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NATIONAL CONFERENCE ON SMOKING OR HEALTH DEVELOPING A BLUEPRINT FOR ACTION New York, New York November 18-20, 1981 Initiated and underwritten by The American Cancer Society, Inc. I TIMN 0237006

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OTHER CO-SPONSORING ORGANIZATIONS: American Associat.on of March of Dimes Occupational He;Llth Nurses, Inc. National Interagency Council on American College of Chest Smoking and Health Physicians National Congress of Parents and American Dental A-;sociation Teachers American Heart As=;ociation National Education Association American Hospital Association Society for Public Health American Lung Association Education, Inc. American Nurses' _~ssociation, Inc. The American Association for o,American Occupational Medical Thoracic Surgery Association American Public American School H=:alth Association U.S. Department of Education H=:alth Association U.S. Department of Defense International Association of Heat and Frost Insulators and Asbestos Worker=, U.S. Department of Health and Human Services (Office on Smoking and Health, Public Health Service) TIMN 0237009 II

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NATIONAL CONFERENCE ON SMOKING OR HEALTH Conference Chairman Charles A. LeMaistre, M.D. President The University oE Texas System Cancer Center M.D. Anderson Hospital & Tumor Institute Houston, Texas Steering Committee Charles A. LeMaistre, M.D. William Anderson, M.D. University of Loiisville Respiratory and Environrnental Medicine School of Mediciae Louisville, Kentscky Merlin K. DuVal, M.D. President National Ceriter Eor Health Education San Francisco, California Charles R. Ebersol Attorney - Ebersol, Roraback & Brower Torrington, Connecticut r Other Planning Matilda A. Babbitz, R.N. Edward J. Beattie, Jr.,. M.D: Ruth Behrens Helene,G. Brown William Cahan, M.D. Thomas Carlile, A.D. John Mack Cartez David Darland, Ph.D. Robert Daugherty, M.D.- Joan De Santis George Dessart Randall B. Grove Andrew Haas Dennis F Hoeffler, M.D., M.P.H. William Griffiths, Ph.D. University of California School of Public Health Berkeley, California John M. Pinney President John M. Pinney Associates Washington, DC Jesse L. Steinfeld, M.D. Dean Medical College of Virginia Richmond, Virginia Committee Members Mary Hughes, Ph.D. Robert J. Johansen Laura Keranen, M.P.H Louis A. Leone, M.D. Eloise Monzillo, R.N. John L. Pool, M.D. Jerome L. Schwartz, Dr.P.H. John R. Seffrin, Ph.D. Irving J. Selikoff, M.D. Mary Singletary William M. Tipping Kenneth E. Warner, Ph.D. Roland F. Wear, Jr., M.D. Madilyn Wills Staff Coordinator Allan C. Erickson Assistant Vice President for Public.Education Coordinat.or,. Tobacco and Cancer Program American Cancer Society TIMN 0237010 III

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TABLE OF CONTENTS C0-SPONSORS .........................................................II COMMITTEE MEMBERS ...................................................III INTRODUCTION ........................................................ 1 OPENING GENERAL SESSION Dr. Charles LeMaistre, presiding .............................. 4 The Health Consequences of Smoking Today Luther L. Terry, M.D ........................................ 5 Keynote Address: Government and the Private Sector Richard S. Schweiker, Secretary of Health and Human Services ................................... 12 Panel Discussion: Critical Issues in Smoking Control ......... 16 WORK GROUP SESSIONS Group 1- PREVENTION OF SMOKING THROUGH COMPREHENSIVE SCHOOL HEALTH EDUCATION Participants............................................... 27 ..Summary and Recommendations ...............................29 Position Paper ............................................34 Group 2 - USE OF."HIGH RISK" CONCEPT IN SMOKING CONTROL Participants................................................ ..57 Summary and Recommendations ...............................59 Position Paper............................................. 65 Group 3 - ADVANCING THE ROLE OF HOSPITALS IN REDUCING SMOKING Participants ..............................................90 Suaunary and Recommendations ...............................92 Position Paper............................................. 99 -X-. Group 44- SMOKING CONTROL.IN THE WORKPLACE Participants........................................ ......120 Suumary and Recommendations ...............................122 Position Paper............................................ 128 t- Group S- fiIGH PRIORITY FEDERAL GOVERNMENTAL INITIATIVES Participants......... ..................................... .150 Summaty and.Recommendations............................... 152 Position Papers ...........................................160 ....... ....................................168 ........................................... 196 Group 6 - EiIGH PRIORITY STATE AND LOCAL GOVERNMENTAL INITIATI ~ES Participants ..............................................210 Sununary and Recommendations ............................... 212 Position Paper... ..........................................216 IV TIMN 0237007

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,t Group 7 - TOBACCO-RELATED RESEARCH: NEW OPPORTUNITIES, NEW ADMINi:STRATIVE MECHANISMS Particiliants .............................................. 224 Summary and Recommendations ............................... 226 Positioa Paper ............................................229 4~ Group 8 - COUNTERING CIGARETTE ADVERTISING AND SUPPORTING THE RIGHT:i OF NONSMOKERS THROUGH THE MEDIA Particijiants ..............................................243 Summary and Recommendations ............................... 245 Positioa Papers ...:.......................................249 ........................................... 263 Group 9 - MOTIVATING SMOKERS TO ASSUME PERSONAL RESPONSIB:LITY FOR QUITTING ON THEIR OWN Particil>ants ..............................................274 Summary and Recommendations.... ...........................276 PositiOLi Paper...., ........................................280 Group 10 -~?UTURE STRATEGIES FOR THE CHANGING CIGARETTE Participants ..............................................290 Summary and Recommendations ...............................292 Positio-i Paper ............................................297 CLOSING GENERAL S;'sSSION............................................. ...308 FINAL MEETING OF CONFERENCE PLANNING COMMITTEE...................... 314 STATEMENT ON BEHAiX OF VOLUNTARY ORGANIZATIONS ......................315 M V TIMN 0237008

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INTRODUCTION What are the crucial problems confronting the nation concerning cigarette smo- king? What are the obstacles that must be overcome to reduce morbidity and mortality from cigarette smoking? And what are the strategies that must be undertaken to iaitiate concerted and constructive action against this major cause of diseases affecting the lives of millions of Americans? -These were among the critical questions that confronted the 21 national or- ganizations that met to plan and develop the National Conference on Smoking OR Health. Representing a broad spectrum of voiuntary and government health in- terests, these men and women determined that there was an urgent need for a different kind of conference. Lectures and seminars had served their purpose in the past. Now the times demanded a total focus on action. Thus, all on the Program Planning Committee committed themselves to help design a National Blueprint_For Action. - Ten key aspects of the anti-smoking campaign were formulated and assigned to• working groups--each with the charge to come up with realistic recommenda- tions. The groups were: Prevention of Smoking through Comprehensive School Health Education; Use of the High Risk Concept in Smoking Control; Advancing the Role of Hospitals in Reducing Smoking; Smoking Control in the Workplace; High Priority rederal Government Initiatives; High Priority State and Local Government Initiatives; Tobacco-Related Research; Countering Cigarette Adver- tising and Supporting the Rights of Nonsmokers Through the Media; Motivating Smokers to Ass+~me Personal Responsibility for Quitting on their Own; and Fu- ture Strategie_ for the Changing Cigarette. Physicians and scientists, broadcasters and journalists, government officials and legislator-, business leaders and hospital administrators, school offi- cials and educ--.tors-, public relations professionals and public educators were invitedo to joii, the working teams in groups of 20., In a compressed and pre- cious time peri.od they debated, discussed, challenged one another and develop- ed recommendati,ons. Some of those 1,nvited were already experts in the anti-smoking arena. Many were exposed for the first time to the fervor and depth of the problems. But all joined han~ls to evolve more than written statements or declarations of great intent. The emphasis was on action. As a result, a host of new and concerned partiLers emerged from the conference. -1- TIMN 0237011

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If there was one dominant thread that was woven throughout the conference, it was the hope that major voluntary organizations would cross institutional boundaries and form cooperative relations to resolve priority problems in a common, unilateral manner. We are encouraged by the formation of a national coalition in Washington by the American.Cancer Society, the American Heart Association, and the American Lung Association. Already the efforts have re- sulted in both preserving and strengthening the important contributions of the Office on Smoking and Health. One particular note of appreciation must be struck at this time. This confer- ence benefited immeasurably from the generous sponsorship of the American Can- cer Society. Through the provision of funds and staff, the Society enabled the development of this conference by all 21 sponsors and deserves the commen- dation of all who may ultimately benefit from'the deliberations of the Nation- al Conference on Smoking OR Health. Charles A. LeMaistre, M.D. Chairman Conference Planni.,g Committee "I TIMN 0237012 -2-

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OPENING GENERAL SESSION / -3- TIMN 0237013

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OPENING GENERAL SE`ISION, WEDNESDAY, NOVEMBER 18 Good morning and w=:lcome to the National Conference on Smoking OR Health. I am Dr. Charles LeM;Listre and I serve as Chairman of the Conference Planning Committee. May I-tsk the Planning Committee and the Steering Committee to rise? These are t4e ones who have done the work to bring us to this moment. A few days ago, a Chicago Tribune columnist asked thoughtfully: What does it ' take to awake this country to the reality of the disaster that is cigarette smoking? He sugge:sted that perhaps on1 if the 350,000'excess deaths occur- ring each year fro-a cigarette smoking happened at one place and at one time would we face the Eacts as they really exist. You and I have an •3pportuni.ty in this conference to awaken America by produc- ing a National Blueprint for Action that is both realistic and achievable. We are here assembled as selected participants from 21 different agencies and from widely divergent backgrounds. Many of us have been critical of the lack of concerted action to decrease the illness and death from cigarette smoking: Many here have beea critical of the agencies sponsoring this conference for - failure to unite in a common cause. Many here have mounted superb individual efforts only to-have the effort fail because the next step was not in place to follow through. Despite all of our frustrations, much has been accomplished and we have a solid foundation from which more can be done. Beginning today, you and I have an opportunity to draft the action by which more can be done - a blueprint for coordinated and concerted action that will accelerate pro- gress. Accelerate progress in the reduction to insignificance of the "single most preventable cause of illness in America" - cigarette smoking. Never before have we been afforded collectively such an opportunity to unite our efforts! The 10 priority aleas were selected by your Planning Committee, the priority areas chosen by rrpresentatives of all the sponsoring agencies listed in your program. May I,. on behalf c,f aLL 21 sponsoring agencies, express our collective appre- ciation to the AC.`, for their catalytic effort and financial support; but more importantly, for ;_.heir insistence from the outset that this conference not be an ACS conference. but rather be truly representative of the views of all 21 agencies includin=; the ACS.. This is a truly magnanimous position, and we ac- knowledge with gr;Ltitude the contribution of the ACS. -4- TIMN 0237014

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THE HEALTH CON`IEQUENCES OF SMOKING TODAY Luther L. Terr•i, M. D. Former Surgeon General U.S. Public Health Service Dr. LeMaistre has asked me to review with you what we know about the health consequences of smoking. I am grateful he gave me this assignment. Like cgany_ of you, I have been involved with smoking and health for a good many years. I found it very useful to go back over the evidence and ask myself, Htz---why we have devoted so much of our lives to it; why we have worked so hard; why we are meeting here in New York to think and talk about it once again? The reason, of course, is the illness and death which cigarette smoking cau- ses, and the economic and social burdens it imposes.upon our government and our people. 'ihese are the health consequences of smoking. In making my -ceview, I will not attempt a clinical review of the evidence but will speak fr~,m a public policy viewpoint. This permits me to use 1964 as my point of depa?ture. 1964, of cour-;e, was the year Charles LeMaistre and his colleagues issued the first report on smoking. It was also the year when my own personal fate was sealed: to bq the Surgeon General forever after remembered for his release and endorseme1it of the Advisory Committee Report on a cold January day, at a press confereace in Washington, in a conference room, in of all places---the State Departm:nt! As I have sai•i many-times before, that report was a carefully prepared scien- tific report Df the Advisory Committee. I shall always appreciate their de- votion and their work in producing this memorable scientific document. I think it is oae of the most significant scientific reports in medical history. Its accuracy and reliability allowed me to accept, endorse and release it. I shall always be grateful for the work of that Committee. The authors of the-1964 report were not the first to indict cigarette smoking. Its hazards had already been proved before the Committee ever met. Some of those who helped furnish this proof are in this audience today; and others are following ouL deliberations from England, and from California, from college campuses and places of retirement. I would name only a few---Do11 and Hill in England; Och=ner, Wynder, Hammond, Horn and others in this country. Some of the =:arlier students of the issue are gone. I mourn the loss of my teacher and 1.ifelong friend, Alton Ochsner, who died last September 24. With Dr. Michael Oe Bakey, Dr. Ochsner pubLished one of the first studies of the smoking-dise=_ise relationship in 1939. He was teaching his students about the health hazar~is of cigarette smoking for several years before that article was published. -5- TIMN 0237015