 0076106 ~' ........ TIEX 0007605 .........
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TABLES PAGE I. Demographic Data Age I-I Marital Status I-2 ~ Educational Level I-3 Occupation of Respondent Male I-4 • Female I-5 Respondent as Head of House I-6 Occupatlon of Head of House Male I-7 Female I-8 Income l-g II. Attitudes Smoking as Cause of Disease II-I Teachers as Examples If-2 Luck or Fate II-3 Public Knowledge of Smoking and Health II-4 Clgaretie Advertising II-5 Take Things as They Come II-6 Cigarettes Ha~ul to Health II-7 Health Professionals as Examples 11-8 Success and Fate 11-9 Safer Cigarette II-10 Smoking Allowed in Fewer Places II-ll Money for a Rainy Day II-12 Smoking as Health Hazard II-13 Doctors as Examples II-14 ~et Ahead tn Life by Good Luck II-15 Problem of Smoking and Health a Minor One II-16 Annoying to be Near a Person Smoking II-17 Fear of Gaining Weight II-18 Factor Scores II-Ig Smoking and Health II-I0 Remedial Action - General II-21 Remedla] Action - Exemplars II-22 Remedial Action - Setting Limits II-23 • Present vs. Future Orientation II-24 Falmlistlc vs. Control Orientation II-25 7"0C19554 " ", : TIMN 0076107 TIEX 0007606
Page 21: CBP09606
PAG£ Va 1 ues Good Faml~y Life vs. Health Able to do What You Want vs. Good Friends II-2l Health vs. Good Friends Able to do What You Want vs. HeaIth II-29 Work You Care About vs. ~ood Friends II-30 No Money Worries vs. Health II-31 Able to do What You Want vs. No Money Worries II-32 Work You Care About vs. Health II-33 Enjoying Life vs. Good Family Life II-34 Work You Care About vs. No Money Worries II-35 Health vs. Enjoying Life I1-38 "Health" Value Score II-37 Concern About Effect of Smoking on Hea|thII-38 Hazards of Different Cigarettes II-3g Comparative Hazard of Your Cigarette II-40 Doctor's Advice on Smoking IS-41 Government Regulations re Cigarette Smoking II-42 Managemen¢'s Right to Prohibit Smoking II-43 Annoying Effect of Cigarette Smoking, Compared with Cigar Smoking II-44 Pipe Smoking II-4B Dr1 nkt ng A1 coholt c Beverages I 1-46 Cracking Knuckles II-47 Chewing Gum II-48 ghlstllng or Humatng II-4g Ill. Perception Adults Who are Cigarette Smokers III-1 Adul~s Who Never Smoked III-2 Adults Who Have Stopped Smoking III-3 Famlly Doctor I1%-4 Heal th I I I Coronary Heart Disease Lung Cancer III-6 Emphysema SIS-6 IV. History. Age Started Smoklng IV-I Attempts to Stop Smoking IV-2 Easy Way to Stop IV-3 Attempts to. Cut Down IV-4 Possibility of Smoking F~ve Years from Now IV-5 ,, _; TI1VIM 0076105 .... - .... TIEX 0007607
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Number of Dtgarettes a Day - Heaviest Period ZV-6 Length of Time a Cigarette Smoker IV-7 Length of Time Since Stopped Smoking IV-8 Pack Years Number of Years Smoked F11ter Cigarettes IV-t0 V. Dosage • How Deeply Inhale V-I How Often Inhale How Far Burned V-3 How Much Burned Without Smoklng V-4 Average Number of Cigarettes per Day V-5 Type of Cigarette ~le V-6 Female Buy by the Pack or Carton V-8 VI. Other Forms Snuff Vl-I Che~tng Tobacco VI-2 Ctga~s VI-3 When Stopped Smok|ng Ctgars VI~ Ptpe VI-G When Stopped Smoking Pipe VI-6 VII. Changes Change to Cigars VII-I Change to Pipe VII-2 Chan~ a~unt of Clgaretta Smk¢ VII-3 Change H~ch Inhal~ Vll-4 Change Brand of Clga~ette VII-G Type Changed to Male VII-6 Female .VII-7 How Long Smoke Brand Changed to VII-8 TIMN 0076109 .............. TIEX 0007608 ..
Page 23: CBP09608
I DEMOGRAPHIC DATA "T00~.955~ TIMN 0076110 - ........ " ............. TIEX 0007609 -
Page 24: CBP09609
1~tspoudenc~ • ASe MALE l~Wg~ I~.R FOUR CUllR~ T~T~L 21 - 2~ 280 15.~ 37~ 9.6 105 6.3 271 12.1 6~ " 25 - 3~ * ~8 35.0 885 22.6 300 lS.0 58~ 2~,Z 1333 35 - ~ 273 ~.2 737 18.9 261 1~.7 ~76 21.2 1010' 17.7 ~ &5 - 54 2~0 13.~ 810 20.7 378 ~.7 ~32 19.3 L0~0 55 - 6~ 231 ~.9 607 ~.~ 325 19.~ 282 12.6 838 1~.7 65 & 0~ 323 1~.0 ~92 12.6 295 17.8 197 8.8 8~ 16.3 ~ 1795 100.1 3907 99,9 IGGA 100.0 22~3 100.1 5702 100.0 ~ ~vP.~ FOII~ER C~tKEXT TOTAL 21 - 24 373 10.~ 292 I0.6 66 7.2 226 12.4 665 10.5 2.5 - 3t, 657 18.4 708 25.8 225 26.3 ~83 2~.6 1365 21.6 35 - ~, 488 13.6 575 20.9 188 20,$ 387 21.2 1063 16.8 45 - 54 ~83 16.3 543 19.8 174 19.0 369 20.2 1126 17.8 55 o 64 $$3 15.4 38~ 14.0 lt,1 15./, 243 13.3 937 16.8 55 & Owr 93,6 25.9 265 8,~ ~ 13,6 120 6.6 1171 18.5 ¢OCAX, R, ~ F,~(' 3580 100.0 2767 100.0 919 100.0 1828 100.1 6327 100.0 t- 1 TI1VIN 0076111 "" TIEX 0007610
Page 25: CBP09610
1311 73,1 3110 79,~ 1~18 85,2 169~ 7~.~ ~21 77.5 62 3,3 109 2.8 ~$ • 2,9 61 2.7 171 &7 2,6 170 &,4 44 2,6 ~26 5.6 217 3,8 18 2.0 88 2.3 20 ~.2 68 3,0 106 1.9 356 19,9 ~17 10.7 ~7 7,6 290. 12.9 773 13,6 1 0.1 ~ 0.3 7 0.~ S 0,3 1~ 0,2 1795 ~.2 3907 100.1 166& 99.9 22~3 99,9 5702 100,0 2534 70.8 3.967 71.7 691 7~5,3 1276 69,8 4501 71,2 578 16.1 ~ g.S g8 10.7 162 8.9 838 13.2 ~ 3.1 21~ 7.8 SO 5.4 16~ 9.0 326 5.2 ~ 1.7 1~ 3.6 ~ 2.3 79 &,3 160 2.~ 273 7.6 201 7.3 56 6.0 145 7,9 474 23 0.6 S 0,2 ~ 0,3 2 0.1 .28 O.& 35~ ~g,9 27&7 1~,~ 919 I~,0 1828 100,0 6327 100,0 TIEX 0007611
Page 26: CBP09611
t~Lf Grade school on lesm 228 12.7 492 12.6 223 13,4 269 12.0 720 12,6 So-,- h~sh school 238 13.3 663 17.0 232 13.9 431 19.2 901 15.8 Hiih school j~adu~ts 450 25.1 1280 32.8 ~91 29.5 789 35.2 1730 30.3 So~ ~ollsge 378 ~.1 755 19.3 3~6 20.B ~09 18,2 1133 19,9 no de~ee 236 13.1 3~6 8,9 182 10.9 154 7,3 582 10.2 9os~ ~aduata ~ee 251 14.0 363 8.8 177 10.6 166 7.4 59~ 10.4 Un~ 8 0.A 8 0.2 A 0.2 A 0.2 ~F 0,3 N.A. 6 0.3 20 0.5 9 0.5 11 0.5 2~ 0,5 ~ 1795 100.0 ~907 100.1 166A 99.8 22~3 100.0 57~2 100.0 Grade school or Zess 584 16.3 218 7.9 72 7.8 146 8.0 802 12.7 Som~ h~gh 8chooi 605 16.9 556 20.3 171 18.6 385 21,1 1161 18.4 ~£~h g~hool ~adua~e 1261 ~5.2 1066 38.8 323 35.2 743 40.7 2327 35.8 $~ colle&e 588 16.4 547 19,9 181 19.7 366 20.~ 1135 17,9 ~ ~e~e 29~ 8.2 i~7 7.1 90 ~.8 107 5.8 ~91 7.8 Pose K¢ad~£e de~e 209 5.8 148 5,4 76 8.2 72 3.9 357 5.6 ~ I~ 0,~ 5 0.2 I 0.1 ~ 0.2 19 ~.3 ~. A. 25 0.7 i0 0.~ 5 0.5 5 0.3 35 0.5 ~ 3580 99.9 27~7 100.0 91% 99.9 1828 100.0 6327 100.1 ..... TIMN 0076113 39181/93 p-Io3 , z - 3 " 7"0~1:95G0 TIEX 0007612
Page 27: CBP09612
& kJ,.~dz~d vo:ke~.s ~37 18,8 5&2 13.9 26~ 2~.1 274 12.2 879 15 & ?~p~:eco~s ~ i0.8 563 14.4 265 1~.9 298 13.3 757 Sales ~e~ 71 4.0 178 4.6 74 &.~ 104 4,6 249 4.& & k~drld ~cka~ 28~ I+.0 ~3 ~Q.S 298 17.9 SOS 22.5 ~091 Lg.L Ope~s & ~ndrsd ~:8 142 7.9 ~38 ~.2 134 8.0 ~ 13.6 580 lO.Z ~ozers, oChe: cK~ P~ +Z 2.3 ~S 3.2 33 2.0 92 +,L 167 2.9 Se~ 66 3.7 72 1.9 26 1.6 ~6 2.1 1~ 2.~ ~e~loyed ~o~ =e~d) 57 3.2 ~9 3.3 ~ 1.8 ~9 4.~ 1~6 ~.] ~l~O & ~nd~4 vo~e~ 31 1.7 ~ 1.2 26 1.6 20 0.9 77 Y~e s F~ ~p~26 1.~ 2S 0.7 16 1.0 10 0.4 ~2 0.9 & +~r+ecn~ 31 1.7 69 1.8 47 2.8 22 1.0 100 1.8 ~e~L~ • k~nd~d ~ ~ O,S ~ 0.6 ~ 0.~ 10 0.~ ~0 0,7 ~ ~ 18 LO 27 0,7 19 1.1 8 0.~ 45 0.8 Cc~, Fondu & k~d~ ~*~ 53 3.0 ~A 3.2 65 3.9 59 2.6 277 3.1 ~t~a & ~d ~, 29 1.1 59 1.~ ~ 1.8 29 1.3 78 ?~vst, R~ld ~s 0 O.O 0 0.0 0 0.0 0 0.0 0 0.0 O~er SaUce ~ ~ 0.7 21 0.5 16 1.0 5 0.2 3~ 0.6 Ys~ ~o~ & Fo~u S 0.3 3 0.1 2 0.1 I t 8 0.1 ~o~:s, o~ t~ ~a~ 9 0.5 iS 0.6 ~ 0.2 12 0.5 2~ 0,4 ~.A. {~cL~d) 33 1.8 38 1.0 16 1.0 ~ 1.0 71 1.2 • .A. sS 3.6 ~ 1.2 64 3.S 62 2.8 191 3.3 ~ 1795 ~.9 3~7 100.0 i66& 99.9 2263 100.0 ~702 100,0
Page 28: CBP09613
35183/92 ~hac £o you~ FF3~t.E & ~nd~ed ~rke~ 3&1 9.5 26~ 9.8 112 ~2.2 ~6 8.5 609 9.6 F~:s a ~a~ ~Ee~s 10 0,3 5 0.~ 2 O.Z 3 0.2 Z5 0,2 ~aSe=S, Off£ci~s a P:op~e:o:: 91 2.5 117 6.~ 31 3.~ 86 4.7 208 3.3 C1~:1~ i k:d,d ~mn 3~8 9.7 393 16.3 1~0 10.9 293 16.0 741 S~us vo~, 56 1.5 49 L.S 16 1.5 35 1.9 103 ~ k~ndmd eo~e~ 65 1.3 36 ~.3 ~ 1.3 ~& 1.3 81 Ope~s~ & k~d~ed vo~tn ~2 4.2 1~ ~.0 ~ 3.3 79 6.3 261 ~.1 P~vate Ho~ehold ~en ~6 1.3 19 0.7 2 0.2 17 0.9 65 ~.0 Oc~ Se~ce ~=kers 191 5.3 177 6.4 ~ 5.2 129 7.1 368 5.8 ~o~t ocher ~ Ya~ ~ O.a 10 0.4 1 0.2 9 0.~ 25 ~cudenc S5 ~.S ~ 1.3 ~ 1.3 24 1.3 91 ~t 1801 50.3 U37 45.1 ~19 ~5.6 818 ~.8 ~38 ~mZ~ed ~o~ ~c1~) ~ 2.6 83 3.0 18 2.0 6~ 3.6 177 2.8 Y~ & Yl~ ~p~ ~ 002 0 000 0 0.0 0 0.0 6 ~,~ E P~cors 17 O.S 21 0.8 11 1.2 10 0.5 38 0.6 Cle~ & k£~d ~n 51 l.& ~ 1.2 Z7 1.9 17 0,9 85 1.3 Silos ~:8 l~ 0.4 & 0.1 3 0.3 1 0.1 20 0.3 & k~d ~m~ 6 0.2 & 0.1 3 0.3 1 0.1 10 0.2 P~a~e R~d ~ 17 0.5 5 0.2 4 0.3 1 0.1 22 0.3 O~her Se~£~ ~ ~ 0.6 ~ 0.5 2 0.2 ~ 0.6 3G 0.6 ~am ~o~s $ Fo~ ~ 0.1 1 * 1 0,1 0 0,0 5 ~T~ 35~ 99.9 2747 1~.1 ~19 99.8 1828 100.1 6327 99.8 TIEX 0007614
Page 29: CBP09614
Ten 1532 85.3 3599 92.1 1569 9~.3 2030 90.5 5132 90.0 go 2~7 13.8 285 7,3 88 5,3 197 8°8 532 9,3 X, A,16 0.~ 23 0.6 7 0.4 16 0.7 3~ 0,7 TOZ, AL 1795 I00.0 3907 I~0.0 16¢~ 100.0 2263 100.0 5702 100.0 FE~L[ TeJ • ~0 31.8 797 2g.0 2~1 ~6.3 ~56 30.~ 1S~7 30.6 No 2403 67.1 1928 ~.2 673 73.2 12~5 68.7 ~331 ~8.~ g.A. " 37 1.~ 22 0.8 5 0.5 17 0.9 5~ 0.9 ~ 3580 1~.0 27~7 2~.0 919 100.0 1828 100.0 6327 TIMN 0076116 ~ • ...................... ..~. TIEX 0007615
Page 30: CBP09615
K4LE ~l~r~ ~d ?I~ ~gers 93 5.2 122 3.1 67 ~.0 ~ 2.~ Zl~ 3.8 E ?~opr~stots 206 11.~ 574 14.7 ~6~ 16.0 308 13.7 7SO 13.7 S~Ii ~:~l:l 69 3.8 ~79 4,G 76 4,S 103 4.6 248 4.3 & k~od:sd ~ck*~ 300 16,7 810 20.7 297 17.8 513 22.9 1110 19.5 P~Co Ho~ehold ~ 6 0.3 3 0.1 2 0.~ Z * Och,~ Se~em ~mtu 80 4.5 ~8 ~.0 71 ~.3 87 3.9 238 4.2 ?s~ L~or.~r~ & Fondu 8 0,4 ~ O,A S 0.5 7 0,3 23 0,4 ~o~l~l, o~l~ c~ Ys~ 36 2.0 ~9 3.0 33 2.0 86 3.8 155 2.7 Student 22 1.2 50 1.3 L7 1.0 33 L.~ 72 1.3 ~e~Zoye4 (not ~e~d) 32 1.8 10~ 2.7 2B 1+7 76 3.~ 136 2.~ ~T1~D & ~adted ~zke~ 31 L.7 47 1,2 27 1.7 20 O.g 78 F~n ~d Y~ ~le~ 29 1.6 29 0,7 ~ 0,9 ~ O,& & P~p~aC~s 30 1.7 69 1.8 47 - 2,8 22 1.0 99 Cle~ & ~ud:ed ~c~ 19 1.1 22 0.6 13 0.8 9 0.4 ~1 0.7 S~e~ uor~r~ 16 0.9 27 0,7 19 1.1 S 0.4 43 0,7 & ~d~d volUteS 62 3.5 ~5 3.2 67 4.0 58 2.6 187 3.3 P~c~ ff~ehold vo~:u 1 O.Z 2 0.1 1 0.1 I * 3 OC~r Se~cs ~ 11 0.6 24 0.6 17 1.0 7 0.3 ~5 0.6 La~o:ers, oCh*r c~ +s~ 9 0.~ 1+ 0.+ ~ 0.2 10 0.+ 23 0.+ D.X. (~c+:*d) I 0.1 ~ 0.1 2 0.1 2 0.1 ~.A. (~c~=,d) 30 1.7 38 ~.0 16 1.0 ~ 1.0 68 1.2 D.L 8 0.4 22 0.5 7 0.; i4 0.6 29 0..~ N,A. 82 ~.6 ~5 ~,0 68 &.l 87 3.9 ~7 ~T~ 1795 100.1 3907 100.1 166& 100,0 2243 I00,0 5702 100.1 , 0076117
Page 31: CBP09616
ACTIVE ~ E',rE~, LeOlU4]~ ~ "~TAL & ItJJ~d:ed v~zl~:8 46? 13.0 401 14.6 163 17.8 2~8 :3.0 860 1.3.7 & P:apz-.Y.e Corn 33~ ~).3 363 13.2 i33 2.4.5 230 Z2.6 695 LLoO C~.e~.~-.~. A k~"d=ed yonkers ~92 $.4 :~05 7.$ .5~ 6.3 147 8.0 3~7 6.3 $_~!_~_~ v~rk~e 122 3,4 117 6.3 4.3 4..7 74. /.ol 239 3,8 ~ k~dzsd vovke~8 4~6 12.7 371 ~,.$ ).10 12.0 26;. 14,3 827 13.1 Ops:a~ves & 1~md=ld vo~ks=s 289 8.1 271 9.9 74 8.1 197 10.8 56(3 Pt~.vacs Household voC~,r~z's 28 O,8 1.7 0.6 , O 0,0 1.7 0,9 45 0.7 Ot~ar Se~.c8 wrke:o 1~ 4.1 154 $.6 4.2 4..6 I/2 6.1 3~ ~.7 74r~ Labor~-s & Fo:a~en i(] 0.3 9 0.3 1 0.1 8 0.~, 19 0.3 l~bot~:S, ocho'~ Ch,,~ Wa~m 84 2.3 ~0 2.2 16 1.7 4J~ 2,& 1~ 2.3 SC-,~-uc ~0 0,8 30 1ol 10 1.1 20 1.1 60 Hotwe~.~o &65 1.3o0 220 8.0 68 7.4 ~52 8.3 685 1.0.$ Unemplcr~d (~o~' :ett:ed) ~1.6 3.2 88 ].2 22 2,4 66 3.6 204 3.2 & k.~Jsdrod uuz~r~j 105 2oP 2S 1.0 16 1.,5 14 0.9 133 2.1 & Pz'opt'~oocozo 64 L.8 $3 1.9 26 2.6 29 1.6 1t7 1.8 Cle=*r.sL ~ Ic~d~ed vorka~8 55 ;,.$ 28 1,0 1,1 ~.4 1,5 0.8 83 1.3 Soles ~,o~'ke=s 33 0.9 2~ 0,9 14 1.$ 11 0.6 ~8 & ~4,~l~sd varka~"a 94 2,6 63 2,3 20 2,2 &3 2,4 1.57 2,5 Oper~sti~s k k:Lud=~d vo=.ka~,~ 49 1.4 20 0.7 7 0,8 13 0,7 59 L't~.~es ~ld VOL'~r~ 13 0.6 4 0.1 2 0,2 2 0.1 17 0.3 O~l~ Sez~r4.~- v~mru 39 1.1 18 0.7 6 0.7 !2 0.7 :57 0°9 F&m Lsbo:e~s & Yoreuml 7 0.2 0 0,0 0 0,0 0 0.0 7 0,1 ~ox.t=s, o~.h~r r~m 7az~ I0 0.3 7 0.$ i 0.1 6 0.3 17 0.3 D.~. (]~tc~.~td) $ 0.1 4 0.1 0 0.0 ~ o.2 .9 0.1 o.l(. 1,5 0.4 1.~ 0.5 2 0.2 1:3 0.7 30 ~.A, 1~0 4,2 10~ 3.9 52 5.7 56 .~.1 230 4..0 ~ 3580 99.9 27&7 99.8 91.9 1.00,1 1628 99.9 6327 " O. 4.~/87199 q. 35/831~2 Wh~c :1~ your ~.~ ~ m~gve: Co 36~8&195 m "t~o" ~ m~' Co 37/8q194 vs~ ~ed J.~ cb~s TIEX 0007617
Page 32: CBP09617
$3,000 105 $.8 182 4.7 6~, 3.8 118 5.3 2~7 ~.0 S3,~O0 - $~.999 117 ~.~ 2~1 6.~ 90 ~.~ 1~1 7.2 368 6.3 ~,000 * ~7,~99 183 i0,2 301 7.7 ZOZ 6.1 199 8.9 ~8~ 8.5 ~7,~0 - ~9,999 18~ 10.3 ~79 i2.3 171 10.3 308 13.7 ~ 11.6 $I0,0~ - ~14~999 ~19 23.3 909 23.3 ~OO 24.0 ~09 22.7 1328 23.3 ~l~,O00 - ~19,999 27~ 15.3 681 17.4 2~ 17.8 385 17.2 956 16.8 ~20,0~ ~d ~r 3~ 19.8 ~0 20.5 3g~ 23.8 ~ 18,0 1135 20.3 ~u~ed 82 4.6 180 7~ ~.1 ~4 3.1 55 3.3 69 3.1 198 3.~ ~ 1795 99.9 390? 1~.0 ~64 99.9 2263 100.1 5702 i00.~ ~e= $3,~0 393 ~.0 190 6.9 52 5.7 1~ 7.6 583 9.2 ~,O~ - ~4,999 3~8 10.3 202 7.3 52 ~.6 1~0 8.2 ~70 9.0 ~S~O~ - ~7,699 3~ 8.~ 246 9.0 % 10.2 ~2 8.3 ~64 8.9 ~7,~ - ~9,999 ~18 ~.7 32~ 11.8 9~ 10.2 231 ~.~ 7~3 11.7 $10,0~ - ~1t,99~ S~ "17.2 553 20.1 202 22.0 351 ~:0~ - ~19,999 3~ 10.8 383 1~.0 ~7 ~.8 2~6 1~.0 769 12.2 820,000 ~ ~: ~ 10.2 ~7 16,3 171 18.5 276 1~1 8~ 12.9 ~ed 2~ 6.9 1~ ~.0 61 6.6 103 5.6 410 6 D. [, &70 ~.i 237 8,6 66 7.1 ~71 9,& 707 ~.2 ~ ~ ~.~ 27&7 ~00.0 929 99.7 ~028 TIMN 0076119 TIEX 0007618
Page 33: CBP09618
II ATTITUDES "7"0019567 TIMN 0076120 TIEX 0007619
Page 34: CBP09619
S~ons~ ~Sree ~209 67.~ ~89~ ~8.~ i~3 66.9 78~ ~.7 3103 ~.~ ~7 ague 363 20.2 ~5 28.8 343 20,6 782 34.9 1488 ~o opin~/n. X. iS" 5.3 2~ 5.5 67 ~.0 1~6 6.~ 308 ~,~ ~1~1~ 4~sa~ee 82 4.6 398 10.2 80 4.8 318 14.2 ~80 8.~ SCraWly d£saSret 42 2.3 2~8 6.6 55 3.3 203 9.1 300 ~, A, ~ 0.2 19 O.S 8 0.~ ~ 0.6 23 0.~ ~ 1795 100,0 3907 100.0 166~ 1~.0 22~3 100.0 5702 100.~ 25~ 71.0 1355 69.& 672 73.1 ~83 37.~ 3~99 61.6 59P 16,7 780 28,& 1&7 14.0 633 ~.6 ~79 21.8 169 &,7 ~6 5,7 36 3.9 ~0 6,6 325 167 *.7 28~ 10,3 W 5.3 235 12.9 A51 7.1 99 2,8 169 6,2 ~ 1.6 ~& 8.~ 268 2 0.1 3 0.1 0 0.0 3 0.2 5 35~ 1~.0 2747 1~,1 919 99.9 1828 100.2 6327 100.0 Q. ,b ~.=o~ "7"001956S =" TIMN 0076121 ................................ TIEX 0007620--
Page 35: CBP09620
Ktldly ,Stee 360 20.1 776 19.9 199 18.0 477 21.3 1136 19.9 No opinion/D. I. $3 3.0 !25 3.2 37 2.2 88 3.9 178 3.1 H£Zdly 4L~,lcr~e 162 9.0 ~37 13.7 174 10.5 363 16.2 699 12.3 StrOngly d~a&Sree 7Z ~.O 422 1Q.8 100 ~.1 ~22 I~.4 ~9~ 8.7 N.k. 5 0.] ~ 0.3 1 0.1 ~ 0.5 18 0.3 ~ 1795 100.1 3907 9%9 166~ 100.1 ~3 100.0 ~702 100.0 ~61 ~.~ ~3~ ~8,~ 72~ 39.7 3818 50.4 53~ 19.5 181 19.7 355 19.4 1100 17.4 ~S 4.3 29 3.2 go 4.9 131 3.7 463 ~6.g ~6 12.6 347 1~.0 674 10.7 $6 0.~ 7 0.8 9 0.4 2747 99.9 919 100.1 1828 99.9 6327 100.2 '~" "" " IZ - 2 TIMN 0076122 TIEX 0007621
Page 36: CBP09621
H~Yg~ EI/E~ FOIL-~ CUIU~N~ TOTAL 341 1B,9 836 21.4 313 18,9 523 23,3 1177 20.7 314 17.5 727 18.6 281 16,9 446 19,9 1041 18.3 338 18.8 663 17.0 301 18.1 362 16.1 1n01 17,~ 595 3].1 1328 3~.0 605 36.3 723 32.2 192] 33.7 8 0.~ 2~ 0.5 11 0.7 13 0.6 32 0.6 1795 99.8 3~7 100.0 166~ 100.1 22~3 99.9 5702 100,2 FEHALE I'T~VE~ ~VER ~"OR,.~,.P, CUIIR.~T TOTAL 713 19.9 646 23.5 1e3 17.8 ~83 26.~ 13~9 ~1.5 634 17,7 51~ 18.7 166 18.1 ~8 Zg,O 2148 18.1 51~ 14.4 200 7.2 70 7.~ 130 7.1 7~ 11.3 633 17.7 ~0 16.0 168 18.2 272 1~.9 1073 17,0 10~8 29.8 929 33.8 3~6 37.7 583 31.9 1997 31.6 17 0.5 lg 0.7 S 0.7 12 0.7 35 0.6 3580 100.0 27~7 99.9 919 100.1 182g 100.0 6327 100.1 TIMN 0076123 ........................... T EX 0007622-
Page 37: CBP09622
81:=m~gl), agree 6,31 2~..0 1102 28.2 t,2~ 25.5 678 30.2 1~33 25.9 H£1dZ7 a~re* 209 11.6 .48~ ~.~ 190 11.4 299 13.3 6~8 12.2 ~o op~t~/ D.K. 58 3.2 B& 2.1 30 1.8 5& 2.~ 1~2 2.5 ~ZdZy d~t~e 328 1B.3 661 16.9 305 18.3 35~ ~.g 989 17.3 st~l~ ~ 761 &=,~ ~60 39.9 713 62.8 8~7 37.8 2321 ~0,7 ~. A. 8 0.~ ~ 0.3 ~ 1795 99.9 3907 99.9 166~ 99,9 22~3 100.0 5702 99.9 , 28.2 8Q~ 29.3 Z&7 26.9 558 30.5 1816 28.7 ~.1 326 ~.8 ~t 10.2 232 12.7 759 12.0 &.& 63 2.3 . 18 2.0 &5 2.~ 220 3.~ ~,0 ~5 16.2 1~2 ~.5 303 16.6 983 ~.5 ~.9 ~7 &O.O ~ ~.Z 682 37.3 2526 39.9 0.3 ~ 0.~ 3 0.3 8 0.4 23 0,4 ~.9 27~7 1~.0 ~1~ 1~.~ 1828 1~.0 6327 100.0 ....... TIEX 0007623
Page 38: CBP09623
MALE ~f~V~R EVEE FOI~E~ Ct~ItRENT TOTAL St~onEly agree 808 ~5,0 1~3 37.4 740 ~,4 723 3~.2 22~1 39.8 ~dly xS=ee 214 ~.9 ~31 11,0 198 11.9 233 10,~ 5~ 11.3 " ~o op~/~, g, 72 ~.0 ~1 3,1 ~3 3.2 68 3.0 193 ~.~ ~l~y d~a~ 43& 2&.2 8~7 22.~ 375 22.5 502 22.G 1311 23.0 S~:on~y ~saS:es 261 14,6 ~Ol ~,6 293 17.6 708 31,6 1262 22.1 N, A. 6 0,3 1~ 0,4 3 0.3 9 0.~ 20 0,~ ~ 1795 1~.0" 3907 S9.9 15~ 99.~ 2263 100.0 57~2 100.0 nsv~t ~ tq)lMll ~ TOTAL ! I ! ! ! ! ! ! ! ! $~rou~ly aS:ee 1999 $$.9 1063 38,7 47~ $1.? $88 32.2 3062 40.4 M~l~Lly~ee 4J~ 12.4 288 10.5 99 10.8 189 10.3 732 11.~ ~o op£nl~n/D. K. 200 S.6 115 4,2 33 3.~ 82 4.5 ~15 5.0 N/idly dlsaw~ee 567 15.6 618 22.5 193 21.0 425 23,2 Ll85 18,7 8tr~nsly disaSz'ee 358 10,0 656 2.~,9 118 12.9 538 29.5 1014 16.0 N. &. 12 0~3 "7 0.3 1 0.1 6 0.3 19 0.3 TOTAL 3580 100.0 2747 100.1 919 100.1 1828 100,0 6327 100.0 q. ~,.....+ p..=,,,,.'~ '.+?. ~- ~ + ~-~ ~,~: ,,." _ _ + TIMN 0076125 .......................... TIEX 0007624
Page 39: CBP09624
8t~ouZly a|~oe /~37 26.3 1027 28..1 373 22.4 654 29.2 146z, ~Zdly aires 2t2 ~.~ ~3 11.8 178 10.7 285 12.7 70~ No ~/D. K. 52 2.9 91 2.3 38 '2.3 53 ~ 2.~ 143 ~l~y d~saS~ 233 1~.1 613 ~.7 231 " 1~.1 362 16.1 866 Sc~nSly d~as,e 80~ ~.8 1703 ~3.6 ~i ~9.3 882 39.3 2~07 ~.0 N.A. 7 0.~ i0 0.3 3 0.2 7 0.3 17 0.3 T~ 1795 100.0 3907 100.0 1~ 100.0 22~3 100.0 ~OZ ~00.i St:~-ou|ly ~.t'ae I209 33.8 875 31.9 2~ 2~.1 6&5 35.2 20~ , 3~.9 ~ ~p~/D.~. 127 3.8 62 2.2 23 3.1 34 1.9 189 3.0 ~Y ~as~* 456 ~.7 ~g 12.3 ~7 1~.8 212 11.~ 79~ 12.8 Stonily d~m ~ 36.7 1085 39.5 ~11 ~.8 67~ 36.9 2398 ~.A" 7 0.2 ~ 0.3 6 O.S 9 0 .S 22 0.3 ~ "~ 1~.1 27~7 gg.g 919 1~.0 1828 100.0 6327 100.0 TIEX 0007625
Page 40: CBP09625
S~ro~ly a~e~ 14~2 ~1.4 2~70 ~.8 13~2 ~1.2 1~18 ~4.3 403~ ~0.7 ~ldl~ ~S~e 219 ~.2 827 21.2 213 12.8 614 No op~/D.R. 6~ 3.6 107 2,? 30 1.8 77 3.4 1~1 3.0 ~l~y d~saS~s 25 I. ~ 183 ~. ? ~ 1.8 153 ~.8 208 3.6 Sc~y disa~es 21 1.2 20~ ~.3 38 2.3 168 7.5 Z27 ~.0 N,A. 4 0.2 IA 0.~ 1 0.1 ~T~ 1795 100.0 3907 100.1 166A 100,0 22~3 100.0 57D2 99.9 Sc~nEly a~e ~96 8S.S 1807 65.8 796 8~,6 10~ 55.3 4903 77.5 ~y aS~e 303 8.5 ~7 19.9 85 9.2 462 25.2 850 13.4 Ho op~i~/D. K. 61 1.7 1~ 3.~ ~ 1.2 ~ 4,9 lsl 2.3 ~1~ d~aaS~e ~7 1.6 14~ 5.2 13 1.4 131 7.1 201 St~n~y dlaaS~e ~0 1.4 137 ~.0 14 1.5 ~3 6.7 187 3.0 N.A, 13 0.~ ~ 0,~ 0 0.0 12 0,7 25 ~ 3580 l~.l 2747 ~.9 919 99.9 1828 99.9 6327 100.0 ~" 0019~74 TIMN 0076127 ~ - 7 TIEX 0007626
Page 41: CBP09626
HALE 308 17.2 779 19.9 29~ 17.6 ~85 21,6 lo87 19,1 ~6 2.6 122 3.1 35 2,1 87 3.9 168 2.9" 1~3 8,0 5~7 1~,0 151 9,1 396 17.6 890 12.1 82 ~.6 &26 10.9 ~8 5.9 328 14,& 508 8.9" 3 0,2 15 O,& 1 0,1 1~ 0,6 18 0.3 1795 100,2 3907 99,9 166~ 100.0 22~3 99.9 57Q2 ZO0.O F~4ALE SeronZly 88ree 2819 78,7 1446 52,7 633 71,1 793 43,3 4265 67.4 ~y ~e 436 ~,2 488 17,8 ~5 1~,7 353 19.] 924 14.6 ~o ~/D.¢. 35 1.5 84 3.0 18 2.0 66 3,6 139 2,2 ~y d¢ll~ee 160 4.5 373 13.6 72 7.7 301 16.5 533 8.~ S~gly ~ee 96 2,7 3~ ~,6 36 3.9 310 17.0 ~42 7.0 N,A, 1A 0.~ i0 0.~ 5 0.~ 5 0,3 2~ 0,~ .~ ~ 100,0 27~7 1~,1 919 99,S 1828 100,0 6327 100,0 TIMN 0076128 II - 8 .. TIEX 0007 627
Page 42: CBP09627
~L~ NE~ER IVEI FORMER CURI~ltT TOTAL $Cr~ngly ag~e, 414 23.I i001 25.6 383 23.0 618 27.6 1415 24.8 " No opln~/D,g, llS 6.6 187 4.8 86 5.1 ' ~01 4.5 305 5.3 N.A. ~ 0.8 17 0.~ 6 O.A ~ 0.5 32 0.~ ~T~ 1795 100.0 3907 100.0 166A 9~,8 2243 L00.2 57~2 E00.~ F'Ei~IAL£ NEVEr ~ 1~I1 ~Ullll~ TOTAL St~y ~irse 816 2~.7 677 2~.7 2~ 22.4 471 25.8 1563 24.7 ~1d17 aS~ee 598 16.7 4~ ~.O 145 ~.8 266 14.6 1009 16.0 No op~on/D.K. 29A 8.2 ~5 ~.9 G9 5.2 86 A.7 ~ldly ~sa~tae 6~3 18.0 478 17.4 173 18.8 303 16.7 1121 17.7 S~y ~sai~ee 1131 31.6 1029 37.~ 339 36.9 690 37.8 2160 34.1 ~.A. 28 0.8 17 0.6 7 0.8 10 0.~ ~5 0.7 ~T~ 35~ 1oo.O 27a7 100,0 919 99.9 1828 1~0.I 6327 100.0 ...... ~r.; .,,., • "/-0019576 Q..q~u -, TIMN 0076129 TIEX 0007628
Page 43: CBP09628
,~EVER I~V~R FOI~R CURIU~NT TOTAL Sc~on~ly ss~e ~2 2~ 101~ ~5.9 321 19.3 69] 30.9 1~5~ 25.5 ~o opiu~/D.~. " ~08 6.0 186 ~.8 ~6 ~.0 120 5,3 29~ ~.2 ~ldZy d~s~gree 283 ~. 8 6~8 16.6 280 16.8 ~8 16. ~ 913 16.3 Sc:ouSly d~sa~:ee 672 37.~ 135~ 3A.7 707 ;2.~ 6A8 28.9 2027 3~.~ ~.A. S 0.3 23 0,6 7 0.~ 16 0.7 28 0.5 TOTAL 1795 1OO.O 3907 100,O 1664 100.0 2243 99.9 5702 99.9 Scc~gly agcee 843 23.3 748 27.2 187 20.4 561 30.7 1591 25.2 H~tdly ag~e~ ~05 1~.1 ~82 17.6 ~9 14.1 ]53 19.3 987 ~o op~/D.g. 2~9 7.0 18S ~.7 G7 7.3 118 6.5 ~3~ H~ly ~$=ea 303 14.0 436 ~.9 139 ~.I 297 16.3 939 14.8 Strongly d~ee 1~62 ~0.8 87~ 31.8 389 62.~ 68~ 26.5 2336 36.9 ~.~. 18 0.~ ~ 0.S ~ 0.8 1~ 0.7 ;~ 0.S ~ . ~ 99.9 27~7 1~.0 919 1~.I 1828 100.0 6327 100.0 TIMN 0076130 -" TTEX 0007629 "
Page 44: CBP09629
$c~-ongly &S~ss ~LI~ 61.8 165~ ~2.2 9~$ $~.8 706 )~ldly slrae 312 17.& 703 18.0 290 17.4 413 18.4 103.5 17.S ~o ~on/D.~. 57 3.2 ~8 3.3 37 2.2 91 ~.1 lS5 ~.2 ~l~y d~aaS~ee 150 8,9 601 ~.4 226 13,6 375 16.7 7~1 13,~ Sc=oa117 dt~aS~ee ~2 8.5 810 20.7 16~ 9,8 6~6 28.8 962 16.9 ff.A. 3 0.2 l& 0.; 2 0.1 12 0.~ ~O~ 1795 100.0 3907 1~0.0 166~ 99,9 ~ 100.0 ~702 100.0 $c=on~l.y aSree 2~63 71.6 1271 4~.3 613 G6.7 658 36.0 383; 60.6 HllcLl.y aS~'~e 400 11.4 635 1~.8 135 1~.7 3~ 16.6 8~3 13.3 :lo op~/D.K. 126 3.3 72 2.6 lg 2.1 53 2.9 198 3.1 ~l~y dtlaSree 230 6.~ 357 13.0 81 8.8 276 ~,1 587 9.3 SCC~817 d~e~ 265 ~.g ~g7 ~.7 67 7.3 ~ 29.0 8~2 13,3 ~.~. 8 0.2 ~ 0.~ ~ 0.4 ~ 0.S 23 0.~ ~ ~ 1~.0 27~7 ~.9 919 100.0 1828 1~,0 6327 100.0 Too_!s s Q.. 2q p-XZ-17 TIMN 0076131 TIEX 0007630
Page 45: CBP09630
I~ALE H~YE~. ~ FOR~R CURRF.NT ~OTAL 51,0 20~4 52.3 871 52.3 1173 ~2.3 2959 2~.1 882 22.6 39~ ~.7 ~87 21.7 1332 ~.5 ~1 3.9 76 ~.6 75 3.3 231 ~.~ t68 12.0 197 11.8 271 1Z.1 67~ 7.6 3~ 8,7 11h 6.9 226 10.1 ;76 8.3 0.~ 22 0.6 11 0.7 ~ 0.~ 30 0.5 100.1 3907 100.1 166A 100.0 22~3 100.0 ~702 XO0.O FF~J.E S~:~'*m~.y ~e 2081 3~.]. 1398 ~0.9 , ~6 ~8.6 ~2 ~ly a~* 720 20.1 ~82 21,2 23~ 25.~ 348 19.0 1302 20.6 Xo op~/O.R. 169 ~.7 83 3.0 27 2.9 56 3.1 232 ~.0 ~dly d~ee 349 9.7 337 ~.3 126 13.7 2~ 11.3 686 10,8 S~ d~aK~e ~3 7.I 3~ ~.3 81 8.8 255 N.A. 8 0.2 11 0.4 5 0.~ 6 0.3 19 0.3 ~ 35~ 99.9 27A7 1QO.1 919 I~.0 1828 100.0 6327 XOG.O TIMN 0076132 II - 12 .......... " ........ TIEX 000763"t "-
Page 46: CBP09631
3m C~.gs~e~'~o ~ok~.ng ~.8 enoush of a hoa~.zh hazard Eor eomeeh~nK ~o be done a~ul: S~onK~ ~ ~3~ 73.0 223~ $7°2 ~69 ~0.2 ~05~ 47.$ 3~6 ~.2 Htldly aSrae 287 1~,0 8~2 ~I,S 288 17,3 ~64 2~,1 1139 20,0 ~o op~on/O,~, 60 3,3 1~2 3,6 ~8 2,9 9~ ~,2 202 3.3 ~ldly d~sas=ea 87 ~,8 309 7,9 88 ~,3 221 9,9 396 5.9 H,A, 3 0,2 22 0,6 7 0,~ 1~ 0,7 2~ 0,~ ~T~ 1793 99,9 3907 100,0 166~ ~9,9 22~3 100,0 ~702 99,9 FD]ALE S ~:~'(~t f~.7 skate 28~ ~,2. 1627 ~9,2 719 78,3 9~ W,7 ~99 71,1 ~y a~=ea 4~ ~,~ ~05 18,~ ~2 13.3 383 21.0 916 ~o opiu~/D,[, 113 3,2 ~1 ~,~ 1~ 2,0 102 ~,~ 2~ 3,7 ~dl~ d~saS~ 103 2,~ 230 8,~ 33 306 ~7 10,8 333 ~,3 S~=on~Zy d~saa~ 78 2.2 247 g.0 21 2.3 226 12.~ 325 ~.A. 3 0.1 17 0.6 5 0.] 12 0.7 20 ~ ~ 1~.1 27~7 100.0 9~ 100.0 1828 100.2 6327 ~.0 Q. 0076133 ............................. ~INX 0007632
Page 47: CBP09632
PIALE 1140 63.S 1923 49.Z 1051 63.2 872 35.g 30fi3 53.7 347 19.3 7]3 18.8 28~ 17,1 4~9 20,0 1080 18.9 4A 2,3 127 3.Z 36 2.2 91 ~.1 171 3.0 ~7 8.7 ~63 1~.~ 181 10.9 382 17.0 720 12.6 99 ~.~ 5~5 L3.9 111 6.7 ~3; 19.3 6~ 11.3 8 0.~ 16 0.~ 1 ft.1 15 0.7 26 ~.~ 1795 99.S 390? 99.9 ~66~ 10~.2 2263 lO0.a STfi~ 99.9 2~9 77.0 1373 50.0 ~32 68.7 ' 7~1 ~.6 ~132 6~.3 7S 2.1 88 3.2 21 2.3 67 3.7 16~ 2.6 ~6 4.~ 384 14.0 62 6.S 322 17.6 ~O 8.~ 121 3.~ ~6 14.8 ~5 ~.g 361 19.8 ~27 8.3 3 0.1 14 O.~ 6 0.7 8 0.4 ~7 0,3 3S~ ~.0 2747 100.0 919 ~00,1 ~828 ~.~ 6327 100.0 "'-' ' TIMN 0076134 ...... TIEX 0007633
Page 48: CBP09633
~1 ~9.~ 7~4 ¢9.1 290 ~7.~ ~5~ 20.2 109~ 19.2 57 3.2 65 1.7 ]6 Z.2 29 1.3 122 2,t 386 21.5 810 20.7 372 22.3 ~38 19.5 1196 21.0 75~ ~1.8 17~3 44.6 750 45.0 993 44.3 249~ 43.7 4 O.Z 18 0.5 8 0.~ ZO 0.4 Z2 0.4 17~. 1~.0 ~. 100.1 166~ " 99.8 224~ 99.9 5702 100.0 F~RU.E 751 21.0 424 15.4 128 13.8 296 16.2 22.75 la.S H:LIcLI.y s$caa ~1 12.3 317 1.t.$ 101 I]..0 216 11.8 : 758 12.0 No optn'~.an/D.l,~. 131 3.7 71 2.6 18 2.0 53 2.9 : 202 3.Z H;Lldly dt.saSree 7&9 20.9 $59 20.6 199 21.7 360 19.7 3308 20.7 S c::anS17 418aScee 1686 61.5 136& ~9.7 /470 51.2 89~, 48.9 28,50 ~,$.1 ~..4. 22 0.6 12 , 0.6 3 0.3 9 0.5 ~_/34 0.5 "~OTJ¢ Sp. . 10~)__.0 2747 100.0 919 100.0 18;28 L00.0 27 I00,1 - 15 TIMN 0076135 T T 0007634
Page 49: CBP09634
NEVEE EVEI FORMER C~]L~qT TOTAL 154 8.6 495 12,7 138 8.3 357 i$,9 649 Mildly awcee 146 8.1 462 11.8 126 7.6 336 15.0 608 £0.7 No opinlon/D.Ko 51 2.8 133 3.4 45 2.7 88 3.9 18~ 3.2 Mil~l7 disaS'Jree 275 15.3 681 L7.4 231 13.9 450 20.1 956 15.8 S~on~ly dlsa$~ee 1160 64.6 2116 54,1 1118 67.1 998 44,5 32?6 57.& ~.A. ~ 0.5 20 G.5' 6 0.4 14 0.6 29 0.5 TOTAL 1795 99.~ 3907 99.9 1664 100.0 22~3 i00.0 570Z I00.0 FEH~LE 2~ 8.2 301 ii.0 47 5.1 254 13.9 595 9.~ ~7 a~e 216 6.0 292 I0.~ 52 5.7 2~0 13.I 508 S.0 ~o ~/D,K, 149 ~.2 9~ 3.~ I~ 1.5 80 ~.3 2~3 3.8 ~03 ~.3 ~72 17.2 10~ 11.~ 363 19.9 875 13.8 SCreWY disa~e 2~96 69.6 ~78 57.5 693 75.~ 885 48.4 4072 ~.~ N.~ 24 0,7 I0 0.4 4 0.4 6 0.3 3~ 0.6 ~ ~ 1~.0 2747 ~.1 919 100.1 1828 99.9 6327 1~.0 TIMN 0076136 = - 1~ " "" ::~ ~0i9553 ...... - ....... TIEX 0007635
Page 50: CBP09635
/~LE ]~'[Y~& ~& FOIL-',IZ& ~ TOTAl, SCzon~y aKcee 1099 ~,2 1267 3Z,~ 83~ 49,9 436 19,4 2:]66 ~1.5 ~ldly aS:ee 28~ 15.8 685 17.5 335 20,2 ~9 15.6 069 17.~ ' ~o op~/D.~. 39 2.2 86 2.2 Z3 1.~ 63 2.8 12~ 2.2 ~1d1~ disagree 223 ~.~ 92~ 23.6 299 18.0 62~ 27.9 ~1~7 Z0.L ScsonSly d~saS=ee 1~1 7.9 928 23.7 171 10.3 7~7 33.7 1069 18.7 ~.A, 9 0.5 17 0.~ ~ 0.2 13 0~ 26 0.3 TOTAL 1795 100.O 3907 99.9 156~ 100.0 22~3 99.9 5702 LO0.O FDIALE ~ &'V~& FO l~'~&. ~ TOTAL Sc~ouSly al~cee 2.q23 70.$ 9~S ~.~ ~8 e0.8 390 21.3 3~71 5~.9 ~£I~y ~ee ~2 10.1 378 13.7 136 1~.7 2~2 13.2 7~0 11.7 No op~n~on/O.~. S5 2.~ J0 1.8 12 1.3 38 2.1 13~ 2.1 ~1~ d~as~e 362 10.1 ~SS 21.~ 132 I~.A ~56 25.0 950 15.0 SC~SI~ d~a~ee 2~5 6.8 769 28.0 79 8.5 690 37.8 LOX~ 16.0 ~.A. 3 0.1 L~ 0.~ 2 0.2 12 0.7 17 0.3" ~ ~ 100.0 Z7~7 99.9 919 99.9 1~8 100.1 6327 100.0 : 7"00195.84 ....... "~" ":X~4': .- ~." q 2C p-~Z-20 - TIMN 0076137 ....................... TIEX 0007636 '--"
Page 51: CBP09636
One o~ t:ko t:h:Lnp 1: e,,'loy mosc /,a pl"~,':L=.g ~the-d. R~vi~.. ~ FOl~q~, CUltP, ENT TOTAL S c~t$17 a~ee 1003 55,9 2~8 5~.2 g~ 5~.8 1205 53.7 3121 5~,7 ~Z~y ~$~e ~62 ~,7 923 23.6 ;39 26.~ ~8~ 21,6 1385 2~.3 ~o ap~/D,Z. ~ 2,5 65 1,7 31 1,9 3~ 1,5 110 ~1~7 d~as~m 178 9.9 506 12.9 19~ 11.7 312 13,9 ~84 12,0 S ccou~ ~saZ~e105 5.9 279 7.1 82 ~.9 197 8.8 ~8~ 6.8 ~.A. 2' 0.1 16 O.~ 5 0.3 1~ 0.5 18 0.3 T~ 1795 ~,O 3907 99.9 ~664 10~.0 2243 100.0 5702 ~00.0 FEI'4ALi[ ks~v~. EV~ ~OitM~t ~ TOT&L $ t:z~.y aS~m 2039 ~7.0 1329 ~8,~ A~2 ~9,i 877 &7,9 3368 ~3,2 ~7 a~ 760 21,2 ~81 21.2 2~ 2~,1 3~1 19.2 23~1 21,2 No ~/g.~, 206 3,0 57. 2.1 18 2.0 39 2,1 163 2,6 ~l~y ~g~e 39~ ~,0 ~7 16,3 ~3 14,7 312 17,1 ~2 13.3 Sc:~y ~8~ 266 7,~ 321 11,7 82 8,9 239 ~,1 587 9,3 ~ "3~ 1~,0 27~7 ~00,1 919 100.0 1828 99,9 ~327 ...... TIEX 0007637
Page 52: CBP09637
So,ugly aSCee 437 24.3 952 24.4 411 24.7 541 24.1 1389 24.4 l~ldly agree 487 27.1 1001 25.6 481 28.9 520 23,2 1488 2e.i • o op~/O.~. 200 ~.1 2~7 ~.6 105 6.3 152 6.8 ~57 8.0 ~dly d~sa~e 274 ~.3 636 16.3 260 ~.6 376 16.8 910 16.0 St~n~17 d~s~m 3~ 21.7 1052 25.9 402 2~.I 650 29.0 IA42 N.~. 7 0.A 9 0.3 5 0.3 ~ 0.2 16 0.3 ~ 1795 99.9 3907 LO0.1 166~ 99.9 22~3 100.1 " 5702 100. ~ ~ ~O~.I~R ~ TOTAL 5tmily ape ~0 31.0 1055 38.6 328 35.7 727 39.8 2165 3~.2 ~1417 a~e 1001 28.0 620 22.6 252 27.5 368 20.1 1621 25.6 No op~/D.~, ~53 ~.7 135 ~.9 51 5.6 8~ ~.6 588 9.3 ~l~y di~S~e 435 ~.1 330 ~.0 ~1 14.3 199 10.9 765 S¢~1y disable 569 ~.9 597 21.7 ~ 16.8 ~3 2A.2 1166 18.4 N.A. ~ 0.3 10 0.~ 3 0.3 7 0.~ 22 0.3 ~ ~ ~0O.0 27&7 i~.0 ~19 1~.2 1828 ZOO.0 6327 99.9 -/-00195~ , ~..~- .?~... ~.~:~.~!~ ~*'? ,." T~ 0076139 Q. ~ ~-23 ~ - TIEX 0007638
Page 53: CBP09638
4 0.2 88 2.3 11 0.7 77 3.4 92 1.6 3 0.2 49 1.3 5 0.3 44 2.0 52 0.9 ~ 0.2 52 1.3 8 0.5 44 2.0 56 1.0 9 0.~ 73 1.9' 9 ~.5 6~ 2.9 82 1.~ 19 1.1 . ~ Z.0 '~3 0.5 67 3.0 99 21 1.2 114 2,9 2~ 1.~ 90 ~.0 13S 2.4 39 2,2 l~ 3.7 30 L.8 11& 5.1 183 3.2 55 3.1 25~ 6.3 62 3.8 192 8.5 ~9 1~ 6.2 252 E,~ " 1~ S.O ~2 6.8 364 6.~ ~0 6.1 387 9.9 128 7.7 259 11.~ 497 8.7 161 " 9.0 36~ g.3 127 7.& 237 10.6 ~25 9.2 275 1~.3 623 ~.9 255 13.3 368 16.4 898 L5.7 983 5~.8 1~2~ ~.~ 891 53.S 533 23.8 2407 42.2 0 0,0 3 0,1 L O.L 2 0.1 3 O.L 1793 100.1 3907 99.9 1666 100.0 2243 1~.1 570Z 99.9 . ~ 0.3 51 1.9 1 0.1 50 2.? 62 1,0 7 0.2 , Z~ 0.9 1 0.1 23 1.3 31 ~ 0.~ 63 Z.3 4 0.4 ~9 3.2 78 ~ 0.9 ~ 2.9 7 0.8 73 4.0 11~ ~ 1.3 9S 3.~ 18 2.0 77 ~.2 1~3 2,3 7& 2.2 ~? ~.7 ~ 2.7 132 7.2 231 3.7 I%7 5.5 245 8.~ 56 6.1 18g ~. 3 4~2 7.0 2~ 6,8 2~ ~.6 51 5.6 185 10.1 48~ 7,6 2233 62.& 10S2 38.3 569 61.9 483 26,G 3285 0 0.0 7 0.2 0 0.0 7 " 0.~ 7 0.1 0076]40 TIEX 0007639 -
Page 54: CBP09639
326 18.2 602 2.5,~ 357 21.~ 2~5 10.9 928 2.6.3 200 11.1 327 ~.4 183 11.0 1~ 6.4 527 9.2 1S7 ~.7 337 8,6 160 %7 177 7.9 ~9~ 8.7 321 17.9 637 16,3 266 16.0 371 16,5 958 16,8 129 7.2 333 8.3 ~ 8.0 201 9,0 46~ 8.1 98 5.~ 230 ~.9 8~ 5.2 1t5 6.5 328 5,8 120 6.7 279 7,1 99 5.9 180 8.0 399 7.0 183 10.3 ~27 10.9 139 8.3 288 ~.8 610 10.7 33 1.8 8G 2.2 22 ~.3 6~ 2.9 119 2.1 2 0.1 10 0.3 ~ 0.2 6 0,3 12 0,2 179S 1~.1 3907 ~.0 1664 99.9 22~3 372 lO.& 230 8.G 10~ 11,& 12S 6.8 601 9.5 2~ 6 .O 1~ S. 2 52 ~ • 7 92 5.Q ~59 S • 7 325 9.1 232 8.5 93 10,1 139 7,6 557 8.8 6&9 18.1 430 ~ . 7 1~1 16 . & 279 217 S.1 ~8 8.3 52 5.7 176 9.6 ~5 7.0 ~97 5,~ ~ 6.6 57 6.2 ~S 6.8 379 6,0 ~ 6.0 ~0 7.7 ~3 &.7 167 9.1 &2~ 6.7 395 ~.0 328 ~.9 95 10.3 233 ~,8 723 11.~ 70 2,0 73 2.7 18 2.0 S~ 3.0 1~3 2.3 73 2.0 6~ 2.& ~ 0,~ ~ 3.3 138 2.2 7~ 2.2 ~X 3.3 18 2.0 73 ~.0 170 2.7
Page 55: CBP09640
37 2.1 I~S 3.7 33 2.0 112 5.0 182 55 3.1 167 ~,3 50 3.0 117 5.2 222 3.9 &2 2.3 137 3,~ 39 2.3 ~8 4,; 179 3,1 62 3.5 188 &.8 6~ ' 3.7 127 5.7 250 80 4.3 2~ 5.2 83 &.9 ~1 S,~ 28~ 5.0 133 7.& 320 8.2 ~7 7.7 193 8.5 ~3 8.0 ~1 "8.~ ~ 7.8 ~6 7.6 179 8.0 ~e 237 ~.2 &21 10.8 187 11.2 23~ 10.4 6~8 11.5 871 48.6 1367 3~.0 ~8 &8.~ 559 2~.9 2238 39.3 0 0.0 11 0.3 2 0.1 9 0.~ 11 0.2 1795 ~.2 3907 1~.0 16~ 99.8 22&3 100.1 ~702 100. ~S ~.0 1~7 ~.7 19 2.1 138 7,6 192 3.0 19 0.5 82 3.0 9 1.0 73 4.0 101 1.6 33 0.~ 101 3.7 ~ 1.~ ~ ~.8 13~ 2.1 ~ 1.2 ~9 5.8 ~ 3.7 125 6.8 203 3.2 &1 1.1 101 3.7 ~ 1.6 86 ~.7 ~42 2.2 57 1.6 ~7 ~.3 20 2.2 97 5.3 17& 2.8 60 L.7 ~7 4.2 18 2.0 99 5.& 177 2.8 95 2.7 ~Z 4.7 32 3.5 99 5.4 ~6 3.6 ~32 3.7 ZGX 5.~ 38 4.~ ~3 6.7 293 ~.6 2~ 5.9 2Z7 7,P 67 7.3 ~0 8.2 428 6.8 232 S.5 ~gS 7.~ 68 7.4 ~27 6.t 427 6.7 478 ~3.3 ~08 ~.2 ~8 ~.g ~80 9.~ 786 2~2 5~.8 8~ 32.4 ~54 49.5 436 23.9 3032 ~ ~ ~ O.& & 0.4 7 0.4 ~2 0.2 3580 ~9.9 2747 ~.0 ~ ~.~ ~a2a ~00.0 6327 g9,9 0076142 00075;i
Page 56: CBP09641
NEVE~ g~rzE ~OI~R ~J P.~ENT • TOTAL 3 23 ~,3 268 6,9 2~ 1,6 261 I0,7 29I 6 33 1.8 198 5.1 3~ 2.L 163 7.3 231 ~.1 5 6a 2,3 197 5,0 50 3,0 1~7 6,6 23; ~,2 6 68 2.7 260 6.7 79 6.7 181 8.1 208 5.6 7 61 3,7 332 8.5 90 ~.~ 2~2 ~0,8 399 7.0 8 72 ~.0 226 8.3 98 S.9 228 10,2 398 9 109 6.~ 2~ 5.6 88 5.3 13~ 5.8 ~28 5.7 ~1 6.7 270 6.9 129 7.7 161 6,3 - 391 6.9 11 269 15.0 6~ 11.9 227 13.6 237 10.6 733 12.9 12 207 11.5 336 8.5 186 11.2 168 6.6 5~1 13 115 6.6 168 3.8 78 6.7 70 3.1 263 ~.6 1~ 17~ 9.6 271 6,9 169 10.2 102 6.5 6~6 7,8 ~ 515 28.7 609 15.6 6~ 2~.A 203 9.1 I12~ ~9.7 3 32 0.9 2~ 7.8 19 2.1 196 10,~ 2&7 3.9 6 51 L,6 ~2 ~,6 25 2,7 ~7 7.0 203 3,2 7 .~ 3.3 2~ 7.8 26 2,6 ~9~ 10.5 33~ 5,3 8 ~1 3,6 2~5 8,9 5g 6,6 186 10,2 366 3,8 9 173 &.8 136 S.O ~ t.& 96 5,3 309 12 386 10.8 2&5 8,9 122 ~.3 ~3 6.7 631 10.0 13 224 6.3 8~ 3.2 35 3.8 ~2 2.8 311 • 6.9 ~6 345 ~.6 200 7.3 107 11.7 93 5.1 5~5 8.6 ~ 1661 60.2 456 16.6 299 32.6 157 8.6 189730.0 H.~ o o.o 6 0.2 1 0.1 5 0.3 6 0.1 T~ 35~ 99.9 2~7 100.1 9~ i~.1 1828 100.1 6327100.1 ..... - 0007642
Page 57: CBP09642
6 27 I,~ 68 1.7 17 1.0 31 2.3 95 1.7 7 78 ~.~ 200 5.1 56 3.4 1~ 6.~ 278 8 101 ~.6 21~ 5.6 74 4.~ i~5 6.5 320 5.6 9 105 5.8 195 5.0 80 ~.8 125 5.~ 300 5.3 10 175 9.7 ~2 8,8 1~ 8.0 208 9.3 317 11 612 ~.0 901 23,1 " 391 23.5 510 22.7 i313 23.0 12 188 ZO.S 421 10.8 197 11.8 224 10.0 eO9 10.7 13 ~65 .9.2 306 7.8 lGl 9,7 1~5 6.~ ~71 8,3 14 222 ~.~ 433 11.1 207 12,4 22G 10.1 655 11.5 ~ 290 16.2 676 17.3 302 18.1 374 16.7 966 t6.9 H.~. ~ 0.2 2 0.~ 2 0,2 0 0.0 3 0.2 ~ 1793 2~.O 3907 ~00.2 266& 99.7 2243 1~.2 5702 ~.2 3 32 0.9 61 2.2 14 ~.S ~7 2.~ 93 7 202 5.6 ~2 8.~ ~ 6.~ ~66 g.~ ~2~ 6.7 8 236 6.6 2~ 7.& 8a 7.2 ~38 7.6 440 7.0 10 ~3 9.6 ~ 9.3 81 8.8 ~73 9.5 S97 ~ ~1 26.3 SI0 ~.2 191 20.8 419 22,9 155~ 2~.~ ~ 331 9.2 23& 8.5 83 9.0 1~I 8.3 ~S~ ~ 253 7.1 ~2 ?.0 85 9.3 107 ~.9 &~S ~.~. 2 0.1 & 0.1 0 0.0 4 0.2 6 ~ 3~ ~.O 27~7 1~.0 919 1~.2 1828 1~,0 6327 99,9 00 6144
Page 58: CBP09643
~ 26~ I~.8 630 ~.~ 272 ~6.~ ~58 16.0 ~9~ ~,7 4 ~1 8.~ 329 8.~ 168 10.1 1~1 7.2 ~80 8.~ 5 123 6.9 261 ~.7 13~ 8.1 126 5.6 38~ 6.7 6 ~29 7.2 3~7 8.1 132 7.9 185 8,2 ~ 7.8 7 22& ~,5 ~09 10.5 167 10.0 242 10, 8 633 8 1~0 7,8 31; 8.O 150 9.0 1~ 7,3 ~S& 9 120 6.7 225 5.8 98 5.~ ~7 5.7 3~5 10 1~6 8,1 319 8.2 ~2 7.3 197 8,8 ~65 8.2 ~ 1~ 10,3 36~ 9.3 131 7,9 233 10,~ 5~S 9.6 12 77 &.3 20~ 5.3 73 ~.~ 133 5.9 283 5.0 13 81 ~.5 168 ~.3 75 6.5 93 A,Z 2~9 6.4 I~ 60 3.3 158 ~.0 6~ 3.8 9& a.2 218 3.8 ~ 88 ~,9 19A 5.0 72 ~.3 122 5.~ 2B2 A.9 N.A. 7 0.~ 13 0.3 ~ 0.3 8 0,~ Z0 0.~ T~ 1795 100.1 3907 1~.0 166~ 99.B ~3 100.0 5702 100.0 3 431 ~.0 ~ 16,0 ~0 16.3 288 ~.8 869 13.7 4 298 8.3 237 9,~ 97 10.6 160 8.8 355 8.8 5 247 6.9 163 ~.9 ~6 6.1 107 5.9 ~ 6,~ 6 3~2 8.7 2~ 8.7 90 9.8 I~8 8.1 ~50 8.7 7 389 10.9 J~9 13.1 129 1~. 1 230 ~2 • 6 748 8 298 8.3 20S 7.5 73 8.0 132 7.2 503 8.0 9 ~5 7,1 170 6.2 65 7.1 10S 5,7 ~ 6.7 10 326 9.1 197 7.1 S7 6.2 140 7,7 523 8.3 ~ 337 9.~ ~1 9.Z 70 7.6 181 9.9 588 9.3 ~ 1~ S.O ~5 &.9 ~0 4.4 95 5.2 315 13 193 5.4 92 3.~ 23 2.5 69 3.8 285 &.5 1~ ~9 3.3 88 3.2 19 2.1 69 3,8 207 3,3 ~ 177 5.0 1~3 ~.2 &~ ~.8 99 S.; ~20 ~.A. 18 0.5 ~1 0.~ ~ 0,6 ~ 0.3 29 0.~ ¢~ 3580 99.9 27A7 100.1 919 1~.2 1828 i~.2 6327 100.1 ~. 3c, ~, ~ . .~ t~t..t.~~~ .... TIMN 0076145 -"
Page 59: CBP09644
HAL~ 1~tvtn$ • Kcmd fm~.Zy l:L£e 266 40.6 605 41.9 243 41,3 362 ~2.3 871 349 53.3 773 53.5 312 53.1 461 53.9 ~122 53.5 9.¢. 36 3,5 61 ~.2 31 5.3 30 3.5 97 4 0.6 5 0.3 2 0.3" 3 0,3 9 0.4 ~,~. ¢~ 64~ 1~.0 1445 99.9 588 ~00.0 S56 1~0.0 2099 Be£nl he~hy 740 ~8.9 ,647 62,8 231 66.0 416 61.1 1387 60,6 D,~. 72 5.7 35 3.4 ~ 4.3 20 2.9 107 4.7 N.A. 14 1.~ 7 0.7 4 1.1 3 0.A 21 0.9 ~ . ~7 1~.0 1031 1~.1 350 I~.0 681 99.9 Z288 1~.0 .......... - .................... Txi~gX 0007645
Page 60: CBP09645
b,~V£~ £VE~, FOP~.~K CUR.I~qT TOT~ ~s~Z ~lm CO do v~t you v~c 263 ~0.2 ~3 ~1.1 227 38.6 ~66 ~2.8 856 ~0.8 O.~. 2~ 3.7 26 1.8 ~0 ~,7 ~6 1.9 50 2.G g.A- ~ 0.6 3 0.2 0 0.0 3 0.~ 7 0.3 TO~AL 655 100.1 1444 100,O 588 100.O 8~6 100.1 2099 1N0.0 FE~ALE ~e~aZ able Co ~ ~c you ~C ~10 32.6 3~7 33.7 106 30.3 241 35,~ 757 33.1 ~g 8oo4 ~ds 809 ~.4 662 64.2 233 86.6 429 63.0 1471 64.3 D.~. 3~ 2.7 17 1.6 7 2.0 10 1.5 51 2.2 ~.~, ~ 0.3 "~ O,S ~ 1.1 1 O.1 ~ n.~ 1257 100.0 1031 100.0 350 100.0 681 100.0 2288 100.0 Q. "- TIMN 0076147 • . TTEX 0007646 -
Page 61: CBP09646
HALE ~S $ood ~ 1~ ~.3 2~ 17,0 103 17,5 143 16,7 3~ 16,5 D,K,10 I,$ 22 1.3 ; 0.7 18 Z.1 32 ~,5 ~.X.3 0.5 2 0.1 1 0.2 1 0.1 5 0.2 635 100.0 14G~ 99.~ 588 100.0 856 100.0 2099 100.0 FEMALE i~ 8~.1 866 ~.0 29~ 8~,3 571 83.8 192~ ~.0 166 13.2 161 ~.7 66 13,1 95 14.0 307 29 2.3 17 1.6 5 1.~ ~ 1.8 ~6 2.0 ~ 0.; 7 0,7 ~ 1.1 3 0.~ 12 0.5 1237 100,0 1031 100.0 350 99.9 681 i00.0 2288 99.9 q... 2. TIMN 0076148 ,',~,, . .,..'~.,, .I,. "~ • " TIEX 0007647
Page 62: CBP09647
NEVEg EVEg FOP~E~ CU~ TOTAL B~nS ab~ ~o do ~h~c you v~c ~00 Be~n~ ~chy ~4~ 83,2 121~ 84.~ 513 87.2 70Z ~1.9 17~9 63.8 D. ~. 8 ~.2 16 1.1 ~ 0.9 11 1.3 Z~ 1.1 ~. A. 2 0.3 3 0.2 1 0.2 2 0.2 5 0.2 TOTAL 65~ 100.0 1444 100.0 588 100.0 85~ 100.0 2099 99.9 FE~LE ,~vgg gVLeg F~ER ~ TOTAL Be~=g ~Zt ~o do vha~ yo~ v~c 103 8.2 ~0 10.7 25 7.1 8~ 12.~ 213 Be~ng heathy 1133 90.1 907 88.0 321 91.7 586 86.0 2040 89.2 D.E. 17 i.~ i0 1.0 2 0.6 8 ~.2 27 1.2 ~.Z. 4 0.3 ~ 0.~ 2 0.6 2 0.3 8 0.3 TOTAL 1257 100.0 1031 100.1 350 100.0 681 100.0 2288 100.0 TIEX 0007648
Page 63: CBP09648
Do~s work you csce ~ouc 401 61.2 913 63.2 3~8 59.2 565 66.0 131~ 62,6 Ha~nS good f~ds 235 35.9 ~ 3~,2 219 37,2 27~ 32.1 729 D.C. 13 2.0 34 2.4 20 3.~ 1~ 1.~ ~7 2.2 g.*. 6 0.9 ~ 0.2 i • 0.2 2 0.2 9 0.& T~ ~55 100.0 1~;~ 100.0 588 1~.0 856 gg.g 2099 DoCzsx york you c~=,, "~'ou~ • 716 57.0 622 49.J 199 56.9 423 5Z.1 1338 58.5 ~-wln,~ sood. f~mnd~ ~88 38.8 38~ 30.5 Z~Z ~.6 2~2 35.S 873 38.Z D.~. 42 3.3 20 1.6 6 1.7 1~ 2.1 $2 2.7 R.A. 11 0.9 5 0.¢ 3 0.9 2 0.3 16 0.7 ~OT, tL 12.q7 100.0 1031 100.0 350 100.1 ~81 100.0 2288 100.1 ._ TIEX 0007649
Page 64: CBP09649
ZF ~4h:f.r.h ta mote ~.~po~ant t:o you.~* MALE got hav£ng ~o vo~ about ~ney 75 11.~ 205 1~.2 ~3 9.0 L~2 1~,8 280 . 13.3 B~g heathy ~70 87.0 ~18 8~.3 525 89.3 693 81.0 1788 85.2 D.K. 8 1.2 17 L.2 9 1.5 8 0.9 2~ 1.2 • .A. 2 0.3 4 0.3 1 0,2 3 0.4 6 0,3 655 100.0 1444 100.0 ' 588 ~' 100.0 856 ZO0.L 2099 100.0 ' ~ot h&v'£nS Co eo'r~'~, about: mo~ey 136 10.8 130 12.6 29 8.3 101 14.8 266 11.6 B~::~l~ I~Lthy 1086 86.4 888 86.1 317 90,6 571 83.8 1974 86.3 D.K, 29 2..3 11 1.1 3 O.g 8 1.2 40 1.7 • .~ 6 0.5 Z 0.2 1 0.3 1 0,I 8 0.3 1257 100.0 1031 100.0 350 100.1 681 99.9 2288 99.9 TIMN 0076151 *LonE ~o~n qu~sc£mm,.4re ._ TIEX 0007650
Page 65: CBP09650
~AL~ ~37 66.7 898 52.2 383 65.~ 51S ~0.2 133~ 63.6 198 30.2 ~07 33,1 188 32.0 3~9 37.3 705 33~6 16 2.4 32 Z.2 14 Z.~ 18 2.1 4 O.S 7 0.3 3 0.~ 4 0.3 11 O.~ 6~5 ~g,9 1~ 100.0 58S 100.0 8~5 100,1 2099 100.0 3~u; ~1l to do ~= ~o~ ~ ~9 47.7 500 48.~ 164 ~6.9 336 ~9.3 1099 48.0 ~ 396 47.4 ~98 48.3 17~ ~0.3 322 ~7.3 ~094 47.8 D.~. ~ ~,3 ~ 2.9 8 2.3 22 3.2 8~ 3,7 N,A, 8 0.6 3 0.3 2 0.S 1 0.1 11 ~ ~7 100.0 ~31 2~.0 3~0 100.1 ~81 99.9 2288 TIMN 0076152 0007651
Page 66: CBP09651
l'~V'~lt ~A'TEP. ~ORNEP,, ~ TOT~ Oo£n~ v~ you care ~0uc ~ 1B,9 24~ 17,0 82 ~3.~ 16~ 19.2 369 17.6 3e£~S be~chy 523 79.8 i~2 81.9 ~99 8~.9 683 79.8 1705 81.2 D,~. ~ 0.8 13 0.9 5 0.9 8 0,9 18 0.9 W.A. 3 0.5 + 0,3 3 0.5 1 0.1 7 TOT.~ 655 100,0 1~44 100.1 $88 1~0,1 856 100.0 2099 100.0 DO~"B vo~k ~'ou eJ:e aboul: 151 ~.8 ~ ~.0 32 9,1 102 ~.0 295 12.9 ~e~s hea1~ 1077 55.7 ~1 85.5 313 89.~ 568 83.~ 19~8 85.6 O.K. 1~ 1.1 ~ 1.5 ~ 1.1 ~ 1.6 29 1.3 • .A. ~ 0.~ 1 0.1 1 0.3 0 0,0 6 0.3 TOTAL 12~7 100,0 1031 100.1 350 99.9 681 100.0 2288 100.1 TTEX 0007652
Page 67: CBP09652
MALE ~oTin~ ~e 1~2 21.7 36~ 25.2 ~8 23.5 226 2G.~ 506 2~.~ ~ s Z~d ~1~ ~fe ~87 7~.~ 1029 71.3 ~31 73.3 598 G9.9 1516 72.2 D.K. 2~ ~.7 ~ 3.1 16 2.7 29 3.~ 69 3.3 ~.A. 2 0.3 6 0.~ 3 0.5 3 0.~ 8 0.~ TOTAL 655 1.00.1 1;~ 100.0 588 100.o 856 100.1 2099 100.0 N~VZSi £VY.~ FO I~EP. cln~4T TOTAL Enj (r~isxS 1~, 227 16.1 209 20.3 ~& 18.3 1~5 21.3 ~36 19.1 ~ ~ ~cod ~1~ ~a 972 77.3 ~0 ~7.6 277 79.1 ~23 76.8 1772 77.~ D.X. ~8 3.8 20 1.9 8 2.3 ~ I.~ ~8 3.~ ~.~. 10 0.8 2 0.2 1 0.3 TOTAL 1257 100.0 1031 100.0 350 100.0 681 100.0 2288 100.0 TIMN 0076154 *l, msS ~orm qu~Cioun~i'c~.,
Page 68: CBP09653
H~Ir~lt ~Y~II: 701L~R CL~P.~4T ~OT~ ~tn8 ~k 7o~ ~:e ~c ~ 66.0 %3 65.3 377 6~.1 ~66 66.1 157~ 6~.~ ~oC hs~u~ ~ vo~ ~ey 20~ 31.3 ~66 32.3 lg~ ~3.0 272 31.8 671 ~2.0 D.L 17 2.6 29 2.0 1~ 2.2 1~ 1.9 ~ 2.2 g.A, 1 0.2 6 0.~ 4 0.7 2 O.2 7 0.3 't'OT~ 6.~.~ 1.00.1 14~4 100.0 $88 100.0 856 3.00.0 2099 100.0 l~Svork you ~uz~ about 729 58.0 ~07 58.9 216 61.1 393 57.? 1336 $8,4 NoC hsv£u$ to vo~ ~ey 497 39.~ ~04 39.2 130 37.1 27~ ~0.2 90~ 39.6 D.~. 22 1.8 ~g 1.8 ~ ~.4 1~ 2.~ ~ ~.8 N.&. 9 0.7 L O.~ ~ 0.3 . TOTAL 1237 100.0 1031 100.0 3~0 99.9 68;. 100.0 228B 100.0 ~-..,.-: ~-~? .~, ~-,..,, f.'-, ~ < ,; -~- 0019602 TIMN 0076155 q. ~av ZI - 3~ ............. TIEX 0007654
Page 69: CBP09654
1K ~£~.h ,is ~oz~- f.~o'~,c~C Co you?* HALE N~'VE~ EVER. FO P.I~?. CURIE~IT TOTAL Be~.aI ha~chy ~33 81.4 1147 79.4 ~86 82.7 6~ 77.2 1680 ~0.0 ~J~l l~f~ 103 ~.7. 266 18.4 88 15.0 178 20.8 369 17.6 . D.R, 16 2.~ 26 1.8 11 L.9 15 1.8 42 2.0 N.A. 3 0.$ 5 0.3 3 0.5 2 0.Z 8 0.~ TOTAL 655 100.0 1444 99.9 588 100.1 856 100.0 2099 100.0 FEMALE h~v~ ~ TOgaS2 ~ TOTAL 3e4,,| he~.cl~ 1068 85.0 855 82.9 293 83.7 562 82.5 1923 ~4.0 ~nJ~ng l~fe 167 ~.7 ~5 ~.0 48 ~.7 107 15.7 302 13.2 • .A. 23 1.8 ~ 0.~ 2 0.6 2 0.3 Z7 1.2 TIMN 0076156 q. Jw .... . _ TIEX 0007655
Page 70: CBP09655
~'t.uubec o~ C:Lzes "t[e~l.Ch" vu ~'soa.,u ova= ochec values. (q. HALE N~VZa E'~I~ FOP, I~P. ~ TOT~ N~e 6 0.9 12 0.8 5 0.8 7 0.8 Once ~ 2,3 44 3.1 ~5 2.6 29 3.5 5g 2.8 ~ 37 5.6 80 5.5 2& ~.1 56 6.5 117 5.6 ~, c~8 6~ 9.9 138 9.6 ~9 8.3 89 10. ~ 203 9.7 7ouc C~s 105 1~.0 2~ 16.6 88 ~.0 ~2 17,7 3~5 ~.~ " 7t~ C~a 202 30.8 &50 31.1 lgl 32.5 259 ~.2 652 ~1.1 S~x c~ms 225 3A.6 ~80 3~. 2 216 36,7 26~ 30,8 705 33.6 ~¢~ 655 99.9 1444 99.9 588 100.0 856 99.9 2099 100.1 FEMALE Non,, 8 0.6 10 1.0 0 0.0 10 1.5 tR 0.8 Once 1.9 1,$ ~.7 1.7 6 1.7 11 1.6 36 Trice 37 2.9 &$ ~,,~ 15 4,3 30 4.& 82 3.6 ~ee c~s 103 8.2 78 7.6 22 6.3 56 8,2 ~81 7.~ You~ ~s 199 ~.8 155 ~.0 ~3 ~.3 112 16.5 356 15.5 Y2~ ~s 383 30.5 271 26.3 86 2~,6 18~ 27,2 65~ 28.6 S~ ~ 508' 40.4 455 ~.1 ' 178 ~.9 277 ~.7 963 T~ ~57 99.9 1031 1~.1 3~ 190.1 681 200.1 2288 100.1 .......... - .................... TIEX 0007656
Page 71: CBP09656
~,lr..lal~ m~ you:' YO~y ~c8~8d ~03 ~,~ ~18 22.9 92~ 22,6 h~ ~c,~ed ~ 0.2 8 0.~ ~ 0.3 't'O'~J~ 22~3 99.9 1828 100.0 4071 TIMN 0076158 • "1". o0.~.a~;o,-- .~'l ,t '~ ," .~..~: ,, • :~ -- 38 0007657
Page 72: CBP09657
probably ~ h~doul co ~MZCk c~ ochres 697 38.8 ~809 ~.3 679 ~0.8 ~30 50,4 250~ 43.9 hszsrdo~ co hatch ac ~1 1~ O.S ~27 3.2 2~ L3 XO~ ~,7 ~ 2,5 D.~. 93 5.2 ¢8~ ~.Y 89 $.~ 95 4.2 277 H.A. 2 0.2 ~ 0.~ 20 0.6 ~ 0,2 ~7 0.~ T~ ~795 100.0 3907 200.0 1G6A 1~.0 22~3 100.0 S702 100.0 hea~ch c~ ochers 99& 27.8 1307 &7.6 372 ~.5 93S 51.2 230~ 36.A about eq~lly hm¢do~ 2277 63.6 ~&l ~5.2 ~98 5~.2 7;3 ~0.7 3518 55.6 ¢tia~eCces art pcob~1? N~ ~:do~ co hu~ aC ~ 60 1.7 89 3.2 9 1.0 ~ ~.& 1~9 2,~ D,E. 2&0 6.7 103 3.8 37 4.0 6~ 3.6 3&3 5.4 • .A. 9 0.3 7 0,2 3 0.2 ~ 0.2 16 0.3 T~ 3~ 100.1 2747 100.0 9~ gg.g 1828 100.i ~327 100.1 ........ TIEX 0007658
Page 73: CBP09658
~ ~ TOTAL h~z~ ~o he~ CE~ o~rl 213 ~.8 233 ~.3 466 ~.9 ~d Z ~ko is p~o~bly ~ ~o h@~ ~m ocb~s 1~ 11.1 517 23.0 701 17,9 ~ sm ~ ocher k£n~ 253 ~2 321 1~.3 ~7~ 1~.7 D.K. 2S 1.7 39 1.7 68 1.7 .~ c£~met~s ~ p~ob~ly about ~ly ~rdo~ ~5 ~2.0 • 908 ~0,~ 1773 ~st~ Co ~l~h ac ~1 21 1.3 106 ;.7 127 3.2 ~ardo~ 89 ~.3 95 4.2 1~ ~. 7 ~* ha~rdo~ 10 0,6 ~ 0.2 1~ T~ 1664 100.0 ~43 99.9 3907 F~MAL£ ~-~d ~ ~ Z ~ar~ to he~ch C~ o~e~ 141 ~.3 510 27,9 651 23.7 DeE, ~ ~C~8 ~7 ~ 499 54.3 7~3 ~0.6 ~42 45,2 C£~ccas a=s ~rdo~ 2 0.2 4 0.2 S 0.2 0076160 TIEX 0007659
Page 74: CBP09659
HALE ?e~. both qu,f.c ~,,d cue dram 78 4.7 1~4 7.3 242 6.2 ~em, q~C 32~ 19.5 ~23 18.9 7A7 19.1 ~ms, cuc d~ ~8 3.5 193 8.6 ~1 5.~ ~, c~ s~nS 0 0.0 10 0.6 10 0.3 ~. ~e ~98 72.0 iA49 6~.6 26~7 67.7 D.X. ~ 0.3 3 0.1 8 0.2 ~.A. 2 O.2 1 * 2 0.1 ~ 166~ 100.1 22~3 99.9 3907 100.0 ~, bor.~s qu:L~: a=d cur. dov~ ~0 4.& 132 7.2 172 6.3 Tee~ q~ 177 ~.3 383 21.0 560 20.4 ~es, ~u~ ~ 21 2.3 17& 9,~ 195 7.1 ~o, ~e 673 73.2 ~ 60.8 1785 65.0 D.[. 2 0.2 0 0.0 2 a.~, . 1 0.1 2 O.2 3 0.1 ¢~ 919 100.O TIEX 0007660
Page 75: CBP09660
~i~:m~m sank:L~l~ 1062 59.2 ~928 49,3 97~ 58.3 957 ~2.7 2990 52.~ 6&& 35,9 ~778 &S.S 6~ 36.7 2267 ~2.0 2~22 ~2.5 83 4.6 ~82 ~.7 72 &.3 ~ ~,9 265 6 0.3 19 0.5 11 0.7 8 0.~ 2S 1795 100.0 3907 100.0 1666 100.0 ~2~3 100.0 5702 99,9 FEMALE ~es 2433 68.0 2,367 69.7 596 64.8 771 42.1 3800 60.1 ~o 885 2&.7 ].215 44.3 271 29.5 966 51.7 2100 33.2 D,E. 246 6,9 1~8 5.6 66 S,O 102 5,6 39~ 6.:2 M.A. 16 0.6 $7 0.6 6 0.7 11 0.6 ~3 0.$ 2'O'L'AL 3580 100.0 2T&7 $00.0 919 TIMN 0076162 ~:".~~'019~ .. q. ~,v' ~Z - 6:2 TIEX 0007661
Page 76: CBP09661
gEVEB EVER FOI~R CUEI~I~I~I~I~I~I~I~I~I~NTTOTAL On$~ £~ sa~e~y hazard 382 21.3 955 26,6 396 2~.7 561 25.0 ~337 23.6 Whether safe~y hazard o~ no~ 10~1 58.6 * 1899 ~8,6 910 5~.7 989 ~.1 2950 ~1.7 " D.E. 3~ 2.8 113 2.9 ~9 3.~ ~ 2.~ 1~ 2.9 H,~. 9 0.~ 1~ 0.~ 5 0.3 10 0.~ 2~ 0,~ Ho~ shoed no~ ~ve ~he =£8h~ 2~S 13.8 805 20.6 2~ 15.3 551 2~.5 10~3 16.~ ~n'C k~ £f C~y 8ho~d ha~ ohm ~shC 54 3.0 120 3.1 42 2.5 78 3.5 174 3,1 TOT~ 1795 i00,0 3907 ~00.0 FEHALE h'EVE~ EVEI FORidY.~ CURRLNT TOTAL Oul7 £f saree7 h~ard 676 18.9 585 21.3 162 17.6 ~23 23.2 1261 19.9 - ~e~er ~e~ hazard o~ uo~ ~78 63.6 1516 55.2 602 65.6 91~ 50,0 37% 50.0 D.K. ~9 3.3 69 2.5 22 2.& 67 2.6 188 M.A. 15 0.~ ~ 0.~ ~ 0.~ 8 0.~ 27 0.~ Not shoed noC ha~ the ~C 355 9.~ ~87 17.7 97 10.5 390 21.3 8~2 13.3 ~n'C ~ if Chey shoed ~ 35~ 99.9 27&7 99.9 919 100.0 1828 1~.0 6327 100.0 TIMN 0076163 ~" ":" ~~ -.~ ~:~-'.~': ~ ~;~ ' ' ~ ~0019610 1I - 43 ......... " TIEX 0007662 -
Page 77: CBP09662
~o ~37 24,3 998 25.5 ~67 28,0 53~ 23.7 1~35 25,1 ao~h 4qu~ly ~o~8 310 17.3 30i 7,7 249 15,0 52 2,3 611 10.7 ~e£~e~ £s ~S 9 0,S 58 1,~ 33 2,0 25 1,1 67 1,2 D,~, ~ 0,a 10 0.3 3 0,2 7 0,3 25 0,5 S~ T~ 1~3 77.0 19~2 49.9 1167 70.1 7~5 3~.0 333~ 58.5 ~ 179~ 1~.0 3907 100.0 166~ 100,0 2263 100.0 5702 I00.0 Ye~ 1036 28,9 321 11,7 217 23,6 106 5.7 1357 ~o 972 27,1 773 28,Z 300 32,7 473 25,8 1745 27,5 Bo~b equ~l.ly axmoyLns 798 22,3 196 7,1 162 17,6 34 1,9 99~ 15.7 Ns~.~= £s ~8 28 0.8 ~ 0,8 6 0,7 16 0.9 50 0,8 D,R, 43 1,2 8 0,3 4 0,4 ~ 0,3 51 0,8 ~,A, "8 0,3 6 0,2 S 0,5 1 0,1 16 0.2 S~~ 288~ ~,6 1326 ~,3 69~ 7~,~ 632 3&,7 ~211 66,6 ~ 3580 1~,0 27~7 100,0 919 1~,0 1828 100,0 6327 100,0 q..- - - TIMN 0076164 T'r 000"/663
Page 78: CBP09663
I, IALE Yes 87Z ~,8.6 808 ZO.7 590 3S,4 218 9,7 1080 29.~ D.~, 11 0,6 22 0.6 ~ 0.9 ? 0,3 33 0.6 ~.~. 1 0.1 4 0.1 0 0.0 ~ 0.2 S 0.1 S£~ ~0~ 1383 77.1 ~ 179J 100.0 3907 ~00.0 166~ 100.0 22~3 1~.0 5702 ~00.0 F'~d4ALE Tes 1036 28.9 321 ~1.7 ~17 23.6 10~ ~.7 L3S7 21.5 ~o 972 27,1 773 28.2 300 32. ? 473 2~. 8 174S 27,6 Both eq~ly ~£nS 798 ~.3 296 7,2 ~62 17.6 34 1.9 994 ~be= £~ ~o~=S 28 0.8 ~2 0.8 6 0.7 16 0,9 ~0 O,[. 43 L,Z S 0.3 ~ 0.4 4 0.3 ~1 ~.L. 8 0.3 ~ ' 0.= S 0.3 I 0.~ $4 0.2 S~ ~ 28~ 80,6 ~26 ~.3 6~ 7~.~ ~32 ~.7 4211 66.6 ~ 3S~ 1~.0 2747 1~.0 919 1~.0 1828 100.0 8327 100.0 TIMN 0076165 TIEX 0007664
Page 79: CBP09664
HALE Tie 756 42.2 820 22,0 620 36.6 210 9.6 1576 27.7 No 425 23.7 895 22.9 4Z~ 24.7 484 2Z.6 Z320 23.1 Both equ.sl.2ya~,zto~f.n~ 271 9.~ ~ 3.2 96 5.8 28 1.2 295 5.2 Hereby: ~s ~S 6 0.3 43 1.1 24 0.8 29 ~.2 G9 0,8 g,K. ~ 1.2 • ~7 Z.J 31 1.9 26 1.2 ?~ 1.4 g.A. 3 0.2 13 0.3 ~ 0.3 8 0.~ ~6 0.3 S~ ~ ~83 77.0 1952 ~0.0 1167 70.1 785 35.0 3335 ¢~ 1795 100.0 3907 ZO0,O "166~ 100.0 22~3 ZO0.O 5702 100.0 ~Sl 33.3 466 17,0 328 35.8 138 7.6 1557 26.2 1054 29.4 684 24.9 2~ 28.S 420 23.0 1738 27.~ ~20 14.5 Z02 3.7 67 7.3 ~ ~.g 622 16 0.3 28 1.0 3 0.3 25 1.4 ~ 0.7 ~ 2.4 3S 1.3 22 2.4 ~ 0.7 ~1 ~ 0.3 ~ 0.~ 10 1.0 1 0.1 29 0.~ 2885 ~,S ~26 ~.3 694 75.6 632 ~.7 4211 6~.6 3~ ~00.0 27&7 100.0 9~9 1~.0 ~828 100,0 6327 100.0 Q' " " TIMN 0076166 ...................... T' EX 0007665
Page 80: CBP09665
~L~ ~4~V~R ~V~R FOR~R CURR~ ~OTAL ~es ~20 ~1.3 852 21,8 65& 3~.~ i~8 8.8 1772 31.1 ~o 3~8 19.~ 9Z~ 23.5 ~01 2~.1 523 23.3 1272 22.3 ~o~*~11y~8 ~8 2.7 55 1.~ #6 2,8 9 0.~ 103 1.8 ~et¢he= l~tng 5 0.3 31 0.8 9 0.5 22 1.0 36 0.6 ~.E. 5Z 2.9 8o 2.0 52 3.1 z8 ~.2 132 H.A. 10 0.5 10 0.3 S 0.3 5 0.2 20 S~T0~ 1383 77.1 1952 ~9.9 1167 70.1 785 3;.9 3335 T~ 27~5 100.0 3907 100.0 166~ 100.0 22~3 k0O.0 5702 100,O 1750 68.9 ~99 18.2 ~6 37.7 ~3 8.5 2249 35.6 769 21.5 699 25.5 272 29.6 ~27 23.~ 1~68 23.2 1~2 ~.0 ~9 1.8 28 3.1 21 1.1 191 3.0 ~ 0.3 ~ 0.~ 5 0.~ 8 0,4 26 0.~ 196 3,~ 52 1.9 33 3.6 19 1.0 2~8 3.9 ~ O.& l& 0.5 I0 1.1 ~ O,Z 29 0,3 2885 ~,6 1326 68,3 696 75.~ 6~ 3~,7 ~2~1 66,6 3580 100.0 2747 100,0 919 1~.0 2~8 100.0 6327 100.0 ..................... "1 TIEX 0007666
Page 81: CBP09666
~ss 1001 ~3.8 993 25.~ 727 ~3.7 266 11.9 1994 35.0 ~o 33~ 1~.6 861 22.0 385 23.2 ~75 21,2 1195 21.0 Soeh eq~11~ ~oy~uK 30 1.7 ~6 1.2 3I 1.9 15 0.7 76 1.3 ~e£che~ ts ~oy£n8 2 0.1 28 0.7 9 0.~ ~9 0.8 30 0.5 D.~. 10 0.6 ~8 0.5 ~ 0.7 7 0.3 28 0.~ N,A. 6 0.3 6 0.2 3 0.2 3 0.1 12 0,2 S~D T~ 1383 77.1 1952 SO.O 1167 70.2 78S 3~.0 3335 58.5 T~ 17~ 1~.0 3907 1~.0 1564 L~.0 2243 100,0 $702 LOO.O FEI~IAI.E ~ ~ YORP~B, CI.~RIU~q'~ TOTAL Tea 2013 56 • 2 610 ~o 722 20.2 633 ~3.2 Both eq~kZy ~£n8 98 2.7 39 1.~ 20 2.2 19 1,0 137 2.2 ~c~r 1s ~ 14 0.4 20 0.7 ~ 0.~ 16 0.9 3~ 0.5 D.E. 27 0.8 ~ 0.5 ~ 1.2 6 0.Z 42 0,7 S.l. ~ 0.3 9 0.3 7 0.8 2 0.1 20 0.3 ~ ~ 2~5 ~.6 1325 ~8,3 69~ 75.5 632 3~.~ ~211 66,6 ..................... TIEX 0007667
Page 82: CBP09667
vh~sc~n~ or h-~u~ ? (~ked on~y of patens "A~ee~nS SC~on~y" or "Ascee~g ~d~' Co sCaCe~nC ~) MALE Yes 998 55.6 967 2~.8 72~ ~3.5 Z~3 10.8 1965 3~.5 ~e 327 18.2 871 22.3 388 23,3 483 21.5 1198 21.0 Bo~h cquallTa~noT~n8 37 2.1 ~ 1.0 23 i.~ 17 0.8 77 ~.~ ~che~ Ls ~o7L~8 2 0.1 37 0.9 L3 0.8 2~ 1.1 39 0.7 D,K, ~ 0.7 28 0.7 15 0.9 13 0.6 60 ~.7 B.A. 7 0.~ 9 0.2 ~ 0.2 5 0.2 16 0.3 S~E~D ~ 1383 77.~ Ig52 ~9.9 1167 70.1 785 35.0 3335 ~ 1795 100.0 3907 100.O ~664 I~.0 22~3 L00.0 57~2 ~ --v~a lq:}]~'E (:URRE3T TOTAL Yes 20SI 58.1 6~6 23,5 438 ~7,6 208 ~.3 2727 ~3.1 No 693 19.t 603 22.0 2~ 2~.X 38~ 20.8 1296 Z0.5 Boch eq.=lly ~o~g ~3 1.2 22 0.8 ~ ~.2 ~1 0.6 G5 1.0 Nelthe~ ~ ~o~8 18 0.5 ~ 1.1 7 0,8 23 1.~ ~8 0.8 D.K. 37 1.0 16 0.6 % 1.0 7 0.~ 53 0.8 N.A. 13 0.~ ~ 0.3 7 0.8 2 0.2 22 0.~ S~ ~T~ 2~ 80,6 ~326 ~8,3 69~ 75,5 652 3~.5 ~211 ~6.6 - ~ 35~ 1~.0 2747 100.0 ~19 1~.0 1828 1~.0 5326 100.0 TIMN 0076169 "7-0019616 ::- .... -:-:: - TIEX 0007668
Page 83: CBP09668
III PERCEPTION TIMN 0076170 7"O01961'7 ........... TIEX 0007669
Page 84: CBP09669
2 ~ wsnc you co cl~Lnk of 20 adults ~hac you know ... How many oe chess 20 paople ch&c you kuov vould you say ace ¢tSsrecce smoksrs7t RALE 3 0.5 ~ 0.8 9 ~.~ 2 0.2 1~ 0.7 17 2.6 ~ 0.8 L1 ~,9 ~ 0.1 29 17 2.6 29 2.0 16 ~.7 13 1.~ ~6 2.2 &2 G.& ~ 6.6 ~3 10.7 3] 3.9 138 6.6 ~Z 33.7 ~31 29.8 197 33,~ 23& 27.3 ~$2 31.1 ~8 2&.1 ~35 30.1 ~1 25.7 28~ 33,2 393 28,3 ~ ZO.~ 392 27.1 117 19.9 275 32.1 526 2~.1 5 0.8 7 0.5 5 0.9 2 0,2 655 ~.0 1~ 99.8 588 ~0.1 856 99.9 2099 100.2 26 2.3 20 LO 8 2.3 2 0.3 &8 3.8 27 2.6 ~ 3.1 16 2.3 75 3,3 368 29.3 327 ~1.7 ~9 36.9 198 29.1 256 20.& 2&8 2&.1 67 19.~ 181 26.6 50A 22.0 2~ 16.8 26~ ~.6 ~ ~.& 22& ~2,9 &7~ 20.8 &7 3.7 ~ ~.3 ~ 3,& 1 O,~ 60 2,6 1257 100.0 1031 100.1 350 99.9 681 100.0 2288 1~.0 TIEX 0007670
Page 85: CBP09670
~e 39 6.0 ~4~ 9.8 56 9.~ 8~ 9,9 ~80 8,6 Fc~ ~3 S.6 9~ ~.6 3~ 6.0 60 7.0 1:8 6.6 6 - 10 160 24.4 203 14.1 99 16,8 LO~ 12,1 363 17.3 ~ , ~ &2 6,~ &3 3,0 18 3,1 25 2.9 8~ &,O Hone ~ ~,6 350 2k,2 133 22,6 217 25.4 439 20.9 D.LI~.~ 39 6,0 22 1,5 ~ 2,0 10 ~.2 61 2,9 ~ 655 I~,0 1~4& 100,1 5~ 100,0 85~ ~.0 2099 100.0 ~ E~F.Jt F09~'~ ~ TOTAL 72 5.7 81 ~,9 22 6.3 59 8.7 153 6.7 81 6.4 103 10,0 34 9.7 69 10.1 184 8.0 62 ~,9 8~ '7,9 26 7.4 SS 8.1 143. 6.3 ~2 &,l 52 5,0 ~ ~,3 37 5.~ 10~ ~,~ 208 16,~ 189 18,3 68 19,4 ~ 17,8 397 17.~ 31~ 2~,~ 20? 20,1 89 2~,~ ~ 17,3 326 2~,0 ~1 10,~ ~ ~,3 ~ 7,1 19 2,8 175 7.6 73 5,8 17 1,6 6 1,7 ~ 1,6 90 3,9 170 ~,5 ~6 22.9 58 16,6 178 26,1 406 17.7 89 7,1 21 2,0 ? Z,O 14 2,1 110 4,8 ~57 99.8 1031 100,0 350 9~,9 681 1~,0 2288 99,9 TTEX 0007671 ....
Page 86: CBP09671
HALE ~e~ 67 10,2 1~3 ~.9 ~1 2.0 102 11.9 210 ?ou~ ~8 7.3 96 5.6 3~ L8 62 7.2 1~ 6.9 ~ 102 ~.6 • 218 ~.1 107 18.2 1~ 13,0 320 6 - 10 97 1~.8 2G2 18.1 135 2~.0 ~7 1~.8 359 17.1 ~ . ~ 19 2.9 63 ~.~ ~5 7,7 18 2.1 82 3.9 16 - 20 3 0.5 ~ 1.0 ~3 2.2 2 0,2 18 0.9 ~one 175 26.7 338 23.~ 100 17,0 238 27.8 513 O.~./N .K. 37 ~,6 20 1.~ 10 1.7 10 1.2 57 2.7 ~ 655 99.9 1~ 99.9 ~88 100,1 8~6 99.9 2099 ZQ0,0 205 8.~ 96 9.3 19 3.~ 77 11.3 201 ~8 ~.6 110 10.7 39 ~.1 71 10.4 268 11.7 ~ 6.7 72 7.0 20 3.7 52 7.6 1~6 6.8 68 5.~ 50 4.8 ~ ~.6 3~ 3.0 118 ~6 ~.~ 169 ~.S 65 18.6 8~ ~.3 305 13.3 16& 13.0 163 ~.8 66 18.3 99 16.5 327 36 2.9 45 ~.~ ~ 7.1 20 2.9 8~ 3.S ~ 1.0 27 2.6 23 6.6 & 0,6 39 1.7 ~S 30.6 297 28.8 71 20.3 226 33,2 682 ~ 7.1 22 2.~ 8 2.3 1~ 2.1 11~ . ~.9 ~S? ~00.1 103~ 1~0.0 3~0 100.0 681 99.9 2288 100.0 0019620 TIMN 0076173 ........................... T~EX 0007672 ....
Page 87: CBP09672
NEaR ~/~ ~gL~R CIJRR~ TO~AL Ye~ ~8 19.9 774 19.8 2B3 17.0 491 21.9 1132 19.8 ]o ~1 ~.7 18S8 ~7.5 883 $3.0 975 43.5 2~61 ~'no ~IFdoc~ov 180 10,0 411 10.~ 144 8.6 267 11,~ 591 10.4 D.~. 454 2~.3 860 22.0 351 21.1 509 22.7 1314 23.0 X.A, 0 0.0 ~ 0.1 3 0.Z 1 * ; 0.1 ~ 1795 99.9 3907 99.9 ~64 99.9 2243 100.0 5702 100.0 Y,m 532 14,9 S~ 18.4 135 14.7 371 20.3 103~ Ho • I768 49.~ 1~ 51.5 5~ ~.B 90Z 49,4 3183 50.3 ~ =o f~y ~etor 232 6.5 16~ 6.0 ~ 5.2 ~6 6.3 39~ 6.3 O.[. ~0~ 29.2 6~7 23.9 22~ 24.Z 436 23.9 ~703 26.9 ~.A. ~ O.L 5 0.~ 2 O.Z 3 0.2 7 0.~ ~ ~ ~.Z 2747 99.9 915 95,~ 2828 ~O0.Z 6327 ~00.0 TIEX 0007673
Page 88: CBP09673
YaJ ~3 63.7 1731 ~.3 9~ S~,7 787 3~.1 297~ ~0.~ ~o 585 32.6 1918 ~9.1 '606 3~,~ 1312 58.5 2~03 ~3.9 D,~. 65 3.6 2~ 6.2 106 5.~ 138 6.Z 30~ " ~ 179~ 100.0 3907 100.0 1~6~ 1~0.0 22~3 100.L 5702 1~0.0 Te8 2202 61.5 1181 43,0 552 60.1 629 3~.~ 3383 53,5 ~o 1196 33.~ 1446 52.6 325 35.4 1121 81.3 2~42 41.7 ~ 3580 I~0.0 27~7 100.0 Sl~ 100.1 1828 100,0 6327 Tee 901 50.2 1909 48.8 902 5~.2 1~7 ~.9 2810 ~9.3 ~o 873 48.e 1943 ~9.7 733 ~4.0 ~ZO ~3.9 2816 D.K. 21 1.2 ~& L.4 28 1.7 26 1.2 7~ N.A, O 0.0 1 * ~ 0.1 0 0.0 ~ T*~ 2099 58.6 1457 53,0 550 59.9 907 49.~ 3556 56.2 ~o 1630 39.9 ~68 46.2 362 39 .& ~6 ~9.5 2698 ~Z, 6 ~ 35~ 99.9 27~7 100,0 ~19 99.S 1~ 100.1 6327 ,. ....,...,~..~ .'..~,~ • . ~ - ~ 0076175 -. 0007674
Page 89: CBP09674
671 37.~ ~6 31.6 6~2 39.2 ~8~ 26.0 1~07 33.~ 109A 8~.9 2623 57.1 ~90 59.S 1633 72.8 3717 65.2 ~ 1,7 66 1.2 Z1 1.3 25 1.1 76 1.3 0 0.0 2 0,1 1 0.1 1 * 2 17~5 100,0 3907 10o.0 1664 100.1 22~3 99.9 5702 1386 38.7 877 31.9 ' 36~ ~0.0 509 27.~ 2263 35.8 2166 ~9.9 18A3 67.1 ~ ~9.0 1301 71.2 3989 ~7 . 1.3 2A 0.9 8 0.9 16 0.9 71 1.1 1 * 3 0.1 1 0.1 2 0,~ ; ~.1 3580 99.9 27~7 100.0 919 100.0 18~8 100.1 6327 100,1 g6~ ~3.8 ~IOZ ~3.8 987 Sg.3 ii15 ~g.7 3087 53.8 792 ~.1 1738 44.5 651 35.1 1087 48.5 2530 44.4 3S 2.0 S5 1.7 2~ 1,5 ~0 1.8 101 1.8 2 0.1 2 0.1 1 O.Z ~ * ~ 0.1 1~S 100.0 3~7 100.1 1~64 1~,0 ~3 I~.0 5702 100.1 ~*ALE 2086 58.3 ~86 57.8 8~ 66.7 974 53.3 3672 58.0 lt69 tl.0 L146 41.7 300 32.7 8~6 ~6.3 2615 2~ 0,7 ~ O.t 5 0.~ 7 0.~ 36 0.6 1 * 3 0.1 2 0.~ 1 0.1 4 0.~ 3580 100.0 27t7 1~.0 919 99.9 1~8 100.1 6327 • ~8s ch~ 0,05 pec~nc, TIMN 0076176 TINX 0007675
Page 90: CBP09675
IV HISTORY TIMN 0076177 "~" 001~..624 TIEX 0007676
Page 91: CBP09676
12 & u~d~r 105 6.3 223 9.9 328 8.~ 13 62 "2.5 86 3.8 128 3.3 Z& 106 6°2 ld0 7.1 254 6.8 1S 180 10.8 211 9.6 391 10.0 ° , 16 199 1.2.0 278 12.6 677 12.2 17 176 10.6 228 10.2 ~06 10,3 18 277 16,6 340 13.2 617 13.8 19 - 20 274 16.5 367 1~.5 621 15,9 21 - 24 1~0 11.4 227 10.1 417 10.7 25 & o~ ~ 6.8 132 5.9 24J 6.3 o.~. 4 0,2 8 0.4 ~ 0.3 H.~. 0 0.0 3 0.1 3 ~ 165~ ~9.9 22&3 100.0 3907 1~0.1 FEStaL[ 11 & ~ 13 1.4 58 3,2 71 2.6 13 18 2.0 47 2.6 65 2.4 14 33 3.6 60 3.3 93 3.6 13 54 5.9 110 6.0 164 6.0 16 100 10 • 9 195 10.7 295 10.7 17 82 8.9 136 SoS 238 8,7 18" 131 16.6 263 14.4 41& 13.1 19 - 20 177 19.2 325 17.8 502 18.3 2~ & oyez 165 18.0 315 17.2 480 17.5 D.Z. 4 0.A 2 0.1 6 0,2 "IX~.~L5 919 100. O 1828 100.0 2747 100.1 TIMN 0076178 q. 29 ............. " ......... : ............... TIEX 0007677.
Page 92: CBP09677
HALE goa4 6~ ~i. 1 012 36.2 1796 38.2 -- One~ 222 ~3.3 48& 2Z.6 .7C6 18.L ~ee 2~ 12.0 358 16.0 558 14.3 ~5 ~i8 272 16.3 38& 17.1 6~6 16,8 6 o~ ire ~i~8 2~ 14.7 163 7,3 ~7 10.~ T~ ~'~ ~,r c~e 36 2.2 30 1.3 66 1.7 g.A. ~ 0.~ ~ 0.5 18 0.~ ~ 166~ 100.0 22n3 1~.~ 3907 1~,2 433 ~7.1 740 40.$ 1173 42.6 ~3 13.& 354 19.4 &77 17.4 ~ "~.2 2~9 14.2 371 13.5 143 ~.6 323 17.7 466 17.0 ~ ~.~ ~g 6.5 2~3 7.~ ~ 2.1 26 1.3 43 1.6 S 0.5 9 0.5 14 O.J 919 1~.0 1828 1~.1 2747 .09.9 TIMN 0076179 ~. $7/65 ~-~':V'-~'~"" " TTEX 0007678
Page 93: CBP09678
(,~ked ~u.l.y o£ people vho CURRENT ~ ~ TOTAL Ye~ 357 16.0 360 19.7 717 ~.7.6 1'~-obably 1.~ 6.9 112 6.1 266 ~p~ 65 2.9 ~7 2,6 ~12 2,7 No 193 8.6 182 10.0 375 9.2 ~.~. ~ 0.2 ~ 0.2 8 0.2 SE~D T~ 8~ 36.3 7~ ~0.5 1552 38.0 TOTAL ?.2&3 100.0 1828 100.0 ~071 100.0 TIMN 0076180 ............. TTEX 0007679
Page 94: CBP09679
FOUR ~ TOTAL Yes 832 $0,0 1491 66.5 2323 59.5 No 817 49.1 745 33,2 1562 40.0 D.K. 13 0,8 6 0.3 19 0.5 TOTAL 1664 100.0 2243 100.0 3907 100.1 l~O~lgR ~ TOTAL Yes 426 &6.4 1365 74.7 1791 65.2 • o 486 52.9 ~57 25.0 9~3 3~. 3 D.~. 5 0.~ 3 0.2 8 0.3 • .A. 2 0.2 3 0.2 5 0.2 ~ g19 I00.0 1828 I~.I 2747 100.0 TIMN 0076181 *L~a8 chin O.OS pe~cenC. ...................... T]IEZ. 000'7680
Page 95: CBP09680
HZVEa EVER FOEMER C,/~,3Eh'T D~finil:ely uo~ ~8~ 88.4 ~&9 39.6 13£6 ~.8 203 9.1 ~ob~y 7eo ~ 1.~ 1003 25.7 ~ 0.7 991 ~A.2 1028 18,0 ~ly ~es ~ 0,2 262 6,7 0 0,0 262 11.7 2E6 ~.7 O.R. 17 0.9 ~9 ~.3 9 0,~ ~0 ~.3 1~6 2.~ M.k, 3 0.2 3 0.1 0 0,0 3 0,1 e 0.1 T~ 179~ 1~,0 3907 100.0 166~ 99.8 22~3 1~.0 ~702 100,0 FEHALE ~m~.~aly no= 3295 92.0 8~.G 29.7 690 75.2 L26 6.9 4~ 65.0 ~b~17 =o~ 2~ 5.9 7~7 27.2 192 20.9 555 ~,& 959 ~,2 P~ob~ly ye~ 31 0.9 ~6 31,5 2B 2.9 838 ~5.9 897 14.2 ~f~tely y~ 22 0,6 221 8.1 2 0.2 219 12.0 2~3 3.8 D.~ 17 0.5 94 3.~ 7 0.8 87 ~.8 ~ 1.8 N.A, 3 0,1 3 0.i 0 0.0 3 0.2 6 0,1 ~ 35~ ~,0 27~7 ~.0 9~ 1GO.0 1828 ~.2 6327 100.1 TIMN 0076182 ZV-5 ......................... T:]:EX 0007681
Page 96: CBP09681
X~mm ~ i • ~7 i 0,2 0 0.0 i 0.1 5 - It * by 107 18.2 11~ ~, 3 221 D. 3 ~ - 2~ s ~ • lS8 32.0 3~9 ~.7 $37 37.2 2~ - 34 • ~? 62 10.~. 146 17.0 208 35 - ~ • dsy t~ 18.0 1~8 17.3 2~4 17.6 ~5 - 5~ s d~ 23 3.9 19 2.2 42 2.8 55 ~d ~ 55 9.~ 37 4.3 92 6.~ ~oe deem~ 22 3,7 26 3.0 t8 3.3 ~ 588 1~.0 856 99.8 Z4~4 99.9 3 O.g 0 0.0 3 0.3 58 16.6 47 6.9 105 10.2 89 2~.4 1&3 21.0 232 22.5 ~ 32.0 301 44.2 413 23 S.6 82 12.0 IOS 10.2 31 8.9 70 10.3 ~01 9.8 4 1.1 6 0.9 10 ~7 4.9 ~ 1.9 3o 2.~ 13 3.7 19 2.8 32 3. 350 1~0.1 681 1~.0 1031 100. t 0076183 TIEX 0007682
Page 97: CBP09682
vhan ~o~ ve:e (~ ~ Q. 35). ~C~ T~ ~ ~ - ~SPOND~T'S AGE ~S ~ ~ ~. ~8) HALE ~I'ORI~K ~ TOTAL 89 5.3 27 1.2 116 3.0 ~0 7.~ ~ 2,6 $77 2~3 14.6 323 1~.4 566 1179 70.9 1822 81.2 3001 76.8 8 0.5 8 0.~ 16 2 0.1 3 0.1 5 0.1 16~ 100.0. 22&3 99.9 3907 Less t~, I 7~ ~ 1.~ 3 0.2 16 0.6 I ~. - 2 ~s, 5 ~. ~ 10.~ 50 2.7 I~ 5.3 ~ ~s. - 4 7e~ 97 ~0.6 75 ~.~ 172 6.3 ~ ~. 2~. - 9 y ~. ~ ~e. ~8 17.2 283 ~.5 ~1 16.1 10 ~s ~ m~ ~8 59.6 l&~ 77.3 2961 D.[. ~ 0.3 2 0,1 7 0.3 ~,~ 2 0.2 2 0.1 + ~ 919 99.9 2828 1~.0 27&7 100.1 */d~e r.h--, TIMN 0076184 "T'OO19G31 ............... TIEX 0007683
Page 98: CBP09683
27 Hay ion| ha~ ~.~: been s£nc,~ you s~oked c£g~.~'e¢~es ~a~rly regularly? (A~ked m'.ly of ~o~r e~ok~rs) ~O~R • tLE FEMALE TOTAL L~es ~n 1 year 135 8.1 11~, 12./, 2~9 9.6 1 7*~ " 2 yea~, 5 ~ 65 3.9 61 6.6 126 ~.9 2 yea~. 6 ~ - ~ ~em 2~8 13.~ 13~ L4.3 ~9 ~3.5 ~ years, I ~:h - 9 7e~s, 11 ~C~ &74 28.5 269 29.3 743 28.S 10 yea~ ~d ~tr 7~0 ~.0 326 35.5 1076 ~.~ 17 1.1 1~ 2.4 31 1.2 ~ ' 166~ 2~.0 919 99.9 " 2583 100.0 q. 39 TIEX 0007 684
Page 99: CBP09684
~-9 66 ~,2 ~23 ~6.~ ~ 53 9.0 85 9.9 ~38 9.6 ~-19 55 9.~ 80 9,3 ~5 9.3 " 2~2~ 37 6.3 78 ~.1 ~ 7,9 2~-29 22 3.7 6S 7.9 ~ 6.2 3~3~ Z7 ~.6 ~ 5.7 76 33 ~ over 9~ 16.7 L7~ 20.3 272 18.8 ~C dece~ed Ii8 20.I 91 10.6 209 14.5 ~ ~88 100.0 8~6 99, 8 1~ 99.9 ~ ~ 5 ~36 ~.9 2~0 20.6 276 26.8 5-~ 46 13.1 2~ 27.8 167 16.2 1~1~ 28 8.0 93 ~. 7 1~ 11.7 2~2A 2G 5.7 ~ 7.3 70 6.8 2~Z9 ~ 3. I 38 5.6 4g ~. 8 3~ ~0 2.9 2~ 3.~ ~ 3.3 35 ~ ~ 20 5.7 ~9 7.2 69 6.7 ~ 350 99.1 ~81 1~.0 1031 1~.O TIEX 0007685
Page 100: CBP09685
c~rscces ~ Q. ~e 173 29.~ ~08 ~2.6 281 ~9.~ Le~o c~ 1 y~ 35 6,0 26 3.0 ~2 ~.0 I ~ar - 2 ~a. 5 ~s. ~3 7.3 ~2 6.1 95 6.6 ' ~ ~s. - ~ ~s. ~2 8.8 ~ 5.3 98 6.8 4 ~s. 1 ~. - 9 ~. ~ ~s. 109 18.~ 19~ 22.7 303 21.0 10 ~e~ ~ ~er 1~8 Z3.~ 401 ~6.8 53~ 37,3 O.£. 33 5.6 20 2.3 ~3 3.7 N.*. ~ 0,9 9 1.1 14 1.0 ~ ~8 1~.0 856 99.~ 14~ 99.9 None h2 12.0 ~0 5.9 82 8.0 ~ss ~ 1 ~ 8 2.3 6 0.9 l& I 7~ - 2 ~s. ~ ~s. 51 1&.6 3~ 5.7 90 8.7 2~ ~s. - 4 ~. 39 ~,1 35 5.1 74 7,2 & ~s. 1 ~. - 9 ~u. ~ ms. 60 17.1 165 2A.2 225 21.8 - 10 ~s ~ ~ ~ 32.3 362 53.2 675 D.L 32 9.1 31 ~.6 63 6.1 H.A. 5 1.& 3 0.~ 8 0.8 ~ 350 99.9 ~1 100,0 1031 100.1 ..... TTEX 0007686
Page 101: CBP09686
V DOSAGE TIMN 0076188 -~ ..... . ,:;... '7"001.9G35 ........ T~EX 0007 687
Page 102: CBP09687
dcz~ ~ the 8~ke ~ you s~ke(d) c~za~CCes. ~K CU~T TOT~ ~eply ~nCo the ~esC 763 ~5.8 680 30.3 1443 36.9 0nly partly inca chest 39~ 23.7 734 32.7 ~28 28.9 ~ fac b~k as ChEoa~ 223 13.~ ~I0 18.3 633 16.2 " gel1 ba~ ~C~ ~Ch 82 4.9 " 1~g 7.5 251 drav 1C ~ aC all 129 7.8 163 7.3 292 7.5 Zntc ~aSC - D.L~.A. h~ Z~r ~3 2.6 50 2.2 93 Into ~uch - D.K.~.A. h~ far ~ 0.3 7 0.3 12 0.3 D.K. 25 1.5 29 1.3 5~ ~.~ N.A. 0 0.0 1 * 1 ~ 166~ 100.0 22~3 ~.9 3907 100.0 D~aply ~-co ~/~e chest 251 27.3 300 16.4 551 20.1 f8: back ~ ~sC 224 26.4 566 31.0 7~ 28.8 back ~Co ~u~ 60 6.5 193 20.6 253 9.2 ~esC - O,K.~.A. h~ ~a~ ~ 2.& 37 2.0 59 2.1 21 2.3 46 2.5 ~7 2.4 0076189 ~ ~-v-~ ~ 0019636 TTEX 0007688
Page 103: CBP09688
~LE F01~l~ C~IUt~IT TOTAL of ea~h cLSstscce 987 59.3 L312 ~8.5 2299 58.8 of ea-~y, c~gaz'ecce 267 ~6.0 ~8 21.8 755 19.3 '. of se~ cL~ecces ~OL 6.1 1~ 6.0 235 6.0 ~nhale D.R,/N.A. ho~ o~Ce~ 10 0.6 5 O.Z 13 0.~ ~n'c £nh~e 297 17.9 29~ 13.1 ~.X. 2 0.1 10 0,; 12 0,3 ~ 16~& 99,9 22~3 ~00.0 3907 99.9 l~)m(F.~ ~ TOTAL o~ e~h c$~reCce ~ 16.B 385 21.1 ~39 19.6 Z~ D.~.~.A. h~o~t~ 10 1.1 11 O.G 21 0.8 ~'~ ~4 2~ 27,0 ~0 21.9 6~8 23.6 H.~. G 0.7 5 0.3 11 0.~ TOT~ 919 100.1 1828 100.1 2747 100.0 , TIEX 0007689
Page 104: CBP09689
J~ ~*r ~ po**~ble 2~ 15.3 2~ 10,~ ~98 12,7 314 o~ ~'e 496 29.8 $60 25.0 10~6 27,0 Ho~e.r.A~n ~/2, ~ ~ 3/4. ~2 9,7 230 ~0,3 392 10.0 1/2 ~ ~n 730 &3.9 ~76 52.~ ~06 ~8,8 O,E.~,~, h~ 2 0.1 8 0.4 10 0,3 D.£, 20 1.2 ~ 1,1 ~ 1.2 ~ 156A ~00.0 22~3 100.1 3g07 100.0 p~n-,:Lble 1~5 3.5,9 236 12.9 382 13.9 ~ 18Z 19,8 353 19.3 $35 19.5 1/2, ~ C~ 314 78 8.5 182 10.0 260 9.5 ~o 503 ~&.7 1029 56.3 ~32 55,8 D.£.N.A. ~ ~ 2 0,2 ~ 0,8 X7 0.6 8 0.9 ~ 0.7 21 0.8 ~ 929 100.0 ~8 ~,0 2747 TIMN 0076191 TIEX 0007690
Page 105: CBP09690
26/27 A~ • ~=e~al ~-ult, ho~ ~ o£ ~ou~ cig&~e~e buras (burned) ~r~hou~ your HALE V~7 11c~e ~5~ 33.~ A65 20.~ ~0~ ~6.2 so~ 322 '19.3 ~59 20.2 781 20.0 A~=&¢8 ~¢ ~36 38.2 1010 ~5.0 1~46 ~2.1 A ~ts~ ds~ 120 7.2 2$7 12.8 407 10.~ 9.~. 29 ~.7 15 0.7 ~ 1.1 ~.k. 1 0.1 • ~ 0.2 5 0.~ ~' 166~ 99.9 22~3 100.~ 39~7 99.9 We~y IJ. I:¢ie 265 28.8 3~,0 18.6 605 22.0 s~ 182 19.8 367 20.1 549 20.0 A ~8c desZ ZO8 ~.8 300 16.4 ~8 L4.9 9.E. 1~ 1.~ 17 0.9 31 1.1 ~.~. 1 0.1 2 0.1 3 0.I ~ 919 1~.0 182~ 100.0 27~7 100.0 .., : ,TIMN 0076192 c~. 37 p.V-4, V - & TTEX 0007691
Page 106: CBP09691
day 77 ~.6 11~ 5.0 189 s day 260 ~.6 400 17.8 660 a ~y 570 34.2 908 ~.~ 1478 37.8 2~8 i~.~ 3~ I~.~ ~38 18.3 a ~y t d~ 284 L7.~ ~2 13.~ 586 ~.0 s ~y 6~ 3.7 h7 2.1 108 ~.8 ~ ~ 9.3 60 2.7 2~ S.S ~ 0.~ 21 O.g 2g 0.7 1 0.1 ~ 0.1 4 ~ 1664 100.0 22~3 100.0 3907 L~ss oh-- I • day 0 0.4} 0 0.0 0 0.0 i - 4 • 4•y 1-14 12.6, 1~ 7.9 Z~8 9.4 ~. ~ • ~y 2S3 30.8 463 ~.3 746 i~ - 24 a ~y ~ 32.6 7gG 43.5 10~ 39.9 25 - ~ ~ ~Y 70 7.6 207 ~.3 277 10.~ 35 - ~ ~ ~Y 93 10,1 166 9.1 259 45 - $4 a ~y 11 1.2 16 0.9 27 • 1.0 55 ~ m: 38 t.l ~ 1.4 63 2.3 D.E. 10 1.1 8 O.h ~S 0.7 . ~. 0 o.0 3 o.~ ] 0.1 ~ 9~ 99,9 1828 1~.0 27&7 1~. "" TIMN 0076193 O.. ~0/39 p-V-3 -/"001S~;40 ...... ........... TIEX 000~692
Page 107: CBP09692
F~.II:I= 935 58.2 1788 79.7 2?23 69.7 ~-F~ar 718 ~3.1 4~9 20.0 1167 29,9 N,A. ~ 0.7 6 0.3 17 0.4 ~ 23~8 8~.0 1711 76.3 3109 79.6 ~O2 2~8 . 14.~ 523 23.3 771 [9,7 N.A. ~8 1.1 9 0.~ 27 0.7 ~rd P~ 267 ~6.0 296 13.2 563 Sof~ Pt~ ~6~ 81.9 i~17 85.5 3281 8~.0 S.A. 33 2.0 30 1.3 63 1.6 S~ ~ar 62~ 37.2 28~ ~.5 900 ~8 909 5~,~ ~67 69,~ 2676 63.~ ~ m ~8 7.7 37~ 16.7 502 12.8 ~l~e: ~ 3~ 2.3 ~2 1.9 8~ 2.1 ~-F~l~a~ ~ ~77 3~.7 238 10.6 8~ 20.9 ~l~er ~l 767 46.~ 136[ ~0.7 2~8 ~ 1~ m ~4 7.~ 374 ~6.7 ~98 ~.7 X~-~Zlce~ 1~ n 0 0.0 0 0.0 0 ' E.A. 18 1.1 22 2,0 ~0 1.0 ~ ~66A 100.0 22~3 100,0 3907 "'= .....TIEX 0007693
Page 108: CBP09693
N,A. 9 1.0 2 0.1 11 0,~ " ~1~ 6~ 72.0 1239 6~.8 1900 K~Chol 2~7 26.9 586 32.1 833 30.3 N.A. ~ 1.2 ~ 0.2 1~ 0.5 ~:d Pack 1~2 ~.5 205 11.2 ]~7 So~c ~ 740 ~.6 1612 88.2 2352 85.7 N,A, 37 ~.0 ~ 0,6 ~8 1.7 ~ 1~2 18.7 90 ~.9 262 9.5 ~ 593 64.& ~090 59.7 ~683 61.3 1~ ~ 143 ~.5 ~34 34.~ 777 28.3 U.A. 11 1.2 1~ 0.8 25 0.9 ~11cer ~c 35 3.8 37 2.0 72 2.6 ~On-F~Ce~ ~r ~2 14.4 53 2.9 18~ 6.7 ~L~C~= ~S. 533 58.1 987 54.0 ~20 55.4 ~-Y~Zce: ~ 60 6.5 ~3 5.6 162 5.9 ~lCer ~ m 142 ~.5 633 34.6 775 28.2 g~Y£Ice¢ I~ m 1 0.I 1 0.1 2 0.1 N.A. 16 1.7 14 0. S 31 1. ~ 919 100.1 1828 100.0 2747 100.0 :: TIMN 0076195 ~. ~ ~-v-7 7-,0019642 .... "-- TIEX 0007694 _
Page 109: CBP09694
3t,/34 ~'ben you. b~' (bo~,;bC). do (d.'Ld) yo~ u~ual~y b~y c.'L[a,:eC*'e,, by the ~a~k. o~ b~' ~h,e ca~to~? ~LE 87 ~h~ pac~ 883 53.1 By =b~ ~c~o, 751 ~$,1 1141 50.9 1892 ~8.~ ' DI~L~ bu~ ~,/ ~o~cenI0 0.6 lg 0.8 29 0.7 ~.~ 20 1,2" 18 0.8 38 TOTAL 166~ i00,0 2243 i00.0 3907 99.9 ~LE ~OW ~ TOTAL By .k. ?.~ 576 62.7 714 39.1 1290 47.0 By ~s ~=co= 337 36.7 ~9~ ~.8 I~31 ~Z.l Dt~eC but ~ ~8a~e~ 4 0.4 8 0.4 ~.A. 2 0.2 ~ 0.7 14 0.~ ~ -. ~9 10o.0 la2S ~0.0 2747 1~.0 • "-- TSEX 0007695 -
Page 110: CBP09695
TIMN 0076197 "7" 0C~4'1 ..... " ......................... TIEX 0007696
Page 111: CBP09696
MAL£ NEVER EVER FO~fE~ CURI~NT TOTAL Nov uae snuff 48 2.7 92 2.4 44 2.6 48 2.1 140 2.5 Used ~o use snuff 38 2.1 187 4.8 106 6.4 81 3.6 225 3.9 N~ver used Jnuff 1697 94.5 3622 92.7 1512 90.9 2109 94.0 5318 93.3 uoc echoed Lf nm~ use 0 0,0 0 0.0 0 0.0 0 0.0 0 0.0 ~.~. 12 0.7 7 0.2 2 0.1 5 O.Z 19 0.3 TOTAL 1795 200,0 3907 100.1 1664 100.0 2243 99.9 5702 IO0.0 FEHALE Nov use snuff 69 1.9 16 0.6 5 0.$ 11 0.6 85 1.3 USed Co use ~nuff 36 1.O 52 1.1 10 2.1 %% L.2 68 I.~ Nsvec used snuff 3&67 96.8 2692 98.0 902 98.2 1789 97.9 6158 97.3 Used Co u~e suu~f/ noc stated if soy use 0 0.0 0 0.0 0 0.0 0 O.0 0 0.0 N.A. 8 0.2 $ 0.3 2 0,2 6 0.3 16 0.3 TOTAL ~80 99.9 2747 100.0 919 i00.0 1828 100.0 6327 100.0 TIMN 0076198 7"0019645 3/4 ~-i ~ - I
Page 112: CBP09697
7 Do yot~ .,ow they BEVEE eVER FO~IMER Ct/RE~T TOTAL M~ ~ev ~obacco ~ ~,~ 198 5,1 87 5.2 111 4,9 280 ~.9 Used =o chew Cobacco 125 7,0 795 20,3 348 20,9 447 19.9 920 15,1 Used to r.hav tobacco/ 0 0,0 0 0,0 • 0 0,0 0 0,0 0 0.0 not slated ~f nc~ usa ~.A. i . 0.1 2 0,1 i 0,1 I * 3 0,1 TOTAL 1795 100,1 3907 100,0 1664 100,0 22&3 99.9 5702 L00.0 ~9=5¢ EVEr FO~ Ct~t~21T TOTAL ~o~ ¢h~, tobacco 3~ 0.9 4 0,I 1 0.1 3 0.2 38 0.6 ~sed =o ~ ~b~c~o 39 1,1 37 1.3 13 1.4 24 1.3 7~ 1.2 ~e~ ~d cobac~ 3501 97.8 2704 98.4 905 g8,5 1799 98.& 6205 98.1 0o0 0 0o0 0 0.0 0 0.0 0 0.0 0.2 2 0.1 0 0.0 2 0.1 6 0.I TOTAL 3580 I00.0 2747 99,9 919 100.0 1828 100.0 6327 100.0 ' Too/.s¢4 :" 0076199 ......... T3~EX 0007698.
Page 113: CBP09698
~m,' smok~ c:Lgars 20~ 11.5 816 20.9 229 13.8 $~7 Z$.:' 1022 17.9 , i;eed co ~k. r.'Lprl ~65 14,8 1172 30,0 682 41,0 490 21.8 1437 :25.2 ~v,~ euoksd c~.8ara 1323 73.7 1.917 49,1 752 65.2 1165 51.9 32~ 56.8 ~d Co s~/noC 8~ced ~ n~ s~ke ~ 0 0.0 2 0.~ 1 0.1 I * 2 N.A, 1 0.1 0 0.0 0 0.0 0 0.0 1 F~J.E _z ._ _z ._ ~_ _. _z ._ 0.2 28 1.0 4 0.3 24 1.3 3~ 0.3 0.4 I38 $.0 36 3.9 102 3.6 152 2.4 99.2 ~ 93,9 879 95,8 1698 92.9 6~1 96.9 * 0 0.0 0 0.0 0 0.0 i * 0.~ ~ 0,~ 0 0.0 ~ O.Z 9 O.L 3580 9g.9 2747 100,0 919 100.0 1828 100,0 6327 99.g TIMN 0076200 *La~ than 0.05 perc~nC. q. ~g/~" ~" ~ ~0G~64~ .......... ... . .. ,y~.~.,~ 000"~ 699
Page 114: CBP09699
HALE - ~F~ " EVER I~)P, HEP. C~II~,.F~T LMa ~ I year ~ I.~ 111 2.8 4~ 2.~ 70 3.1 129 2.3 I ~e~¢ - 2 ~e~8, 5 ~uch8 53 3.0 LSO ~.G 82 4.9 98 ~.~ 233 ~ yea~. 11 moues 53 " 3.0 220 ~.6 1;6 8.8 74 3.3 273 4.8 10 years ~d ova: 88 4.9 ~20 10.7 300 18.0 ~0 5.3 508 8.9 O.~. 1~ 1.1 8& 2.1 27 1.6 57 2.5 103 1.8 H.A. 14 0.8 37 0.9 8 0.5 29 1.3 51 0.9 ~ ~ 265 14.~ 1172 29.8 682 ~1.0 490 21.8 1437 25.3 ~ 1795 100.0 3907 100.0 1664 100.0 2263 100.~ 5702 100.0 FEHAL[ NEVF~ year - 2 yesr~, 5 ~n~ 2 0.1 23 0.8 1 0.1 22 1.2 25 0.4 y~s, 6 ~s - 4 y~rs 2 0.1 ~ 0.6 7 0.8 g O.S 18 0.~ P yeses, ~ ~u~s 2 0.1 26 0.9 8 0.8 18 1.0 28 0.5 10 ~e~s ~ ~e~ 3 0.1 27 1.0 ~ 1.2 - 16 0.9 30 0.5 D,~ 2 0.1 20 0.7 4 0.4 16 0,9 22 0.3 ~.*. 1 * 1~ 0,5 ~ 0.3 1~ 0.6 15 0.2 S~ ¢~ 14 0.6 T~ 35~ 100.0 2747 100.0 919 100.0 1828 100,0 6~27 100,0 *L~se r..~n 0,05 pecceuc. 0076201 " ........... "'- TIEX 0007700
Page 115: CBP09700
MALE NEV~ EVER FOI;~/~ CI~AE~qT" TOTAL No~ s~ z 92p~ 140 7,8 ~69 14.6 160 9.6 ~9 18.2 709 ~svar ~o~d • pipe. 1375 76.6 1652 ~2.3 635 38.2 1017 ~5.3 302~ Used Co s~ z p~pe/noC sO, cad ~ n~ s~ • p~pe 0 O.0 0 0,0 0 0.0 0 0.0 0 0.0 N.A. 2 0.1 1 * 0 0.0 ~ * 3 0.1 TOTAL 1795 100.0 3907 100.0 1664 100.0 2243 99.9 5702 100.0 ~c~ smoke • p£pe 1 * 23 0,8 8 0,9 IS 0.8 24 0.4 Used ca am~im a p£pe 2S 0.8 120 4,4 32 3,5 88 4.8 148 2.3 Never smokmd : pipe 3~6~ 99.0 2501 94.7 S79 95.~ 1722 94.2 6143 97.1 Used Co smoke • p£pe/uoC seated £f umt smoke • p£pe 0 0.0 0 0,0 0 0.0 0 0.0 0 0.0 ~,A, 7 0.2 3 0.1 0 0.0 3 0.2 10 0,1 TOTAL 3580 100.0 2747 i00.0 919 100.0 1R28 100.0 ~327 99,9 TIMN 0076202 TIEX 0007701
Page 116: CBP09701
8 0.~ 83 2.1 33 2.0 ~7 2.1 20~ 5.2 7Z ~.3 132 ~.9 2~1 ~.2 ~ O.S 190 ~.9 69 ~.1 1~ ~,~ 201 3.~ ' 69 3.8 3~ 8.0 16~ 9.8 1~8 6.6 381 5.7 ~ 6.9 783 20.0 ~6 2902 297 1~.2 907 ~.9 1~ 0.8 7~ 1.9 33 2.0 ~ O.~ 39, 1,0 12 ~.7 27 278 ~,¢ 168~ ~3.1 869 ~1.9 816 36.3 1963 3~.~ 1~5 100.0 ' 3907 100.0 166~ 100.0 ~3 LO0,O 5702 100.0 ~,MALE 3580 100.0 27~7 100.0 919 100.0 1828 100.0 6327 100o0 TIMN 0076203 ~e ~ 0.05 parc~nc. ............................ TSEX 0007702 __
Page 117: CBP09702
VII CHANGES TIMN 0076204 -Foc19G~l ....................... TIEX 0007703-
Page 118: CBP09703
62~ ~7.$ 808 36.0 1~32 3~,7 17 1.0 0 0.0 17 0o~ 91i 5~,7 1077 48.0 19S8 50.9 166~ i00.0 22A3 100.0 3907 IOG,O TIMN 0076205 ...... ..... TIEX 0007704
Page 119: CBP09704
~O C~6 38.8 813 36,2 1~$9 37.3 ~.A. 20 1.2 4 0,2 24 0.6 1029 61.8 1225 ~.6 2254 57,6 '1'0¢,~., 1~64 100.0 2243 100.0 3907 100.0 0.7 4 0.2 10 0.4 3.7 98 5.4 132 4.& 103 5.7 143 ~.2 100.0 la2S 100.0 2747 TIMN 0076206 Q, ~8/47 p-v'r.,3:-~) TIEX 0007705
Page 120: CBP09705
cL~reCCe you a~ksd? Sam~,,-d ,.,.,:e 1~8 8.9 292 13.0 ,~0 12.3 " Satok~t lena ~1 7.9 22~ 10.0 3~6 9.1 , ~o ~m ~14 78.9 1672 7~05 2986 76.4 ~.~ 63 3.8 40 1.8 103 2.6 X.~ 2 0.1 3 0.1 5 0.1 ~ 166~ IO0.G ~43 99,9 3907 99,9 ~mokad mote L1,.Z 12.1 26,9 13.6 360 13.1 Smoka4 lama 8~ g.& ~87 ZO.Z 273 ~.~ Chansed - O.Y../lf.,t.. boy 8 0.7 17 009 23 0.8 Ifo chanp 606 72.5 1326 72.5 1992 72.5 D.K. 6,9 .q.3 h8 2.6 97 ~ 919 1~001 1828 99.9 2747 99.9 TIMN 0076207
Page 121: CBP09706
~8 Did y~u ~h~e ~re o~ ~e8~ of each ct~rec~e? ~6 ~r~S the ~ you've been ~ok~8, ~ you ehan~ed h~ ~ch yo~ ~hala o~ ~ch cl~sreCce? ~7 D~d you ~o~=~.~e ~e o= lees o~ etch ~Sarecca~ ZnhaZed ,-c~ra 195 1/,.7 220 9.8 ~l.q 10.6 T.uhalnd less 105 6.3 268 11.9 ~sed - D.~./ ~.~. ~ ~ 0.7 ~3 0.6 ~o c~Se *1262 75 ~8 ~678 74.8 2940 75.2 D.g. 85 5.~ 62 2.8 2~7 3.8 H.~. 6 0.4 2 0.1 8 0.2 1666 100.0 2243 lO0.O 3907 99.9 "E. _~ E ! Znhaled more 266 1~.9 28.5 10.1 331 ~.0 ~ed ~es ~7 7.3 Z48 13.6 3~ 12.5 ~S~ - D.~./~.A. h~ 5 0.5 3 0.2 8 0.3 ~ ~e ~ 70.1 ~03 71.3 19~7 70.9 D.E. 57 6.2 87 4.8 1~ 5.2 H.Z. 0 0.0 2 0.1 2 ~ 919 1~.0 1828 100.1 2747 ........ T~IEX 0007707 ._
Page 122: CBP09707
I~ALE 30i ~1.2 ~79 ~6.0 780 ~.0 No 276 ~6.9 375 ~3.8 651 ~,A, 1~ 1.9 2 0.2 13 0.9 TOT.qL S88 100.0 856 100,0 . 1~ 100.0 FEI'~,LE 164 46.9 414 60.8 578 S6.1 I79 $1.1 263 38,6 442 2.0 & O.S 11 1.2 350 100.0 681 100.0 1031 100.1 ........................... TIEX 0007708 .....
Page 123: CBP09708
).~h 8.0 292 13.0 626 10.9 163 9.8 18~ 8.2 3~7 8.9 & 0.2 3 0.1 7 0.2 256 ~.5.6 397 ~7.7 6~3 ~5.7 ~h 2.6 79 3.5 ~3 3.2 1 0.1 3 0.1 6 37 2.2 56 2.~ 93 2~7 ~,5 ~18 16.6 675 ~7.3 7 0.~ ~ 0.2 ~ 0.3 1~ 8.7 1~9 6.6 2~3 7.3 1~ 8. ~ 285 ~. 7 7 O.& A1 1.8 2 0.1 6 O.2 S 0.2 5 0.3 ~ 0.7 20 0.5 ~7 8.2 ~ 6.0 27~ 6.9 ~2 7.3 23~ ~.~ 3~7 9.1 26 1o6 ~ 2.2 76 1.9 6 O.h 61 1.8 47 1.2 1 0.1 0 0.0 ¢ 0.~ ~ 0.2 S 0.2 ~i ~.1 679 21.6 7~ 20,0 ~u~ t:hml 0.05 percsn.t;. "T'OO/3Gg,7 "' 0076210 TINX 0007709_
Page 124: CBP09709
~:Llc:er 106 ~.~., $ 307 16.8 ~ ~-F~e~ 5~ • 6.0 Z04 ~.7 Z~9 S.8 N.A. 3 0.3 3 0.2 6 0.2 ~ ~ ~.6 312 Z7.Z 437 / ~1 37 4.0 100 5 .~ 137 5.0 ~.A. 2 0.2' 2 0.1 ~ 0.1 ~ ?~ 23 2.~ ~2 2.8 75 2.7 Sof~ ?~k 1~ 14.8 357 19.5 493 18.0 ~,~. ~ ' 0.~ ~ 0.3 10 0,4 S~ ~S ~ 10.~ 256 14.0 352 ~.8 1~ m 18 2.0 72 3.g 90 3.3 N.A. 3 0.3 2 0.1 5 0.2 ~&S~ F~: ~: 9 1.0 10 0.5 ~-~e: ~: 37 4.0 7& 4.1 ~e~ ~S ~ 8.4 22S ~.4 30~ 11.0 ~te= ~S 18 2,~ 30 2.6 48 2,7 ~= 1~ m 18 2.0 70 3.8 ~ 3,2 '~F~r 1~ m 0 O.0 0 0.0 0 0.0 ~.~ 5 0.~ & 0.2 9 0.3 S~ ~ 26~ 17.9 414 22.7 578 21,1 ~ ~19 100.0 1828 100.0 27~7 1~.0 ... TEVIN 0076211 TIEX 0007710
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1 ye~ || 1~.0 112 13.1 200 13.9 ~lO m 67 11.~ 1~3 16.7 210 14.5 ~te ~ 10 ~s . ~ 10.~ 1~2 16.6 206 14.3 D.[. ~3 7.3 29 3.~ 72 N.~. 29 &.9 2~ 2.8 S~ 3.7 ~ ~ &76 81.0 7~3 8S.? 1209 ~ 588 100.0 8S6 1~.0 I~G 1 ~s~ $& 15.4 113 16.6 167 16.2 2-5 ~'ean S5 Z~.3 206 30.2 291 28.2 ~10 7~s ~ 9.? 102 1~.0 136 ~.2 ~:, ~ 10 7~s 40 ~.4 105 ~.4 14~ 14.1 " D.~. I8 S.2 39 S.? 57 5.5 X.A. 12 3.~ ~ ~.S 2~ 2.3 ~ ~ 2~3 Sg.A ~77 ~.7 820 79.~ ~ 3~0 1~.0 681 1~.0 1031 TIMN 0076212 ..................................... TIEX 0007711 ......
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~L~ Y~ 363 21.8 a08 18.2 771 19.7 ~o 646 38,8 813 36.2 =459 37.3 r ~.A, 20 1.2 4 0.2 24 0.6 SZ:LECTE~ 'Z~Z'XL i02g 61.8 1225 54,6 2254 57.6 TOTAL 1664 100.0 2243 100.0 3907 LO0.O 919 100.0 1828 100~0 27~7 100,0 *~s r.h-,, 0.05 ' "+';+~"~ " ~ TIMN 0076213 q. 4S/&7 p-VIZ-9 ............. TIEX 0007712
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cONSEQUENCES OF SMOKING FOR WOMEN a report of the Surgeon General U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES • Public Health Service Office of the Assistant Secretar~ for Health Office on Smoking and Health TIEX 0007714
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TABLE OF CONTENTS Iraneh, Center ~TRODUCTION AND SUMMARY ..................... 1 on PART I Of. pATTERNS OF CIGARETTE SMOKING.. ............... 15 Introduction ......................................... 17 The Rise of Cigarette Smoking: 1900-1950 ........... 17 The Emergence of Filtertip Cigarettes: 1951-1963 .. 21 Smok- Increasing Public Health Awareness: 1964-1979 ..... 21 Exposure to Cigarette Smoking Among Successive Birth Cohorts .......................... 28 and Cigarette Smoking Among Young Women ........... 33 Stand- Summary ............................................ 36 References .......................................... 39 for PART II • BIOMEDICAL ASPECTS OF SMOKING MORTALITY ............................................ 44 Introduction and Background ....................... 45 Mortality Trends .................................... 45 Epidemiological Studies ............................. 46 The American Cancer Society 25-State Study ................................. 47 The Swedish Study .............................. 51 The Canadian Veterans Study ................... 51 Japanese Study of 29 Health Districts ........... 51 The British Doctors Study ....................... 51 The Framingham Heart Study .................. 52 The British-Norwegian Migrant Study ................................. 52 Overall Mortality for Females--Cigarette Smokers Versus Nonsmokers ............................... 53 Mortality Ratios ...................... ' ........... 53 Amount Smoked and Age ........................ 54 Duration of Smoking ............................ 57 Age Began Smoking ............................. 58 Inhalation ....................................... 59 "Tar" and Nicotine Content of Cigarettes ..................................... 59 xxi TIEX 0007715
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Comments ........................................... 61 Summary ............... . ............................. 61 References .......................................... 62 MORBIDITY ............................................ Days Lost from Work ................................ 67 Limitation of Activity ............................... 68 Cigarette Smoking and Occupation .................. 69 Summary ............................................ 70 References .......................................... CARDIOVASCULAR DISEASES ........................ 77 Introduction ......................................... 79 Mortality Rates ..................................... 79 Atherosclerosis ............. • ......................... 84 Risk Factors ......................................... The Effect of Smoking ............................... 86 Atherosclerosis .................................. 86 Coronary Heart Disease ......................... 88 Cessation of Smoking and "Tar" and Nicotine Content of Cigarettes ................................. 92 Angina Pectoris ................................. 93 Cerebrovascular Disease ......................... 93 Arteriosclerotic Peripheral Vascular Disease .............................. 95 Aortic Aneurysm ................................ 96 Hypertension .................................... Venous Thrombosis .............................. 97 High-Density Lipoprotein ........................ 98 Oral Contraceptive Use, Smoking, and Cardiovascular Disease ............................ 98 Carbon Monoxide .................................... 101 Comment ............................................ 101 P Summary ............................................ 102 References .......................................... 103 CANCER ................................................ 107 Introduction ......................................... 109 Lung ................................................ 111 Geographic Differences .......................... 116 Smoking Patterns Among Women ............... 117 Cessation of Smoking ............................ 120 Experimental Carcinogensis ..................... 121 Larynx 121 Oral ................................................. 122 Esophagus ........................................... 12~ xxii TXEX 0007716
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:.. 61 125 61 Urinary Bladder ..................................... 62 Kidney ................................... ' ........... 125 ' pancreas ............................................ 126 65 Summary ............................................ 126 67 References .......................................... 127 68 69 Non-neoplastic Bronchopulmonary ............................................... 133 " 70 Diseases introduction ......................................... 135 75 Definitions .......................................... 135 ' 77 smoking and Respiratory Mortality ................. 137 " 79 Smoking and the Epidemiology and 79 Pathology of Cold .................................. 141 84 Smoking and Respiratory Morbidity ................. 146 86 Smoking and Pulmonary Function ................... 156 86 Smoking and "Early" Functional 86 Abnormalities ................................. 157 88 Smoking and Ventilatory Function .............. 160 Summary ............................................ 163 References .......................................... 163 92 Interaction Between Smoking and 93 Occupational Exposures ............................... 169 93 Smoking Patterns in Women ......................... 172 Patterns of Employment ............................. 175 95 The Reproductive Role .............................. 177 96 Specific Interactions Between Occupational 96 Exposure and Smoking ............................ 179 97 Asbestos ......................................... 179 98 Cotton Dust ..................................... 181 Summary ............................................ 186 References .......................................... 187 }1 PREGNANCY AND INFANT HEALTH ................. 189 Introduction ......................................... 191 Smoking, Birth Weight, and Fetal Growth ........... 191 Placental Ratios ................................. 194 Gestation and Fetal Growth ..................... 195 Long-Term Growth and Development ............ 196 Role of Maternal Weight Gain ................... 202 Smoking, Fetal and Infant Mortality, and Morbidity ..................................... 206 Spontaneous Abortion ........................... 206 Congential Malformations ....................... 207 Perinatal Mortality .............................. 211 Cause of Death .................................. 214 Complications of Pregnancy and Labor .............. 214 ooo TTEX 0007717
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Preeclampsia .................................... Preterm Delivery, Pregnancy i~i. Complications, and Perinatal Mortality by Gestation ................... Long-Term Morbidity and Mortality ............ : .... 211i Sudden Infant Death Syndrome ............. "'" ~! Mechanisms .... 2~ ! Experimental Studies ............................. Tobacco Smoke ". 2~ Nicotine .................................. Carbon Monoxide Polycyclic Aromatic Hydrocarbons ............... Other Components .... Fertility " Smoking and Reproduction in Women ........... Smoking and Age of Menopause ................. Smoking and Reproduction in Men .............. Fertilization and Conceptus Transport ..................................... 23? Summary ............................... : ............ References .......................................... PEPTIC ULCER DISEASE ............................. Summary 254 References .......................................... 254 INTERACTIONS OF SMOKING WITH DRUGS, FOOD CONSTITUENTS, AND RESPONSES TO DIAGNOSTIC TESTS .............................. 259 Women Smokers and Nonsmokers and Drug Consumption Patterns ....................... 259 Altered Clinical Response to Drug Therapy by Smokers as Compared to Nonsmokers .......... 261 Oral Contraceptives and Smoking ..... ~ ............. 262 Alterations in Normal Clinical Laboratory Values in Women Smokers ......................... The Influence of Smoking on the Nutritional Needs of Women ....................... 264 Summary ............................................ 26~ References .......................................... 26~ PART III • PSYCHOSOCIAL AND BEHAVIORAL ASPECTS OF SMOKING IN WOMEN ............................. 269 ~ Introduction .......................................... 271 | TZEX 00077~8
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initiation of Smoking in Adolescent Girls ............ 271 Concepts of Adolescent Behavior ................. 272 Prevalence and Patterns of Adolescent Cigarette Use ...................... 273 Prevalence .................................. 273 Age at Initiation of Smoking ................ 275 Number of Cigarettes Smoked ............... 277 ~29 Type of Cigarette Smoked ................... 278 Smoking Cessation .......................... 278 Smoking Prevalence and Ethnicity .......... 280 Alcohol and Marihuana Use ................. 280 Demographic and Psychosocial Correlates of Smoking in Adolescence ................................... 281 i Socioeconomic Influences .......... : ......... 281 ~ Family Patterns 282 ~ Smoking Among Parents and Siblings ....... 282 Peer Group Influence ........................ 284 Scholastic Achievement and Aspirations ..... 285 Dynamic/Personality Factors ................ 286 Prediction of Future Smoking Behavior ..... 288 Prevention of Smoking and Considerations for Future Research ...................................... 290 Prevention of the Initiation of Smoking ................................... 290 Research Goals .............................. 291 Maintenance of Smoking Behavior .................. 293 Patterns of Cigarette Smoking ................... 293 Smoking Prevalence and Ethnicity .......... 296 Pharmacological Effects of Smoking ....................................... 297 Nicotine ..................................... 297 Peripheral Effects ........................... 297 Central Effects .............................. 298 A Possible Role for Nicotine in Smoking Maintenance ..................... 298 Differences in Nicotine Metabolism .......... 300 Smoking and Stimulation Effects ................ 300 Smoking Cessation .................................. 302 Demographics ................................... 303 Age .......................................... 303 Education ................................... 303 Income ...................................... 304 Occupation .................................. 304 I1 Psychology of Changing Smoking Habits ........ 305 ~v TIEX 0007719
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Treatment Studies ............................... 306 The Smoking Withdrawal Syndrome ............. 315 Smoking and Weight Control .................... 315 Treatment Recommendations .................... 319 Conclusions ...................................... 321 Dissemination of Information About Smoking ....... 321 Health Attitudes and Behaviors ................. 321 Sources of Information .......................... 322 Health Care Providers ....................... 322 Educators ............. " ...................... 324 Peer Group .................................. 324 Family ...................................... 325 Media: Television, Radio, Film, Newspapers, Magazines ..... • .............. 325 Advertising .................................. 325 The Failure to Disseminate Information ................................... 327 Stress at Work ....................................... 327 Smoking Habits of Health Professionals ............. 329 Physicians ....................................... 329 Psychologists .................................... 332 Nurses .......................................... 333 ~ The Pregnant Smoker--A Special Target ............ 336 ~ Sources of Information .......................... 336 Physician Advice ............................ 337 Prevalence of Smoking and Quitting During Pregnancy ............................. 340 Psychosocial Factors in Quitting ................. 344 Recommendations ............................... 345 Summary ............................................ 346 References .......................................... 347 TIEX 0007720
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INTRODUCTION AND SUMMARY. TIEX 0007721
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INTRODUCTION AND SUMMARY The 1980 Report on the Health Consequences ofSmoking fo- cuses upon the evidence relating cigarette smoking to health effectS in women. It is not presented as a detailed discussion of the entire range of effects of smoking on health. Such a detailed review of all existing evidence can be found in the 1979 Report of the Surgeon General on Smoking and Health. Instead, this volume on smoking and women's health is offered as a review and reappraisal of smoking and major health relationships spe- cifically in women. It is intended to serve the medical commu- nity as a unified source of existing scientific evidence about health effects of smoking cigarettes for women. As an examina- tion of current knowledge, it will logically lend itself to applica- tion in both the personal and public health arenas. Its content is the work of numerous scientists within the De- partment of Health, Education, and Welfare, as well as scien- tific experts outside that organization. This volume examines the major issues relating tobacco use to women's health including trends in consumption, the biomed- ical evidence of the health effects of cigarette usage by women, and determinants of smoking initiation, maintenance, and ces- sation. This section summarizes the principal findings of this report. It is hoped that the entire volume will serve to highlight the established risks of smoking for women and their children, as well as to define the areas in need of further investigation. Patterns of Cigarette Smoking 1. Women have differed from men in their historical onset of widespread cigarette use, in the rate of diffusion of smoking among each new birth cohort, in their intensity of cigarette smoking and their use of various types of cigarettes. 2. Men took up cigarette smoking rapidly at the beginning of the twentieth century, especially during World War I. Cigar- ettes rapidly replaced other forms of tobacco. By 1925, approximately 50 percent of adult males were cigarette smokers. Smoking among men accelerated rapidly during World War II. By 1950, the prevalence of cigarette use among men approached 70 percent in some urban areas. 3. The onset of widespread cigarette use among women lagged behind that of men by 25 to 30 years. The proportion of adult women smoking cigarettes did not exceed one-quarter until the onset of World War II. 4. Between 1951 and 1963, increasing proportions of women .3 TIEX 0007722
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and men smokers converted to filtertip cigarettes. By 1964, 79 percent of adult women smokers and 54 percent of adult men smokers used filter cigarettes. 5. After reaching a peak value of 4,336 in 1963, annual per capita consumption of cigarettes declined in 1964, 1968-70, and in the period since 1975. The most recent estimate of 3,900 cigarettes per capita in 1979 is approximately equal to that ob- served in 1952. 6. From 1965 to 1978, the proportion of adult men cigarette smokers Cleclined from 51 to 37 percent. The preliminary esti. mate of adult men's smoking prevalence for 1979 is 36.9 percent. From 1965 to 1976, the proportion of adult women smokers re. mained virtually unchanged at 32 to 33 percent. Since 1976, the proportion of women smokers has declined to below 30 percent. For 1979, the preliminary estimate of adult women's smoking prevalence is 28.2 percent. The overall smoking prevalence of 32.3 percent for both sexes in 1979 represents the lowest re- corded value in at least 45 years. 7. The proportion of adult smokers attempting to quit smok. ing declined from 1970 to 1975, but increased in 1978-1979. In contrast to past years, the proportions of women and men now attempting to quit smoking, and their reported quitting rates, are indistinguishable. Approximately one in three adult smok. ers now makes a serious attempt to quit smoking during the course of a year. Approximately one in five of those who attempt to quit subsequently succeed. 8. The proportion of adult smokers using lower "tar" and nicotine brands has increased substantially. In 1979, 39 percent of adult women smokers and 28 percent of adult men smokers reported primary brands with F.T.C. "tar" delivery less than 15.0 milligrams. It is not known whether smokers of the lowest "tar" cigarettes are more or less likely to attempt to quit smok. ing, or to succeed in quitting, than smokers of conventional fil-~ tertip or non-filter cigarettes. 9. The average number of cigarettes smoked by women andi men current smokers has increased. The relationship of this finding to recent declines in the average F.T.C. "tar" and nicotine deliveries of cigarettes is not well understood. 10. With each successive generation, the smoking character- istics of women and men have become increasingly similar. 11. Among women, the average age of onset of re ing progressively declined with each successive birth from 35 years of age for those born before 1900, to 16 age among those born 1951 to 1960. The average age regular smoking among young women is now virtually to that of young men. 4 TIEX 0007723
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EDITORIAL - . CONTENTS • ~.'.~- EDITORIAL :' ~" ." i: Toward a Noi~smok~ng Oe~e~flon ............... TOWARDANONSMOKINGGENERATION :,.,.. " ~ ..:.::.'"' ...... ~O. nrow~.U,S~. ' . :.,. ~ REVIEW " . ~:~. Technical Review of Cl~e~ Stating by HELENE G. BROWN, Chairman, National Public Education Committee, .'.":;'~ .... ' " :~ ,:..- ~ An Addiction .................... : : ....... 4 American Cancer 5ociety, Inc. ~"/~ ~ " : " ' " ~' • Nalional i~t~ute on D~R Abuse, U.S.A. ~", : " Psychla~icDNo~der .I0 t ~ very clear that the tide h~ turned amok¢~ fed a le~en~ abilily to ~n- ..~ :, ..... • .... ..,..,... : ...................... ,,., in hvor of smoking control worldwide, trol external ~ven~ and their own be- ~":' ; " .... ' ~ Behavior in Wom~ .......... ' " ~ 14 Adults have b¢~n giving up cigarette harlot, and lower sell-womb lhan their ::) '~ B~HAVIOR ~ :.~. E. ~ri~ U.S.A, " ..... smoking in r~rd numb¢~ and fewer nop~moking p¢¢~. M~t pro~tams / ~;:-~.:' ~SATIOH' C~llon in Wom~ ......... ~ ......... 1 young people are picking up the habit, failed to addrc~ the different psych~ ~. Grit~ ~ Bi~man, U.S.A. A recent stud~ fo~ Ih¢ Hational Insti- logical needs of the young smok~. ~ CE~ATIOH Smo~g Ce~a/hn Experience ~ Swedzn .......... lute of Education of the U.S. Govern- Current approaches to smoking "' '; " . - L Wilhd~n, A. Hial~rs~n, Sw¢den mcnl indicated that the smoking rat~ prevention fo¢~ on preparing the in- Legs Stop ExpoH~g ~e ~o~g Epidemic., ...... of young men aged 12 to 18 have de- dividual to deal with life stress~, to .. .~ W,S.Ro~U,S~ ' . .:~ BEH&VIOR Smoking Habits in Italy ............ " ....~ .' ....~,34 clincd by one-lhiId to the lowest level enhance individual stlf-~tcem and to ~..? : -. ..~. ~ ~.;. M.A. Modolo, L. Mineili, O. C~¢hlt¢lli. Italy • since 1964. For the first time in history, make decisions a~inst coercion into ~ POLICY f'.~.>~" Smoking on A~I~ ........................... the percent of the mate population smo~ng. Young people understand the .~:~,:. ,. : ~?.:: -C.Dahle, U.S.A. " ~ ho are smokc~ is below that of wo- immediate effects of smoking ~d how ' Adol~cent Smoking Prevention: . men ol similar ages. Even among the effects relate to the quality of their "~'~ ~. ~. M~A~ster, U~ . ' young ~omcn the smoking rate h~ live. " ' ~:~r~tC~cerandSmo~ug ..................... 46 sh,,~ n a relative dccrc~c of 17 percent Succe~ in antismo~ng efforts will 7.. ~ ' -~. " • :'. H. W. D~I, U~A. since 1'~74. now increasingly ~ m~sured at the ~. : C~: Frm t ~ c~e~y of HetI~ and W~lfue, Du,ing the last decade strong el- individual level, ~e vlctori~ will be fo, t~ Itax'¢ limited smoking in public achieved at great ~st in r~ources and ~ " WORLD SMOKINO ~ H~LTH All rights fe~ed. No ~pr~ucllon without Vol. $, No. 3, Aumm 19~0 wrllicn ~rmlssi~. Pub~shed thee II~s m pl.lce,. Many o~ganizations now re- lime. But if we are ever to achieve a Publllhedbyl~A~rlcanCa~rS~ty, lnc. ~Msrch, Jun¢,Hovc~cr)Idis~lbutediree :~" ... 717 ~rd A~, Haw YoI& H.Y. 1~17 In I~ Unite4 Slates and st liCl sll~t~ing at meetings and in build- smoke-free world, it will be by prepar- " ' , (2t2) 311-2~ ~ l~fmmallon and idea in t~ i~gkl Me . t~ ol the sut~s, ~ n~e~ly Of t~ ing~. ('Otlrlt have decided that indi- ing a gene~tion of individuals who .~ ' ~ Copyright~ lgS0 American CanctrS~lety~ In~ A~rl~nC~rg~kt~, Inc. vid~tah have Ihc right to breathe clean ch~se not to smoke, t ~ "AMERICAN CANCER S~iETY, 1NC. OFFICERS ~ ~ ail at work. Govcrnmenls around the ' ~a~l B. Gusber¢, M~, Hon. Joseph H. Yotmg Lane W. Adams • '.. PreValent Chalrm~ Exe¢. Vice Pre~ldem ~odd have adopted long-term institu- U.S. Smokers (in tho~ands) ,,~ ~ ~ 'EDITORIAL ADVEORY BOARD litmal goals in support of noasmokin8. ' ~'.'"? Pwl. T. Abel~n . Dr. ~. Cuyler Hammond Dr. G. Godber Dr. L. M. Ramstrom ~ Yet thoutands o[ yotmg people con- 1968 1974 1979 ~ ., Benb$w[tzedm,d .~N.Y~U.$.A. Cambridge, U.K~ £¢ockholm,$we~n linue ~o sla~ smoking. As virtually no Young Men ~ . Dr. K. Blart¢¢it Dr. R. Mas~onl Dr. N. Om~ ProL F. 5~mldt one begins to smoke after age 21, it 12-18 2,000 2.300 1.500 ~. O~lo, Norwa~ Gene~a,~wl~er~td Geneva, Switzerland Mannheim, German~ is incrcasingly evident Ihat we need to Young Women " ' c~nccnlrale on prevention of smoking 12-18 !,!00 2,100 1,800 ~ilor: WalterS. Ro~ Produetlon: Ma~ Taub. Alfred P. Howdl ManMingEditor: Susan Smisko . Ass~tants: Udina Frett.lrene Helmre~h ~ ~ : • Medkai Advhor: Nichol~ G. Botfigliefi. M.D. Pr~freader: Mau~n in young people. Hew knowledge shows ~timatcs based on ~eys s~mored by ,-~ Statistical Consultant: ~wrence Garfinkel Ci~lation: Ronald Dad~a Ihe way. the O~ce of Smoking a~ Health~ ~,: An: M~hael Bell~nena It h~ been found that young U.S. Public Health Se~ke. _ i I i ii ' i fl I II IIll I I I I I . I
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THE CIGARETTE CONTROVERSY TIMN0017604 TIEX 0007726__
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| Preface For many adults, cigarette smoking is one of life's pleasures. Does it cause illness--even death? No one knows. -~'he case against smoking is based almost entirely on~nferences from statistics. The "con- ventional wisdom" about smoklng came from judgments expressed by committees of doctors in England and the U.S. In our country, anti- smoking organizations pressured the govern- ment to endorse the,se judgments. Never belore (or since) had a committee "discovered" a single "cause" for so many diseases. A number of respected scier~tists do not b~ lieve a causa~ re}atio~ship between smoking and illness has been established. Others believe that it has. If smoking does cause disease, why, after This booklet is presented by The Tobacco In- years of intensive research, has it not been statute in the belief that full, free and informed shown how this occurs? And why has no discussion of the smoking and health contro- gredient as found in smoke been identified as versy is in the public interest, and in tl~e con- the causal factor? viction that the controversy must be resolved by scientific research. 1 TIMN 0017605 TIEX 0007727
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Smoking--Health Statistics It is no wonder that an American Cancer So- ciety official has said that "a clever enough Statistics are said to show that among the 60 researcher can make almost anything induce million Americans who are smokers, some may cancer in animals, but his findings may have no fall victim sooner or in greater number than relevance to human exposure." other people to three major types of ailments-- Somehow it's possible, the argument goes, cancer, diseases of the heart and circulatory that direct exposure to tobacco smoke can system, and the pulmonary illnesses, emphysema damage cells in the respiratory tract. The human and chronic bronchitis, heart is not exposed to smoke, and so there is -lhese happen to be our greatest medical " even greater guessing about how it might be problems, coming to the forefront as the major affected. infectious diseases of the past were "conquered" through scientific research. There have been other coincidental trends, among them the growth in popularity of cigarettes. Scientists call these heart and lung problems "degenerative" ailments, for they seem to de- The Problems of Guesswork velop very slowly, through some kind of distor- tion or breakdown of body mechanisms. Though Simply blaming cigarettes for heart disease each illness is very different, all three--and doesn't help. In some countries not even sta- more---are blamed by som~ sources primarily tistics fit that notion. The government's National on one factor, cigarettes. Heart and Lung Institute points out that we've .learned so much about how to treat heart ail- ments that we overlook how little we know about their causes. "We tend to obscure our ignorance," the Institute says, "by making it seem that a problem has been solved when it Laboratory Work has, in fact, been only half solved." We hear about laboratory "proof" that smoko Emphysema, which makes breathing dilficult, ing causes cancer. Mice have been painted, is a kind of lung damage typically found in older hamsters swabbed and rats injected with "tars" persons. Doctors ponder whether, among other condensed from tobacco smoke in laboratories things, it might be caused by inhaling some but not found in the smoke itself. Rabbits have substance or whether it might result from some been fed nicotine. Dogs have been forced to blood circulation difficulty. In any event, and "smoke" through holes cut in their windpipes, despite speculation that smoking has something Subsequent "changes" in various cells of these , to do with it, the official view of the government animals have been cited as evidence that cig- institute responsible for lung research remains arettes cause disease, though production with candid: "We do not know the cause of pul- smoke of human-type lung cancer--or heart monary emphysema, how to stop its progress disease or emphysema--has never been verified even if detected early, or how to prevent heart in laDoratory ~xperimcnt~. disease ~au~l by emphysema." 2 3 TIMN 0017606 TIEX 0007728__
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Those who consider smokinga menace, rather lung cancer stays right around 60 and, if than an enjoyment, have acted as prosecutors, anything, may be moving to older ages. trying to convince the public they have an air- • While women the world over have long since tight case. But isn't the "jury" entitled to some joined men in cigarette smoking, the lung serious doubts? For example: cancer rate in men is inexplicably higher: • Smoking cannot be the sole cause of an), ill- About a 5 to 1 ratio in the U.S., 2 to 1 in the hess, because in every case nonsmokers are ~ Philippines, 18 to 1 in Finland, 15 to 1 in the afflicted too. Netherlands. Such observations, needless to say, do not • Research suggests that because a patient tells , a doctor he smokes, he is more apt to be diag- exonerate cigarettes. Yet, drawing conclusions nosed with an ailment "associated" in the against cigarettes is equally unjustified. familiar statistics with smoking, • Those statistics themselves are shaky. In cases of fatal illness, causes are verified by Deceptive Propaganda autopsy in only about one-fifth. As one expert says, "meaningful mortality statistics can be ca.o,,~ (kaon~tcl'...) n. A false or absurd story or a~sembled only by analysis of postmortem '~"~': ~ .cax... --Funk&Wagnall~ $~andar~ observations, not by guesswork, no matter Encyclopedic Dictionary hOW educated the guesser." Have you heard these canards? • At the same time that increases in lung cancer "300,000 people die each year because they have been reported, new techniques and smoked." equipment have made it possible to identify "100,000 doctors have given up smoking." more cases with certainty. Thus statistics can ~';'Smokers have black lungs." help suggest the incidence at any given time, but they are of doubtful value in telling us the Where do~'hese ritually repeated claims come incidence at one time compared with another, from? or what the real trend is. Take the "300,000 deaths" charge. One gov- • Too many conflicting reports are ignored in ernment official said years ago that such an estimate would involve "making so many as- the anti-smoking me~sages from "authorities." sumptions" that it might be "misleading." For instance, the American Heart Association warns about tobacco but doesn't remind us Yet, a year later, a former advertising execu- that in Japan, where the smoking rate is much tive who just doesn't like smoking announced higher among men than in the U.S., the heart " that cigarettes cause 125,000 to 300,000 deaths disease death rate is far lower. Or that the a year. U.S. rate has been falling for the past 15 years Another government official agreed, claiming in the face of increasing smoking. ' smoking was responsibte for at least 125,000 • We are told that more people have begun premature deaths a year. He acknowledged smoking at younger ages, which suggests to getting the figure from the advertising man. some that illnesses associated with smoking So the advertising man was asked in a Con- should appear sooner. Yet the peak age for gressional hearing where he got his estimate. 5 TIMN 0O 17607 T~EX 0007729
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His reply: From the government! The govern- What about those "100.000 doctors" who have ment man tried to justify it. He took some ar- quit smoking? A government bureau coined the bitrary percentages of the annual deaths from slogan, "Maybe they know something you don't." various ailments, including several which were This is supposed to scare us, too. not even claimed by the Surgeon General to be Well, that figure came from a government- causally related to smoking! sponsored mail survey of 5,000 doctors. After Later, the Surgeon General himself undertook "~ several follows-ups, including phone calls, the to explain the 300,000 figure. He did this by: ~ survey people heard from only a third of their 1. Taking as his basis the unsupported estimate ~ sample 5,000 and of those a third said they were above, ex-smokers. So the government people multi- plied the whole U.S. doctor population (about 2. Adding to it another unsupported 102,000 300,000) by one-third, and claimed 100,000 had deaths--"from diseases where the relation- quit smoking! ship to cigarette smoking, while not so ob- vious, is nevertheless clearly indicated." 3. Adding to this another unsupported but "rea- sonable estimate" of 60,000 excess deaths The Truth Comes Out for smoking women, who had not been in- cluded in the earlier estimates. Don't blame yourself if you can't follow this. Nobody took the trouble to expose this silly It makes no sense. The "survey" itself was never game. or to point out that the "'authorities" published. A disillusioned government agency considered nothing but smoking in comparing spokesman recently confided: the longevity of one group of persons with an- '~We never did finish it. There were too many other. But scientists, quietly studying twins, errors in it, se many errors that we couldn't do made a significant contribution. Let us see what a thing with it. Every time you turned a page happens, they reasoned, to people with identical there was an error .... It was a waste of money, genetics and different smoking habits, but, what I object to more, it was a waste of time." No matter. The 100,000 number, so carefully manufactured, no doubt will endure! What about the third canard--the so-called What Scientists Found . "smoker's lung"? Can a doctor really look at By 1970 there appeared a study of Swedish lung tissue and tell whether it came from a identical twin pairs with differing smoking habits, ! smoker? Not long ago. a president of the Amer- including cases where one twin didn't smoke ican Cancer Society testified before Congress at all. There was no association between smok- 1 that this is possible. ing and higher overall mortality. Later similar Well, said an expert to the same Congressional findings were reported among Danish twins. But committee, "1 would estimate that of 1,000 pathol- tobacco's foes still repeat that number 300,000. ogists in this country 998 would say, '1 could not A simple, rounded, large, impressive--and tell," and the other two would say, 'lcould tell,' meaningless--statistic, and that those two who could tell either had 6 7 TIMN 0017608 TTEX 0007730
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some divine intuition or were not telling the mothers. Some of them began smoking after truth." their first pregnancies. The babies they bore Said another pathologist witness: "It is not before they were smokers also tended to be possible, grossly or microscopicaly, or in any lighter in weight. other way known 1o me, to distinguish between Thus, there may be other, more significant the lung of a smoker or a nonsmoker." differences between groups of smoking and Later, to illustrate an environment story, a nonsmoking mott]ers--age, economic status, medical news weekly tried to find a "clean lung" employment, race, diet and many other char- photo to contrast with the darkened lung of a acteristics that could affect the outcomes of 48-year-old man who was born and died in New pregnancies. York City. Said the magazine: "Only by photo- graphing the lung of a four-month-old infant who died of epilepsy did we find the expected contrast." Many Contrasts Smoker's lung? Yes, you'll hear of it now and then, even from those who should know better. Smoking and health statistics have been built It's handy, just like the "300,000 excess deatlqs" up by comparing smokers and nonsmokers. But and the "100,000 doctors." But it is hardly truth, when large numbers of people are sorted into two groups this way, are there no other differ- Thus have critics of cigarette smoking con- ences between them? Differences which might ducted themselves, adopting aggressive posi- account for contrasts in health palterns? lions, reaching for the most sweeping and dra- There are, indeed, say authorities who have matic claims, often beyond statistical or scientific studied such things. Some of them are sur- fact. pri~ing. Smokers~generally are more communicative. They are more creative, more energetic, drink more coffee and liquor, marry more often, prefer Smokin9 and Women spicier and saltier food. They take part more You've become accustomed to seeing maga- in sports and change jobs oftener. They are zine and newspaper articles which say that more likely to have parents with heart disease smoking can harm your unborn child. Studies and high blood pressure/ do show that smoking mothers, on the average, These and other findings, accumulating in the have slightly lighter weight babies. Yet with medical literature, raise the question of whether more women reportedly smoking, infant mortality smokers may have higher illness rates because rates keep reaching historic lows. Some studies of the kind of people they happen to be. have shown that the lighter babies of smoking Science has learned that a blueprint of our mothers actually have better survival rates than constitutional, physical and chemical makeup is similar weight babies of nonsmokers, laid down at the moment of conception. This is A suggestion that smoking may not be the genetics and, as the saying goes, we cannot cause of slightly lower weights among newborns choose our own grandfathers. The blueprint is c~me I~rom 8, Cali{ornJa study of more than 13,000 still fuzzy--we do not know, for example, the 8 9 TIMN 0017609 TIEX 0007731 .
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extent to which our genes may map our actual • In California, the Public Utilities Commission behavior and choice of lifestyle, and how these was asked to ban smoking on buses. But after in turn may affect our relative well-being, a t~earing the Commission said, "'there was no Research, said a 1974 Congressional commit- testimony that the average nonsmoker's health is impaired by exposure to the smoke pro- tee report, "is making great strides with the dis- c~uced by a nearby smoker." covery of genetic factors in the predisposition of people to fall victim to certain diseases." Lung •In Washington, D, C., the Civil Aeronautics cancer and heart disease were among those Board was asked to ban smoking on airplanes. mentioned. Instead, the Board formalized the airlines' ar- The committee noted that recent research has rangement to seat smokers and nonsmokers shown, for example, that some persons produce separately for their mutual comfort, citing a in their bodies an enzyme whose activity is highly U.S. government study that concluded, "in- associated with lung cancer. One pathologist halation of the by-products from tobacco has said this could explair~ why there are people smoke generated as a result ef passengers who "don't do anything that would be consid- smoking aboard commercial aircraft does not ered conducive to cancer--and yet they develop represent a significant health I)azard to non- cancer of the lung at age 50. There are others smoking passengers." who smoke three packs a day . , . and they die • In Er~gtand, a medical committee appointed at 90 of something else." by that country's leading anti-smoking group, Action on Smoking and Health, concluded The Congressional panel said certain genes have been discovered to be present in some in- 1973: "'There is no evidence that other persons that cause blood disorders leading to people's smoke is dangerous to healthy heart attacks and may account for a fifth of all n.onsmokers .... " attacks in persons under 60. Scientists-have conducted many experiments Similarly, there's been a recent discovery that to measure any effects of smoke or, nonsmokers. some people lack a biological factor which, They've carefully analyzed the air of "smoke- when present, helps protect the lungs from filled rooms," looking for "pollutants," under ex- emphysema. Whether this deticiency is more treme conditions rarely if ever found in a normal common among smokers isn't yet known, social situation. They've shown there is no valid evidence to justify a claim that the health of non- smokers is harmed by smoking of others. Yet some persons would like government bodies to adopt new laws or regulations to curb The Nonsmoker our right to make our own personal decisions about smoking. Some persons who believe smoking is harmful to the smoker have also jumped to the con- In this case, the solution seems clear: Personal clusion that tobacco smoke harms the non- courtesy, thoughtfulness and tolerance by both smoker, There has been considerable investiga- smokers and nonsmokers; a few simple, volun- tion of the question--and here are some of the tary practices in special situations; and respect results: for individual freedom of choice. 10 TIMN 0017610 TTt X 0007732
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Needed: Objective Research In 1970, Washington University at St. Louis announced a $2 million tobacco industry grant It is human nature to want to assume some for the study of immunologic factors in cancer. things we don't really know. Certainly that has In 1972, Harvard Medical School received a been the case among many people who have $2.8 million tobacco grant for a major investiga- had something to say about smoking and health, tion of pulmonary and cardiovascular diseases. But that is not the spirit of science. True In 1974, the University of California at Los scientists make assumptions only for the pur- Angeles was given a $1.7 million industry grant pose of testing them, proving or disproving them. for research on lung defense mechanisms and In that spirit, notwithstanding the easy an- early detection and treatment of cancer. swers some people claim to have, scientists throughout the world continue to seek the truth about smoking. Both the U,S. government and the U.S. tobacco Elusive Answers industry are probably the largest sponsors of such research. Throughout these years, answers have been slow in coming, and paradoxically, theories Over twodecades, since thebeginningoftheir about causes of illness have broadened as a joint program, our tobacco companies and grow- result of research sponsored by many different ers have committed some $50 million to help sources. Heredity. Stress. Behavior. Air pollution. independent scientists and research institutions Viruses. Occupational hazards. Immunology. who are seeking the truth. Thinks we eat. Things we drink. These and In many years, their commitment has ex- more. as well as the hypothesis that tobacco ceeded the government's, is at fault, occupy the interests of inquisitive And there are "'no strings," no industry con- scientists today. trot. Every research grantee is encouraged to As one of the world's leading scientific jour- publish his results in the scientific literature, nals, Nature, said in a very recent editorial: Since 1954. the Council for Tobacco Research. "It is the mark of the successful scientist that guided by its independent and expert Scientific he has rich enough an imagination to look for Advisory Board. has awarded about 500 grants ... alternative hypotheses, particularly when the and contracts totaling almost $30 million to 221 conventional one is popular." medical schools, hospitals and other research institutions in the U.S. and five other nations. In a ten-year program begun in 1964, some $15 million in tobacco industry funds, adminis- tered by the Education and Research Founda- tion of the American Medical Association, sup- ported 222 smoking and health research projects in 87 institutions. More recently, there have been three addi- tional, major projects sponsored by the industry. 12 13 TIMN 0017611 TIEX 0007733
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Statements if] this booklet are fully documented. For a list of reterence sources, or for further information, write: THE TOBACCO INSTITUTE 1776 K Street Northwest Washington, D. C. 20006 1974 i' TIMN 0017612 TIEX 0007734 "-'-'~
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THE CIGARETTE CONTROVERSY Eight Questions and Answers TIMN 0128819. THE TOBACCO INSTITUTe- T~EX 0007735 1969 T~ KU 000003~89
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TABLE OF CONTENTS THE CIGARETTE CONTROVERSY EIGHT QUESTIONS AND ANSWERS Page Number Preface ................ i I Does Scientific Evidence Really Establish a Case Against Cigarettes? .... 1 II what are Some of the Major Defects in the Statistical Case Against Cigarettes? .... 5 III Are There Other Puzzling Confusiohs in the Statistical Case? .......... ll IV What Happens to the Research That Does Not Condemn Cigarettes? ....... 15 V " A ~mst Misleading Statistic on Cigarettes: How Was It Arrived At? .... 19 VI Have you Been Misled by "Scientific Surveys" About Cigarettes? ......... 23 VII Are Smokers a "Different Kind of People?" . 29 VIII Wh~t are the Tobacco People Doing , • Abcut Smoking and Health? ......... 35 Bibliography ................ 39 12S 20 TI KU 000003290 T' I .X 0007736
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The facts and statements in this document are presented by The Tobacco Institute in the belief that the many controversial questions concerning smoking and health must ultimately be answered by further scientific research and new knowledge -- and that full, free, and informed public discussion is essential in the public interest. T! KU 000003Z~J'I TIMN 0128821 T'rEX 0007737
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i PREFACE For many adults, cigarette smoking is one of life's pleasures. Does it cause illness -- even death? No one knows. The case against smoking is based almost entirely on inferences drawn from statistics and no causal re- lationship has actually been established. Many respected scientists find that cigarette smoking has not been shown to cause any human disease. Many others believe that it has. The controversy concerns millions of persons -- smokers and nonsmokers. This document presents some relevant facts. Until colonization of the Americas, tobacco was unknown to the rest of the world. A short time later, in the first half of the 17th Century, King James I of England called the use of tobacco "a custom loathsome to the eye, hateful to the nose, harmful to the brai~, dangerous to the lungs." At about the same time, one Dr. Roger Marbecke, in a work entitled "A Defence of Tobacco," recommended smoking is moderation as beneficial. TI ~U 0o000~9~ -•- TIEX 0007738
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The controversy had begun. It continued, little changed, until recent years. Amid rising longevity, rapidly spreading use of the internal combustion engine, growing urbanization, a quickening pace of life and a reported increase in lung cancer, there has been a steadily mounting barrage of charges against smoking. In 1964, a panel of advisers to the United States Surgeon General reported that cigarette smoking was a cause of lung cancer. They further declared smoking to be a cause of cancer of the larynx and chronic bronchitis. They suspected it of causing heart disease. In 1965 the U. S. Congress said "cigarette smoking may be hazardous to your health." From these developments have come many public warnings: "Don't smoke." "Stop smoking." A concerned public needs the truth about smoking and health. This requires that both sides of the controversy must b% known. Statistics are not enough. If smoking does cause disease, why has it not been proved, after 15 years of intensive research, how this occurs? Why, if smoking does cause disease, has no ingredient ............. !'~- TI KU 000003293 TIEX 0007739
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iii as found in smoke been identified as the causative factor? The type of malignancy for which smoking is most often bl.~med is "epidermoid" lung cancer. Have researchers ever produced this in animals with cigarette smoke? No. Countles.3 attempts have failed. Why do so many more men than women get lung cancer? No one k~ows. If cigarette smoking is indeed the hazard it is said to be, the roughly six-to-one diffsrence is most perplexing. Why is it that lung cancer often does not occur in those parts of the lung which are exposed to the most smoke? ~o one knows. DO ~mokers get lung cancer at an earlier age than nonsmokers? Apparently not. Lung cancer occurs most often around age 60 -- no matter how long or how much a person has smoked, or whether he has smoked at all. Do ~tatistics prove that cigarette smoking is a cause of lung cancer, heart disease, emphysema, bronchitis, and othe~ diseases? It is a cardinal principle that statistizs alone cannot prove the cause of any disease. Has any new evidence that actually convicts cigarettas been reported in recent years? No. Interest- • 0007740
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iv implicated factors other than cigarettes. The role of emotional .~tress in disease, for instance. Does ~mokinq cause disease? That question is still an o.~en one. TI KU 000003295 TIEX 0007741
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I. Does Scientific Evidence Really Establish a Case Against Cigarettes? You i~t.ay have read about various "mouse" experiments. They have been widely, publicized and acclaimed as laboratory proof of the charges against cigarettes. They are _.no longer so widely publicized. The mouse experiments, it turned out, do not. help to prove the case against smoking. Smoking Mice Thou~ands of mice in many laboratories, have been made to inhale cigarette smoke for days, weeks, and months. How many cases of "epidermoid" lung cancer resulted -- the type ~Lttributed by some to cigarettes? -None = " This type of lung cancer has never been produced in mice with cigarette smoke, a fact not widely publicized. T2 K/J 000003296 TTEX 0007742
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2. Painted and Injected Mice On t~e other hand, much has been made of the fact that painting smoke condensate ("tar") on the backs of mice has caused some cases of skin cancer in the laboratory.2 Still, these laboratory experiments hardly advance the case against smoking. For one thing, the doses used in some of these experiments have been estimated to equal a man's smoking 100,000 cigarettes a day.3 Moreover, cancer has been produced in mice or rats by injecting sugar,4 mineral oil,5 tomato juice,6 and other 7 substances considered quite harmless to man. It has been appropriately said of the mouse painting experiments that they involve the application of "the wrong material, in the wrong form, in the wrong concentration, to the wrong tissue of the wrong animal."8 Apart From Mice, What? Othcr laboratory and clinical observations have similarly failed to prove that smoking causes diseases. No ~esearch demonstrates that any ingredient as found in cigarette smoke causes cancer or cardiovascular, respiratory, or other illnesses in hu~nans. No research has demonstrated any physiolo,i'ical process through which cigarette smoke results in ....... TI KU 000003297 TIMN 0128827 TIEX 0007743
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3. As far as lung cancer is concerned, researchers have reasoned that if it is caused by cigarette smoking, then as smoking increased, cancer should have increased propor-~ tionately in all areas of the body exposed to smoke. It has been found that this is not the case. There has been no increase of cancer to correspond with the increase in smoking in all parts of the respiratory system, including 9 i0 the mouth, nose and larynx. In the lung, cancer often does not o=cur in those areas which are exposed to the most smoke.II Much '~eight has been given, also, to so-called "changes" in the lun-~s of smokers. But such "changes" also occur in the trachea12 where cancer is a relative rarity.13 Further, studies have shown that the same "changes" are found in both smokers and nonsmokers.14 They are found even in children.15 And no one has ever demonstrated that these "changes" actually 16 do lead to cancer. "No Valid Experimental Evidence" One m~_dical authority summed up, in a statement to the u. s. Senate: "There is no valid experimental evidence confirming the ~_mo_k!nq, lu..%q cancer theory..17 As bl~ntly as that. T~ ~U 000003~98 ............... TIEX 0007744__
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4. What Supports The Charges? Thu~;, the anti-smoking charges rest almost entirely on statistic~al associations, providing the critics of cigarette,s with a "guilt by association" basis for their claim th<Lt cigarettes do indeed cause disease. ......... ~-~'l'I KU 000003?-99 TIMN 0128829_~ TTEX 0007745
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II. What are Some of the Major Defects in the Statistical Case Aqainst Cigarettes? The .statistical association between smoking and disease has conti~ued to be a major and widely reported subject following the 1964 appearance of the U. S. Surgeon General's Advisory Committee Report, "Smoking and ~ealth." Less publicized are the continuing objections of qualified experts -- doctors, scientists, statisticians -- who find the ~tatistical case less than convincing. In fact, they find major defects in the statistical case agai-~st cigarettes. Consider the following: 1 Nonsmokers and Illness Nonsmokers suffer from the same heart and lu~q diseases as smoker.~. As a matter of fact, these diseases existed long before cigarette.~ became popular.18' 19 Therefore, smoking obviously is not t_.h_:~ cause, and may well not be even _~a cause of such diseases. .~- T! KU 000003300 TIEX 0007746
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6. 2 The Disease-Rate Question Authcrities differ ov~r how much of the reported increases in diseases associated with smoking is apparent, and how much is real. For example, some suggest that the reported increase in lung cancc:r incidence is due in great part to improved diagnosis.20 Many earlier cases were undoubtedly identified as "cons~iption," "pneumonia" or "lung abscess.''21 Now lung cancer is more accurately diagnosed--due to the use of X-rays, bronchoscopes and other new diagnostic techniques:.22 As to heart ailments, an English expert has concluded that ther:~ may have been no increased incidence of coronary heart dis~ase in recent years, and that there is no good evidence of an increased incidence of coronary thrombosis. He sugges~s that changes in disease descriptions, the age mix of th~-~ population and postmortem techniques are among reasons w]~ reported disease rates show increases.23 3 The "Dose-Response" Mystery The ;~nti-cigarette charges appear contrary to a recognized "dose-response" concept: If cigarettes do cause can~er, then the earlier a person starts to smoke and the more he smokes, the sooner he would be expected to get lu~g cancer 0007747
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7. Yet while people are smoking earlier and more heavily with each generation, the peak age for lung cancer remains 24 about the same, at around 60. If anything, this peak age may now be moving upward.25 4 The Sex Puzzle Equ~lly puzzling in the statistical findings is the gap between lung cancer rates in men and women. For~ years ago, relatively few women smoked cigarettes. If smoking causes cancer, one would expect that as more women to,~k up smoking, their lung cancer rate would approach that of ~n. But the gap between male and female lung cancer death ra~:es has actually widened -- and the reason has yet to be adequately explained. A 1968 report to Congress by the U. S. Public Health • Service :~howed that in 1950 the lung cancer fatality rate among men exceeded the female rate by 4.7 to one~ and that 26 by 1965 :he ratio was 6.1 to one. 5 The Geographic Puzzle . If :~moking caused lung cancer, it would be reasonable to expec~ more of the disease in countries where more cigarettes are smoked per capita. But consider these examples. TIMN 0128832 .. n ooooo o TIEX 0007748
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A. Although people in Great Britain smoke fewer cigarettes per person than Americans, the incidence of lung cancer in Britain is twice as high. B. Per capita cigarette smoking in the Netherlands is also less than it is in the U. S., yet lung cancer death rates are about one-third higher than here. c. Australians smoke almost as many cigarettes per person as do the British, yet have less than one-half the incidence of lung 27, 28 cancer. 6 The Statistics Are Spread Too Thin Statistics have been used to link cigarette smoking with near£y two dozen diseases, including lung cancer, heart dis.~ase, bronchitis, emphysema, cirrhosis of the liver -- nearly every ailment that afflicts the human body.29 As one noted medical statistician has observed, "The idea that cigarette smoking causes all these many deaths from all these many causes does indeed seem seriously question_able. There is not any scientifically known ph~/m~co!~ic or l~hysical explana£ion ~o~ so widespread and multifarious an effect..30 _._ TI..KU 000003303 TIMN 0128833 " T~X 0007749
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Thes~ are six major defects. However, authorities have gone on to point out many other contradictions and perplexities in the anti-smoking statistics. ......... .:. _-T! KU 000003304 TININ 0128834 ~ TIEX 0007750
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T~ KU 000003305 -r~ o ~"T1~.X 000775"!
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III. Are There Other Puzzling Confusions in the Statistical Case? In the history of medical science, statistics have often mistakenly been interpreted as having "proved" the "cause" of diseases. Statistics may have appeared to "prove" pellagra, was caused by eating corn. But further research proved that the cause is a vitamin deficiency. Statistics may have appeared to "prove" living at lower altitudes caused cholera. But further research proved a bacillus is the cause. Statistics may have appeared to "prove" malaria was caused by "night air." But further research proved a microbe is the cause. As the Surgeon General's Advisory Committee i°tself declared ~n 1964: "Statistical methods cannot establish proof of ~. causal relationship in an association."31 T1 -0128836 000775 .
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12. Contradiction After Contradiction The smoking and health figures are, in fact, a mine of contradictions and paradoxes. As survey after survey appears, the list of confusions lengthens. Everywhere there are questions which need answers. And the questions have no answers. Here is a sampling of the contradictions in the reports used to indict smoking: i. A 1967 U. S. government health survey reported that people who smoked ten cigarettes or less a day had a better overall health record than nonsmokers.32 2. The same U. S. government survey also reported that the prevalence of heart conditions and hypertension in women smokers was only about half that in 33 women who had never smoked. 3. Heart disease, in another report, was less frequent among ex-smokers than 34 ° among nonsmokers. TI KU 000003~07 Th~ Surveys -- Are They Representative? Even the Surgeon General's Advisory Committee conceded that the ~even major studies it had considered in writing its 1964 repo~'t were not designed to represent the U. S. population. TEVIN 0].28837 TIEX 0007753
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Said the report: "Any answer to the question 'to what general populations of men can the results be applied?', must involve an element of unverifiable judgment.''35 But this candDr disappeared in subsequent official reports on smoking and health, even though some of the same studies were used to expand allegations about smoking and higher death rat~s. The Inhalation Puzzle In a British study that greatly stimulated the cigarette controversy, smokers who inhaled were found to have a lower incidence of lung cancer than those who did not inhale. This led Sir Ronald Fisher, geneticist and world- famous statistician, to comment: "Should not these workers have let the world know, not only that they had discovered the cause of lung cancer (cigarettes), but also that they had discovered the means of its prevention (inhaling cigarette smoke)?"36 The Pipe-Smoking Puzzle Take another aspect of this remarkable inhalation puzzle." one compound often singled out as particularly suspect ....... TI KU 000003308 TIMN 0128838 TIEX 0007754
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37 is benzpyrene. The Surgeon General's Advisory Committee reported the isolation of nearly ten times as much benzpyrene from Ripg. smoke as from cigarette smoke.38 Yet the same report showed that pipe smokers who inhale have death rates apparently no different from nonsmokers.39 To add to the confusion, the same statistics showed a higher mortality rate for former pipe smokers than for pre- sent pipe smokers.40 Still More Contradictions Contradictions multiply, and absurdities abound. A California study, for instance, sh~wed that smoking mothers had more low-weight babies than mothers who did not smoke. Yet, the nursery death rates for low-welght babies of smoking mothers were 40% to 60% lower than for such babies born to the mothers who did not smoke.41 It is obviously ridiculous to draw positive conclusions exo~atin~ cigarettes from such data. Yet many of the con- clusions drawn against cigarettes are equally unjustified. ......... T~ KU 000003309 x o zSs39 TIP..X 0007755
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IV. Wha{: Happens to the Research That Does Not Condemn Cig:~rettes? It Ls minimized. Overlooked. Or -- flatly ignored by the anti-smoking propagandists. The truth remains: A great deal of research does not support i~he ritually repeated charges against smoking. In fact, mu~]h research suggests some vastly different conclus- ions. Some examples: i. From an ~/%alysis of more than 1,400 autopsies conducted at the Legal Medical Institute of Santiago, Chile, reported here in 1968: No significant relationship was found between ciqarette smokinq and heart disease.42 2. From lung cancer research published in West Germany in 1964, covering 26,000 autopsy records dating back to the early 1900's plus 1,229 current cases: No significant __~-~i~O smoking lun~ and cancer.43 I[WI.~ v* - ~ ~ _ TZ ~U 00o0033t0
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16. 3. From a 1964 study examining 1,000 cases of lung cancer at Mercy Hospital in Pittsburgh, Pennsylvania: Approximately half (.~4) of these lung cancer patients were nonsmokers.44 These and other research studies further explain why many of the nation's most highly qualified doctors have taken strong positions against the unsupported condemna- tion of smoking and have urged additional study. These doctors, it should be noted, are not for cigarettes -- they simply do not believe that a case has been proved against cigarettes. The disagreement of some of these doctors is a matter of Congressional record. The Conclusions of Some Distinguished Experts The following statements were made by experts in hearings before the U. S. Senate: "(T)he conclusions are unwarranted...There is no valid experimental evidence confirmin~ the smokin~-lun~ cancer theory. "45 " (T)he evidence linkin~ heart attacks with ~i~arette sm_ okin~ is far from conclusive and...such a relationship • TINI 0128841 KO 000003311 TIEX 0007757 ....
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17. " (T)h.e presumed link between cigarette smoking and chronic b~:onchitis and emphysema is only a theory pro- posed on__~:he basis of data which are, to say the least, meager an,! inconclusive.''47 "(T)here is a large volume of wood scientific evidence whi~c_h___t~_n, ls to refute the premise that cigarette smoking is c_ausall_y ;:elated to cancer of the lung."48 _'_' (A)_n apparent statistical association ha.s' spotlighted a conveni~ent though probably innocent suspegt..49 Thes:~. statements, of course, are not to be understood as a comm.tment for cigarettes; they are intended to repre- sent the 1.ittle publicized current of medical judgment that finds the case against cigarettes far from proved. Five Facts It w~.ll be valuable to note five facts before we go on. Firs;~, as we have seen, the anti-smoking side of the controver~:y has not been universally accepted by the responsibl.e scientific community. Seco~-Ld, there is awareness among scientists ~hat not all research ,~-:ondemns smoking. Thir<!, much of the statistical research now used to con- demn smoking is flawed, contradictory, and vulnerable to challenge. ......... ~. TI KU 000003312 TIEX 0007758
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Four=h, in any event, statistics alone cannot prove the cause of any disease. Fifth, experimental research has not substantiated the charges against smoking. Those facts, together, may help explain why some critics of smoking have reacted by adopting particularly aggressive positions -- reaching for the most dramatic and "sweeping" of statisi:ical claims. Reaching, it often appears, well beyond st,~tistical fact. Let us turn, next, to what is perhaps the most striking illustrat.on of this. TI KU 000003313 TIMN 0128843 /-- ~-: TZEX 0007759
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V. A Most Misleading Statistic on Cigarettes: How Was It Arrived At? The misleading claim that "300,000 excess deaths a year" are caused by cigarettes has echoed from hundreds of editorials, news stories and speeches. A factual figure? No. It is sheer speculation. Where it comes from is worth retracing. The Story Behind The Statistic The Surgeon General's Advisory Committee Report did not offer any such figure. It said that any such figure "cannot be accurately estimated.''50 The Assistant Surgeon General, who was also the Committee's Vice-Chairman, told the press at the time: "The Committee considered the possibility of %tying to make such calculations, but it involves making so many assump- tions that the Committee felt that it should not attempt this, that it might be as misleading as it was informing."51 TIMN 0128844 Tz K. ooooo3 1 TIEX 0007760
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20. The Figure Is Born Yet, on the first anniversary of the report, on January ll, 1965, a former advertising executive attacked 52 cigarettes as causing 125,000 to 300,000 deaths a year. He was at the time chairman of an organization called the National Interagency Council on Smoking and Health. Soon, a government official was saying in a speech that smoking was responsible for at least 125,000 pre- mature de~ths a year. His ~ource, he said, was the Chairman of the Council.53 Back To The Ad Man The latter was asked in a hearing before the U. S. Congress, where he got his figures. His reply: From the governmen ~ ! 54 So, :he ball was shot back to the government man, who then coun=ed up 138,000 -- 33,500 from lung cancer, 80,000 from coro,~ary disease, 16,500 from bronchitis and emphysema, and 8,000 from cancer of the oral cavity, esophagus, larynx and bladd=.*r. 55 To a,:hieve this figure, the government official had _a_rbitrar_i-v included several diseases which were not claimed even bc~_ the Surgeon General's Advisory Committee Report to be c_ausally ;:elated to smoking. TI KU 0000033~5 TIMN 0128845 TIEX 0007761--
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21. Later, the then U. S. Surgeon General undertook to explain the 300,000 figure. He did this by: i. Taking as his basis the unsupported explanation of 138,000 deaths. 2. Adding to it another unsupported 102,000 deaths -- "from diseases where the relation- ship to cigarette smoking, while not so obvious, is nevertheless clearly indicated." 3. Adding to this another unsupported but "reasonable estimate" of 60,000 excess deaths for women, who had not been included in the earlier estimates.56 Guesswork Becomes "Fact" In the public press, this game of statistical volleyball -- which wa:~ utterly without factual support -- was never exposed. But 300,000 is simple, rounded, and a very large statistic. It is striking, easy to remember, easy to quote -- and meaningless. Sta:istics such as the notorious 300,000 figure -- designed for publicity value -- can be worse than meaningless. They can confirm prejudice and close the mind -- and even deter fu-~ther needed research, as medical observers have Neither side of une controversy can afford them. TIEX 0007762
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• " ...... _.- T! KU 000003317 TIMN 012884'7 ~ TZEX 0007763
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VI. Hage you Been Misled by "Scientific Surveys" About Cigarettes? Statistics derived in a survey are only as good as their sources. Statisticians are rarely decived about this -- and the famous caution of Sir Josiah Stamp is right to the point. Public agencies, noted this distinguished economist, "are very keen on amassing statistics -- they collect them, add them, raise them to the nth power, take the cube root and prepare wonderful diagrams. But what you must never forget is that every one of those figures comes in the first instance from the village watchman, who just puts down what he damn pleases..57 An exaggeration? Judge For Yourself Take one of the most widely heralded pieces of statistical research ever done for the government -- a report called "Zigarette Smoking and Health Characteristics." TTEX 0007764
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24. Three years in the making, this report reflected detailed i~terviews in about 42,000 American households, probing the smoking habits and medical histories of some 134,000 Americans.58 Released to the press in May, 1967, the report was an immediate sensation. Here, it appeared, was massive new evidence against cigarettes. Apparently authoritative, objective, scientifically gathered and weighed. The public read about it in such terms as these: "Smoking Is Linked To Loss Of Time From Work And Recreation," New York Times. "U. S. Study Ties Heart Disease to 2-Packs-a-Day Smokers," Philadelphia Inquirer. "New Data Indicts Smoking," Washinqton Star. "Study Links Smoking to Increased Illness," Cleveland Plain Dealer. "Study Shows Smokers Lose A Third More Job Time," Baltimore Sun.59 Along with the survey, newsmen were given the startling claim that "there are 77 million 'excess' lost work days associated with cigarette smoking each year.''60 This well-r~membered charge was reported as fact. But {t was neither stated nor justified by the survey. Second-Hand Information You would suppose that the information in this study TIEX 0007765
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came first-hand from smokers themselves. It should have. Much of it, indeed, should have come from the smokers' doctors. D~ on the smoking habits and health record of three 9~:~ ~._five men in the survey who had ever smoked did not 61 even come from the men themselves. And none of it came from their doctors. The i~formation came from anyone at home, other than children, ,~hen the interviewer called. Memory -- Or Guesswork? Pictuce, if you will, a ring of the ~oorbell. A 19-year-ol.~ greets the interviewer.62 Her parents are away, she is interested -- and one of America's most ambitious "medical studies" is under way. ~oes .-{our father have any ailments, conditions, or problems with his health? Does he smoke? During the period w____hen he_ wa.~ smoking the moste how many cigarettes a day did be _usually smoke?63 (Could she know? could even her father remember pcecisely?) Our teenager is now in the midst of a detailed five-page questionnaire. Against the chance she might overlook an ailment, tle interviewer is armed with a list of 28 "conditions" relevant to his task. These are read out, in turn, and the willing teenager remembers -- or makes her TIEX 0007766
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26. Asthma? Skin Trouble? Hemorrhoids? The list starts with asthma and tuberculosis. It ends with chronic skin trouble, rupture, and prostate trouble. And it includes varicose veins, rheumatism, goiter, "any allergy," mental illness, chronic nervous trouble, kidney 64 stones, and hemorrhoids. The smoker himself would have had a hard time making valid diagnoses. Even his doctor might not have the facts. Regacdless, the on-the-spot data were recorded. Then assembled, tabulated, and given the weight of scientific finding_~ -- to two decimal places. The Misunderstanding Publicity releases were drafted, distributed to the press, an.~ the nation received its latest "research" report on smoking and health. There was a critical misunderstanding: That this poll was indee.~ scientific research -- and that it offered authoritative medical fact. it would have been hard to miss the headlines and news stories. The publicists' work was well done. ....~__-TI KU 00000332~ TIEX 0007767
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27. The 2,000 Studies In another instance, in 1966 a government official said, in ~L widely publicized speech, that many "studies" published since the 1964 Surgeon General's Advisory Committee Report "further confirm the Committee's conclusions" on smoking and health.65 To back his contention, the govern- ment furnished a bibliography of some 2,000 items. But ~;hat were those "studies?" Most of them, it turned out, were not studies supporting the government official's statement. Included were: 1. Letters to magazine or newspaper editors. 2. Articles of opinion -- including items in 66, 67 Good Housekeeping, The Saturday 68-72 73 Evening Po.~.~, and Playboy, all writ£en by laymen, one of whom was poet-humorist Ogden Nash explaining why he was continuing to smoke.74 3. Papers already included in the 1964 report. 4. Studies published long before the 1964 report. Two of the listed publications, in fact, dated back t~ the 1800's. 5. References to anti-cigarette campaigns. As fc)r the rest of the 2,000 papers, most repeated earlier findings dnd many actually conflicted with the anti-smokin9 TIMN 0128852 ...T, ooooo a TZEX 0007768
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28. premise -- showing no association between_smoking and lunq cancer o~ between smoking and heart disease. Sir Josiah's warning goes unheeded. TI KU 000003323 TIEX 0007769
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29. VII. Are Smokers a "Different Kind of People?" Eminent doctors and scientists increasingly suggest that this may be so. Authorities point out that there are patterns of behavior and background which differ between smokers and nonsmokers, when considered as groups. (It may be that some smokers are also different from other smokers -- different enough to affect reported disease patterns for the whol~ group of smokers.) Here are some reported findings: SmoKers generally are more communicative. They are more creative than nonsmokers -- more energetic,.75 more volatile.7£ 77 They drink more black coffee and liquor. They marry more often.78 They prefer spicy or salty foods in preference to blander diets.79 They participate in more s;orts.80 They 81 change jDbs more often, evidencing, perhaps, what one researcher has described as the smokers' search "for aims °°82 and purpDses. TI KU 000003324 TTEX 0007770
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30. As children, they were more independent.83 As adults, they are me, re outgoing -- living, so to speak, more in ..overdrive.''84 They ¢.iffer in family background as well. They are more__like!~ to have parents with heart disease and hyper- 85 tension. A "di~:ferent kind of people," it appears -- with smoking being one more difference in a comprehensive pattern of differences. Many authorities are convinced that here ~s a consideration with a real and possibly critical bcaring on the smoking-health controversy. And, as such, it is one of a growing-number of considera- tions which are unsettling attempts to find in smoking a cause of ill health. Why The Differences Are Important People who smoke apparently tend to differ quite importantly from people who do not -- in their heredity, in c__~og~tit,.Itional makeup, in patterns of life, in the more demanding pressures under which they have chosen to live. Are they the kind of people who, expectably, would have higher illness rates than nonsmokers -- because of the kind Qf people they happen to be? T1KU 000003325 TIMN0128855 000777
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The Role of Heredity Evidence of the role heredity may play comes from Sweden. In that country, researchers studied sets of twins -- one twin a smoker, the other a nonsmoker. Comparisons between smoking and nonsmoking twins showed no difference in the relative health of their heart and circulatory systems. Heredity appeared to be very important in the health of the heart.86 The Role of Emotional Stress Cancer researchers have noted the mounting evidence that e_.motional and psychological factors may be of crucial importance in an individual's susceptibility to disease. "Data gathered here and abroad," The New York Times summed up recently, "support the view that the way a person handles zertain emotional stresses may be a determining factor is whether he develops cancer.''87 As research data accumulates, more and more factors come under' suspicion as contributors to the illnesses for which some blame smoking.
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32. The Factors Multiply The possible role of air pollution is being more closely studied.88 Virus research is being broadened.89 Certain occupational hazards90 and stresses91 are sus- 92 pected. Enzymes may play a role. Obviously, much more work must be done. Too little is yet known about the psychological, physical and genetic differences between people who smoke and people ,~ho do not. More d~ta are needed about the incredible number of variables that can modify or even control a person's pre- disposition to disease. More research is needed on the ways in which al___~l factors dew~lo~, combine and interact -- differently in each individual, leading to illness in some cases, but not in othezs. As one leading medical specialist cautioned, in his testimony before the U..S. Senate: 'j._Th9 ~cc)ntinuing need for honest research in seeking the answer Zo this unsolved problem cannot be sides~eDped ~r~e~y~.ecause an apparent statistical association has spotl~g~e@ a convenient though probably innocent suspect.''93 The problem is not a simple one. Too many factors are involved. And until their rol~ and their relationships are .......... TIEX 0007773 .......
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understood, no one can be sure about the role of smoking. Only fu_~.-ther research can provide the answers. ..... . ;TI KU 000003328 TIEX 0007774
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VIII What are the Tobacco People Doing About Smoking and Heal th? A grcat deal. Far more, in fact, than most people realize. The tobacco industry has mounted no publicity campaign about the research it has been supporting with respect to the smokiDg-health controversy. Outside the medical and scientific communities, the work is little known. No One Is Doing More The tobacco industry is funding more scientific research into the problems than any other source, govern- mental or private.94 From the beginning, the industry's policy has been to work u- as dispassionately as possible -- toward ~ conclu- sive, scientific understanding of the actual facts, whatever these facts turn out to be. TI KU 000003329 TIEX 0007775
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36. Multi-Million-Dollar Research The .%merican Medical Association, both a close observer of and participant in the cigarette controversy, has emphasized that although epidemiological and correlational studies have associated smoking with a number of diseases -- including canceT, coronary disease and emphysema -- their actual causes remain obscure. Only further research, AMA believes, will serve to clarify the picture.95 In 1964, the AMA House of Delegates adopted as offical policy the statement that there is "a significant relation- ship between cigarette smoking and the incidence of lung cancer an,~ certain other diseases, and cigarette smoking is a serious health hazard."96 AMA then authorized its Education and Research Founda- tion to begin a long-range scientific study of tobacco and health. :~ince then, tobacco companies in the U. S. have pledged $[8 million in support of the project -- no strings attached -- over a ten-year period. The money is spent as the Found.~tion sees fit.97 In the summer of 1968, the Foundation gave its first formal re~ort covering the work to date of 104 investigators or teams in 50 institutions in the U. S. and five other countries. Referring to the supported research, the report stated: TZ KU 000003330 TIMN0128860 ..... ~ TIEX 0007776
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37. "('i)he problems related to establishing any kind of cause and effect relationship between tobacco use and health are far more complex than had been supposed... "It is evident that we have a long hard road to travel and that this will be done slowly. Many years may be .~quire~ to gather sufficient experimental facts and data to clear what is at best a muddied picture." (Emphasis 98 added.) Prcviding tobacco company funds for AMA research is only part of the story. Together, as an industry, since 1954, cigarette makers have co,mitred unrestricted funds to the multiplying pro- jects o~ The Council for Tobacco Research-USA. The Council alone has awarded millions in grants for research to some 300 scientists at more than 150 hospitals, universities and research organizations. A Scientific Advisory Board determines these grants. It is composed of distinguished, independent scientists affiliated with leading academic, research and governmental institutions. CTRsupEort includes full freedom to perform research and publish results, with no strings attached. And, to date, nearly 600 scientific papers reporting the research have been published by grant recipients.99 YEVgN 0128861 'T~EX 0007777
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38. The Work Goes On Yet, ;-Ls all of these investigators recognize -- and as many other scientists and doctors are aware -- the work is nowhere near an end. The r.-:search commitments of industry, government and voluntary agencies grow steadily larger. Necessarily, if the smoking-health controversy is ever to be resolved. And i~: must be. In the only way possible: by the facts. Suspi,:ion and unconfirmed accusation are so much easier than knowledge. But they are unworthy substitutes. TZEX 0007778
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39. Bibliography The Cigarette Controversy i. Hea].th Consequences of Smoking: 1968 Supplement to the 196~' Public Health Service Review. U. S. Department of Heal.th, Education and Welfare, Public Health Service Pub]oication No. 1696, 1968, p. 93. 2. Smo}:ing and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. U. S. Dep~_~rtment of Health, Education and Welfare, 1964, p. 143. 3. Hea~ings, Legal and Monetary Affairs Subcommittee, Co~-.4ittee on Government Operations, U. S. House of Rep~esentatives, July 18-26, 1957, p. 236. Testimony of i~an G. Macdonald, M.D., clinical professor of sur~[ery and coordinator of cancer teaching, University of ~'.outhern California. 4. Hueper, W. C., and Conway, W. D. Chemical Carcinogenesis and Cancers, Charles C. Thomas, Springfield, Ill., 1964, p. 1.5. 5. Ibic[, p, 82. 6. Bel].ows, C. M. Experimental Production of Sarcoma in Rat~. Zeitschr. f. Krebsforsch (Journal of Cancer Res<~arch) 34: 348-361, 1931. 7. Hea~'ings, Committee on Commerce, U. S. Senate, Part i, Mar. 22-Apr. 2, 1965, Serial 89-5, pp. 732, 739. Tes~imony of Douglas H. Sprunt, M.D., chairman, Depz~.rtment of Pathology, University of Tennessee, and William H. Carnes, M.D., head of Department of Pathology, University of Utah. 8. Hockett, R. C. Where Do We Go From Here in "Tobacco and Health Research? Address to Burley and Dark Leaf Tob~.cco Export Association, Lexington, Ky., Oct. 2, 1967. 9. Health Consequences of Smoking. A Public Health Service Review: 1967. U. S. Department of Health, Education and Welfare, Public Health Service Publication No. 1696, 196V, p. 145. T~EX 0007779
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40. i0. Vital Statistics of the United States. National Center ~or Health Statistics, Public Health Service, U. S. Department of Health, Education and Welfare, Vol. III, 1350, p. 63; VOI. II, 1964, p. 1-59. ii. Garland, L. H. et al. The Apparent Sites of Origin of Carcinomas of the Lung. Radiology 78 (i): i, ii, Jan. 1362. 12. Alerbach, 0., et al. Changes in Bronchial Epithelium in Relation to Cigarette Smoking and in Relation to Lung Cancer. New England Journal of Medicine 265 (6) : 253-267, Aug. 10, 1961. 13. Vital Statistics, I0 supra. 14. C.~rnes, W. H., The Morphological Precursors of Cancer. L. Severi, editor. University of Perugia, Italy, 1962, p-.~. 658-660. 15. Hearings, Committee on Commerce, 7 supra, p. 302. Testimony of Thomas J. Moran, M.D., director of l.mboratories, Memorial Hospital, Danville, Va. 16. Ibid, pp. 1008-1009. Testimony of Milton B. Rosenblatt, M.D., associate clinical professor of medicine, New York Medical College. 17. Ibid, p. 1013. 18. Rosenblatt, M. B. Lung Cancer in the 19th Century. Bulletin of the History of Medicine 38 (5) : 395-425, Sept.-0ct. 1964. 19. Campbell, M. Death Rate from Diseases of the Heart: 1:376-1959. British Medical Journal: 528-535, Aug. 3 [, 1963. 20. Gilliam, A. G. Trends of Mortality Attributed to Carcinoma o: Lung: Possible Effects of Faulty Certification of Deaths to Other Respiratory Diseases. C~ncer 8 (6) : 1~30-1136, Nov.-Dec. 1955. 21. Hearings, Committee on Commerce, 7 supra, pp. 1000-1001. Testimony of Milton B. Rosenblatt, M.D., associate clinical p;:ofessor of m~d~cin~, ~ew York Med£cal Coll~ge. 017.8864 00000~I~'~4" TT X 000'7'7130
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22. Rose~latt, M. B., and Lisa, J. R. Diagnostic Progress in Lui~g Cancer: Historical Berspective. Journal of Americ~an Geriatrics Society 16 (8): 919-929, Aug. 1968. 23. Robb-~:mith, A.H.T. The Enigma of Coronary Heart Disease. Year :~ook Medical Publishers, Inc., Chicago, 1967, pp. ix, 1].8-i19. 24. Passey, R. Some Problems of Lung Cancer. Lancet: 107-1].2, July 21, 1962. 25. Fiore~-~tino, M. Lung Cancer in the U. S.: Observations on th~ Age at Death. Medical Records and Annals 61 (7): 228-25.0, 1968. 26. Health Consequences of Smoking: 1968 Supplement, 1 ~pz~, p. 94. 27. Segi, M. Cancer Mortality for Selected Sites in 24 countries, No. 4 (1962-1963). Department of Public Health, Tohoku University School of Medicine, Sendai, Japan, Sept. 1966. 28. Tobacco Consumption in Various Countries, No. 6, Second Edition. D. H. Breese, editor, Tobacco Research Council, LondoD, 1968. 29. Smoking and Health, 2 supra, pp. 109-ii0. 30. Berkscn, J. Smoking and Lung Cancer. American Statistician 17 (4): 15-22, Oct. 1963. 31. Smoking and Health, 2 supra, p. 20. 32. Cigarette Smoking and Health Characteristics: United States July 1964-June 1965, Series i0, No. 34. National Center for Health Statistics, Public Health Service, U. S. Department of Health, Education and Wel{are, May 1967, p. ii. 33. Ibid, p. 32. 34. Doyle, J., et al. Cigarette Smoking ~nd Coronary Heart Disease: Combined Experience of the Albany and FraminghamStudies. New England Journal of Medicine 266 (16): 796-801, Apr. 19, 1962. ~ 35. Smoking and Health, 2 supra, p. 94. ~0~5 0128865 _ . TIEX 0007781--
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42. 36. ~.'isher, R. A. Smoking--The Cancer Controversy. Oliver • ~nd Boyd, Edinburgh, 1959, p. 47. 37. ~moking and Health, 2 supra, pp. 55, 57. 38. [bid, p. 58. 39. _~bid, p. 92. 40. :bid, p. ll2. 41. ":erushalmy, J. Mother's Cigarette Smoking and Survival of Infant. American Journal of Obstetrics and Gynecology ~)8 (4): 505-518, Feb. 15, 1964. 42. viel, B., et al. Coronary Atherosclerosis in Persons ~)ying Violently. Archives of Internal Medicine 122 (2) : [)7-103, Aug. 1968. 43. i~oche, R., et al. Statistical Studies of Bronchial Carcinoma in the North Rhine Westphalia State. ~'~eitschr. f. Krebsforsch (Journal for Cancer Research) 66: 87-i08, Mar. 1964. 44. i?errone, J.A. One Thousand Cases of Lung Cancer. ~ennsylvania Medical Journal 67 (4) : _ 31-34, Apr. 1964. 45. IIearings, Committee on Commerce, 7 supra, pp. i012-1013. 't~estimony of Milton B. Rosenblatt, M.D., associate clinical :)rofessor of medicine, New York Medical College. 46. [bid, p. 971. Testimony of Sigmund L. Wilens, Ph.B., M.D., ,:hief, Laboratory Service, New York Veterans Administration Hospital. 47. ..l~id, p. 996. Testimony of Israel Rappaport, M.D., former ..Lssociate clinical professor of medicine, Columbia University Medical School. " 48. .1~id, p. 269. Testimony of'Thomas H. Burford, M.D., ~:hief, Chest Su.rgical Service, Barnes Hospital and ~'~ashington University School of Medicine, St. Louis. "-~ 49. "bid, p. 795. Testimony of Hiram T. Langston, M.D., chief of surgery, Chicago Tuberculosis Sanatorium. ~0. ~imoki~g ~n~ ~l~h, ~ uupr~, po 31. TI KU 000003336 TIMN 0128866 TIEX 0007782
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51. Transclript, news conference on release of Smoking and Healti~, 2 supra, Jan. ii, 1964. 52. News ~elease~ National Interagency Council on Smoking and H:~alth, Jan. ii, 1965. 53. Horn, D. cigarette Smoking in the High Schools. Addre~s to American Association of School Administrators, Atlan~ic City, N. J., Feb. 17, 1965. 54. Heari~-Lgs, Committee on Commerce, 7 supra, p. 124. Testimony of Emerson Foote, chairman, National Interagency Council on Smoking and Health. 55. Ibid, p. 133. 56. Terry, L. L. Emerging Anti-Smoking Activities of the Federc1 Government. Address to National Tuberculosis Association Annual Meeting, Chicago, May 31, 1965. 57. Stamp, J. Some Economic Factors in Modern Life. P. S. King & Son, Ltd., England, 1929, pp. 258-259. 58. Cigarette Smoking and Health Characteristics, 32 supra, p. 56. 59. New York Times, Philadelphia Inquirer, Washington Star, Cleveland Plain Dealer, Bait±more Sun, editions of May 2, 1967. 60. News ~elease, National Center for Health Statistics, Publi~ Health Service, U. S. Department of Health, Education and Welfare, May i, 1967. 61. cigarette Smoking and Health Characteristics, 32 supra, 62. Ibid, p. 57. 63. Current Estimates from the Health Interview Survey: United States July 1964-June 1965, Series I0, No. 25. National Center for Health Statistics, Public Health Service, U. S. Department of Health, Education and Welfare, Nov. 1965, pp. 39-44. 64. Ibid. T1 KU 000003337 T gg 0007783
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65. Stewart, W. H. Smoking and Health: A Progress Report. Address to Eighth Annual American Cancer Society Science Writers' Seminar, Phoenix, Ariz., Mar. 29, 1966. 66. New Research on a Stop Smoking Drug. Good Housekeeping, Mar. 1964. 67. The Better Way. Is There a Best Way to Stop Smoking? Good Housekeeping, May 1966. 68. Davidson, B. Crash Effort for a Safer Cigarette. The Saturday Evening Post, Apr. 18, 1964. 69. McGra~y, P., and Morgan, M. Cancer is Yielding Up Its Secrets. The Saturday Evening Post, May 9, 1964. 70. McGra~y, P., and Morgan, M. Will Chemicals Cure Cancer? The S~turday Evening Post, May 16, 1964. 71. Nash, O. The Kinsey Report Didn't Upset Me Either. The S~turday Evening Post, Mar. 14, 1964. 72. Zinsser, W. K. Pipe This. The Saturday Evening Post, May 33, 1964. 73. Where There's Smoke There's Ire. Playboy, Aug. 1965. 74. Nash, O., 71 supra. 75. Heath, C.W. Differences Between Smokers and Nonsmokers. AMA A:chives of Internal Medicine I01: 386-387, Feb. 1958. 76. Thoma:~, C. B. Characteristics of Smokers Compared with Nonsmokers in a Population of Healthy Young Adults, Including Observations on Family History, Blood Pressure, Heart Rate, Body Weight, Cholesterol and Certain Psychologic Traits. Annals of Internal Medicine 53 (4): 697-7[8, Oct. 1960. 77. Matarazzo, J. D., and Saslow, G. Psychological and Related Characteristics of Smokers and Nonsmokers. Psychological Bulletin 57 (6): 493-513, Nov. 1960. 78. Lilienfeld, A. M. Emotional and Other Selected Character- istic:5 of Cigarette Smokers and Nonsmokers as Related to Epidemiological Studies of Lung Cancer and Other Diseases. Journ.~l o~ National ~anc~r In~tltute 22 (2)~ 259-281. Feb. 1959. TIEX 0007784
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Nort~ American Professional Groups. Journal of the American Medical Association 192 (3): 89-94, Apr. 19, 1965. 92. Catching Cancer in a Cytoplasmic Web. Medical World News: 21-22, May 17, 1968. TIM 0128869 TIEX 0007785
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93. Hearin.~s, Committee on Commerce, 7 supra, p. 795. Testimony of Hiram T. Langston, M.D., chief of surgery, Chicago Tuberculosis Sanatorium. 94. Smoking and Health Research--Who's Footing the Bill? Tobacco Reporter, Feb. 1968. 95. Smoking and Health. Journal of the American Medical Association 205 (i0) : 695, Sept. 2, 1968. 96. The Project for Research on Tobacco and Health, 1964-1968. Americ.~n Medical Association Education and Research Foundation Report to the Profession and Abstracts of the Gr0~nts, June 1968, pp. 4-5. 97. News Release, American Medical Association, May i0, 1968. 98. The Project for Research on Tobacco and Health, 1964- 1968, ')6 supra. 99. News Release, The Tobacco Institute, Sept. ii, 1967. TI KU 000003340 - TIEX 0007786
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SMOKING AND HEALTH 1964 -1979 THE CONTINUING CONTROVERSY THE TOBACCO INSTITUTE 1875 I Street, Northwest, Washington, D.C. 20006 January 10, 1979 T-E ~,,X 0007787 TIMN 289718
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._ Figure 1 The Changing Histopathology of Lung Cancer 1963-1975 50 N = 1682 40 -- Adeno Squamous 0 "" "-. ,,~ o~ 20 - ~._ ."-... ~_~..:~ .I ~ Small ~~ f--Large/Broncheo- Undiff 10- / ~ ~ ~ --- .......... //Alveolar Mixed 0 63 65 67 69 71 73 YEAR OF DIAGNOSIS Source: Vincent et al. 1977 (20). TIEX 0007876 TIMN 289811
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Figure 1 Incidence Rates* per 100,000 Population from Second National Cancer Survey (SNCS) (1947-49) and Third National Cancer Survey (TNCS) (1969-71) SNCS TNCS SNCS TNCS SNCS TNCS 4_ I I j 5- 2- 6- CANCER ORAL CAVITY BLADDER ESOPHAGUS SITE & PHARYNX O -- white male A -- nonwhite male [] -- white female O -- nonwhite female *Age adjusted to the 1950 U.S. population standard. Source: Devesa and Silverman 1978 (3). T~ .'IX 0007886 104 TIMN 289821
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Figure 2 Journal of the National October 1978 Cancer Institute Volume 61 Number 4 BLADDER CANCER MORTALITY, 1950-69, AMONG WHITE MALES IN THE NORTHEAS'[ | LAK £ Rate in upper decila for all U.S. counties. Rate in upper 20% for all U,$. counties. U.S. DEPARTMENT. OF HEALTH, EDUCATION, AND WELFARE Public Health Service National Institutes of Health TIEX 0007893 111 TIMN 289828
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TIEX 0007919 TIMN 289854
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TIEX 0007950
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SMOKING on~ HEALTH REPORT OF THE ADVISORY COMMITTEE TO THE SURGEON GENERAL OF THE PUBLIC HEALTH SERVICE -! U.S DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Pubhc Health Service TIEX 0007951
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Table of Contents Page FOREWORD .................. v ACKNOWLEDGMENTS ............. ix PART I INTRODUCTION, SUMMARIES AND CONCLUSIONS Chapter 1 Introduction ............ 3 Chapter 2 Conduct of the Study ........ 11 Chapter 3 Criteria for Judgment ........ 17 Chapter 4 S-mmaries and Conclusions ..... 23 PART II EVIDENCE OF THE RELATIONSHIP OF SMOKING TO HEALTH Chapter 5 Consumption of Tobacco Products in the United States ............ 43 Chapter 6 Chemical and Physical Characteristics of Tobacco and Tobacco Smoke .... 47 Chapter 7 Pharmacology and Toxicology of Nico. tine ................ 67 Chapter 8 Mortality .............. 77 Chapter 9 Cancer ............... 121 Chapter 10 Non-Neoplastic Respiratory Diseases, Particularly Chronic Bronchitis and Pul- monary Emphysema.. " ....... 259 Chapter 11 Cardiovascular Diseases ....... 315 Chapter 12 Other Conditions .......... 335 Chapter 13 Characterization of the Tobacco Habit and Beneficial Effects of Tobacco 347 Chapter 14 Psycho-Social Aspects of Smoking . 359 Chapter 15 Morphological Constitution of Smokers. 381 vii TIEX 0007952
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Chapter 3 Criteria for Judgment TIEX 0007953
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Chapter 3 CRITERIA FOR JUDGMENT In making critical appraisals of data and interpretations and in formulat- ing its own conclusions, the Surgeon General's Advisory Committee on Smoking and Health--its individual members and its subcommittees and the Committee as a whole--made decisions or judgmen~ at three levels. These levels were: I. Judgment as to the validity of a publication or report. Entering into the making of this judgment were such elements as estimates of the com- petence and training of the investigator, the degree of freedom from bias, design and scope of the investigation, adequacy of facilities and resources, adequacy of controls. II. Judg'ment as to the validity of the interpretations placed by investigators upon their observ~itions and data, and as to the logic and justification of their conclusions. III. Judgments necessary for the formulation of conclusions within the Committee. The primary reviews, analyses and evaluations of publications and unpub- lished reports containing data, interpretations and conclusions of authors were made by individual members of the Committee and, in some instances, by consultants. Their statements were next reviewed and evaluated by a subcommittee. This was followed at an appropriate time by the Committee's critical consideration of a subcommittee's report, and by decisions as to the selection of material for inclusion in the drafts of the Report, together with drafts of the conclusions submitted by subcommittees. Finally, after re- peated critical reviews of drafts of chapters, conclusions were formulated and adopted by the whole Committee, setting forth .the considered judgm~t of the Committee. It is not the intention of this section to present an essay on decision-making. Nor does it seem necessary to describe in detail the criteria used for making scientific judgments at each of the three levels mentioned above. All mem- bers of the Committee were schooled in the high standards and criteria im- plicit in making scientific assessments; if any member lacked even a small part of such schooling he received it in good measure from the strenuous debates that took place at consultations and at meetings of the subcommittees and the whole Committee. CRITERIA OF THE EPIDEMIOLOGIC METHOD It is advisable, however, to discuss briefly certain criteria which, although applicable to al~udgments involved in this Report, were especially significant for judgments based upon the epidemiologic method. In this inquiry the 19 TIEX 0007954
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epidemiologic method was used extensively in the assessment of causal fac- tors in the relationship of smoking to health among human beings upon whom direct experimentation could not be imposed. Clinical, pathological and ex- perimental evidence was thoroughly considered and often served to suggest an hypothesis or confirm or contradict other findings. Wlii~n ~oupled with the other dat~, results from the ~pidemiologi.e studies can provide the basis upon which~ ,, I~ " " .~ ..~ay be made, In carrying out studies through the use of this epidemiologic method, many factors, variables, and results of investigations must be considered to deter- mine first whether an association actually exists between an attribute or agent and a disease. Judgment on this. point is based upon indirect and direct measures of the suggested association. If it be shown that an asso- ciation exists, then the question is asked: "Does the association have a causal si~_ificance ?" significance of an association is a matter o~ judgmere" wliich goes beyond any statement of statistical probability. To judge or evaluate the causal significance of the association between the attribute or agent and the disease, or effect upon health, a number of criteria must be utilized, no one of which is an all-sufficient basis for judgment. These criteria include : a) The consistency of the association b) The strength of the association c) The specificity of the association d) The temporal relationship of the association e) The coherence of the association " These criteria were utilized in various sections of this Report. The most extensive and illuminating account of their utilization is to be found in Chapter 9 in the section entitled "Evaluation of the Association Between Smoking and Lung Cancer". CAUSALITY Various meanings and conceptions of the term cause were discussed vigoroudy at a number of meetings of the Committee and its subcommit- tees. These debates took place usually after data and reports had been studied and evaluated, and at the times when critical scrutiny was being given to conclusions and to the wording of conclusive statements. In addi- tion, thoughts about causality in the realm of this inquiry were constantly and inevitably aroused in the minds of the members because they were preoccupied with the subject of their investigation--"Smoking and Health." Without summarizing the more important concepts of causality that have determined human attitudes and actions from the days even before Aristotle, through the continuing era of observation and experiment, to the statistical certainties of the present atomic age, the point of view of the Committee with regard to causality and to the language used in this respect in this report may be stated briefly as follows: 1. The situation of smoking in relation to the health of mankind includes a host (variable man) and a complex agent (tobacco and its products, partic- 20 TIEX 0007955
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SMOKING AND HEALTH 1964 -1979 THE CONTINUING CONTROVERSY THE TOBACCO INSTITUTE 1875 I Street, Nortl~west, Washington, D.C. 20006 January 10,1979 TIEX 0007956 TIMN 289718
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SMOKING AND HEALTH 1964 -1979 THE CONTINUING CONTROVERSY THE TOBACCO INSTITUTE 1875 I Street, Northwest, Washington, D.C. 20006 January 10, 1979 T "r ~,,X 0007959 TIMN 289718
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__..~ Figure 1 The Changing Histopathology of Lung Cancer 1963-1975 N = 1682 40- Adeno /// Squamous 20 "~. ~,... ~. ~,~.. ~.~ ~.~ ----Small Undiff 10 / Broncheo- 0 63 65 67 69 71 73 YEAR OF DIAGNOSIS Source: Vincent et al. 1977 (20). TIEX 0007969 TIMN 2898
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a corresponding increase in adenocarcinoma (see Figure I). He added that ~ t~eir data proved to be representative of ,! national trends, adenocarcinoma will soon become the most prevalent type of lung cancer in the United States" (20). Speculating about the factors responsible for this development, Dr. Vincent mentioned the increasing incidence of lung cancer in women, modifications in the way pathologists identify lung cancer cell types and environmental and occupa- tional agents and alterations that have occurred over the last few years in cigarettes. He conceded, however, that his team had considered such factors as "length of smoking history, form of tobacco used, quantity of tobacco used, age habit started, degree of inhalation and the use of filters", and that they had been "unable to equate the histology of lung cancer with any of these factors". The reasons for this development, if it ultimately proves to be representative of the national experience, remain unknown. One wonders if this reported increase in adeno- carcinoma may have a similar basis as the over-all lung cancer "epidemic" discussed above -- that is, observer variations. Much of the over-all "epidemic" may be due to changes in clinicians" techniques; much of the adenocarcinoma increase may be due to modifications in the way pathologists classify lung cancer cell types. TTEX 0007970 95 TIMN 289812
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SMOKING and HEALTH a report of the Surgeon General r--] The Health Consequences of Smoking [] The Behavioral Aspects of Smoking [] Education and Prevention DHEW Publication No (PHS) 79-50066 U,S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Office of the Assistant Secretary for Health Office on Smoking and Hea.h T'F NX 0 0 0 ? 9 7 6
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Smoking Welfare, Public Control, for United States, and Welfare, 10, No. 34, condition. by the June 16, 4. CARDIOVASCULAR DISEASES. National Heart, Lung, and Blood Institute TIEX 0007977
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cONTENTS Atherosclerosis ........................................................... 7 The Nature of Atherosclerosis in Man ..................... 7 The Effect of Smoking on Atherogenesis ................ 10 Experiments in Animals ....................................... 16 Research Needs ................................................... 18 Conclusions ......................................................... 19 Myocardial Infarction ................................................. 19 The Nature of Myocardial Infarction ...................... 19 ~ Summary of Epidemiological Data .......................... 20 The Effect of Smoking on Myocardial Infarction in. Man ............................................. 38 The Effect of Smoking on Myocardial Infarction in Animals ........................................ 40 Research Needs ................................................... 40 Conclusions ......................................................... 41 Sudden Cardiac Death ............................................... 41 The Nature of Sudden Cardiac Death in Man .......... 41 Sudden Cardiac Death in Animals .......................... 43 Summary of Epidemiological Data ......................... 43 The Effect of Smoking on Sudden Cardiac Death in Man .................................................. 44 The Effect of Smoking on Sudden Cardiac Death in Animals ............................................. 45 Research Needs ................................................... 45 Conclusions ......................................................... 45 Angina Pectoris ........................................................ 46 The Nature of Angina Pectoris in Humans ............. 46 Summary of Epidemiological Data ......................... 46 The Effect of Smoking on Angina Pectoris ............. 48 Research Needs ................................................... 48 Conclusions ......................................................... 49 Cerebrovascular Disease .............................................. 49 The Nature of Cerebrovascular Disease in Man ........ 49 Summary of Epidemiological Data ......................... 50 The Effect of Smoking on Cerebrovascular Disease .. 50 TIEX 0007978 4-~ ,
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Research Needs ................................................... 52 Conclusions ......................................................... 52 Peripheral Vascular Disease ........................................ 52 The Nature of Peripheral Vascular Disease in Man .. 52 Summary of Epidemiological Data ......................... 53 The Effect of Smoking on Peripheral Vascular Disease .............................................. 53 Research Needs ................................................... 54 Conclusions ......................................................... 54 Aortic Aneurysm of Atherosclerotic Type ...................... 55 The Nature of Atherosclerotic Aortic Aneurysm ....... 55 Summary of Epidemiological Data ......................... 55 The Effect of Smoking on Aortic Aneurysm ............ 56 Research Needs ................................................... 56 Conclusions ......................................................... 56 High Blood Pressure .................................................. 56 The Nature of Hypertension ................................. 56 Summary of Epidemiological Data ......................... 57 The Effect of Smoking on Blood Pressure .............. 58 Research Needs ................................................... 58 Conclusions ......................................................... 58 Other Conditions ....................................................... 58 Venous Thrombosis .............................................. 59 Thromboangiitis Obliterans (Buerger's Disease) ......... 60 Oral Contraceptives, Smoking, Myocardial Infarction, and Subarachnoid Hemorrhage Among Women ...... 60 The Effect of Smoking on Blood Lipids .................. 61 Other Constitutents of Smoke ............................... 62 Discussion and Conclusions .......................................... 63 References ............................................................... 67 LIST OF TABLES Table L--Autopsy studies of atheroclerosis .................... 11 4-4 TIEX 0007979
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52 • 52 Table 2.--Coronary heart disease mortality ratios related to smoking--prospective studies ...................... 22 .. 52 ~an ..52 Table 3.--Coronary heart disease morbidity as related to 53 smoking ................................................................ 27 53 Table 4.--The effect of the cessation of cigarette 54 smoking on the incidence of CHD .............................34 54 Table 5.--Annual probability of death from coronary heart 55 disease, in current and discontinued smokers, by age, ~ ....... 55 maximum amount smoked, and age started smoking .... 35 55 56 Table 6.--Coronary heart disease morbidity as related to 56 smoking--angina pectoris--prospective studies ............. 47 56 Table 7.--Age-standardized death rates and mortality 56 ratios for cerebral vascular lesions for men and 56 women, by type of smoking (lifetime history) and age ... 57 ',ii .... 58 at start of study .................................................... 51 58 59 ,61 67 ,11 TIEX 0007980
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~ factor data, carried less risk than high tar and nicotine ones but that they also bore ~/g/~t be desirable a considerably greater risk than not smoking. ~een at autopsy, ~ Relatively little is known about the mechanisms by which smoking aady~, there is no : enhances atherogenesis or increases the risk of heart attack. This ~therogenesis. Th/s ignorance in no way weakens the force of the information noted above; t~e findings on the nevertheless, better insight into the pathogenesis of these effects death, aortic would be of potential value in designing less hazardous cigarettes or in to smoking. It is attempting otherwise to limit the hazard of smoking. Moreover, it is ~ adverse effect on likely that there would be an appreciable gain of information about a prior myocardial basic processes of atherogenesis, thrombosis, cardiac metabolism and . isehemia, and cardiac rhythmicity and eetopie electrical activity. Some ~$~iation between experiments can be done acutely in man; many can be done in animal disease models with smoke constituents. Chronic or acute experiments in are major and nonhuman primates with natural or modified whole smoke taken by While certain inhalation in a humanlike nonaversive manner of smoking now appear possible. It should be emphasized that a number of strong concepts lot drawing final exist in atherogenesis, thrombosis, and cardiac structure and function It is of interest within which to mount appropriate experiments. with angina Data on the epidemiological relationships between smoking and vascular heart attack, peripheral vascular disease, aortic aneurysm, and the patients' arteriosclerosis noted above have been assembled in a manner to allow ~ daudication. ~i a statistical statement of the nature of the correlations between : cigarette smoking and cardiovascular disease. Correlation is not and the ~ synonymous with causation. It is important for the public to a neutral or hyPerten, i understand the nature or character of the associations that have been with the i found. The characteristics are fully established for heart attack and ~ include the fact that the correlations are strong ones, generally having a~areh into ~ a relative risk of two or more. They are consistent, reappearing in have been i different population samples over and over, and they are independent uch i of other major risk factors. There is also a graded relationship; that little smoking is an antecedent event in time and the cessation of smoking is a~e from a followed by a reduction in risk over time; the association has strong predictive capacity in the same population sample and also when applied to other samples. Within the limits of the research that has and the been done, the findings of epidemiology, clinical investigation, and Could pathology are generally congruent. The results from the various disciplines and techniques of study tend to support each other. for Although there are reports which do not confirm the statements made of above, they constitute a minor part of the data and fail to cast and reasonable doubt. Animal experimentation is not yet well developed in les/oas smoking research in relation to cardiovascular disease. Smoking is not a necessary condition for atherosclerosis and heart less , attack since these occur in nonsmokers. Repeated and very extensive IO~ger experience has found, however, that it is a sufficient condition to increase the mortality from heart attack among the category of people who smoke and that it does so in a predictable way. 4--65 TIEX 0007981
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SMOKING AND HEALTH 1964 -1979 THE CONTINUING CON I HOVERSY THE TOBACCO INSTITUTE 1875 I Street, Northwest, Washington, D.C. 20006 January 10,1979 T "!" ~.. ~. 000?982 TIMN 289718
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THE CIGARETTE CONTROVERSY TIEX 0007986 TIMN0017604
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Preface For many adults, cigarette smoking is one of life's pleasures. Does it cause illness--even death.'? No one knows. " :i'he case against smoking is based almost entirely on3'nferences from statistics. The "con- ventional wisdom" about smoking came from judgments expressed by committees of doclors in England and the U.S. In our country, anti- smoking organizations pressured the govern- ment to endorse these judgments. Never belore (or since) had a committee "discovered" a single , "cause" for so many diseases. ~ A number of respected scientists do not be- lieve a causal relationship between smoking and i~lness has been established. Others believe that it has. If smoking does cause disease, why, after This booklet is presented by The Tobacco /n- years of intensive research, has it not been stitute in the belief that full, free and informed shown how this occurs? And why has no in- discussion of the smoking and health contro- gredient as found in smoke been identified as ~fcr~y i~ in the public ;n~el'e$#, ~nd in t)~ con- the causal factor? viction that the controversy must be resolved by TF ~,,X 0 0 0 7 ~ 8 7 scientific research. 1 TIMN 0017605
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Smoking--Health Statistics It is no wonder that an American Cancer So- ciety official has said that "a clever enough Statistics are said to show that among the 60 researcher can make almost anything induce million Americans who are smokers, some may cancer in animals, but his findings may have no fall victim sooner or in greater number than relevance to human exposure." other people to three major types of ailments-- Somehow it's possible, the argument goes, cancer, diseases of the heart and circulatory : that direct exposure to tobacco smoke can system, and the pulmonary illnesses, emphysema damage cells in the respiratory tract. The human and chronic bronchitis, heart is not exposed to smoke, and so there is These happen to be our greatest medical " even greater guessing about how it might be problems, coming to the forefront as the major affected. infectious diseases of the past were "conquered" through scientific research. There have been other coincidental trends, among them the growth in popularity of cigarettes. Scientists call these heart and lung problems "degenerative" ailments, for they seem to de- The Problems of Guesswork velop very slowly, through some kind of distor- tion or breakdown of body mechanisms. Though Simply blaming cigarettes for heart disease each illness is very different, all three--and doesn't help. In some countries not even sta- more--are blamed by some sources primarily tistics fit that notion. The government's National on one factor, cigarettes. Heart and Lung Institute points out that we've .learned so much about how to treat heart ail- ments that we overlook how little we know about their causes. "We tend to obscure our ignorance," the Institute says, "by making it seem that a problem has been solved when it Laboratory Work has, in fact, been only half solved." We hear about laboratory "proof" that smok- Emphysema, which makes I~reathing difficult, ing causes cancer. Mice have been painted, is a kind of lung damage typically found in older hamsters swabbed and rats injected with "tars" persons. Doctors ponder whether, among other condensed from tobacco smoke in laboratories things, it might be caused I~y inhaling some but not found in the smoke itself. Rabbits have ~ substance or whether it might result from some been fed nicotine. Dogs have been forced to blood circulation difficulty. In any event, and "smoke" through holes cut in their windpipes, despite speculation that smoking has something Subsequent "changes" in various cells of these , to do with it, the official view of the government animals have been cited as evidence that cig- institute responsible for lung research remains arettes cause disease, though production with candid: "We do not know the cause of pul- smoke of human-type lung cancer--or heart monary emphysema, how to stop its progress disease or emphysema--has never been verified . even if detected early, or how to prevent heart in laboratory experiments, disease caused by eml~hysema." 2 3 0007988 0017606
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TIEX 0007990
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BItO~ & WILLI.~E~ISON TOr-~ACCO C(}ltPOIt~kTION 1600 West Hill Street .R O. Box 35090 .Louisville, Kentucky 40232 (This is the second edition of this manual, It contains the latest available figures and each section has been expanded from the pre- vious edition.) ~ TOS2G55 TOBACCO: ISSUES/ANSWERS/ACTIONS The American tobacco industry is embroiled in controversy. Though tobacco is one of the oldest commercial enterprises in the nation, constant pressure is being placed on our federal, state and local governments to severely curb or even eliminate our industry. The groups exerting such influence are well- organized. They are well-schooled in attracting legislative and public attention. In marked contrast, our industry in general (and Brown & Willi~mson in particular) has maintained a low profile amidst the growing national debate on smoking. That posture is changing. We are launching our own information programs to complement the expanded activities of the Tobacco Institute and to support actions of the Tobacco Tax Council. TOBACCO: Issues/Answers/Actions is designed to provide .you with a balanced view of issues facing Brown & Williamson. In preparing this reference source for you, wr have tried to avoid overly emotional prose, in favor of makinC as factual a presentation of the situation as possible. That is not to suggest a lack of Brown & Williamson concern or commi=mcnU. To ~h= contrary, we are attempting to present a reasoned, balanced summary of the cigarette/smoking issue so that.you--as a concerned citizen--can help counter the often unreasoned claims and demands of some of our adversaries. TIEX 0007991
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Your understandin~ of the issues and your efforts to discuss them on a person-to-person level--with friends, neighbors, relatives, co-workers, business associates and others you encounter and influence--will be of immense value to Brown & Williamson and the growers, distributors, whole- salers and retailers who also are a part of our industry. Of greater significance, your liberal use of this reference material will help our industry begin to dispel the many misconceptions that tobacco/smoking opponents create. You will be helping to preserve the values, of American free enterprise and to protec~ the inherent rights of consumers' freedom of choice. Both of these liberties are being increasingly eroded by government, largely through legislation urged by small, but vocal, groups making the sweeping claim that they represent "the public." References are available in the Corporate Affairs Department for all elements of this handbook. We urge you to read TOBACCO: Issues/Answers/Actlons carefully. Learn it. Use it to voice your opinion as a private citizen in support of our industry. We underscore your role in this effort as one of a "private citizen" because of the climate surrounding the smoking issue. The con=roversy is escalating rapidly. Statements of Brown & Williamson corporate positions, particularly for the media or before public forums, still must be voiced only by officially designated persons. CORPORATE AFFAIRS DEPARTMENT TOS2656 TIEX 0007992
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TIEX 0007993
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pment~ TIEX 0007994
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S66L000 X~IL
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Paragraph Number HISTORY OF TOBACCO On the subject of tobacco, historians are certain of 1. one thing: it (and every form of its present-day use) had been accepted custom for centuries before the Spaniards be- gan opening the Americas to European exploration in the waning 1490s. It took almost a century of observing the native North 2. and South Americans and their use of tobacco before promi- nent European explorers began capitalizing, on tobacco's,' ccmmercial promise. But capitalize they did. European adventurers waged 3.. battles over tobacco shipments on the high seas; tobacco in some countries was legal tender, and often it incited economic conflicts between nations. To this day, tobacco remains an important agricultural 4. commodity that affects the lives and livelihoods of people throughout the world. In capsuled style, here are some of the more signifi- 5. cant data about tobacco and its historic role in commerce and society, especially in the United States. T082660 THE ORIGINS * Though it had existed and had been used in many forms for 6. centuries in the Americas, the first Europeans to observe tobacco being consumed were the Spaniards in the 1490s. * R~drigo de Jerez, a sailor/scout with Christopher Col,~--hus 7. in the West Indies, is reported to be the first E~/ropean to smoke tobacco (1492). * French Ambassador Jean NicQt (from whom tobacco ~erives 8. its scientific classification, Nicotiana), Englishman Sir Walter Raleigh and Portuguese archivist Dam~ao de Goes were among the first to introduce tobacco to European aristocracy in the late 1500s. * After experimenting unsuccessfully with native Virginia 9. tobacco for two years, Virginia colonist John Rolfe un- explainably obtained some West Indies tobacco seeds, which yielded a much milder product. In 1613, R~ife shipped a small consignment of Virginia leaf to England. That event marked America's first commercial export, and was the first step in dissolving the virtual monopoly that Spain had on the European tobacco market. TIEX 0007996
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Paragraph Number * Within two decades, neighboring Maryland became an impor- 10. rant tobacco growing ~d exporting locale. Near the tuxn of the century, North Carolina also was well into the market, followed in the 1800s by Kentucky, Tennessee and others. THE ECONOMICS * By the early 1600s, Spain dominated the tobacco exporting 11. market in Europe, and England alone paid 200,000 pounds sterling each year for Spanish tobacco. * England's James I, in 1604, issued a strong public attack 12. against tobacco, but at the same time sold rights to mer- chants to handle tobacco products. * Colonial American exporters, sensing a growing econcm/c 13. might, began to independently export to other European nations. Perturbed, James I made American tobacco a royal monopoly about 1620, requiring that all American leaf come first to London. * That restriction, plus subsequent production quotas, en- 14. raged colonial growers and they began to seek whatever means available to circumvent the Crown. Among their measures was an inter-colony trade route set up between -- xTOs~66~ North Carolina growers and New England shippers. New Englanders would by-pass London and go directly to other European markets with their North Carolina tobacco. * Parliament subsequently levied a tax on inter-colony 15. trade. This, and a lengthy series of other economic pres- sures, including severe indebtedness to English tobacco brokers, helped move the colonies into the Revolutionary War • * The year the war erupted, the Crown received $16.5 million 16. in tobacco tax revenues from the colonies, a total prob- -ably equaling that from all tax revenues received from all of England's other territorial possessions combined. * Loans from the French, backed by tobacco, helped finance 17. the war with Britain, and tobacco grower George Washington urged colonists to help the soldiers. He commanded: "If you can't send money, send tobacco." * Though a tax on snuff had existed in the colonies as early 18. as 1794, taxation of tobacco began in earnest in 1862 when the U.S. Government needed funds for military operations. The earliest tax was 40 cents per pound on manufactured ~obacco and 40 cents ~er thousand on cigarettes. Before federal income taxes were first levied in 1913, tobacco taxes were the principal source of government revenue, T~E~ 000'7 997
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Paragraph Number accounting for as much as 31 percent as early as 1880. (Federal, state and municipal tobacco taxes today total more than $6.2.billion annually.) Sales of U.S. tobacco products have grown considerably 19. since John Rolfe's first export. _ U.S. leaf exports from 1800 to 1978 have increased from approximately 97 million pounds to 700 million pounds. - Between 1800 and 1978, the amount of tobacco grown in the U.S. increased from approximately 100 million pounds to 2 billion pounds. - Cigarettes sold in the U,S. from 1910 .to 1978 have increased from about 10 billion to 616 billion. DEVELOPMENT OF THE U.S. TOBACCO INDUSTRY * One of the earliest tobacco manufacturing facilities in 20. the colonies was a snuff plant built in Rhode Island around 1750. It, and other snuff and cigar plants erected in the Northeast, gave that region an early dominance in tobacco manufacturing that pre-dated the Revoluntionary War and was maintained until the beginning of the 20th century. * Cigarettes began to become fashionable in the mid-1800s. 21. They were made largely in New York, and at first almost totally from imported Turkish tobaccos. The thousands of Civil War soldiers who were exposed to new kinds of tobacco ?O~6Ge products returned home after the war and created new de- mands and markets. Tobacco manufacturing, especially cigarettes, began its shift southward, first to the Tide- water growing states. * Production of cigarettes at first was by hand. In 1876, 22. it took a worker 10 hours to roll 3,000 cigarettes. The first successful cigarette machine was introduced in the early 1880s by James Bonsack, and by 1883 Washington Duke and Sons Company had perfected Bonsack's machine. It could produce about 220 cigarettes per minute. ~ With mechanization, use of domestic leaf and reduced ~ax 23. on small cigarettes, manufacturing costs, and hence retail prices, fell in the 1880s. Demand surged. * In 1880, four. c~mpanies produced 80 percent of the nation's 24. cigarettes. They were Allen and Ginter (Richmond); William S. Kimball and Company (R~chester); Kinney Tobacco Company, and Goodwin and Company (both of New York City). Between 1880 and 1885, the firm of Washington Duke Sons a~d Company (Durham) entered the cigarette production field. * The Duke firm, previously only a producer of smoking 25. tobacco, quickly took to the Bonsack machine, made some TIEX 0007998
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Paragraph Number technical improvements in it and negotiated a handsome re- bate with the manufacturer. The other cigarette companies also had production equi~xnent, but were slow to.make a sub- stantial commlitment to its use. * With aggressive advertising, production and the opening of 26. a second plant, this one in New York, the Duke enterprise became the cigarette sales leader in 1889. The next year, unable t,. compete successfully against Duke, the four other major fiL,LS united with the Duke organization to form the American Tobacco Company. Together, they produced 91 per- cent of the nation's cigarettes. * By 1894, the American Tobacco Company not only controlled 27. the cigarette market, but was the dominant power in every line of tobacco manufacturing, except for cigars. The com- pany became known as the "Tobacco Trust." * In 1901, American Tobacco invaded the English market with 28. an acquisition of a leading manufacturer. Thirteen British companies responded by forming the Imperial Tobacco Com- pany. American and Imperial battled to a truce in 1902. They jointly formed British-American Tobacco Company to conduct business throughout the world, but leaving the U.S. as exclusively American's market and Great Britain and Ireland as strictly Imperial's. * In 1911, in a major federal anti-trust case, the U.S. 29. Supreme Court decided against American and required dis- position of the business. Out of the mandated break-up came a new line-up of cigarette companies: American, Liggett & Myers, P. Lorillard and R. J. Reynolds. American ~0~~ was also forced out of its BAT holdings; BAT and Imperial were made two separate companies. * While American Tobacco was approaching break-up in the 30. early 1900s, two other companies were being formed. In 1906, Brown,& Williamson Tobacco Company was incorporated. In 1907, the owners of Britain's Philip Morris reincorpor- ated and by 1919 had created an American-owned c~mpany, Philip Morris & Co., Ltd. ~ By 1926, Brown & Williamson had entered the cigarette business through the acquisition of a ~all North Carolina manufacturer. In 1927 the company was reorganized as Brown & Williamson Tobacco Corporation and became affiliated with BAT. * By 1930, there were six major U.S. manufacturers. Listed 31 in order of 1930 production, they were: American, Reynolds, Liggett & Myers, Lorillard, Philip Morris, Brown & Williamson. * Today, those same six companies account for almost 100 per- 32. cent of the U. S. cigarette production. Based' on 1978 TIEX 0007999
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Paragraph Number production figures, they are aligned t~his way: Reynolds, Philip Morris, Brown & Williamson, American, Lorillard and Liggett & Myers. * In the 1970s, BAT began marketing cigarettes in the U.K. 33. and Imperial began competing in world markets. A parent company of BAT was formed, B.A.T Industries, Ltd. TIEX 0008000
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TIEX 0008001
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Paragraph Number TOBACCO ECONOMICS INTRODUCTION There is no controversy about one aspect of tobacco: I. the tobacco industry is a substantial, healthy and important member of our nation's economy. This section profiles the industry, giving the most re- 2. cent employment, revenue, tax and related information. It also deals with three areas that anti-tobacco groups often unjustly criticize: the tobacco price support program, Public Law 480 and industry advertising. TOBACCO CONSUMPTION In 1978, total U.S. cons~ption of tobacco products (in- 3. cluding overseas armed forces) was: * 616 billion cigarettes * 4.7 billion cigars and cigarillos * 1.64 billion little cigars * 44 million pounds of pipe and roll-your-own tobacco * 92.3 million pounds of chewing tobacco * 24.3 million pounds of snuff In 1978, Br~wn & Williamson produced: 4. * 115 billion cigarettes * 5,214,766 pounds of pipe tobacco * 3,029,753 pounds of roll-your-own tobacco * 1,159,000 pounds of chewing tobacco * 1,477,000 pounds of snuff Tobacco cons~ption in the U.S. is relatively level at 5. the current time at approximately 600 billion units. I~ediately after the 1964 Surgeon General's report, 6. annual cigarette sales dropped to 505 billion units fr= 516 TO% 6GV billion. Cigarette sales quickly recovered and have general- ly increased in subsequent years, although various events have impacted upon sales. The chart on the following page s~ws the changes in industry cigarette sales and the occur- rence of certain significant events in the years since 1963. ECONOMIC PROFILE _The average U.S. tobacco smoker spends more ~han $280 a 7. year on tobacco products. For 1978, industry sales were $18 billion, $16.6 billion for cigarettes alone. TIEX 0008003
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Surgeon General's Report 1/64 Package Caution Notice 1/66 : I i I I Advertising "Fairness Doctrine" 6/67 Z Revised Package Caution Notice .< I 11/70 , Broadcast Ban 1/71 ~> m "~ Advedising- Health ' , ~ Warning 1/72 rn , 10t~ Anniversary con General's Re ~ort 1/74 I" Start of HEW War on Smoking 6/77 I I I- i I I New Surgeon General's Report 1/79 i I I I I I I ~ .
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Paragraph Number Approximately one out of every $75 of all retail expendi- 8. tures is spent for tobacco products. These products account for one out of every $27 spent on nondurable constuuer goods. In 1976, retail tobacco expenditures were 41 percent of the sum spent for new automobiles, 151 percent of the sum spent for drugs and sundries and about the same amount as what was spent for radios, televisions, records and musical instru- ments cumbined. Exports of leaf and manufactured tobacco totaled $2.12 9. billion in 1978 and imports came to $428 million. The differ- ence represents a positive net contribution of over $1.69 billion to the U.S. balance of payments. Manufacturing facilities. There are about 147 tobacco 10. product factories with federal permits to manufacture. Tobacco manufacturing facilities are located in 20 states. Nearly all cigarettes are manufactured by the six 1 I. largest tobacco companies. Ranked by percentage of cigarette sales, those companies are: R.J. Reynolds, Philip Morris, Brown & Williamson, American, Lorillard and Liggett & Myers. The industry employs about 72,700 production workers, 12. with a total payroll of over half a billion dollars. The tobacco industry has a financial impact in a number 13. of areas. There is a substantive impact on growers, warehous- ing, wholesaling, retailing and associated industries. For example, the 1978 tobacco crop brought growers $2.55 billion (it was the fifth largest cash crop), and the value of tobacco and related products to wholesalers was $11.9 billion. The total contribution of the tobacco industry can be 14. measured by compiling the wages and taxes paid and profits earned by the industry itself and by the industries it sup- poz~cs (suppliers, .wholesalers, etc.). In 1977, tobacco's total contribution to the nation's Gross National Product was $48.6 billion -- roughly 2.6 times greater than net consumer expenditures on tobacco products. The tables on the following page reveal more on tobac- 15. co's econ~xnic contribution to the nation: T082669 TIEX 0008005
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Paragraph Number TOTAL ECONC~4IC CONTR/~5~fION OF TOBACCO INDUSTRY AS MEASURED BY SELECTED ECONOMIC INDICATORS (Billions of Dollars) Contribut ion 1977 of Tobacco Percentage Indicator Actual Industr~ Contribution Current GNP $1,896.7 $48.6 2.6% Real GNP (1972 $) 1,332.1 35.0 2.6 Total Compensation 1,153.4 25.2 2.2 Disposable IncomeI, 304.0 23.0 I. 8 Corporate Profits Before Taxes 183.5 7.3 4.0 P e rso hal Cons umpt ion Expe ndi fur es I, 212.6 40.2 3.3 Gross Private Domestic Investment 299.0 13.9 4.6" TOTAL CONTRIBUTION OF TOBACCO INDUSTRY TO NATIONAL EMPLOYMENT (Thousands of Employees) Contribution Industrial 1977 of Tobacco Percentage Sector Actual Industry Contribution All Industries 90,545 2,067 2.3% Farming 3,244 165 5.1 Manufacturing 19,554 445 2.3 Durable Goods 11,480 275 2.4 Non-Durable Goods 8,074 171 2.1 C~m_mercial & Other 47,137 1,289 2.7 Wholesale & Retail Trade 18,292 829 4.5 A more detailed analysis of tobacco's impact in these 16. areas is in the "The Allies" section of this report. Division of revenues. The average price of a pack of 17. cigarettes in January, 1979, was 59 cents. Of this, 23 cents was paid to various levels of goverr~nent as taxes., Of the rem~aining 29 cents, five cents went to the grower, 18. 12 cents to the wholesaler and retailer and 19 cents to the manufacturer. About one-tenth of the money going to the manu- facturer is profit. TOS2GTO TAXES Federal, state and local goverr~ents collect some $6.2 19. billion annually in direct taxes on tobacco products. This TIEX 0008006
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Paragraph Number revenue helps provide schools, roads, hospitals and vital goverr~nent services. T0.~bacco excise tax collections are ex- ceeded only by excise revenues from alcoholic beverages and gasoline. Since 1863, when the federal government began taxing tobacco, more than $131 billion has been collected. Federal taxes. For the fiscal year ended June 30, 1978, 20. the feder ~. government collected $2.42 billion dollars from excise ta~ s on tobacco products. Of this, $2.37 billion came from the excise tax of eight cents on each pack of cigarettes • The industry paid suppliers more than $1.8 billion in 21. 1977 for services .and materials (other than tobacco) related to the manufacturing and marketing of tobacco products. Sub- stantial amounts are collected in corporate and individual income tax by the Internal Revenue Service from manufacturers, ,~' wholesalers, suppliers, other tobacco-related companies and their employees. In 1977, 3.2 percent of federal tax revenues came frcm tobacco and related industries. State taxes. States collected some $3.76 billion in 22. taxes from the sale of tobacco products in the year ending June 30, 1978. State excise taxes on cigarettes range from a low of two cents in North Carolina to a high of 21 cents in Connecticut, Florida and Massachusetts. In states with income taxes, corporate and individual in- 23. come taxes are collected from tobacco manufacturers, distribu- tors, retailers, suppliers and their employees. State sales taxes are collected on cigarette purchases in 30 states and the District of Columbia. These taxes range from one to four cents per pack. Tobacco and related industries provide 3.2 percent of 24. all state and local tax revenues. M~nici~al taxes. Taxes of $125.7 million on tobacco 25. products were collected in 1978 by 365 cities, towns and c~unties which impose municipal taxes on tobacco products. New York City has the highes~ municipal tax -- eight cents a pack, which is added to the state tax of 15 cents. Total. Federal, state and municipal excise taxes on 26. cigarettes for the fiscal year ending June 30, 1978, amounted to more than $6.2 billion • . . or nearly $30 for every man, woman and child in the nation. TOSZGTI TIEX 0008007
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Paragraph Number The tables below give more detailed information on the 27. tobacco industry's contributions to the nation's economy through taxes. TOTAL CONTRIBUTION OF TOBACCO INDUS%'RY TO FEDERAL TAX REVENUES (Billions of Dollars) Contribution 1977 of Tobacco Percentage Tax Category Actual Industr~ Contribution FICA Taxes $I 18.7 $ 2.8 2.4% Personal Inccme Taxes 169.4 3.6 2. I Corporate Inccme Taxes 61.3 2.5 4.1 Indirect Business Taxes 25.0 3.0 12.0 TOTAL $374.4 $I 1.9 3.2% TOTAL CONTRIBUTION OF TOBACCO INDUSTRY TO STATE AND LOCAL TAX' REVENUES (Billions of Dollars) Contribution 1977 of Tobacco Percentage Tax Cateqory Actual Industr~ Contribution Social Insurance Taxes $ 21.7 $ .4 1.8% Personal Income Taxes 56.6 1,2 2.1 Corporate Income Taxes 10.5 .4 3.8 Indirect Business Taxes 140.0 5 • 3 3.9 TOTAL $228.8 $7.3 3.2% Large cigarette taxes enacted in recent years in many 28. states have resttlted in s~bstantial declines in tax-paid cigarette sales in those states. Many smokers cross politi- cal boundaries to buy cigarettes which are taxed less heavily, and others buy contraband cigarettes smuggled from low-tax states. Information on the growing bootlegging problem can be found in the "The Adversaries" section of this book. TOBACCO PRICE SUPPORT T082672 The tobacco price support is not a tobacco subsidy pro- 29. gram--it is a tobacco price stabilization program for the tobacco leaf market,~ It is a loan program like the program :~Or wheat, and other agricultural ccmunodities to .stabilize prices so farmers can get a reasonable return on their in- vestments. TIEX 0008008
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Paragraph Number The program mandates quotas limiting the acreage a farmer 30. can use for tobacco growing and the poundage he can sell. Without it, the tobacco supply probably would be larger, not smaller. The program also allows the tobacco farmer to bor- row money, using the tobacco as collateral. The program must be approved periodically by the growers to remain in exist- ence. Unlike the stabilization programs for other agricultural 31. c~nmodities, the tobacco price stabilization program has in most years paid back more to the government than it borrowed. This is partially because tobacco stored as collateral for the loan plus interest can be held for up to ten years before being sold at a time of high demand. Between 1933, when the program began, and 1977, the cumu- 32. lative realized cost to the federal government has been $52 ~, million, or an average of $1.2 million a year, plus adminis- trative expenses. Part of this expense was offset by interest inccme. The cost is twelve one-hundredths of one percent of all farm c~modity price support operations. Compare this to: * the $186 million loss sustained by the corn stabilization program in 1977 alone. * the more than $6 billion in federal and state excise tax revenue generated each year by manufactured tobacco products. Thus, the tobacco program is one of the least expensive and most successful farm commodity programs. Tobacco is one of the few crops that still utilizes 33. family hand labor and provides a reasonable income on a small family fazmo Tobacco growing is labor intensive. While it takes approximately 3.5 man-hours to grow one acre of corn, it requ/res over 250 man-hours to grow one acre of tobacco. Tobacco is grown on over 490,000 farms in the U.S. On 34. many of these farms, more than one family depends on the in- c~ne frem tobacco sales. If the tobacco price stabilization program were ended, many of ~hese farm families--estimated to be over 600,000 in all--would be forced to seek other forms of employment, and undoubtedly many thousands would find themselves suffering unnecessary economic hardships. On October 12, 1976, then candidate, now President Jimmy 35. Carter said about the tobacco price stabilization policy, "I personally see no need to do away with a program that costs the goverr~nent next to nothing, while enabling so many hard working f~m~lies to earn a living." ~ 0~21~'~-~ TIEX 0008009
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Paragraph Number PoL. 480 Public Law 480 is often mistakenly referred to as the 36. "Food for Peace" program in connection wi~h tobacco. The Act contains two titles. Title I of Public Law 480 authorizes the President to enter into long term concessional loan agree- ments with foreign governments to finance the sale of U.So agricultural commodities. This arrangement not only helps develop foreign markets for U.S. farm commodities but re- lieves the recipient government frem diverting scarce re- sources which might otherwise be devoted to public services, such as econ~nic development, in order to meet commercial com- modity import requirements° Since the purpose of the Title I program is to provide 37~ assistance through loans to developing countries to meet c~nmodity import requirements, it is not a food aid program° Only Title II of Public Law 480 provides food to the needy in developing countries and tobacco is not ~erm_itted under this title. Title I financing is based upon the availability of corn- 38° modities in the U.S. and the needs of the recipient country° In 1978, long-term dollar credit sales for tobacco under Public Law 480 totaled $2.6 million, for 1.4 million pounds-- a mnall portion of the total program. A group of U.S. Sena- tors stated in 1977 they had heard of no case where sales of tobacco displaced sales of food commodities and it cannot be assumed that more food c~-~dities would be purchased if tobacco w~re eliminated. ADVERTISING Any discussion of tobacco econom/cs would be incomplete 39. without a discussion of advertising expenses, since the tobacco industry spends more than half a billion dollars a year to prcmote its product. This expense is frequently criticized by anti-smoking 40. groups, who claim that the goll of tobacco advertising is to encourage people to begin smoking. Brown & Williamson and the industry disagree with this claim. Tobacco advertising is designed to gain a share of a 41. fully developed market. The advertiser's task then is to divide rather than to expand the cigarette market. As a re- sult, cigarette manufacturers use competitive advertising to maintain their share of the total cigarette market by pro- moting brand identification and preferences among individual TIEX 0008010
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Paragraph Number customers. This may explain an observation made by a psychology professor who has studied the effects of ad- vertising: One never sees an advertisement which says "smoke cigarettes." It is always "smoke my brand" or "switch to my brand." Proposals to ban or restrict cigarette advertising art 42. increasing almost everywhere. A wide variety of such restr :- tions are already in effect, ranging from the abolition of all advertising in Finland and Norway, to the abolition of radio and television advertising in the United States, Ireland, the United Kingdom, France, West Germany, Sweden, Switzerland, Denmark, and Greece. The experience of those countries which banned cigarette advertising indicates that such restrictions did not have the anticipated effect. A comparison of sales figures in countries before and 43. after cigarette advertising was banned or restricted indicates that such limitations have not reduced consumption. Although bans on posters and radio and television advertising were initiated in France, the French m/hinter of health reported increases in tobacco consumption. During the first six years following the ban of broadcast advertising in the U.S., sales of cigarettes increased about 25 percent. A survey examining this trend concluded: On the basis of this uncontestable, empirical evidence, the broadcasting ban on cigarette advertising has been a failure. Although cigarette advertising bans are based on the as- 44. sumption that advertising influences young people to smoke, research conducted since the issue arose and bans were enacted does not support the argument. To the contrary, the prepon- derance of evidence indicates that advertising does not signi- ficantly influence a young person's decision to smoke. A Canadian study of the psycho-social aspects of ciga- 45. rette smoking, spanning the years 1972-76, cites some 20 studies which have concluded ~hat the desire to belong to a group and the smoking habits of friends influence teenagers most heavily. Additional factors that have been found to in- fluence the initiation of smoking include familial influences, pleasure, personality, socioeconomic status, and educational level. A professor of psychology at Indiana University reported 46. the results of his smoking behavior tests to Congress, saying there is "no scientific basis" for inferring that cigarette advertising has a significant influence on young p~.ople's smoking. He pointed out that soap ~omp~nics spend millions of dollars on advertising -- not to induce people to wash, but to use their brand when they do. TIEX 0008011
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Paragraph Number The director of the U.S. Office of Smoking and Health 47. has said: "It is qlu~.e correct, on one hand, mot to make ads the culprit in terms of why teenagers, for example, take up smoking. Advertising certainly is not the culprit." While advertising bans and restrictions apparently have 48. failed in their intended purpose, they have deprived the public of information about product changes, In the case of cigarettes, the introduction of brands that . ave undergone technological innovations has been hindered. Even pr~ninent anti-smoking campaigners are opposed to 49. advertising bans for just this reason. One such individual, Dr. Ernst Wynder, told a Swiss reporter: I do not believe that advertising has much influence. Advertising does not influence people to smoke, but it helps them to choose one or another brand. Above all, I am against an advertising ban because the 'lighter' and less harmful cigarettes manufactured nowadays, would not be widespread enough without advertising. In recent years, international anti-smoking forces have 50. attacked tobacco cempanies' international marketing tactics. They claim that cons~ers in developing countries are being exploited because warning clauses are not included on packs and in advertisements in many of those countries. However, in all countries where tobacco products and 51. advertisements carry warnings, it is a result of government legislation or heavy pressure on the tobacco industry. ~ne governments of developing countries are aware of the contro- versy surrounding tobacco, but have chosen to treat the matter differently. Also, critics claim that international tobacco ccmpanies 52. are "using double standards in the selling of high "tar" and nicotine cigarettes in developing countries. But it is con- sumer preference that detentes the type of cigarettes sold .in any market. For cigarettes, as for food and other commod- ities, cons~ers in developing countries have different tastes from consumers in the West in many cases. The policy of the international companies is to offer 53. cons~ers a wide range of brands with varying yields--but in all markets account must be taken for consumer preference. In the developing countries, cigarettes produced by cottage in- dustries have a higher yield than international company brands. These cigarettes have cc~npeted very successfully against in- ternational brands. And where local national companies are producing machine-made cigarettes, their brands are as high, or higher, in yield as the international brands sold in those countries. TIEX 0008012
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Paragraph Number Furthermore, in most developing countries, the per capita 54. consumption of cigarettes is extremely low. In some African countries, for example, it is as low as 12 or 13 Cigarettes a month -- and a very high proportion of cigarettes are sold by the single unit, not by packs. Consequently, "tar" and nico- tine per cigarette is meaningless as a comparison of aggregate "tar" and nicotine consumption between smokers in developed countries versus smokers i . developing countries. TIEX 0008013
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TOs~678 TIEX 0008014
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Paragrapl~ Numl~er (The following section on Smoking & Healt~ eprinted from a publication of The. Tobacco Institute. ) SMOKING AND HEALTH -- THE PROPER PERSPECTIVE? As the chronologies in this article show, numerous pub- I. lications have charged that cigarette smoking causes disease in the smoker and adversely affects the nonsmoker. What those chronologies do not show, however, is the other side of the story. Despite the fervent desire by many zealots to sug- gest otherwise, that other side exists. The case against tobacco is not closed. The "other side" has two parts; the first involves a 2. critical assessment of the evidence against tobacco. Many people believe that evidence is overwhelming. But as one Congressman said in 1971 to summarize the opinion of many "outstanding researchers of unassailable credentials" about the nature of that information: "it is a case of inconclu- sive evidence piled on top of inconclusive evidence to con- vince people that something they would like to believe is true" The second part involves a dispassionate review of the 3. evidence providing alternative explanations for, or requiring further research into, the association between smoking and disease. The general acceptance of the anti-smoking rhetoric has 4. made it difficult to present the side that the anti-smokers want to ignore. A scientist actively involved in smoking and health research recently commented, for example, that "when it comes to tobacco, opinions are given often with such emo- tionalism that there is very little discussion, much less scientific objectivity." The following discussions are designed to raise only a 5. few of the questions that must be considered before that ob- jectivity can be attained. The issues of smoke and the health of the smoker, on the 6. one hand, and the health of the nonsmoker on the other, are different in several scientific and political respects. Con- sequently, this section will treat the issues separately. THE NONSMOKER Chronolo~ of Scientific Claims that Smoke Harms the Nonsmoker discriminate short time intervals in subjects exposed to carbon monoxide (CO). (See paragraphs 40 - 46) TIEX 0008017
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Paragraph Number 1969 Cameron's Detroit survey associates children's respira- 8. tory infection and parental smoking. (See paragraphs 62 - 66) 1970 Ray and Rockwell report deteriorating psychomotor 9. function (e.g., driving) with increasing CO absorption. (See paragraphs 40 - 46) 1971 Surgeon General Steinfeld proposes government ban on 10. smoking in public places, claiming a possible health hazard to nonsmokers. His speech marks the beginning of public awareness of the nonsmoker issue. (See para- graphs 36 - 39) 1972 Publication of first HEW annual report to cite evidence 11. that atmospheric tobacco smoke might adversely affect the nonsmoker. Hoegg introduces the concept "cigarette equivalent," a measure of exposure to atmospheric tobac- co smoke. 1973 Russell says that nonsmokers exposed to atmospheric 12. tobacco smoke absorb about the same amount of CO as smokers. Aronow and Isbell report decreased duration of exercise before onset of pain in angina patients ex- posed to 50 parts per million CO. (See paragraphs 40 - 46) 1974 Harlap and Davies examine hospital admissions of 13. children less than one year of age. They report a re- ~~6"~ lationship between maternal smoking and bronchitis and pneumonia in children aged 6 - 9 months. Colley, tak- ing into account smoking habits of both parents, ex- tends Harlap's findings to include all children under one year of age. (See paragraphs 62 - 66) 1975 Third World Conference on Smoking and Health. Public 14. smoking introduced as a new focus of the anti-smoking campaign. HEW annual report originates the term "in- voluntary smoking" to describe nonsmoker exposure to tobacco smoke. 1976 Weber, et al., report increased eye, nose and throat 15. irritation resulting from exposure to high concentra- tions of atmospheric tobacco smoke. Cuddeback's study says that a nonsmoker spending eight hours in an un- ventilated tavern is exposed to the equivalent of smoking 36 cigarettes. (See paragraphs 40 - 50) Becker announces discovery of an allergy-causing substance in tobacco. (See paragraphs 52 - 54) 1977 Brunnemann and Hoffmann claim the concentration of 16. nitrosamines (suspected carcinogens) in sidestream smoke to be 50 times greater than in mainstream smoke. TIEX 0008018
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Pamgraph Number 1978 Aronow reports that remaining two hours in a room con- 17. raining tobacco smoke adversely affected 10 heart dis- ease patients. (See paragraphs 55 - 61) The British Medical Journal endorses peoples' right to breathe smoke-free air. Miller's "Pennsylvania Study on Passive Smoking" claims wives of smoking husbands die earlier than wives of nonsmoking husbands. 1979 Tager study says that children's lungs may be adversely 18. affected by parents' smoking. (See paragraphs 62 - The Puzzling Attack on Smokinq in Public Places Widespread publicity seems to inevitably accompany the 19. release of reports supposedly showing that nonsmokers should worry about their health when exposed to tobacco smoke. Anti- smoking organizations, moreover, grab these opportunities to fan the fears of an already anxious society. In the process, an atmosphere of emotionalism has been generated. As a result of this highly charged atmosphere, misin- 20. formation has been spread far and wide. The sample may be small, and the experimental design faulty. Cautionary caveats may be clearly stated, and researchers may say that they cannot draw any firm conclusions. Further research may be called for, and more questions raised than answered. Yet the preliminary findings and questionable experiments become implanted in the public mind as fact. This emotionalism has confused the scientific picture. 21. Whether reactions to smoke are real or imagined is a question scientists must wrestle with. The answers are varied. For example, the 1979 Surgeon General's Report states that the observed response to smoke in some healthy nonsmokers "may be due to psychological factors." A Harvard University professor who has studied public 22. smoking issues says that simply the odor of smoke "may trigger emotional responses not yet well understood." And a physician who writes a medica~ column comments that the symp- toms of nonsmokers "may come from anger rather than from the smoke itself •" A study conducted for Western Airlines helps demonstrate 23. that there is a psychological basis for nonsmokers' reactions to smoking. Ventilation tests indicated that the best means of segregating smokers and nonsmokers in airplanes was to put smokers on one side of the aisle and nonsmokers on the other. Yet Western was swamped with complaints when they ~ried it. A former aviation editor for UPI commented on the 24. Western Airlines experience: "It seems that all a nonsmoker needed was to see someone smoking, and that was enough to TIEX 0008019 I
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Paragmph Number make him think he could smell the smoke. I'm afraid this is just one more instance where emotionalism gets in the way of established scientific facts." The emotional and psychological reactions of nonsmokers 25. to smoking may simply reflect frustration with life in general. A Harvard Medical School social anthropologist who has studied smoking customs in different societies thinks this may be the case. He believes that u.~.~eavals in society and overcrowding have made people superseLsitive to other people's behavior. Because smoke is so visible, people have something positive to react against. "To some people," he says, "the smoker has become a ready target for general frus- trations, anxiety and discontent." It may be annoyance, .fear, or general frustration which 26. fires the fervor in antiT~mokers. But health is the banner under which they marshal~ their forces. Yet scientists have publicly stated that it has not been proven that nonsmokers suffer adverse health effects from "passive smoking." Among those who acknowledge there are unanswered ques- 27. tions on the public smoking issue are some well-known ad- versaries of smoking. For example, the president of the American Health Foundation stated in 1976 that "(P)assive smoking can provoke tears or can be otherwise disagreeable but it has no influence on the health." That same year an advisor to the National Advisory Committee on Smoking and Health made a similar statement. "In very direct terms," he said, "there is no medical proof that nonsmokers exposed to cigarette smoke in ordinary relation with smokers suffer any damage." Various scientists who reject the health hazard to non- 28. smokers theme testified to this effect in several hearings in 1978. Some examples of these statements by medical experts clearly illustrate that the conclusions reached by anti- smokers on the public smoking issue have not gone unchal- lenged. In September, 1978, a t~racic surgeon told the Chicago ~ 29. City Council Comm/ttee on Environmental Control: "An asser- tion that tobacco smoke is a health hazard to the normal non-smoker is untenable. The weight of evidence as it exists in the world literature does not support a claim of adverse health effects for those exposed to 'passive smoking.'" That same month congressional hearings were held in 30. Washington. Experts in the fields of medicine, psychology, social relations, attitude research and indoor contaminants testified. Ten others submitted statements for' the'record on public smoking issues. Among those who appeared before this congressional sub- 31. ccmmuittee was an emeritus professor of pharmacology. His TIEX 0008020
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Pa~graph Number closing remarks reflect the opinions of the other witnesses. "Ks a scientist, I am interested in reliable data which demonstrate whether a nonsmoker absorbs tobacco smoke in public places and if so, whether the amount is sufficient to cause adverse health effects," he said. "The literature, in my opinion, does not support the theory that a nonsmoker ab- sorbs amounts which can cause harm." In October a Nation~. Cancer Institute spokesman told 32. a congressional committee that "the fact remains that we really do not have conclusive scientific evidence about the adverse health effects of passive smoking on the bystander." During the cottrse of the Proposition 5 controversy in "~ 33. California, a specialist in lung disease was interviewed by the Los Angeles Times. The author of numerous articles on lung function discussed exposure of nonsmokers to cigarette smoke. He told the Times: "I do not believe that available published data demonstrate such exposure to be a significant health risk to nonsmokers." Finally, as 1978 ended, the New Jersey Public Health 34. Council held hearings on proposed public smoking requlations. Among the medical experts who appeared was a professor of pharmacology who has written numerous articles on the health effects of drugs and inhalants. He told the Council: "Based upon the world literature and my own observations, smoking in public places does not, in my opinion, constitute a health hazard to nonsmokers." The anti-smoking movement is puzzling. Violent reactions 35. to smokers and extreme efforts to prevent smoking seem more than a little out of proportion considering the scientific un- certainties. The explanation of a professor of pathology, Dr. Edwin R. Fisher, may have cut to the heart of the issue. "Notwithstanding the scientific facts, there is a small group of vocal nonsmokers who have a special interest in trying to convince people that environmental tobacco smoke is harmful to their health," Dr. Fisher said. "What they are really seeking to do, however, is to rid the world of smoking and thereby 'protect' the smoker from hi, self." The Scientific Facts Background Concern among nonsmokers about the effect of breathing 36. other people's tobacco smoke emerged following a 1971 speech by the U.S. Surgeon General. Calling for a ban on smoking in public places, Dr. Jesse Steinfeld said that "egidence is ac- cumulating that the nonsmoker may have untoward" effect~ from the pollution his smoking neighbor forces upon hi~." TIEX 0008021 |
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Pamgmph Number A year after the speech, the annual HEW report on 37. smoking contained the "evidence" Dr. Steinfeld alluded to. One chapter was devote4 to studies purporting to show that exposuxe to tobacco smoke in the air, sometimes called public smoking, might have adverse effects, on nonsmokers. The publication of that chapter set off a chain reaction. 38. It precipitated studies designed to measure the amounts of smoke abs ,.'bed by nonsmokers and set anti-smokers into action on an e/not .onal crusade against smoking in public places. A nonsmoking society is their goal. And the means to that goal is the perpetuation of the belief that the health of non- smokers is adversely affected by breathing cigarette smoke. Challenges to this belief have come from medical experts 39. who insist on scientific facts, not emotion: "Although some nonsmokers are sincere in their belief :, that atmospheric tobacco smoke is harmful to the non- smoker, their statements frequently and, I might add, almost invariably lack a scientific basis .... " Components : Carbon Monoxide (CO) Certain experiments with CO and nicotine have lead to 40. theories that these cigarette components may have adverse ef- fects on health. Until recently, these theories applied only to smokers. Now, however, the question has been raised abo.ut nonsmokers' exposure to these substances. It should be emphasized initially that CO is present in 41. the air whether or not cigarettes are smoked. Man-made sources include automobile exhaust fumes, industrial emis- sions, gas heaters and stoves. CO is also produced by the ~e6,~~ oxidation of oils and lubricants and the aging of paints, especially on steam pipes. In addition, it is a natural prod- uct of body metabolism. Thus, people are exposed to carbon monoxide from various 42. sources in normal, everyday environments. Yet cigarette smoke adds little to overall tO levels. According to a pro- fessor of medicine and pharmacology who has reviewed the literature: "Environmental studies suggest that tobacco smoke has little impact on the CO content of roem air except under highly artificial conditions." CO levels from cigarettes in rooms with adequate venti- 43. lation have been shown to be well below the limit recommended by OSHA (50 parts per million) for workers exposed over an eight-hour period. This has been demonstrated by actual measurements of CO in the air in public places .and by tests An ro~m~ o~ varlou~ si~. The ~ombine~ r~ul~s o~ ~he~e studies indicate that when tobacco smoke is present under realistic conditions, CO levels rarely exceed 10 -~n. TIEX 0008022
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Pamg~ph Number If this is the case, then why is there so much concern 44. about exposure to other people's smoke? It may be because anti-smokers use only those studies that have supposedly found high CO levels due to smoking. What the anti-smokers don't say is that these experiments were conducted under highly artificial conditions and bear little, if any, resem- blance to real life. Two examples of the types of experiments anti-smokers 45. cite illustrate the point. In one experiment, nine ciga- rettes were smoked one after another in a car without inside or outside ventilation. In another, two smokers and two non- smokers sat in a closed car in.a closed garage while ten cigarettes were smoked within an hour. The key to understanding this issue lies in the proper 46. emphasis on realistic settings and normal ventilation. Under these conditions, cigarette smoke is quickly diffused and .~ will contribute little to the overall CO levels in public places. Components: Nicotine In addition to CO, researchers have also measured nico- 47. tine content in experimental rooms and in public places. Since nicotine is produced almost exclusively by burning tobacco, it is viewed as a reliable indicator of the amount of tobacco smoke in a given environment. A major study measuring nicotine in bars, bus and air- 48. line terminals, and restaurants was conducted by scientists ~6,~2 at the Harvard School of Public Health. The results showed that a nonsmoker would have to spend between 100 and 1,000 hours in these places to absorb the smoke of one cigarette. Testing the air indicates how much nicotine is present, 49. but measuring physiological responses suggests how much has been absorbed. Important work in this area was completed by two Germans who tested skin temperature, pulse rate, EKG and blood pressure of nonsmokerskexposed to smoke in an experi- mental room. None of these parameters was significantly altered. The investigators decided that the amount of nico- tine absorbed was too small to affect these sensitive physio- logical indicators. A pharmacologist who has reviewed the. studies examining 50. nicotine absorption by nonsmokers has concluded: "It seems clear that, based on nicotine uptake, the nonsmoker is ab- sorbing very little tobacco smoke." TIEX 0008023
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Paragraph Number Health Tests of the air in public places ~nd measurements of 51. absorption of tobacco smoke have shown that nonsmokers are exposed to small amounts of carbon monoxide and nicotine. Yet anti-smokers repeatedly charge that breathing environ- mental cigarette smoke damages nonsmokers. Allergy A common complaint of nonsmokers is that they are "aller- 52. gic" to cigarette smoke. It has not been shown, however, that tobacco smoke contains a human allergen. In fact, even the 1979 Surgeon General's report admits: "The existence of a tobacco smoke allergy in man is unproven." The "allergic" nonsmoker may be experiencing an irrita- 5'3. rive rather than an allergic reaction. The Director of the Allergic Disease Center at Tulane University has emphasized that such a distinction must be made. After reviewing studies on the allergy question, he said: "I think it is fairly safe to conclude that most of them suggest that the predominant effect of cigarette smoke is Qne of an irritant and not an allergen." In his judgment, "it has not been clearly established that allergens for man are present in tobacco smoke." A small group of people may be sensitive to tobacco 54. smoke, but in many cases they may really be responding to high room temperatures, stuffiness, and lack of adequate ventilation rather than tobacco smoke, which happens to be very visible. Clearly, personal annoyance and emotional reactions have to be considered as factors in nonsmokers' responses. But these should not be confused with true aller- gic reactions. Heart and Lung Disease Anti-smokers have charged that cigarette smoke adversely 55. affects people with preexisting heart and lung conditions. This assertion, as it relates to people with heart dis- 56. ease, relies heavily on an article published by Aronow in 1978. This study of ten heart patients reported that ex- posure to cigarette smoke caused heart pain to develop sooner after exercise. The wide publicity given this small study has heightened concern among nonsmokers about tobacco smoke in public places. This report has been heavily criticized. 'The sample was 57. 'extremely small. No allowance was made for the possible ef- fects of psychological stress on patients' reactions to TIEX 0008024 I
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~ Pa~gmph Number cigarette~ smoke. And although Aronow said some of the re- sults w~re "presumably due to absorption of nicotine," no / meas~ents of nicotine absorption were published~ After describing such deficiencies, a Los Angeles chest 58. physician concluded that the study "is questionable," and a professor of pathology has referred to the experimental de- sign as "exceedingly poor." The Director of Cardiovascular Research at a Veterans' Administration hospital has responded to the charge that pub- lic smoking harms people with heart problems. After reject- ingthe idea that tobacco smoke exposure causes heart disease in the healthy nonsmoker, she ~dded: "Nor do available studies establish that atmospheric tobacco smoke under real- istic conditions adversely affects nonsmokers with preexist- ent cardiovascular disease." With respect to lung disease, a Canadian group studied ' 60. the reactions of asthmatics to levels of tobacco smoke typi- cally found in public places. After two hours of exposure, no systematic lung changes were observed. Such results prompted a well-known pulmonary expert to say: "I must con- clude that there is no proof that smoking in public places adversely.affects patients with lung disease either acutely or chronically." Present evidence does n6t prove that exposure to tobacco 61. smoke aggravates heart and lung disease in nonsmokers. Parental Smoking The few studies suggesting that parental smoking affects 62. children have been used to heighten concern about tobacco smoke exposure in public places. Some studies, for example, have reported an increased 63. frequency of respiratory infections in the children of smok- ing parents. These same studies, however, often point to the possible role of cross infec%ion for parents and genetic pre- disposition in both parents and children. A 1979 article reported that children whose parents 64. smoked had reduced lung function compared with children whose parents did not smoke. Significantly, no relationship was found between parental smoking and the frequency of respira- tory illness in children. Moreover, there are several prob- lems with the study, including the size of the sample and the lack of analysis of other relevant factors. Yet this re- port received wide publicity and instant credence with no reference to these limitations, some of which were alluded to by the authors. TIEX 0008025
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Pa~g~ph Number Other work has shown no relationship betwee~ parental 65. smoking habits and respiratory illness in ~hi~.~, For example, a five-year study on respiratory ailments in 428 children concluded: "Smoking and nonsmoking parents have about the same proportion of children with respiratory symp- toms. The number of cigarettes smoked by the parents has no influence on respiratory symptoms in their children .... " And one of the largest studies on the subject conclud~¢ 66. that: "exposure to low levels of smoke produced by cigarette' smokers does not result in chronic respiratory symptoms or loss of lung function among children .... " Conclusion Smoking in public places has not been proven to be harm- 67. ful to the health of the normal nonsmoker. So what is the basis for all the furor? Perhaps emotion and fears instilled in nonsmokers have obscured the scientific facts. But as a well-known medical columnist recently admonished, emotion must not be allowed to distort the scientific reality: "if we are to be scientific about smoking and if we are to take paranoia and pique out of the is- sue, we should also acknowledge the medical facts involved--and to this date they indicate no physical danger tothe nonsmoker." THE SMOKER Chronoloq~ of Scientific Claims that Smoking Harms the Smoker 1953 Wynder and Graham publish one of the first "skin paint- 68. ing studies. Nearly 50 percent of mice painted with cigarette "tar" reportedly develop skin cancers. (See paragraphs 91 - 94, 152 - 158) 1954 Preliminary results of the Hammond-~orn (American Can- 69. car Society) study point to increased lung cancer and ~O~OO heart disease rates in smokers. Doll & Hill's "British doctors" study alleges a "steadily rising mortality from death rates due to cancer of the lung as the amount of tobacco smoked increases." Later reports also discuss heart disease patterns. (See paragraphs 95 - 119) 1956 Auerbach contends that he can tell a smoker's lung from 70. a nonsmoker's and that smokers' lungs show many patho- logical changes. 1958 Dorn's study of 200,000 U.S. veterans reports smokers 71. up to 16 times more likely to die of lung cancer than nonsmokers. (See paragraphs 95 - 119) TIEX 0008026
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Pamgmph Number 1962 England's Royal College of Physicians' first report 72. claims a causal relationship between smoking and lung cancer. 1964 Publication of first "Surgeon General's Report (actu- 73. ally a report of the Advisory Committee to the Surgeon General). Report claims causal relationship between smoking and lung cancer (See paragraphs 84 - 125) and chronic bronchitis (See paragraphs 172 • 189), probable causal relationship with various other cancers, and association with heart disease (See paragraphs 126 - 149) and emphysema (See paragraphs 172 - 182). HEW publishes a report almost every year thereafter. The ACS "million persons" study claims a "dose-response" relationship between smoking and death rates. (See paragraphs 95 - 119) 1965 Emerson Foote, an ad agency executive, starts wide- 74. spread belief that smoking may be responsible for as many as 300,000 "excess deaths" per year in the U.S. 1966 Kahn's 8 I/2 year follow-up of the Dorn veterans sup- 75. ports the earlier report. (See paragraphs 95 - 119) 1967 First World Conference on Smoking and Health. Partici- 76. pants launch crusade for "citizen action against smok- ing." Anti-smoking forces decide to stage a s~milar conference every four years. HEW issues a household survey of "morbidity," asserting that smokers are sick more often than nonsmokers. (See paragraphs 95 - 119) 1968 Selikoff article says that smoking asbestos workers 77. have "92 times the risk" of dying from lung cancer as nonsmoking, non-asbestos workers. (See paragraphs 95 - 119) 1970 Auerbach's beagle dogs study results announced. Said 78. to be first successful induction of lung cancer in dogs from "smoking." (See paragraphs 88 - 90) 1973 Annual HEW report warn~ that smoking during pregnancy 79. may harm the unborn child. (See paragraphs 191 - 209) Dontenwill reports changes in the larynx of Syrian golden hamsters after chronic inhalation of cigarette smoke, 1975 Third World Conference on Smoking and Health. Emphasis 80. shifts from smoking and health research to "safer" cigarette, public smoking, behavior modification. British researchers, including Sir Richard Doll, report an increased risk of heart attack for young women who smoke and take the pill. (See paragraphs, 126 - 149) 1977 The title of the third Royal College of Physicians' Re- 81. port, Smoking o~r Health, provides a new theme for anti- smokers. TIEX 0008027
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Pamgmph Numl~er 1978 Ax~erican Medical Association says that results of AMA/ 82. ERF study, funded with a $15 million tobacco industry grant, support previous contentions about the hazards of smoking. National Cancer Institute's Gori publishes his "toward a less hazardous cigarette" ~tudy. He is "crucified" by anti-smokers for implying existence of a "safe" cigarette. 1979 Publication of a 15in anniversay Surgeon General's 83. Report -- a 1,200 pa~e, $250,000 document. "Tobacco Dependence" is labeled a mental disorder in the American Psychiatric Association's new diagnostic manu- al (to be published I/I/80)0 Fourth World Conference on Smoking and Health. Presence of national and inter- national bureaucrats suggests shift of the anti-smoking campaign from voluntary organization to the government arena. Lun~ Cancer Foremost in the litany of claims about smoking and dis-. 84. ease is the assertion that smoking causes lung cancer. Daniel Horn said eleven years ago "you could stand on a rooftop and shout 'smoking is dangerous' at the top of your lungs and you would not be telling anyone anything they did not already ~~ know." That comment applies especially to lung cancer: al- most everyone has been told ~hat smoking has been associated with lung cancer, What everyone does not know is that there is another 85. litany, a litany of vital questions that remain unanswered about the meanin~ of that association. Why have experiments in which animals supposedly m~mic 86. human smoking re~eatediy failed to produce the type o__f fun@ cancer for which smokinq is m~st often blamed? Ten years ago, the HEW report on smoking and health ad- 87. mitred the failure of these experiments, The report said that large scale inhalation ~tudies, using a variety of ani- mals, "have essentially failed in producing squamous cell cancer of the lung." That criticism is still valid. One experiment, using beagle dogs, was for many years 88. widely publicized as having provided the conclusive inhala- tion evidence. However, the work by Auerbach, et al., has been largely discredited as physiologically inappropriate (the dogs were forced to inhale the smoke through holes cut in their throats) and scientifically lax (expecially because of the failure to establish proper nonsmoking c~ntrols). Shortly after the experiment was published, one scien- 89. tist discussed the failure to expose the non-smoking dogs to TIEX 0008028
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Pamgraph Numi:~er the same surgery and bypassing of natural functions forced on the smoke-exposed dogs. He said that failure defied compre- hension, and added that "the consequences of this ,work will be confusion rather than enlightenment." More recently, careful examination of beagle dogs avail- 90. able for research in the U.S. has indicated that entire beagle populations, including the dogs used in this experiment, may have been i~ected with canine lungworms. This may be vital information, since the lung changes caused by these worms can be indistinguishable from the changes reported by Auerbach. Other animal experiments cited as proof that smoking 91.. causes lung cancer have involved painting "tar" (an artifi- cially obtained laboratory product) on the animals' shaved skin. Such experiments are inappropriate for comparison to the inhalation process of humans. Even the 1979 Surgeon General's Report has rather grudgingly conceded that "con- siderable criticism" has been directed at these studies. Any layman can recognize some major probl~ns with this 92. technique: (I) mouse backs and rabbit ears are not the same as human lung tissue, (2) inhalation differs markedly from "painting," (3) the chemical properties of the "tar" obtained in laboratory procedures may be quite different from anything inhaled by smokers. Furthermore, the quantities used in these experiments 93. were, to say the least, unrealistic: ~~ "The quantity of 'tar' needed to produce the cancer is fantastically higher than that found in cigarette smoke. To expose yourself to the same amount of 'tar', you would have to smoke 100,000 cigarettes a day." Such "painting" experiments have been eloquently de- 94. scribed as involving the application of "the wrong material, in the wrong form, in the wrong concentration, to the wrong tissue of the wrong animal." What do the statistics prove? Most of the information used as "evidence" that ciga- 95. retie smoking causes lung cancer comes from epidemiological studies • The bulk of these studies have two primary methods of 96. approach: retrospective and prospective. A retrospective study isolates a group of lung cancer patients,' then tries to backtrack in time to de~ermine smok£ng histories. A prospec- tive study identifies a specific group, determines their smoking habits, and then observes the disease patterns that TIEX 0008029
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Paragraph Number develop. Both types of studies then arrange the raw data into various groups, and run statistical tests to determine if one group (smokers) differs from another (nonsmokers) with respect to a particular disease. Such statistical studies have their place, but "cancer 97. is a biologic, not a statistical, problem." People have be- come accustomed to saying that "statistics prove" something, but statistics can never prove anything. They basically in- dicate the likelihood that any observed patterns are not caused by chance. Thus, "statistically significant" results may have no biological relevance. Moreover, epidemiological studies can always be affected 98. by the undiscovered effects of occupational exposures, the inherited tendency to develop certain diseases, and many other biological and behavioral unknowns.' Thus, such studies "do not permit statements about causality. They can only point to differences between the observed groups." Are these statistical studies unassailable? They are not. Irregularities have been found in most of 99. these studies. While the precise meaning of these inconsis- tencies may be unclear, they obviously show that the case against smoking is not as simple as many people would like to believe • For example, if smoking causes lung cancer, it would be 100. reasonable to expect more of the disease in co=tries where TO~~~ more cigarettes are smoked per capita. But that doesn't always happen. For example, Austria, Belgium, and Finland report higher lung cancer rates but considerably lower per capita tobacco consumption than the United States, Canada and Australia. If cigarettes do cause cancer, then the earlier a person 101. starts to smoke and the more he smokes, the sooner he would be expected to get lung cancer. Yet nonsmokers and smokers (whether they smoke a lot or W little) all appear to develop the disease at approximately the same age. "That both the age of starting to smoke, and the rate of smoking, should have no appreciable influence on the average age of onset of lung cancer greatly taxes, if it does not destroy, any causal hypothesis." ~ The same type of epidemiological information used to 102. suggest that lung cancer has increased in smokers, suggests that it may also have increased in nonsmokers. In an April, 1979, report on this phenomenon, a scientist wh'o believes that smoking causes lung cancer still conceded that factors besides cigarette smoking must have had a "significant effect" on the mortality rate of lung cancer. TIEX 0008030
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Pamgmph Number IS the lung cancer "epidemic" real? If so, do we know what caused it? In recent years, some people have decided that we are 103. experiencing an "epidemic" increase in lung cancer deaths. Anti-smokers have pointed to this "epidemic" and simultaneous increases in the smoking habit as "proof" that smoking causes lung cancer. Clearly, anti-smokers find this simplistic ex- planation appealing, but is it right? • One of the first problems involved is the type of data 104. relied on to describe large-scale mortality patterns. Most such data are drawn frcm death certificates, a notoriously inaccurate source. An article discussing death certification r recently said that death certificates "are sometimes material- ly inaccurate and research based on them alone may not be secure • • • •" During the early part of this century, doctors had very 105. limited capabilities for diagnosing lung cancer in living patients. The main clinical tools -- X-ray, bronchoscopy, and sputum cytology -- did not become widely available to physicians until after 1930. Thus, the "epidemic" may re- flect dramatic medical progress: "The prodigious increase in lung cancer during the past three decades is not due to the exposure of the population to an alleged carcinogen but is the natural consequence of the widespread use of techniques not previously available." This clinical progress may have become a tw~-edged sword. 106. Clinicians may have over-used their new tools -- to the point that they diagnosed lung cancer that could not be found in actual autopsy examination. Numerous comparisons of clini- cians' diagnoses with autopsy results have in fact reported chest specialist, for example, said that he found a high degree of clinical diagnostic accuracy when internal cancers such as stomach or colon cancer were involved. However, when the clinical diagnosis was lung cancer, autopsy con- firmed onlZ 4__5 percent of th@ cases. Even if one assumes for the moment that part of the 107. "epidemic" is real, the trends in lung cancer death rates still cannot be explained satisfactorily by smoking patterns. For example, statisticians have suggested that the rate 108. of increase in lung cancer mortality may be declining. Natu- rally, anti-smokers have been quick to suggest that changes in cigarettes and smoking habits have caused the decline. In 1975, a Bri£ish thoracic surgeon asked if such changes in lung cancer pa~terns resul~ed from the discovery of the rela- tionship of cigarette smoking to the disease and the subse- quent national campaign against the habit. He said that this TIEX 0008031
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Paragraph Number explanation seemed "likely" until one realized that the lung cancer changes actual!~y began fifty years ago He concluded that the observed patterns merely represented the "natural history" of the disease. Have critical fa6tors been overlooked in the statistical studies on lung cancer in women? Reports that lung cancer death rates have been rising 109. rapidly for women have been used as "proof" that increased smoking by women is responsible. A Yale epidemiologist has suggested that "detection 110. bias" has distorted the statistical picture. Detection bias occurs when a disease is diagnostically sought more vigorous- ly in people who are exposed to the suspected cause, than in . people without such exposure. He has found that the use of certain diagnostic techniques has dramatically increased in women lung cancer patients -- from 52 percent of patients in 1953 to 78 percent by 1964. He commented that his discovery, which suggests that "the current increase of lung cancer in women may arise mainly from improved detection, also evokes suspicions that cigarette smoking may lead more to the diag- nosis of lung cancer than to the disease itself." Even if the increase in women's lung cancer rates is 111. real, other factors besides smoking may be responsible. For example, "much more significant than changes in women's smoking habits have been the changes in their employment." The former head of the National Cancer Institute's en- 112. vironmental cancer program has made the same point. He, too, has said that the adoption of smoking by women cannot explain ~O~6~~ their lung cancer patterns, but that changes in their occupa- tional exposures may. • Finally, a British medical physicist has carefully exam- 113. ined lung cancer mortality patterns of males and females in England and Wales over the past century. He reported that there is a "remarkable synch~ony in the recorded changes" for males and females for the past 70 years. Thus, although the lung cancer rates have always been higher for males than females, the ~atterns of increase over time have been almost exactly the same. By contrast, women's consumption of ciga- rettes increased markedly 30 years after the striking rise in men's consumption. Thus, he has observed that if smoking caused this increased mortality there should be "kinks" in the patterns -- that is, the female lung cancer mortality patterns should not parallel the men's in time. They shotLld instead be out of phase by a 30 year period. There are no such kinks. He has specifically noted that "the most striking sun- 114. rained rise in the increments of mortality for both sexes TIEX 0008032
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Pamgmph Number covers the period 1916-20 to 1931-35, when cigarette smoking can have made virtually no contribution to the large increase" in the female rate. Is cigarette smoking the only logical explanation for lung cancer? Research has implicated many other factors in the 115. development of lung cancer. These include genetic influences, occupational exposures, viruses, diet, pollution, stress, aging, etc. The late Sir Ronald Fisher of England, the world-famous 116. statistician and geneticist, suggested in the 1950s that con- stitutional factors might be far more important than smoking in lung cancer development. Only recently, a prominent medi- cal physicist reviewed much of the literature on smoking and lung cancer, and concluded that Fisher's hypothesis provides the best explanation of the data. Another likely explanation is occupational exposure, 117. which has been strongly associated with an increased lung cancer risk. A recent study found such excess risk for such unrelated and apparently inexplicable employment groups as dental lab technicians, decorators, electricians, bar and restaurant managers and workers in the radio-television broad- casting industry. If decoraCors and broadcasters are at risk, how much more endangered are the thousands of miners. and machinists, the coke-oven and refinery workers, and all the other employees in occupations more readily recognized as hazardous? Although occupational exposure standards have been es- 118. tablished for 17 industrial agents, thousands of workers are still exposed to substances for which no standards have been established. This problem was recognized by one of the leading authorities on occupational cancer, who warned that ?0~6~ such exposure could continue if public attention was concen- trated on cigarette smoking: "Human exposure to many of these agents [potential human carcinogens] is not only widespread, but also often intense, and most of them are used without observing any real precautions. This lack of pre- cautions may continue as long as the exposed public can be persuaded that the main lung cancer hazards are limited to cigarette smoking." His concerns are shared by others, including an expert 119. in environmental contaminants who has studied ~hese problems for many years: "A real question exists if cigarette smok- ing is not diverting attention from the effects of occupation- al exposure on industrial workers." He contends that when TIEX 0008033 I
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Paragraph Numl~er both smoking and occupation are considered, "it is the occupa- tion -- and not smoking -- that appears to be the major cause of lung cancer." what is the significance of the recently reported changes in lung cancer types? Several distinct cell types of lung canc~ have been 120. identified. Squamous cell cancer has been more strongly statistically associated with cigarette smoking than the others. Another major type, adenocarcinoma, has not been associated, or only weakly so. It has been generaliy.ac- cepted that adenocarcinoma is more common in women and in nonsmokers. In 1977, pathologists at Roswell Park Memorial Institute reported that they were finding a rapid decrease in squamo~s cell carcincma and a corresponding increase in adenocarcinoma. They speculated that one of the factors responsible 122. might be alterations that have occurred over the last few years in cigarettes. They considered "length of smoking history, form of tobacco used, quantity of tobacco used, age habit started, degree of inhalation and the use of fil- ters." They were "unable," however, to equate the histology of lung cancer with any of these factors. Thus, the reasons for this development, if it proves ~o 123. be representative of the United States as a whole, remain unknown. Another curious lung cancer pattern was recently re- 124. ported by a group of American Cancer Society investigators. They reported a striking increase in "scar cancer of the lung," that is, cancer of various cell types arising from lung scar tissue. Certainly no friends to tobacco, they nonetheless conceded that smoking habits bore no relationship to the increase. Conclusion The claim that cigarette smoking causes lung cancer has 125. not been scientifically proven. The charge ignores basic un- resolved scientific questions concerning cell types, animal experimentation, smoking patterns and lung cancer rates, diag- nostic variations, etc. Lung cancer is an extremely complex disease. A one-sided attack on cigarette smoking as the causal agent does nothing to advance the search for its cause and cure. TIEX 0008034 I
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Pamgmph Number Heart Disease Smokers and Nonsmokers People who smoke tend to differ significantly from those 126. who do not -- in lifestyles, in disease patterns,, even in the type of pressures under which they choose to live. Smokers tend to be more v ~.atile. They drink more coffee 127. and alcohol. As extroverts, they may be more entertaining socially. Smokers marry more often. They participate in more sports. They attend more ballets and concerts. They change jobs with greater frequency. And they are more likely to have parents with heart disease .and hypertension. In other words, smoking may be only one el~nent in acom- 128. prehensive pattern of differences, all or. none of which may • play a significant role in disease development. Discussions of the relationship between such personality 129. ind lifestyle characteristics and heart disease have often focused on two defined behavior patterns: Type A and Type B. Type A people are chronically concerned about the passage of time, and their self-imposed deadlines and goals keep them in a constant state of activity. They tend to be more competi- tive and more intensely ambitious than Type B individuals. Physically, they push themselves closer to their limits, yet they express less fatigue than Type B's performing the same task. Not unexpectedly, Type A people have more heart disease. 130. They also tend to smoke more. But does smoking cause the increased heart disease risk? Or is it that Type A's -- whether they smoke or not -- are more prone to develop heart disease T0 ;?,698 Heredit~ The genesis of heart disease may occur long before an 131. individual decides to smoke qr not. The powerful influence of heredity has been suggested, for example, by autopsy studies of fetuses and infants. Apparently, these studies often find early changes suggestive of future heart disease. One such report concluded, "we can assume that the seeds of atherosclerosis are sown in fetal life." Other evidence strongly suggestive of a hereditary in- 132. fluence is provided by the fact that heart disease patients generally tend to have brothers, sisters, fathers, mothers, etc., with the same problem. TIEX 0008035 I
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Paragraph Num~er Stress "Stress" has become one of the catchwords of our civili- 133. zation. Simplistically defined, stress is the internal state resulting frcm an imbalance between demand and the ability to cope. Stress happens when the factors of disturbance (anxi- ety, anguish, frustration, etc.) are greater than the factors of repair and release. Stress is highly personal; the event may be far less 134. significant than the individual's response to it. For exam- ple, "to prescribe a few months' vacation on a remote island for a recuperating cardiac patient might be ideal forone patient and lethal for another." Stressful life events, including death of a loved one, 135. job dissatisfactions, marital conflicts, etc., all appear to be significantly related to the risk of heart disease. Re- cent widowers in one study population, for example, were re- cently described as having a death rate from coronary heart disease that was 67 percent above the expected rate for married men of the same age. Life doesn't have to be tragic, however, to be stressful. 136. Marriage and the birth of a child, for example, also rank high on a list of stressful "life changes" that may lead to an increased risk of heart disease. Curiously, smokers and nonsmokers may differ in the 137. pattern of life changes leading to that increased risk: "smokers appear to have a continual build-up of life change during the year preceding onset of the disease; whereas non- ?0~00 smokers experience a sharp increase in life change I - 6 months before onset." In summary, "there is now increasing support for the 138. view that emotional stress is a major etiologic factor in coronary heart disease." Risk Factors k Almost all discussions of heart disease center on the 139, magic phrase "risk factor." Risk factors are characteris- tics (either biological or behavioral) that have been statis- tically associated with the subsequent development of a disease. Cigarette smoking is generally, described as a risk factor for heart disease, as are aging, sex (i.e. being male rather than female), elevated levels of cholesterol and re- lated fats in the blood, hypertension, diabetes, parental history of heart disease, obesity, personality ~nd physical inactivity. TIEX 0008036
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Paragraph Number "Risk factor" does not mean "cause." Dr..Theodore 140. Cooper illustrated this when he testified before Congress as the Assistant Secretar~ for Health of the Department of Health, Education and Welfare. Senator Hart offered Dr. Cooper the perfect opportunity to identify cigarette smoking as a cause of heart disease, but Dr. Cooper refused: Senator Hart: "I would merely ask if cigarette smoking causes heart disease?" Dr. Cooper: "No." Senator Hart: "It does not?" Dr. Cooper: "No. I think to be absolutely candid with you, the risk factor does not mean cause . • • •" Another point to remember is that heart disease risk 141. factors are so poorly understood that they are of little value in predicting future disease. Even the "best" combina- tion of risk factors fails to identify most future heart dis- ease cases. A British Medical Journal editorial referred to "the epidemiological gloom" that exists because of this failure. The editorial observed that if one identified 100 hypertensive smokers with raised cholesterol levels, 92 would not develop clinical signs of coronary heart disease over the 70~0~ next ten years. It concluded: "We must therefore realize that risk factors cannot be causal and that they have very. poor predictive value." Ex-Smokers Anti-smokers like to say that quitting smoking is fol- 142. lowed by a decreased risk of developing disease; they point to such reduced risk as "proof" that smoking causes heart disease. They conveniently ignore data from some of the major population studies that do not show reduced disease rates for ex-smokers. After s~nmarizing the inconsistencies in this ex-smoker 143. data, a specialist in heart disease epidemiology concluded that: "the data on discontinuation of cigarette smoking shows such contradictory and inconsistent findings that they frustrate all attempts to argue from effect to cause." A review of Doll's British doctors' data indicated that 144. the doctors had an ei@ht ~ercent increase in heart disease mortality during the period that the proportion of cigarette smokers decreased approximately 50 percent. TIEX 0008037
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Paragraph Number And a review of the coronary heart disease (CHD) mortal- 145. ity experience of American physici~r'~ ,'e: .r~.:~'~• ~-~.,.-~ed a similar lack of effect of smoking cessation (and ~he presumed reduction of other risk factors): "there has been no significant change either in longevity or in average age at death from coronary heart disease among doctors in the United States over the past 20 years." In addition, data that d__o suggest reduced disease rates 146. for ex-smokers may be seriously flawed. Ex-smokers were re- cently described as quite different from smokers (and.more like non-smokers) long before they quit smoking. In other words, ex-smokers may have reduced disease rates because of the kind of people they are, not because they quit smoking. Disease Patterns and Smokinq Coronary heart disease mortality is reportedly declining. 147. Naturally, anti-smokers like to associate this with reduced cigarette consumption. Simplistic -- and possibly suspect -- conclusions abound in discussions of smoking and health. This may be another example of such conclusions. A recent, detailed c~mparison of changes in smoking and 148. mortality patterns concluded that "It appears that changes other than smoking must account for the bulk of the decline Conclusion The Annals of the New York Academ[ of Sciences aptly 149. described the state of knowledge regarding the cause of heart disease: "The vast majority of individuals destined to develop and die from atherosclerotic disease do so for as yet unknown reasons." Tobacco Smoke Components Tobacco smoke is a complex mixture of thousands of com- 150. ponents. Over the years, much time and effort has been devoted simply to determining the identity of those compo- nents. This has proven difficult, however, and much remains to be learned about the structure and makeup of tobacco smoke. Despite these problems, tobacco smoke or one of its corn- 151. ponents (usually "tar," nicotine or carbon monoxide) is commonly assumed to cause disease. Such assumptions are based primarily on laboratory experiments using extremely large amounts of these substances -- quantities which may seriously affect the experiments' relevance to humans. But TIEX 0008038
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Pamg~ph Number neither "epidemiological studies, nor animal and clinical studies, have identified any ingredient or group o~ ingre- dients as found in smoke as disease producing in humans." [Emphasis added] "Ta r" The frequent use of the word "tar" has created the im- 152. pression that it is present in tobacco smoke. But this is not correct. The substance called "tar" is actually a labora- tory product obtained by collecting the particulate matter in tobacco smoke. The collection method most often used involves passing cigarette smoke through a cold trap at extremely low temperatures. Material collected in this way hardly dupli- cates what humans are exposed to in the smoking process. Even if the "tar" obtained by these methods were exactly 153. the same as the smoke inhaled by the smoker, it still might be very different by the time it is studied in the laboratory. This is because, once collected, it continues to undergo chemical changes, even while stored on the laboratory shelf. Despite its probable lack of relevance to the smoking 154. process, "tar" has been used in animal experiments studying the relationship between tobacco smoke and cancer. In many TO~,~VO~ of those experiments, "tar" was repeatedly painted on the skin of test animals over pr61onged periods of time. Any tumors that developed were then compared with lung tumors in humans • For obvious practical, as well as technical reasons, it 155. is apparent that what was done to those laboratory animals is not what happens in the human body. After all, how can skin painting be compared to tobacco smoke inhalation, and how can the skin of animals be compared to the cells which line the human lung? Many scientists have been dubious about making such com- 156. parisons for years, warning about the difficulties that must be considered in projecting ~he results of animal experiments to the human situation. One scientist went so far as to say that such experimental evidence was "claptrap." Another major difficulty involved in studying "tar" 157. centers around the difference between quality and quantity. An experimental toxicologist said in 1976 that an effect ob- served in a particular species does not necessarily mean that it might "occur either quantitatively or qualitatively in man." He also pointed out that: "a~ents have been identified in 'tar' which might in theory have a carcinogenic effect, but the qualitative identification of a particular agent TIEX 0008039
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Pamgmph Number in a complex mixture does not mean that it is present in sufficient quantities to produ.-a a biological effect .... " All in all, the current state of scientific evidence 158. concerning "tar" was concisely summarized during a Congres- sional hearing: "Human beings do not smoke 'tar' and no signifi- cance of laboratory reports on 'tar' yield to human health has been established." Nicotine Although nicotine is present in tobacco smoke, it is 159. rapidly absorbed and excreted. Consequently, nicotine has been described as having no known chronic or cumulative ef- fects. Still, nicotine has been blamed for playing a role in the development of heart disease. In examining that assertion, the recent observations of 160. two European scientists who have been involved in this area may be particularly relevant. When asked whether nicotine affects the blood vessels, a researcher who is generally anti- smoking replied that any effect is "quite harmless" and "we therefore do not believe that nicotine can cause arterio- sclerosis." Another scientist who based his response on his "long years of experience" also stated "there are no indica- tions that nicotine plays a part in the causation of chronic cardiovascular disease . . ." A discussion between two American scientists invited to 161. attend a one-day conference on cigarette smoke components also is of interest. When asked "whether nicotine is related to cardiovascular disease and whether coronary disease or atherosclerosis is related to nicotine," a physician with expertise in this area replied, "There are no data on that." Like the "tar" experiments, animal studies on nicotine 162. and heart disease have been raundly criticized for their un- realistic and excessive test conditions: "There have been some studies which have exhibited minor or questionable changes with the use of an equivalent dose of 600 or more cigarettes a day in man. This is such a large number that I think man would find it difficult to find the t/me to smoke them." The relevance of their results also must b'e questioned, 163. because other animal experiments using more rea'listic doses • of nicotine have failed to show any influence on the athero- genic process : TIEX 0008040
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Pa~gmph Numi:~er "In these experiments it was clearly demonstrated in the rabbit that realistic doses cf either nico- tine or cigarette smoke failed to initiate, exacer- bate, or otherwise influence the atherogenic pro- cess in that species." A particularly telling cc~ment about the alleged role of 164. nicotine in disease causation is provided by a r,cent report on the status of a federal smoking and health pr,,~ram. Al- though much of the report is predictably anti-smoking, it concedes that: "evidence linking [nicotine] to the chronic pathogenic effect of smoke is not available." In summary: "While many studies have been done in this 165. field, none have established nicotine as contributing to the causation, aggravation or precipitation of any cardiovascular disease." Carbon Monoxide (CO) Carbon monoxide is a tasteless, odorless gas produced by 166. many natural and man-made sources, including automobile ex- haust fumes and industrial emissions. Burning cigarettes also produce carbon monoxide but that amount has been de- scribed as "insignificant" compared to those other sources. It is also naturally produced during body metabolism. To support their health claims about the adverse effects 167. of CO, anti-smoking advocates have emphasized the results of ~O~ certain animal studies, particularly those published by a ,~ team of Danish scientists who exposed rabbits to large quan- tities of CO and a high cholesterol diet. The exposed rabbits reportedly developed vascular changes similar to early atherosclerosis in man. In 1977, a prominent health investigator apparently was 168. thinking about those experiments when he answered his own rhetorical question, "Does CO play a role in arteriosclerosis?" Although he is definitely a member of the anti-smoking esta/>- lishment, he admitted that "l%t certainly works in rabbits, but there is considerable doubt whether it works in man." Recently, those same Danish researchers announced that 169. it may not work in rabbits, either. They had decided to redo their earlier tests after learning that their results had not been duplicated in experiments using monkeys, baboons, dogs, and pigeons. They were unable to duplicate their own results: "Investigation revealed that irrespective of dura- tion or level of exposure [to CO], n6 significant morphological chan~es were present tO discriminate between experimental and control animals," TIEX 0008041
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Paragraph Number In an apparent r~ference to that development, a German 170. researcher reflected on its potential impact: "Now as regards the role of carbon monoxide, some two years ago we believed that in CO, we had found the evil doer. Unfortunately, it turned out that the tests in question ~'d not been interpreted quite correctly so that :oday we have to back off from the CO hypothesis as far as the causation of arteriosclerosis is concerned." What can one conclude from all this discussion? At best, 171. one can say that many questions remain unanswered about the role of tobacco smoke and its components in heart disease causation. In the words of one researcher who has tried to establish a causal link between smoking and disease: ,~ "We assume that it is the tar which causes lung cancer, but we do not know this for certain. Until now, we have implicated nicotine in the development of cardiovascular disease, but we cannot prove this. The same is true for CO." Obviously, such indecisive words from an anti-smoker 172. demonstrates that statements asserting cause-and-effect are at best oversimplifications of the scientific da~a. Chronic Obstructive Pulmonar~ Disease (COPD) ~0~0 Causation Chronic bronchitis and emphysema are the main components 173. of t~e disease group sometimes called chronic obstructive pulmonary disease, chronic obstructive lung disease (COLD), chronic nonspecific lung disease_(CNSLD), chronic obstructive airways disease (COAD), or b~onchitis-emphysema complex. As this confusion regarding terminology might suggest, 174. scientists have difficulty in understanding the origin and the mode of development of these diseases. Nonetheless, one frequently hears that cigarette smoking is the cause of COPD." That c~mment may reflect wishful thinking rather than an accurate appraisal of the scientific information. T7EX 0008042
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Pa,'a=lraph Number Even HEW statements have conce@ed that "the cause or 175. causes of emphysema are not known" and "the etiology, the. cause, in other words, of the disease (emphysema) is really not known, to be truthful with you." An HEW 1979 budget submission referred to cigarette smoking as the primary "risk factor" (not "cause") in COPD development. The s~bmission work continued that "other risk factors -- environmental, occupational, an< genetic -- and their interrelationships are also under close ~crutiny in efforts to develop prevention, education and control programs against COLD." As that HEW submission suggests, research is badly needed to study COPD causation and development. 176. Recently, for example, Mayo Clinic scientists said: "It remains a fruitful area of research to identify important 177. components in the multifactorial etiology of COPD." And in the midst of his near-polemic against smoking, even the staunch anti-smoker Sir Charles Fletcher conceded 178. that "m~st smokers suffer no substantial obstructive damage," and that "research is still needed" to discover the reason. Diagnosis and Definition Bronchitis and emphysema are difficult to define and diagnose. Emphysema, in fact, is definitively diagnosed 179. after death, because the definition of emphysema is based on ~~ lung changes that can be seen only at autopsy. • t~,~ Bronchitis, on the other hand, has an extremely loose "definition" that may or may not have much relevance to 180. actual disease. Bronchitis is basically diagnosed by the patient: he has bronchitis if he gives the "right" answers to a set of questions about how much, and how often, he pro- duces sputum. The validity of such a method of diagnosis has been justifiably questioned. Most of the time, bronchitis and emphysema cannot be distinguished (clinically or epidemiologically) from each 181o other. The 1967 annual HEW report recognized that this "inability to distinguish between chronic bronchitis and emphysema has hampered medical research." And ten years later a British epidemiologist wrote that use of the phrase "chronic bronchitis" to describe various syndromes "is now confusing and misleading." He also said that "it is sad that there is no longer such wide agreement on the definitions and classification of chronic non-specific lung diseases." TIEX 0008043
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Paragraph Number Early Changes The diagnostic uncertainties have generated interest in 182. attempting t~ identify early lung changes that might predict COPD. Subtle differences in lung function tests, in cell structure and color, in the speed with which substances are z[eared from the lung, etc., have been studied. Some of this %ork has suggested that a few smokers may develop such changes. The meaning of these changes, if they actually occur, has yet to be determined. For example, one review of availabie .information on changes in the periphery of the lung said that: "Although these abnormalities can be found in some smokers, it is not at all clear whether chronic obstructive lung disease will eventually develop in these people. Long-term follow-up studies will be necessary to establish this point." Other Factors Repeated acute episodes of childhood respiratory 183. diseases may play an important role in an adult's developing COPD. This association between childhood and adult disease reportedly exists regardless of whether or not the person smokes. The nature of this association remains to be determined. Research interest has recently focused again on what has 184. been called a "family factor" in the development of COPD. This factor has not yet been defined, and the reasons behind its development "remain in large part unstudied." It ~O~O~ probably involves a mixture of hereditary and environmental influences, but at this point no one knows for certain. This family factor seems a likely explanation, for 185. example, for one group's finding that the first-degree relatives (parents and siblings) of both lung cancer and COPD patients had more pulmonary dysfunction than the relatives of controls. They said this dysfunction could not be explained by such factors as age, sex, race, smoking or socioeconomic differences. Perhaps the family factor also explains the increased 186. frequency of COPD that has been found in COPD patients' brothers and sisters. TIEX 0008044
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Paragraph Number Structural abnormalities of the lung may be another set 187. of factors that deserve attention. For example, one scientist recently found reduced numbers of blood vessels in the disease-free parts of lungs from people.who had died of emphysema. He said that this vascular .abnormality might just be an early state of the disease, but it might also be a genetic variation likely to lead to COPD. Occupational exposures must be taken into account in any 188. discussion of potential causes of COPD. A Canadian researcher recently reported: " • • • in our recent study of pulp and paper mill workers with severe respiratory deficiencies, we found that 62 percent had a history of smoking, while such history was found among 66 percent of the other workers. Thus, smoking was slightly less prevalent among workers with signs of respiratory failure than among those with no such signs. (But there was a relation to high exposure to fumes.)" Conclusion COPD is actually a complex and poorly understood set of 189. diseases. Yet many discussions treat it as a single, simple entity with only one cause &- cigarette smoking. Until the many areas of confusion are resolved, 190. however, any conclusions about the relationship between COPD and smoking must remain merely conjecture. ~0~70~) Smoking and Preqnancy As the number of women who smoke has increased, so has 191. the amount of attention given to what one HEW report called "smoking-related problems unique to women." The report was referring to studies which report an association between smoking and medical problems ~n infants. Among these conditions are low birth weight (LBW), congenital malformation, perinatal mortality, and spontaneous abortion. However, inconsistencies between studies of these conditions make it impossible to draw convincing conclusions about the nature of the association. TIEX 0008045
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Paragraph Number Low Birth Weight (LBW) Smoking as a causal factor in LBW (under 5.5 pounds) was 192. rejected by the director of a large Public Health Service study. By comparing birth weights of children born to women before and after they began to smoke, Dr. Jacob Yerushalmy demonstrated that smoking women tended to have smaller infants even before they took up the habit. The crucial factor in a higher tendency to LBW, he suggested, is "the smoker, not the smoking." A similar conclusion was reached by two English 193. pediatricians who cited the Yerushalmy study in their own report. After comparing a population of European and black infants, the pediatricians found "no effect on any of the fetal measurements which could be attributed to smoking." They speculated that social class could be "the crucial factor" in explaining differences in fetal growth, "since smoking is more frequent in lower social class groups, and may be an index of a certain type of mother who tends to have babies of low birthweight." (Emphasis added) Attempts to characterize this maternal "type" are 194. complicated by the fact that LBW apparently is a "typically multi-factorial" condition. This may include "the combined effect of various early and existing negative social and biological factors, which vary from one population to another." Among the factors which have been identified as possible 195. influences are the amount of weight gained by the mother, fetal nutrition, prenatal care, and chronic major illnesses. In addition, alcohol abuse, occupational exposure and marital stress have been related to birth weight. Clearly, LBW is a complex problem. Thus, a simplistic 196. focus on smoking may be inappropriate and scientifically TO~~0 un sound • Perinatal Mortalit~ Fetal and infant deaths also have been attributed to the 197. smoking habits of the mother. However, a comprehensive study conducted in 1970 indicates otherwise. The National Academy of Sciences Committee on Maternal Nutrition found that "smoking is not significantly associated with excess fetal or neonatal mortality." TIEX 0008046
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Paragraph Number More recently, the editor of a British medical journal 198. who reviewed the literature on the mortality of LBW infants reached a similar conclusion: "We may tell women~ that if they smoke their baby may be small. But lwe) should not claim risk to life." Spontaneous Abortion The relationship between spontaneous abortion and 199. smoking is unclear, but it is certainly unproven that the association is causal. In 1973, an HEW review of the topic said, "the lack of 200. control of significant variables other than cigarette smoking does not permit a firm conclusion to be drawn about the nature of the relationship." • Four years later, a smoking and health investigator contended, "We are still at a loss for the cause of 201. spontaneous abortion." And in 1978, a British medical editorial stated that: 202. "What remains to be established is whether the association between cigarette smoking and spontaneous abortion is causal." Congenital Malformation A recent British study on the relationship between 203. maternal smoking habits and congenital malformation seriously challenges the claim that it is causal. An examination of more than 60,000 deliveries showed the same overall incidence of congenital malformation infants born to both smokers and nonsmokers. The only condition possibly associated with TOSZ711 smoki'ng was neural tube defects. Curiously enough, however, a greater percentage of all babies with this defect were born to nonsmokers. This fact, the authors noted, goes "against the argz~ment that smoking i~a substantial factor in the aetiology of this condition." Another large scale population study, the Ontario 204. Perinatal Mortality Study Committee sample, also found "no evidence that smoking was associated with a higher incidence of congenital malformations." TIEX 0008047
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Paragraph Number The results of such studies led the 1979 Surgeon 205. General's Report to conclude that "there is no convincing evidence that maternal smoking increases the incidence of congenital malformations." Child Development Effects of maternal smoking have occasionally been said 206. to extend to the subsequent growth and learning ability of the child. What is the basis of these allegations? Apparently, it is largely derived from a British study which suggests that children of smoking mothers lag behind the • children of nonsmoking mothers in physical and mental development at ages seven and eleven. The researchers somewhat tentatively describe their 207~ results as "lending support to the hypothesis that it is smoking itself which, at least in part, 'causes' the impairment." This hesitancy may be based partially on their observation that the effect of smoking is "relatively small"~ in comparison with such factors as social class and the number of children in the household. Once again, such observations raise questions about the need to consider multiple factors. Moreover, other results sharply conflict with the 208. British findings: "At four and seven years there was no significant difference in either physical measurements or intellectual functioning." Such inconsistent findings from studies of smoking women 209. and their children make it impossible to draw convincing conclusions about smoking and pregnancy. Attempts to do so ignore data which suggest that medical problems of infants and children are affected by a multitude of factors that must TO~I be considered in any discussion of these problems. RESEARCH Scientific research is the key to unlocking the 210. mysteries of disease causation and development. But that "unlocking" process is an extremely complex one. The causes of cancer, for example, are poorly understood. So-called r£sk factors have been identified in relation to coronary heart disease. Yet their role in heart disease causation ~s unclear • TIEX 0008048
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Paragraph Number Occupational exposure is emerging as a serious problem 211. in an age of modern technology, but no one knows.3ust how serious. Diet and nutrition certainly must affect bodily functions, but how? Stress, tension and anxiety exert daily strain on the capacity to deal with life. But what is the toll in terms of illness and death? People differ in genetic makeup. Are these differences a substantial influence on susceptibility to disease? These questions have a direct bearing on smoking and 212. health issues. For this reason the tobacco industry has already committed over $82 million to research designed to pursue the answers. In many years, tobacco industry smoking and health 213. research spending has exceeded that of any governmental department as well as the combined grants of the major voluntary health agencies. Broad research programs have been supported by industry 214. funds. For example, with the help of $2.75 million, the UCLA School of Medicine is exploring lung defense mechanisms and early detection and treatment of cancer. The research team is also studying novel concepts of treatment (including recombinant DNA) of other diseases such as sickle cell anemia. Another grant for $4.4 million to Washington University in St. Louis is underwriting a study of possible immunologic factors in cancer. And a $4.8 million commitment to Harvard Medical School has funded work on pulmonary and cardiovascular diseases. Less ambitious projects than these multi-million dollar 215. university grants have generally been funded through the Council for Tobacco Research (CTR). In 1954 the industry established what is now known as CTR to provide financial support for independent scientists to study the many phases of the smoking and health question. Although funded by tobacco manufacturers, CTR remains 216. completely autonomous. As an administrative agency, CTR evalL%ates and funds researc~ proposals, but it does not operate a research facility. All the work, therefore, is done through grants-in-aid, supplemented by contracts for research with institutions and laboratories. As of June, 1979, 387 scientists in 250 medical schools, 217. hospitals and institutions in the U.S. and 10 foreign countries have been funded. CTR grantees have complete scientific freedom to conduct 218. their studies, and they alone are responsible for reporting or pu~li~hin~ their TIEX 0008049
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Paragraph Numl~er Serious questions raised by the smoking and health 219. controversy are not rejected out of hand bv 9h~ ~gustry. To the contrary, concerted efforts are being made to determine the validity of those questions. The position of the tobacco industry is that the answers will be found only through sound, objective scientific inquiry. To this end, the commitment to research is substantial. TOSZTI4 0008050
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TOBACCO INSTITUTE LIBRARY The Health Consequences of Smoking THE CHANGING CIGARETTE a report of the Surgeon General U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Office on Smoking and Health TIEX 0008052
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Section 4. CARDIOVASCULAR DISEASES TIEX 0008053
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CONTENTS Introduction The Relation of Cigarette Smoking to Cardiovascular Risk Factors in Cigarette Smoke Related to Cardiovascular Function Nicotine Carbon Monoxide Other Components Studies of the Impact of Lower "Tar" and Nicotine Cigarettes on Coronary Heart Disease The Challenge of Future Research Proposed Future Research Descriptive Studies Cohort Studies Observational Studies Clinical Trials Case-Control Studies Studies of Mechanisms Animal Experimentation Technical Resource Center Be~,~vioral Ramifications Summary References LIST OF TABLES Table L--Coronary heart disease--mortality ratios Table 2.--The effect of the cessation of cigarette smoking 113 TIEX 0008054
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• the independent effect under study. Despite shortcomings, case-control studies represent the major lies has been that the means for assessment of the relative cardiovascular risk of varying ~ly 10 years. Occasional. cigarettes. Further, serial case-control studies, similarly designed, a meaningful analysis, performed, and analyzed, could provide information on changes in risk tion of cigarettes, the over time. In such studies care must be taken to select appropriate ~. data are collected and controls, to treat cases and controls alike, to avoid hospital-based rosters, and to study well-defined and documented endpoints. Studies of Mechanisms In view of the difficulties involved in doing large population-based raking intervention on studies and the need to know more about the mechanisms whereby s the most promising of cigarettes cause damage, more studies are needed on the components Trial (MRFIT) (~8), in in cigarettes that affect cardiovascular risk. It may be that nicotine o a special-intervention and carbon monoxide are the chief toxic agents, but until more is ' in its 6th year, avoids learned of the other constituents, judgements are based on scanty sease experience of the information. the inferences that may Perhaps the main reason to pursue the study of disease mechanisms ~rettes per se (which is is to shorten the turnaround time for assessing any new brand of ~mewhat limited and do cigarette; studies could be designed to measure particular constituents .t this study directs its of the cigarette smoke and characteristics of the subject at risk. ~sure control as well as With better noninvasive cardiovascular techniques, studies of how a studies like the MRFIT particular cigarette affects cardiac function could be performed in cohorts may provide greater depth. Such studies would provide better measurement of the e available in strictly biological effect of the cigarette smoke components in individual smokers. Measurement of expired carbon monoxide, serum carboxy- nent of other major risk hemoglobin, thiocyanate, and cotinine would help resolve not only dent effect of smoking differences in the composition of cigarettes, but also major differences ;hould incorporate the in the ways individuals smoke (/,7,/`8). These more precise measure- mmunities that current ments of smoke exposure and dosage of smoke constituents could be )uld not begin to smoke, correlated with a host of biochemical and physiological parameters. The number of biochemical factors found to be affected by smoking continues to grow. Lower HDL cholesterol levels are found in smokers f relatively short turn- than in nonsmokers, an effect that is associated with an increased CHD than other studies, risk(17). A variety of effects could be weighed to produce a multifactorial ey can suffer from a analysis of how cigarettes produce atherosclerosis, sudden death, and ~f the disease, under other cardiovascular problems. ~ust assess the death Physiological studies using treadmill performance, scintillation ~udies of this kind is scanning--including gated pool studies--and Holter monitoring could y of the deceased, provide better clues to the action of cigarettes on cardiovascular e associate introduces a function. If such alterations in function could be more certainly tied to controlled somewhat by later events, they might prove invaluable predictors of smoking- f the control group, related risk for a given individual. Ti~X 0008055
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The Tobacco Institute recognizes that there are differences of opinion conce, ning smoking and health. This booklet is pres~;nted in the belief that full, free and informed discussion of the smoking and health ¢ontrov,:,rsy is in the pub- lic interest, and in the convi(:tion that the con- troversy must be resolved by :~clentiflc research. ~' The Tobacco Institute 1776 K Street, Northwest _ Washingto.n, D C. 20006 ON ~ll~ OOGB-gE ,. ~ TZ KU 000003653 Ot 9t-6t TIEX 0008056
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ON SMOKING ~ |,ow many cigarettes ~re sold annually in the U.S.? Nearly 620 billicn cigarettes were purchased in 1976, about a pack-and-a-half a day by the aver- " age smoker. Sales have moved steadily upward in this decade and are continuing to increase at a rate of about 1% per year. "How many people smoke? Nearly ~0 milfion adult Americans~about 40% of the aduff pol~ulation. Are smokers different from non-smokers? Yes. Some doctors have concluded that smokers hav~ behavior patterns different from non-smok- ers. Generally, smokers tend to be more asser- tive, time-conscious and energetic than non- smokers. Did the Surgeon General's Report establish that smoking causes cancer and other diseases? No.. The report of the Advisory Committee to the Surgeon General in 1964 failed to establish a cause-and-effect relationship between cigarette smoking and cancer and other diseases. The report w~s essentially, a "study of numbers"~a selective review of population studies which com- pared disease rates among smokers, ex-smokers and non-smokers. The report showed a statis- tical association between cigarette smoking and lung cancer. However, the report stated, "Statistical methods cannot establish proof of ~ causal relationship in an association. The causal significance of an association is a matter of judgment which goes beyond any statement of statistical probability." What questions were left unanswered by (he Surgeon General's Report? Many questions were left unresolved. Why, for examl~le, ~o non-smokers fall victim to heart 1 " TIMN 0129162 "" TIEX 0008057__
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disease, lung cancer and other diseases fro- the blood rapidly and there is little cumulative quently associated with smo<ers? If, as some effect. By the time the cigarette is finished much anti-smoking groups claim, cigarette smoking is of the nicotine is already metabolized. As was the major cause of lung cancer, why is it that pointed out in the 1964 Surgeon General's Ad- the vast majority of the "heacy" smokers never visory Committee Report on Smoking and Health, develop the disease? Why i-asn't independent ~ "nicotine in quantities absorbed from smoking scientific research been able to identify any one and other methods of tobacco use is very low or combination of the thousands of components and probably does not represent a significant as found in cigarette smoke as the cause of any -, healtl~ problem." particular disease? Why in m()re than forty years "Tar" is the particulate matter collected by of research hasn't anyone b~,~en able to repro- super-cooling and condensing tobacco smoke duce the type of lung canc,';r associated with under special laboratory conditions. This method smoking--through tobacco smoke inhalationw of producing "tar" has little to do with the way in laboratory animals? we smoke cigarettes. Concern about "tar" is primarily due to early experiments which involved painting the artificially-produced substance on Have scientists deteE, dned what laboratory animals' skin, Other common sub- causes cancar? stances such as tea have also been applied in No. Scientists are continuing research to de- much the same way, producing skin cancer on termine what causes cancer in humans. In at- the backs of test animals. Such experiments are tempts to learn the cause of lung cancer, for of little scientific value since the skin of test example, some researchers a,e investigating the animals does not approximate the lining of a effects of environmental agent~ in the air such as human lung, and because the quantities of "tar" vapors, dust and other pollutants. Other scion- used have been estimated to equal a man's fists are studying the possibili:y that certain indi- smoking 100,000 cigarettes a day. viduals may have a genetic predisposition to cancer. Some studies of the incidence of lung Are gases contained in cigarette smoke cancer by geographic area dc not show correla- harmful to the smoker? tions with levels of smoking. It is claimed that cigarette smoke contains harm- ful quantities of carbon monoxide, nitrogen di- Are cigarettes with Io'~ "tar" and oxide and hydrogen cyanide. However, such nicotine "safer" for s ~okers? gases occur only in low concentrations and small Cigarettes have never been p,oven to be unsafe, quantities compared to the high concentrations Many varieties of low "tar"-nicotine cig~.rettes , and large amounts necessary to produce sig- are now on the market in response to consumer nificant effects. preference trends. Sales of ci~larettes with 15rag. Any combustion process produces carbon of "tar" or less increased by 50% in 1976 and , monoxide: cooking on a gas range, auto ex- comprised more than 25% of .:he market in 1977. haust, garbage dump fires, etc. Dr. Helmut Wakeham, said in an article published in Pre- ventive Medicine, December 1977, "Cigarette Are "tar" and nicotin-': in ¢igarettea smoking is an insignificant source of carbon dangerous? monoxide in the overall atmosphere as compared Claims that "tar" and nicotine in cigarettes harm with other natural and man-made sources." the smoker are not supporte,, by scientific fact. Very little, if any, nitrogen dioxide is present in The nicotine from a cigarette is eliminated from fresh cigarette smoke. As for hydrogen cyanide, 3 :"~i " TZ KI.I 0000036S5 0129163 .. TZEX 0008058
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the 1964 Surgeon General's F~eport on Smoking still those who believe that it is their duty to and Health reported that it is !}resent in tobacco "protect us from ourselves." Fifty years ago it smoke only in insignificant arrounts, was the consumption of alcoholic beverages • l~'~ which aroused the passion of such crusaders. Does cigarette adverti:;ing cause young Prohibition was supposed to save the nation, but, people to start smokirg? ~ as we now know, it created more problems than '~, it solved, A number of independent stud es have examined ~ The opposition to the personal enjoyment of reasons why individuals cho(:,se to smoke. No study has demonstrated that advertising is re- . tobacb% began soon after Sir Walter Raleigh sponsib~e. Dr. Ernst Wynder President of the brought the first cargo of ieaf to England in the sixteenth century. As early as 1604, anti-tobacco American Health Foundation has said, "1 do not believe that advertising has much influence." pamphlets such as "A Counterblaste to Tobacco" in a recent editorial about its cigarette advertis- authored by King James ~ of England were circu- ing policy, The Columbia Jou,'nalism Rev/ew re- lated. Today, with tobacco well into its fifth marked: "What about the so~:d research (which century of use, the controversy continues. indicated) that cigarette advertising rarely in- In the 1950s and 60s, the attack against tobacco fluences decisions to smoke or not to smoke, but was aimed at the productwcigarettes--and led to (rather) that its effect and purHose is to influence the package warning label, the broadcast adver- the choice of brands?" tising ban and higher taxes. Nevertheless, cigar- ette sales continued to rise. Recently, the attack Advertising creates brand cyalties; it appar- ently does not create new .-.;mokers. Tobacco has shifted to the users of the product--smokers companies do not encourag.-~ young people to ~by attempts to .make them socially unaccept- smoke. They regard smoking as an adult custom able. based on a mature indivi,.lual's freedom of American Lung- Association past-president choice. Jack Hoffman has said, "Probably the only way we can win a substantial reduction of smoking is 11What organizations oppose smoking if we can somehow make it non-acceptable so- and tobacco? oially. We thought the scare of medical statistics and opinions would produce a major reduction. Some are the voluntary health associations It didn't." (American Cancer Society; American Lung As- There are some who would go further, calling sociation; American Heart ;~.ssociation) which for an all-out prohibition of tobacco. Or. Benjamin existed long before the 1964 Surgeon General's Byrd, a past-president of the American Cancer Report. Other organizations have sprung up Society said recently, "1 think we would be better since then, mostly during th:~ last three to five I~ off if there were no cigarettes in the U.S. I would years. Most are. acronyms: ASH (Action on like to see them banned by Congress." Smoking and Health); FANS :Fresh Air for Non- Smokers); GASP (Group Against Smokers Pol- What we expect from the lution) and SHAME (Society to Humiliate, Aggra- anti.smoking movement in the future? vate, Mortify and Embarrass Smokers), We can expect many of the same activities that =~,t#~J) What motivates the anti-smoking have been part of the anti-smoking movement in the movement? past. These have included a series of "media event" reports on the alleged hazards of smoking and in- Despite the presence of warning notices on all creasing diversion of research lands by vo!untary cigarette packages sold in this country, there are health organizations into propaganda ventures. 4 5 TIMN 0129164 • rz leo OOooo3~5e - TIEX 0008059
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Also, we will m"ost likely con:inue to hear scien, smoking and the sale of cigarettes at the New tifically unsupportable claims, such as the large Orleans Superdome: "For the Constitution to be number of deaths annually atlributed to smoking, read to protect non-smokers from inhaling tO- and baseless estimates of the costs of tobacco bac¢o smoke would be to broaden the rights of usage to society, the Constitution to limi.ts heretofore unheard of The most rational alternative to such tactics . . . This court is of the opinion that the State's would be to let the facts about smoking and health permissive attitude toward smoking in the Lou- speak for themselves to an intelligent public, and to isiana Superdome adequately preserves the dell- permit informed persons to f-~-ake their own deci- cate balance of individual rights without yielding sions about smoking. But the,e is no sign of this to the temptation to intervene in purely private technique emerging in the mow,~ment matters." 14Are non-smokers subjected to a heal,h 16What is the economic impact of tobacco? hazard when they breathe other people's The tobacco industry has a malor impact on the smoke? U,S. economy. Tobacco is grown in 22 states on Public smoking in a normal ~;nvironment has no some 400,000 farms and is the fifth largest cash known association with disease. Dr. Reuel Stal- crop behind corn, soybeans, wheat and cotton. Iones, who was a consultant t~ the Surgeon Gen- Last year customer expenditures for tobacco eral's Advisory Committee, stated, "In very direct products exceeded $16 billion. The U.S. is also terms, there's no medical pro,}f that non-smokers the leading exporter of tobacco and the third exposed to cigarette smoke i~ ordinary relations largest tobacco importer. The result is a posi- with smokers suffer any damage." A study con- rive net contribution of more than $1 billion per ducted by two scientists from Harvard Univer- year to the U.S. balance of payments. sity's School of Public Health also failed to dem- onstrate any health hazard ~o the non-smoker. 17 What'-~ the effect of tobacco taxes? The scientists took a special .]ir sampling device into several Boston area public places (restau- Federal, state and local governments realize rants, waiting rooms, cocktail lounges)to measure some $6 billion annually in direct taxes on to- the smoke concentrations, rheir figures show bacco products. This revenue helps provide that in order to inhale the equivalent of a single schools, roads, hospitals and other vital govern- filter cigarette, the. non-stuD<or would have to ment services. Tobacco tax collections are ex- sit in a crowded cocktail lounge for more than ceeded only by those from alcoholic beverages 100 consecutive hours, and gasoline. Since 1863 when the Federal Gov- " ernment began taxing tobacco, more than $107 5 What about the alleg:.=d "right" to billion has been collected. breathe smoke-free air? 18 Do smokers pay their fair share of taxes? Stated in terms of a "right" lhe issue becomes more fundamental than jus: the question of They certainly do. Last year, for example, Vir- whether or not people sho~dd be allowed to ginia smokers paid over $110 million in combined smoke in public places. According to Federal federal, state and local taxes. In Fairfax County District Judge Jack M. Gordon, the issue really in Virginia (where a restrictive public smoking involved personal freedom. 1"hat was the view ordinance was recently enacted), smokers paid expressed by Judge Gordon n his decision dis- $7.8 million more than non-smokers in local, missing a lawsuit that would have prohibited state and federal excise taxes. SMOKERS PAY 00000365? TIEX 0008060
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THESE TAXES WITHOU " RECEIVING ADDI- growing and the poundage he can sell. The pro- TIONAL SERVICES. As one Virginia Congress- gram also allows the tobacco farmer to borrow man pointed out: "They arc. collecting more taxes money, using the tobacco as collateral. Without from smokers than from re)n-smokers. What will it the tobacco supply would be larger, not smaller. happen when they succee( in forcing smokers to Unlike the stabilization programs for other quit, thus losing county t,_-x revenues? Will the agricultural commodities, the tobacco price eta- Supervisors find new sour,:es of revenue, or will bilization program has in most years paid back more to the government than it borrowed. This they cut back local services?" is.partially because tobacco stored as collateral for the loan plus interest can be held for up to 9What is the tobac,:o industry doing ten years before being sold at a time of high to help resolve thc smoking and demand. Since the program began in 1933, the health controversy? cumulative realized loss to the federal govern- In the last 24 years the tobacco industry has pro- ment has been around $52 million, part of which vided more than $70 million for independent was offset by interest income. (This compared research regarding questions related to smoking to the toss sustained by the corn stabilization and health. In many of th;;se years this commit- program which has cost the government $16.9 ment had exceeded that cf any government de- billion since 1933.) Thus, the tobacco program partment, and has been substantially more than is one of the least expensive and most successful the research expenditure reported by all the of the farm commodity programs. voluntar~ health associations who spend a major Tobacco is one of the few crops that still portion of their donated funds for administration utilizes family hand labor and provides a reason- and for public relations campaigns. The tobacco able income on a small family farm. Tobacco industry is committed to advancing scientific growing is labor intensive. While it takes approx- imately 3.5 man-hours to grow one acre of corn, inquiry in this area. it requires over 300 man-hours to grow one acre 20 Do the tobacco ccmpanies of tobacco. control If the tobacco price stabilization program were the research they .;ponsor? ended, over 600,000 farm families would be Absolutely not! The com,~itment of the tobacco affected. (Tobacco is grown on over 400,000 manufacturers to resolve tile smoking and health farms in the U.S. On many of these farms, more controversy has never b:~en fully appreciated, than one family depends on the income from to- Grants are made with no strings attached except bacco sales.) Many of these farmers would be a pledge to apply the money to legitimate scien- forced to seek other forms of employment, and tific research. Each rese;~rcher is free to pub- undoubtedly many thousands would find them- lish his study results, wh;Ltever they may be. selves on government welfare rolls. On October 12, 1976, then candidate, now 1 What is the toba¢,:o subsidy program? President Jimmy Carter said about the tobacco price stabilization policy, "I personally see no It is not a tobacco subsidy' program--it is a to- need to do away with a program that costs the bacco price stabilization 3rogram. It is a loan government next to nothing, while enabling so program exactly like the program for wheat and many hard working families to earn a living." other agricultural commod ties to stabilize prices so farmers can get a reasonable return on their investments. The .progr~.~m mandates quotas /imiting the acreage a farmer can use for tobacco TIMN 0129166 .~.~ TZ ~U O0000:~Se .. TIEX 0008061
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TO THE TOBACCO INSTITUTE: I, too, am concerned about unjustified atIacks on smokers and tobacco. Please add my name and address to your mailing list and keep me inlormed about these issues. (PLEASE PRINT OR TYPE) NAME STREET OR BOX ClI¥ STALE ZIP
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~, PERMIT NO. 73450 • Washinqlon. C).C Business Reply Mail Nn po~laq~ stamp n~c.~ssmy iI mailed in the United Stales THE TOBACCO INSTITUTE - Suite 1200 1776 K Slreel, N.W. , Washinglon, D.C. 20006
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The Tobacco Institute recognizes that there are differences of opinion conce, ning smoking and health. This booklet is pres:;nted in the belief that full, free and informed discussion of the smoking and health ¢ontrov,:rsy is in the pub- lic interest, and in the convi(:tion that the con- troversy must be resolved by :~clentlfic research. The Toba©¢o Inatitule 1776 K Street, Northwest Washington, D C. 20006 O~ ~la~ TZ KU 000003653 TIEX 0008064
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~ ON SMOKING 1 How many cigarettes are sold annually in the U.S.? Nearly 620 billion cigarettes were purchased in 1976, about a pack-and-a-half a day by the aver- " age smoker. Sales have moved steadily upward in this decade and are continuing to increase at a rate of about 1% per year, How many people ~moke? Nearly ~0 milJion adult Americans~l:)out 40% of the adult pol~ulation. Are smokers different from non.smokers? Yes. Some doctors have concluded that smok:ers have behavior patterns different from non-smok- ers. Generally, smokers tend to be more asser- tive, time-conscious and energetic than non- smokers. Did the Surgeon General's Report establish that smoking causes cancer and other diseases? No. The report of the Advisory Committee to the Surgeon General in 1964 failed to establish a cause-and-effect relationship between cigarette smoking and cancer and other diseases. The report was essentially • "study of numbers"~a selective review of population studies which com- pared disease rates among smokers, ex-smokers and non-smokers. The report showea a statis- tical association between cigarette smoking and lung cancer. However, the report stated, "Statistical methods cannot establisl~ proof of a causal relationship in an ~ssociation. The causal significance of an association is a matter of judgment which goes beyond any statement of statistical probability." What questions were unanswered by the Surgeon General's Report? Many questions were left unresolved. Why, for examl:)le, ~o non-smokers fall victim to I~eart 1 TIMN 0129162 " " - TIEX 0008065--
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disease, lung ~ancer and other diseases fie- the blood rapidly and there is little cumulative quently associated with smo<ers? If, as some effect. By the time the cigarette is finished much anti-smoKing grou~s claim, cigarette smoking is of the nicotine is already metabolized. As was the major cause of lung cancer, why is it that pointed out in the 1964 Surgeon General's Ad- the vast majority of the "hea~y" smokers never visory Committee Report on SmOking and Health, develop the disease? Why iasn't independent ~ "nicotine in cluantities absorbed from smoking scientific research been able to identify any one and other methods of tobacco use is very low or combination of the thousands of components and probably does not represent a significant as found in cigarette smoke as the cause of any -' healt~ problem." particular disease'?. Why in m()re than forty years "Tar" is the particulate matter collected by of research hasn't anyone b,;en able to repro- super-cooling and condensing tobacco smoke duce the type of lung ¢anc:;r associated with under special laboratory, conditions. This method smoking--through tobacco smoke inhalation-- of producing "tar" has little to do with the way in laboratory animals.'? we smoke cigarettes. Concern about "tar" is primarily due to early experiments which involved painting the artificially-produced substance on Have scientists dete~r, fined what laboratory animals' skin. Other common sub- causes cancer? stances such as tea have also been applied in No. Scientists are continuin.;] research to de- much the same way, producing skin cancer on termine what causes cancer in humans. In at- the backs of test animals. Such experiments are tempts to learn the cause of lung cancer, for of little scientific value since the skin of test example, some researchers a,e investigating the animals does not approximate the lining of a effects of environmental agents in the air such as human lung, and because the quantities of "tar" vapors, dust and other pollutants. Other scien- used have been estimated to equal a man's fists are studying the possibili:y that certain indi- smoking 100,000 cigarettes a day. viduals may have a genetic predisposition to 9 cancer. Some studies of the incidence of lung Are gasee contained in cigarette smoke cancer by geographic area dc not show correla- harmful to the smoker? tions with levels of smoking. It is claimed that cigarette smoke contains harm- ful quantities of carbon monoxide, nitrogen di- Are cigarettes Io'~ oxide and hydrogen cyanide. However, such with and nicotine "safer" for e ~okers? gases occur only in low concentrations and small Cigarettes have never been p,oven to be unsafe, quantities compared to the high concentrations Many varieties of low "tar"-nicotine cig&rettes and large amounts necessary to produce sig- are now on the market in res,,)onse to consumer nificant effects. preference trends. Sales of ci~tarettes with 15me. Any combustion process produces carbon of "tar" or less increased by 50% in 1976 and . monoxide: cooking on a gas range, auto ex- comprised more than 25% of .:he market in 1977. haust, garbage dump fires, etc. Dr. Helmut Wakeham, said in an article published in Pre- ventlve Medicine, December 1977, "Cigarette Are "tar" and ni¢otin-': in cigarettes smoking is an insignificant source of carbon dangerous? monoxide in the overall atmosphere as compared Claims that "tar" and nicotine In cigarettes harm with other natural and man-made sources." the smoker are not supporte~, by scientific fact. Very little, if any, nitrogen dio~xide is present in The nicotine from a cigarette is eliminated from fresh cigarette smoke. As for hydrogen cyanide,
Page 481: CBP10066
the 1964 Surgeon General's Report on Smoking still those who believe that it is their duty to and Health reported that it is !)resent in tobacco "protect us from ourselves." Fifty years ago it smoke only in insignificant an'cunts, was the consumption of alcoholic beverages 10 which aroused the passion of such crusaders. Does cigarette adverti.';ing cause ~,oung Prohibition was supposed to save the nation, but, people to start smokirg? '~ as we now know, it created more problems than ~, it solved. A number of independent stud es have examined ~ The opposition to the personal enjoyment of reasons why indiv{duals chin:so to smoke. No tobac~o began soon after Sir Walter Raleigh study has demonstrated that advertising is re- sponsible. Dr. Ernst Wynder President of the brought the first cargo of !eat to England in the American Health Foundation ilas said, "1 do not sixteenth century. As early as 1604, anti-tobacco believe that advertising has much influence." pamphlets such as "A Counterblaste to Tobacco" In a recent editorial about its cigarette advertis- authored by King James I of England were circu- lated. Today, with tobacco well into its fifth ing policy, The Columbia Jou,'nalism Review re- marked: "What about the sol d research (which century of use, the controversy continues. indicated) that cigarette advertising rarely in- In the 1950s and 60s, the attack against tobacco fluences decisions to smoke or not to smoke, but was aimed at the product--cigarettes--and led to (rather) that its effect and pur!~ose is to influence the package warning label, the broadcast adver- the choice of brands?" tieing ban and higher taxes. Nevertheless, cigar- Advertising creates brand oyalties; it appar- ette sales continued to rise, Recently, the attack ently does not create new .-.;mo~ers. Tobacco has shifted to the users of the productQsmokers companies do not encourag.-~ young people to Qby attempts to make them socially unaccepto smoke. They regard smoking as an adult custom able. based on a mature indivkiual's freedom of American Lung, Association past-president choice. Jack Hoffman has said, "Probably the only way we can win a substantial reduction of smoking is 11What organizations oppose smoking if we can somehow make it non-acceptable so- and tobacco? cially, We thought the scare of medical statistics and opinions would produce a major reduction. Some are the voluntary h.=alth associations It didn't." (American Cancer Society; American Lung As- There are some who would go further, calling sociation; American Heart Association) which for an all-out prohibition of tobacco. Dr. Benjamin existed long before the 1964 Surgeon General's Byrd, a past-president of the American Cancer Report. Other organizations have sprung up Society said recently, "1 think we would be better since then, mostly during th.'~ last three to five I) off if there were no cigarettes in the U.$. I would years. MOst are. acronyms: ASH (Action on like to see them banned by Congress." Smoking and Health); FANS :Fresh Air for Non- I~ 13What can we expect from the Smokers); GASP (Group Against Smokers Pol- lution) and SHAME (Society t,) Humiliate, Aggra- anti.smoking movement in the future? vats, Mortify and Embarrass Smokers). We can expect many of the same activities that 2 What motivates the anti-smoking have been part of the anti-smoking movement in the movement? past. These have included a series of "media event" reports on the alleged hazards of smoking and in- Despite the presence of warning notices on all creasing diversion of research f~nds by voluntary cigarette packages sold In this country, there are health organizations into propaganda ventures. 4 5 TEVIN 0129164 ~, . rz ,~o 000003~5¢ 0008067
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Also, we will ~ost likely con:inue to hear scien- smoking and the sale of cigarettes at the New ~.ifically unsupportable claims, such as the large Orleans-Superdome: "For the Constitution to be number of deaths annually atlributed to smoking, read to protect non-smokers from inhaling to- and baseless estimates of the costs of tobacco bacco smoke would be to broaden the rights of usage to society, the Constitution to limi.ts heretofore unheard of The most rational alternative to such tactics . . . This court is of the opinion that the State's would be to let the facts about smoking and health permissive attitude toward smoking in the Lou- speak for themselves to an intelligent public, and to isiana Superdome adequately preserves the dell- permit informed persons to ~ake their own decio cate I~alance of individual rights without yielding sions about smoking. But the~e is no sign of this to the temptation to intervene in purely private techniclue emerging in the mov=,~ment, matters." 14 Are non-smokers subjected iDa health 16What is the economic impact of tobacco? hazard when they breathe other people's The tobacco industry has a major impact on the smoke? U.S. economy. Tobacco is grown in 22 states on Public smo~,ing in a normal ~;nvironment has no some 400,000 farms and is the fifth largest cash known association with disease. Dr. Reuel Stal- crop behind corn, soybeans, wheat and cotton. lones, who was a consultant t~ the Surgeon Gen- Last year customer expenditures for tobacco eral's Advisory Committee, st;Lted, "In very direct products exceeded $16 billion. The U.S. is also terms, there's no medical pro¢~f that non-smokers the leading exporter of tobacco and the third exposed to cigarette smoke i~ ordinary relations largest tobacco importer. The result is a posi- with smokers suffer any dam.age." A study con- five net contribution of more than $1 I~illion per ducted by two scientists from Harvard Univer- year to the U.S. balance of payments. sity's School of Public Health also failed to dem- onstrate any health hazard ;o the non-smo~<er. 17What's the effect o! tobacco taxes? The scientists took a special .air sampling device into several 8oston area public places (restau- Federal, state and local governments realize rants, waiting rooms, cocktail lounges)to measure some $6 billion annually in direct t~xes on tO- the smoke concentrations, r'heir figures show bacco products. This revenue helps provide that in order to inhale the equivalent of a single schools, roads, hospitals and other vital govern- filter cigarette, the non-smo<er would have to ment services. Tobacco tax collections are ex- alt in a crowded cocktail Io~.~nge for more than ceeded only by those from alcoholic beverages and gasoline. Since 1863 when the Federal Gov- 100 consecutive hours. " ernment began taxing tobacco, more than $107 5 What about the alleg=.~d "right" to billion has been collected. breathe smoke-free air? 18 oo smokers pay their fair share ol taxes? Stated in terms of a "right" the issue becomes more fundamental than jus: the question of They certainly do. Last year, for example, Vir- whether or not people sho=dd be allowed to ginia smokers paid over $110 million in combined smoke in public places. According to Federal federal, state and local taxes. In Fairfax County District Judge Jack M. Gord,}n, the issue really in Virginia (where a restrictive public smoking involved personal freedom. That was the view ordinance was recently enacted), smokers paid expressed by Judge Gordon n his decision dis- $7.8 million more than non-smokers in local, missing a lawsuit that would have prohibited state and federal excise taxes. SMOKERS PAY 7 Ot 9t65 rx I~u 0000036S~ TIEX 0008068
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THESE TAXIES WITHOU " RECEIVING ADDI- growing and the poundage he can sell. The pro- TIONAL SERVICES. As one Virginia Congress- gram also allows the tobacco farmer to borrow man pointed out: "They are collecting more taxes money, using the tobacco as collateral. Without from smokers than from n,)n-smokers. What will it the tobacco supply would be larger, not smaller. happen when they succee( in forcing smokers to Unlike the stabilization programs for other quit. thus losing county t.:x revenues? Will the agricultural commodities, the tobacco price eta- Supervisors find new sour,lee of revenue, or will bilization program has in most years paid back more to the government than it borrowed. This they cut back local services?" is:partially because tobacco stored as collateral for the loan plus interest can be held for up to 9 What is the tobac,:o industry doing ten years before being sold at a time of high to help resolve the smoking and demand. Since the program began in 1933, the health controversy,~ cumulative realized loss to the federal govern- In the last 24 years the tobacco industry has pro- ment has been around $52 million, part of which vided more than $70 miilion for independent was offset by interest income. (This compared research regarding questi~,ns related to smoking to the toss sustained by the corn stabilization and health. In many of th::se years this commit- program which has cost the government $16..9 merit had exceeded that cf any government de- billion since 1933.) Thus, the tobacco program partment, and has been substantially more than is one of the least expensive and most successful the research expenditure reported by all the of the farm commodity programs. voluntary health associations who spend a major Tobacco is one of the few crops that still portion of their donated funds for administration utilizes family hand labor and provides a reason- and for public relations campaigns. The tobacco able income on a small family farm. Tobacco industry is committed to advancing scientific growing is labor intensive. While it takes approx- imately 3.5 man-hours to grow one acre of corn, inquiry in this area. it requires over 300 man-hours to grow one acre of tobacco. 20 Do the tobacco companies control If the tobacco price stabilization program were the research they sponsor? ended, over 600,000 farm families would be Absolutely not; The comi;,itment of the tobacco affected. (Tobacco is grown on over 400,000 manufacturers to resolve ti~e smoking and health farms in the U.S. On many of these farms, more controversy has never b..~en fully appreciated, than one family depends on the income from to- Grants are made with no strings attached except bacco sales.) Many of these farmers would be a pledge to apply the money to legitimate scien- forced to seek other forms of employment, and tific research. Each researcher is free to pub- undoubtedly many thousands would find them- lish his study results, wh;ttever they may be. selves on government welfare rolls. On October 12, 1976, then candidate, now 1What is the toba¢,:o subsidy program? President Jimmy Carter said about the tobacco pdce stabilization policy, "1 personally see no It is not a tobacco subsidy prograrn----it is a to- need to do away with a program that costs the bacco price stabilization orogram. It is a loan government next to nothing, while enabling so program exactly like the program for wheat and many hard working families to earn a living." other agricultural commod ties to stabilize prices so farmers can get a reasonable return on their investments. The progr;_~m mandates quotas /imiting the acreage a farmer can use for tobacco .~_~ TIEX 0008069__
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TO THE TOBACCO INSTITUTE: I, too, am concerned about unjustified attacks on smokers and tobacco. Please add my name and address to your mailing list and keep me inlormed about these issues. {PLEASE PRINT OR TYPE) NAME STREET OR I]OX STATE ZIP t
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PERMIT NO. 73450 Washinqlon. D.C Business-Reply Mail ., Fn~h~qn. wdl hO I);Ii(I by THE TOBACCO INSTITUTE Suite 1200 " 1776 K Street. N.W. ,,, Washin.qlon, D.C. 20006
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, ~ ~ mzkcs a ~m of O~ voiun~cy use. I ~uld ........ TIEX 0008075.
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The Cruci._~l Pause" Winter On A Southern Maryland Tobacco Farm - ~ ~ ~ ~of~. • ......
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TIEX 0008078__
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• " " ~.~', ase~ of scales. ~rerm~:m he took :w~ina~r~.a~t~- ~ pm¢~ sto~ int~ for ~r~~a~of ;~ ~w~sfeB~elu~enenv¢~ ~avay~lesu~lyof~ ~ sing ~ a ~ ~ve~ ~ a :'~1. a I~, ~d a ¢~ But I ~vs ~m hi,~K a ~bl¢ tob~ ~pply st~ ~ld ~ ~¢: ~ shouM~ ~. It Y~ .... ( ...... t ~ ~ ~ ~ C~e~g on a Su~,eon :~ ~ AN~ V~ ~g~ TO I p~'en~ health S~a~'s ~t~c ~y ~ over- ~e ~e-u ~1i¢ ~ of his ~n ~ f~ S~'~ Y~ ~ ~" • ~aq~ity~a~Bm ~i~ ~ H~e, ~ a club H~et.T~n's~ofJests(1611) Su~e~Ge~J~d~sB. Sir W~t~ ~ei~ (t552-161g) ~ ~pi~ s~ ~g ~ ~ ~ ~ ~ pi~ "T~ Health Co~#eace$ .av~. ~. ~ ~ ~ ~s ~tc ¢~ T~ng ~- ~"~F~ ~ ~ ~X PaRe~ o~. ~i~ did ~m ~ =y ~- vm~ ~ his ~ = a fav~ of ~t ~ ~ ~s ~. 1112181 ~ "" '- idu~ to ~ ~ ~e ~:~ ~ei~ ~u~ ~ m~ ~'s ~ ~ ~ h~ ~ ~ A/~we~y~ver~for~r. ~t<~k~.~y.~n e~. J~ ~fom ~ s~ ohm ~ ~m~~s~ ~do ~s ~ j~ ~ ~s fo~ :lony ~u~d f~ Vi~nia in 1586. ~[v we~ ~ ~k¢. ~t .p~w~ ~d ~e p~u~ of ~Qu~El~.~ys~n~ra ~to~e~'It~my~n PageI42 ~ve ~ ~t~ ~ ~. ~ Bd~h psy~t ~ ~t ~ ~s "'It is no~ys ~ for ~ pit $,,~th ~d.. 37 G~ gus~R $~. ~~. ~a¢ tung~, co~ ~di~, ~- WC1.) Much of ~ e~¢ ci~ ~ m~r ~ Ey~ncg g~mly ~t~d :s~ ~ ~¢~~¢~ of yew fa:~dngint9~=~.Ifa ~n ~ ~ ~=~ ~ ~k, ~ ~ ~ ~o~ngci~n~" m~er~.~'llfi~ofw~ w~. E}~k f~. ~ ~ ~ys.a I~y~e~a~~ ~tte ~king ~ f~ a concl~ive ~a~it) ~w is linked to di~. ~on. ~t ~. ~. ~ ~s ~ ~ ~swer ~or ~s v~ ¢om~l~ ~ in- He s~ ~ ex~v~ li~n[ Hv~ ~o~ to ~ i~ s~en~ ~ ~ ~c~l~ ~1~'" d~ not exist t~y. ~ ~ e,:~t~ ~. ~ng ~. ~k~' ~~ ~ly ~ ~o~.'" "'~ ~e t~ ~y in~nsi~en~, s~a; ~. living ~ i~ He ~s f~ ~. un~ .,~fi~te~.~d u~u~ con. I~. ~ staying u¢ igeC, ~y~nck h ts~iy ~ of~- s~ ~ ~ a ~ous 1~ ~ieto~ptt~su~fion=~ven ~dte~is~e~ethem- only for ~ ofp~ th= f~~Ey~k.a~k- :n~ ~s lung ~er or ~iov~- d~tly ~ ~ d~¢ in qu~on. ~t ~ ~mning n~r of ~ople ~y any u~ ~p~ m ~ok~. .~k. published in Bfi~m T~e Cu.~e$ ~ ~m ~ • ~is~ifion to lun~ f~t ~m~i~ ~ms." h~ ~d his wo~. Bu~ ~ • :d~ectso/Smokin~,.~M~aeTe~ ~r, ~ ~ often ~e ~ ~ Yet E)~nak's w~. in mmm. ~ h~nciusio~o~.~ ~e T~ ~ 9 - TIEX 0008080--
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state's t~.Ooomy ~ ~ ~ m New n~y S l.6 bi~o~ = 1979. t to t~ e~nomy of the U. S. ~ sel~ Morn vending ~plo~ent tO~C¢O'S ~pple eff~, ~ ~ Ore of ¢v,~ ~ )obs in ~ ~p~ ~mt pm of ~ CM~--~ till- S 1 bilEon in I979--5 ~em of indm- TX~X 000808~ ~
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.......... TIEX 0008082__
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Thank You, For Not... EDITOR'S .~,~TE: T1a/s .~. stocking set,on a~l l~t up ~ signs eight-hour day. Tol~.~o smoke` undcr evil. which they ~rt l:~rmit-,~l to ha~. ~-t~le ~ mpp~red i~ ~ Imgthkr ver- ova_.' the a~a and small signs on ~ t~Jistic conditions, rarely exc~Ls t~n ~ they have to ham ~ in the ~ ~ua m~ P1"o- tab!.~s declaring %'biOKL~G PRO- l:mrts-l~r-n~jllion. This is. I suppose, a ~,irly f~or ~ McDo~. ~n ~,~_~ i~- HIBtt~, BY LAW," Printing on ~c The an'J-smoking z~aJot.s don't wa~ r~spons¢ to the fru.~'~o~ and com- s-lzuc~r ,~ [~e Um~c,~. or" So~h srr~iJsigns-inthepmposedCal~ornJa totalk, aboutfa~sorr~a~sdccond~- plcxiW of our world. Am~lJvesina ~ bes bern • cs~su~tant forThe and D~ie Count, laws--must be "not cions, however. They like to re-port socie~,." wh~r~ inflation depletes h~s Tob~:o[as~u~.'T'nankyoufork'~mg k~ssthan~ofaamchiahciL~L'" ~ k:v¢l~ of carbon mono:dde i,n ~e savings and minorities riot. He ~.n't me get ~1 ~ wl~t follows o~" my d~:t-" Much of ~is nonsonse cortes ~rom aL- arou~l smokexs. Bet ~ for his car, I~ ft'icnds ~t sk:k be s~. b~_ auct'a2J¢ Wpe:s who ne~i nh-pick~n g in one exberim~nt they put four I~o- and dk:. and the l~mb rnay f~l a~ any .jo~s and like to mc~u~ t~oms ar~ r, be pis - two st~:~kcxs a,nd two non.smokers time. He can't ur, c~rstand a~y o~ th~ " The~'s only one ~nd-smokin~ or- p:m:onlit~Jesil~san~issuenoncompti- -Ln ~clos~LVolksv,~en-sizec~rina If he tries t6 find r~l answers, he ~',~,~n I 4rove any respect for. and ar~_~: c~,~,~ons. Either way it ~t~'cs a closed ~ a~ bad the smokers runs up aga~st K~.vncsian =~nomics. that's on~ c:ailed SMASH (SocJely for mln,[kss do~s~ wl'~ch tar.ks the smoke I0 cigarettes in ~ one-hour pc- Islamic mor~/, d~ DNA molecule. MordS~don~ Smoker Humilia~o~). Idnd of fervor wb3ch makes SMASH rlod. Then ~ r~a~:h~'s r~por~d an process th~olo~'. ~ Sah 2--ancl This was estab]Lshed a few years a~o and Carry Na~on in~r~st~ng. (C~T')" offensivelyhJ~levelofc.a.,'honmonox- can't und~t~,~ci that either, so lots of by a man named P.Jc~ Bennett in Wash- Na~0n. God bl~ss her. i~sisu~ tha~ ide a~ictin$ the nox~smo~. Man. people give up a~i cmbmc~ O~ easy ing-~on State. and its e~s~nt~.l mission Pr~sic~nt McKJn~y died of nicotine thaCs heavy .science_ a.nsw~-s they need to $,~t aJong. They is to ~ up smokers. Any member poi~qnJng, a condition notably ~ T~ onJy conclusion you can dz-aw insist ~ve~.'chi~ w~ b~ fir~ if v~ just whock~bb~rsasmoker{~mthe v~_~I by two bull¢~ in ~ stomach.) fromthJssmdyistttazzprudantnon- ~tr~lofcommu~smorca~esu~zor lit~t-a~re as "the smashee") ear~s a B~l'mnmmuch worried about these smoker shouldn't aca:~pt an invitation nucJ~ax r~tors or clemon run~ They HcroMedaJlJonandis¢ligibleform~- ar~.m~k~rseither. Theyc~'tboth~r tosJtwithsmokcrsinasm~llcarina bel~ve everything will be resolved if l:>¢rshipi~r,h¢SM,a~HHal]ofFan~. ~u~,sstheyl~[alawpassed, a.~d closedlla.,-a~.fll~vemydoubtsahou~ wea~:e.ptd~usorvi',~minEoruam, ~ org~'~on issues a ~eril~ t.hat'~ bard to do. I ca~ marshal my ~ ~uys anyhow.) fo~ ~ananar or solar rn~nu~ spelling om DAMN (Drasd¢ fca-~.sinthedemocra6csyst~mandde- Now I don't m~d int~sdn~cmz~- NuketbcAy~ol]ah! and Mor1~'.vin~Jy Nasty) cotm~rmca.s.. ~ az~d lobby and rt~x:k and ~ ]~- hess. I have som~ mys~t'. I think col~ The true b~llever liv¢~ in a cor~orta- ur~tobeus~la~instsmoke~Ii@tins ters~.ndvot~.Icanhat~l.lethcs~l:~opl~, drinksgiverr~coldsor~.lldndofbe- bleworld. Ijustdon°tw'amhimmess~ng up in any ar~a other than "'~ clos¢~ ~ml I reall.v can't sland are the sur- lieve in ta~ing in tongue. | think up where they belong." The SMASH ro~. ~e l~rents w~o ue~.t me like achiJd Jimmy Carter h~ been & goo~ Having discussed t~ whole m~rto reflecu the ~ sens~flides ~ ~t up ~le signs saving "Thank Presider. ar~an~nt, rm back wh~r~ I or" ~ m~nhersldp: you ~or not smolcing.'" Thes~ mot.hers I'm ~ ~o lel anti-smokers co~t What ~ [ do about ~II ~os~ ~ ~ I~HO IGNORES A REQL~ST have rr~ heram~ in. I could rip doum the p~ts-per-mi~on of carho~ monox- you for not smoking" signs? TO STOMP o.~rE S[.~l" the -;i~s. I could write in c~s, ki~ in some ~ Tl~y can c~Icutaze I ~nk ['I~ put up some si~s of my CETSTWOB[.,'I"TSSTOMPED. suc~.s~ngcolorfuiactsl'dthanklocal d~ "social cost" of smoki~g. Butldo ow~ l~;o1:ieforl~:rformJng.Bmd~seatede- mind bein~ pushed azouod by these Now I can't zeaUy ob~ct to ~ m~,-ingr~s~ons~s.Theymak~melouk numbers..lus~becaus~tl~,havcsom~ l~ople. ThrrCs somet~Jng c~mple~e like -- te~m~e¢ or a slob or som~ kind or imaginative statistic~ doesn't mean I Thank¥ouForNo~ a~d sadsfyin~ahout their~pproach to c~-az} ze..aJot. So ! can't do much of shouklh~ve toh~deinzck~,.,~ttolJgi~t T'n~ Srrmsher is a bullying psycho, o~' T~-. =se stupid sig~s ate l:opping up all Besides, anYOne who ",v~'1~ to s~- course.bu~h~hasasetofbellefs.a¢l~ar over. and'a~yd"¢¢atme-Al]Icaado ~t~smok©rsisworki~fromaprincl- Thank¥o~F~rNo~ ~oal. and a pro~'-a.m. I can handle him. is ~:~ and v~ th~s espy. pl~ w61ch c~n t~asonably be a~p~ed Io .~a~l~d~J In H" he t~tesmns to I~ me u~, I ca~ [_-_- :'s k~k ~ ~ whole mba~o rambunmdous chilcl~ c~ppled old r~spond: ! can beat h/m up: I caa sc--r.-. Why do all ffiese people wan~ me people (espec~ly those with w~kers thr~aumh/mwit.hadogormylawy~'; tos~.,_-psmol~g?Iseesevera]re~sons, whosiowupaline),eldleptics.andcid- Tha~kV~lF~N~t l c:m hire a ion~shoreman to br~k his • ! don°t smoke in elev~ors or doc- zcns who ~a~ B~rmuda onion or ~r Sup1~rlin9 Thl~l thumbs. It may Zet n'~-~sy, but it w~ll all tot's o~Tices, [ don't lisht up in any chea~ l~qUme. This, f~iendSo is z thor. b~ straightforward and aboveboat~ plac~ where I think sorneone might I~ ou~Jy bad pdncipl~. ! have less respecz for all ~e people bo~-d by my smoking--unk:s$, of In a l~Ut',~sti," socisty, [ have a woridngtopasspubllcsmoldngL~ws, cou~=--scxneonc puts up one of thos~ to do a lot of ta"~ngs whlc~ may offend They want to r~strict my smoking to nasty ~ you" si~s+ Then I'm som~x~y. I c~n eat sn~s. ovm a [an',. Thank V~I ~ ~ my bedrnom ;and one comer of a,n/L~- smokLn~ on rs'inciple, h~.ve loud parries, ~ the Aya~llah. Rea~in@ l~ly~y club and Lhe b~c.tc of nn a/rpl~ne. Havingsa/dthaLl}~stento~dthat Ettermyfront|awn.wei~h3OOIxxa~Ls, ($~ASH~wouldletm~smok¢ [ don't think my c/gaz~rte smoke hur~ ~d vote for Jerry Brown. If I'm not on ~he wing of the ~la~-) anyb, Kly.TheSurl~nGeneraYsreport demonstrably l~rrn~n~ someon~ ~v- "n~nkVouPorNc~ Th~ ~mo~ing-L~w advocates want m said ;hal it found "ERie or no physi- es~-~nt should leave me 1]o~. Th~Cs Beln~ .~11~ s~1~-aze rn~ from my nonsmoldng olo~: r~spons~ to smoke'" in h~l~2~y" wh~individoaJf.~-edomis. LaCsi~ton. friends and give none of us an), say in nons~okers. OSHA has ~sua~lisl~cl ', Another ~-ason lots of p~opl~ ar~ ~he matter. They want to make r~stau:, fifty .,~rts.l~r-rnilllon as a safe carbon so uptight aix~t my smokin; is ~at ThaCs enough. I think. ! muse h~ve r-~nts .~vc baR" fl~ei~" spa~e to a non- monoxide Emir for workers over an they s~ tobacco as - ne~ly de~ned made my point by nc~-. Thank you! The To/~acco Obaerver IN THIS ISSUE OF ~7~, W~smngton. O. C. co~E~: • ~ank You For 8ain(I ~u~u~ (Pa~ 4) M~SOTA TOBACCO LITIGATION Feb~ 1981 TIEX 0008083
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SMOKING AND HEALTH 1964 -1979 THE CONTINUING CONTROVERSY THE TOBACCO INSTITUTE 1875 I Street, Northwest, Washington, D.C. 20006 January 10, 1979 T "1" ~..X 0008084 TIMN 289718
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TOBACCO INSTITUTE LIBRARY The Health Consequences of Smoking THE CHANGING CIGARETTE a report of the Surgeon General U.S. DEPARTMENT OF HEALTH ANO HUMAN SERVICES Pub/~ Health Service Office o41 Smoki~ and He,Jib TIEX 0008088
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C. Relation of i~ smokem B~/aA . a~e we to believe? KV. Incidence of care (HIP). infarction. ,1969. T.I., MELLEM. during hypoxia and ~d atheroseler~is in of 74(~): 24~246, of Health, of the Assistant ~ Publication No. d biochemical and ~.~e Section 5. CHRONIC OBSTRUCTIVE .~ ~.~ ~. LUNG DISEASE between tobacco smoker~ ' habits among December levels in January 15, (Editors). ~d Health, New ' I~ 8~r. U.S. relation 1976. TIEX 0008089
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CONTENTS The l%eseareh Problem Current Research Findings Future Research Approaches Epidemiologie Studies Priorities for Research Recommendations Research Recommendations Summary References TIEX 0008090.
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The Research Problem The causal relationship between cigarette smoking and chronic obstructive lung disease (COLD) (chronic bronchitis and chronic obstructive pulmonary emphysema) is well documented (35). However, the possible differences in the effects of higher versus lower "tar" and nicotine cigarette smoke in the pathogenesis of chronic obstructive lung disease are not known. COLD usually progresses slowly; physio- logic and pathologic abnormalities may exist for an extended period of time prior to the development of disabling clinical manifestations. The latter are usually associated with severe lung damage or destruction. It is uncertain which of the many ingredients in cigarette smoke has a role in the production of COLD. Lower "tar" and nicotine cigarettes may have no impact, or indeed an untoward impact, on the develop- ment of COLD. Therefore, it is urgent that research be carried out to resolve this complex problem. Cigarette-related chronic lung disease may be subdivided into three major components: (1) uncomplicated chronic bronchitis, a disease of mucous hypersecretion and cough; (2) chronic bronchitis and bronchio- lar inflammation, similar to (1) but with airflow limitation caused by intrinsic airway pathology; and (3) emphysema, a disease associated with anatomical hyperinflation of the distal air spaces and destruction of lung parenchyma. Because cigarette smoking is associated with all of these conditions, they commonly coexist. The factors causing one or more of these diseases to develop in response to cigarette smoke in some individuals and not in others are unknown. Cough and mucous hypersecretion are common symptoms among cigarette smokers, while evidence of airflow limitation is significantly less common. Recent evidence suggests that the early stage of emphysema is associated with cigarette smoking-related inflammation in airways less than two millimeters in diameter (11). Research on the response to inhaled irritants is usually focused on one or more of the anatomical components of the lung: the airways, the cellular and biochemical contents of the alveolar spaces, and the contents and structure of the alveolar septa or interstitia. Responses in the airways may consist of alterations in epithelial cell types, mucous gland hyperplasia, hypersecretion of mucus, inflammation, impair- ment of mucociliary function, abnormalities of immunologic factors or other substances, smooth muscle hyperreactivity and hypertrophy, and intrinsic narrowing fibrosis or destruction of small airways. Physiolog- ic responses reflect airflow limitation, early closure of small airways, and nonuniform distribution of inspired air. In the alveolar spaces, free cells (including alveolar macrophages and neutrophils), surfactant (a phospholipid secreted by the alveolar lining cells), enzymes released or secreted by macrophages or neutrophils, and protease inhibitors and other proteins that reach the alveolar spaces by transudation from the circulation are all under study. The alveolar TTEX 0008091 I~
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A study carried out in two successive decades, in which successively autopsied airways from lungs of smokers were studied for bronchial epithelial changes, demonstrated a decrease in changes thought to be related to carcinogenesis (2). This favorable change was thought to be related to the increasing use of lower "tar" and nicotine cigarettes. Unfortunately, this study did not examine the lungs for evidence of chronic obstructive lung disease. Future Research Approaches Animal models in which emphysema has been induced by elastolytic enzymes have been reported by a number of authors (2/,), but for reasons that may reflect a combination of factors, such as the shorter life span of animals, the method of smoke exposure, and species resistance, there are no published studies that acceptably show in an animal model that the development of emphysema is induced by cigarette smoking. Thus, a successful animal model has not been developed in which the relationship of different types of cigarettes to the development of emphysema can be studied. One study in which dogs received smoke directly through chronic tracheotomies reported the development of emphysema (3). The lesions were not conclusive and the results have not been confirmed by others. Therefore, to elucidate more clearly the differences between regular and lower "tar" and nicotine cigarette smoke exposure, it will be necessary to study other aspects of lung function, either biochemical or physiological, that may be altered by the cigarette smoke and that are projected to be important pathogenetic mechanisms in humans. As suggested in the preceding paragraphs, much new information will be needed before conclusions can be drawn about the effect of lower "tar" and nicotine cigarettes on the development of COLD. Acute and subacute responses could be measured by physiologic studies, although such responses may not be relevant to the develop- ment of chronic, irreversible lung disease. The quantity and composi- tion of mucus secreted in the airways in response to different types of cigarettes may be studied in animals or humans. The histology of the bronchial mucosa may be evaluated in human material from lobes or lungs resected for other reasons, from biopsy specimens, or from post mortem findings in which changes related to chronic bronchitis or emphysema are specifically quantitated. In autopsy or resected lungs from smokers of regular and of lower "tar" and nicotine cigarettes, factors in the small airways such as lumen size, number of airways, cell types, goblet cells, muscle hypertrophy, and inflammation may be evaluated. Enzyme inhibitors produced in the tracheobronchial tree could also be evaluated, as could the secretion of immune globulins. Effects of cigarette smoke on the mucociliary function of the bronchial mucosa is another potential measurement. 14,9, T~EX 0008092
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SMOKIN ,OBACCO INSTITUTE LIBRARY and HEALTH a report of the Surgeon General [] The Health Consequences of Smoking [] The Behavioral Aspects of Smoking [] Education and Prevention U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Office of the Assistant Secretary for Health Office on Smoking and Health TIEX 0008094
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10. ALLERGY. National Institute of Allergy and Infectious Diseases TIEX 0008095
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CONTENTS Introduction Basic Mechanisms Tobacco as an Antigen Identification of the Tobacco Antigen(s) Epidemiology The Effects of Cigarette Smoking on the Immune System Target Organs of the Allergic Response Summary Conclusion and Comment References TIEX 0008096 lo4
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Introduction Tobacco and its products, including smoke, can affect the immune system in two ways. As antigens, they can interact with the immune system to induce specific responses evidenced by production of specific antibody or sensitized cells. Or, as irritant, pharmacologic, and toxic agents, they can interact with cellular elements of the host defense system, thereby influencing the functional ability of these elements. Physicians have long noted the association between the development or aggravation of allergic or allergic-like symptoms on direct exposure to tobacco and tobacco products, including smoke, thus giving grounds for suspicion that tobacco can be causally related to the symptoms. There is evidence that tobacco smoke condensate can induce an immune response in animal models and in man. The existence of a tobacco smoke allergy in man is unproven, however, and is complicated by the difficulty of demonstrating a cause and effect relationship between the immunologic event and its manifestations. The problem can best be understood by appreciating the current concept of that which characterizes an allergic individual--the ability to produce a unique serum antibody upon exposure to a given antigen. A property of that antibody is its selective fixation to cells located in certain tissues, such as skin and respiratory membranes. Upon subsequent exposure, the antigen becomes bound at the cell surface by the preformed antibody. This phenomenon has been the basis of the skin test--an important aid in the diagnosis of allergy. In this procedure, introduction of the antigen into the skin, rendered sensitive by these previous events, induces pathophysiologic changes similar to those that occur in nasal and bronchial membranes upon natural exposure. The end result is an immediate wheal and flare inflammatory response. Much of the past research in this area has relied heavily upon the use of skin tests. However, in the 15-year interval since the first Surgeon General's Report on smoking, research developments have made it possible to add new insights to the topic of tobacco allergy. In 1967, the Ishizakas (51) identified the skin sensitizing factor or reaginic antibody as immunoglobulin E (IgE), thus providing a major breakthrough in the understanding of allergy. Subsequently came descriptions of the specific localization of IgE on membranes of tissue mast cells (111) and the release of chemical mediators from the protoplasm of these cells when IgE reacts with corresponding surface antigens (52). In such instances, the antigen can be classified as an allergen. Along with these advances came an appreciation of some of the limitations of skin testing. Among these is the fact that mast cell chemical mediators can also be released by nonspecific irritation (81, 99). Also, the presence of specific IgE fixed in the skin, as noted by the wheal and flare test response, is not the sole determinant for clinical expression of an allergy. Skin testing, done with appropriate materials TIEX 0008097 ~o-~
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The data did not show any significant association between parental a~l ~) m~/hr/cig was smoking habits and either symptoms or pulmonary function tests in spouses o~ children. ~ular system of the i$"diCn--ar~':~rul diseases. The In summary, a substantial proportion of the normal population ~l be examined here. experiences irritation and annoyance on being exposed to cigarette .11 smokers and 7 smoke. The eyes and nose are the areas most sensitive to irritation, and the level of irritation increases with increasing levels of smoke ~. were smoked or ,t~dg~_.~ _^~1 that the contamination. Healthy nonsmokers exposed to cigarette smoke have 1hey ,v~.~ ,^werin~" little or no physiologic response to the smoke, and what response does ~.a • aignifican~j° ~ ~'~ Nonsmol~ers WhO occur may be due to. psychological factors. There probably is a slight ,~l~'~e~r~e~e~v_ironmentshowed no reduction in the maximum exercise capacity in older nonsmokers etal. (56)performe~i, a exposed to levels of CO occasionally found in involuntary smoking alternately to smoke- situations. ~"~ they were under ~.~ that expOSure to the Effects of Carbon Monoxide in Psychomotor Tests -~-~o ~5 beats per minu_,te) There has been some cono a over the effects of relatively low levels of _r~','~%~l pressure. ~ne carbon monoxide on psychomotor functions (the ability to perceive and ¢{$~_.~ue.in part, to t.he react to stimuli), especially on those functions related to driving an ~[~-~nsitive to the automobile. Yabroff, et al. (85) recently reviewed this topic extensive- .... o~ults, or the ly. They concluded that "experimenters have found some performance -~ma~ ~ -- nee " ~. a~ t~ a differe tasks associated with driving affected by low levels of carboxyhemo- ~~-tobeingina globin, some as low as 2 percent. However, disagreement exists ~ ~ regarding the levels at which particular tasks are affected. These tasks ~. ~h a group of 56 include: ~la~htincrease in 1. Vigilance--both visual and acoustical needed for defensive ~_~=~-~ f~ the entire group, driving. ~ ~ indifferent to 2. Color vision and discrimination, especially important in discerning ~~ smoke, both taillight or brake light usage and traffic lights. for ~ ~ to smoke. 3. Brightness discrimination, important to driving as a clue used in ~ higher heart rate distance estimation. ~ ~ of the study, 4. Peripheral vision, used in surveying the environment, signs, and ~|~ h the physiologic other traffic. ~,~.,:~ 5. Glare recovery, which is the ability to recover visual acuity after ~llllll~k the exercise time being subjected to bright lights of another motor vehicle at night ~~iaerease in heart or in going from bright sunshine into a shaded area (e.g., a tunnel). ~li¢{lll~¢~oon monoxide. 6. Speech linkage." ~~l~ tl~ in younger A number of authors have tested driving ability directly. Ray and ~ ...... ,- Rockwell (63) found that, as COHb increased, time estimates were ~[~ to machine- shorter, distance estimates were longer, and taillight discrimination ~ ~ They were and determination of velocity change in the lead car took longer. There ~ ~ hag volume, were also slight changes in normal driving and cornering. Weir and ~ nitrogen Rockwell (85) also found slight deterioration in driving performance; measurements of visual acuity showed that drivers required more:time ~f-reported to retrieve visual information and spent less time looking outside the 1~, MEF~ forward direction (20 degrees x 20 degrees visual angle). These to 17. changes were noted at 6 to 8 percent COHb and are similar to those - TIEX 0008098 11--27
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found in drivers under low alcohol concentrations. The combined effect of alcohol and CO has been studied and no additional impairment due to CO could be demonstrated for tests of coordination or cognitive function (58). When actual driving skills were tested (SD, significant interactions between CO and alcohol occurred for tasks which demanded higher information processing such as curve negotiation and car following (at 12 percent COHb). In summary, it is possible to demonstrate changes in psychomotor function at levels of CO found in involuntary smoking conditions, but these effects generally are measurable only at the threshhold of stimuli perception. Effects of CO on driving performance and interactive effects of CO and alcohol have been demonstrated only for levels of COHb above those found in involuntary smoking conditions. Special Populations The above studies examined the effects of involuntary smoking on relatively healthy populations. An exposure that is harmless for someone who is healthy may have a very different effect on someone with heart or lung disease or hypersensitivity to substances found in smoke. Children are also a group in which effects may differ, due to their greater ventilation per body weight. This section will review the evidence on the effects of involuntary smoking for each of these special populations. Cardiovascular Disease Carbon monoxide, which has 230 times the affinity of oxygen for hemoglobin, impairs oxygen transport in two ways. First, it competes with oxygen for hemoglobin binding sites. Second, it increases the affinity of the remaining hemoglobin for oxygen, thereby requiring a larger gradient in POe between the blood and tissue to deliver a given amount of oxygen. Carbon monoxide also binds to other berne- containing pigments, most notably myoglobin, for which it has even a greater affinity than for hemoglobin under conditions of low P(:h. The significance of this binding is unclear; but may be important in tissues such as heart muscle, which have both high oxygen requirements and large amounts of myoglobin. In healthy individuals the levels of COHb due to involuntary smoking are probably functionally insignificant, with small changes being demonstrable only under extreme exertion. In individuals with a limited cardiovascular reserve, however, any reduction in the oxygen carrying capacity of the blood may be of greater importance. Ayres, et al. (11, 12) exposed a group of patients to various concentrations of CO (COHb 9 percent), and found that they had lower arterial and mixed venous POe's, decreased lactate extraction, and decreased coronary sinus POz. u-z8 T:I:EX 0008099
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Smoking & Health Research - Fiscal 1980 DEPARTMENT OF HEALTH, EDUCATION & WELFARE Natl. Institutes of Health Natl. Cancer Institute $13,235,000 Natl. Heart, Lung & Blood Institute 10,600,000 Natl. Inst. of Environmental Health Sciences 1,200,000 Natl. Inst. of Child Health & Human Devel. 2,358,000 Alcohol, Drug Abuse and Mental Health Admin. Natl. Inst. on Drug Abuse 2~973~000 $30,366,000 DEPARTMENT OF AGRICULTURE Science & Education Administration Agricultural Research Service $ 3,657,000 Cooperative State Research Service 46~000 $ 3,703,000 AMERICAN CANCER SOCIETY $ 300,000 AMERICAN HEART ASSOCIATION not available AMERICAN LUNG ASSOCIATION $ 200,290 TOBACCO INDUSTRY Council for Tobacco Research $ 6,000,000 Harvard Medical School grant 420,498 U. of Calif. (UCLA) School of Medicine grant 350,000 Washington U. School of Medicine $ 7,170,~98 U. of KENTUCKY Tobacco & Health Research Institute $ 3,323,865** Sources: HEW -- provisional figures from budget offices by phone, 2/10/81-2/13/81 USDA -- by phone from budget office, 2/~/81 ACS -- by phone from ACS, 2/11/81 AHA -- spokesperson reported by phone 2/5-/81 no such breakout is kept ALA -- spokesperson responded by mailgram 2/6/81 that ALA's "national research program provides starter grants to young investigators for basic research in several aspects of lung disease including reactions to chemicals, environmental pollutants and toxic agents"; annual report shows $88,130 for smoking and health research grants and $112,160 for smoking and health "fellow- ships" CTR -- by phone from council, 2/4/81 Industry grants -- from Tobacco Institute records (calendar 1980) U. of Ky. -- by phone from office of the assistant director, 2/4/81 * Basic cancer immunology ** Includes administrative costs The Tobeee~ Institute February 1981 (revised) TIEX 0008100
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7obacco Industry Research on Smokin~ and Health In the past three decades, hundreds of scientists have conducted thousands of research projects and written millions of words in dedicated exploration of the question of ~moking and health. Result: There are still eminent scientists who question whether any causal relationship has been proved between cigarette smoking and human disease -- including lung cancer, coronary heart disease or emphysema. They believe that much more exhaustive investigation will be required to clear up what the American Medical Association has called "at best a muddied picture". Nhat has been learned is this: Establishing cause-and-effect relationships, which have been claimed to exist by gove~,'~.ent agencies and other groups, is much more complex than originally thought. No ingrredient, as found in cigarette smoke, has been demonstrated as the cause of any human disease. Wh__~o sponsored the research There are those who believe that voluntary health associations have provided the money for most of this research. Others think it wins strictly a project of the various U.S. government depaxh~nts. It is true that both have been active to varying extents in this field. But, a major portion of this scientific inquiry has been financed by the people who know the most about cigarettes and have. a great desire to learn the truth-- the tobacco industry. The industry has committed itself to this task in the most objective and scientific way possible. A $91 million program In the interest of strict objectivity, the tobacco industry has supported independent research efforts with completely nonrestrictive funding. It established, in 1954, what is now known as CTR, the Council for Tobacco Research-UIg, Inc., to provide financial support for research by .independent scientists into all phases of tobacco use and health. Although funded by the tobacco manufacturers, CTR remains completely autonomous in its progrmms of gTants-in-aid and contracts for research with institutions a~d laboratories. It operates no research facility but works with the guidance of eight inde- pendent scientists and physicians in selecting the research projects it funds. As scientific advisory board members, these scientists retair~ their affiliations with their respective universities and institutions. Each researcher an~ instiru~zion funded by CTR has complete freedom to publish results, whatever they be. Total CTR research commitment to date: more than $64 million. TITX 0019533 TZEX 0008101
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-2- In 1964, the tobacco industry made a commitment for additional independent research that amounted, during a 10-year program, to $15 million. This com:nitment ~s made to the Educalion and Research Foundation, an arm of the American .~edical Association [A~k-ERF]. Under this progr~n the AMA-ERF, like the CTR, made grants for scientific research with complete freedom and autoncmy. h%at they did As of Dec. 51, 1980, the Council for Tobacco Research had awarded grants to more than 413 scientists in 258 medical schools, hospitals and institutions in this country and i0 foreigrn countries. During the l0 years of the AMA-EP/ program 2Z2 ~-ants were awarded to scientists in 87 medical and research institutions. While the projects of these researchers ms), be considered relatively nab-row in individual scope, the industry h~s not overlooked its research responsi- bilities in broader areas. • In 1971, Washington University in St. Louis announced a tobacco industry grant of $2 million to study p~ssible immunologic fsc~ors in cancer. The gr~nt has since been increased to $4.4 million. • In 1972, H~rvard Medical S~P=ol announced a $2.8 m~llion tobacco industry co~izment for a five-year study of pulmormry and cardiovascular diseases. The program was ex~tended in March 1977, with an sdditiorml $1.9 .~tillion for a total of $4.7 million. i In 1974, the UCIA School of Medicine announced.a $1.7 million ir.d~stry- financed research program on 2ung defense mechan/sms. The study also includes early detection and treatment of cancer. An additional $1.05 million renewal grant was announce~ in June 1979. T~e total commitment to clare is, then, $2.75 million. These projects total $91 million. In many years the toDacco industr~'s smoking-health research spendin~ has exceeded th~se of any government depart- ment. They surpass the combined tobacco-related grants of the m~jor voluntary health organizations. What the~, found The findings of research studies funded in wh~le or in part by the industry have resulted in publication of more t~mn 2,000 scientific papers in the professional literature, Through this work much valuable data have been produced abou~ the nature of lung cancer, heart disease, chronic respiratory ~ilments and other diseases. However, there's still a lot more to be learned. TITX 0019534 T206533 TIEX 0008102
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-5- The findings are not secret All of the more than 2,000 papers have been published in medical and scientific journals in the United States and other ~arts cf the world. These doc~-~ents are available, therefore, to scientists and doctors interested in the smoking and health issue. The work should go forward There are eminent scientists who believe that the question o£ smoking and health is an open one and tF~t research in thL~ area must go forward. From the beginning, the tobacco industry has believed that the Amer±can people deserve object±re, scient±fic answers. With this credo, the tobacco industry stands ready today to r~ake new co~itments for additional valid scientific research that my shed light on the question of smoking and health. TH~ TOBACCO INSTITUTE February 1981 TIT 19535 T206534 TIEX 0008103
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7obac¢o Industry Research on Smokin~ and Health In the past three decades, hundreds of scientists have conducted thousands of research projects and written millions of words in dedicated exploration of the question of smoking and health. Result: There are still eminent scientists who question whether any causal relationship has been proved between cigarette smoking and human disease -- including lung cancer, coronary heart disease or emphysema. They believe that much more exhaustive investigation will be required to clear up what the American Medical Association has called "at best a muddied picture". What has been learned is this: Establishing cause-and-effect relationships, which h~ve been claimed to exist by government agencies and other ~roups, is much more complex than originally thought. No ingredient, as found in cigarette smoke, has been demonstrated as the cause of any human disease. Wh___osponsored the research There are those who believe that voluntary health associations have provided the money for most of this research. Others think it w-as strictly a project of the various U.S. government departments. It is true that both have been active to varying extents in this field. But, a major portion of this scientific inquiry has been financed by the people who know the most about cigarettes and have. a great desire to learn the truth -- the tobacco industry. The industry has committed itself to this task in the most objective and scientific way possible. A $91 million program In the interest of strict objectivity, the tobacco industry has supported independent research efforts with completely nonrestrictive funding. It established, in 1954, what is now known as CTR, the Council for Tobacco Research-USA, Inc., to provide finmncial support for research by.independent scientists into all phmses of tobacco use and health. A/though funded by the tobacco manufacturers, CTR remains completely autonomous in its programs of grants-in-aid and contracts for research with institutior~s and laboratories. It operates no research facility but works with the ~uiclance of eight inde- pendent scientists and physicians in selecting the research projects it funds. As scientific adv/-sory board members, these scientists retain their affiliations with their respective universities and institutions. Each researcher and institution funded by CTR has complete freedom to publish results, whatever they be. Total CTR research commitment to dire: more than $64million. TITX 0019533 TIEX 0008104
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In 1964, the tobacco industry made s commitment for additional independent research that amounted, during a 10-year program, to $15 million. This commitment was made to the Education and Research Foundation, an arm of the American ~{edical Association [AMA-ERF]. Under this program the AMA-ERF, like the CTR, made gr~nts for scientific research with complete freedom and autonomy. ~gmt t.he9, did As of Dec. 51, 1980, the Council for Tobacco Research had awarded grants to more than 413 scientists in 258 medical schools, hospitals and institutions in this country and i0 foreign countries. During the i0 years of the AMA-EP/ pro~rmm 222 &n-ants were awarded to scientists in 87 medical and research institutions. While the projects of these researchers may be considered relatively narrow in individual scope, the industry has not overlooked izs research responsi- bilities in broader areas. • In 1971, Washington University in St. Louis announced a tobacco industry grant of SZ million to study possible immunologic factors in cancer. The grrant has since been increased to $4.4 million. • In 1972, Harvard Medical School announced a $2.8 million tobacco industry commitment for a five-year study of pulmonary and cardiovascular diseases. The proKram was extended in ~mrch 1977, with an sdditiorml $1.9 mil!~on for a total of $4.7 mill~on. • In 1974, the UCIA School of Medicine announced.a $1.7 million industry- financed research program on lung defense mechanisms. The study also includes early detection and treatment of cancer. An additiorml $I.05 million renewal grant was announced in June 1979. The total commitment to ~ate is, then, $Z.75 million. These projects total $91 million. In many years the tobacco industry's smoking-health research spending has exceeded those of any government depart- ment. They surpass the combined tobacco-related grants of the nmjor voluntary heal th organizations. What they found The findings of research studies funded in. whole or in part by the industry have resu/ted in publication of more t~mn 2,000 scientific papers in the professional literature. Through this work much valuable data h~ve been produced about the nature of lung cancer, heart disease, chronic respiratory ailments and other diseases. However, there's still a lot more to be learned. TITX o019 34 T20653~ TIEX 0008105
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-3- The findings are not secret All of the more than 2,000 papers have been publfshed in medfcal and scientific jourrmls in the United States and other parts of the world. These documents are available, therefore, to scientists and doctors interested in the smoking ~nd health issue. The work should go forward There are eminent scientists who believe that the question of smoking and health is an open one and that research in this area must go forward. From the beginning, the tobacco industry has believed that the American people deserve objective, scientific answers. With this credo, the tobacco industry stands ready today to make new commitments for additional valid scientific research that may shed light on the question of smoking and health. THE TOBACCO INSTITUTE February 1981 T206534 TIEX 0008106
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Tobacco Prepared by The Tobacco Institute Industry Washington, D.C. 20006 Telephone: 202/457-4800 or toll free: 800/424-9~76 Profile 1980 .p.__,~. ;. ":. ,-T~ ~ ...-..- • -" .~. •. ;~... Consum on .. : : ~;,:~-,~,:.~. -:-->.~. U.S. Tobacco Production To¢~l U.S. cons~=pdo, including ov¢rscas armed forces Tobacco Growing was about: , • "E~acco is grow. on an estimated 276,000 farms in 22 states. ~¢r¢ were 543,535 aJloemems [o grow ¢obacco • 620 bllllorl cigarettes sued by the t'cdcraJ gov¢mm¢,[ for 1979.* The acreage • 4.3 billion large clgars and cigarillos harvested was 826.320, ~ ~3 p=ccnt drop from 1978, with • 1.5 billion little cigars aa ~v,'rag¢ yield of !,848 pounds per ~cr¢. Toea~ U.S. h~- • 39 mllllon pounds of pipe and roll-your-own vest was the sma~Ics~ in 36 yeats because of smaller tobacco planted area., an cxtrcm¢ly wet growing sc~so, and • 100.9 million pounds of chewing tobacco worse outbreal¢ ever of a leaf ~,gus. Early ¢stima¢¢s on 1980 harvested acres indicated a rise ¢o 923,000, almos¢ a • 23.9 million pounds of snuff " ::"' ~ " "13 perc~t The output of cigarettes from U.S. factodcs'wasT04..4 biI- A breakdown b~ type of tobacco ~own in 1979 shows lion. - ' flue-cured, 945 million pounds; budey, 447 million; south- Of the total, 12.7 billion cigarettes were shipped"to~0ver- ern Maryland, 22.0 million; fire-cured, 45.0 million; dark seas forces, 1.2 billion to Puerto Rico and other.~U.S, air.cured, 17.0 million; cigar filler types, 20.0 million; possessions and 79.7 billion to other countries, cigar binder, 28.0 million; and cigar wrapper, 4.0 million. Per-capita U.S. cigaz'ett¢ consumption, based on popul,,- "lbbacco growing" requires a great deal of labor. More than tion 18 and over, was 3,924. Record high wa~ 4,345, in . a ha/f million farm families are involved directly and indi- 1963. . ~ recdy in producing tobacco in the U.S., aided by addi- .. -: tional seasonal workers. Approximately 250 man-hours of F, xpend~tgre~ labor are required for each acre of tobacco harvested. By comparison, it takes about three man.hours to harvest an U.S. expenditures for tobacco products were estimated at acre of wheat. $19 billion, a record high and an increase of almost $1 bil- lion more than in 1978. Tobacco Sale~ About $17.5 billion, approximately 92.1 percent, was for Approximately 95 percent of the nation's tobacco is sold at cigarettes, $670 million for all cigars and $830 million for auction in 157 markets, with the remainder sold directly pipe and roll-your-own tobacco, chewing tobacco and from the farms or by farmers' cooperatives. snuff. ,. The average price of tobacco sold at the 799 auction ware- house sales floors in the U.S. in 1979 was $1.41 per WoIld Pro~uct|orl pound, ~ 15.8 percent increas¢ above 19"/8's $1.22. Tota~ world production of tobacco was estimated at 5.6 Crop Income mJlfion me~c tons, about :3 pexcent below last year's out- pat, mosdy because of weather and disease damage in the Tobacco was the sixth largest cash crop, behind corn, soy- Northern Hemisphere. beans, hay of all kinds, wheat and cotton. The tobacco Major tobacco-pr~lucing nations were: Republic of'China crop was worth more r_han $2.2 billion, representing 2.9 (970.0(30 metric tons). U.S. (703,290), India (451,200), pement of the ~oral for all cash crops and farm corn- Brazil (397,000), USSR (264.000), Turkey (2_39.000). Bulgaria (157.300). /apart (~53.200), Greece (125,338). Zimb'abwe (~12.500), Republic of Korea (111,600) and *The allotment total Js lager ~haa the number of farms. Some ItaJy (l I 1,000)o farms arc g~ven allo(ments for more than one type of tobacco. TIEX 0008107
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modifies. The U.S. Department of Agricultur~ (USDA) fcx'm of cigarette excises. Federal, state and local govern- estimates these cash receipts from the crop in 1979: merits collected $6.3 billion in direct taxes on tobacco prod- acts in FY 1979, Cigarette taxes represented 98.8 percent, or $6.2 billion., (rnil~$ c~ do,lain) "l~es on other tobacco products totaled $78,4 million, Since Nor~ C~rolina ...... 894 Cenn~-fl~at ......... 26 1863, when cigarettes were added to the tobacco products Kentuek'y ........... 549 Ohio ................ 22 taxed by the federal government, governments at all levels South Carolina ...... 178 Wi~cona~n ........... 22 have collected over $138.9 billion in tobacco taxes. Ciga- Vl~inl,, ............ 15g Indi~,r~ .............. lY re~es have accounted for 94.3 percent of that, or more than Tcnns~ .......... "15~ Pcrmsylwnl- ........ lS $130 billion. • ~" ~..: ..... :,:,-~.. ~ ......... .~":"..i ~ " ....":= '.~::,- Z: :" :: .~ " " . . .. -, 3" : - . - ~ .-.--~-. :- .- ~ .... ,-o ,.. .,.. ; ~ .:...~;.~.y::~.~.~ ~......W~..~g/o~ ...-=..._.¢~ ..~-_ TI~ federal, government's~ share w~-$2.4 billibn, with ,. . ............ ,; ,_ .- . ,,-_ ._~ . ~.'~..~. .... - , , . . , " , .... - ...... ..~ ~/.gat2e~ taxes,, at 8 cents per pack, accounting for 98.3 " .':: ",":::.':,C-',"!~:'::::~.~:~.,~::~i ":¢ ~ .~.~. -~'~'~i4:~ ~.~.,.~- "_~.~ ~nceiat, o¢$2~ ~illion. Aleut $41 million was collected on ""lhbac~o. i/ also'grow~i/~ Alabama, Arkansas, Illlndi~. ='.-~ oth= ag,~__~products. , ,.. :... • Kansas, Louisiaaa~ Minnesota and:the Commonwgalth of .,.~: _~ " , ..... : :: i - : '-."-, ~-." Puerto Rico, " -" : ~" ": / - =. -',',-~'- ~::'>--~;~":~,:- ~tat~ . . "...,. • .,. :. ..... • :~ , • :: ." ~,-:--:' -. "~:" :,~.': State taxes on all tobacco products were more than $3.7 - bilHon. Of the total, 99 percent was cigarette taxes, and Gov@ITlrn@ll~ - nearly $35,3 million was collected on other tobacco prod- Tobacco Programs " Parm Guotas ..... , ...... Local USDA administers laws tostabilizetobaccoproductionand Tobacco taxes in 365 cities and counties yielded $127.9 assure fair prices. Most tobacco farmers, through periodic rail!iota Of that amount, $127.7 million, or 99.9 percent, referenda, have continued to favor marketing quotas. Be- was taxes on cigareltes. Local governments collected • cause of the production cbntrols, less tobacco is produced at, . $140,000 on other tobacco products. high~" prices than would b¢ Likely without them. . . :- ~ --? "~: ~.': ". ,i'::,:. .' " : , .." . -" ..'" ~ ...... - ".'- - '~ ~ -'-"- - When growers approve n~a~keting c~uota~ f(~r a certain type ;' ' " Manufacturing of tobacco, price supporm for it axe mandatory. Under the Factoltes price support program the Commodity Credit Corporation (CCC) makes loans to farmers through theh- cooperative /n FY 1979, I~.3 factories with federal permits rnanuf~ctur~d asso~a~ons, w~th the tobacco• as collateral. The associ- tobacco products in 20 states. The concentration was in the a~Jons handle- and sell the tobacco, repaying loans as the. s<~hwest and mid-Atlantic states. tobacco is sold. The realfzed cos~ of the price suppo~ Ir~ FY'.1979, 218 warehouses wer~ authorized by the U.S. program since its s¢art ~n 1933 has been about. ! percent of governmen~ ~o export tobacco. Federal permits to manufac- the cos~ for all 13 farm commodRy pric~ support programs, mre cigarette papers and tubes wer~ issued ~o six establish- [n FY ! ~ the tobacco program lost,/~l~[~,,~ merits. u .... ~ ~ ~'~ ~;~ -,~ r~..f.~ .... ~,.~.-.Z^ .... ,~ ~_. Employment ~:~,,~,,,.,.,., ~,.,~ .... ~,: ::.:~ ..=_ L~,.~; ;,~,~,,.,2 .~.tt. Some 69,900 persons were employed m tobacco manufactur- ,., -. ~.q~$~ ,.X.k,,e~¢~.~ ingduring 1979, rept~sentinghandred~ofmillions inpayroll ,araamg ,. "~ " ~ .L~.~ q/ dollars. The 55,400 in production averaged $252.70 a week USDA grades all tobacdo before it is sold. Government~,~ and worked a, average of 38,0 hours weeldy. grade standards are the basis for CCC loans. Daily market, c-he ~, the manut:acmr~-- emr, lo,~ees two-thirds or a--roxi- news r~ports inform growers of prices and market condi ~ ....... ¢" r ~ • , r~- ~ . . • , " . .mately 45,300, wer~ employed by cigarette manufacturers, tion~, the ......... fiscal year inspection aria market news servlc¢ ~,~An° oth~ 7,800 worked ~or cigar makers. The remaining COSTS Were ~ O rtlIIllOI1 t c ." .. "... ";.', " -," ' ':.- "_ ~_: _~ .k~ 16,800 were i? .oth.er aspects of obac o manufacture. Government e eipts from Taxes Distribution and Sales Total Excises Retail More than halfthereceipts from domestic civilian rctailsales An estimated 1.4 million retail oudets disu'il~te tobacco of cigareltes went to federal, state and local treasuries in the products. They range from individual vending machines to TIMN 328538 I TIEX 0008108
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tobacco departments of large chain-opented stc~es. Related of impccted manufactured produc~s was $51.4 million, up 2.6 employment numbers in the millions, penmnt from 1978. Wholesal~ More than 1,520 primary tobacco wholesalers and another Over 79.7 billion U. S. cigarettes were exported to 150 coun- 1.054 miscellaneous wholesalers dis~bute tobacco prod- tries last year, a 7.7 percent increase over 1978. At $908.6 ucts. The 1979 trade estimate of the wholesale value of million, their value was 21.2 percent greater than 1975 tobacco and related products is $12 billion. Cigarettes ac- ports. Th¢ leading importers were Belgium-Luxembourg, counted for almost $1L4 billion, cigars more than $367.8 Hong Kong, United Ara~ Emirates, the Netherlands Anti- million and chewing, pipe and roll-your-own tobacco ~d He,, Saudi Arabia, Kuwait, lapan, Spain, Iran and the Ca- . snuff another $139.4 million- Other smokers' article% such- ' mu-'y. I0.1ands. • " .... "~ ~t~lt~ I~l~.t~^,,~, " . :-" ',~L" -:" "' Cigar; cheroot and httl= c~gar exports were 17%2 mflhon ... , . ,~ml,q,,=~ t=~= ~, ' ' - ~ units, valuedat~.8 m/Ilion. Th¢ quantity represents an I1.7 : " : m/Ilion unit increase over 1978. Related Indu~o$ About 2 million pounds of foreign cigars and cheroots (al- Dependence on a complex indus~al and s~rvi6¢ n~two~ most lOO million units) were imported with a value of $28 • greatly extends th¢ contribution of tobacco to th¢ nation's million. economy. The need for farm and~ manufacturing materials, supplies and equipment as well as services ranging from Exportsofpipoandroll-your-owntobaccoinbulkwere26.9 transportation to advertising provides employment to addi- million pounds (10 times 1978 exports) and 948,000 pounds tional millions and adds humiteds of millions of dollars to in packages. The/r value was Y~.3.5 million and $2.~ million .......... respectively Exports also included 95,000 pounds of snuff pel3onnt ~ onsllless lll¢Om~ lit ;HtllOSt ev~ $ia[e. " .... " Exports and Imports ~ore than 99 l~:ent of all leaf tobacco exported was ship- The United S~ates is the leading exporter of tobacco and the. trod from the East. ,.~e major custom district ports were: third largest tobacco Lmporter. In rbcent yeazs al:~ut one-third of the U.S. tobacco crop ha~ been exported. In 1979, U.S. exports of leaf tobacco and manufactured products totaled almost $2.2 billion, a record and $300 million more than in Me~z Tons Value {millions) 1978. Imports totaled approximately $463 million. The dif- Nodelk ............. 129,853 $549.8 ference represents a record positive contribution of more than Wllmin~toct .......... 93,193 452.9 $1.7 billion to the U.S. balance of peyments in ca/endar y,ar Baltimore ........... 11,304 58.2 1979. New York ............ 6,196 43.2 New Orlean, ........ 4,458 19.0 Leaf Charte~ton .......... 4,411 19.9 gierni ............... 3~223 15.6 More than 567 million pounds of unmanufactured leaf to- bacco were exported. Value was $1.2 billion, compared with Imports of unmanufactured leaf totaled 377.2 million Cigarettes accounted for.98 percent of the value of manufac- tured tobacco products exported. The major ports shipping pounds, valued at $412 million, a 12.3 percent increase over cigarettes overseas were: the 1978 total of 336 million pounds. More than 40 percent of the leaf imported, about" 167.I million pounds, was oriental, for use in domestic cigarettes. Units 0~llto~,,) Value (rni,lons) Turkey continued to be the ma.j~r supplier of this kind of leaf, Norfolk ............. 38.9 $453.1 followed by Greece, Italy, Bulgaria and Yugoslavia. Baltimore ........... 14.0 152.1 New York ............ 9.~ 107.S Products Miami ............... 7.O 7~.~ The value of exported manufactured products in 1979 was San Francisco ....... 3.3 37.5 more than $96¢ million, a 25.7 percent increase. The value TIMN 328539 TIEX 0008109
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T~'$ ~,ofltrJbutJofl begun in 1978, shows tha~ in 1979 zoba¢co generazed all- to An ri a's Natiorml E onomy r~.y and indirectly, in all ~0 s~ates: A new study by the Wharton Applied Research Center of * 2 million lobs o~ sll kinds the University of Pennsylvawia shows that tobacco and to- * $30 billion in wage~ and earnings bacco products generate $57.6 billion annually toward the * $1S.5 billion In capita! Investment Gross National Product. • $22 billion in federal, state and local taxes Tobacco's ¢onu-ibution to America's GNP is roughly two and a half times net expenditures on the industry's prod- ... in all, almost 2.5 cents of every dollar generated by u~ts, demonstrating (h-ama~ic.ally fl~e magnitude of toba~o th : .... .~u.~ "o --'~ b'" ^ -edcans in a : r - . . : -. ~ =..s~.e.yem~ ,A s .... j ramr~et o~ the stud, ~s available The new study, "ancexteosion of a first_-of-i~-kind-l~roject.,~ " ~mm.'I~te "lbbaccoInstimte.) SOURCES: U. $. Depar~nent of Agriculture: Economics, Tobacco Tax Council, The T~z B~en ~n Tobacco, 5407 Statistics, and Cooperafive~ Service, Tobacco Sim~uion, Patte~on Avenue, Richmond, Vtrginia 23226. Agricultural Outlook and Crop Produc~on." Foreign Ag- ricultural Service, Foreign Agriculrare C~rculo.r (To- National Association of Tobacco Distributors, The ~wco) and United States Exports; Agricultural Smbi|iza- C~or~finator, 630 Third Avenue, New Yolk, New York tion and Conservation Service, Commodity Cred~ Cot- 10016. , .. potation Repor~ ~ Fi~owial Condition and Opermz'on~. :" and Commodity Fact Shee~s: AgrlcuItural Marketing Cigar Association of America, Misceflo~eous C~gar Service, Tv~cco M~rket ReWe~. . . dustry Monthly Statistics, 1120 19th S~reet, N.W., Wash- U. $. Departmen~ of Labor:. Bureau of" ~c Statistics, ington, D.C. 20036. .... " Employment and Earnings. Wha~on Applied Research Center:. A Study of ~he U.S. U.S. Department of" ~easury: Bureau of Alcoho|, "lb- Tobacco Induswy'~ Economic Contribution ro ~he Nation, bacco and Firearms, Esmb[i~hmen~ Aurhori~d To 017- lt~ Fifty Stores m~l ~e Dtsrr~cr of Colurrd2ia l~79, The erote Ureter the Supervision (~f the Bureau of Alcohol, Wharton $~hoo|, University of Pennsylvania, Philadei-" Tvbacco and FirewT~. • . • - phia, Pennsylvania I910~, _ -:.~ .."....~...~ -_.:-... - . . TIMN 328540 TIEX 0008110
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"1 T061~45 The Tobacco institute Tobacco National 16751 Street, Northwest Institute Edition Washington DC. 20006 TIMN 00993801 TIEX 0008111
Page 526: CBP10111
" T061~,46 America's Golden Leaf The $21.3 billion Americans paid Giving the over the counter in 1979 for tobacco U,$, Economy products generated $57.6 biJlion to- $57.6 Blllion~., ward the nation's GROSS National Product. accorc~ing to a new study by the Un[versityof Pennsylvania's Wharton Applied Research Center. Tobacco's estimated contribution ~ the 1979 GNPwas roughly two and a half times net expenditures on the industry's products. This fact alone demonstrates drama[icaJly the mag- nitude of tobacco's i.ndirect, or"spiIT- over," effect on the nation's economy. The new study, extending a first-of- its-kind research project begun by Wharton in 1978, delines the direct contributions and multiplier effects of the five major sectors ot the to- bacco industry: farming, auction warehousing, ma~nufactudng, dis- tdbution and sales. Wharton measured the jobs, in- comes and taxes generated by those aotivities in 1979 and, using an econometric model, determined the ripple effects of America's oldest industry and its essential supplier~ on the entire U.S. economy. • -/.: .... TIMN 0099381 TIEX 0008112
Page 527: CBP10112
T061247 America's Golden Leaf Providing From field hanC to cfuality contro~ siva, lhe major leaf-growing states Mare Than engineer to the neighborhood rank high, too. An impressive 2 Million businessman who knows his cus- 7.4 percent of employment in Ken- Jobs,.. tamers preferences m tobacco tucky, for instance, is directly or in- products, the industry employed - directly attributable to tobacco, 6.8 more than 393,000 persons full time percent of lobs in North Carolina. in t979. One surpdsirtg finding is that to- Another 1.6 million jobs existed in bacco contribute8 3,800 jobs in other industries because Americans Alaska. or 3 percent of that pioneer enjoy tobacco. Some are obvious, state's total employment. such as matchbook real<ors and Tobacco accounts for 4.6 percent of packaging suppliers, even flavoring oil U.S. agricultural employment, formulators and public opinion sur- Wharton estimates almost 103,000 veyors who learn what the 13ublic full-time jobs in tobacco farming, wants in its tobacco.produc~s. But and at least another 400,000 part- the income flows generated by the time during harvest time. Tobacco is popularity of thego~en leaf create grown in 22 states, including some jobs too, in sales and service indus- that may su rprise the average Amer- tnes of all kinds, from utilities to auto- icon because they are as far removed makers to advertising, from the Old South as Massachu- Tobacco and its supplier industries setts and Minnesota, Pennsylvania and Indiana. account directly and indirectly for the employment of 2.5 ;3ercent of The Wharton study revealed the America's private sector labor force, equivalent of 2,670 fuIMime iobs in The largest numbers of jobs, gener- the auction warehousing sector. ally, are in the most populous states ; However, the seasonal nature of the (see table, page 6). But because , tobacco farming is so labor inten- Yob~ct:o's Cont~ibut|on to Employment 2.S% T~o income I~ws generated by [he . pooulanty of the ~olclen leaf create lOt:s too. in ~ales ~eS of aJI ~nds, from uSllttes to au~omak. ors tO advertising. • .--. TIMN 0099382, TIEX 0008113
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To6124S America's Golden Leaf operation entailed employment of others) and corrugated containers Paying Bills more than 17.000 part-timers. (inclucling Iowa arid New Jersey). For People... Employment in all 50 states is of- All told, the 2-million-plus persons fected by tobacco distribution and whose jobs relate to tobacco earned sales. The golden leaf's total con- - $29.9 billion in 1979. These workers tribution to wholesale and retail era- had disposable income of $27,6 ployment, an estimated 880.000 lion to spend on the goods and ser- lobs. is second within tobacco's , vices of still other industries, The core sectors only to that of tobacco direct and indirect contribution of f~lrming, at 4.4 percent of the no- the tobacco industry to U.S. person- tional total. The 167,500 tobacco- al consumption expenditures was related jobs in re[ailfng and vending $49.0 billion, or3.3 percent of the comprised 39 percentof all employ- national total. This and the $15.5 bil- merit Cirectly generated by tobacco lion total capital investment attribut- in 1979. abte to tobacco activity affected all sectors of the economy, bringing Nearty 36,000 persons produce dollars to the local department goods and services purchased store, the beach resort, the foundry, directly by cigarette manufactur- even :o [he typewriter service ors. Employment is generated by contractor. transportations and marketing of cigarettes in every state, but rough- ly half the states have acldittonai jobs because cigarette makers buy such major necessities as the flavor- ings and humectants, which prevent drying in processed leaf (California. Florida and Texas are,~ust three). paper (including Wisconsin. Mis- souri and Ohfo), packaging film (Connecticu,: and New Yorl£ among Wisco0slfl In~ludad in Wharton Applied . Z-.-~ New Yor~ study ¢l~toba~oo' s dll*ect andindirect ~" '' ' contributions to thc U.'~. are separate Pen nsylvanla and all the|r counties. California Individual studies will be Included In this / Ihn ~" serles~AmericaJs ~ l "~ois Kentucky ~ Tobaec~institute ~ .... " ' " ~ • - • beginning inOotober ~f Tennes=ee "NorthCarolina "-~ 5 .:-'i :-- :TIMN 0099383 TIEX 0008114
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T061~49 '" " TIEX 0008115
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TOGI:50 America's Golden Leaf Generating Tobacco is more heavily taxed than government in t 979, and 2.6 per- $22 Billion any consumer product, starting with cent at the state and local level. This In Taxes... the more than $6 billion in excises was one of the most significant pumped annually into federal, state direct contributions of America's and Ioca~ government coffers to golden leaf to the national economy. help with everything from road building to school lunch programs. The"cores" of the tobacco industry The U.S. Treasury receives 8 cents --farming, auction warehousing, manufacturing, intermediate dis- and the states 2 to 21 cents in taxes tribution, including wholesalers for every pack of cigarettes sold• At and manufacturers' sales forces. least 360 municipalities add taxes of their own, ranging from 1 to 10 cents and retailing and vending--contrib- a pack. uted almost a penny of every federal tax dollar and more than acent Wharton surveyed taxes genera(ed and a half of every state tax dollar by bhe tobacco industry and by the collected in 1979• ripple effects it produces. The result- ing pemonal and corporate income. Farming and manufacturing alone real estate, personal property, so- contributed $58 million to local cial insurance, excise, sales and treasuries in real estate and person- other indirect business taxes totaled al property taxes; local sales taxes $t4.3 billion [n 1979 at the federal added and local level and another $7.7 billion at the $t28 million. state an¢~ local levels. Looking at it another way, excises and sales taxes on tobacco prod- ucts accounted for 8.1 percent of all such taxes collected by the federal Cont~tbution to State and Excise $3,~, 1,5 Federal TeXN Sales 398.9 in t979 Corporate income 195.9 Total $4,31 ?.8 Total direct Fedml contribution to loc~| tax revenues was Ex $248 million Flea .;28.5 Personal income 4~. 1 Corporate Inoom~ 1,028.0 ~ Total .... |4~442.5 ... " ++i.i :. " TIMN 0099385 TIEX 0008116
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America's Golden Leaf ~, Best Selle~ American smokers likeAmedca's : ;;~. Here and tobacco, as do smokers arounct the Abroad... worlcl. U.S. smokers--and chewers and snuff users--purchased $21.3 billion worth of'tobacco products in 1979, according to the Wharton study. That included a record 624 billion cigarettes. The U.S. is the world's largest tobac- ' co exporter, shipping one-third of its entire crop overseas. In 1979 tobac- co directly contributed $2.2 billion to the natio.n's exports and $500 million to its imports. This continued to have - " a positive effect on the country's in- terna[k~nal balance of payments. Those tobacco products sold in ~his country in 1979 entailed the service, ~, in transfer from farm to manufacturer, ~.~. _ of 151 auction markets in 12 states. They accounted for roughly $2.4 billion in sales. The distribution sector, operating in all 50 states, included more than 1,500 p rimar~ tol3acco wholesale companies and 1,000grocery, drug and other wholesale firms whose 1979 cigarette and tbbacco prod- ucts sales were $15.3 billion, or 86 Percent of wholesale tobacco sales. The remaining 14 percent was purchased and distributed by retail chains. Six cigarette makers operated 12 manufacturing facilities in four states, and 56 makers of cigars and other tobacco ;)inducts were widely scattered in 14 states. Twelve per- cent of all their products were sold in 1979 through vending machines, the rest through supermarkets, con- venience stores, gas st~t~'ons, dnJg stores, discount stores and, of course, tobacconists. "'-' :.:.. ' ....". !TIMN 0099386' ....':- ,..:.~:.:.. ; , TT_EX 0008117
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America's Golden Leaf Regardless o! Golden~ formation into the fille Dbacco prod- ~butions to the economy, the con, tiny tobacco seed con~dbu[es tO ~he smoking and nation's Gr~s National Product in a ~talth must ~ropo~on inordinate to its size. On e.tifl¢ tlleat¢h. its way tO the consumer tobacco ~e=timt, ~he accounts for 2.4 percent of~e GNP, ~ob=¢=o Institute or ~most ~o ~d a half pennies or f~ee and info~ eve~ dollar generat~ by all ~e di=cu,=i~, of tobacco i:in the goods and sewices r~de[ed to publi¢ interest. and by ~meric~s ~n one b~ause Amenca and ~e enjoy tobac~. ~e golden leaf is in~e~ golden eve~ sense of the word. TIEX 0008118-
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To61245 The Teba¢¢o institute Tobacco National ', 8751 Street. Northwest Institul:e Edition Washington OC. 20006 TIMN 0099380 : TIEX 0008119
Page 534: CBP10119
TO61247 America's Golden Leaf Providing From fielc~ hanc to Cuali['y control siva. the major leaf~rowing states More Than engineer to ~e ne~g~bor'nood rank high, too. An impressive 2 Million businessman who knows his cus- 7.4 percent of em01cymet~t in Ken- Jobs,,, tomato preferences in tobacco tucky, for instance, is directly or in- 13roducls, the industry employed - directly attributable [o tobacco, 68 more than 393,000 persons full time percent of lobs in North Carolina. in "t979. One surprising finding is that Another 1.6 million iobs existed in bacco contributes 3,800 jobs in other industries ~3ecause Americans Alaska. or 3 percent of ~at pioneer enioy tobacco. Some are obvious, state's total employment. such as matchbook makers and Tobacco accounts for 4.6 percent of packaging suppliers, even flavoring atl U.S. agricultural employment. formulators and public opinion sur- Wharton estimates almost 103,000 veyors who learn what the ~3ublic ful[-time jobs in tobacco fanning, wants in its tobaccqptoducts. But and atleast another 400,000 part- the income flows generated by the time during harvest time. Tobacco is popularity of the go~c~en leaf create grown in 22 states, including some jobs too, in sales and service inclu~ that may surprise the average Amer- tnes o| all kinds, from utilities to auto- ican because they are as far removed makers to aclverti$ing, from the Old South as Massachu- Tobacco an~ its supplier industries sorts ant Minnesota, Pennsylvania and Indiana. account directly and indirectJy for the employment of 2,5 percent of The Wharton study revealed the America's private sector labor force, equivalent of 2.670 full-time jobs in The largest numbers of jobs, goner- the auction warehousing sector. ally, are in the most populous states However, me seasonal nature of the (see table, page 6). But because tobacco farming is so labor inten- ~nt~butlon te Eatp~yment I T~e incom~ genera~e~ by me gol~l~ leaf create ~o~ too. in sale~, u~J~Jes to automa~- ~, ors tO az:Ivertls~lag, t .... . TIMN 0099382, TTEX 0008120
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~8000 X~& ' 0~6600 N[IAII& . :....
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TOGI 50 America's Golden Leaf Generating 'TObaCCO iS more heavily taxed ~h, an government in 1979, and 2.6 per- $22 Billion any consumer product, starting w~th cent at :he state and ~ocal level. This In Taxes... the more than 56 ~iilion in excises was one of the most significant pumpecl annually into federal, state direct contributions of America's and local government coffers to golden leaf to the national economy. help with everything from road The "cores" of the tobacco industry building to school lunch programs. The U.S. Treasury receives 8 cents --farming, auction warehousing, and the states 2 to 21 cents in taxes manufacturing, intermediate dis- for every pack of cigare.~es sold. At tribution, including wholesalers least 360 municipalities add taxes of and manufaclurers' sales forces. their own, ranging from 1 to 10 cents and retailing ant vanc;ing--conmb- uted almost a penny of every federal a pack. tax dollar and more than a cent Wharton surveyed taxes generated and a t'~f of every state tax dollar by t.he tobacco industry and by the collected in 1979. ripple effects it produces. The resuft- Farming and manufacturing alone ing personal and corporate income, contributed $58 million to IocaJ real estate, personal property, so- cial insurance, excise, sales and treasuries in rea~ estate and person- other inctirect bus~ness taxes t~taled al properb/taxes: local sales taxes $14.3 billion in 1979 at the federal added $62-million and local excises level and another $7.7 billion at the $'~28 miilion. el:ate anc~ loc.-~ levels. Looking at it another way, excises and sales taxes on tobacco proc~- ucts accounted t~r 8.1 percent of all such taxes collected by the federal Cont~ibutlan to State and Exoise $3,851.5 Fecllr=l Taxes Sales 398.9 Gorp~rete bt©ome ~95.9 T~:taJ clirect Fed,oral Taxes Imil~|on~) $:~48 rnil/ioa FIGA 528,5 Personal in@area 466.1 Corporate ln¢ome Total ~4,442,,~ S ' ., " ,.i..i " " TIM-N 0099385. TIEX 0008122
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Let's set the record straight... There is no tobacco subsidy! One of the most misunderstood To remedy the situation and to 24 types of tobacco produced in the facets of the tobacco industry" is the prevent a recurrence, the nation's U.S. and Puerto Rico are under price support program. Industry critics leaders proposed and Congress the program. denounce a federal bureaucracy that approved permanent government Tobacco farmers accept strict encourages farmers to grow the leaf programs aimed at stabilizing the acreage and poundage allotments set while discouraging smokers from using national economy, including yearly by the U.S. Department of tobacco products, agriculture. Tobacco and other farm Agriculture (USDA). Total allotments, Ending the tobacco "subsidy," commodities were covered in price the "national marketing quota," equal they argue, will put an end to this stabilization and production the amount USDA estimates will meet apparent dichotomy, control legislation, domestic tobacco industry and foreign In fact, there is no tobacco subsidy. The 1938 Agricultural Adjustment buyer needs. There/s a government price support Act established acreage allotments, The price support program does program. It guarantees farmers a marketing quotas and a regulated more than control quantity. It estab- minimum price for their tobacco. And marketing system for tobacco. The lishes a minimum price for tobacco their corn, flee, peanut and cotton program ensured that the farmer sold at auction. This minimum price is crops ~ 13 different commodities would earn a reasonable return on his especially important to the tens of altogether, considerable investment, yet provided thousands of farm families who grow The money isn't a gift. It's a loan, for an adequate supply of tobacco to tobacco on acreage so small that no repaid with interest. In the 47 years meet domestic and export needs, other crop there could support since the tobacco price support a family. program began, it has been the most HOW it works Most tobacco today is sold at a successful farm program the All types of tobacco are eligible warehouse auction after grading for type and quality. The grade determines government has ever had. for price support. The program is the per-pound price support. voluntary, with growers of each type If leaf is unsold at the government- How it all began of tobacco given the option, via pegged minimum price, and if the More than a half century ago, the referendums every three years, to tobacco grower has not exceeded his Great Depression was threatening to participate. Currently, 20 of the production quota, he is eligible for a destroy the American economy. The government loan equal to the support stock market had crashed. Businesses price. The tobacco is taken as loan were closing, Unemployment lines collateral by a government-funded, stretched across the nation. Consumer grower owned and operated purchasing power was low and cool~erative, which processes and agriculture prices could stores it for future sale. not sustain farm families. The 1932 tobacco crop sold for nine cents a pound, and farmers were using leaf as fuel rather than sell at a loss. TIEX 0008123
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The money the cooperative pays television audience in 1981 he wasn't big farmers and by newcomers, a drop the farmer is loaned to it by USDA's going to complain about the cost of in price, a decrease in income for many Commodity Credit Corporation tobacco price supports. "It's making small farmers who depend upon (CCC), the price support program us money," he said. income from an acre or two of leaf for overseer. The government does incur other their existence, and the squeezing of minimal expenses, such as inspection small farmers offthe land because What it costs and market news service costs. Recent banks and other f'mancial institutions Among the most imperishable of administrative costs have totaled about will not provide operating loans farm crops, tobacco can be stored as $6.6 miIffon annuaJly, varying down- without guarantee of repayment, which long as several yeats before being sold ward in earlier, pre-inflation years, is presently assured by the price in a more favorable market. During the half-century that support program. Loans are made on a crop-year taxpayers have "lost" $57 million on There would be widely decreased tax basis, and it may take a number of the program, tobacco product collections in 20 states that grow years to dispose of loan receipts from purchasers paid the U.S. Treasury tobacco, widespread disruptions in a particular crop. However, when the more than $72 billion in excise taxes, banking and commercial systems and cooperative sells the tobacco, each including the current federal tax of -- to continue the scenario to its logical government loan is repaid with eight cents on each package of conclusion -- regional recessions. interest. If sale proceeds don't cover cigarettes. They have provided state If Congress were to heed critics, the loan, the unpaid balance is written governments with an additional $56 considerably increased acreage could be off as a program cost. If proceeds billion and local governments with devoted to tobaccco. With restrictive exceed the loan, the net is distributed another $2 billion in the same period, quotas gone, a larger tobacco to the growers, supply would enter the market, at In 47 years of tobacco price There is no tobacco subsidy reduced prices. support, the CCC has loaned farmers So there is no tobacco subsidy. Some more than $5 billion. The repayment misinformed critics argue that, even if Encourages smoking? rate has been about 99 percent. Loan there is no subsidy, the program makes Does the price support program repayments plus interest have exceeded tobacco products more readily avail- encourage starting or continuing to losses in almost all 47 years, able. But they ignore two basic facts: smoke? Yes, say critics. No, say The $57 million net loss currently I. The program is intended to, government health officials. on CCC books is the result of but two and does, keep tobacco leaf John Pinney, director of the or three major losses. They amount to prices higher than they would be government's Office on Smoking and just one-tenth of one percent of all without it. Health, declared in 1980: "We've losses for a/l commodity price support 2. The program is intended to, and reached the conclusion that the price programs (see table), does, keep domestic tobacco support program in no way affects any Admitting the program frequently supplies lower than they would be aspect of cigarette smoking. It doesn't receives an undeserved "bum rap" without it. have anythingto do with whether or from critics, Agriculture Secretary Ending the program could bring not people start. It does not in John R. Block told a national these disastrous results: overplanting by any way affect whether or not they quit smoking." , And Joseph Califano, then-secretary of the Department of Health, Eduea- Government Price Support Loans tion and Welfare, testified before Net Loss on Corttmodity Inventory and Loan Ol~erations, Congress in 1978: "I do not believe that anyone smokes or doesn't smoke October 1933 - September 1980 ordecides to begin or continue or (Millions of Dollars) stops smoking because of the tobacco subsidy. I don't think it is in any way Corn ......................... $3,208 Oats ............................ 210 related to that." Wheat ......................... 2,962 Soybeans ........................ 120 He gave the program the wrong Cotton ........................ 2,337 Tobacco .......................... 57* name in calling it a subsidy. But he Penn uts ........................ 1,141 Rye .............................. 33 gave it an accurate assessment. Sorghum ........................ 999 Sugar Beets ....................... 17 Rice ............................. 412 Honey ............................. 1 Barley ........................... 225 * $17 rail//oa of th~s amount i~ offset by interest payment~ on the loans on