Tobacco Documents Online

CHAPTER VII Recommendations of Conference Work Groups Group 1. Addiction, Habituation, Pharmacology of Tobacco Group 2A Behavioral Problems and Progress Group 2B Behavioral Problems and Progress Group 3. Towards A Less Harmful Cigarette Group 4A School Programs: Program Content, Mate- rials, Ages to Reach Group 4B School Programs: Program Content, Mate- rials, Ages to Reach Group 5. College Programs Group 6. Teacher Education Group 7A Giving Up Cigarette Smoking Group 7B Giving Up Cigarette Smoking Group 8. Role of Physician and Other Exemplars Group 9. Government Action and Legislation Group 10. Communications-The Media WORK GROUP 1: ADDICTION, HABITUATION, PHARMACOLOGY OF TOBACCO Chairman: • C. M. Fletcher, C.B.E., M.D., F.R.C.P. Postgraduate Medical School, London, England ' (Secretary, Royal College of Physicians Committee on Smoking and Air Pollution) Secretary: Sam R. Hall, Ph.D:, Research Department, American Cancer Society. Recorder: Charles Dick, Communications Director, ~ Roswell Park Memorial Institute Work Group 1: Addiction, Pharmacology 259 The work group first discussed the semantics of habit uation and addiction and agreed that, in accord with re- cent World Health Organization recommendations, the word dependence, which does not specifically imply a major role for either psychological or biochemical factors, is preferable for describing those subjects who exhibit a continuing need for smoking. This would link smoking dependence with other major forms of dependence such as heroin and alcohol. The group also agreed that there is considerable pre- liminary evidence of at least two distinguishable groups of dependents. In one group psycho-social factors appear to predominate, stopping smoking is relatively easy and withdrawal symptoms are slight or absent. In the other the dependence is harder to break and withdrawal symp- toms may be severe but are inadequately described. It appears that in this group the dependence may have a pharmacological element. The force of the dependence is shown by its persistence in the face of knowledge and ex- perience of the harmful effects of smoking although pres- ent inactivity of governments appears to reinforce it. It was agreed that in spite of the amazing lack of defin- itive information, nicotine was the most likely component of cigarette smoke to provide the presumed biochemical or pharmacological basis of dependence. The group concluded that the development of rational programs for smoking control required far more accurate information on the nature of cigarette dependence. They were convinced that at present far too little time and money are given to this problem in relation to the major harm that smoking is known to do to the public health. A revolution in the attitude of administrators, physicians and research workers is required to insure that the major gaps in our present knowledge are filled. The group's recommendations are: 1. A group of experts on the physiological, psychologi- cal and pharmacological aspects of other forms of drug dependence should be convened to review critically the scanty existing knowledge of tobacco dependence and to make definitive recommendations for development and 258

260 Recommendations of Conference Work Groups prosecution of research. The problem of tobacco depen- dence should also be brought into the purview of the WHO Expert Committee on Drug Dependence. 2. Research should meanwhile be carried out into the validity of the proposed classification of types of cigarette dependence which should be correlated with studies of smokers' reactions to nicotine and other relevant compo- nents of tobacco smoke. 3. Further studies of the nature and duration of ciga rette deprivation syndromes should be-prosecuted. 4. A multi-disciplined research group should be estab- lished within an appropriate existing research organization to insure that effective research is now begun on these and related problems. WORK GROUP 2A: BEHAVIORAL PROBLEMS AND PROGRESS Chairman: A. C. McKennell, Ph.D. Professor of Psychology Southampton University, England Secretary: Selwyn Waingrow, Assistant to the Director, National Clearinghouse for Smoking and Health, United States Public Health Service Recorder: Fred Learned, Associate Director for Public Information, American Cancer Society. The following recommendations are restricted to gen- eral proposals. Specific recommendations are included in the Group 211 report. Recommendations: . 1. A working committee, international and interdisci- plinary in composition, should be established to take the initiative in implementing the proposals. The following would be among the terms of reference this committee should consider. 2. Problems related to the standardization of instru- ments and the definition of such criteria as smoking, Work Group 2A: Behavioral Problems 261 non-smoking, amount of smoking, ex-smoking, etc., in order to facilitate comparability of research findings. 3. Base line data should be gathered in each country to define and monitor the incidence of smoking in their populations. 4. Coordinated international research should include replication of studies in different countries and in cross- cultural settings. 5. In order to facilitate such replication as well as the evaluation of research findings, high standards of report . ing should be defined and encouraged. This involves among other things the necessity for including in research reports a full disclosure of research design, questionnaire content, statistical results and methods analyzing the data. In addition, when education materials are used in an in- tervention campaign, full description of materials and techniques should be included. 6. Consider ways and means of reviewing behavioral and social science literature, including those involving smoking research, insuring that practical implications for action programs are spelled out and communicated to those responsible for such programs. 7. In reviewing such literature, areas should be identi- fied where existing knowledge is insufficient as a basis for action. 8. In order to increase our fund of knowledge, encour- age investigators in behavioral and social sciences, includ- ing areas of communication and education, to carry out research into smoking within their own theoretical areas of interest. This should be done internationally. 9. Consider ways of encouraging governmental sup- port of behavioral research as applied to the smoking problem. 10. Utilize the World Conference attendance list as the nucleus of a mailing list to facilitate international commu- nication and exchange of information. 11. Encourage people in various countries to submit reports to centers already engaged in collecting and dis- seminating such data, i.e., as an example, the National Clearinghouse for Smoking and Health. ,:

u . _. ._r.... v.,, s. i I 262 Recommendations of Conference Work Groups 12. A mechanism should be established to improve communications between research workers and practition- ers to insure that research findings are translated in the light of existing knowledge. 13. Priority should be given to those programs which appear to offer the most chance for success. Success with a portion of the population, we think, will alter the social climate and increase the probability of success with the remainder of the population. 14. Smoking, its beginning, cessation, and support for non-smoking, is a many,-faceted and complex behavioral problem involving as it does individual social and cultural factors. Behavioral science findings today indicate that the chances of success in action programs will be en- hanced if the problem is conceptualized in its complexity and program activities are focused on as many facets of the problem as are possible within the resources of the program. WORK GROUP 2B: BEHAVIORAL PROBLEMS AND PROGRESS Chairman: Daniel Horn, Ph.D. Secretary, National Interagency Council on Smoking and Health, and Director, National Clearinghouse for Smoking and Health Secretary: Frederick F. Ikard, Research Psychologist, National Clearinghouse for Smoking and Health, United States Public Health Service Recorder: Keith Kost, Editor, Public Health Reports, U.S. Public Health Service Specific recommendations are in four areas: I. Initiation of Smoking A. Research should be conducted in all aspects rele- vant to the initiation of smoking, to include studies on: 1. The role that peers, parents, teachers, and others have in discouraging or encouraging the initiation of smoking. 2. The process of initiation, including the first desire to smoke, the experimental phase, and the actual style Work Group 2B: Behavioral Problems 263 of smoking that eventually becomes characteristic of the individual. 3. The differential characteristics of smokers and non-smokers that may be related to the problem of ini tiation. II. Cessation in the Normal Adult. A. Goals should be to get the adult smoker to stop ig- noring the danger of smoking and to accept smoking as a personal problem; to get the smoker to seriously consider quitting and to help him quit smoking cigarettes, even for a limited time; and to help him continue a new habit of non-smoking. B. Encourage longitudinal research on tIie current effective methods people are using to stop cigarette smok ing, including: 1. Collecting information from the millions of peo- ple who have successfully stopped smoking cigarettes, with specific attention on how they quit and how they remained non-smokers. 2. Classifying smokers as to significant social and personal variables, and classifying smoking situations to provide background information for educational programs. 3. Studying those factors which help keep people who have stopped smoking from returning to the smoking habit. C. Encourage research into communication patterns and the new and effective ways of communicating with various target groups. Explore current advertising tech- niques that may be applicable in such things as determin- ing what target groups pay attention to what health mes- sages and with what effect. D. Encourage more research in the learning theory as it applies to the smoking problem. E. Encourage research into motivation leading to cor- rect action, as well as the motivation behind not taking action. F. Encourage research into the immediate effects of smoking, and the practical use and effectiveness this `~++:..iv~.. <.... r

- _ .e.. _........,._. scf.,u...;i,u1G~.a.^~wee,~cw....~:.a ._....,..... ,...~ . i , ; ~.. ~ 264 Recommendations of Conference Work Groups knowledge might have in producing desired behavior changes. G. Conduct studies on how changes in the environ- ment (such as restricting areas where smoking can take place) might have on smoking behavior. The eventual goal here is to determine if smoking can be made socially unacceptable. H. Conduct studies on the effects that increased cost of cigarettes (by taxation and other means) would have on smoking behavior. I. Conduct studies involving whole communities in dif- ferent countries to help isolate and understand the roles that cultural and social factors have in smoking behavior. J. Encourage more research in the area of smoking and accidents. III. Cessation in the Adult Who Must Quit for Medical Reasons Cigarette smokers who already suffer from chronic res- piratory diseases, cancer, and heart disease should be given specific consideration as a target population for cig- arette smoking control programs. Factors relevant to mo- tivation of these patients for cessation of smoking need further delineation. It is recommended that specific stud- ies aimed at this target population be conducted to iden- tify these factors and to determine how these patients can better be helped in their efforts to stop smoking. IV. Acceptance of Less Hazardous Ways of Smoking The research problem here is to determine whether it is possible to produce less hazardous ways of smoking with- out interfering with programs designed to get people to stop smoking. 'WORK GROUP 3: TOWARDS A LESS HAIiMb'UL CIGARETTE Chairman: Ernest L. Wynder, M.D. ~ Associate Member, Sloan-Kettering Institute for Cancer Research Secretary: Harold S. Diehl, M.D., Vice Chairman, Na- tional Interagency Council on Smoking and Work Group 3: Towards A Less Harmful Cigarette 265 Health; Deputy Executive Vice President for Research and Medical Affairs, American Can- cer Society Recorder: Mortimer Frankel, Associate, Materials De- velopment, National Tuberculosis Association In 1964, the Surgeon General's Committee on Smoking and Health called for remedial measures to reduce the health hazard associated with cigarette smoking. One of these measures is the establishment of a less-hazardous cigarette. The proceedings of the workshop dealing with this area indicated significant progress in the identification of fac- tors in cigarette smoke that contribute to the health haz- ards as well as means of their reduction. Since a definite dose-response relationship exists be- tween the number of cigarettes smoked and diseases of the cardiovascular and pulmonary systems, anything that will reduce total smoke exposure is likely to be followed by a reduction in risk. Such a reduction may be expected more rapidly for cardiovascular than for neoplastic dis- ease. When considering myocardial infarction, the prepon- derance of evidence suggests that nicotine plays an essen- tial role in its pathogenesis and that its reduction would be associated with a reduction in deaths from this impor- tant disease. The effect of nicotine on myocardial infarc- tion was thought to be related to its possible effects on blood coagulation and on mobilization of free fatty acid. The particulate matter in tobacco smoke is clearly carcino- genic to the experimental animal and specific carcinogenic and co-carcinogenic components have been identif ed. There was a body of opinion that the gaseous phase in cigarette smoke might also affect the. pathogenesis of lung cancer and chronic pulmonary disease and that a reduction of all potential toxic substances should be accomplished. There was some disagreement as to the relative impor- tance of various toxic substances in cigarette smoke, par- ticularly as to their effect on man.

I 266 Recommendations of Conference Work Groups Adequate means are already available for a practical lowering of "tar" and nicotine levels of cigarettes. In fact, there has been a trend towards a reduction of these values in American cigarettes during the past decade. Means are also available to reduce gaseous components. Persuasive means need to be introduced for the to- bacco industry to manufacture less-harmful cigarettes and for increasing their acceptability with that portion of the public that cannot give up smoking. Such measures in- clude: 1. Regulatory standards for a cigarette to be called a "filter" cigarette. 2. Regulatory standards providing that a filter and the non-smokable overlap should be not less than 30 mm. in length. 3. Regulatory standards governing the yield of "tar" and nicotine and, possibly, other smoke components. 4. Regulatory listing on all packages of the "tar" and nicotine content, and perhaps in the future, of other deleterious substances. 5. Encouragement of the design of cigarettes to re- duce the practice of inhalation. A suggestion was made, based on extensive experimen- tal data, that increased nitrate levels of tobacco would re- duce the formation of carcinogenic hydrocarbons. The workshop members expressed a desire for closer cooperation with one another. It was proposed that a work group be initiated consisting of members of the De- partment of Agriculture, Roswell Park Memorial Ir sti- tute, New York University, the University of Kentucky and the Sloan-Kettering Institute to meet at three- monthly intervals. It is hoped that other interested private research groups, as well as scientific directors of the to- bacco industry, will join this group and that open chan- nels of communication will be maintained with the Lung Cancer Task Force. Some concern was expressed about claims made for new filters or processes to reduce the health risk of ciga- rette smoking in cases where such claims have not been Work Group 3: Towards A Less Harmful Cigarette 267 accompanied by well-documented scientific data. It was suggested that the Public Health Service establish a panel that has the scientific aptitude and that is given legal au- thority to protect patent rights in order to evaluate such claims. Efforts must be continued to develop chemical and bio- logical methodology to establish the relative important;e of toxic substances in tobacco smoke and provide guide- lines for permissible levels of these substances in ciga- rette smoke. The ultimate proof for a less-harmful cigarette must be the human experience. It was suggested-and it seems feasible-to build a surveillance system in several major hospitals in the United States and abroad where the smoking habits of individuals with diseases now known to be associated with cigarette smoking would be recorded. Such records would include the brand of cigarettes smoked by each individual. In this manner the relative health risk associated with a given type of cigarette could well be established. Members of the workshop agreed to initiate such a system, hopefully with the support of public health agencies. Speaking personally, and as someone who has spent nearly all of his scientific life involved in epidemiological and the basic research aspects of the problem under dis- cussion at this conference and as someone who has watched man's apparent difficulty in giving up smoking and preventing youth from starting, it is evident that both for practical as well as academic reasons work on the less-hazardous smoking products must be continued and extended. It represents one of the logical measures called for by the Surgeon General's Report. Our workshop be- lieved that if properly pursued and supported, and if its suggestions-many of which are practical today-mate- rialize, this remedial measure will make its contribution to our common goal, the reduction, if not elimination, of all diseases linked to cigarette smoking. It is towards this goal that our workshop hopes to have made a contribu- tion.

268 Recommendations of Conference Work Groups WORK GROUP 4A: SCHOOL PROGRAMS-PRO- GRAM CONTENT, MATERIALS, AGES TO REACH Chairman: Miss Elsa Schneider Educational Specialist, U. S. Office of Edu- cation Secretary: John Cooper, Ph.D., Executive Secretary, American Association for Health, Physical Education and Recreation Recorder: Edward Mileff, Ph.D., Consultant in Health Education, American Association for Health, Physical Education and Recreation WORK GROUP 4B: SCHOOL PROGRAMS-PRO. GRAM CONTENT, MATERIALS, AGES TO REACH Chairman: Mr. Robert L. Leake Specialist, Health, Physical Education and Safety, Utah State Board of Education Secretary: Vincent Granell, Ed.D., Director, Smoking ~ and Health Project, American Association for Health, Physical Education and Recreation Recorder: Mrs. Margaret Young, Assistant Director, Smoking and Health Project, American Asso- ciation for Health, Physical Education and Recreation The work group recognizes that cigarette smoking is one of the major health hazards facing the youth of the world. In view of this the following recommendations are sub- mitted: I. Smoking and Health in the Education of Children A. Consideration must be given to individual, familial, social and environmental factors. It is recommended that a multiple approach be used involving schools, commu- nity, parents, youth groups, etc. It is further recommended that the program start in conferences with parents of pre- school age children. Furthermore, because of the multi- plicity of factors related to smoking and health, educa- tional efforts should be concerned with an individual's well-being. Work Groups 4A & 4B: School Programs 269 B. Any educational effort should be linked with some form of evaluation of effectiveness. In view of the lack of knowledge of the effectiveness of various educational efforts, it is recommended that interdisciplinary research be encouraged in the development of methods of instruc- tion. Examples of possible approaches of instruction to be assessed include: 1. Immediate vs. long-range effects 2. Formal vs. informal instruction 3. Separate course vs. integrated programs 4. Small group or individual approaches vs. mass approaches 5. Approaches comparing efforts aimed at in- dividuals, high risk groups and peer groups C. There should be an exchange of plans and results of educational efforts and relevant research. A feedback of new information and findings should be available to teach- ers and schools as to what is being done on the campus, in the community, and the world at large. II. Teaching Learning Suggestions A. Formal education in smoking and health should in- clude planned educational efforts in all subject areas in- cluding the subject matter area of health education. This education should take place at all grade levels. An integrated approach for primary grades can be used as "teachable moments" incorporated into health instruc- tion related to heart, respiration, clean air, etc. Attention should be given to developing value systems which will form the foundation for making judgments and decisions concerning smoking and health. Formal organized instruc- tion may begin with identification of student needs in the elementary grades. Formal organized instruction should be implemented in junior and senior high health classes sup- ported by all other curricular areas such as science, eco- nomics, social studies, government, etc. An educational approach must have out-of-school in- volvement with parents who have access to materials and workshops, to help with shaping favorable attitudes in the area of smoking and health. B. Educators should encourage activities of both a di- Z i

~._a. ~. 270 Recommendations of Conference Work Groups dactic and emotionally stimulating nature related to smok- ing and health, such as the use of bulletin boards, films, studies, etc. C. Education for health should encompass the wide range of health problems we face in our world community since they are often related. D. The education of children for health should follow accepted education principles. The child should be encour- aged to make his own decisions on health matters on the basis of scientifically accurate information. E. Schools and teachers serve in an exemplary role, ltherefore teacher behavior and school activity should be aimed at making smoking a socially undesirable form of behavior. Teachers, including their organizations, and all ~other school personnel, should recognize their ethical re- sponsibility to children and youth regarding smoking on school grounds and in school buildings. A group decision of self imposed non-smoking should be sought by all ad- ults. It is further recommended that this be extended to in- clude all groups who use school grounds and school build- ings. III. Student-Centered Activities A. Educational efforts within schools must be aware of the potential of student leadership and should recognize the potential in utilizing the power of peer leaders. B. Classroom teachers or other interested and responsi ble adults cooperating in smoking and health activities should seek to motivate peer leaders to assume responsi- bility in developing student-centered activities in the area of smoking and health. C. Those activities related to smoking and health should be planned and developed through student organi- zations. D. Programs in schools for helping students cope with their own smoking problems should include such activities as smoking withdrawal clinics. IV. The Role of Community Agencies Related to Smoking and Health Education in Schools A. Community agencies should provide continuing Work Groups 4A & 4B: School Programs 271 constructive support to the school in its educational efforts ~ relating to health. ~ M B. Health agencies in the community should make their ~ resources available for workshops and other pre-service ® and in-service education programs for teachers and other personnel. C. Health agencies can help to make consultants and ~ O ~ resource personnel available to educators responsible for curriculum development and to provide other consulta- ~-+ tion services as requested. D. Health agencies can involve school personnel in community activities and programs that have special ap- plication for schools. E. Health agencies can make teaching materials avail- able and provide resources for pilot • programs in the school and community. F. Subjecting children and youth to "crash programs" whose value has not been established should be avoided. F~1 The interagency approach to working with schools holds many advantages and can preserve the individual in- tegrity of the agencies involved. WORK GROUP 5: COLLEGE PROGRAMS Chairman: Samuel Fuenning, M.D. University of Nebraska (Chief Liaison Officer, American College Health Association) Secretary: Walter James, Vice President for Public Ed- ucation, American Cancer Society Recorder: Spencer Mapes, Associate Director, Public Education, American Cancer Society In the work group on College Programs, discussions cen- tered on the following aspects of the subject: 1. Health education of students: formal and informal 2. The Administration ~ 3. College Health Services 4. Faculty and Staff 5. Utilization of Community Resources including voI- untary, official and professional health agencies _- 4

..«..,-..r..~.....w y.....rs..., .w.~+.-wh.*s~~'ss.x~~., _..u._r......«~...a,...a .:Y..,.1.:...r. .r.. . J 272 Recommendations of Conference Work Groups 6. Research and Evaluation From these broad areas of consideration, the following rec- ommendations resulted: 1. A Personal Health Education course of relevance and quality, to include the subject of cigarette smoking and health, should be offered by every college as a re- quired course; however, when such a course has not yet been established, the college administration should pro- vide covering of the subject in other ways. 2. Informal education featuring peer group activities should be encouraged. 3. College Health Services should encourage students not to start smoking, discourage student smoking, provide assistance to students who wish to give up smoking ciga- rettes; such activities would involve environmental, clinical and exemplar factors. 4. The American College Health Association should call to the attention of its membership the exemplar role of the ACHA and that this be taken into consideration when policies are made regarding cigarette smoking in college health facilities. This recommendation should also be brought to the attention of other college health services not affiliated with the ACHA. 5. The Administration of a college should take a firm position against cigarette smoking and should strive to es- tablish a campus climate discouraging to cigarette smok ing by all steps feasible aind practicable, such as: (a) encourage campus personnel-administrative, faculty and staff and students-to demonstrate in their personal regimes those attitudes and behavior that would reflect an understanding of the relationship between cigarette smok- ing and health; (b) consider formation of a campus advi- sory committee including students to coordinate and expe- dite activities to discourage cigarette smoking; (c) des- ignate one individual as coordinator of campus programs with continuing responsibility for activities in the cigarette smoking and health area; (d) cease from sponsoring the sale of cigarettes on the campus, in areas over which the Administration has control, by vending machine, over-the- counter or otherwise. I Work Group 5: College Programs 273 6. Faculty and staff should be informed regarding ciga- rette smoking and health and should have opportunities to become involved in education, research and other activi- ties on campus both within the classroom and on campus. In these activities, their exemplar role should be brought to their attention. 7. It is recommended that colleges and universities be encouraged to increase their research efforts in the area of smoking, to include: a. Descriptive studies (present status) b. Behavioral studies (causation) c. Experimental studies (effectiveness of program) d. Evaluative studies (present practices) Health Education Health Counseling Health Programs Included in research projects should be those to provide guidelines data on: a. Peer group influence b. Evaluation of course content on smoking c. Relationship of knowledge to behavior d. Why some students begin or quit cigarette smoking e. Influence of the accessibility of cigarettes on stu- dent smoking f. Influence of faculty smoking habits g. How to involve students in program activities h. How to involve faculty in campus research proj- ects on cigarette smoking i. How to make research findings on cigarette smok- ing and health widely available in colleges. 8. College Health Services should maintain morbidity statistics that include the smoking habits of the individuals concerned. When feasible, these studies should be com- bined with those of other colleges. 9. A demonstration project be established on a univer- I I

f 274 Recommendations of Conference Work Groups sity providing a health education program for all students, employees and faculty. Included in the project will be an evaluation of change in attitude and behavior regarding cigarette smoking. 10. It is recommended that college athletic departments and coaching staffs should recognize the role they may play in influencing athletes and students to smoke or re- frain from smoking and that they accept their responsibil- ity to do what they can to eliminate this health hazard. Finally, this work group recommended that the World Conference on Smoking and Health give careful consider- ation to the widest effective dissemination of the Confer- ence Proceedings to colleges and to educational organiza- tions and facilities, such as: college presidents, state offices of education, professional educational associations, college libraries. WORK GROUP 6: TEACHER EDUCATION Chairman: Willis Baughman Vice President, American Association for Health, Physical Education and Recreation, University of Alabama Secretary: Sol Lifson, Director, Education, Public Rela- tions and Materials Development, National Tuberculosis Association Recorder: John Dibeler, Executive Director, Nassau (New York) Division, American Cancer So- ciety The recommendations for Teacher Education may be pre- sented under four headings: 1. Role of the school 2. Basic need for teacher education 3. Content and method in teacher education 4. Other areas of concern 1. Role of the school In view of the accepted facts concerning the health haz~ ards of cigarette smoking, the community has an ympor- Work Group 6: Teacher Education 275 tant role to discourage cigarette smoking among youth. The school is one of the key community agencies in car- rying out this role. In order for the school to contribute effectively, teachers must be given adequate preparation and support during their training and teaching by all other segments of the community, especially the home, the health professions and the communications media. 2. Basic need for teacher education a. An adequately qualified instructor with a primary in- terest in health should provide academic leadership for the preparation of all prospective teachers. b. All active teachers should be required to participate in an in-service program in smoking and health taught by a qualified instructor in allied sciences and health. 3. Content and method in teacher education a. The materials content and methodology for prepar- ing school personnel to provide dynamic instruction about smoking and health must take into consideration the latest thinking about effecting change in teacher knowledge and attitudes and in teaching practice. The content and meth- odology must take into account such things as current facts about smoking and health, growth and development of youth, dynamics of behavior change, social and cultural factors, peer group influences, * development of ego strength, self direction and decision making, sources of materials, placement in the curriculum of instruction relat- ing to smoking. b. To supplement basic preparation, local reinforce- ment and support for the teacher must be continually available. c. Since teachers serve in an exemplar role, considera- tion should be given during pre- and in-service preparation to the effect of their own smoking practices upon their in- struction. 4. Other areas of concern a. Research 3

t 276 Recommendations of Conference Work Groups We recommend that institutions prepare teachers to conduct research and experimentation in teaching and learning procedures to identify and develop effective teaching methodology and program organization which will favorably influence smoking and health behavior. This research requires adequate funding by both governmental and voluntary health and education agencies. Such re- search would involve worldwide pilot projects for evalua- tion before implementation. b. Specialists and personnel Health and smoking education requires teachers who have specific preparation for their responsibilities in health education. To meet this need we recommend the follow- ing: (1) That institutions preparing teachers include on their faculty a person or persons adequately prepared and with a primary interest in health education to provide aca demic leadership. (2) That such people be given the opportunity for con- tinuous in-service preparation through a series of confer- ences on smoking and health organized on a worldwide regional geographic basis to be funded by governmental and private agencies and foundations in education and health. (3) That school districts employ on their teaching staffs a qualified specialist with primary responsibility for assisting elementary school teachers to fulfill their respon- sibilities in education concerning smoking and health. WORK GROUP 7A: GIVING UP CIGARETTE SMOKING Chairman: Keith P. Ball, M.D., F.R.C.P. Central Middlesex Hospital, London, England Secretary: Miss Cherry Tsutsumida, Public Health Edu- cator, National Clearinghouse for Smoking and Health, United States Public Health Service Recorder: Alan C. Ford, Project Coordinator, Ohio De- partment of Health . .,.~4?...~..L ~'n.f.a.r..~..r.~u.`_ Work Groups 7A & 7B: Giving up Cigarettes 277 WORK GROUP 7B: GIVING UP CIGARETTE SMOKING Chairman: George Christakis, M.D. Assistant Dean and Associate Professor, Com- munity Medicine, Mt. Sinai School of Medi cine Secretary: Nathaniel H. Cooper, M.D., Director of Com- munity Program, American Heart Association Recorder: Miss Miriam Zwerin, Educational Materials Writer, American Heart Association Resolved: That the conference support a reduction in the social acceptability of smoking by: 1. Sending requests to appropriate management person- nel in the transportation industry to stop distribution of free cigarettes and to enforce existing regulations restrict ing smoking in public vehicles. 2. Sending requests to appropriate management per- sonnel in the movie and television industries to eliminate, as much as possible, smoking by characters in their pro- ductions. 3. Suggesting that all educators, health workers, and others who set a public example, refrain from smoking during public appearances, particularly before young peo- ple. Resolved: That a task force be organized to investigate, support, and disseminate information on methods and modalities which are successful in self-help programs of smoking withdrawal. Resolved: That each university, medical school and hospital should set up a committee on smoking and health to review the policies and practices at these institutions and to make recommendations to reduce health hazards by eliminating smoking. Resolved: That publications to lay readers should con- tain many more articles motivating people to stop smok- ing. Particularly those health journals that are used by medical professions in disseminating health information in the various countries represented at the World Confer- ence. I s ,r.