Tobacco Documents Online

A NATIONAL DILEMMA: CIGARETTE SMOKING OR THE HEALTH OF AMERICANS Report of the National Commission on Smoking and Public Policy to the Board of Directors American Cancer Society, Inc. January 31,1978 TIMN 431947

NATIONAL COMMISSION ON SMOKING AND PUBLIC POLICY n David Baltimore. Ph.D. Bentamm F Byrd. Jr.. M.D. Merlin K. DuVal, M.D Charles 8 Et+ersol Marshall Evans Robert W. Holley, Ph.D. Alice S. Huang, Ph.D. Mrs. Robert W. Huff Allan K. Jonas George Kneeland Philip Lee. M.D. ChartesA. LeMaistre, M.D. Salvador E. Luria. M.D. Baldwin Maull J. Quigg Newton Comelius W. Owens Mrs. Martin Perkins H. Marvin Pollard. M.D. Robert E. Shank. M.D. Scott K. Simonds. Dr.PH. William H. Wendel Kerr White. M.D. VICTOR WEINGARTEN Executive Director Eileen Lanman Staff Associate Please Reply To: 801 SECOND AVENUE NEW YORK, NEW YORK 10017 212/897•1811 January 31, 1978 The Honorable Joseph H. Young Chairman American Cancer Society 777 Third Avenue New York, New York 10017 Dear Judge Young: The National Commission on Smoking and Public Policy was- created in October 1976 by the American Cancer Society to take testimony from knowledgeable persons regarding the problems caused by cigarette smoking, to assess the effectiveness of current anti-smoking activities, and, on the basis of its findings, to recommend possible new approaches to this majbr public health problem. The Commission's focus has been on public policy, particularly the role of the Federal government, state and local governments, and national voluntary health agencies. To perform its task, the Commission appointed Regional Planning Councils in eight parts of the country, and held Public Forums from March through June 1977 in each of these regions, at which time persons concerned with cigarette smoking were invited to testify. The Commission also invited the Tobacco Institute, the industry spokesman, to appear at any or all of its last seven Public Forums, but the invitation was declined. Ultimately, the Commission took testimony from 300 individuals from all fifty states. In addition, it examined data - both published and unpublished - from a variety of Federal and state agencies, the Library of Congress, and the 10-K reports filed with the Securities and Exchange Commission by the six major tobacco producing companies. It was also given access to a substantial amount of cigarette-related data from industry sources. TIMN 431948

The Honorable Joseph H. Young 2. It also drew upon the proceedings of the Third World Conference on Smoking and Health, and papers on various aspects of the cigarette smoking problem from a variety of scientific and medical journals. The Commission's findings are based upon this total input, and its recommendations are the result of its analysis and interpretation of all information and data collected. The Commission wishes to express its thanks and apprecia- tion to all who have helped with its task - particularly the 58 Divisions of the American Cancer Society that assisted the Regional Planning Councils, the witnesses who came to the Public Forums at their own expense, and the Society's Board of Directors for financing this activity and for giving the Commission full and complete freedom to pursue whatever avenues it wished. The Commission believes that cigarette smoking is a clear and present danger to all who smoke, and it hopes that the American Cancer Society and all other responsible forces in the Nation concerned with the well-being of its citizens will help to implement the recommendations contained in this report, which can help people, particularly youngsters, from starting to smoke and assist those who now smoke to stop. Sincerely, Philip R. Lee, M.D. Acting Chairman TIMN 431949

NATIONAL COMMISSION ON SMOKING AND PUBLIC POLICY David Baltimore, Ph.D. Professor of Biology Massachusetts Institute of Technology Center for Cancer Research Cambridge, Massachusetts Benjamin F. Byrd, Jr., M.D. Nashville, Tennessee Merlin K. DuVal, M.D. Vice President University of Arizona Health Science Center Tucson, Arizona Charles B. Ebersol Torrington, Connecticut Marshall Evans Former Vice Chairman, Westinghouse Pittsburgh, Pennsylvania Robert W. Holley, Ph.D. Salk Institute LaJolla, California Alice S. Huang, Ph.D. Harvard Medical School Department of Microbiology Mrs. Robert W. Huff Chairman Interagency Council on Smoking and Health Rome, Georgia Allan K. Jonas Los Angeles, California George Kneeland St. Regis Paper Company New York, New York Philip R. Lee, M.D. University of California School of Medicine San Francisco, California Charles LeMaistre, M.D. Chancellor University of Texas System Austin, Texas Dr. Salvador E. Luria Director, Center for Cancer Research Massachusetts Institute of Technology Cambridge, Massachusetts Baldwin Maull Former Chairman, Marine Midland Bank New York, New York J. Quigg Newton The Commonwealth Fund New York, New York Cornelius W. Owens Former Executive Vice President, AT&T Atlanta, Georgia Mrs. Marlin Perkins St. Louis, Missouri H. Marvin Pollard, M.D. Ann Arbor, Michigan Dr. Robert Shank Washington University School of Medicine St. Louis, Missouri Scott Simonds, Dr.P.H. University of Michigan Ann Arbor, Michigan William H. Wendel President The Carborundum Company Niagara Falls, New York Kerr White, M.D. United Hospital Fund of New York New York, New York Victor Weingarten Executive Director Eileen Lanman Staff Associate TIMN 431950

CONTENTS page Letter of Transmittal National Commission on Smoking and Public Policy INTRODUCTION 1 THE REPORT IN BRIEF ... 3 FINDINGS 3 The Health Hazards 3 The Economic and Social Costs 4 How Many Cigarettes? How Many Smokers? 6 The Government Has Determined That Smoking Is Dangerous to Your Health, But ... 7 Cigarette Advertising Versus Health Education 9 How Many Smokers Have Quit? 10 Non-Smokers' Rights 10 Smoking and the Schools 11 Smoking and the Health Care Community 11 GOALS AND OBJECTIVES 12 RECOMMENDATZONS 14 SMOKING AND THE FEDERAL GOVERNMENT: ISSUES AND ACTIONS 25 CONGRESS 25 DEPARTMENT OF HEALTH, EDUCATION AND WELFARE 34 Food and Drug Administration 40 FEDERAL TRADE COMMISSION 46 DEPARTMENT OF LABOR 51 DEPARTMENT OF DEFENSE 54 SMOKING AND STATE AND LOCAL GOVERNMENTS: ISSUES AND ACTIONS 55 SMOKING AND THE SCHOOLS: ISSUES AND ACTIONS 58 TIMN 431951

page SMOKING AND THE HEALTH CARE COMMUNITY: ISSUES AND ACTIONS 61 SMOKING AND THE AMERICAN CANCER SOCIETY: ISSUES AND ACTIONS 63 LEGISLATION 63 EDUCATION AND INFORMATION 67 SMOKING CESSATION 68 RESEARCH IN SMOKING 69 OTHER ACS INITIATIVES 70 SMOKING AND OTHER VOLUNTARY HEALTH AGENCIES: ISSUES AND CTI NS 71 SUMMARY 73 APPENDIX 77 Names of Witnesses at Regional Public Forums 77 Who Smokes? 94 Cancer Epidemiology, A Summary of Current Information on the 17 Most Common Malignancies 99 Morbidity and Mortality Statistics: National Center for Health Statistics 108 Report of Advisory Committee on Intergovernmental Relations: Cigarette Bootlegging - A State AND Federal Responsibility (May 1977) 124 Federal Trade Commission Report of Tar and Nicotine Content of the Smoke of 166 Varieties of Cigarettes (June 1977) 134 TIMN 431952

A NATTONAL DILEMMA: CIGARETTE SMOKING OR THE HEALTH OF AMERICANS - Report of the National Commission on Smoking and Public Policy rrIMN 431953

1. INTRODUCTION This Report addresses the issues and actions surrounding a single problem -- cigarette smoking -- that represents the most unnecessary and most preventable cause of illness, disability, and death in America. Illness related to cigarette smoking accounts for nearly 10% of the Nation's total health expenditures. In November 1977, Secretary of Health, Education and Welfare Joseph A. Califano, Jr. estimated the current cost of cigarette-related illness to society at a minimum of $18 million. This figure did not include any amounts lost as a result of premature permanent disability or death due to cigarette-related illness or any of the human and economic costs of cigarette-related fires. The Secretary's arithmetic was incomplete because the Federal government has never undertaken an analysis of the real cost of cigarette smoking to society. This Commission was created to take testimony from knowledgeable persons regarding the problems caused by cigarette smoking, to assess the effectiveness of current anti-smoking activities, and, on the basis of its findings, to-recommend new approaches to this major social problem. The Commission's focus has been on public policy, particularly the role of the Federal government, state and local governments, and national voluntary health agencies. The Report is divided into two major sections. The first section is a brief summary of the Commission's Findings, Goals and Objectives, and Recommendations. The second section features a more comprehensive TIMN 431954

2. discussion of current issues and actions in the area of cigarette smoking at the level of the Federal government, state and local governments, schools, and voluntary health agencies. The Commission has also included its recommendations for future action by these governmental and private agencies. The pursuit of health is both a public and a private enterprise. Solutions to the many problems posed by cigarette smoking will require action by individual Americans as well as a continuum of effort by government, business and industry, the health care community, and the major voluntary health organizations. However, the rights of informed adults to smoke if they choose must be recognized. To suggest otherwise would be to imply a prohibition that is neither enforceable nor desirable in a democratic society. TIMN 431955

THE REPORT IN BRIEF ... FINDINGS SMOKING -- THE HEALTii HAZARDS The Commission reaffirms the 1975 finding of the U.S. Public Health Service report, The Health Consequences of Smoking: "Cigarette smoking remains the largest single unnecessary and preventable cause of illness and early death." 1. Cigarette smoking was related in 1977 to: # more than 320,000 deaths; ~ 145,894,000 days of excess bed disability (almost three days more per-smoker than per non-smoker); # 81,360,000 lost workdays. 2. Thirty deaths per hour -- one death every two minutes -- are attributable to cigarette smoking. 3. Cigarette smoking is estimated to be related to 20% of all cancer deaths. ~ 4. Cigarette smoking is estimated to-be related to: # 80% of lung cancer; ~ 80% of emphysema; ~ 75% of chronic*bronchitis; ~ 30% of coronary heart disease. 5. Cigarette smoking is a major factor in most cases of oral cancer and cancers of the larynx, pharynx, and bladder. 6. Cigarette smoking among pregnant women is a major cause TIMN 431956

4. of low birthweight infants, birth anomalies, and maternal and neonatal mortality. 7. Cigarette smoking poses a major health hazard for women who use oral contraceptives. 8. Tobacco and nicotine are capable of inducing psycho- logical or physiological dependence or habituation; cigarette smoking is characterized, therefore, by many as a form of compulsive drug use or drug addiction. Smoking -- The Economic and Social Costs The Commission finds that the ledger of losses and profits from cigarette smoking is unbalanced. Society's losses outweigh its profits. 1. The cost of medical and hospital btlls due to ci-garette- related illness in 1975 was estimated by the Natfional Clearinghouse on Smoking and Health and the American Medical Association to be between $11.1 and $11.4 bil- lion. Other estimates are as htgh as $14 billron, Even the low estimate, however, came close to constitutfing 10% of the total U.S. health bill of $122 bfllton that year. The 1977 estimate is $15 bi•11ion. 2. The loss of income from lost workdays due to cigarette- related illness amounts to about $3 billion each year, as calculated by multiplying weeks of work lost times the average weekly wage of $190.90 reported by the U.S. Bureau of Labor Statistics for July 1977. 3. At a minimum, the current cost of cigarette smoking to society for medical and hospital bills and lost income from lost workdays is $18 billion. TIMN 431957

4. In 1976 the tobacco crop yielded $2.3 billion, including foreign exports. The estimated income of those employed in every aspect of the tobacco manufacturing industry was $756 million. 5. The revenue from tobacco products in 1976 was: tobacco tax revenues $ 6.113 billion tobacco crop 2.3 billion fertilizer, seed, fuel, pesticides, etc. .54 billion tobacco payroll •.756 billion $ 9.709 billion There are other revenues involving suppliers, whole- salers, distribtitors, advertisers, etc., that are not calculated and that would add several billion dollars more to this sum. 6. In total tobacco manufacturing probably brings in less than $12 billion, but costs smokers, their families, and society $18 billion in medical and hospital bills and lost wages -- a net loss of $6 bi'llion. 7. This does not include the costs of cigarette-related fire injury or property damage, for which no estimates are availabie, or the costs of premature early disability and death from cigarette-related illnesses. 8. Fire marshals report that 50% of all hospital fires and about 56% of all fatal residential fires are cigarette related. 9. Insurance companies are beginning to recognize that non- smokers are less of a risk in many categories. Several 5. r TIMN 431958

6. companies now offer premium discounts of up to 20% to non-smokers, not only in life policies but also in health, accident, fire, auto, and homeowners insurance. Smoking -- How Many Cigarettes? How Many Smokers? 1. Cigarette production and consumption in the United States are at an all-time high. In June 1977, 48 million adults and 6 million children and teenagers were buying 626 billion cigarettes annually. This is an average of 11,592 cigarettes, or 579 packs, per year for each smoker. 2. More cigarettes are being consumed than ever before, but fewer adults smoKe than in 1964. Since publication of the Surgeon General`s Report on Smoking and Health, the percent- age of men smoking cigarettes has declined by 25.6% and the percentage of women smoking by 9.8%. 3. Sixty-five percent of adults now do not smoke; 35% do. Non-smoking adults now comprise about two-thirds of the adult population. 4. More cigarettes are being consumed, however, by those who do smoke, and teenagers, especially young women, constitute a relatively higher percentage of smokers than ever before. 5. The tobacco industry still maintains a public stance that denies any linkage between illness and cigarette smoking. However, it has moved rapidly to meet the public demand for cigarettes with lower tar and nicotine content. . TIMN 431959

7. 6. About 24l of all cigarettes sales are in the low-tar category (15 mg. of tar or less); almost 90% of all sales involve filter cigarettes. Five years ago cigarettes with 15 mg. of tar or less rarely existed. Almost a score of new low-tar brands have reached the tobacco shelves in the last 18 months. The percentage jump in low-tar cigarettes from 1976 to 1977 was high -- almost 40%. 7. The low-tar cigarette appears to be more profitable than the conventional cigarette for the manufacturer, and currently more than 50% of the industry's advertising budget is allocated to the low-tar cigaret'te. 8. Trends indicate a reduction, but not an elimination, of the health risks involved in smoking such cigarettes. Smoking -- The Government Has Determined That Smoking Is Dangerous to Your Hea th, But ... 1. Scientific evidence has supported for more thon a decade the conclusion that cigarette smoking is a hazard to health. However, the cigarette industry remains largely unregulated and unaccountable to any agency of govern- ment for the content of its products or the health consequences of their use. 2. At least severt Cabinet departments and more than 12 agencies with regulatory responsibilities are assigned authority with regard to major aspects of the cigarette problem. There is neither cooperation nor coordination among any of these Federal departments or agencies, nor is there cooperation or coordination within the same Cabinet department on the issue of cigarette smoking. rfINiN 431960

8. 3. The entire U.S. Department of Health, Education and Welfare -- which includes the National Cancer Institute -- has placed such a low priority on this issue that it has spent slightly less than $10 million annually for research and public and professional education and information on the effects of cigarette smoking. In contrast, the U.S. Depart- ment of Agriculture spends seven times as much -- more than $70 million annually -- merely to support tobacco prices. 4. The U.S. Congress has specifically exempted cigarettes and other tobacco products from any regulation or control by the Consumer Products Safety Commission or the Environ- mental Protection Agency. 5. The Food and Drug Administration appears to have juris- diction over tobacco products, but it has failed to exercise its authority since at least 1906. The safety of new additives in the newer brands of cigarettes has been questioned. However, tobacco companies do not have to disclose -- and no agency of government has inquired -- as to the contents of these new cigarettes. There has been no move to determine whether the additives are carcinogenic or hazardous in other ways. 6. For seven consecutive years, the Congress has failed to act upon a recommendation by the Federal Trade Commission that the warning on the cigarette package be made more explicit regarding the risk of cancer, heart disease, and other diseases caused by cigarette smoking. 7. The Federal excise tax on cigarettes, 8t a pack, has remained unchanged since 1951. State taxes range from 2Q to 23¢ a pack. A major bootlegging industry in cigarettes has arisen because of this disparity. TIMN 431961

9. Estimates are that high-tax states lose one dollar in tax revenue for every dollar they collect. This loss amounts to almost $1 billion per year in state revenues. 8. The sale of cigarettes to minors is prohibited by law in every state, but this prohibition is rarely, if ever, enforced. Cigarettes are freely available to minors through vending machines and over-the-counter sales. In contrast, the prohibition of the sale of liquor to minors appears to be effectively enforced. Smoking -- C5 arette Advertising Versus Health Education 1. The cigarette industry is spending more than $422 million annually for advertising. It spends more on advertising in one day than the Federal government's principal agency concerned with smoking problems, the National Clearinghouse on Smoking and Health, spends for all of its operations in one year. 2. The National Interagency Council on Smoking and Health, with more than 30 institutional members, has an annual budget of $55,000 -- scarcely enough to support the most minimal activities. In contrast, in just one state, Connecticut, where there was no cigarette legislation under considera- tion in 1976, the tobacco industry reported expenditures of more than $300,000 for routine lobbying activities. 3. The three major national voluntary health agencies concerned with smoking, the American Cancer Society, the American Heart Association, and the American Lung Associa- tion, have been actively engaged in public information and public and professional education. However, largely because of Federal limitations on legislative activities by non-profit organizations, which prevailed prior to TIMN 431962

I 10. 1976, none of the agencies has been involved to the degree necessary in effective public policy or legisla- tive activities, consumer protection efforts, or promo- tion of the rights of non-smokers. This has allowed the industry's lobbying efforts to go virtually unchallenged in these vital areas. Smoking -- How Many Smokers Have Quit? 1. Over 30 million Americans who once smoked have stopped. 2. Almost 90% of these smokers stopped "cold turkey;" the remainder used a variety of smoking cessation techniques. 3. These techniques have been shown to have essentially the same cessation rates - 20% to 30% - after one year. 4. This emphasizes the importance of efforts to improve the effectiveness of these techniques, and, more impor- tantly, to prevent the start of the habit. 5. None of the major national voluntary health agencies concerned with smoking has been really actively engaged in supporting research to find out why people smoke and what makes them quit. 6. The variety of smoking cessation techniques that have been developed have been based on little systematic research. Smoking -- Non-smokers' Rights 1. There is growing activity on the part of state legis- latures to deal with problems concerning cigarettes and smoking. TIMN 431963

11. 2. In 1976, of the 45 legislatures that met, 41 had bills introduced dealing with limitations on smoking in public places, smoking in schools, advertising of tobacco pro- ducts, sales to minors, commerce, and other legislation not included in these categories. 3. Nineteen of the states enacted bills into law safe- guarding the public interest by limiting smoking in public places. Smoking -- The Schools 1. Public and private schools have not widely adopted effective measures to meet the problems of cigarette smoking by students and faculty, even in elementary and junior high schools. 2. School heal-th education programs regarding cigarette smoking are sporadic, episodic, and; most noteworthy, receive no support at all from the U.S. Office of Education, which is located within the Department of Health, Education, and Welfare. Smoking -- The Health Care Community 1. Patient education about the health hazards of smoking by family practitioners, obstetricians, pediatricians, and dentists is inconsistent and weak. 2. Health professionals often do not take advantage'of the "teachable moments" that come during their examinations of patients who smoke. 3. Most cigarette smokers report that they have never been advised by a physician to stop smoking. TIMN 431964

12. 4. Health facilities and practitioners can play a major role as exemplars and educators. However, the indica- tions are that this is not being done. 5. Of the nations 7,200 hospitals, very few are actively involved in the anti-smoking effort. 6. Few of the major medical, nursing, dental, or hospital societies have adopted effective programs designed to use their influence to help patients stop smoking. GOALS AND OBJECTIVES In view of these findings, this Commission recommends to the Nation at large, to the various branches of government with authority to act on the issue of cigarette smoking, and to the Board of Directors of the American Cancer Society, that a pri- mary goal be adopted. This goal is that we move, as rapidly as possible, toward a non-smoking society. The objectives served by such a move would be: 1. to improve the health of individuals and the population as a whole; 2. to reduce the burden of illness in society; 3. to reduce the social and economic burdens that result from cigarette smoking. These objectives might be achieved by: 1. Reducing, to a minimum, the number of cigarette smokers. This could be accomplished by helping those who now smoke to stop, and by conducting vigorous educational programs directed at deterring young people from starting to smoke. TIMN 431965

13. 2. Reducing the risk of disease for those who smoke and are yet unable to quit. 3. Reducing the exposure of non-smokers, particularly those sensitive to cigarette smoke, to the smoke of others and to sidestream sMoxE. To help achieve these objectives and obtain the benefits to be derived from them, the Commission has developed the following Recommendations. TIMN 431966

14. RECOMMENDATIONS The Federal Government A major Federal initiative is required to reduce the toll of premature death and suffering related to cigarette smoking, to protect individuals from the risks associated with smoking, and to help slow the rapid rise of medical and hospital costs. Executive Office of the President -- establish a Cabinet-level Committee on Cigarette Smoking and the Health Status of the Nation. Members of this committee should include representatives from the following departments and agencies: • Department of Health, Education, and Welfare • Department of Agriculture • Department of Defense • Department of State • Department of Labor • Department of Commerce • Department of the Treasury • Federal Trade Commission • Environmental Protection Agency I Consumer Products Safety Commission Congress -- place the interest of 218 million Americans above the interests of six major cigarette-producing companies by passing legislation to: ,yINiS 431967

15. 1. Replace the Federal excise tax of 8t per pack with an increased graduated uniform tax based on tar and nicotine content. This would provide a financial disincentive for those who smoke the high tar/nicotine cigarettes and a financial incentive to smoke the low tar/nicotine cigarettes. It would also help to curb the spread of cigarette bootlegging, and result in substantial increases in revenue to all states through Federal-state.revenue-sharing.based on per capita con- sumption or some other formula. 2. Phase out, over a ten-year period, the present tobacco price support system, which in effect, is a tobacco subsidy and initiate a new program that demonstrates compassion for the economic needs of the tobacco far- mer. We recommend that the ten-year program include: I full payment to farmers for not growing tobacco; I assistance to farmers while they continue to re- ceive tobacco price support subsidies to help them grow the least harmful varieties of tobacco; I expanded research into non-harmful alternative uses for tobacco, such as a potential source of protein. 3. Enact into law the Federal Trade Commission recommen- dations to make the health warning on the cigarette TIMN 431968

16. package more explicit. The label would read: "Warning: Cigarette Smoking is Dangerous to Health, and May Cause Death from Cancer, Coronary Heart Disease, Chronic Bronchitis, Pulmonary Emphysema, and other Diseases." 4. Eliminate tobacco products from the Food for Peace Program (Public Law 480). 5. Direct the Food and Drug Administration to safeguard the public interest by exercising its authority to regulate tobacco products, including the additives currently being added to cigarettes. 6. Review the protection it now affords the cigarette in- dustr, ~ the expe-:~ of the public health and welfare, and make certain that some appropriate agency of Govern- ment, either the Food and Drug Administration or the Consumer Product Safety Commission, holds the industry accountable for the safety of its product. Department of Health, Education, and Welfare -- act as a prime advocate of a Federal initiative in the area of cigarette smoking. The potential role of the Department spans public health educa- tion and information, research, regulation, and financing. 1. The Secretary should form an Intra-Agency Council to assure a degree of cooperation and coordination among the many bureaus and offices within the Department that have a potential to impact upon the cigarette problem. These include the National Cancer Institute; National TIMN 431969

17. Institute of Heart, Lung, and Blood Diseases; National Institute on Drug Abuse;. National Clearinghouse on Smoking and Health; Food and Drug Administration; Na- tional Center for Health Statistics; Health Care Financing Administration, and the Office of Education. 2. The Department should increase the priority of funds for education and information concerning hazards in- volved in cigarette smoking; increase, manyfold, the funds made available to the National Clearinghouse on Smoking and Health. 3. Prepare in cooperation with the major voluntary health agencies, a large-scale, paid anti-smoking campaign, using all media. 4. Support a thorough study of the net costs to society of cigarette smoking, so that these costs can be more equitably distributed, with smokers bearing far more of the economic burden than is now the case. 5. Support high-quality research on the impact of passive smoking. 6. Increase funds for epidemiologic studies of social, be- havioral, and biological factors in cigarette smoking. 7. Support a study of the addictive qualities of nicotine, and recommend maximum levels of use in cigarettes. TIMN 431970

18. Food and Drug Administration -- exercise its authority to regulate the tar-nicotine and carbon monoxide content of tobacco products and to assure the appropriate labeling of their contents. It should also study the potentially harmful additives now being used in many of the newer cigarettes. If it believes it is not authorized to undertake this study, it should request clear Congressional authority to do so. Federal Trade Commission -- pursue a purposeful and practical tack in regulating cigarette advertising. 1. Seek to obtain a voluntary agreement with the cigarette industry to eliminate the use of models in all advertising. 2. Seek an agreement under which cigarettes above a specified tar-nicotine content would not be advertised. We recommend maximums of 10 mg. tar and 0.7 mg. nicotine in cigarettes for which advertising would be permitted. These levels should be reduced, however, on a gradual basis. 3. Require that tar-nicotine and carbon monoxide content be prominently printed on every cigarette package. 4. Require that the warning label be displayed on every package and in all advertisements, particularly billboards, at a size that is readily visible. Department of Labor -- support the general policy that the work- place should be a smoke-free environment. "No smoking" should be the general rule. Special areas should be set aside in places of employment for those who want to smoke, The Occupational Safety and Health Administration should recommend a major study of the impact TIMN 431971

~..;Eln_mk 19. of cigarette smoking in the workplace, particularly in closed environments, Based on its findings, it should recommend and enforce appropriate standards. Department of Defense -- discontinue its practice of encouraging cigarette smoking through the sale of tax-free cigarettes; taxes should be added to the price of cigarettes sold at all military establishments. The Department should not permit the illegal sale of cigarettes to minors. It should make cessation programs widely available. Educational and informational campaigns on the risk of cigarette smoking to the individual should be added to the current Information and Education programs. The Secretary should direct each of the Armed Forces (Army, Navy, Air Force, Marines, Coast Guard) to examine their policies with respect to smoking in public facilities, and assure adequate non-smoking areas. State and Local Governments Government, at all levels, should view smoking as harmful and destructive and should provide smoke-free environments for its employees and guarantee non-smoking areas in all government facilities open to the public. 1. "No smoking" should be the general rule in all public places; a smoking area should be provided where appropriate. 2. The ban on the sale of cigarettes to minors should be enforced. Vending machines should be allowed only in places where they can be supervised or monitored. Penalties for violation should be made more severe. 3. State legislatures should enact legislation to eliminate "contributory negligence" on the part of smokers as an TIMN 431972

20. industry defense in legal actions against cigarette companies. 4. A portion of cigarette tax revenues accruing to the states should be earmarked for the training of competent health educators and for public information and education campaigns about smoking. This should include school health education as well as purchase of anti-smoking ads. Public and Private Schools 1. Smoking should not be permitted in elementary or secondary schools. 2. Highest priority should be assigned the development of a comprehensive health education program stressing health maintenance to be taught kindergarten through 12th grade as a part of the required curriculum. Emphasis in the early grades, with reinforcement in each subsequent year, should be placed upon the undesirable consequences of cigarette smoking. Use should be made of non-smoking peers in stressing the social unacceptability of cigarette smoking, in addition to communication of the immediate and long-range disease consequences of taking up the cigarette smoking habit. 3. Smoking cessation clinics, appropriate for various grades, should be part of school health services. Funds for such activities should be made available at the state level. The Health Care Community Health professionals, particularly dentists, obstetricians, TIMN 431973

21. pediatricians, general practitioners, should set exemplar roles by not smoking. They should inform patients about the risks of smoking, should counsel them on quitting techniques, refer them to smoking cessation clinics whenever desirable, and should make a patient's smoking history and status part of the medical record. Hospitals should prohibit smoking in non-private rooms and public areas, and the sale of cigarettes on premises should be discontinued. Closed circuit TV, video tape materials, and other teaching aids should be available and promoted for patient education. Outpatient clinics and emergency rooms should prohibit.smoking, except in designated areas. Patient education programs and cessation activities should be part of every out-patient clinic program. National, State, and Local Medical Societies as well as nursing, dental, pharmaceutical, and allied health professional societies - particularly the American Medical Association, National Medical Association, American College of Surgeons, American College of Obstetricians and Gynecologists, the Academies of Pediatricians and Family Practitioners, and other appropriate specialty groups - should encourage their members to be more vigorous in anti-smoking efforts. This is particularly true of the state and county medical societies. State medical and dental societies and other health professions should play an active role with legislatures on policies related to cigarette smoking. The societies should also work with local school boards in the development of effective school health education programs and cessation clinics. TIMN 431974

22. Insurance Companies Insurance companies should review and make public current actuarial records and their experience with respect to smokers and non-smokers. They should make available to non-smokers, at substantially reduced rates, policies for health, accident, auto, life, homeowners, and fire insurance. American Cancer Society The Society is currently engaged in an extensive five-year anti-smoking campaign known as Target 5. In view of our findings, it should consider a major expansion of that effort. Speci- fically, it should: I Accept responsibility for public policy activities, including legislative initiatives, and the training of its volunteers to participate in such actions. ® Establish a full-time legislative capability at the. National level to fulfill its major responsibilities for initiating legislation, organizing support, monitoring enforcement, and testifying before appro- priate governmental bodies on matters affecting public policy, including cigarette smoking. Within five years, it should be spending the maximum amount permitted by law for this activity. Each Division should make a similar commitment. National and Division Committees on Public Issues should provide leadership for this. 3 Expand the capabilities of local ACS units in helping smokers to quit when they are ready to quit through a wide range of interventions. ® Accelerate its efforts in support of epidemiologic TIMN 431975

23. research on smoking. • Undertake an independent assessment of the National Cancer Institute's research on the possibility of less hazardous cigarettes. • Consider ways and means of increasing interest in motivational and behavioral research on smoking problems by qualified researchers, and be prepared to finance promising research in smoking areas not funded by government. • Fund an independent expert study of the economic impact of phasing out the present tobacco price support system. • Develop and field-test special curriculum programs and materials for school health education on smoking beyond the K-3 level, and promote the use of those found to be most effective. • Work more closely and effectively with medical, dental, nursing, and pharmaceutical societies and hospital associations to strengthen their exemplar and helping roles in smoking control. • Increase its public information, public education, and professional education activities and programs in the smoking area, with the goal of increasing awareness of the specific health hazards related to cigarettes, as well as the benefits of quitting. Special emphasis should be given to high-risk groups (those highly exposed to occupational carcinogens such-as asbestos workers, pregnant women, heavy smokers, and persons who started smoking early in l,ife). TIMN 431976

24. 0 Local ACS anti-smoking efforts appear to be fragmented and sporadic. It is recommended that each ACS Division and Unit set up special Task Force groups to direct and coordinate accelerated anti-smoking activities. I Increase substantially the financial resources it cur- rently devotes to support Target 5 objectives and the recommendations of this Report. This should include provisions for full-time staff assigned to anti-smoking activities, as well as a full-time employee to coordinate this national program. ! Accept the leadership in coordinating efforts more fully with other health organizations in achieving common goals. Other Voluntary Health Agencies Cooperation among voluntary health agencies, particularly in the area of approaches to public service television and radio stations for anti-smoktng spots and programs, should be increased so that the effort does not suffer from fragmentation and lack of cooperation. The agencies should also work more closely and cooperatively on public policy issues affecting cigarette smoking. Smokers Cigarette smokers who cannot yet quit should become fully aware of the risks associated with cigarette smoking. They should recognize and be sensitive to the needs of non-smokers., parti- cularly those who may be sensitive to cigarette smoke. They should make every effort to support programs of education, particularly for children, related to cigarette smoking; and finally, they should continue their pressure on cigarette companies to produce and market cigarettes that may be less hazardous. TIMN 431977

I SMOKING AND THE FEDERAL GOVERNMENT: ISSUES AND ACTIONS Despite its own findings and warnings about the hazards of cigarette smoking, the response to this problem by the Federal government on both Congressional and Executive levels has been minimal and symbolic. In fact, the failure of the Executive and Legislative branches to safeguard the public interest and the public health could be described as a national disgrace. CONGRESS Cigarettes -- An Unregulated Consumer Product In its zeal to protect the tobacco growers and the tobacco industry, and in its unwillingness to confront the human suffering and economic loss involved with cigarette smoking, the Congress has exempted cigarettes from the re- gulation of the Consumer Products Safety Commission and the Toxic Substances Act. It has also prevented independent initiative by the Federal Trade Commission, and has failed to respond to its recommendations for at least the past seven years. 25. The subservience of the Congress to the political and economic power of the tobacco industry began in 1906 when, to make cer- tain that tobacco products would not come under the jurisdiction of the Food and Drug Administration, it declassified nicotine as an addictive drug, and by decree: ruled that cigarettes, therefore, were neither a food nor a drug product. In 1973 the Congress came to the industry's assistance when a Federal Court held that the Consumer Products Safety Commission had the authority to consider a petition to ban cigarettes yielding more than 21 mg. of tar because they were hazardous. Under pressure from the tobacco lobby, allied with the fire- TIMN 431978

26. arms lobby, the Congress quickly decided that neither tobacco products nor firearms came under the Commission's jurisdiction. This classic example of political expedience, contravening the preponderance of available evidence, was written into the re- cord of the Congress' accountability on the smoking issue. As a result, the tobacco industry remains a virtually unregulated industry, unaccountable to any department or agency of govern- ment for the hazardous content or the health consequences of its products. Even though there is some suspicion that new additives being used in the manufacture of the low tar/low nicotine cigarettes may be harmful, and possibly carcinogenic, the industry is not required, and the government does not ask, that there be any disclosure as to what goes into cigarettes. The public is totally unprotected. Cigarettes -- A Food for Peace? The only area of Congressional concern in which there has been some progress involves an effort to eliminate tobacco products from the Food for Peace export program. Under this $1.3 billion prograri,authorized by Public Law 480, the government ships cigarette products overseas. In practice, the cigarettes ex- ported tend to have the highest tar and nicotine content and are the most hazardous. The present warning label is not put on the package unless the host country specifically requests it. In late spring 1977, the House of Representatives for the first time in history, voted to exclude tobacco products from that program. The Senate did not go along, and, in conference between the two bodies, tobacco products were restored to the list of products eligible for export under Public Law 480. As part of the compromise, it was agreed that public hearings would be held for the first time since 1933 on the tobacco price support program. - TIMN 431979

27. Tobacco Subsidy In 1976, 1,042,600 acres of tobacco were grown in the United States yielding an average of 2,032 pounds per acre. The crop produced $2.3 billion in income. That same year the Department of Agriculture spent about $70 million for its price support program for tobacco farmers. This effort is commonly known as the tobacco subsidy program. In terms of the total crop and cigarette output, the program is more symbolic than meaningful. More than 400,000 families in 12 states grow tobacco, but the level of participation differs greatly. As a group, however, tobacco growers constitute an effective lobby whose rights are zealously protected by the Representatives from their districts and the Senators from their states. Many of these legislators hold key positions on the variety of Subcommittees in both the House and the Senate that deal with agricultural and price-support programs, as well as House and Senate Committees that oversee the appropriation of the Department of Health, Education, and Welfare. Tobacco growers and their families are concentrated in 24 Congressional Districts in seven states. (Of these, 21 are in four states only -- North Carolina, Kentucky, Tennessee and Virginia.) In each of the 24 Districts, there are over 10,000 tobacco farms. A vital economy in these districts is based upon the economic prosperity of the large number of tobacco farmers. As a cash crop, tobacco is far and away the most profitable "legal" commodity to grow on an acre of soil, even though be- tween 275-300 man-hours of labor are required to produce and market one acre of tobacco, as compared to three man-hours for an acre of wheat. TIMN 431980

28. In the House Agriculture Committee, agricultural subsidy pro- grams are handled by Subcommittes organized on the basis of commodities. All but two members of the tobacco Subcommittee are from major tobacco-producing states. In the past ten years, there have never been more than two members of the Subcommittee at a given time that were not from a tobacco-producing state. Thus, decisions about the national program in the House are made almost exclusively by members whose constituents will re- ceive tobacco subsidies. Although it would appear that efforts to eliminate the tobacco support system in the short term are not very feasible politi- cally, there has been a move within the Congress this past session to question both the need and the desirability of the program, given its health consequences. Public hearings on this subject for the first time in the program's 44-year his- tory are scheduled for 1978. The entire tobacco industry in 1976 accounted for slightly over $16 billion in sales. Cigarette sales represented $15.2 billion of this total. The price support program costs about $70 million. It represents approximately 1/2 of one percent of the gross cigarette revenue. This is not very significant in terms of dollars, but it has assumed large symbolic proportions. This Commission considered many facets of the tobacco subsidy question. Its conclusions were: 1. The tobacco price support system was instituted in 1933 at the depth of the Depression to prevent over- production and to protect growers. There is relatively little logical reason to continue that program in to- day's economy. TIMN 431981

29. 2. The amount of money involved is relatively insignificant in comparison to total revenue from tobacco production and total cigarette sales. However, the fact that the government is supporting production of a product that it alleges to be the most identifiable health hazard in the United States would indicate that the time has come to review government's relationship to and support for tobacco production. 3. Agricultural and political realities indicate that substitute crops may not be feasible; nevertheless, the public interest would best be served if the tobacco price support program were phased out over a period of years, with Federal programs developed to mitigate against adverse economic impacts on the growers. 4. The economic and social costs of smoking are so great that it would pay the government to subsidize farmers not to grow tobacco. This Commission recommends that: • The tobacco price support program be phased out over a period of ten_years; • Production of less hazardous and less toxic tobacco be phased in during that time period; The Department of Agriculture should provide compensatory payment to farmers who partici- pate In this program; ~ TIMN 431982

30. I The price support program be discontinued imme- diately for all except the low tar-nicotine varieties of tobacco. This condition would not be a hardship to farmers because, in order to participate in the price support program now, they must certify that they do not use DDT, TDE, toxaphene, and enderin insecticides. In addi- tion, only some tobacco varieties are actually supported by the government-sponsored program. Tobacco and Taxation Of the $15.2 billion in gross receipts from cigarette sales in 1976, the Federal government received $2.488 billion, and the state governments received $3.518 billion, in tax revenue. The few city and county governments that tax cigarettes received $113.6 million. The total tax revenue at all levels of govern- ment was slightly over $6.11 billion. The Federal excise tax -- U a pack -- has remained constant since 1951. State taxes vary from a low 2¢ a pack in North Carolina to 23¢ a pack in New York, Massachusetts, and Florida. Ten states receivp more than $100 million each from this source, with California, New York, Pennsyivania, and Texas grossing more than $250 million each. The high tax in several states has made cigarette smuggling and bootlegging between low and high tax statet a major ac- tivity of organized crime in America. In each of the states receiving more than $100 million, cigarette bootlegging has become a major problem. The high tax states estimate that they are losing one dollar of tobacco sales for every dollar of taxes collected. TllVil~ 431983

31. New York State, for example, estimates that it has lost more than $1 billion in the past ten years to cigarette bootleggers. In 1977 the state legislature was told that the number of~boot- legged cigarettes entering New York is 1.2 million packs a. day -- a total of 460 million packs a year.. Industry sources claim that 35% of cigarette wholesalers in New York City have gone out of business because of the bootlegging problem; 2,000 jobs involving truckmen, wholesalers, vending operators, and retailers have been lost in the New York City metropolitan area. One approach to the tax problem would be a uniform Federal tax with rebates to the states on the basis of per capita consump- tion under a Federal/state formula agreement. The concept of a uniform Federal incentive tax proposal has been studied and considered as an option by the Advisory Com- mission on Intergovernmental Relations in its May 1977 report, entitled "Cigarette Bootlegging: A State AND Federal Respon- sibility." Some of the proposals of the Commission are in- cluded in the appendix to this Report. Another approach would be a graduated uniform tax based on tar-nicotine content, with a lower tax on the low tar/nicotine cigarette and the highest tax on the cigarettes with the highest tar/nicotine content. Assuming that taxes are passed on to the consumer, a graduated tax would probably have de- sirable impact on the sale of cigarettes through vending machines. Distributors stock machines with the most popular brands, and it would appear likely that the less expensive brands would become more popular. Since vending machines re- main the principal source of supply of cigarettes'to minors, stocking the low tar/nicotine cigarettes would have a long- term beneficial value. TIMN 431984

32. Senators Kennedy, Hart, Brooke, and others as well as Con- gressman Drinan and others have introduced legislation pro- posing a "health tax" on cigarettes. The additional funds would help defray the economic costs of cigarette-related illness. An increased graduated uniform tax -- one-cent per pack would yield revenue of approximately $300 million -- could be earmarked for a variety of public interest purposes: 1. Defray the Medicare/Medicaid costs of cigarette-re- lated illnesses; 2. Pay for anti-smoking ads on television; 3. Increase funding for research to help develop less harmful strains of tobacco, less hazardous cigarettes, synthetic cigarettes, and to teach smokers to smoke in a less hazardous manner; 4. Provide assistance to school systems for health edu- cation programs; 5. Sponsor behavioral and motivational research designed to determine why people do or do not do things that are good or bad for them, with particular emphasis on helping people to stop smoking; 6. Support demonstration projects in smoking cessation; 7. Develop alternative uses for tobacco; 8. Conduct campaigns of public information and professional education to help lay and professional people more effectively deal with cigarette-related problems. TIMN 431985

33. This Commjssion recommends that: 0 An increased graduated uniform Federal tax re- place the present 8t Federal excise tax on all cigarettes; 0 This tax should be based upon tar/nicotine content to create an incentive for the lowest tar/nicotine cigarettes and provide a penalty for the highest tar/nicotine cigarettes; i The Federal government should be the sole collector of the tax and should rebate to the states the amount due based on per capita consumption and other revenue- sharing formu1as, guaranteeing that no state would receive less money than it derives at rp esent. ® The increased funds should be earmat^ked for the purposes enumerated in the preceding section of this report. The Commission believes that adoption of these Recommendations would: 1. Drastically reduce the incidence of bootlegging; 2. Increase state cigarette tax income; 3. Provide additional funds for information, education; and research efforts; TIMN 431986

34. 4. Defray costs the government now incurs through Medi- care-Medicaid reimbursement for cigarette-related ill- ness. In other words, while the Federal government's general revenues would be decreased by the earmarked graduated uniform tax con- cept, the government would be more than compensated by increases in funds to defray the economic cost of cigarette-related illness. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE On October 31, 1977, Secretary of Health, Education, and Welfare Joseph A. Califano, Jr. asked this question during a speech be- fore the American Public Health Association: "If we decide that cigarette smoking is affecting the health of too many citizens, are we ready to reduce or discourage cigarette consumption?" The Department of Health, Education, and Welfare (DHEW) had apparently decided over the years that the answer to this ques- tion was "No." * Cigarette Advertising Versus Health Education In 1976, and continuing into this present year, the cigarette companies are spending more money advertising their product in one da than DHEW has allocated for one year for activities of the National Clearinghouse on Smoking and Health -- its principal arm in the area of smoking. The industry's adver- tising expenditures are currently in excess of $422 million a year -- over $1,156,000 per day. The total annual budget for the Clearinghouse is about $900,000 -- $2,465 per day. Even this amount is threatened each year during the annual budget review process. The effectiveness of the Clearinghouse activity is diminished further by a lack of commitment about its value. * On January 11, 1978, Secretary Califano announced a new HEW initiative in the area of cigarette smoking. TIMN 431987

35. The Office of Education is not supporting a single project any- where in the United States involving school health education as it pertains to the problems of cigarettes. This has been true for at least seven years. But education is only one of the potential arenas of action in smoking in which DHEW has failed to operate adequately. Research in Smoking The National Cancer Institute, with a fiscal year 1978 budget of $867 million, is devoting about 1% of its resources to cigarette-related research or any other activity designed to reduce morbidity and mortality from this product, although cigarettes are clearly related to the epidemic of lung cancer during the past 25 years. Less than 10% of the victims of this disease survive five years. The National Heart, Lung, and Blood Institute, with a 1978 budget of $445 million, second only to the National Cancer Institute, is also devoting approximately 1% of its funds to cigarette-related research, although 30% of coronary heart disease, 80% of emphysema, and 75% of chronic bronchitis, all diseases within the Institute's jurisdiction, are cigarette related. Funds appropriated by the government to support research in the general area of smoking are seriously deficient. Several specific areas of research demand increased governmental support. Pharmacology of Nicotine. In a paper delivered to the Third World Conference on Smoking and Health, Jane Frances Emele said: "Nicotine is an extremely powerful drug. It is power- ful not only pharmacologically, but psychologically, behaviorally, commercially i.n the form of tobacco, and scientifically, as j evidenced by the magnitude of interest it has engendered since 1900." Her paper also said: "The clinical pharmacological TIMN 431988

36.. effects of nicotine as it is present in the main smoke stream depend on the physiological state of the subject, the degree of nicotine absorption, the extent of the habit, and the psy- chological predisposition of the smoker, to mention only a few contributing factors." It is to be noted also that the pharmacological effects of smoking are not solely related to nicotine, but are the end result of the smoke per se and all of its particulate matter. Dr. Gio Gori, Deputy Director of the National Cancer Institute, has informed this Commission that, in his opinion, nicotine is an addictive drug and, in fact, it is the element in the cigar- ette which causes people to smoke more and more and makes it more difficult to stop when they wish. Several schoolchildren testified before this Commission that they smoke and are "hopelessly hooked." Adults have also testified that they are "hooked" and cannot break their ad- diction. Smoking Cessation Techniques. Of the over 30 million adults who have stopped smoking, the National Clearinghouse on Smoking and Health estimates that 90% quit "cold turkey" on their own. The remaining ten percent were helped by a variety of cessation methods and techniques. The testimony received by this Commission indicates that of the smoking cessation efforts that were struc- tured in such a way as to be measurable, the most effective reported a quit rate of 30% at the end of.12 months. The most promising long-term results were reported in the June 1977 American Journal of Public Health..A follow-up study of clinic participants showed that 17.8% were.stiil not smoking after five years. In addition, of those who continued to smoke, nearly one- half were smoking less than they had been before the clinic. 1 ~~~~ ~3~~~

37. r This Commission has had access to more than 100 different smoking cessation methods used around the world. No one method when measured carefully appears to be significantly more successful than another. We have found that there are nine identifiable different combinations of individual counseling, group counseling, tranquilizers, and placebos used by smokers to help them quit. Studies reviewed indi- cate that any male smoker could succeed in giving up the addiction temporarily regardless of how much or how long he smoked; regardless of his personality characteristics, anxiety level or socioeconomic status; regardless of his type of smoking or reasons for smoking. Women appear to have a more difficult time giving up the smoking habit. There were differences, however, between long-term and short-term quitters. Men who could quit for good were more satisfied with their lives, their jobs, and their relations with women. They had lower levels of chronic illness and anxiety. They were less addicted to smoking, and they relied less on cigarettes to alleviate negative effects than persons who returned to smoking. The evidence also appears to indicate that many people are psychologically dependent on cigarettes, that tranquilizers do not help, and that group counseling was not superior either to individual counseling or to medication. While initially counseling appeared to have higher success rates, it became obvious that at least four months is needed to help pass the common point of return to smoking. There was additional testimony that environmental influences have a strong impact on those who return to smoking and that, particularly where women are concerned, nutritional advice to avoid weight gain is an essential element of a successful smoking control program. Cessation methods have been classified in the following categories: Seventh-day TIMN 431990

38. Adventist Five-Day Plan; voluntary and commercial withdrawal clinics; aversive control techniques; self-control procedures; hypnosis; physician intervention methods; risk-factor trials and studies; and miscellaneous. A variety of pharmaceutical agents are also used to help people quit smoking and to help them overcome withdrawal problems. Low Tar/Low Nicotine Cigarettes. Research conducted by the American Cancer Society, which is the most comprehensive and most reliable long-term study of cigarette smoking undertaken in this country, is based essentially on studies of people who smoked cigarettes with 17 mg. tar content or higher. About 30% of the brands on the market today have 15 mg. or less tar. (These cigarettes presently account for 24% of all cigarette sales.) Recently, more brands have begun to appear with 10 mg. tar or less. In fact, of the 166 domestic varieties on the market in June 1977, 57 brands had 15 mg. tar or less. (28 had 10 mg. tar or less; 24 were between 11 and 14 mg.; and 5 had 15 mg.) Based upon the 17 mg. research, it has been shown that this degree of "low tar" cigarette is somewhat less hazardous than the higher-tar cigarette. There are other indications from the National Center for Health Statistics, National Clearinghouse on Smoking and Health, and the National Cancer Institute that the health hazard may be substantially reduced by the lower tar, lower nicotine cigarettes. This appears to be a trend, but many years will have to elapse before epidemiologic research can actually show the effect of these cigarettes on health status. Dr. Gio Gori, Deputy Director of the National Cancer Institute, has reported that, in his opinion, it is possible to produce a far less hazardous cigarette by lowering the tar and nicotine content and by using more porous paper to reduce the hazard caused by carbon monoxide. According to Dr. Gori, if cigarette manufacturers JAMN 431991

39. were to reduce the acidity in the tobacco they now use and move to a more alkaline variety, the health hazard would be substantially reduced. He cites England, for example, which uses a high-acid, blonde tobacco and experiences a lung cancer death rate of 75 per 100,000. France uses an alkaline, dark tobacco, which is substantially harsher, but results in a lower death rate from lung cancer of 28 per 100,000. In the United States a blend of both tobacco varieties is used, and the lung cancer death rate is 45 per 100,000. This Commission does not believe that it is possible to speak of cigarettes as ever being "safe"; however, some scientists have testified that providing there are no new unknown carcino- gens being used as additives, the lower the tar and nicotine, the more porous the paper, and the more efficient the filter, the more likely the cigarette is to be less hazardous. Effects of Passive Smoking. This Commission received a limited amount of testimony, as well as supplemental data, about the effects of passive smoking. Researchers at the Naylor Dana In- stitute for Disease Prevention have reported that a non-smoker lingering in the smoke-filled atmosphere of a commuter train bar car for an hour can absorb as much of a carcinogen called DMN as a person who smokes 17 to 35 filter cigarettes a day. In previous tests, DMN has been shown to cause cancer in labora- tory animals. A representative of the Airline Pilots Association told the Commission that carbon monoxide in the cockpit of a plane reaches levels sufficiently high to jeopardize the safety of the entire crew and passengers because pilots' responses are slowed. An air traffic controller has testified that efficiency is im- paired because of the he`avy concentration of smoke in the con- TIMN 431992

40. trol tower, jeopardizing controllers' performance and, there- fore, the safety of passengers. Flight attendants have tes- tified about the difficulties caused by cigarette smoke in the plane's cabin. A New Jersey employee at AT&T, who won a Jersey Supreme Court case on the subject, testified about the negative impact of cigarette smoke in the workplace. The literature concerning passive smoke is not now extensive, but it is growing. Cigarettes and the Food and Drug Administration The Food and Drug Administration -- FDA -- is responsible as a regulatory arm of DHEW for protecting the health of Americans against impure and unsafe foods, drugs, and cosmetics, and other potential hazards, such as radiation, medical devices, and diagnostic products. It is specifically responsible for assuring the safety, effectiveness, and labeling of all drugs for human use. The "Delaney clause," or the food additive amendents to the Food, Drug, and Cosmetic Act, gave the FDA the authority in 1958 to require pre-marketing clearance for new food additives and prohibit the approval of any additive "found to induce cancer in man or animal." For more than 70 years, since Congress' 1906 decree declassi- fying nicotine as an addictive drug, FDA has assumed that it lacked authority to inquire into the safety of cigarettes or other tobacco products. Public interest attorneys who have researched this question have filed suit in the Federal District Court in Washington, D.C. alleging that FDA does have such jurisdiction and asking the Court to order the agency to exercise its regulatory authority over cigarettes. A spokesman for the DHEW has informed this Commission that, in its opinion, FDA does have that authority. The fact remains, however, that, to date, the FDA has initiated TIMN 431993

41. no action in this field. An attitude survey prepared for the FDA indicates that while a vast majority of Americans surveyed believe that the claims made for any product advertised must be true or else the govern- ment would not permit the advertising to exist, the fact re- mains that there is no health or safety accountability of cigarette prodUcts to any agency of government; nor is any agency of government currently examining the contents of cigarettes to estimate or control the degree of hazard. Smoking, the Health of Americans, and DHEW -- Time to Act As the Nation's lead agency in matters affecting the health, education, and welfare of Americans, DHEW has the obligation, the capacity -- and the resources -- to act as a prime ad- vocate of innovative initiatives to mitigate the many serious problems stemming from smoking. However, of a total budget of $161 billion in 1978, only slightly more than $10 million is being devoted to information and edu- cation activities and cigarette-related research bypthe entire Department of Health, Education,and Welfare. This is about 1/100th of 1%. No DHEW funds and no DHEW effort are being de- voted to attempts to regulate tobacco products. In effect the Federal government is spending $70 million to help grow tobacco, and $10 million to fight the effects of cigarette-related illness. This imbalance is unconscionable. To reduce the toll of cigarette-related illness -- the economic and human costs of that illness--several issues must be faced and dealt with: 1. What is the pharmacologic effect of nicotine on humans? Is it an addictive substance? TIMN 431994

42. 2. Are the additives in cigarettes hazardous or carcinogenic? 3. Are Low-tar/low-nicotine cigarettes less hazardous to health over the long term? 4. Why do people start smoking and keep smoking? 5. What makes them stop on their own initiative? 6. Are there more effective techniques to help people who want to stop smoking, but cannot? 7. What are the risks of smoking to non-smokers? 8. What impact does social acceptability/inacceptability have on smokers' behavior? Testimony before this Commission indicates that smoking cessa- tiop programs will have limited impact unless changes are brought about in the social climate and changes occur in the regulation of manufacturing and distribution of tobacco pro-- ducts. In view of this data, this Commission recommends that: ! The Department of Health, Education, and Welfare accord a high priority for research, information, and education, and regulation of the health hazards involved in cigarette smoking, It should: 431995 T~

43. 1. Seek clarification from Congress of the Food and Drug Administration's authority to examine all potential health hazards of all substances contained in tobacco products (e.g., tobacco, tar, nicotine esters, gases, additives, filters, cigarette paper); 2. Commission a careful research study of the pharmacologic effect of nicotine on humans; 3. Recommend that maximum levels of nicotine be established if nicotine appears after study to fall within the general classifi- cation of addictive drugs; 4. Seek authority from Con ress for the Food and Drug Administration to regulate nicotine as an addictive drug; 5. Increase the priority of funds for epidemio- logic studies of social and behavioral fac- tors related to cigarette smoking; T'IMN 431996

44. 6. Support more research on the effects of passive smoking; 7. Support a study of the effectiveness of present smoking cessation techniques; 8. Reimburse through Medicaid and Medicare for smoking cessation techniques found to be most effective; 9. Support more research on the development of new and more effective smoking cessation techniques; 10. Increase the priority of funds for edu- cation programs on smoking in elementary schools (K-3) with careful evaluation of the outcome through the Office of Education: 11. Prepare a large scale paid anti-smoking campaign in cooperation with the voluntary health agencies. Funds for such adver- tising would be derived from increasing the Federal excise tax on cigarettes. There is ample precedent for this. In 1975, the Federal Government was the nation's tenth largest national advertiser, spending $113.7- million for such activity. While the largest portion of that sum was used for recruiting purposes by the Army and Air Force National Guard and for such quasi-governmental units as the postal service, Conrail and Amtrak, we believe tha t because of the high cost of ciga- rette-related illness -- $18 billion annually -- such an expenditure would be warranted TIMN 431997

45. 12. Increase substantially funds made available to the National Clearinghouse on Smoking and Health for information programs, in- cluding a large scale program on TV, radio, magazine and newspaper advertisements on the hazards of cigarette smoking; 13. Fund social and economic research into the net costs to society of cigarette smoking, so that the costs can be more accurately calculated and more equitably distributed, with smokers bearing more of the costs than is now the case. 14. Bring up to date the Surgeon General's 1964 report, taking into account the new data that has been developed on the impact of cigarette smoking. TIMN 431998

46. FEDERAL TRADE COMMISSION The Federal Trade Commission -- FTC -- which is charged with the responsibility of monitoring the marketing and advertising prac- tices of the tobacco industry, has assigned 1-1/2 attorneys to its major suit charging the six major cigarette companies, twenty of their advertising agencies, and two trade associations with violating prior agreements. Representing the industry are at ieast 80 attorneys, who are challenging the validity of the sub- poena. The FTC can say, in truth, that it has brought suit against the industry. In reality, even if successful, FTC officials admit they could receive 10 to 12 million sheets of paper, a degree of "cooperation" that would totally overwhelm the present staff. If past patterns hold true, it would be almost ten years before the industry agrees to cease and desist marketing and practices complained about in 1975. The FTC's own estimate is that some time around 1985 a new consent decree will be issued, and the in- dustry will agree to cease and desist practices complained about in 1975. FTC's case, however, will no longer have any validity because the industry will have long ago shifted its marketing and advertising strategy. The tobacco industry has almost unlimited resources to fight and delay public initiatives -- in fact, that is the industry's legal strategy. Despite this fact, the Congress has blocked almost every move to protect the American people from any of the known cigarette-related hazards. Cigarettes -- The Warning Label The present warning on each cigarette package now reads: Warning: The Surgeon General Has Determined That Cigarette Smoking Is Dangerous to Your Health. For seven consecutive years, the Congress has ignored an FTC recommendation that the warning label on the package be made more TI~~ 43,999

47. explicit. That new warning label, recommended again on July 20, 1977, would read: Warning: Cigarette Smoking Is Dangerous to Health, and May Cause Death from Cancer, Coronary Heart Disease, .Chronic Bronchitis, Pulmonary Emphysema, and Other Diseases. As an alternative, the FTC said it would accept a revised warning, which would read: Warning: Cigarette Smoking Is a Major Health Hazard and May Result in Your Death. Although the latter statement has the approval of the American Cancer Society's Board of Directors, there is no present indication or expectation that the Congress will respond more favorably this year than it has in the past. Cigarette Advertising -- After All, If Smoking Isn't Profitable, Why Bother? In the 1950s there were six major brands of American cigarettes on the market. They were: Lucky Strike, Old Gold, Chesterfield, Philip Morris, Camel, and Pall Mall. According to the June 1977 report of the Federal Trade Commission, there are now 166 American brands on the market. Competition for a share of the market has grown more intense. In 1964, the year the Surgeon General released his report on smoking, total domestic cigarette advertising costs were $261.3 million. Currently, it is estimated that the six cigarette companies are spending in excess of $422 million. Two companies, R. J. Rey- nolds and Philip Morris, have each spent $40 million launching two new low tar/low nicotine brands -- Real for R. J. Reynolds and Merit for Philip Morris, and each hoped to achieve at least an initial 1% of the market for that expenditure. (Each 1% represents $152 million in sales at the retail level.) Real's hopes were realized in 1977 when it wound up with sales of $162 million. Since cigarette advertising was banned from radio and television, the promotional dollar iS now concentrated largely in newspapers, 71j14N 432000

48. magazines, and billboards. Sponsorship of various sporting events and direct point-of-sale promotion, while seemingly ubiquitous, utilize a minor portion of the advertising budget. Qualified witnesses before this Commission have estimated that major publications derive substantial revenues from cigarette advertising, and some are sustained by them. One witness who testified before this Commission indicated that annual revenue from cigarette advertising in major newspapers and magazines was as follows: The New York Times, $5 million; Miami Herald, $3 million; Parade Magazine, almost 80% of its advertising revenue; TV Guide, more than $20 million; McCall's, more than $4 million; Playboy, about $12 million; Time Magazine, $15 million. (A given issue of Time has between 20 to 88% of its color advertising supplied by the tobacco companies.) The cigarette companies allege that their expenditures are not designed to lure people into smoking, but rather to establish brand identification. Objective analyses of cigarette advertising over the years find that it has been seductive in its quality and relies heavily upon the use of enticing models to create favorable images. Qualified witnesses have told this Commission that almost all cigarette advertising is seductive and attempts to entice. In recent months, there appears to be a subtle shift to print~ advertising -- the ads contain more text and fewer models. Whether this presages "new" directions in cigarette advertising is unknown at this time. In view of the seductiveness of cigarette advertising, a variety of suggestions were made'to this Commission. Among them were: 1. all cigarette advertising should be banned; 2. cigarette advertising should not be allowed as a deductible business expense; 3. the use of models in:cigarette advertising should be eliminated; TIMN 432001

49. 4. advertising should show only the package; The concept of banning cigarette advertising is not new. Seven countries have enacted total bans, and Great Britain last year entered into a voluntary agreement with its cigarette industry banning advertising of cigarettes above 19.mg..of tar and, in 1978, 17 mg. of tar. Italy has banned all advertising since the mid-1960s. In most Scandinavian countries, the ban of advertising of tobacco has been enforced or is being prepared. In Iceland, the ban has been in effect since 1972. In Norway, since July 1975. In Finland and Sweden, since 1976. In Denmark, the ban extends only to television and radio, as in the United States. According to one presentation made at the Third World Conference of Smoking and Health, an international review of the effect of cigarette advertising bans on cigarette consumption suggests no significant reversal in the upward trend in per capita cigarette consumption. The growth of the cigarette smoking habit was not any slower in countries that had banned or never had permitted cigarette advertising. These studies raise doubt that banning cigarette advertising is an effective policy option for reducing cigarette smoking. It is obvious, however, that more time and more study is necessary before any conclusions can be drawn. In examining these suggestions, the Commission was aware that the removal of cigarette, advertising from radio and TV appears to have been counterproductive in the United States. Under the FCC's Fairness Doctrine, one anti-smoking ad had to be carried for every three paid ads when advertising was permitted on radio and TV. During that time, cigarette consumption was steadily downward. Starting in 1971, when radio and television adverti- sing was banned, the curve has been steadily upward. It has been suggested that radio and TV advertising should be permitted again, providing that the Fairness Doctrine prevails, or at least adver- tising of cigarettes below a specified tar/nicotine content should be permitted. TIMN 432002

50. After full discussion and consideration of these major alterna- tives, the Commission decided that legislative bans in general turn out to be counterproductive and fail to achieve their objectives. Guided in part by a report presented to the Federal Trade Commission in June 1977 on consumer beliefs and behavior with respect to smoking, the Commission found it helpful in its deliberations to consider what motivates individuals to stop smoking. The FTC report indicates that there are three levels of indivi- dual awareness that must be reached before someone is sufficiently motivated to quit: Level I is general awareness of the statement "The Surgeon General Has Determined That Cigarette Smoking Is Dangerous to Your Health." Level II is general acceptance of the statement that "cigarette smoking is dangerous to health." Level III is personalized acceptance of the belief that "a cigarette smoking is dangerous to my health." According to the FTC study, a person may be informed on one level, but not on the other, and until an individual reaches Level III, motivation to stop is not apparently sufficient. In view of the findings of this report as well as other considera- tions, this Commission recommends that: 0 The Congress should accept the Federal Trade Commission's first suggestion to make the warning on cigarette packages and cartons and in all cigarette advertising more explicit: Warning: Cigarette Smoking Is Dangerous to Health, and May Cause Death from Cancer, Coronary Heart Disease, Chronic Bronchitis, Pulmonary Emphysema, and Other Diseases. • The FTC should .require that tar/nicotine and carbon monoxide content be prominently printed TIMN 432003

51. on every package; ® The FTC should seek voluntary agreement with the cigarette companies to: 1. Eliminate the use of all models in cigarette advertising; 2. Eliminate the advertising of all brands above an agreed upon tar/nicotine content. We recommend maximum levels of 10 mg. tar and 0.7 mg. nicotine in cigarettes for which advertising would be permitted; 3. Refrain from any promotion aimed at the under-19 age group. DEPARTMENT OF LABOR The Occupational Safety and Health Act of 1970 designated five Federal agencies to provide administrative, scientific, and legal support to protect the health and safety of workers: The two most important of these agencies are OSHA and NIOSH. The Occupational Safety and Health Administration -- OSHA -- is located within the Department of Labor and is responsible for setting and enforcing health and safety standards in the workplace. It has the right to enter workplaces to inspect conditions and the authority to issue penalities on discovery of violations. The National Institute for Occupational Safety and Health -- NIOSH -- is located within DHEW and is responsible for conducting research and recommending health and safety standards. Neither OSHA nor NIOSH is barred specifically by the Congress from examining the impact of cigarette smoking in the workplace. To date, however, neither agency has made vigorous efforts to act on the problem of smoking in the workplace. OSHA has asked its research affiliate, NIOSH, to conduct'an extensive investigation and study of the dangers to workers, TIMN 432004

52. including those with heart conditions or chronic lung disease, of the carbon monoxide (CO) in tobacco smoke. But it has taken no action on the hazards posed to non-smokers who, in a closed environment, must inhale the smoke of others. Smokers are still not segregated from non-smokers, even where excessive levels of carbon monoxide generated by indoor smoking are present. Neither agency has explored the possible relationships between cigarette smoking and occupationally related diseases and ill- nesses, even though A recent Court decision HAS ordered employers to provide non-smoking environments in the workplace. In addition, these agencies have not yet taken any steps to explore the synergistic effects of cigarette smoke with other chemical or other agents commonly found in manufacturing plants and other workplaces. During the course of its Public Forums, this Commission received testimony regarding the hazards of cigarette smoke in closed working environments. Airline pilots, flight attendants, and air traffic controllers have testified that the safety of passengers in the air is jeopardized because of the high concen- trations of smoke in the cockpit, passenger cabin, and control tower. Carbon monoxide concentration in inhaled tobacco smoke is 400 ppm. Safe limits for levels in working areas have been set at 8.7 ppm for 8 hours, or 35 ppm for one hour, by the United States Ambient Air Quality Standards for CO. These levels are exceeded constantly in smoking areas. Definite physiological changes occur secondary to CO with slowing of response time at 3-5% levels. This can be dangerous -- motor vehicle accidents can be caused by this slowing of response time. Thus, chronic exposure to CO at the concentrations found in cigarette smoke can and does cause trouble. In areas heavily polluted with smoke -- conference rooms or other closed areas -- high levels of CO are a common problem, with levels of 50 ppm to 100 ppm frequently documented. TIMN 432005

53. Continuous exposure of the non-smoker with a cardiopulmonary problem to such levels is a severe and dangerous problem. In lung and cardiac patients, episodes of angina and acute short- ness of breath precipitated in this environment are well documented. Carbon monoxide combines with hemoglobin -- the oxygen-carrying substance in red blood cells -- just as quickly as oxygen, but leaves at a very much slower rate; it builds up rapidly in the blood and deprives cells of oxygen. This greatly increases the chances of heart attack or cardiac arrest. Headaches, dizziness, and weakness are common complaints and most likely due to lack of oxygen in the tissues. A presentation delivered at the Third World Conference on Smoking and Health alleged that sidestream-smoke from an idling ciga- rette probably makes up 95% of the smoke in a room. Eighty to ninety percent of the volatile and particulate agents and 50% of the carbon monoxide are filtered out of inhaled smoke before reaching the smoker's lungs. Thus, the sidestream smoke has twice the toxic material, or more, than inhaled, or mainstream, smoke. This sidestream smoke is what so-called "non-smokers" get into their lungs in a smoke-filled environment. This is why it has been estimated that in such an environment a non- smoker can inhale the equivalent of 5-6 cigarettes. A growing amount of evidence indicates that smoking constitutes a health hazard to non-smokers as well as smokers, particularly in closed environments. Synergistic effects have also been documented between cigarette smoking and asbestos, beryllium, and a variety of other substances found in many manufacturing plants. The Commission recommends, therefore, that: • As a matter of normal practice, the workplace should be a smoke-free environment; i Smoking areas should be set aside for those who do smoke; TIIygN 432006

54. 8 OSHA should be guided in setting and enforcing standards for smoking in the workplace by research undertaken by NIOSH. DEPARTMENT OF DEFENSE Cigarette smoking received its biggest boost during World War I, and later, World War II. Prior to 1916, most cigarettes were hand-rolled. The industry was relatively minor. In fact, Dr. Alton Ochsner of Tulane University, a pioneer in research on the health hazards of smoking, testified before this Commission that as a young resident just before the United States entered World War I, he and his colleagues were called together by their Chief and asked to examine a patient with lung cancer. His Chief said this was such a rare disease that they might never see it again in their lifetimes. According to Dr. Ochsner, the pro- duction of machine-made cigarettes and their easy availability to men in service was the start of the cigarette health hazard. The various branches of the military service make cigarettes freely available at PXs; the cost is very low because the ciga- rettes are tax free. The military establishment is in effect, underwriting future disability and death for members of the Armed Forces as well as their dependents. Because the military is a closed society, it provides an ideal setting to conduct effective experiments in educating and informing people about the hazards of cigarette smoking. This Commission recommends that: ® The Secretary of Defense direct each of the branches of the Armed Forces (Army, Navy, Air Force, Marines, Coast Guard) to: 1. Examine its policies with respect to smoking in public places; 2. Add taxes to the price of cigarettes TIMN 432007

55. sold at military establishments; 3. Refrain from selling cigarettes to minors, particularly military dependents; 4. Institute effective information and educa- tion progr'ams designed to help men and women in service not to start smoking; 5. Make available cessation programs for those who have started to smoke and want or need help in quitting. SMOKING AND STATE AND LOCAL GOVERNMENTS: ISSUES AND ACTIONS As evidence of the adverse health consequences of smoking accu- mulated, state legislators throughout the country have started to take remedial action. In November 1977, 41 of the 50 states had introduced legislation concerning cigarettes and smoking, and 19 states had enacted laws. Most of this legislative activity was concerned with some form of non-smokers rights, guaranteeing to a greater or lesser ex- tent a smoke-free environment in at Teast some public places. Limitations on smoking in public places, smoking in schools, sales to minors, advertising, and commerce were the principal topics covered. Some states (Arizona, Nebraska, Nevada, Minnesota, New York, South Dakota, and Utah) have enacted particularly broad and comprehensive statutes prohibiting smoking or requiring the provision of separate smoking areas in a wide variety of en- closed public places -- elevators, theaters, libraries, museums, concert and-dance halls, hospitals, nursing homes and other health care facilities, schools, intrastate buses, trains, and planes,public buildings, meeting rooms, waiting rooms, retail stores, restaurants and cafeterias, and other areas. In other states, legislation has been introduced and not_yet enacted,_. 'FI]Vly 432008

56. but efforts are growing and continuing. Why does tobacco smoke cause trouble to people? Tremendous numbers of people are sensitive to or allergic to the in- visible particles of smoke that contain irritating substances causing allergic reactions in the nose. Nasal stuffiness, dripping secretions, sneezing, and sometimes complete blockage, often make it necessary for a person to breathe through the mouth. This is a very common and aggravating factor in chronic sinusitis and postnasal drip. Because the lining of the sinuses and nose is swollen and boggy, secretions become blocked or partially blocked and cleaning slows down; bacteria by the millions start multiplying, and an infection characterized by yellow, greenish, or brownish sputum appears. Chronic changes in the sinus lining occur with scarring and thickening. Chronic sinusitis, and often postnasal drip, can last for years. Avoiding tobacco smoke is often the greatest help, but people with such allergies may not find this out for years. At the Third World Conference on Smoking and Health it was re- ported that the American Medical Association has estimated that approximately 34 million people with sensitivity of the res- piratory tract have a real, and sometimes extremely serious, problem in breathing the smoke of others. This Commission has heard testimony from restaurant owners, hotel chain operators, and other entrepeneurs who have volun- tarily segregated smokers from non-smokers in their establish- ments. Some of those who testified indicated that this not only received customer approval, but also caused no adverse re- actions from customers or clients. State legislators concerned with non-smokers' rights have in- formed this Commission that in many instances they are handicapped TIMN 432009

57. by the lack of proposed model legislation, by the lack of sup- port from voluntary health agencies such as the American Cancer Society and the American Heart Association and state medi- cal societies, and by the lack of a central source from which they can learn about the experiences of other legislators in other states. In many instances the statutes enacted were the direct result of the concerted pressures exerted by local and state-wide groups of non-smokers and the mobilization of public support behind these efforts. The rights of non-smokers' campaign `~ has been both helped and hindered by the zeal of some of the more aggressive organizations in the field, which have "turned off" some of the more conservative organizations. This frag- mentation of effort and the failure of some of the major health organizations, including ACS to actively campaign for non- smokers rights, to support legislative and legal action initiatives, and to set the example that it is requesting other health-re- lated facilities set, frustrates the efforts currently under way. In most instances it took two or more legislative sessions be- fore laws were passed. The process is not always easy; nor are the results always quickly achieved. The more successful legislation appears to draw a distinction between places where smoking must be banned outright, whether because of their small size or inadequate ventilation (e.g., public elevators, buses), the large number of persons likely to be present therein(e.g., conference rooms and auditoriums), or the special susceptibilities or needs of persons present (e.g., hospitals, doctors offices, or other medical care set- tings). The best of the statutes recognizes the right of the public to transact business with their government in a smoke-free en- vironment. From testimony, before this Commission, it appears TIMN 432010

58. that the best chances for enforcement of these new laws are not with the police or with the courts, but with the sensitization, education, and voluntary compliance of the smoking minority. In most states that have enacted no smoking legislation, penal- ties can be as high as a $500 fine and a 30-60 day jail sentence. As a response to this activity, the tobacco industry has launched a major effort to safeguard smokers' rights. This has been re- flected in organized letters to the editor across the country, petitions to the Civil Aeronautics Board urging that the no- smoking section of airplanes be discontinued, the collection of signatures at airports by paid tobacco industry personnel, and an effort to sway public opinion through columnists and editorial writers. This Commission recommends that: ® Non-smokers should be entitled to a smoke-free environment; 8 Smoking should be prohibited in most public .places -- elevators, stores, theatres and meeting rooms; ~ Smokers and non-smokers should be segregated in places such as restaurants, trains, and busses. SMOKING AND THE SCHOOLS: ISSUES AND ACTIONS Many children are starting to smoke as early as age 10 or 11, some even earlier, according to testimony presented to this Commission. Youngsters have testified that by age 12 they are "hopelessly hooked;" they said they have as much difficulty in stopping smoking as do adults. A fair amount of conflicting TIMN 432011

59. testimony was received about the wisdom of banning smoking in schools or setting aside smoking rooms or smoking areas. There appears to be no consensus on this subject. The warning on a cigarette package does not appear to act as a deterrent to children smoking, peer pressure does play an im- portant part in this process. Youngsters either smoke or do not smoke largely because of their association with other youngsters who do or do not. Insofar as the Federal government is involved with this problem, the Office of Education, which ostensibly should be most con- cerned,is not funding as mentioned earlier,a single program in the entire country in this area. This has been true for at least seven years. Anti-smoking material that is generated, comes essentially from the voluntary health agencies or from specific teachers who have an interest in the problem. There appears to be no consensus by school boards either about whether to approach this problem or how to approach this pro- blem. The National Congress of PTAs and most of its state chapters are on record, however, as being opposed to smoking in the schools. Two approaches appear to be effective in school education re- garding smoking, according to testimony presented before the Commission. Appearances by laryngectomees, persons who have had cancer of the larynx, usually called the voicebox, and have had all or part of the larynx surgically removed seem to be effective. These individuals describe their smoking habits to school children and show the effect. Oral surgeons showing the effects of oral cancer also seem to have impact. The most effective programs presented to us, however, appear to involve students themselves, generally high school TIMN 432012

60. students who work out anti-smoking programs that they then pre- sent to elementary and junior high school students. No one program appears to be more effective than others, and the same difficulties that are found in adult cessation programs appear to be present in programs relating to school-age children. The questions that this Commission has considered are: 1. Should smoking be permitted on school property, or should smoking be banned? 2. Should smoking be prohibited for students, but per- mitted for teachers? 3. Can effective cessation programs be tailored for school-age children, and can they be structured so that they can be evaluated? This Commission recommends that: 9 Smoking should not be permitted in elementary schools or in junior or senior high schools by either students or teachers; 0 Every possible effort -- federal, state, local, school, and voluntary -- should be directed to trying to help youngsters not to start smoking; ® Children who have started smoking should be treated as adults who wish help in stopping; ® Smoking cessation programs tailored to the needs of children should be developed and evaluated. TIMN 432013

51. SMOKING AND THE HEALTH CARE COMMUNITY: ISSUES AND ACTIONS In October, 1977, the Veteran's Administration, in recognition of the fact that "smoking remains a major hazard to health" committed itself to a program calling for "the voluntary re- duction and eventual elimination of smoking in its health care facilities." The VA enunciated policies discouraging smoking of all kinds in every VA health care facility, and said it would encourage "no smoking" among employees, pa- tients, and visitors. The following guidelines were for- warded to Directors of facilities: 1. Forbid the distribution of free cigarettes to patients; 2. Restrict cigarette sales in hospitals, clinics, and other direct care facilities to canteens or similar areas where other products are sold; 3. Discourage smoking by professional personnel and staff in the presence of patients; . 4. Restrict smoking to specifically designated waiting areas, patient day rooms, staff lounges, and private offices; 5. Eliminate smoking among patients with high-risk diseases through aggressive and ongoing patient education; 6. Encourage all personnel involved in public appearances not to smoke while in the public eye; 7. Cooperate with community groups in the development and implementation of community-wide programs concerned with the hazards of smoking. TIMN 432014

62. This Commission recommends that: ® Similar guidelines should be adopted by all government and private hospitals and clinics; I The promotion of healthful lifestyles should-be the core of preventive programs offered by phy- sicians, health depar.tments,,health plans, and voluntary health associations; I Physicians should counsel patients on the risks of smoking and how to quit smoking or make re- ferrals to various types of smoking cessation programs offered in the community; ® Obstetricians, in particular, should take advantage of the "teachable moments" that arise when counsel- ing pregnant patients; expectant mothers are eager to produce healthy infants, and smoking jeopardizes the chance of normal uncomplicated delivery and a normal healthy infant. ® State Medicaid programs, pre-paid health plans, and insurance companies should either sponsor or pay the cost of smoking withdrawal methods for beneficiaries. TIMN 432015

63. SMOKING AND THE AMERICAN CANCER SOCIETY: ISSUES AND ACTIONS Of the three major voluntary health agencies concerned with the smoking problem, the American Cancer Society is the largest and potentially the most powerful. Its 2-1/2 million volun- teers constitute what could become an extraordinarily effec- tive force in several areas -- legislation, education and infor- mation, smoking cessation, and research. Up to now, however, the Society has not used its potential resources to the fullest, particularly in the area of public policy. LEGISLATION Until 1976, tax legislation acted as a deterrent to non-profit organizations insofar as legislative activity was concerned. A new law now permits such organizations to spend up to 10% of their income, or a maximum of $1 million annually, for such activity. This Commission believes that the Society has a new opportunity to act in arenas from which it has previously been excluded. We note, with approval, its recent move to create a new Commit- tee on Public Issues at the National level as well as the creation of such committees within its Divisions. Properly and adequately staffed, this new National Committee can move the Society into the major arenas of action on smoking issues. Today the major opportunities for action lie with the legisla- tive branches of Federal and state governments as well as with law-making bodies at the local level. Regulatory agencies at all levels of government could exercise a powerful influence. The Committee on Public Issues of the American Cancer Society can answer questions about the Society's commitment to social change in the area of cigarette smoking. Such questions were raised by various persons before this Commission. For example, Nutrition Action, a Washington-based consumer organization, TIMN 432016

64. which has studied the ACS role in public policy, has asked this Commission what ACS will do in the smoking area regarding a number of public questions. Among them are: ® Who will prepare legislation to restrict smoking in public places, ban advertising of cigarettes, eliminate price support for tobacco, or set progressively lower limits on tar and nicotine in cigarettes? 0 Who will lobby the Congress to propose and enact such legislation? i Who will generate field support from local and state ACS chapters to key members of the Congress and state legislators? 0 Who will generate publicity to promote public acceptability of such legislative proposals? b Who will organize and assist at Congressional hearings and in the deliberations of the anti- smoking caucus? Who will provide materials and key witnesses? 0 Who will file petitions with the Federal Trade Commission to seek ore stringent warnings on cigarette packages,~and in advertisements) and to regulate the forms of advertising that entice young people to smoke? 9 Who will petition other agencies to regulate the tar and nicotine levels of cigarettes and to actively implement legislation enacted with the support of the American Cancer Society? ® Who will lobby agency officials and key members of the Executive branch to undertake these actions? A Who will lobby the Congress to support proposed action by the Executive branch? This Commission believes that these are pertinent and valid questions. We have adopted them as our own and raise them with the Society. If the health hazard posed by cigarette smoking and the human TIMN 432017

65. and economic consequences of that hazard are regarded by the Society as serious social problems, then the Society should take equally seriously a review of the resources it currently commits to these problems. Within the framework of existing tax laws, the Society has ample room for a vastly expanded program of political action. Significant amounts of money and significant numbers of human resources will have to be invested, however, if any legislative and administrative program is to have a marked, or even a measurable,impact on the Congress and other Federal, state, or local agencies. This Commission recommends that the American Cancer Society: ! Accept responsibility for public policy activities, including legislative initiatives and the training of its volunteers to participate in these acti- vities; ® Establish a full-time legislative capability at the National level to fulfill its major responsibilities for initiating legislation, organizing support, monitoring enforcement, and testifying before appropriate governmental bodies on matters affecting public polic , including cigarette smoking. Within five years, it should be spending the maximum amount permitted by law for this activity. Each Division should make a similar commitment. National and Division Committees on Public Issues should provide leadership for this. ® Testify at Congressional hearings in 1978 and urge that tobacco products be eliminated from the Food for Peace program. Until that is done, it should urge that low tar/low nicotine cigarettes be substituted for the high tar/hi h nicotine '1'IAIN 432018

66. cigarettes now being exported; and that both tar/ nicotine content and the health warning be printed prominently, in the language of the host country, on every package for export. ® Petition the Congress to phase out the tobacco price support program. a Petition the Congress to support the Federal Trade Commission's recommendation for a more explicit warning on cigarette packages and to require that tar-nicotine and carbon monoxide content be prominently printed on every package and carton of cigarettes. This warning label should be displayed prominently on every package and in all advertising. 0 Petition the Congress to place cigarettes under the clear regulatory jurisdiction of the Consumer Products Safety Commission, Environmental Protec- tion Agency, or the Food and Drug Administration. 0 Testify at the March 1978 hearings on the proposed Occupational Health and Safety Administration regulations; recommend that the impact of cigarette smoke in the workplace receive the priority it deserves on the basis of the numbers who die or are disabled each year of conditions related to that factor. ® As part of its involvement in legislation and public policy, give a high priority to the non- smoker rights campaign at all levels of govern- ment. 4 Implement its Target 5 recommendations by preparing and making available to appropriate officials proposed model legislation. 0 Take the initiative in convening, with other organizations, a conference of state legislators TIMN 432019

67. concerned with the non-smoking effort; urge its Divisions and other affiliates to become active in this area. I Urge local and network radio stations to carry anti-smoking ads to try to reach as many adults and children as possible; EDUCATION AND INFORMATION This Commission recommends that the American Cancer Society: 0 Increase its public information, public education, and professional education activities and programs in the smoking area, with the goal of increasing awareness of the specific health hazards related to cigarettes, as well as the benefits of quitting; special emphasis should be given to high-risk groups (asbestos workers, teenagers, women, blue- collar workers, pregnant women, and heavy smokers). 4 Work with the American Academy of Pediatrics and the American College of Obstetricians and Gyneco- logists to encourage its members to do a more effective job of working with young women, parti- cularly pregnant women and young mothers who smoke. i Play a major role with state and county medical societies, state and county hospital associations, and in working with health personnel at all levels so that they set an example by not smoking and by joining the anti-smoking campaign. • Intensify efforts in cooperation with the other voluntary health agencies to mount a well-designed campaign with assured continuity, custom-tailored for children in specific grades, and based upon the ability of children in those grades to comprehend the specific approaches being made. TIMN 432020

68. Develop and field test special curriculum programs and materials for school health education on smoking beyond the K-3 level, and promote the use of those programs found to be most effective. Every possible effort should be made to try to help youngsters not to start smoking. Those who have started should be treated as adults who wish help in stopping. D Launch a public information and education effort promoting the concept of the workplace as a smoke-free environment; such a campaign will require continuity over a period of years, and the society's commitment should be sufficient to sustain that effort. SMOKING CESSATION Over the past seven years, the American Cancer Society, through its Divisions and Units has sponsored as many clinics and has reached as many smokers in this country AS other smoking with- drawal programs,with perhaps the exception of the Seventh-Day Adventist Five-Day Plan. In California alone, ACS clinics have reached an estimated 40,000 people during the past five years. An independent evaluation of 29 ACS clinics held in the Los Angeles area between November 1970 and June 1973, which repre- sented about 50% of all the clinics held in the Los Angeles area during that time period, showed that of those who participated, the quit rate was 30% at six months, 22% at 12 months, and 18% at 18 months. Some American Cancer Society clinics show a 25-30% cessation rate after one year, and some show even higher success rates depending on the extend of maintenance exmployed. Some commercial plans claim higher success rates, and some which use a combination of smoke satiation, rapid smoking, and shock TIMN 4320? 1

69. treatments, claim higher success rates in quitting after one year. Witnesses have noted that while most commercial firms make claims of up to 89% success, these evaluations are con- ducted by the organizations themselves and are largely based on those persons who complete treatment, and their statistics are often limited to persons reached at follow-up. This Commission recommends that the American Cancer Society: • Place particular emphasis on developing smoking cessation programs for high-risk groups (asbestos workers, teenagers, women, blue-collar workers, pregnant women, and heavy smokers'). • Place special emphasis, also, on cessation pro- grams for children. • Expand the capabilities of local ACS units in helping smokers to quit when they are ready to quit throu h a wide range of interventions. • Support the tack that smoking withdrawal programs, whether voluntary, commercial, and university sponsored, should be requested to disclose meaningful, relevant information concerning the effectiveness of their methods. • Recommend that an impartial group of smoking cessation experts be organized and funded (not by the Society) to conduct impartial evaluations of smoking cessation methods and report the resul ts to the publ i c. RESEARCH IN SMOKING This Commission recommends that the American Cancer Society: • Monitor the role of the National Cancer Institute on research of less hazardous cigarettes. • Attempt to increase interest in motivational and TIMN 432022

70. behavior research on smoking problems b qualified researchers, and be prepared to finance promising research in smoking areas not funded by the government. In making this Recommendation, the Commission recognizes the difficulties of obtaining research proposals of sufficient quality to warrant their financing. • Fund an independent expert study of the economic impact of phasing out the present tobacco price support system. • Initiate and participate in research projects to determine the effectiveness of limitations on advertising as they pertain to smoking habits. 6 Accelerate its efforts in support of epidemiologic research on smoking. OTHER ACS INITIATIVES This Commission recommends that the American Cancer Society support three special initiatives: • Increase substantially the financial resources it currently devotes to support Target 5 objectives and the Recommendations of this report. This should include provisions for a full-time staff assigned to anti-smoking activities, as well as a full-time employee to coordinate this national_ rp ogram. • Set up special Task Force groups within each ACS Division and Unit to coordinate accelerated anti- smoking activities. • Accept the leadership in coordinating efforts more fully with other voluntary health organizations in achieving common goals. ~ 43 TI~ 2pZ3

71. SMOKING AND OTHER VOLUNTARY HEALTH AGENCIES: ISSUES AND ACTIONS The three major national voluntary health agencies concerned with cigarette-related problems, the American Cancer Society, the American Heart Association, and the American Lung Association, have combined annual inc6mes`in excess of $230 million. The Commission's best estimate is that only a very small amount of those funds have been devoted to the smoking problem. Even that effort is a fragmented one -- with little coordination or cooperation among the agencies. Although each agency has been actively engaged in public information and public and pro- fessional education with regard to smoking, none has expended substantial sums in this area in relation to the size and scope of the problem. The American Lung Association has used some of its volunteers to campaign for state legislation restricting smoking in specified public areas; however, neither the American Heart Association nor ACS have participated in this activity to any substantial degree. State legislators have testified before this Commission that they rarely hear from either organization when legislation is introduced or when hearings on bills are held. The National Interagency Council on Smoking and Health, with more than 30 institutional members, has a current budget of $55,000 -- scarcely enough to support even the most minimal activity. While the Commission realizes that each agency should and must retain its own identity and freedom of action, we also recognize that there are some areas in which coordingation and cooperation would be in the public interest. One such area is the approach to television and radio for free public service time at decent viewing hours for anti-smoking ads. In this area, the fragmenta- tion of effort appears to be against the public interest. TIMN 432024

72. This Commission recommends, therefore, that: I The three major voluntary health agencies concerned with the cigarette problem work cooperatively in preparing anti-smoking spots and approach the television and radio media as a unified, rather than a fragmented group. We believe that under present Federal Communications Commission regu- lations regarding public service announcements -- whether or not there are paid advertisements for cigarettes on the air -- the scope and importance of the health hazard in cigarettes warrants positive steps by local and network stations to continue to carry anti-smoking ads to try to reach as many adults and children as possible. I The three agencies review their various public policy programs regarding cigarette smoking, and that they seek a closer working relationship on those aspects of the problem which would appear to benefit from a more collaborative approach. TIMN 432025

73. SUMMARY On the basis of all it has found, this Commission reaffirms the 1975 report of the U.S. Public Health Service that concluded: Cigarette smoking remains the largest single unnecessary and prevent- able cause of illness and early death. Illness related to cigarette smoking accounts for at least 10% of the Nation's entire health care bill. Although the scientific evidence has been consistent in support of this conclusion for more than a decade, and similar findings have been reported in the international health literature, the fact remains that the cigarette industry in the United States is essen- tially unregulated, unaccountable to any agency of government for the content of its products or the health consequences of their use. The Tobacco Institute, the industry's spokesman, is virtually alone in still maintaining the linkage between smoking and various diseases to be purely statistical. At the eight Public Forums, a significant number Of witnesses rec- ommended that the Commission advocate a series of prohibitions which ranged from (1) the elimination of tobacco as a crop; (2) the prohibition of further manufacture and sale of cigarettes; (3) further prohibitions on advertising in all media; and (4) bans on smoking in a variety of public places, including the workplace. All of these recommendations were given serious consideration by this Commission. We concluded that, as members of a free society, we should recognize TIMN 432026

74. the rights of informed adults to smoke if they choose. To suggest otherwise would be to imply a prohibition, which is neither enforceable nor desirable in a democratic society. Having reached this conclusion, the Commission believes that in selling to adults, the cigarette industry has the responsibility not to misrepresent, or obscure the hazards, or seduce the public, through advertising imagery. The right of non-smokers to breathe air uncontaminated by tobacco smoke and to be free of the hazard to their health -- as well as the annoyance -- created by breathing the smoke of others should be given equal consideration. We further believe that smokers should be required to bear a greater part of the cost of their habit, and that the subsidy of smokers by non-smokers should be ended in many areas. The Commission is very concerned with the easy availability of cigarettes to children and young people who are subjected to a variety of pressures to start on this addictive habit. We believe that local, state, and Federal government has the ability to enforce -- and tobacco retailers and distributors have a responsibility to obey -- laws that exist in all states forbidding the sale of cigar- ettes to minors. We find that, with only a few exceptions, this is not being done. We urge not only that this enforcement be intensified, but that penalties for its violation be made more severe. TIMN 432027

75. We believe that government, voluntary agencies and the tobacco industry should work together to discourage young people from start- ing to smoke. Industry spokesman say they are willing to promote cigarettes as "an adult custom." We believe that there is danger in such promotion: too many youngsters emulate adults. if' there can be agreement in principle, however, that the aim is to discourage smoking among young people, cooperation to this end should be sought. For those who do smoke and wish to stop, this Commission believes that programs and techniques to assist them should be made more easily available and accessible. Those who cannot yet stop despite their efforts should be made more aware of the existence of less hazardous cigarettes and encouraged to smoke in a less hazardous fashion. The industry shquld also be encouraged to teach smokers to use their products less hazardously. Based upon all of the data available to us, we do not believe that there is a "safe" cigarette. We would urge that no responsible individual or organization use that term. We do believe that the Federal government, voluntary health agencies, and informed citizen groups, as well as the tobacco industry, have an obligation to determine, if possible, what constitutes a less hazardous cigarette and to work cooperatively to reduce the risks for those who choose to smoke. We believe that the trend toward cigarettes with low tar/low nicotine content should be acknowledged and encouraged, and that TIMN 432028

76. consumer pressures in this direction should be continued. We believe that the Federal government should phase out the present tobacco price support system over the next decade with a program that demonstrates compassion for the economic needs of the tobacco farmer. We further believe that the government should support research into synthetic tobaccos that would be non-carcinogenic and not associated with adverse risks of cardiovascular, pulmonary, and other diseases. The failure of the Executive and Legislative Branches in the past to safeguard the public interest and the public health through regulation of an industry, whose product constitutes both a proven major health hazard and an economic drain, is a national disgrace. This largely unregulated industry has wielded considerable power through the largess of its tax yield and its significant lobby. The human suffering and the national economic loss related to cigarette smoking can no longer be ignored. TININ ~~20 29

77. NAMES OF WITNESSES TIMN 432030

78. LOS ANGELES REGIONAL FORUM March 22, 1977 Larry Agran Community Cancer Control Los Angeles, California Lloyd Anderson Assistant Vice President Farmers Insurance Group Los Angeles, California H. Bennett Arnberger Student, University of California Berkeley, California Wilbert S. Aronow, M.D. Chief, Cardiology Section, Veterans Administration Hospital Long Beach, California Harry Bergman Jessie Beck's Riverside Hotel Reno, Nevada Lilian Blackford, Ph.D. San Mateo County Department of Public Health and Welfare San Mateo, California John V. Briggs California State Senator Betty Carnes Scottsdale, Arizona Pat Caulf ield Oceanside, California Art Cole San Francisco, California George Crawford, Ph.D. Weber State College Utah Brian G. Danaher, Ph.D. Stanford Heart Disease Prevention Program, Stanford University Medical Center Elfriede Fasal, M.D. Chief, Cancer Control Unit, California State Department of Health Philip C. Favro California State Fire Marshal John R. Goldsmith, M.D. Medical Epidemiologist, California State Department of Health Ann Hammond Health Education Center Palo Alto, California W. Kevin Hegarty Chairman of the Board California Hospital Association Charlton Heston Beverly Hills, California Ida Honorof Sherman Oaks, California Daniel Horn, Ph.D. Director, National Clearinghouse for Smoking and Health, U. S. Department of Health, Education and Welfare Dale Houghland Chairman, California Interagency Council on Smoking and Health Robert W. Jamplis, M.D. President, California Division American Cancer Society Melvin Jensen Jensen and Ritchey Advertising Agency Los Angeles, California Dolphin Lair Los Angeles, California Sidney Ottman, Ed.D. California Congress of Paretns and Teachers Herm Perlmutter Californians for Clean Indoor Air, Inc. Jerome L. Schwartz, Dr. P.H. Chief, Health Care Research, Off ice of Planning and Program Analysis, California State Department of Health TIMN 432031

79. LOS ANGELES FORUM, cont'd. March 22, 1977 Kent W. Sorensen Micronetic Laboratories San Jose, California Stanford D. Splitter, M.D. Berkeley, California Edwin K. Stone, III GASP (Group Against Smoking Pollution) Dexter Suzuki Teacher Kailua High School Honolulu, Hawaii William Thomas Salt Lake City, Utah Tum Vongsawad President Youth Gives a Damn Los Angeles, California Rick Wentworth, Ph.D. Mayor City of Manteca, California Drake W. Will, M.D. Chief of Pathology The Queen's Medical Center Honolulu, Hawaii Sheridan Weinstein, M.D. Regional Health Administrator U. S. Public Health Service Salvatore V. Zagona Professor, Department of Psychology University of Arizona TIMN 432032

80. DENVER REGIONAL FORUM May 12, 1977 Ms. Jean Anderson Tulsa, Oklahoma David Bachman, M.D. Little Rock, Arkansas Rep. Polly Baca Barragan Denver, Colorado Ms. Kathy Borgaard Cheyenne, Wyoming Lorin Brock, M.D. Denver, Colorado Chaplain Ed Christian Porter Memorial Hospital Denver, Colorado William H. Duff Denver, Colorado Earl B. Flanagan, M.D. Carlsbad, New Mexico Hugh Fowler (R., Colo.) State Senator Denver, Colorado Dr. Rick Guyton University of Arkansas Fayetteville, Arkansas Dr. Jacque Herter Jackson, Wyoming Shirley Hunter, R.N. Oklahoma City, Oklahoma Mrs. Nyna Keeton Little Rock, Arkansas Dr. Paul Kotin V.P.-Health, Safety and Environment Johns-Manville Corp. Englewood, Colorado Dr. Charles LeMaistre Chancellor, University of Texas System Austin, Texas Dr. Edward A. Martell National Center for Atmospheric Researet Boulder, Colorado Alton Ochsner, M.D. Director, Ochsner Clinic New Orleans, Louisiana Mark David Olge Denver, Colorado Dr. Harvey Phelps Denver, Colorado Richard E. Poole Director, Eastside Neighborhood Health Center Denver, Colorado John Ralston Former Coach, Denver Bronco Football teE Denver, Colorado Raymond Reese Denver, Colorado Anthony Robbins, M.D. Director Colorado Health Department Denver, Colorado Dr. George Schneider Louisiana State University New Orleans, Louisiana Stanley I. Stein Colorado Pharmacal Association Denver, Colorado Dr. Robert Taylor Cheyenne, Wyoming Larry Wall Colorado Hospital Association Denver, Colorado Lupe Zamarripa Austin, Texas TIMN 432033

81 . SEATTLE REGIONAL FORUM May 17, 1977 Dr. Jeanne Benoliel Chairman, State Board of Health Seattle, Washington John Bigelow Executive Director Washington State Hospital Association Seattle, Washington Mike Brondson Issaquah, Washington Robert J. Brown Olympia, Washington Lee Clark Burn Unit Manager Harborview Medical Center Seattle, Washington Alan Davidson Principal Kent Meridian Sr. High School Kent, Washington Bruce Flynn Attorney Seattle, Washington Terry Gardner State Representative Juneau, Alaska William Hutchinson, M.D. Director Fred Hutchinson Cancer Research Center Seattle, Washington Jeanette Jacobson Seattle, Washington Paul Juhasz University of Washington Dept. of Civil Engineering Seattle, Washington Trig Kjellend Eugene, Oregon Judith Miller Society of Public Health Educators Seattle, Washington Dr. William Morton Dept. of Environmental Medicine University of Oregon Eugene, Oregon John Murphy Anchorage Principals Association Anchorage, Alaska David McCord Farmer's Insurance Seattle, Washington Pam McGee Tacoma, Washington Donald Rogers, M.D. Pathologist, State of Alaska Anchorage, Alaska Dr. Gary Striker Dean of Curriculum, University of Washington School of Medicine Seattle, Washington Dr. David Thomas Fred Hutchinson Cancer Research Center Seattle, Washington Edmund Truelove, D.D.S. Chairman, Dept. of Oral Diagnosis University of Washington School of Dentistry Seattle, Washington Georgette Valle State Representative Chairman, House Ecology Committee Seattle, Washington TIMN 432034

ST. LOUIS REGIONAL FORUM May 19, 1977 Roger J. Adams, D.D.S. Department of Oral Pathology Washington University Dental School St. Louis, Missouri Mitchell Alevy, Ph.D. St. Louis, Missouri Oscar Austad President, The Austad Company Sioux Falls, South Dakota Warren Bosley, M.D. Grand Island, Nebraska Robert Bruce, M.D. Asst. Prof., Medicine Washington University School of Medicine St. Louis, Missouri Wilma Claseman, M.D. Assistant Health Commissioner St. Louis, Missouri Jerome Cohen, M.D. St. Louis University Hospitals St. Louis, Missouri Ray G. Cowley, M.D. Director, Missouri State Chest Hospital Mount Vernon, Missouri Tom Fite Sullivan, Missouri Edwin Fisher, Ph.D. Washington University St. Louis, Missouri Elbert Glover, Ph.D. University of Kansas Lawrence, Kansas Congressman Charles Grassley Des Moines, Iowa Hans Hager St. Louis, Missouri Douglas Hanson St. Louis, Missouri Bill Hull Lawrence, Kansas 82. Fred Holmes, M.D. Director, Cancer Data Service Kansas University Medical Center Kansas City, Kansas John King Christian Civic Foundation St. Louis, Missouri Christa Lira Centerville, Iowa Gayla Lottes St. Louis, Missouri Lou Lyons Clinton, Iowa Nola Mae Morgan, Ph.D. Principal, Shenandoah Elementary School St. Louis, Missouri Rep.Carl Muckler St. Louis, Missouri Dan Overton St. Louis, Missouri Jerome Porath Asst. Supt., St. Louis Catholic Schools St. Louis, Missouri Joy Rice St. Louis, Missouri Sylvan Sandler American Pharmaceutical Association St. Louis, Missouri Roger Secker-Walker, M.D. Director, Pulmonary Division St. Louis University Hospitals St. Louis, Missouri Herbert V. Skaggs Program Director, KTVI-TV St. Louis, Missouri Raymond G. Slavin, M.D. St. Louis, Missouri Jackie Smith TIMN 432035 St. Louis Football Cardinals St. Louis, Missouri Manfred Thurmann, M.D. President, St. Louis Heart Association St. Louis, Missouri

83. CHICAGO REGIONAL FORUM May 25, 1977 Lawrence Bates, M.D. Meridian Medical Indianapolis, Indiana Chris Caffrey Edina, Minnesota David Carr, M.D. May Clinic Rochester, Minnesota Rep. Michael H. Conlin Capitol Building Lansing, Michigan Tom Cousins WCCO Television Minneapolis, Minnesota Kenneth M. Friedman, Ph.D. Purdue University West Lafayette, Indiana Rep. Ronald Griesheimer Waukegan, Illinois Jack L. Harris, M.D. Medical Director Armco Steel Corporation Middletown, Ohio John C. Hayden Wauwatosa,.Wisconsin Ernest Johnson, M.D. Ohio State University Director of Physical Medicine School of Medicine Columbus, Ohio Rep. Phyllis Kahn State Capitol St. Paul, Minnesota Saul Kelson, M.D. Toledo, Ohio Roy Leonard WGN Radio Chicago, Illinois Eugene E. Levitt, Ph.D. Director, Seciton of Psychology Riley Hospital Indianapolis, Indiana Janet McCaffrey Minneapolis, Minnesota Dale McCarren WBBM Newsradio Chicago, Illinois Fred Magel River Forest, Illinois Dr. Richard Martwick County Superintendent Educational Services Region of Cook County Chicago, Illinois Pat Patterson Minneapolis, Minnesota David Penner, M.D. Detroit, Michigan Kent Peterson Minneapolis, Minnesota Paul Q. Peterson, M.D. Director, Illinois Department of Public Health Chicago, Illinois Professor Ivan Preston School of Journalism University of Wisconsin Madison, Wisconsin Mrs. Candy Rotolo Dublin, Ohio Robert L. Schmitz, M.D. Mercy Hospital and Medical Center Chicago, Illinois Leonard Shuman, M.D. University of Minnesota Division of Epidemiology Minneapolis, Minnesota TIMN 432036

84. CHICAGO FORUM, cont'd. May 25, 1977 Lynn Smith Monticello Times Monticello, Minnesota Harry Spataro Downers Grove, Illinois Patty Stearns Alliance of Non-Smokers Chicago, Illinois Martin G. Swaney City of Milawukee Health Dept. Milwaukee, Wisconsin Mrs. Nancy Thorson Director, Speech Pathology Good Samaritan Medical Center Zanesville, Ohio Bob Wandberg Olson Junior High School Health Department Chairman Bloomington, Minnesota Sherwyn Warren, M.D. Chairman, Illinois Interagency Council on Smoking and Disease Winnetka, Illinois Arthur W. Weaver, M.D. Northville, Michigan Harold R. Wilby State Insurance Commission Madison, Wisconsin Al Zack Principal, Bentley High School Livonia, Michigan TIMN 432037

85. ATLANTA REGIONAL FORUM June 14, 1977 Crawford W. Adams, M.D. Nashville, Tenn. James W. Alley, M.D. Director, Division of Physical Health Georgia Department of Human Resources Atlanta, Georgia S. Eugene Barnes, Ph.D. Professor of Health Education U. of Southern Mississippi Hattiesburg, Mississippi George Bass, M.D. Spartanburg General Hospital Spartanburg, South Carolina SP5 Jay D. Bates Fort Gordon, Georgia Adrienne Black Attorney Decatur, Georgia Alan Blum, M.D. Miami, Florida Fletcher Blalock Pensacola, Florida Governor Farris Bryant Jacksonville, Florida Bob Butterfield Atlanta, Georgia Gene Bridges Supt. of Education Escambia County Pensacola, Florida Hon. Barney Burks Mayor, Pensacola Pensacola, Florida Hon. Buddy Childers State House of Representatives Rome, Georgia Frank Biasco, Ph.D. Associate Professor of Psychology U.W.F. Pensacola, Florida Mrs. Carol Cole Pensacola, Florida Ron Creel Montgomery, Alabama Yank Dean President, Allied Sports Company Eufaula, Alabama Charles 0. Draper, Ph.D. Clinical Psychologist Jackson, Mississippi John Evans, M.D. Vick§burg, Mississippi Louis U. Fink Orlando, Florida Thomas J. Gleaton, Ph.D. Georgia State University Atlanta, Georgia George Gingell Vice President WRBL-TV Columbus, Georgia Chief J. B. Gossett Fire Marshal Atlanta Bureau Fire Service Atlanta, Georgia Joseph Harner, M.D. Anniston, Alabama Rufus R. Hackney, Ph.D. Vice President, Student Affairs Francis Marion College Florence, South Carolina Avery Harvill, P.E.D. Clayton, Junior College Morrow, Georgia Julie Hewitt Lithonia, Georgia TIMN 432038

86. ATLANTA REGIONAL FORUM, cont'd. June 14, 1977 Mrs. David S. Morton Atlanta, Georgia Fred Herren Head Football Coach Newbetty College Newbetty, South Carolina William A. Hopkins, M.D. Atlanta, Georgia Livingston Ivy Principal Washington High School Pensacola, Florida Eric James, Ph.D. Department of Chemistry University of South Carolina Columbia, South Carolina Earl Leinbach Anderson, South Carolina Jack Linscott Marietta, Georgia Richard Marks, Jr., M.D. Department of Radiation Therapy Medical University of South Carolina Charleston, South Carolina Mrs. Sherry Shealy Martschink Charleston, South Carolina Jack Mathis R. L. Mathis Certified Dairy Decatur, Georgia Mitch Modrall Drug-Alcohol Educational Coordinator Inscape House Fort McClellan Anniston, Alabama Mrs. Dot Mims Florence, South Carolina Miss Holly Morton Atlanta, Georgia J. E. McDowell, CLU General Agent Southern Life Insurance Company Greensboro, North Carolina Walter C. Payne, Jr., M.D. Pensacola, Florida Mrs. Pat Rubel Spartanburg, South Carolina Roger Setters President, Louisville Chapter Group Against Smokers' Pollution Louisville, Kentucky Jimmy Spradley Atlanta ARTC Center Griffin, Georgia Randolph D. Smoak, Jr., M.D. Orangeburg, South Carolina 29115 Carl B. Sturm, D.D.S. Louisville, Kentucky Richard Thigpen, J.D. Executive Vice President University of Alabama Tuscaloosa, Alabama Mrs. Carrie Nell Thompson Director, UNICEF Atlanta, Georgia William E. Tryon, M.D. Marietta, Georgia Debbie Tyson Kennesaw, Georgia Hoke Wammock, M.D. Enoch Callaway Cancer Clinic LaGrange, Georgia Mrs. Pat White Health Educator Clayton Councy Health Department Jonesboro, Georgia John J. Witte, M.D. Communicable Disease Center Atlanta, Georgia Ashbell C. Williams, M.D. Jacksonville, Florida TIMN 432039

87. ATLANTA REGIONAL FORUM, cont'd. June 14, 1977 Steve Woodson Joe Young Raleigh, North Carolina Pensacola, Florida TIMN 432040

88. BOSTON REGIONAL FORUM June 2, 1977 P. Daniel Barker Merrimack, New Hampshire Norman Becker, D.M.D. Massachusttts Dental Association Marblehead, Massachusetts Robert E. Biron, M.D. Manchester, New Hapmshire Bernard Bisson Director Alcohol Education Program and Smoking Education Program Southwestern Vermont Blake Cady, M.D. Lahey Clinic Boston, Massachusetts William J. Caldwell Damariscotta, Maine William W. Campbell Rhode Island Laurence H. Coffin, M.D. Thoracic and Cardiovascular Surgeon Medical Center Hospital of Vermont Burlington, Vermont Israel Cohen President Radio Station WCAP Lowell, Massachusetts Michael Cowell State Mutual Life Assurance Company Worcester, Massachusetts Philip Cole, M.D. Associate Professor, Epidemiology Harvard School of Public Health Boston, Massachusetts John DiBiaggio, M.D. V.P., Health Affairs University of Connecticut Health Center New Britain, Connecticut Lawrence DiCara Boston City Councilman Boston, Massachusetts Ellen Fairbanks Shrewsbury, Massachusetts Rev. Robert Farley Pastor, Seventh Day Adventist Church Berlin, New Hampshire Emerson Foote Carmel, New York Jonathan Fielding, M.D. Commissioner, Department of Public Health Boston, Massachusetts Peter Fuller Boston, Massachusetts Milton Geyer Chief of the Public Health Education Section Connecticut State Department of Health Hartford, Connecticut Seebert J. Goldowsky, M.D. Providence, Rhode Island Dwight Harken, M.D. Clinical Professor of Surgery Harvard University Cambridge, Massachusetts Alice Tirrell Knight Representative to the New Hampshire General Court Goffstown, New Hampshire Norman Knight President, Knight Broadcasting Boston, Massachusetts Roy Korson, M.D. University of Vermont College of Medicine Vermont TIMN 432041

W BOSTON REGIONAL FORUM, cont'd. June 2, 1977 Douglas Lloyd, M.D. Commissioner of Health Connecticut State Department of Health Hartford, Connecticut Herbert Landrigan Exeter, New Hampshire Louis A. Leone, M.D. Director, Department of Medical Oncology Rhode Island Hospital Providence, Rhode Island Frank Lilly Executive Director American Lung Association of Mass. Newton Upper Falls, Massachusetts Edward Machnik Raynham, Massachusetts Edward Maloof, D.D.S. Teamsters Union Local #25 Boston, Massachusetts Brendan Maher Professor of,Psychology of Per- sonality Harvard University Cambridge, Mass. Kenyon Martin Director National Mime Theater Boston, Massachusetts J. Wister Meigs, M.D. Cancer Epidemiology Unit Yale University of School of Medicine New Haven, Connecticut Margaret Murphy, R.N. Massachusetts Nurses Association Boston, Massachusetts Richard Overholt, M.D. Dedham, Massachusetts 89. John Patterson, M.D. University of Connecituct Health Center Farmington, Connecticut Alexis A. Parker Manchester, New Hampshire Lois Pine State Representative Boston, Massachusetts John L. Pool, M.D. Norwalk, Connecticut Roni Rechnitz Executive Director Citizens for Clean Air Brighton, Massachusetts Marvin Rosenberg Director of Department of Community Health Services Faulkner Hospital Roslindale, Massachusetts Michael Ryan Governor's Office Providence, Rhode Island Hughes J-P Ryser, M.D. Boston University School of Medicine Boston, Massachusetts Lila Saplinsley State Senator Providence, Rhode Island Albert Schilling, M.D. Director, Rhode Island Cancer Control Program Providence, Rhode Island Milford Schulz, M.D. Massachusetts General Hospital Boston, Massachusetts Michael Sedberry Roxbury Crossing, Massachusetts Barbara Smith New Britain, Connecticut TIMN 432042

90. BOSTON REGIONAL FORUM June 2, 1977 Judith Singer Milton, Massachusetts Marshall Smith, M.D. Eastern Maine Medical Center Bangor, Maine Richard F. Straub Director, Connecticut Lung Association East Haven, Connecticut David Swartz State Representative Boston, Massachusetts James Swomley Executive Director Connecticut Lung Association East Hartford, Connecticut Stanley Swartz, D.M.D. Tufts Dental School Boston, Massachusetts Allen Togut, M.D. Brockton, Massachusetts John W. Turner, M.D. Springfield, Massachusetts Howard Ulfelder, M.D. Harvard Medical School Boston, Massachusetts 'I'IlViN 432043

91. PHILADELPHIA REGIONAL FORUM June 16, 1977 Rodney P. Adair New York, New York James E. Allen, M.D. Snyder, New York Oscar Auerbach, M.D. Senior Medical Investigator V.A. Hospital East Orange, New Jersey 07018 Leonard Bachman, M.D. Secretary of Health Commonwealth of Pennsylvania Harrisburg, Pennsylvania Maurice Bliefeld Bayside, New York Mrs. Sylvia Block White Plains, New York Commissioner Goerge Brown N.Y.S Drug & Alcohol Commission Hempstead, New York Bernard Burbank, M.D. Medical Director McGraw-Hill New York, New York Keith Colonna President, Students Opposed to Smoking Virginia Commonwealth University Richmond, Virginia Dr. J. Richard Crout Director, Bureau of Drugs Department of Health Education and Welfare Rockville, Maryland Ms. Jeanne A. Cunnius New York, New York Mrs. Ann Dailey Baltimore, Maryland J. Mostyn Davis, M.D. Shamokin, Pennsylvania John Dean Mamaroneck, New York Joseph M. Deignan, M.D. Winchester, Virginia Zenon Deputat North Tonawanda, New York Kathleen Dooling, R.N. Watertown, New York Robert C. Eyerly, M.D. Geisinger Medical Center Danville, Pennsylvania Ernest M. Fidance, D.D.S. Wilmington, Delaware Hon. Frederick G. Field,Jr. Albany, New York Samuel E. Fisher Philadelphia,Pennsylvania Jane Frelick, R.N. Wilmington, Delaware Mark Gordon, Esq. Federal Trade Commission Washington, D.C. Gio B. Gori, Ph.D. National Cancer Institute Bethesda, Maryland Dr. Dorothy Green Arlington, Virginia Dietrick Hoffmann, Ph.D. Chief, Division of Environmental Cosmogenesis Naylor Dana Institute American Health Foundation New York, New York Steven R. Homel, M.D. Director, Center for Health Education Philadelphia, Pennsylvania TIMN 432044

92. PHILADELPHIA FORUM, cont'd. June 16, 1977 Robert V. P. Hutter, M.D. Director of Pathology St. Barnabas Medical Center Livingston, New Jersey Hon. John B. Kelly, Jr. Councilman-at-Large Philadelphia, Pennsylvania Janith Stewart Kice, M.D. Garden City, New York Dr. Robert Kochenour Superintendent Chambersburg Area School District Chambersburg, Pennsylvania Patricia Lenihan, R.N. Kenmore, New York Hon. Thomas F. McGowan Buffalo, New York James Manley Assistant Superintendent Northgate School District Pittsburgh, Pennsylvania Bernard Mausner, Ph.D. Beaver College Glenside, Pennsylvania Thomas S. Nealon, Jr., M.D. St. Vincent's Hospital and Medical Center New York, New York Frank Nemia Binghamton, New York Rhoda Nichtor Plainview, New York Ovide F. Pomerleau, Ph.D. Director, Center for Behavioral Medicine University of Pennsylvania Philadelphia, Pennsylvania Hon. Nick Joe Rahal Washington, D.C. Commissioner Joseph Rizzo Philadelphia Fire Department Philadelphia, Pennsylvania Arthur Roth Rockville Centre, New York Jeffrey B. Schwartz Chief Counsel Department of Health Commonwealth of Pennsylvania Harrisburg, Pennsylvania Donna Shimp Salem, New Jersey Robert Shute, Ph.D. Assistant Professor, Health Education Pennsylvania State University University Park, Pennsylvania Remigia Simone Garden City, New York Hon. John M. Skevin State Senator, New Jersey Oradel, New Jersey Steven Sklar Maryland House of Delegates Baltimore, Maryland W. Bernard Suttake Bergen County Health Dept. Hackensack, New Jersey Jack Valenti President Motion Picture Assn. of America Washington, D.C. Alice Van Landingham TIMTL"'q 432045 President American Association of Retired Persons Washington, D.C. Ronald Vincent, M.D. Chief of Thoracic Surgery Roswell Park Memorial Institute Buffalo, New York

93. PHILADELPHIA REGIONAL FORUM, cont'd. June 16, 1977 Laurie Weisbeck David Yasgur Alden, New York Mamaroneck, New York Ernst L. Wynder, M.D. Kevin Young President Holland, New York American Health Foundation New York,New York Ronald Wilson Division of Analysis Department of Health Education and Welfare National Center for Health Statistics Rockville, Maryland f TIMN 432046

94. WHO SMOKES? - Approximately 53 million people smoked in 1975. - 56% were male and 44% were female. - Of those who smoked, 67% of the men were between 15-24 years of age and 72% of the women were in that age bracket. - 14% of the men were aged 12 to 20 and 12% of the women were in that group. - 78% of the men and 71% of the women were married. - The highest smoking rates are among those who are divorced or separated. - The smoking rates are lowest for those who never went to high school - 37% for men and 18% for women. - Among males, those who attended high school but not college showed 46% current smokers, those with some college 36$.and those who graduated from college 28%. Among females, comparable proportions are 32% , 32% and 21%. - Men in relatively affluent families are less likely to smoke while women in this group are more likely to be current smokers. f TIMN 432047

95. Only 35% of the men who reported_an annual family income of $20,000 or more are cigarette smokers, while 46% of the men in the $7,500-$10,000 range are smokers. Among women, however, there is an increase in smoking from 24% for those in families earning under $3,000 to 34% for those with incomes of $20,000 or more. - 94% of smokers earned $15,000 or less a year. - Among men, 54% were manual workers, 13% had clerical or sales jobs, 21% had professional or managerial jobs. - Among women, 28% were housewifes, 37% had sales or clerical jobs, 14% were manual workers and 14% were service workers. - The remainder among both sexes were spread out under a variety of occupations. - The heaviest smokers are concentrated among the middle- aged adults. - 90% agree that smoking is harmful, 84% think it is enough of a health hazard for something to be done about it, and 82% believe it frequently causes disease and death. - More than three our of every four respondents feel that teachers, doctors and other health professionals set a good example by not smoking cigarettes. Almost two out of three smokers feel that members of these groups should set an example. TIMN 432048

96. - There is a growing belief that non-smokers have a right to be allowed to breathe air free from the contaminants in cigarette smoke. * "The smoking of cigarettes should be allowed in fewer places than it is now". 57% agreed in 1970 and 70% in 1975. This means that more than half the smokers at the present time would like to see smoking allowed in fewer places than it is now, despite the fact that there are more and more restrictions on places where people are allowed to smoke. Nearly 2/3 (63%) say that it is annoying to be near a person who is smoking cigarettes. - In 1975, 56% believed that cigarette advertising should be stopped completely. - Two out of three smokers are concerned about the possible effect of cigarette smoking on their health. - Unless cessation efforts have great success, demographics alone will increase the number of smokers in the next 5 years to 60.2 million in 1980. TIMN 432049

97. t Nearly 60% of those who will start smoking between now and 1980 are teen-agers. Of the 1976 smoking population, 58% of teen- aged girls and 70% of younger adult women say they want to quit. The remainder of the smoking population suggests it is committed to smoking and does not intend to stop. More than half of adult smokers of both sexes have tried at least once in the past years to stop smoking. More than 30% of them have tried three or more times. Of the women who tried to quit, 76% of teen- agers and 55% of the younger adults could not stop smoking for more than a month. Overall it appears that the real difficulty is providing the smoker with additional motivation and encouragement needed to get through the few critical months of not smoking. TIMN 4320.50

98. - Nearly 60% of those who will start smoking between now and 1980 are teen-agers. - Of the 1976 smoking population, 58% of teen- aged girls and 70% of younger adult women say they want to quit. The remainder of the smoking population suggests it is committed to smoking and do not intend to stop. - Data from 17 treatment studies indicate over a 20$ success rate for those who stop during intervention. Other data from different cessation techniques do not deviate significantly from the 17 treatment studies. - More than half of former adult smokers of both sexes have tried at least once in the past years to stop smoking. More than 30% of them have tried three or more times. - Of the women who tried to quit, 76% of teen-agers and 55% of the younger adults could not stop smoking for more than a month. - Overall it appears that the real difficulty is providing the smoker with additional motivation and encouragement she needs to get through the first month of not smoking. TIMN 432051

99. CANCER EPIDEMIOLOGY A Summary of Current Information on the Seventeen Most Common Malignancies Philip Cole, M.D. Department of Epidemiology Harvard School of Public Health Boston, Mass. TIMN 432052

100. DISEASE (ICD 7th) ESOPHAGUS (150) STOMACH (151) COLON 153) DEMOGRAPHIC FEATURES Age Direct Direct Di rect Age-adjusted 81 68 50 percent male Race Blacks and Orientals, 2-3x. Orientals, 4x y0rientals Religion Catholics Unknown Jewish Qewish Socio-economic status Inverse Inverse, 4x Direct Marital status Single, 1.5x Never married Unknown U.S. geographic Northeast, d Northeast Northeast variation Little variation, ~ +South Central World geographic Switzerland, France, Finland Japan, Chile, Finland Canada, U.S., Scotland variation *Venezuela, Sweden +U.S. Whites, New Zealand lMexico, Japan, Africa Considerable variation; 7-fold Considerable variation; 5-fold, d' 6-fold 8-fold, 9 Secular trends Increasing Declining, 2% per year Stable ETIOLOGIC FEATURES Cigarette smoking >One pack/day, 3-6x >One pack/day, 1.5-2x No association Occupation Brewers, barmen, waitresses Fishermen, weavers, farmers Asbestos workers, shoe workers, machinists Diet Heavy alcohol consumption, 3x Heavy alcohol consumption, Processed food Hot beverages and spices 1.5-2x High fat, high protein, high Dried or salted fish, carbohydrate diets pickled vegetables beef-eating Familial aggregation No association Families, 2-3x Close relatives, 3x Other diseases Plummer-Vinson syndrome Pernicious anemia, 3-6x Ulcerative colitis, 8-30x Gastritis, 3x Familial colorectal polyposis Diabetes, 0.5x Multiple polyposis Gardner's syndrome Peutz-Jeghers' syndrome Other risk factors Urbanization, direct Blood group A, 1.2x Colon activity, inverse Ionizing radiation Fecal bulk, inverse Intestinal bacteria: +Bacteroides 4Enterococci DESCRIPTIVE STATISTICS INCIDENCE per 100,000 per year MORTALITY per 100,000 per year 3 + 5-YEAR RELATIVE SURVIVAL (S ) Male Female 6.3 1.5 4.4 1.2 4/3 9/6 Male Female Male Female 30.6 30.4 15.5 14.2 50 /43 51147 TIMN 432053

101 . DISEASE (ICD 7th) RECTUM (154) PANCREAS (157) Lt'NG 162-3 ) DEMOGRAPHIC FEATURES Aqe Direct Direct Direct, d +After 75 Age-adjusted 60 65 82 percent male Race sOrientals Whites iBlacks, Orientals Religion No association Jewish, 1.2x d Jewish, 0.1x Christian ~ Jewish, 1.5x Christian Socio-economic status No association Inverse Inverse Marital status Unknown Unknown Unknown U.S. geographic Unknown Unknown Urban variation World geographic Unknown U.S. non-Whites Britain, Finland, Austria variation yJapan, Israel Netherlands 3-fold 3Portugal, Japan, Chile Considerable variation; 7-fold, d 4-fold, Q Secular trends Stable Increasing Increasinq sharply, particularly among 8 ETIOLOGIC FEATURES Cigarette smoking No association >One pack/day, 2-3x Occupation Asbestos workers, shoe Chemists, metal workers, workers, machinists coke and gas plant workers, workers with benzidine and S-naphthylamine Ciet Processed food Unknown High fat, high protein, high carbohydrate diets Familial aggregation Unknown Unknown Other diseases Colectomy Diabetes Other risk factors None ?Alcohol DESCRIPTIVE STATISTICS INCIDENCE per 100,000 per year MORTALITY per 100,000 per year 3 + 5-YEAR RELATIVE SURVIVAL (x ) 10-50x Uranium miners, lOx Asbestos workers, 90x Nickel refiners, 5-lOx Smelter workers, 3x Unknown Relatives, 2-4x Bullous disease, 2-6x Pulmcnary TB, 5-9x Bronchitis Air pollution Radiation Male Female 45.0 8.7 50.1 9.1 1Q/8 16/12 TIMN 432054 Male 18.4 8.5 47/38 Female 12.1 3.6 50 / 42 Male 9.2 9.9 Female 5.0 5.8 2 /2

102. DEMOGRAPHIC FEATURES BREAST 170) DISEASE (ICD 7th) CERVIX UTERI 1M) Age Direct, plateau at menopause Early plateau Age-adjusted percent male Race Whites, 5x Orientals Blacks, 4-5x Religion Jewish, 2x Jewish, 0.25x Socio-economic status Direct Strong inverse Marital status Single, i.5x Ever married, 3x U.S. geographic North South variation World geographic U.S. Whites 3-fold variation +Japan, China 6-fold Secular trends ?tin young +Invasive, 1.5% per year fiIn situ. ETIOLOGIC FEATURES Cigarette smoking No association Unknown Occupation No association Prostitutes +Nuns Diet High fat, Unknown correlational only Familial aggregation Sisters, daughters, 2-4x No association Other diseases Ca colon, endometrium, Venereal diseases ovary Other risk factors Age at first birth, direct Number of sexual partners, Age at menarche, inverse direct Age at natural menopause, Age at first intercourse, direct inverse Artificial menopause, 0.33x Herpesvirus type 2 Obesity, direct ?circumcision DESCRIPTIVE STATISTICS INCIDENCE per 100,000 per year MORTALITY per 100,000 per year 3+ 5-YEAR RELATIVE SURVIVAL (% ) Female 69.4 25.2 72/63 Female 11.6 6.5 63/59 Jewish, l.lx Direct, weak Never married, 1.3-2.4x North Japan, Austria. Chile aNorway, New Zealand, Australia 3-fold Stable Unknown Unknown Unknown Families, 5x Hypertension, 1.5x Diabetes, 1.5x Age at mEnopause,direct Parity, strong inverse Obesity, direct Stilbestrol-Turner's syndrome Female 17.1 4.6 72/72 lrIMN 432055

103. DISEASE (ICD 7th) OVARY (175.0) PROSTATE (177) KIDNEY (180) 0E"OGRAPHIC FEATURES I Age Direct Direct Direct Age-adjusted 69 pei-cent male Race Whites. 7x non-Whites, Blacks, 1.5x Whites, 1.5x after menopause Orientals, 0.3x Religion Jewish, after menopause Protestant, Jewish Unknown Socio-economic status Direct Inverse Direct Marital status Never married, 1.5-2x Married, 1.3x Divorced, 1.3x U.S. geographic Unknown North Midwest, North New North variation England, East World geographic Scandinavia, England, Considerable variation; Canada, Sweden, Norway, variation Wales 13-fold Japan, India, South Africa 6-fold Considerable variation; 6-fold Secular trends Increasing Declining, age 75-84 Stable ETIOLOGIC FEATURES Cigarette smoking Occupation Diet Familial aggregation Other diseases Other risk factors DESCRIPTIVE STATISTICS INCIDENCE per 100,000 per year MORTALITY per 100,000 fler year 3 + 5-YEAR RELATIVE SURVIVAL t Y ) No association No association Direct, weak Unknown Cadmium workers Unknown Unknown Unknown Unknown No association Families, 3x Unknown Mumps, in childhood B.P.H. None Ca endometrium, breast Age at menarche, inverse ?Endocrine None Menstrual irregularity Dysmenorrhea, 1.5x Early menopause Heavy menstrual bleeding Blood group A ?Sexual practices Female Male Male Female 12.5 38.0 8.5 3.9 8.3 15.9 4.0 1.9 35 /34 66/52 43137 44/38 TIMN 432056

104. DISEASE (.ICD 7th) BLADDER (181.0) C.N.S. 193) LYMPHOSARCOMA (200) Df."'OGRAPNIC FEATURES Age Direct, d Bimodal Oi rect Bimodal, ~ Age-adjusted 77 53 60 percent male Race Whites, 2x Unknown Whites Religion Jewish, 1.4x Unknown Jewish 4Protestants Socio-economic status Middle class Direct Direct Marital status Divorced, 1.3-1.5x Unknown Unknown U.S. geographic Northeast, East North Central . Unknown Unknown variation Pacific World geographic Scotland, England, Wales, Norway, Israel Unknown variation U.S. Whites lJapan, Chile Little variation; 3-fold Secular trends Stable Stable Unknown ETIOLOGIC FEATURES Cigarette smoking Smokers, 2x Unknown Unknown Occupation Rubber, leather and dye workers, ?Rubber workers Unknown painters yFarmers Diet ?Coffee drinking Unknown Unknown Familial aggregation No association Unknown Unknown Other diseases ?Schistosomiasis Unknown Unknown Renal papillary necrosis Other risk factors Analgesic abuse Blood group A None DESCRIPTIVE STATISTICS INCIDENCE per 100,000 per year MORTALITY per 100,000 per year 3+ 5-YEAR RELATIVE SURVIVAL (x ) Male Female 22.6 6.8 6.1 1.8 63/57 60/56 Male Female 5.9 5.2 4.6 3.0 31/25 42/36 Male 5.0 3.8 38/31 Female 3.4 2.6 42/28 TIMN 432057

105. DISEASE (ICD 7th) HODGKIN'S DISEASE (201) LEUKEMIA (204) DEMOGRAPHIC FEATURES Age Bimodal Bimodal (acute) Direct (chronic) Age-adjusted 54 61 percent male Race Whites, 1.3x Whites, 3-5x Religion Jewish, 1.3-2x Jewish, 2.4x Socio-economic status Direct, weak Direct, 1.4x Marital status No association Unknown U.S. geographic Northeast, Mid-Atlantic New York, California, variation Minnesota 1South, Mid-Atlantic World geographic U.S., Denmark, Netherlands, Scandinavia, U.S. Whites variation Italy yJapan, Chile, Portugal lJapan, Australia Little variation; 2-fold Secular trends Increasing Marked increase since 1914 ETIOLOGIC FEATURES Cigarette smoking Unknown Unknown Occupation Clerical workers, 1.3x Benzine workers Farmers, 1.3x Diet Unknown Unknown Familial aggregation ?Close relatives Slight Other diseases None Down's syndrome, 8-18x Other risk factors Tonsillectomy, 2.9x In utero irradiation, 1.8x X-ray, 2-6x DESCRIPTIVE STATISTICS INCIDENCE per 100,000 per year MORTALITY per 100,000 per year 3+ 5-YEAR RELATIVE SURVIVAL (X ) Male Female 2.6 2.2 2.2 1.3 59/38 62/48 Male Female 10.3 6.5 8.1 5.2 6/2 9/2 (acute) 40/24 42128 (chronic) TIMN 432058

106. REFERENCES / Boyland E: Causes of cancer of the kidney. In: King JS Jr (Ed.): Renal Neoplasia. Little, Brown and Co., Boston, 1967 Burkitt DP: Epidemiology of cancer of the colon and rectum. Can- cer 28: 3-13, 1971 Choi NW, Schuman LM, Gullen WH: Epidemiology of primary central nervous system neoplasms. I. Mortality from primary central nervous system neoplasms in Minnesota. Am J Epidemiol 91: 238-259, 1970 Choi NW, Schuman LM, Gullen WH: Epidemiology of primary central nervous system neoplasms. II. Case-control study. Am J Epi- demiol 91: 467-485, 1970 Cole P: Epidemiology of Hodgkin's disease. 1972 JAMA 222: 1636-1639, Cole P: Cancer of the lower urinary tract. In: Schottenfeld D (Ed.): Cancer E idemiolo and Prevention: Current Concepts. Charles Thomas, pring ie , Illinois, in press DeWaard F: The epidemiology of breast cancer; review and prospects. Int J Cancer 4: 577-586, 1969 End Results Group, National Cancer Institute: End Results in Can- cer Report Number 4. Axtell LM, Cutler SJ, Myers s. U.S. Department o~Health, Education and Welfare, Bethesda, 1972 Fraumeni JF Jr: Clinical epidemiology of leukemia. Sem in Hematol 6: 250-260, 1969 Haenszel W: Variation in incidence of and mortality from stomach cancer, with particular reference to the United States. J Natl Cancer Inst 21: 213-262, 1958 Haenszel W, Correa P: Cancer of the colon and rectum and adenoma- tous polyps. A review of epidemiologic findings. Cancer 28: 14-24, 1971 Higginson J, Muir CS: Epidemiology. In: Holland JF, Frei, E III (Eds.): Cancer Medicine. Lea and Febiger, Philadelphia, 1973 Hoover R, Cole P: Population trends in cigarette smoking and bladder cancer. Amer.J Epidemiol 94: 409-418, 1971 Kessler II, Lilienfeld AM: Perspectives in the epidemiology of leukemia. Adv Cancer Res 12: 225-302, 1969 King H, Diamond E, Lilienfeld AM: Some epidemiological aspects of cancer of the prostate. J Chronic Dis 16: 117-153, 1963 TIMN 432059

107. Levin DL, Connelly RR: Cancer of the pancreas. Cancer 31: 1231- 1236, 1973 Lundin FE, Erickson CC, Sprunt DH: Socioeconomic distribution of cervical cancer in relation to early marriage and pregnancy. Public Health Monogr 73 (PHSP No 1209), 1964 MacMahon B: Epidemiology of Hodgkin's disease. Cancer Res 26: 1189-1200, 1966 MacMahon B, Cole P, Brown J: Etiology of human breast cancer: A review. J Natl Cancer Inst 50: 21-42, 1973 Mono ra hs on Neo lastic Disease at Various Sites: Tumors of the Kidney an Ureter. Ric es E Ed. , vol. V, Williams and Wilkins Co., Baltimore, 1964 Rotkin ID: Adolescent coitus and cervical cancer: Associations of related events with increased risk. Cancer Res 27: 603- 617, 1967 Shoenberg BS, Bailar JC, Fraumeni JF Jr: Certain mortality patterns of esophageal cancer in the United States, 1930-67. J Natl Cancer Inst 46: 63-73, 1971 Stewart HL, Dunham LJ, Casper J, et al.: Epidemiology of cancers of the uterine cervix and corpus, breast and ovary in Israel and New York City. J Natl Cancer Inst 37: 1-95, 1966 West RO: Epidemiologic study of malignancies of the ovaries. Can- cer 19: 1001-1007, 1966 Wynder EL, Bross IJ: A study of etiological factors in cancer of the esophagus. Cancer 14: 389-413, 1961 Wynder EL, Dodo H, Barber HRK: Epidemiology of cancer of the ovary. Cancer 23: 352-370, 1969 Wynder EL, Hoffman D: Current studies on etiology and prevention. In: Watson WL (Ed.): Lung Cancer. C.V. Mosby Co., Saint Louis, 1968 Wynder EL, Mabuchi K, Maruchi N, et al.: Epidemiology of cancer of the pancreas. J Natl Cancer Inst 50: 645-667, 1973 _.• TIMN 432060

MORBIDITY AND MORTALITY STATISTICS .108. Source: National Center for Health Statistics Table 1. Age-adjusted death rate for arterioscleroticjischemic heart disease by sex: United States, 1950-1975 (For 1968-75, rates are based on deaths assigned to category numbers 410-413 of the Eighth Revision of the International Classification of ~ Diseases, Adapted for Use in the United States, adopted in 1965; for 1950-67, rates are based on deaths assigned to category numbers 420 of the Sixth and Seventh Revisions, adopted, respectively, in 1948 and 1955) Year Both sexes Male Female 1975 196.1 278.2 130.0 1974 207.9 292.9 138.9 1973 218.9 308.2 146.5 1972 223.9 313.7 150.5 1971 225.1 315.0 151.5 1970 228.1 318.0 153.6 1969 235.9 326.1 159.9 1968 1~ 1 243.0 334.7 ' 165.4 ' 1967 ~ - 213.3 301.8 138.0 1966 218.1 307.8 141.2 1965 217.2 305.5 140.8 1964 216.5 303.6 140.6 1963 221.2 .309.4 144.0 ~ 1962 217.5 303.1 141.9 1961 211.7 295.3 137.1 1960 214.6 298.3 139.3 1959 210.4 291.8 136.9 1958 210.4 291.0 137.3 1957 211.2 290.0 139.2 1956 205.1 281.6 134.7 1955 200.0 274.5 131.0 1954 193.4 265.7 125.9 1953 196.1 268.5 128.1 1952 190.2 259.7 124.6 1951 187.0 256.0 121.6 1950 185.2 252.5 120.8 I/ Abrupt shift due to coding change. SOURCE: Reference ( 8) and unpublished data from the National Center for Health Statistics. "TIMN 432061

109. Table 2. Age-adjusted death rate for Malignant neoplasms of respiratory system, for the male population by color: United States, 1950-75 [For 1968-75, rates are based on deaths assigned to category numbers 160-163 of the Eighth Revision of the International Classification of Diseases, Adapted for Use in the United States, adopted in 1965; for 1950-67, rates are based on deaths assigned to category numbers 160-164 of the Sixth and Seventh Revisions, adopted, respectively, in 1948 and 1955] Yea r White male All other male Rate per 100,000 population 1975------------------------- 54.6 66.8 1974------------------------- 54.0 66.8 1973------------------------- 52.7 64.4 1972------------------------- 52.3 61.7 1971------------------------- 50.7 57.7 1970------------------------- 49.9 56.3 1969------------------------- 48.1 55.6 1968------------------------- 47.5 52.8 1967------------------------- 44.5 49.2 1966------------------------- 43.0 47.8 1965------------------------.- 41.7 42.6 1964------------------------- 40.2 40.5 1963i------------------------ 38.4 40.8 1962 ------------------------ 37.3 36.7 1961------------------------- 36.0 35.6 1960------------------------- 34.6 35.6 1959------------------------- 33.2 31.6 1958------------------------- 32.0 29.8 1957-=----------------------- 31.2 28.8 1956------------------------- 30.1 26.9 1955------------------------- 28.5 24.0 1954------------------------- 26.6 23.2 1953------------------------- 25.9 22.3 1952------------------------- 24.0 20.2 1951- ------------------------ 2 22.5 18.8 1950 ------------------------ 21.6 17.0 1 Figures by color exclude data for residents of New Jersey because this State did not require reporting of the item for these years. ` 2 Based on enumerated population adjusted for age bias in the population of races other than white. SOURCE: Reference (12). TIMN 432062

110. Table 3. Age-adjusted death rates for Malignant neoplasms of respiratory system for ths; female population, by color; United States, 1950-75 ~For 1968-75, rates are based on deaths assigned to category numbers 160-163 of the Eight Revision of the International Classification of Diseases, Adapted for Use in the United States, adopted in 1965; for 1950-67, rates are based on deaths assigned to category numbers 160- 164 of the Sixth and Seventh Revisions, adopted, respectively, in 1948 and 1955j White All other Year female female Rate per 100,000 population 1975-.~_.~---------------------- 13. 8 13.4 - ------------------ --- 4 9 - - 1 7 --- - 12,9 13.2 1973------------ ---------- ------- 12.0 12.6' 19 7 2--.-------------------------- 11.8 11.4 1971---------------------------- 10.8 11.5 1970----------------------------- 10.1 10.4 1969----------=------------------- 9.5 9.9 1968----------------------------- 8.9 9.2 1967---------------------------- 7.8 7.9 1966---------------------------- 7.2 7.8 1965----------------------------- 6.9 7.1 1964------------------------------ 6.3 6.6 19631---------------------------- 6.1 6.8 19 6 21------------------.------ 5.7 5.9 1961--___-- ------- ------- -__ 5 5 6 5 . . 9 6 0 - ------ --- --- ---- ----- 5 6 5 - 1 - .1 . 1959--------- ------------- ----- 5.0 5.7 1958------------------------------ 5.0 5.2 19 5 7 ----------------------- ---- 4.8 4.9 1956----------------------------- 4.8 4.8 1955------------------------- 4.6 5.2 1954---------- ------- - 4 - -- ---- .5 4.2 1953---------~---- ------ __- 4.5 4.3 19 5 2 ------------------------- 4.6 4.3 1951--------------------------- 4.5 4.4 19502-------------------------- 4.6 4.1 1 Figures by color exclude data for residents of New Jersey because this State did not require reporting of the item for these years. 2 Based on enumerated population idjusted for age bias in the population or races otFier than •inite. f. SOURCE: Reference (12). °T N 432063

Table 4. Age-adjusted death rate for Malignant neoplasms of buccal cavity and pharynx for the male population, by color: United States, 1950-75 [For 1968- 75, rates are based on deaths assigned to category numbers 140-149 of the Eighth Revision of the International Classification of Diseases, adapted for Use in the United States, adopted in 1965; for 1950-67, rates are based on deaths assigned to category numbers 140- 148 of the Sixth and Seventh Revisions, adopted, respectively, in 1948 and 19551 Year White All other male male Rate per 100,000 population 1975------------------------ 4.5 7.4 1974-------------------------- 4.6 6.7 1973---------------------------- 4.5 7.0 1972------------------------ 4.4 6.4 1971--------------------------- 4.7 6.3 1970--------------------- ----- 4.7 6.3 1969----- ------- -------------- 4.8 6.7 1968--------------------------- 4.8 6.3 1967-------------------------- 4.5 6.3 1966-------------------------- 4.6 5.6 1965---------------------------- 4.5 5.6 1964--------------- ----------- 4.6 6.0 19631-------------------------- 1 4.7 5.4 1962 -------------------------- 4.7 5.2 1961--------- ------ -- 4 - ---------- .7 5.0 1960---------------------- ---- 4.7 4.6 1959-------------------------- 4.8 4.9 19 5 8------------------------ 4.6 4.4 1957------------------------- 4.8 5.3 19 5 6------------------------- 4.7 4.5 19 5 5 -------------------- ----- 4.8 4.1 1954--------------------------- 4.7 4.2 1953-------------------------- 4.6 3.8 19 5 2 ------------------------ 4.6 4.2 1951---------- ------ - 4 --- ------ .6 4.2 19502-------.................. 5.0 4.2 1 Figures by color exclude data for residents of New Jersey because this State did not require reporting of the item for these years. 2Based on enumerated population adjusted for age bias in the population of races other than white. SOURCE: Reference (12). TIMN

112. Table 5. Age-adjusted death rates for Malignant neoplasms of buccal cavity and pharynx for the female population, by color: United States, 1950-75 [For 1968-75, rates are based on deaths assigned to category numbers 140-149 of the Eighth Revision of the International Classification of Diseases, Adapted for Use in the United States, adopted in 1965; for 1950-67, rates are based on deaths assigned to category numbers 140-148 of the Sixth and Seventh Revisions, adopted, respectively, in 1948 and 1955) Year White All other female 'female Rate per 100,000 population 1975------------------------- 1.6 1.9 1974--------------------- -- 1.5 2.0 1973--------------- -------- - 1.5 2.0 1972--------------- -------- 1.4 2.1 1971--------------------- ---- 1.5 1.8 1970------------------------- 1.5' 1.8 1969 --- - - -- - - - - - 4 1 8 1 - - -- - - - - - - - - . . •1968------------------------ 1.4 1.7 1967------------------- ------- 1.3 1.8 1966----- ---------- ------ -_ 1 3 1 7 . . 1965 ---------------------- 1.2 1.6 1964----------=------------- 1.3 1.6 19631---------------------_ 1.3 1.6 19621 ------------------------ 1.3 1.5 1961----------------------= 1.3 1.4 1960-------------------------- 1.3 1.6 1959------------------------ 1.2 1.3 19 58---------------------- 1.2 1.5 1957----------------------- 1.2 1.3 1956------------------------ 1.1 1.6 1955------------------------ 1.2 1.4 19 5 4 --------_-,-_-------- 1.2 1.3 1953------ ------- ---------- 1 1 1 3 . . 1952------------- ------- --- 1.1 1.5 1951------------------------ 1.1 1.5 19502----------------------- 1.2 1.7 1 Figures by color exclude data for residents of New Jersey because this State did not require reporting of the item for these years. 2 Based on enumerated population adjusted for age bias in the population of races other than white. SOURCE: Reference (12). TIMN 432065

113. Table 6. Death rates and mortality ratios by cigarette smoking status and 10-year age groups: United States, 1966-68 Cigarette Totala Age smoking status 35-84 35-44 45-54 55-64 65-74 75-84 Male Death rate per 100,000 population Total male 1,973.7 412.3 990.7 2,422.9 5,066.4 10,491.1 Ever smoked 2,220.6 462.6 1,106.2 2,657.2 5,893.8 11,647.7 Current smoker 2,516.4 523.4 1,243.4 2,959.8 6,704.6 13,442.7 Ex-smoker 1,736.8 256.9 707.7 2,050.8 4,940.0 10,230.4 Never smoked 1,482.1 249.3 628.3 1,767.5 3,794.8 9,417.8 Mortality ratio Ever smoked 1.50 1.86 1.76 1.50 1.55 1.24 Current smoker 1.70 2.10 1.98 1.68 1.77 1.43 Ex-smoker 1.17 1.03 1.13 1.16 1.30 1.09 Never smoked 1.00 1.00 1.00 1.00 1.00 1.00 Female Death rate per 100,000 population Total female 1,121.5 239.0 527.5 1,099.9 2,868.6 7,478.3 Ever smoked 1,746.4 298.6 678.2 1,590.6 4,261.1 14,354.7 Current smoker 1,692.8 294.5 665.3 1,520.7 4,267.8 13,53-2.6 Ex-smoker 1,887.4 320.2 745.0 1,846.4 4,245.0 15,867.4 Never smoked 956.7 178.3 400.2 856.4 2,579.0 6,933.5 Mortality ratiob Ever smoked 1.83 1.68 1.70 1.86 1.65 2.07 Current smoker 1.77 1.65 1.66 1.78 1.66 1.95 Ex-smoker 1.97 1.80 1.86 2.16 1.65 2.29 Never smoked 1.00 1.00 1.00 1.00 1.00 1.00 aStandardized by the direct method on the age distribution of the total population of the United States, ages 35-84, as enumerated in the 1940 census. bRatio of death rate of cigarette smokers to death rate of those who never smoked cigarettes. SOURCE: Reference (5). ,VIMI-4 432066

114. Table 7. Age-adjusted death rates and mortality ratios by sex for persons aged 35-84 with a lifetime history of ever smoking: United States 1966-68 Family income, Men Women race and marital status Death rate Morta~lity ratio Death rate Motta~i~y ratio Family Income Under $5,000 3,287 1.49 2,144 1.86 $5,000-$9,999 1,678 1.40 1,337 1.70 $10,000 and over 1,704 1.56 1,804 2.18 Race White 2,155 1.52 1,670 1.87 Nonwhite 2,902 1.55 2,660 1.72 Marital Status Married 1,898 1.52 1,477 1.96 Unmarried c 4,323 1.54 2,118 1.71 a b c Deaths per 100,000 persons per year who had a lifetime history of smoking cigarettes. Age-standardized by the direct method on the 1940 population. Death rate of those who have ever smoked divided by the death rate of those who have never smoked cigarettes. Includes never married (single), widowed, and divorced but excludes the separated. SOURCE: Reference (5). 1% TIMN 432067

115. Table 8. Days of bed disability per person 17 years of age and over by cigarette smoking status, sex and age, United States 1974 Sex and age Total Present smoker Former smoker Never smoked Male ~ Days pe r person pe r year 17+ 6.1 6.7 6.1 5.1 17-44 4.2 5.3 3.6 2.9 45-64 6.5 8.0 5.1 6.5 65+ 13.9 12.9 13.2 12.4 Female 17+ 8.7 7.9 9.3 8.6 17-44 6.6 6.9 6.8 6.1 45-64 9.6 9.3 9.4 9.1 65+ 13.9 10.3 18.4 13.6 NOTE: Actual number of bed disability days Expected number of bed disability days if all persons had same rate as persons who never smoked 1,076,131,000 930,237,000 Excess bed disability days e 0 145,894,000 SOURCE: National Center for Health Statistics, Health Interview Survey. o A~~®6~ ~~~

116. Table 9. Days lost from work per year due to illness and injury per currently employed person 17 years of age and over by smoking status, sex and age: United States 1974 Sex and age Total Present smoker Former smoker Never smoked Days p er person pe r year Male 17+ 4.5 5.1 5.0 3.4 17-44 4.2 5.5 4.2 3.0 45-64 5.0 4.5 5.5 4.4 65+ 3.8 0.3 7.9 * Female 17+ 4.8 5.6 *3.9 4.5 17-44 4.6 5.3 *3.8 4.3 45-64 5.6 6.5 *4.3 5.4 65+ 0.9 * * * * Figure does not meet standards of reliability or precision. NOTE: Actual number of work loss days = 379,389,000 Expected number of work loss days = 298,021.000 if all workers had the same rate as workers who never smoked Excess work loss days ~ 81,368,000 SOURCE: National Center for Health Statistics, Health Interview Survey. TIMN 432069

117. Table 10. Percent of persons 17 years of age and over who perceive their health to "excellent" by cigarette smoking status, sex and age: United States 1974 Sex and age Total Present smoker Former smoker Never smoked Both sexes 17+ 42.7 41.5 43.0 42.8 17-44 51.3 47.7 55.4 53.1 45-64 34.0 32.6 36.7 32.0 65+ 27.1 24.7 26.5 28.2 Male 17+ 46.8 44.1 44.0 52.0 17-44 56.7 52.9 59.9 60.8 45-64 36.9 32.3 38.0 40.9 65+ 25.5 19.2 25.4 30.0 Female 17+ 39.0 38.7 41.2 38.7 17-44 46.3 42.0 49.2 48.7 45-64 31.3 33.0 34.1 28.9 65+ 28.3 32.4 29.3 27.7 SOURCE: National Center for Health Statistics, Health Interview Survey. ,VIWIS 432010

118. Table 11. Percent of persons 17 years of age and over with one or more hospital episodes in the year prior to interviewed by cigarette smoking status, sex and age: United States 1974 Sex and age Total Present smoker Former smoker Never smoked Both sexes 17+ 13.1 13.5 14.4 12.7 17-44 12.3 13.8 11.7 12.0 45-64 12.9 12.3 15.1 12.1 65+ 16.5 16.5 19.7 15.3 Male 17+ 10.2 10.5 12.8 8.3 17-44 7.0 8.6 8.0 5.3 45-64 13.1 12.4 14.5 12.5 65+ 17.4 19.0 18.5 14.9 Female 17+ 15.7 16.9 17.5 14.7 17-44 17.2 19.5 16.8 15.9 45-64 12.8 12.3 16.2 12.0 65+ 15.8 12.9 23.1 15.4 SOURCE: National Center for Health Statistics, Health Interview Survey. '~,INO 431®71

119. Table 12. Percent of persons 17 years of age and over who have ever smoked who were ever advised by a physician to stop smoking, by smoking status, sex and age: United States 1974 Smoking status and sex All ages 17+ 17-44 45-64 65+ Total ever smoked Both sexes 23.9 19.6 29.2 30.1 Male 23.5 17.8 29.2 32.4 Female 24.4 21.8 29.2 25.3 Former smoker Both sexes 21.3 14.2 26.3 28.2 Male 22.7 13.5 28.0 29.6 Female 18.9 15.0 22.6 24.2 Present Smoker Both sexes 25.2 21.5 31.1 32.6 Male 24.0 19.4 30.2 37.0 Female 26.6 23.9 32.1 26.2 NOTE: Excludes unknown if doctor ever advised person to stop smoking. SOURCE: National Center for Health Statistics, Health Interview Survey. Tl?AN 432072

120. Table 13. Percent of present cigarette smokers 17 years of age and over who have tried to stop smoking, by sex and age: United States, 1974 Sex All ages 17 17-44 45-64 65+ Both sexes 64.7 66.0 62.8 61.1 Male 66.0 66.7 65.1 63.3 Female 63.3 65.3 60.2 57.9 NOTE: Excludes not reported if ever tried to quit. SOURCE: National Center for Health Statistics, Health Interview Survey. TIMN 432073

0" Table 14. Percent of persons 17 years of age and over who have been told by a doctor they had heart trouble, by cigarette smoking status, sex and age: United States 1974 Sex and age Total Present smoker Former smoker Never smoked Both sexes 17+ 9.0 7.8 12.9 9.4 17-44 4.2 4.8 4.7 4.1 45-64 11.1 11.6 14.9 9.9 65+ 22.9 17.9 28.5 23.3 Male 17+ 8.9 8.2 13.8 8.4 17-44 3.8 4.5 4.7 3.6 45-64 12.0 13.0 15.2 10.0 65+ 24.5 18.6 28.5 26.5 Female 17+ 9.0 7.4 11.4 9.9 17-44 4.6 5.1 4.9 4.4 45-64 10.3 10.0 14.3 9.9 65+ 21.8 16.8 28.5 22.4 SOURCE: National Center for Health Statistics, Health Interview Survey. 121. TIlVIN 432074

REFERENCES 1. 122. Ahmed, Paul I. and Gleeson, Geraldine A.: "Changes in Cigarette Smoking Habits Between 1955 and 1966," National Center for Health Statistics, PHS Publication No. 1000 - Series 10 No. 59. 2. Belloc, Nedra B.: "Relationship of Health Practices and Mortality," Preventive Medicine, Vol. 2, pp. 67-81, 1973. 3. Doll, R. and Hill, A.B.: "Lung Cancer and Other Causes of Death in Relation to Smoking," British Medical Journal, Vol. 2, pp. 1071-1081, 1956. 4. Dorn, Harold F.: "The Mortality of Smokers and Non-smokers," in Proceedings of the Social Statistics Section, American Statistical Association Meeting, Dec. 27-30, Chicago, 1958. 5. Godley, Frank and Kruegel, David L.: "Cigarette Smoking and Differential Mortality: New Estimates from Representative National Sample," presented at Annual Meeting of Population Association of American, Seattle, April 17-19, 1975. 6. Hammond, E. Cuyler: "Smoking in Relation to Death Rates of One Million Men and Women," in William Haenzel (ed.) Epidemiological Approach to the Study of Cancer and Other Chronic Diseases, pp. 127-204, National Cancer Institute Monograph No. 19, 1966.' 7. Hammond, E. Cuyler and Horn, Daniel: "Smoking and Death Rates: Report on 44 Months of Follow-up of 187,783 Men," Journal of the American Medical Association, Vol. 166, pp. 1159-1172, 1958. 8. Klebba, Joan: "Mortality from Diseases Associated with Smoking, United States, 1950-1964," National Center for Health Statistics, Vital and Health Statistics, PHS Publication No. 1000 - Series 20. No. 4, 1966. 9. Miller, Henry W.: "Plan and Operation of the Health and Nutrition Examination Survey: United States 1971-1973," National Center for Health Statistics, Vital and Health Statistics, DHEW Publication No. (HSM) 73-1310, Series 1 No. 10 a and b, 1973. 10. National Center for Health Statistics: "Cigarette Smoking: United States, 1970," PHS Publication No. (HSM) 72-1132, Vol. 21 No. 3, Supplement June 2, 1972. 11. National Center for Health Statistics: "Standardized Micro-Data Tape Transcripts," DHEW Publication No. (HRA) 76-1213, 1976. 12. Rice, Dorothy P.: Testimony before the Intergovernmental Relations and Human Resources Subcommittee of the Committee on Governmental Operations, United States House of Representives, June 14,.1977. TIMN 432075

123. 13. "Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service," PHS Publication No. 1103, Washington, DC. U.S. Government Printing Office, 1964. 14. 15. Wilson, Ronald W.: "Cigarette Smoking and Health Characteristics" Vital and Health Statistics, National Center for Health Statistics, PHS Publication No. 1000, Series 10 No. 34, Washington, DC.,U.S. Government Printing Office, 1967. Wilson, Ronald W.: "Cigarette Smoking, Disability Days and Respiratory Condition," Journal of Occupational Medicine, Vol. 15, No. 5, pp. 236-240, 1973. ,rIMN 432076

124. Advisory Commission on Intergovernmental Relations Report entitled: "Cigarette Bootlegging: A State AND Federal Responsibility". (MAY 1977) PRIVATE CITIZENS Robert E. Merriam, Chairman, Chicago, Illinois Jobs H. Ak.r!'er, Peoria, Illinois F. C1i(toa WUite, Greenwich, Connecticut MEMBERS OF THE UNITED STATES SENATE Lawtou Chiles, Florida WiliiatN HatMway, Maine W111iae. V. Roti, Delaware MEMBERS OF THE U.S. HOUSE OF REPRESENTATIVES Ciarefte J. Brows, Jr., Ohio !.. H. Fountain, North Carolina Cbarles B. Raa4el. New York OFFICERS OF THE EXECUTIVE BRANCH, FEDERAL GOVERNMENT W. Micbsel Blumentbal, Secretary of the Treasury Juanita M. Kreps, Secretary of Commerce Tbomas Bertram Lanee. Director, Office of Management and Budget GOVERNORS Otis R. Bowen, M.D., Indiana Ric4ard F. Kreip, South Dakota Vacancy Vacancy MAYORS tlarry E. KiAney, Albuquerque, New Mexico Jack D. Maltester, San Leandro, California Tom Moody, Columbus, Ohio Vacancy MEMBERS OF STATE LEGISLATIVE BODIES John H. Briscoe, Speaker, Maryland House of Delegates Char/es F. K.r("r, Minority Leader, Ohio House of Representatives Vacancy ELECTED COUNTY OFFICIALS Doris W. Dealaaran, Somerset County, New Jersey William E. Duna, Commissioner, Salt Lake County, Utah Vacancy Its proposals in this area are attached. TIMN 432077

125. UNIFORM TAX OPTIONS There are a number of different options that could be used to achieve uniform State tax rates. The most extreme method would be to repeal the State's authority to levy cigarette taxes. The Federal Government would levy a uniform rate, collect all taxes, and return rev- rmues to the States on a formula basis. A modi- fication of this approach would raise the Fed- eral excise tax to, for example, 20 cents and rebate 12 cents to all States who repealed their cigarette tax or kept it at a low level. These options have the major disadvantage of interfering with the States' taxing authority. Although they would completely eliminate all major cigarette bootlegging, they would result in a loss of State autonomy, which could be too great a price to pay, particularly for the vast majority of States not subject to substantial cigarette smuggling activities. Despite its coercive nature, a plan whereby the Federal Government raises Federal ciga- rette tax rates to 20 cents and rebates 12 cents to each State that sets its tax rate (including local taxes)'at no higher than 3 cents for exam- ple, does have some merit. Such a plan would virtually end organized cigarette smuggl- ing by largely eliminating State tax differen- tials. This plan is so coercive that every State would almost certainly be forced to participate. The States that might be reluctant are the high- tax States because of a concern about the loss of revenue. However, the 12 cent rebate plus the 3 cent State tax option and the increase in sales due to reduced bootlegging would offset the repeal of the State tax in every State but Connecticut, Florida, Maine, New Jersey, New Hampshire, and Texas, which would lose rev- enue because of their high consumption and relatively high tax rates. The low-tax and high-sales States would, of course, receive a windfall from this plan. One way to reduce the windfall to some States and to compensate the losers would be to put a percentage cap on how much a State could re- ceive in excess of its actual collections, with the excess revenue used to, compensate States that lose revenue. For example, North Carolina would gain about $67 million from the plan (without the 3 cent option). If a 50 percent cap were placed on distribution, they would gain only about $10 million and $57 million would be available for distribution to other States or for some other purpose. This windfall couYd also be limited by reimbursing only as many cents as the State tax rate up to a maximum of 12 cents. Estimates of the revenue effect of this plan on the States and the District of Columbia are shown in Table 12. The calculations are based on the assumption that every State would levy the 3 cent optional tax, although that might not be the case in States that receive a large rev- enue gain from this plan, such as California, North Carolina, and Virginia. The sales figures used to calculate the revenue from the 3 cent tax are ACIR estimates of States' sales assum- TIMN 432078

126. ing uniform tax rates. (See Appendix B.) The estimates would, of course, change with changes in tax rates and per capita sales. The distribution of revenue to the States would be based on population. This formula would be the easiest to administer, although it would discriminate against States with high per capita sales and favqr States with low per capita sales. The most equitable formula would be one based on cigarette sales without boot- legging. If this plan worked as expected, these sales figures would be available in all States except those that chose not to levy a State ciga- rette tax. Developing sales figures for these States would create some administrative dif- ficulties. If current consumption figures were used, the high-sales States would receive an even larger windfall. Population may not be the best basis for revenue distribution, but it does serve for illustrative purposes. The tobacco industry should not find this plan objectionable, because the average nation- wide tax rate would be almost unchanged from the current 21 cent level and total U.S. con- sumption would not be adversely affected. An approach that would be more feasible TablO 12 Estimated Revenue Disbursements to the States Under Federal Tax Credtt Proposal (Based on 1975 Data) 1 ! ! ~ 4 6 Frupaod 3 C.nt ToW MN Qa61 Cumet li.t lh.nd 81bN Taa MWwe ~r (L~al Ca6ootlon Ravolus Ib'oNw91 (2 + $) (4 -1l flate . lM+ nMarl !h --~ l fM1 Wd0oir) In aAk"' tW MIMa.r1 Wpsm. 3 44.7 $ 58.2 =14.2 S 72.4 ~ 27.7 Alaska 4.0 6.7 1.4 7.1 3.1 Aiizem 33.7 31.9 8.1 40.0 6.3 Ark.nsas 40.4 34.2 8.4 42.6 2.2 CaMiprnir 263.4 339.9 88.d 426.6 16'.1 Coloado 31.4 40.7 9.9 60.6 19.2 GNwi.croYt 7017 49.9 14.0 63.0 (6.8) Od.asra 11.8 9.6 2.6 12.1 0.5 Di.bk10/ Oalrn"bla 7.3 11.6 3.6 15.2 7.9 FlWido 178.0 134.4 98.4 172.8 (6.2) fi.oagia 89.9 79.3 19.7 99.0 29.1 Nl+rai 7.8 14.0 2.3' 16.3 6.s Idaho 8.6 13.3 2.9 16.2 7.7 sleoM 172.8 170.2 49.2 228.4 86.6 Indsna 49.9 85.5 21.9 107.4 87.6 Io.n 43.6 46.2 12.2 68.4 14.9 wnw 29.9 38.8 9.1 46.7 16.a KwMUd7 21.2 54.7 13.6 88.3 47.1 taw.i.e. 52.0 e1.2 14.5 76.7 28.7 Wim 23.0 17.1 4.3 21.4 (1.6) Ysry/.eQ 38.6 86.0 17.8 8$.8 47.3 Wseach"Ift 116.1 96.7 26.8 119.5 4.4 Mldip~n 135.6 147.4 •38.4 186.8 60.2 MmMOit 78.8 ,83.2 16.5 79.7 3.1 IwMripMi 27.6 36.0 8.6 46.0 110.1 Mnow1 66.6 70.6 20.3 86.9 40.4 Iloeqe. 10.8 19.3 2.8 16.1 4.5 Iwba.t. 21.7 25.0 8.1 31.1 9.4 Nwad. 11.2 9.6 3.5 13.1 1.0 Ww qe spdW~ 23.0 13.3 3.4 1a.7 (6.S1 tCOMIMMM TIMN 432079

127. would be to encourage the States to agree on a narrower range of cigarette tax rates than cur- rently exists, which would eliminate a sub- stantial portion of organized bootlegging ac- tivity. Because it is unlikely that the States will agree on such a range voluntarily, the most reasonable alternative might be the adoption of a Federal tax credit program that encourages low-tax States to raise their rates and high-tax States to lower their rates. The vast majority of States levy a rate be- tween 8 and 15 cents. If all States could be encouraged to set their rates within this range, the incentive for bootlegging would be sub- stantially reduced. The problem of casual smug- gling across borders would still exist in a few States, but organized criminal activities would be largely eliminated and revenue losses of high-tax States would be sharply cut. (Casual bootlegging on a large scale would probably exist only where rates in bordering States differed by more than 2 or 3 cents.) The major stumbling blocks to more uniform tax rates are twofold. First, the high-tax States are not willing to lower their rates because of expected revenue loss. Second, the low-tax Table 12 (contlnued) Estimated Rovonuo Dlsbunsmsnts to the States Under F*dfral Tax Credit Propossl (Based on 1975 Data) Aunnt No Ooll.crioe P resos.d lMhd R.wnu. oatts " L i c.nt •tN. Tax It.WNu.' Taeal Il...nw (t t !) N.t odn a A.eu1 (4-1) (Stats condr+u.d) (9+ nMfoM) tM1 WAIbesl (M mlNloey (MN "Iont) (in miss") lMM JMr.r 167.8 117.6 32.7 160.3 t17.b1 Mw YWce 13.4 18.6 3.8 22.3 8.9 Nw Yorfc 332.5 291.4 82.1 373.5 41.0 MmtR CaroMr 20.7 87.9 22.1 110.0 89.3 iNft tlahots 8.0 10.3 2.4 12.7 4.7 011110 191.2 173.1 45.4 218.5 27.3 OldWheen 44.9 43.8 10.3 54.1 9.2 Ok"O" 30.9 38.9 9.0 45.9 15.0 hamsyhrattie 239.6 190.2 52.1 242.3 2.7 IMod. IMsnd 19.0 15.1 4.1 19.2 0.2 MMA proMr 20.7 46.6 10.9 66.4 36.7 !WA Dakols 8.9 11.3 2.5 13.8 4.9 TMIIMMOO 61.6 67.4 17.2 64.8 23.0 Ta2w 249.9 197.0 49.9 248.9 (3.0) t/tMt 6.8 19.5 2.0 22.1 16.3 YGImoM M 8.5 7.9 2.0 9.9 1.4 tl*41N. 16.8 80.8 21.2 101.2 84.4 waNtMoon 54.7 67.1 14.0 71.1 16.4 wMt V1rOlnb 24.4 29.1 7.5 36.6 12.2 M1111carln 81.0 74.2 19.2 93.4 12.4 Wye.M» 4.3 6.2 1.8 7.7 3.4 TOTAL =3,283.6 $3.428.3 =802.6 1 f4.320.6 $1.037.2 '1Aa 3 o.M tax w aypCad to hypotlydcal Wes BpurH .a.uminp that a uNfam tax Is Impw.d. '1+ypaenucN sws ..Onrs....n ea aomvut•d: actual .at.. tquw.s w.re ampoy.a. S7Hrcd: OdnpuRed by Uw ACIR staft sN Appendlx 8. TIMN 432080

128. States are reluctant to raise their rates because of the tobacco industry's opposition to higher cigarettes taxes. The low-tax States could also be concerned about a possible reduction in rev- enue if they lose their tax advantage. These obstacles can be overcome if the Fed- eral Government provides ppyments to those States that move their rates closer to or within a specified range. The payments would be fi- nanced by an increase in the'Federal cigarette tax. For example, a high-tax State that lowers its rate 1 cent per pack might receive reim- bursement equal to 1 cent times the State's cigarette sales. A low-tax State that raises its rate 1 cent might also receive reimbursement equal to 1 cent times sales. In the case of the hifth-tax :State, the reimbursement would off- set the revenue loss resulting from a lower rate; the loss could be more than offset if sales in the State increased because of a decline in smug- gling activities. The low-tax States could use the Federal reimbursement to offset revenue lost because of decreased bootlegging activities and/or to reduce other 'taxes in the State. States in the desired tax range could also be provided tax rebates to offset the higher Fed- eral levy. Criteria for Federal Tax Credit Proposal No matter what type of approach is adopted, there are several criteria that must be con- sidered in the design of a Federal incentive program. These are: Parity. The incentive system should provide relatively equal treatment for all States. The high- and low-tax States, whose taxing policies have helped create the bootlegging problem, should not receive greater Federal aid than the moderate-tax States, who have largely avoided serious bootlegging problems. Thirty- one States currently have a tax rate between 8 and 13 cents. Of these States, only three or four have what could be classified as a signifi- cant cigarette smuggling problem and, in each case, the State borders a low-tax State. Flexibility. A Federal incentive system must be strong enough to provide the States "an offer they cannot refuse," but it should not be so coercive as to seriously limit State tax preroga- tives. The system should allow the States a fair- ly broad range in which to make their tax deci- sions. However, if the range is too great, the goal of achieving the uniformity needed to cur- tail smuggling activities will be compromiaed. Transition. The incentive system should be implemented in a manner that will allow the States time to adjust to the new rules and to minimize the shock of a large tax increase. A problem that has existed for a decade can- not be eliminated overnight. If the program is phased in over a few years, the States will have time to respond to the incentives in an orderly fashion and the cigarette consumer will not be subjected to a large, sudden increase in ciga- rette taxes. THE CIGARETTE TAX AS A REVENUE SOURCE Although the concept of State autonomy is hard to argue with in principle, one may make a convincing case for establishing the cigarette tax as an exception to the principle on practical grounds. First, the high value, low breakage, and small size of the product make it highly conducive to smuggling when tax differentials exist. Thus, a State may create a profit incen- tive for organized crime that is costly to other States by raising or lowering its tax only a few cents. Second, the high concentration of the tobacco industry in three States provides these States with a good reason for keeping their cigarette taxes at a minimum. During per- iods of inflation, the stable rates in these States result In a reduction of the "real" tax rate. This accentuates rate differentials with other States that may be raising their cigarette tax rate to ease fiscal difficulties. Whenever a State is in fiscal difficulty, ciga- rette tax increases are attractive because of the marginal additions to revenue they can pro- vide. The result of a succession of such mar- ginal tax increases Is, of course, a high cigarette tax. Meanwhile the low-tax State has a strong incentive to keep the tax constant. Because the costs of the resulting bootlegging are, to a large extent, born by the Nation as a whole in the form of increased organized criminal activity, there is little reason for a given State to unilat- erally reduce (a high-tax State) or increase (a TIMN 432081

129. low-tax State) its tax. Unless some Federal incentive is supplied for more uniform rates, ,all States will be forced to pay for the excesses of the high- or low-tax States. A further reason for the Federal Government to establish limits to State cigarette taxing authority (as an exceptional case) concerns Federal interest in health and income distribu- tion as they relate to the cigarette tax in partic- ular. The high tax on cigarettes, similar to the liquor tax, has been justified by the value judgement that people should be penalized for consuming a product that is dangerous to their health. It can be argued, however, that such a judgement should be made on a national level and uniformity should be the rule regarding the level of such a tax. The Federal Government has offered little leadership in this respect and has allowed the States individually to make the decision. The States appear to have ignored this role, because the present pattern of cigarette taxes reflects, to a greater extent, revenue conditions rather than health-conscious value judgements. High taxes are found in the Northeast and the Mid- west and lower taxes are found in the South and West. This pattern is in direct conflict with the expected disapproval of smoking, which if reflected in consumption patterns, should be highest in the West and South and lower in the Northeast and Midwest. (See Chapter 7, Table 18.) The Federal Government also has interests in the distributional effects of taxes, and the extremely high regressivity of the cigarette tax makes it subject to Federal concern. A 1970 study indicated that the Federal cigarette tax (8 cents a pack) was the most regressive of all Federal excise taxes.• The tax rate in most States has far surpassed the Federal levy, with the result that the combined State and Federal cigarette tax has a highly regressive impact on income distribution. It has been argued further that the regres- sivity issue should be considered along with the health effect of cigarettes at the Federal level in order to achieve a consistent policy. The solution to bootlegging need not be incon- sistent with the normative value judgement on health and income distribution. If the Federal Government decides that the health impact is most impoitant, then a uniformly high tax credit scheme would be indicated. If it is de- cided that the tax has little effect on cigarette consumption and, thus, on health, then a uni- formly low tax may be agreed upon. In any event, the cigarette tax does appear unique in its impact on Federal matters, and Federal intervention may be required, even with the enactment of Federal contraband legislation. A PROPOSED FEDERAL INCENTIVE PLAN A tax incentive proposal that would meet all criteria listed above and provide a strong in- centive for uniform tax rates is outlined below. • This incentive program would be financed by a phased increase in the Federal excise tax on cigarettes (currently 8 cents). In the first year, the tax would be increased 2 cents, and in each subsequent year, a 1 cent increase would be imposed until a cumulative increase of 6 cents is reached in Year 5. These funds would be used to provide Federal rebates to the States based on cigarette consumption. The program would take the form indicated in Figure 1. This plan is intended to encourage all States to adopt a cigarette tax in the range of 8 to 15 cents by the end of 5 years. One possible prob- lem is that States would wait until the last year to take action, particularly in the case of low-tax States. High-tax States would be under pressure to lower their rate to offset the higher Federal tax rate. Low-tax States would be suli- jected to a higher Federal tax and might be reluctant to raise their own rate, even though they would lose Federal money eacli year they delayed. The maximum rebate of 8 cents is intended to encourage the lowest taxing State-North Carolina at 2 cents-to raise its rate to 8 cents and the highest taxing States-Massachusetts and Connecticut at 21 cents-to lower their rates to 15 cents. The 5-year time period could be shortened or lengthened depending on the actions taken by the States. A maximum rebate is also used to limit the cost in any one year and to prevent low- and high-tax States from receiving larger rebates than moderate-tax States. The maximum rate is TIMN 432082

130. not cumulative and in no case could the total rebate exceed 6 cents in any one year. The rebate allowed for low-tax States is less generous than for high-tax States because low- tax States will be receiving double benefits from the increase in their tax rate and the Fed- eral rebate. The only losses the low-tax States might incur would be due to a reduction in the purchase of bootleg cigarettes as the tax dif- ferentials are reduced. The high-tax States will, of course, suffer revenue losses as they lower their tax rates and must be compensated for these losses. However, a one-for-one rebate may not be required because as bootlegging is reduced, consumption will rise in the high- tax States. The rebates granted to the States would be permanent under this proposal, but an alter- native would be to phase the rebates down gradually or out completely. This would, of course, allow the increase in the Federal excise tax to be phased out as well. However, some in- Figure 1 Schedule for Federal Incentive Plan State aparette Tax Ra1e Federal iAabate ' YNr 1 2-7 cents I cent ralate for each (18 cerN fredeai tax) 2 cent increase fn State tax rate 8-15 cents 2 eertt rebate 16 cents + 1 cent rebate for each I cent deoreaw in State tax rate Year 2 Year 3 YNr 4 Matdmum rebate - 2 eenb 2-7 cents 1 cent rebate for each 2 cent InqeaN in 3hte tax rate • 8-1 5 cents 3 cent rebate 18 cents + 1 cent rebate for each 1 cent decrease In 8tate tax rate Matdrnurn rebate - 3 oents 2-7 cents 1 cent rebate for each 2 cents IncreaN In State tax rate 8-15 cents 4 cent rebate 16 cents + 1 cent reWte for each I cent decrease In State tax rate Max/mum rebate - 4 cents 2-7 cents 1 cent rebate for each 2 cents incr'ease in state tax rate 8-15 cents 5 cerk rebate 16 cents + 1 cent rebate for each I cent decrease In State tax rate Masimum rebate - 5 aefds YNr S 2-7 cents 1 cent rebete for each (14 cent frederai tax) 3 cents Increase In afate tax nte 8-18 cents 8 cartQ rebete 16 cents + I cent credt for eech 1 cent decrease In State tax rate Mabmupt credit • fi aeals ~ TIMN 432083

131 . centive for the States to remain in the 8 to 15 cent range would have to be provided or the differential probably would begin to widen again-unless the States' unpleasant experience with bootlegging was enough to convince them to maintain uniform rates without Federal encouragement. Under this proposal any State that moved outside the 8 to 15 cent range would lose a 1 cent rebate for each 1 cent increase or de- crease. The States might find the 15 cent maxi- mum too limiting as their need for revenue increases. One approach would be to allow a 0.1 cent increase for every 4 percent increase in the consumer price index (CPI) with an adjust- ment to be made every 2 years. Assuming an inflation rate of 6 percent per year, this method would allow the range to rise 0.3 percentage points every 2 years. This formula is very arbitrary; others could be developed that would allow faster or slower increases. The formula could also be tied to some other measure, such as personal income, real gross national prod- uct, or cigarette sales. A final feature of this proposal is that any money generated by the Federal excise tax and not rebated to the States would be allocated to the States to finance their enforcement efforts and/or used to finance Federal enforcement efforts in the event Federal contraband legisla- tion is enacted. To illustrate how this program would work, assume that North Carolina increased their rate 2 cents in the first year and 1 cent in each of the next 4 years. In the first year, they would receive a 1 cent Federal rebate and in each of the next 4 years an additional 0.5 cent rebate per year. At the end of 5 years, their State tax rate would be 8 cents and they would be re- ceiving a 4 cent Federal rebate. Any increase in the rate beyond 8 cents would not earn a Fed- eral rebate. The revenues that would have been raised by increasing the Federal excise tax and the dollar amounts of the rebates to the various States had the plan been administered in 1974 are shown in Table 13. Several general objections can be raised against this approach. Although the States are allowed some flexibility, they almost are being forced to take an action that they would not take if they were not being bribed. States in the upper end of the 15 cent range would have little room to raise their cigarette tax rate, while States at the lower end would have sub- stantial latitude-a perverse effect. However, the 6 cent Federal tax increase would probably eliminate the desire of these States to raise the tax rate. Cigarette smokers nationwide would be subjected to a 6 cent increase in the cigarette tax-a regressive tax-in order to help solve a cigarette smuggling problem that exists to a substantial degree in only about a dozen States. (The total tax increase would be higher than 6 cents in low-tax States and less than 6 cents in high-tax States if the program achieved its intended result.) No assurance exists that the States would take the desired action, particular- ly in the case of the low-tax States. The 1 cent rebate for a 2 cent increase might not be at- tractive enough to encourage the tobacco- producing States to raise their cigarette tax rate. Even a one-for-one rebate might not over- come the traditional resistance to higher cigarette taxes. If the low-tax States failed to act, the plan would be largely ineffective. A related problem is that the 8 to 15 cent range might still provide encouragement for substantial bootfegging. The following quote from the report of the New York State Special Task Force on Cigarette Bootlegging explains why this may be a problem: Moreover, the differential in taxes which supplies the bootleggers profit unfortunately need not be as great now that the bootlegging importation and distribution systems and personnel have been established, as was required in order for bootlegging to have the incentive to increase to the extent it has in recent years, simply because now that such systems and personnel are 'in place' it requires less profit to continue to run it than it did to estab- lish it. Consequently, a reduction of taxes back to the level just below the tax at which cigarette bootlegging flour- ished would not ~e sufficient to elimi- nate the profit differential; the reduc- tion in taxes would have to be reasonably below the critical level above which bootlegging began to flourish.6 TIMN 432084

132. Tabrs 13 Estimatsd Paym.Ms to lfata Undor F.d.rai Inc.ntlw Plan FkM YNr 2 ow.Mbab a n.t.. tato pn mlMlawl Alabanr : 7.00 Alaska 1.01 Arizaw 6.24 Arkaesas 4.73 !CaMforda 63.14 Colorado 6.64 Car»eMca1 6.80 fS.la>rare 1.89 Dl.trfet of Columbla 2.55 Florld. 21.34 Gao.gl. 12.00 NawaY 1.56 Idaho 1.97 IUnoIN 29.36 Ind.n. 17.31 Iowa 6.88 K.nw 5.80 Kanlt+oky 14.97 Ironhlrna 10.05 MaUN 2.94 Maryland 11.96 MaaaohwNb 14.62 MIONOan 24.89 Minn..ota 6.75 ML.MdppI 6.43 Mlpowl 12.96 MoMaea 1.e1 N.Madta 3.52 Nevada 2.35 N.w Nampddra 4.34 Now Jan.lr 17.92 Narr Mexko 2.31 Now Yak 44.67 North Cato~n~ 24.23 North Oakot. 1.60 Okb 26.31 Okl.hana 7.20 Orayon 6.99 F.mtsYkranla 97.13 Rhodektland 2.90 8omAA CaeeM- 7.20 Ooa1b Oakota 1.64 Tsmwp.~ 9.69 Tasa. 27.94 Utak 1.77 Yermont 1.46 VlrOinla 14.98 WasWnplon 6.91 Wad YtrvMa 4.41 Yt7.eaaln 10.36 IA/Fonin0 1.15 2 Cant Federal Tat 1aY..ran00o.nts 5tk Ywr $533.30 llql YNr 0 aae 11.bM aM slo.. Pn rnilloMl a 23.97 3.03 16.72 14.19 159.42 19.62 20.40 6.07 7.65 64.02 3640 4.68 6.91 00.06 61.93 20.64 16.60 44.91 30.16 6.62 35.08 43.86 74.67 20.26 18.20 38.85 5.43 10.66 7.06 13.02 53.76 0.03 134.01 72.09 4.50 78.93 21.60 20.07 81.30 8.10 21.7e 4.62 29.07 83.83 6.31 4.38 44.94 20.73 18.23 31.08 3.45 $1.669.90 NoN- The fiywea In t1Mb qbl" arfa ody illustrative. To tle etlerrt pyt thh praOoaM reduced oIpHMN MfwppMnO, ra0eqe In iM fJHh yMr. In npN aMM, rpNd be uqdnamqr NpW M Nph.W 8tataa and bwar In bw•ta. 9qta.. Saurcv: CanpetW uy the ACIR afaN. _f TVVN ~~~ ® S5

133. This problem could be largely eliminated by narrowing the range, but this step would reduce the States' flexibility and further in- fringe on State taxing prerogatives as well as increase the program costs. Recognizing that there are disadvantages to the Federal incentive approach, some advocates defend it on the grounds that the only way ciga- rette bootlegging can be eliminated or reduced to a low level is to reduce the tax differential. Morris Weintraub, director of the Council Against Cigarette Bootlegging, made the follow- ing statement to the House Committee on the judiciary in 1972: Enforcement alone, unless coupled with a reasonable rate of cigarette taxation, has never been and never will be an effective solution to the bootlegging problem. States will not take action on their own, ac- cording to the New York Commission of Investi- gation: The record is clear that cigarette bootlegging could be ended totally and instantly in the city and State of New York by the elimination, or at least sharp reduction, of the price disparity which is caused solely by the substan- tial differences in State excise taxes. Obviously, such a step would end all profits for the bootleggers and thereby end all bootlegging. This conclusion is clear and inescapable. But it is also clear and inescapable that this simply stated solution may be far from simple to achieve.• The Federal incentive proposal might help to achieve this "simply stated solution," but until all other efforts are exhausted, it may be too radical an approach. The enactment of Federal contraband legis- lation and greater enforcement efforts by the States can reduce bootlegging activity. The size of the reduction that can be achieved is difficult to estimate. Some experts have placed it as high as one-third. However, even if this great a reduction Is achieved, many States will continue to suffer substantial revenue losses from cigarette bootlegging. If bootlegging remains at an unacceptable level after all reasonable enforcement efforts have been tried, a Federal incentive plah as outlined above or the Federal tax credit de- scribed earlier in this chapter may become the logical approach. FOOTNOTES 'Report of the New York State Special Task Force on Ciga- rette Bootlegging (Albany, N.Y.: Dept. of Taxation and Fi- nance, May 1976). lIoint Committee of the American Bar Association, the National Tax Association, and the National Association of Tax Administrators, The Coordination of Federal. State and Local Taxation,1947, pp. 69-70. 8G2nd Congress. 2nd Session, House Report No. 2519, 1853. p. 69. 'Thomas W. Calmus, "The Burden of Federal Excise Taxes by Income Class," Quarterly Review of Economics and Business, Vol. 10,1970, pp. 17-23. 'New York State Special Task Force in Cigarette Bootleg- ging, op. cit., p. 7. 'State of New York Commission of Investigqtion, Report of an Investigation Concerning the Illegal Importation and Distribution of Untaxed Cigarettes In New York State (Albany, N.Y.: March 1972) p. 88. TIMN 432086

134. JUNE 1977 7'IMN 432087

135. REPORT OF "TAR" AND NICOTINE CONTENT OF THE SMOKE OF 166 VARIETIES OF CIGARETTES June 1977 The Federal Trade Commission's Laboratory has determined the "tar" (dry particulate matter) and total alkaloid (reported as nicotine) content of 166 varieties of cigarettes. The laboratory utilized the Cambridge filter method with the following specifications as set forth in the Commission's announcement of July 31, 1967: 1. Smoke cigarettes to a 23 mm. butt length, or to the length of the filter and overwrap plus 3 mm. if in excess of 23 mm. 2. Base results on a test of not less than 95 cigarettes per brand, or type. 3. Cigarettes to be tested will be selected on a random basis, as opposed to "weight selection". 4. Determine particulate matter on a "dry" basis employing the gas chromatography method published by C. H. Sloan and B. J. Sublett in Tobacco Science 9, page 70, 1965, as modified by F. J. Schultz' and A. W. Spears' report published in Tobacco Vol. 162, No. 24, page 32, dated June 17, 1966, to determine the moisture content. 5. Determine and report the "tar" content after sub- tracting moisture and alkaloids (as nicotine) from particulate matter. Concerning the 166 varieties tested, 23 were capable of being smoked to 23 mm. The butt length of the other 143 varieties tested ranged from 25.0 mm. to an average of between 47.7 and 49.5. The butt lengths of 102 of the 166 varieties tested exceeded 30 mm. The samples used were obtained by attempting to purchase two packages of each variety of cigarettes as distributed by the seven domestic cigarettes manufacturers during November 1976 in each of 50 geographic locations throughout the country. All varieties of cigarettes were not available in each of the 50 geographic locations and in these instances, one or more additional packages of cigarettes were purchased in those geographic locations where respective varieties were available. The samples utilized in the tests were representative of the 166 varieties of cigarettes as available throughout the country at the time of purchase. ,VIlViN 432088

136. In the table listing the cigarette varieties in alphabetical order the "tar" content is reported to the nearest 1/10 milligram and the nicotine to the nearest 1/100 milligram, each with appro- priate statistical values. The average weight is reported in grams per cigarette and the butt length range to the nearest 1/10 millimeter. In all other tables the average weight and butt length columns and the figures representing the standard deviation of the mean have been eliminated. The "tar" figures have been rounded to the nearest milligram (0.5 milligram and greater rounded up, 0.4 milligrams and less rounded down) and the nicotine figures have been rounded to the nearest tenth of a milligram (0.05 milli- grams and greater rounded up, 0.04 milligrams and less rounded down). Two tables respectively list varieties in increasing order of "tar" values and in increasing order of nicotine values, and two other lists tabulate the current and four previous testo. Accordingly, "tar" and nicotine figures in the tables and list represent rounded off averages without indication of their precision. We were informed that the formulation of three varieties of Parliament cigarettes were changed and they were collected according to the prescribed procedure. The results of the newer formulation appears in the body of the tables. In some locations the older formulation may still be founds'rheir results are as follows: -:;RAND TYPE TPM dry NICOTINE mg/cig m /ci Parliament king size, filter, (hard pack) 13.1 0.72 Parliament king size, filter 13.6 0.75 Parliament 100 mm, filter 14.9 0.91 TIMN 432089

137. "Tar"4 and Nicotine5 Content of One-hundred sixty-six (166) Varieties of Domestic Cigarettes ggA(yD 1'\'1'E1 ! AVF:RA CIi Wh:l(tH'P2 UU'Cl' 1.F:NGTH3 TI'M dLYG_ _ * N t1~tL1L4k ~- * ASpint F, M, Sl' S4-mm 0.'18 Ul 2'>. U- 30.5 inu 13.7 t 0.2 O.H3 I 0.01 iswrriran liohts F, S1' (20 mm 1 .209 47.7 - 49.5 nmt H.5 ' 0.3 0.68 1 0.01 dmrrt:an 1.iFhtx F, M, Sl' 1:0 mm 1.1401 47.7 - 49.0 nwi 9.9 t 0.'1 U.H3 1 ().02 M+l4larn Longs F, S1' 1:0 mm 1.2430 37.5 - 3H.7 nmi 16.1 1 0.4 1.2') i 0.0'f Amert:nn l.ngs F, M, SI' 120 nnn 1.206_i 37.5 - 39.0 mm 16.3 t 0.5 1.34 + 0.03 Belair F, M, SP 85 mm 0.9774 28.0 - 30.0 mm 14.5 ± 0.2 0.97 + 0.01 Belair F, M, SP 100 mm 1.1541 35.0 - 37.0 mm 17.8 ± 0.3 1.32 ! 0.03 Benson & Hedges NF, HP 70 mm 0.8563 26.0 - 27.5 mm 9.8 ± 0.2 0.64 1 0.02 Benson & Hedges F, HP 85 mm 1.0174 32.5 - 33.5 mm 15.8 ± 0.3 1.03 ± 0.02 Benson & Hedges 100's F, HP 100 mm 1.0906 34.7 - 36.3 mm 16.5 ± 0.3 1.03 t 0.02 Benson & Hedges 100's F, M, HP 100 mn 1.0912 34.0 - 36.0 mm 17.2 ± 0.3 1.05 * 0.02 Benson & Hedges 100's F, SP 100 mm 1.0923 34.5 - 36.0 mm 17.0 ± 0.4 1.04 ± 0.02 Benson & Hedges 100's F, M, SP 100 mm 1.0907 34.5 - 35.5 mm 16.7 ± 0.4 1.03 ± 0.02 Bull Durham F, SP 85 mm 1.1791 27.0 - 27.7 mm 28.9 ± 0.5 1.94 ± 0.03 Camel NF, SP 70 mm 0.8822 23 mm 24.6 ± 0.5 1.58 ± 0.03 Camel F, HP 80 mm 0.9117 26.0 - 28.7 mm 19.4 ± 0.3 1.24 ~ 0.02 Camel Filters F, SP 85 mm 0.9527 27.0 - 28.5 mm 18.1 ± 0.3 1.18 ~ 0.02 Carlton 70's F, SP 70 mm 0.6490 32.0 - 34.7 mm <0.5 ± 0.1 < 0.05 ± 0.00 Carlton F, SP 85 mm 0.7862 32.7 - 34.5 mm 1.4 ± 0.1 0.14 ± 0.01 Carlton F, M, SP 85 mm 0.7762 32.5 - 34.0 mm 0.6 ± 0.1 0.07 ± 0.01 Chesterfield NF, SP 70 mm 0.8672 23 mm 24.1 ± 0.3 1.37 ± 0.03 Chesterfield NF, SP 85 mm 1.0477 23 mm 28.9 ± 0.4 1.68 ± 0.02 Chesterfield F, SP 85 mm 0.9360 27.5 - 30.7 mm 18.7 ± 0.4 1.14 _ 0.02 Chesterfield F, SP 101 nm 1.0910 33.3 - 36.3 mm 18.0 ± 0.3 1.12 z 0.02 Domino NF, SP 85 mm 1.2624 23 mm 32.8 ± 0.8 1.37 ± 0.04 Domino F, SP 85 mm 1.1334 26.7 - 31.0 mm 21.5 ± 0.5 1.08 ± 0.04 Doral F, SP 85 mm 1.1102 32.5 - 33.5 mm 12.0 ± 0.4 0.83 1 0.03 Doral F, M, SP 85 mm 1.1103 32.5 - 33.5 mm 10.1 ± 0.2 0.79 t 0.02 DuMaurier F, HP 85 mm 1.0108 28.5 - 29.5 mm 15.6 ± 0.3 1.06 t 0.02 Eagle 20's F, SP 85 mm 0.9253 28.5 - 30.5 mm 18.3 ± 0.3 1.11 ± 0.02 Eagle 20's F, M, SP 85 tmD 0.9354 27.5 - 31.5 mm 18.4 ± 0.3 1.11!-0.02 English Ovals NF, HP 70 mm 0.9129 23 mm 23.7 ± 0.6 1.63 0.04 English Ovals NF, HP 85 mm 1.1104 23 mm 30.3 ± 0.5 2.15 0.06 Eve F, SP 100 mm 1.0691 33.0 - 37.0 mm 15.9 ± 0.4 1.02 •_ 0.03 Eve F, M, SP 100 mm 1.0874 33.5 - 36.5 mm 16.1 ± 0.2 1.02 ~ 0.02 Eve 120's F, HP 120 mm 1.0163 37.5 - 39.0 mm 15.3 ± 0.4 1.04 ~ 0.03 Eve 120's F, M, HP 120 mm 1.0033 37.5 - 40.0 mm 14.0 ± 0.2 0.99 ± 0.02 Fact F, SP 85 mm 1.0062 33.0-36.0mn 13.3 ± 0.3 0.89 ± 0.02 Fact F, M, SP 85 mm 0.9821 33.5 - 38.0 mm 12.7 ± 0.3 0.87 ± 0.02 Fatima NF, SP 85 mm 1.0418 23 mm 28.8 ± 0.5 1.69 ± 0.03 Galaxy F, SP 85 mm 1.0526 31.7 - 33.3 mm 14.8 ± 0.3 0.92 *_ 0.02 Half & Half F, SP 85 mm 1.1592 26.4 - 28.4 mm 26.0 ± 0.6 1.84 ± 0.04 Hallmark F, HP 100 mm 1.2180 34.5 - 36.5 mm 23.0 ± 0.4 1."7 0.03 Hallmark F, M, HP 100 mm 1.1986 34.5 - 36.5 mm 22.6 ± 0.3 1.80 ~ 0.03 Herbert Tareyton NF, SP 85 mm 1.1034 23 mm 28.2 ± 0.4 1.78 ± 0.03 Hi-Lite F, HP 100 mm 1.0954 34.0 - 35.0 mm 11.0 ± 0.3 0.74 ± 0.02 Home Run NF, SP 70 mm 0.8774 23 mm 21.6 ± 0.5 1.49 ± 0.05 Iceberg 100's F, M, SP 100 mm 0.9421 37.3 - 39.5 mm 3.0 ± 0.3 0.2. 1 0.02 Kent F, HP 80 mm 0.9192 27.0 - 29.0 mm 15.3 ± 0.4 0.95 ± 0.02 Kent F, SP 85 mm 0.9895 28.0 - 30.5 mm 15.8 ± 0.3 1.02 t 0.03 Kent Golden Lights F SP 85 mm 0.9098 34.5 - 36.5 mm 7.6 ± 0.3 ~ 0.61 0.02 Kent Golden Lights , F, M, SP 85 mm 0.9051 34.3 - 36.0 mm 8.3 ± 0.2 0.66 ± 0.02 Kent F, SP 100 mm 1.0806 34.3 - 36.5 mm 18.3 ± 0.2 1.22 t 0.02 Kent F, M, SP 100 mm 1.0579 34.5 - 36.5 mm 16.9 ± 0.3 1.13 -_ 0.02 King Sano F, SP 85 mm 1.0893 28.0 - 30.0 mm 6.2 ± 0.3 0. "2'1 : 0.62 King Sano F, M, SP 85 mm 1.0954 27.5 - 29.5 mm 6.0 ± 0.3 0.29 ~ 0.02 Kool NF, M, SP 70 mm 0.8836 23 mm 20.9 ± 0.4 1.31 s 0.04 Kool F, M, HP 80 mm 0.9419 26.0 - 28.0 mm 17.0 ± 0.4 1.32 0.02 Kool Naturals F, SP 85 mm 1.0298 33.0 34.3 mm 14.0 ± 0.2 0.96 ~ 0.02 Kool F, M, SP 85 mtn 0.9499 28.0 - 30.5 mm 17.0 ± 0.3 L.33 ± 0.02 Kool Milds F, M, SP 85 mm 0.9593 31.5 - 35.5 mm 13.7 ± 0.3 0.89 ± 0.02 Kool F, M, SP 100 mm 1.1543 34.0 - 36.5 mm 17.7 ± 0.3 1.30 t 0.02 1 F-filter; NF-non-filter; M-menthol; HP-hard pack; SP-soft pack; mm-millimeter 2 average weight reported in grams 3 range used for butt length because of variance of overwrap yIMN 432090 4 TPM dry (tar) - milligrams total particulate matter less nicotine and water 5 milligrams total alkaloids reported as nicotine * tolerance shown is two (2) standard deviation of the mean

"Tar''i and Nicotine5 Content of One-hundred sixty-six (166) Varieties of Domestic Cigarettes V38. BRAND TYPE1 AVERA GE WEIGHT2 ' BUTT LENGTH3 TPM dry4 * NI.ATINE5 * L 's M F, HP 80 mm 0.8694 27.5 - 29.5 mm 16.2 ± 0.3 0.95 ± 0.02 ~ a Y F, SP 85 mm 0.9415 27.0 - 30.0 mm 18.2 t 0.3 1.09 ± 0.02 M l.ights F, SP 85 mm 0.8652 33.0 - 35.0 mm 7.8 ± 0.2 0.63 s 0.02 F, SP 100 mm 1.0879 32.0 - 37.3 mm 17.2 t 0.3 1.09 i• 0.02 1 ~ 4 F, M, SP 100 mm 1.0736 32.7 - 37.0 mm 17.8 ± 0.4 1.11 x o.03 1. r. F•r.w„ F, SP 120 mm 1.0371 35.0 - 37.0 mm 19.3 t 0.3 1.45 t 0.03 L. T. Brown F, M, SP 120 mm 1.0464 35.0 - 37.0 mm 19.4 ± 0.3 1.43 t 0.02 Lark F, SP 85 mm 1.0791 27.5-29.0rttin 17.6 ± 0.3 1.08 ± 0.02 Lark F, SP 100 mm 1.2000 30.5 - 32.0 mm 18.4 ± 0.2 1.14 + 0.02 Long Johns F, SP 120 mm 1.1872 35.5 - 38.0 mm 17.9 ± 0.2 1.40 t 0.03 Long Johns F, M, SP 120 mm 1.1795 36.0 - 38.5 mm 15.9 ± 0.5 1.31 ± 0.04 Lucky Strike NF, SP 70 mm 0.9256 23 mm 24.1 ± 0.6 L.42 t 0.03 Lucky Ten F, SP 85 mm 1.2145 32.0 - 34.5 mm 9.0 ± 0.2 0.63 ± 0.02 Lucky 100's F, 5P 100 mm 0.9397 37.5 - 39.3 mm 3.2 ± 0.2 0.27 ± 0.01 Mapleton NF, SP 70 mm 0.9890 23 mm 27.5 ± 0.4 1.26 ± 0.01 Mapleton F, SP 85 mm 1.0929 27.5 - 29.5 mm 22.7 ± 1.0 1.17 ± 0.09 Marlboro F, HP 80 mm 0.9301 25.0 - 26.8 mm 16.8 ± 0.3 0.99 ± 0.01 Marlboro F, M, HP 80 mm 0.9295 26.0 - 27.5 mm 13.8 ± 0.3 0.79 ± 0.02 Marlboro F, SP 85 mm 0.9908 27.5 - 29.3 mm 17.1 ± 0.3 1.03 ± 0.02 Marlboro Lights F, SP 85 mm 1.1123 33.0 - 35.0 mm 11.7 ± 0.3 0.73 ± 0.02 Marlboro F, M, SP 85 mm 0.9617 28.5 - 30.0 mm 13.6 ± 0.3 0.81 ± 0.02 Marlboro F, HP 100 mm 1.0901 33.0 - 35.5 mm 16.5 ± 0.3 1.02 ± 0.02 Marlboro F, SP 100 mm 1.1231 34.0 - 35.0 mm 16.9 ± 0.2 1.04 ± 0.02 Max F, SP 120 mm 1.0152 37.0 - 39.0 mm 17.2 ± 0.3 1.31 ± 0.02 Max F, M, SP 120 mm 0.9996 37.0 - 38.0 mm 17.0 ± 0.4 1.29 ± 0.03 Merit F, SP 85 mm 0.9834 31.0 - 35.0 mm 8.1 ± 0.3 0.55 ± 0.02 iie r i t F, M, SP 85 mm 0.9896 34.5 - 35.5 mm 8.0 ± 0.2 0.55 ± 0.01 Montclair F, M, SP 85 mm 1.0115 26.5 - 27.5 mm 17.6 ± 0.3 1.28 ± 0.03 More F, SP 120 mm 1.1777 34.0 - 36.5 mm 20.7 ± 0.4 1.48 ± 0.03 More F, M, SP 120 mm 1.0729 33.5 - 36.0 mm 21.1 ± 0.4 1.55 ± 0.03 Multifilter F, SP 85 mm 1.1575 32.0 - 33.7 mm 12.1 ± 0.3 0.80 ± 0.02 Multifilter F, N, SP 85 mm 1.1223 33.0 - 34.5 mm 10.5 ± 0.3 0.67 ± 0.02 Neu-port F, M, HP 80 mm 0.9234 26.0 - 28.7 mm 17.4 ± 0.3 1.18 ± 0.02 Newport F, M, SP 85 mm 0.9432 26.0 - 28.3 mm 17.5 ± 0.3 1.22 ± 0.02 Newport F, M, SP 100 mm 1.0580 32.8 - 35.5 mm 19.6 ± 0.4 1.41 ± 0.04 Now F, HP 85 mm 0.7795 32.0 - 34.5 mm 1.5 ± 0.2 0.12 ± 0.01 Now F, M, HP 85 mm 0.9805 32.0 - 34.0 mm 1.3 ± 0.1 0.12 ± 0.01 Oasis F, M, SP 85 mm 0.9484 26.0 - 28.5 mm 18.9 ± 0.3 1.14 ± 0.03 Old Gold Straights NF, SP 70 mm 0.8492 23 mm 20.0 ± 0.4 1.22 ± 0.02 Old Gold Straights NF, SP 85 mm 1.0230 23 mm 24.6 ± 0.5 1.49 ± 0.03 Old Gold Filters F, HP 80 mm 0.8873 26.7 - 28.0 mm 17.0 ± 0.3 1.20 ± 0.02 Old Gold Filters F, SP 85 mm 0.9585 28.0 - 30.0 mm 17.8 ± 0.5 1.16 ± 0.03 Old Gold 100's F, SP 100 mm 1.0913 33.0 - 36.3 mm 21.2 ± 0.3 1.39 ± 0.02 Pall Mall NF, SP 85 ms 1.0694 23 mm 26.0 ± 0.5 1.59 ± 0.03 Pall Mall r, SP 85 mm 1.0044 26.5 - 28.0 mm 17.7 ± 0.3 1.17 ± 0.02 Fall Mall Extra Mild F, HP 80 mm 0.9185 32.7 - 34.0 mm 6.1 ± 0.2 0.53 ± 0.01 Fall Mall Extr.a Mild F, SP 85 mm 0.9610 32.0 - 34.0 mm 6.2 ± 0.2 0.54 ± 0.01 Fall Mall F, SP 100 mm 1.1516 34.3 - 36.5 am 18.9 ± 0.3 1.39 ± 0.02 Fall Mall F, M, SP 100 mm 1.1274 34.5 - 37.0 mm 16.0 ± 0.3 1.23 ± 0.02 Farliament F, HP 80 mm 0.9567 32.5 - 34.5 mm 9.6 ± 0.2 0.58 ± 0.01 Parliament F, SP 85 mm 1.0123 32.5 - 34.0 mm 10.0 ± 0.3 0.62 ± 0.01 Parliament 100's P M F, SP 100 mm 7 1.3167 39.3 - 41.0 mm 11.8 x 0.3 0.75 t 0.02 hilip orris NF, SP 0 mm 0.8411 23 mm 20.3 t 0.5 1.10 t 0.03 Philip Morris Commander NF, SP 85 mm 1.0169 23 mm 24.5 t 0.5 1.38 ± 0.03 Philip Morris International F, HP 100 mm 1.0959 34.5 - 36.5 mm 16.3 ± 0.4 1.03 ± 0.02 Philip Morris International F, M, HP 100 mm 1.0604 35.0 - 35.7 mm 16.5 ± 0.3 0.92 ± 0.02 Picayune NF, SP 70 mm 0.8518 23 mm 21.4 ± 0.3 1.45 ± 0.03 Piedmont NF, SP 70 mm 0.8605 23 mn 23.8 ± 0.5 1.33 ± 0.03 Players NF, HP 70 mm 1.0443 23 mm 34.5 ± 0.7 2.45 ± 0.03 Raleigh NF, SP 85 mm 1.0567 23 mm 24.0 t 0.5 1.42 t 0.03 Raleigh F, SP 85 mm 0.9969 29.0 - 31.0 mm 16.2 ± 0.3 1.06 ± 0.02 Raleigh Lights F, SP 85 mm 0.9865 32.0 - 33.5 mm 13.9 ± 0.3 0.98 ± 0.03 Raleigh F, SP 100 mm 1.1869 34.0-36.7san 17.4 ± 0.4 1.23 ± 0.02 I F-filter; NF-non-filter; M-menthol; HP-hard pack; SP-soft pack; mm-millimeter 2 average weight reported in grams 3 range used for butt length because of variance of ova=wrap 4 TPM dry (tar) - milligrams total particulate matter-].ess nicotine and water 5 milligrams total alkaloids reported as nicotine * tolerance shown is two (2) standard deviation of the mean TIMN 432091

139. "Tar"4 and Nicotine5 Content of One-hundred sixty-six (166) Varieties of Domestic Cigarettes BRAND TYl'E:1 AVERA GE WEIGHT2 BUTT LENGTH3 T PM dr y 4 NICOTINE5 * St. >trrit_ F, SF 100 mm 1.1060 35.5 - 38.5 mm 16.9 t 0.4 1.03 1 0.02 St. `k•ritr F, M, SF 100 mtn 1.1166 35.0 - 37.5 mm 17.2 ± 0.3 1.0h F 0.02 :A 1,.-; F, M, HF Hl) .mi ().950y 26.0 - 2N.0 mm 18.7 ± 0.4 1.19 t 0.02 Saltti:. F, M, SP 81) mm 0.9839 27.0 - 29.0 mm 17.8 ± 0.3 1.16 t 0.02 S.4i 1v-. Lights F, M, SF 85 mm 0.9758 32.0 - 34.0 mm 10.9 ± 0.2 0.77 1 0.01 Salem F, M, SP 100 mm 1.1477 33.0 - 34.5 mm 18.5 ± 0.3 1.25 ± 0.01 Salem Long Lights F, M, SP 100 mn 1.0864 33.0 - 35.0 mm 9.4 0.3 0.73 ± 0.02 Sano NF, SP 70 nun 1.0073 23 mm 17.5 ± 0.5 0.61 ± 0.03 Saratoga F, HP 120 mm 1.0825 37.0 - 39.0 mm 16.1 ± 0.4 1.03 ± 0.02 Saratoga F, M, HP 120 mm 1.0627 37.5 - 39.5 mm 15.3 ± 0.4 0.98 ± 0.02 Silva Thins F, SP 100 mm 1.0088 32.0 - 34.5 mm 16.9 ± 0.3 1.27 ± 0.02 Silva Thins F, M, SP 100 mm 1.0244 32.3 - 34.3 mm 16.1 ± 0.3 1.15 ± 0.03 Spring 100's F, M, SP 100 mm 1.0750 32.2 - 36.2 mm 18.7 ± 0.2 1.08 ± 0.01 Stratford NF, SP 85 mm 1.2137 23 mm 28.6 ± 0.5 1.07 ± 0.02 Stratford F, SP 85 mm 1.1173 27.5 - 29.0 mm 22.7 ± 0.7 1.11 ± 0.06 Tall F, SP 120 nun 1.1744 37.0 - 39.0 mm 18.2 ± 0.4 1.43 ± 0.03 Tall F, M, SP 120 mm 1.1822 37.0 - 39.5 mm 16.1 ± 0.3 1.32 ± 0.03 Tareyton F, SP 85 mm 1.0845 26.5 - 29.0 mm 17.1 ± 0.3 1.17 ± 0.02 Tareyton F, SP 100 mm 1.2304 33.0 - 35.7 mm 16.5 ± 0.3 1.23 ± 0.02 Tempo F, SP 85 mm 1.0263 32.3 - 33.7 mm 6.8 ± 0.2 0.49 ± 0.01 True F, SP 85 nun 0.8376 32.5 - 34.0 mm 4.9 ± 0.3 0.38 ± 0.01 True F, M, SP 85 mm 0.8405 32.0 - 35.0 mm 5.1 ± 0.2 0.40 ± 0.01 True 101" s F, SP 100 mm 1.0808 34.5 - 36.5 mm 13.2 ± 0.2 0.80 ± 0.02 True 100's F, M, SP 100 mm 1.0801 34.5 - 36.5 mm 13.1 ± 0.3 0.79 ± 0.01 Twist F, L/M, SP 100 mm 1.1026 32.0 - 34.0 mm 17.0 ± 0.5 1.30 ± 0.04 Vanguard F, SP 85 mm 1.0241 32.0 - 34.5 mm 15.6 ± 0.3 1.01 ± 0.03 Vanguard F, M, SP 85 mm 0.9861 32.0 - 34.5 mm 13.1 ± 0.4 0.87 ± 0.02 Vantage F, SP 85 mm 1.1876 32.0 - 33.5 mm 10.6 ± 0.2 0.70 ± 0.02 Vantage F, M, SP 85 mm 1.1165 32.0 - 34.0 mm 10.7 ± 0.3 0.75 ± 0.02 Vello F, SP 85 mm 0.9671 33.5-34.0saa 10.5 ± 0.2 0.72 ± 0.01 Vello F, M, SP 85 mm 0.9787 32.0 - 34.5 mm 10.2 ± 0.4 0.71 ± 0.02 Viceroy F, SP 85 mm 0.9769 28.7 - 30.0 mm 15.6 ± 0.3 1.02 ± 0.02 Viceroy Extra Mild F, SP 85 mm 0.9807 32.5 - 34.7 mm 14.0 ± 0.3 1.01 ± 0.03 Viceroy F, SP 100 mm 1.1795 34.0 - 36.5 mm 17.8 ± 0.3 1.25 ± 0.02 Virginia Slims F, SP 100 mm 0.9352 35.0 - 36.5 mm 15.9 ± 0.3 0.95 ± 0.02 Virginia Slims F, M, SP 100 mm 0.9468 33.7 - 35.7 mm 15.6 ± 0.3 0.91 ± 0.01 Winston F, liP 80 mm 0.9374 26.0 - 28.0 mm 18.7 ± 0.3 1.20 ± 0.02 Winston F, SP 85 mm 0.9652 27.5 - 29.0 mm 18.7 ± 0.4 1.21 ± 0.02 Winston Lights F, SP 85 mm 0.9537 32.7 - 34.5 mm 12.3 ± 0.3 0.86 ± 0.02 Winston F, SP 100 mm 1.2548 34.0 - 35.7 mm 19.0 ± 0.3 1.27 ± 0.02 Winston F, M, SP 100 mm 1.1487 33.5 - 35.0 mm 18.2 ± 0.3 1.25 ± 0.02 1 F-filter; NF-non-filter; M-menthol; L/M-lenon/mQntbol; HP-hard pack; SP-soft pack; mm-millimeter 2 average weight reported in grams 3 range used for butt length because of variance of overwrap 4 TPM dry (tar) - milligrams total particulate matter less nicotine and water 5 milligrams total alkaloids reported as nicotine * tolerance shown is two (2) standard deviation of the mean TIMN 432092

140. Tar1 and Nicotine Content of One-hundred sixty-six (166) Varieties of Domestic Cigarettes (shown in increasing order of tar values) Tar Nicotine BR.1ND TYi'r I (mg/cig) (m ci ) .irltJfl +1t~8 :frlt; r. \;w reg. king king etze, size, size, fillPt' fiitvr, mrnthol filtcr, mk-nthul, (burd pnrk) I I 1 U.I U.I ; Ar:t.•:: king aize, filter N: w king size, filter, (hard pack) I I ceberg 100's 100 mm, filter, menthol 3 0.: Lucky 100's tOO mm, filter 3 0. 3 True king size, filter i 0.4 True king size, filter, menthol 5 0.4 King Sano king size, filter, menthol 6 0.3 Pall Ma11 Extra Mild king size, filter, (hard pack) 6 0.5 hing Sano king size, filter 6 0.3 Fall Ma11 Extra "fild king size, filter 6 0.5 ki i filt 7 i' 5 Tempo Kent Gaiden Lights ng king s ze, size, er filter 8 .. U.b L & M Lights king size, filter 8 0.6 Merit i Merit king king size, size, filter, menthol filter 8 8 0.5 U.6 Kent Golden Lights king size, filter, menthol 8 0. 7 American Lights 120 mm, filter 8 0.7 Lucky Ten king size, filter 9 0.6 Salem Long Lights I 100 mm, filter, menthol 9 0.7 Farliament Fenson & Hedges king reg. size, size, filter, filter, (hard pack) (hard pack) 10 10 0.6 1.6 American Lights 120 rmn, filter, menthol 10 0.f Parliament king size, filter 10 0.6 Vello king size, filter, menthol 10 0.7 Vello king size, filter 10 0. 7 Multifilter king size, filter, menthol 11 0.7 Vantage king size, filter 11 0.7 Vantage king size, filter, menthol 11 0. Salem Lights king size, filter, menthol 11 0. k Doral king size, filter, menthol 11 0.8 Hi-Lite 100 mm, filter 11 0. 7 Marlboro Lights king size, filter 12 0.7 Parliament 100 mm, filter 12 0.7 Doral king size, filter 12 0.8 Multifilter king size, filter 12 0.8 Winston Lighta king size, filter 12 0.9 Fact king size, filter, menthol 13 0.9 Vanguard king size, filter, menthol 13 0.9 True 100's 100 mm, filter, menthol 13 0.8 f l 0 13 0 8 True 100's i ter 1 0 mm, . Fact king size, filter 13 0.9 Marlboro king size, filter, menthol 14 0.8 Alpine king size, filter, menthol 14 0.8 Kool Milds king size, filter, menthol 14 0.9 Marlboro king size, filter, menthol, (hard pack) 14 0.8 Raleigh Lights king size, filter 14 1.0 Viceroy Extra Mild king size, filter 14 ! , fi Eve 120's 120 mm, filter, menthol, (hard pack) 14 1.U Kool Naturals king size, filter 14 1.0 Belair king size, filter, menthol 15 1.0 Galaxy king size, filter 15 0.9 Eve 120's 120 mm, filter, (hard pack) 15 1.U Kent king size, filter, (hard pack) 15 1.0 Saratoga 120 mm, filter, menthol, (hard pack) 15 Viceroy king size, filter 16 1.0 DuMaurier king size, filter, (hard pack) 16 1.1 Vanguard king size, filter 16 1.0 Virginia Slims 100 mm, filter, menthol 16 0.9 Kent king size, filter 16 1.0 1 TFM dry (car) - milligrams total particulate matter liess nicotine and water TIMN 432093

141. Tarl and Nicotine Content of One-hundred sixty-six (166) Varieties of Domestic Cigarettes (shown in increasing order of tar values) BRAND Fe^sor. & Hedges iong Johns tcr t:rrinia Slims k'a1l Mall Eve Silva Thins Tall Saratoga American Longs L & Pl Raleigh American Longs Philip Morris International Philip Morris International Tareyton Marlboro Benson & Hedges 100's Benson & Hedges 100's Marlboro Marlboro Silva Thins Kent St. Moritz Old Gold Filters Benson & Hedges 100's Twist Kool Kool Max Tareyton Marlboro Benson & Hedges 100's St. Moritz Max L & M Newport Raleigh Newport Sano Lark Montclair F:oo1 Pall Mall L & M Old Gold Filters Viceroy Salem Belair Long Johns Chesterfield Camel Filters Tall L & M Winston Kent Eagle 20's Eagle 20's Lark Salem Salem ninston TYPE king size, filter, (hard pack) 120 mm, filter, menthol 100 mm, filter 100 mm, filter 100 mm, filter, menthol 100 mm, filter, menthol 100 mm, filter, menthol 120 mm, filter, menthol 120 mm, filter, (hard pack) 120 mm, filter king size, filter, (hard pack) king size, filter 120 nun, filter, menthol 100 mm, filter, (hard pack) 100 mm, filter, menthol, (hard pack) 100 mm, filter 100 mm, filter, (hard pack) 100 mm, filter, (hard pack) 100 mm, filter, menthol king size, filter, (hard pack) 100 mm, filter 100 mm, filter 100 mm, filter, menthol 100 mm, filter king size, filter, (hard pack) 100 mm, filter 100 mm, lemon/menthol king size, filter, menthol, (hard pack) king size, filter, menthol 120 mm, filter, menthol king size, filter king size, filter 100 mm, filter, menthol, (hard pack) 100 mm, filter, menthol 120 mm, filter 100 mm, filter king size, filter, menthol, (hard pack) 100 mm, filter king size, filter, menthol reg. size, non-filter king size, filter king size, filter, menthol 100 mm, filter, menthol king size, filter 100 mm, filter, menthol king size, filter 100 mm, filter king size, filter, menthol 100 mm, filter, menthol 120 mm, filter 101 mm, filter king size, filter 120 mm, filter king size, filter 100 nun, filter, menthol 100 mm, filter king size, filter king size, filter, menthol 100 mm, filter 100 mm, filter, menthol king size, filter, menthol, (hard pack) king size, filter, (hard pack) Tar (MR/ci Nicotine ( Q/ +Q) 1.0 1.3 1.0 0.9 1.2 1.0 1.1 1.3 1.0 1.3 0.9 1.1 1.3 1.0 0.9 1.2 1.0 1.0 1.0 1.0 1.0 i.3 1.1 1.0 1.2 1.0 1.3 1.3 1.3 1.3 1.2 1.0 1.1 1.1 1.3 1.1 1.2 1.2 1.2 0.6 1.1 1.3 1.3 1.2 1.1 1.2 1.3 1.2 1.3 1.4 1.1 1.2 1.4 1.1 1.2 1.2 1.1 1.1 1.1 1.3 1.2 1.2 i TFM dry ktar) - milligrams total particulate matter less nicotine and water TIMN 432094

142. BRAND Tarl and Nicotine Content of One-hundred sixty-six C166) Varieties of Domestic Cigarettes (shown in increasing order of tar values) Tar (maLc ig) Nicotine (me/cis) Winston Spring 100's Chesterfield Pall Mall Oasis Winston L. T. Brown L. T. Brown Camel Newport Old Gold Straights Philip Morris More Kool More Old Gold 100's Picayune Domino Home Run Hallmark Stratford Mapleton Hallmark English Ovals Piedmont Raleigh Chesterfield Lucky Strike Philip Morris Commander Old Gold Straights Camel Pall Mall Half & Half Mapleton Herbert Tareyton Stratford Fatima Bull Durham Chesterfield English Ovals Domino Players TYPE king size, filter 100 mm, filter, menthol king size, filter 100 mm, filter king size, filter, menthol 100 mm, filter 120 mm, filter 120 sun, filter, menthol king size, filter, (hard pack) 100 mm, filter, menthol reg. size, non-filter reg. size, non-filter 120 mm, filter reg. size, non-filter, menthol 120 mm, filter, menthol 100 mm, filter reg. size, non-filter king size, filter reg. size, non-filter 100 mm, filter, menthol, (hard pack) king eize, filter king size, filter 100 mm, filter, (hard pack) reg. size, non-filter reg. size, non-filter king size, non-filter reg. size, non-filter reg. size, non-filter king size, non-filter king size, non-filter reg. size, non-filter king size, non-filter king size, filter reg. size, non-filter king size, non-filter king size, non-filter king size, non-filter king size, filter king size, non-filter king size, non-filter, (hard pack) king size, non-filter reg. size, non-filter, (hard pack) 1 TPM dry (tar) - milligrams total particulate matter less nicotine and water TIMN 432095

Tarl and Nicotine Content of One-hundred sixty-six (166) Varieties of Domestic Cigarettes (shown in increasing order of nicotine values) BRAND Carlton 70's Carlton Now Now Carlton Iceberg 100's Lucky 100's King Sano King Sano True True Tempo Pall Mall Extra Mild Pall Mall Extra Mild Merit Merit Parliament Sano Kent Golden Lights Parliament L & M Lights Lucky Ten Benson & Hedges Kent Golden Lights Multifilter American Lights Vantage Vello Vello Salem Long Lights Marlboro Lights Hi-Lite Parliament Vantage Salem Lights Doral Marlboro rrue Multifilter True 100's Marlboro Alpine Doral American Lights Winston Lights Vanguard Fact Fact Kool Milds Virginia Slims Philip Morris International Galaxy Virginia Slims L & M Kent Kool Naturals Belair Raleigh Lights Saratoga Marlboro Eve 120's Viceroy Extra Mild TYPE reg. size, filter king size, filter, menthol king size, filter, menthol, (hard pack) king size, filter, (hard pack) king size, filter 100 mm, filter, menthol 100 mm, filter king size, filter king size, filter, menthol king size, filter king size, filter, menthol king size, filter king size, filter, (hard pack) king size, filter king size, filter, menthol king size, filter king size, filter, (hard pack) reg. size, non-filter king size,,filter king size, filter king size, filter king size, filter reg. size, filter, (hard pack) king size, filter, menthol king size, filter, menthol 120 nrtn, filter king size, filter king size, filter, menthol king size, filter 100 mm, filter, menthol king size, filter 100 mm, filter, (hard pack) 100 mm, filter king size, filter, menthol king size, filter, menthol king size, filter, menthol king size, filter, menthol, (hard pack) 100 mm, filter, menthol king size, filter 100 mm, filter king size, filter, menthol. king size, filter, menthol king size, filter 120 mm, filter, menthol king size, filter king size, filter, menthol king size, filter, menthol king size, filter king size, filter, menthol 100 mm, filter, menthol 100 mm, filter, menthol, (hard pack) king size, filter 100 mm, filter king size, filter, (hard pack) king size, filter, (hard pack) king size, filter king size, filter, menthol king size, filter 120 mm, filter, menthol, (hard pack) king size, filter, (hard pack) 120 mm, filter, menthol, (hard pack) king size, filter 1 1 TPM dry (tar) - milligrams total particulate matter lees nicotine and water Tar (m¢/cia) 143. Nicotine _(_M_ ci <0.05 0.1 0.1 0.1 0.1 0.3 0.3 0.3 0.3 0.4 0.4 0.5 0.5 0.5 0.5 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.9 0.9 0.9 0.9 0.9 0.9 0.9 0.9 0.9 0.9 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 TIMN 432096 1

144. Tarl and Nicotine Content of One-hundred sixty-six (166) Varieties of Domestic Cigarettes (shown in increasing order of nicotine values) Vanguard Viceroy Eve Kent Eve Marlboro St. Moritz Benson & Hedges 100's Philip Morris International Benson & Hedges 100's Marlboro Benson & Hedges Saratoga Benson & Hedges 100's Eve 120's Marlboro Benson & Hedges 100's DuMaurier Philip Morris Raleigh St. Moritz Stratford Domino Spring 100's Lark L & M L & M Eagle 20's L & M Eagle 20's Stratford Chesterfield Kent Chesterfield Lark Oasis Silva Thins Salem Old Gold Filters Pall Mall Mapleton Tareyton Camel Filters Newport Salem Old Gold Filters Winston Winston Newport Old Gold Straights Kent Tareyton Pall Mall Raleigh Camel Winston Viceroy American Longs Salem Mapleton Silva Thins Winston rF king size, filter king size, filter 100 mm, filter, menthol king size, filter 100 mm, filter 100 mm, filter, (hard pack) 100 nun, filter 100 mm, filter, (hard pack) 100 mm, filter, (hard pack) 100 mm, filter, menthol king size, filter king size, filter, (hard pack) 120 mm, filter, (hard pack) 100 mm, filter 120 mm, filter, (hard paek) 100 mm, filter 100 mm, filter, menthol, (hard pack) king size, filter, (hard pack) reg. size, non-filter king size, filter 100 mm, filter, menthol king size, non-filter king size, filter 100 mm, filter, menthol king size, filter 100 mm, filter king size, filter king size, filter 100 mm, filter, menthol king size, filter, menthol king size, filter 101 mm, filter 100 mm, filter, menthol king size, filter 100 mm, filter king size, filter, menthol 100 mm, filter, menthol king size, filter, menthol king size, filter king size, filter king size, filter king size, filter king size, filter king size, filter, menthol, (hard pack) king size, filter, menthol, (hard pack) king size, filter, (hard pack) king size, filter, (hard pack) king size, filter king size, filter, menthol reg. size, non-filter 100 mm, filter 100 mm, filter 100 mm, filter, menthol 100 mm, filter king size, filter, (hard pack) 100 mm, filter, menthol 100 mm, filter 120 mm, filter 100 mm, filter, menthol reg. size, non-filter 100 mn, filter 100 nsn, filter Tar Nicotine M 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.1 L.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 L.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.3 1.3 1.3 1.3 1.3 1.3 1 TPM dry (tar) - milligrams total particulate matter_fless nicotine and water TU4N 432097

Tar1 and Nicotine Content of One-hundred sixty-six (166) VariQties of Domestic Cigarettes (thown in increasing order of nicotine values) ?5ont:lair }fan Long Johns Kool Tall Belair Koo1 Koo1 Piedmont American Longs Chesterfield Domino Philip Morris Commander Old Gold 100's Pall Mall Long Johns Newport Lucky Strike Raleigh Tall L. T. Brown Picayune L. T. Brown More Old Gold Straights Hove Run More Camel Pall Mall English Ovals Chesterfield Fatima Herbert Tareyton Hallmark Half & Half Hallmark Bull Durham English Ovals Players king size, filter, menthol 120 mm, filter, menthol 100 mm, filter, menthol 100 mm, filter, lemon/menthol 120 mm, filter 120 mm, filter, menthol reg. size, non-filter, menthol 120 mm, filter, menthol 100 mm, filter, menthol king size, filter, menthol, (hard pack) king size, filter, menthol reg. size, non-filter 120 mm, filter, menthol reg. size, non-filter king size, non-filter king size, non-filter 100 mm, filter 100 mm, filter 120 mm, filter 100 mm, filter, menthol reg. size, non-filter king size, non-filter 120 mm, filter 120 mm, filter, menthol reg. size, non-filter 120 mm, filter 120 mm, filter king size, non-filter reg. size, non-filter 120 mm, filter, menthol reg. size, non-filter king size, non-filter reg. size, non-filter, (haYd pack) king size, non-filter king size, non-filter king size, non-filter 100 mm, filter, menthol, (hard pack) king size, filter 100 mm, filter, (hard pack) king size, filter king size, non-filter, (hard pack) reg. size, non-filter, (hard pack) I TPM dry (tar) - milligrams total particulate matter less nicotine and water 145. TIMN 432098 1

Listing of "Tar"i Values for Five (5) Testing Periods TYPE 146. Alpine king size, filter, menthol 13 14 14 15 14 Alpine 100 mm, filter, menthol, (hard pack) 16 * * * * American Lights 120 mm, filter * * * * B American Lights 120 mm, filter, menthol * * * * 10 Amertran Longs 120 mm, filter * * * 21 16 Ameriran Longs 120 mm, filter, menthol * * * 17 16 Belair king size, filter, menthol 15 15 15 15 15 Belair 100 mm, filter, menthol 17 17 17 18 18 Benson & Hedges reg. size, filter, (hard pack) 9 9 9 10 10 Benson & Hedges king size, filter, (hard pack) I 16 16 16 16 16 Benson & Hedges 100's 100 mm, filter, (hard pack) * * * 17 17 Benson & Hedges 100's 100 mm, filter, menthol, (hard pack) * * * 17 17 Benson & Hedges 100's 100 mm, filter 17 18 18 18 17 Benson & Hedges 100's 100 mm, filter, menthol 17 18 18 18 17 Bull Durham king size, filter 28 29 29 30 29 Camel reg. size, non-filter 25 23 24 23 25 Camel king size, filter, (hard pack) * * 18 19 19 Camel Filters king size, filter 19 19 18 19 18 Capri 110 mm, filter * * 18 * * Capri 110 mm, filter, menthol * * 19 * * Carlton 7J's reg. size, filter 2 2 2 <0.5 <0.5 Carlton king size, filter 4 4 4 1 1 Carlton king size, filter, menthol 4 4 4 1 1 Chesterfield reg. size, non-filter 24 24 25 25 24 Chesterfield king size, non-filter 29 28 28 28 29 Chesterfield king size, filter 18 19 19 19 19 Chesterfield king size, filter, menthol 19 19 * * * Chesterfield 101 mm, filter 20 19 20 18 18 Dawn 120 cmn, filter * * 24 21 * Dawn 120 mm, filter, menthol * * 24 22 * Domino king size, non-filter 26 29 30 31 33 Domino king size, filter 23 24 24 23 21 Doral king size, filter 15 14 15 13 12 Doral king size, filter, menthol 13 13 14 11 11 DuMaurier king size, filter, (hard pack) 15 16 15 16 16 Eagle 20's king size, filter * * * 19 18 Eagle 20's king size, filter, menthol * * 19 18 English Ovals reg. size, non-filter, (hard pack) 22 22 23 24 24 English Ovals king size, non-filter, (hard pack) 29 29 29 29 30 Eve 100 mm, filter 19 19 18 17 16 Eve 100 mm, filter, menthol 19 18 19 17 16 Eve 120's 120 mm, filter, (hard pack) * * ~ 14 15 Eve 120's 120 mm, filter, menthol, (hard pack) * * * 15 14 Fact king size, filter, menthol * rt 14 13 Fact king size, filter, menthol * * 13 13 F at ima king size, non-filter 28 28 27 28 29 Galaxy king size, filter 15 15 16 16 15 Half & Half king size, filter 25 25 25 25 26 Hallmark 100 mm, filter, (hard pack) * * * * 23 Hallmark 100 mm, filter, menthol, (hard pack) * * * * 23 Herbert Tareyton king size, non-filter 29 29 28 28 28 Hi-Lite 100 mm, filter, (hard pack) t * * * 11 Home Run reg. size, non-filter 21 20 20 21 22 Iceberg 100's 100 sm, filter, menthol 9 9 9 9 3 Kent king size, filter, (hard pack) 15 15 15 16 15 Kent king size, filter 16 16 16 17 16 Kent Golden Lights king size, filter * * * 9 S Kent Golden Lights king size, filter, menthol * * * * 8 Kent 1A0 mm, filter 19 18 18 18 18 Kent 100 rmn, filter, menthol 18 17 17 17 17 King Sano king size, filter 8 7 7 7 6 King Sano king size, filter, menthol 7 7 8 7 6 Koo1 reg. size, non-filter, menthol 19 20 20 20 21 Koo1 king size, filter, menthol, (hard pack) 16 17 17 18 17 Kool Naturals king size, filter # * * * 14 Koo1 king size, filter, menthol 16 17 17 17 17 Kool Milda king size, filter, menthol 13 13 13 14 14 * Denotes varieties not available during market sampling 1 TPM dry (tar) - milligrams total particulate matter less nicotine and water 'I'IMN 432099

Listing of "Tar"1 Values for Five (5) Testing Periods BFIu'JD t\. o 1 L :'i 1 a >t 1 ~ M I i.hts 1 a M L a M L. ;. Prown L. I, Brown Lark Lark Long Johns Long Johns Lucky Strike Lucky Strike Lucky Ien Lucky 100's Mapleton Mapleton Marlborc Mar.bcrc Marlboro Marlboro Lights Mar'tcro Lights Marit~oro Marlboro Marlboro Max Max Marvels Marvels Marvels Merit Merit Miyako Montclair More More Multifilter Multifiltar Newport Newport Newport Now Now Casis Old Gold Straights Old Gold Straights Old Gold Filters Old Gold Filters Old Gold 100's Pall Mall Pall Mall Pall Mall Pall Mall Extra Mild Pall Mall Extra Mild Pall Mall Pall Mall Parliament Farliament Parliament 100's Fhilip Morris Philip Morris Commander king size, non-filter Philip Morris International 100 mm, filter, (hard pack) Philip Morris International 100 mm, filter, menthol, (hard pack) Phoenix 100 mm, filter, menthol Apr. 1976 147. Nov. 1976 * Denotes varieties not available during market sampling I TPM dry (tar) - milligrams total particulate matter less nicotine and water TIMN 432100 TYPE - 100 mm, filter, menthol king size, filter, (hard pack) king size, filter king size, filter 100 mm, filter 100 mm, filter, menthol 120 mm, filter 120 mm, filter, menthol king size, filter 100 mm, filter 120 mm, filter 120 mm, filter, menthol reg. size, non-filter king size, filter king size, filter 100 mm, filter reg. size, non-filter king size, filter king size, filter, (hard pack) king size, filter, menthol, (hard pack) king size, filtei king size, filter king size, filter, menthol king size, filter, menthol 100 mm, filter, (hard pack) 100 mm, filter 120 mm, filter 120 mm, filter, menthol king size, non-filter king size, filter king size, filter, menthol king size, filter king size, filter, menthol king size, filter king size, filter, menthol 120 mm, filter 120 mm, filter, menthol king size, filter king size, filter, menthol king size, filter, menthol, (hard pack) king size, filter, menthol 100 mm, filter, menthol king size, filter, (hard pack) king size, filter, menthol, (hard pack) king size, filter, menthol reg. size, non-filter king size, non-filter king size, filter, (hard pack) king size, filter 100 mm, filter king size, non-filter king size, filter, (hard pack) king size, filter king size, filter, (hard pack) king size, filter 100 mm, filter 100 mm, filter, menthol king size, filter, (hard pack) king size, filter 100 mm, filter reg. size, non-filter Mar: 1975 Sept. 1975 r

148-. Listing of "Tar"1 Values for Five (5) Testing Periods BRAND Fhoenix Picavune Piedmont Flayers Raleigh Raleigh Raleigh Lights Raleigh Raleigh Extra Mild St. Moritz St. Moritz Safari Salem Salem Salem Extra Salem Lights Salem Salem Long Lights Sano Saratoga Saratoga Silva Thine Silva Thins Spring 100's Stratford Stratford Super M Tall Tall Tareyton Tareyton Tempo Tramps Tramps True True True 100's True 100ta Twist Vanguard Vanguard Vantage Vantage Vello Vello Viceroy Viceroy Extra Mild Viceroy Virginia Slims Virginia Slims Virginia Slime Virginia Slims Winchester Winchester Winston Winston Winston Lights Winston Winston Zack Zack Zack * 1 TYPE 120 mm, filter, menthol reg. size, non-filter reg. size, non-filter reg. size, non-filter, (hard pack) king size, non-filter king size, filter king size, filter 100 mm, filter king size, filter 100 mm, filter 100 mm, filter, menthol 100 mm, filter king size, filter, menthol, (hard pack) king size, filter, menthol king size, filter, menthol king size, filter, menthol 100 mm, filter, menthol 100 mm, filter, menthol reg. size, non-filter 120 mm, filter, (hard pack) 120 mm, filter, menthol, (hard pack) 100 mm, filter 100 mm, filter, menthol 100 mm, filter, menthol king size, non-filter king size, filter 100 mm, filter, menthol 120 mm, filter 120 mm, filter, menthol king size, filter 100 mm, filter king eize, filter king size, filter king size, filter, menthol king size, filter king size, filter, menthol 100 mm, filter 100 mm, filter, menthol 100 mm, filter, lemon/menthol king size, filter king size, filter, menthol king size, filter king size, filter, menthol king size, filter king eize, filter, menthol king size, filter king size, filter 100 mm, filter 100 mm, filter 100 mm, filter, menthol 120 mm, filter, (hard pack) 120 mm, filter, menthol, (hard pack) king size, filter king size, filter, menthol king size, filter, (hard pack) king size, filter king size, filter 100 mm, filter 100 >ml, filter, menthol king size, filter, (hard pack) king size, filter king size, filter, menthol Mar. 1975 senr_ 1975 Anr. 1976 1 Nev_ 1976 .1une 1977 * * * 19 rr 20 20 20 20 21 25 25 24 24 24 31 31 31 32 34 24 22 24 24 24 16 16 16 16 16 * * * * 14 17 17 17 18 17 14 13 14 14 * 17 18 18 18 17 18 18 18 18 17 19 19 20 * 19 19 19 19 19 19 19 19 18 18 18 17 * * * * * 11 11 19 19 19 18 18 * * * 9 22 18 18 18 18 * 17 18 16 16 * 15 18 16 15 17 17 17 17 17 16 16 16 16 16 21 20 19 19 19 * * * 27 29 s * 25 23 17 17 16 17 I * * * 20 18 * * * 17 16 20 21 21 20 17 19 20 19 19 16 11 11 11 8 7 18 17 17 * * 16 16 16 * * 11 11 11 S 5 12 11 11 6 5 13 13 12 13 13 13 13 13 13 13 17 18 18 17 17 * * * 15 16 * e * * 13 12 11 11 10 11 11 11 11 11 11 * * * 11 10 * * * 10 10 16 16 16 16 16 14 14 14 14 14 17 17 18 18 18 17 17 16 16 16 17 17 16 16 16 * * * 16 * * * * 15 * 19 * * * 17 * * * * 19 20 18 19 19 20 20 19 19 19 14 14 13 13 12 19 18 18 19 19 19 19 19 19 18 * 18 16 16 w * 18 18 17 * * * 17 16 t Denotes varieties not available during-market sampling TPM dry (tar) - milligrams total particulate matter less nicotine and water TIMN 432101

Listing of Nicotine Values for Five (5) Testing Periods BRAND Alcine Alpine ar.erican Lights Amerlcan Lights .ATertcan Longs k:1er::d:: i.ORd'9 Fel 3ir Pelair Penson & Hedges Benson fa Hedges Benson & Hedges 100's Benson & Hedges 100's Benson & Hedges 100's Benson b Hedges 100's Bull Durh®m Camel Camel Camel Filters Capri Capri Carlton 70's Carlton Carlton Chesterfield Chesterfield Chesterfield Chesterfield Chesterfield Dawn Dawn Domino Domino Doral Doral DuMaurier Eagle 20's Eagle 20's English Ovals English Ovals Eve Eve Eve 120's Eve 120's Fact Fact Fatima Galaxy Half & Half Hallmark Hallmark Herbert Tareyton Hi-Lite Home Run Iceberg 100's Kent Kent Kent Golden Lights Kent Golden Lights Kent Kent King Sano King Sano Kool Kool Kool Naturals Kool Kool Milds TYPE king size, filter, menthol 100 mm, filter, menthol, (hard pack) 120 mm, filter 120 mm, filter, menthol 120 mm, filter 120 mm, filter, menthol king size, filter, menthol 100 mm, filter, menthol reg. size, filter, (hard pack) king size, filter, (hard pack) 100 mm, filter, (hard pack) , 100 mm, filter, menthol, (hard pack) 100 mm, filter 100 mm, filter, menthol king size, filter reg. size, non-filter king size, filter, (hard pack) king size, filter 110 mm, filter 110 mm, filter, menthol reg. size, filter king size, filter king size, filter, menthol reg. size, non-filter king size, non-filter king size, filter king size, filter, menthol 101 mm, filter 120 mm, filter 120 mm, filter, menthol king size, non-filter king size, filter king size, filter king size, filter, menthol king size, filter, (hard pack) king size, filter king size,_filter, menthol reg. size, non-filter, (hard pack) king size, non-filter, (hard pack) 100 mm, filter 100 mm, filter, menthol 120 mm, filter, (hard pack) 120 mm, filter, menthol, (hard pack) king size, filter king size, filter, menthol king size, non-filter king size, filter king size, filter 100 mm, filter, (hard pack) 100 mm, filter, menthol king size, non-filter 100 mm, filter, (hard pack) reg. size, non-filter 100 mm, filter, menthol king size, filter, (hard pack) king size, filter king size, filter king size, filter, menthol 100 mm, filter 100 mm, filter, menthol king size, filter king size, filter, menthol reg. size, non-filter, menthol king size, filter, menthol, (hard pack) king size, filter king size, filter, menthol king size, filter, menthol Mar. 1975 149. Sanr 197 Nnv~_ 197 6 - 47.na 7 97 0.8 0.9 0.8 0.8 0.8 0.9 ~ * * * * * * 0.7 * * * * 0.8 * * * 1.5 1.3 * * 1.3 1.3 1.0 1.1 1.1 1.0 1.0 1.2 1.2 1.2 1.3 1.3 0.5 0.5 0.5 0.6 0.6 1.1 1.1 1.0 1.0 1.0 * * * 1.1 1.0 * * * 1.0 1.1 1.1 1.1 1.1 1.0 1.0 1.1 1.1 1.1 1.0 1.0 1.8 1.9 1.9 1.9 1.9 1.6 1.6 1.5 1.4 1.6 * * 1.2 1.2 1.2 1.3 1.3 1.2 1.2 1.2 * * 1.2 * * * * 1.4 * * 0.2 0.2 0.2 <0.05 <0.05 0.3 0.3 0.3 0.1 0.1 0.3 0.3 0.3 0.1 0.1 1.4 1.4 1.4 1.4 1.4 1.7 1.6 1.6 1.6 1.7 1.2 1.2 1.2 1.1 1.1 1.2 1.3 * * * 1.3 1.3 1.3 1.1 1.1 * * 1.6 1.5 * * * 1.7 1.6 e 1.3 1.4 1.4 1.4 1.4 1.2 1.3 1.2 1.2 1.1 1.0 1.0 1.0 0.9 0.8 0.9 1.0 1.0 0.8 0.8 1.0 1.0 1.0 1.0 1.1 * * t 1.1 1.1 .~ * * 1.1 1.1 1.5 1.6 1.6 1.6 1.6 2.2 2.3 2.1 2.0 2.1 1.3 1.2 1.2 1.1 1.0 1.2 1.2 1.2 1.1 1.0 * * * 1.0 1.0 * * * 1.0 1.0 * * * 1.0 0.9 * * * 0.9 0.9 1.6 1.6 1.6 1.6 1.7 1.0 1.0 1.0 1.0 0.9 1.8 1.9 1.8 1.8 1.8 * * * x 1.9 * * * 1.8 1.8 1.8 1.7 1.8 1.8 * * * * 0.7 1.6 1.5 1.5 1.4 1.5 0.6 0.6 0.7 0.6 0.3 0.9 0.9 0.9 0.9 1.0 1.0 1.0 1.0 1.0 1.0 * * * 0.7 0.6 * * * * 0.7 1.2 1.1 1.2 1.1 1.2 1.2 1.1 1.1 1.1 1.1 0.3 0.3 0.4 0.4 0.3 0.3 0.3 0.4 0.3 0.3 1.2 1.2 1.2 1.2 1.3 1.2 1.3 1.3 1.3 1.3 * * * * 1.0 1.2 1.3 1.3 1.3 1.3 0.8 0.7 0.8 0.9 0.9 * Denotes varieties not available during market sampling TIMN 432102

150. Listing of Nicotine Values for Five (5) Testing Periods BRAND Kool L & M L 6 M L i M Lights 1. & H L & M L. T. Brown L. T. Brown Lark Lark 4ong Johns Long Johns Lucky Strike Lucky Strike Lucky Ten Lucky 100's Mapleton Mapleton Marlboro Marlboro Marlboro Marlboro Lights Marlboro Lights Marlboro Marlboro Marlboro Max Max Marvels Marvels 1'larvels Merit Merit Miyako Montclair More More Multifilter Multifilter Newport Newport Newport Now Now Oasis Old Gold Straights Old Gold Straights Old Gold Filters Old Gold Filters Old Gold 100's Pa11 Mall Pall Mall Pall Mall Pall Mall Extra Mild Pall Mall Extra Mild Pall Mall Pall Mall Parliament Parliament Parliament 100's Philip Morris Philip Morris Commander Philip Morris International Philip Morris International Phoen ix TYPE 100 mm, filter, menthol king size, filter, (hard pack) king size, filter king size, filter 100 mm, filter 100 mm, filter, menthol 120 mm, filter 120 mm, filter, menthol king size, filter 100 mm, filter 120 nm, filter 120 mm, filter, menthol reg. size, non-filter king size, filter king size, filter 100 mm, filter reg. size, non-filter king size, filter king size, filter, (hard pack) king size, filter, menthol, (hard pack) king size, filter king size, filter king size, filter, menthol king size, filter, menthol 100 mm, filter, (hard pack) 100 mm, filter 120 mm, filter 120 mm, filter, menthol king size, non-filter king size, filter king size, filter, king size, filter menthol king size, filter, menthol king size, filter king size, filter, 120 mm, filter menthol 120 mm, filter, menthol king size, filter king size, filter, menthol king size, filter, menthol, (hard pack) king size, filter, menthol 100 mm, filter, menthol king size, filter, (hard pack) king size, filter, menthol, (hard pack) king size, filter, menthol reg. size, non-filter king size, non-filter king size, filter, (hard pack) king size, filter 100 mm, filter king size, non-filter king size, filter, (hard pack) king size, filter king size, filter, (hard pack) king size, filter 100 mm, filter 100 mm, filter, menthol king size, filter, (hard pack) king size, filter 100 mm, filter reg. size, non-filter king size, non-filter 100 rtm, filter, khard pack) 100 mm, filter, menthol, (hard pack) 120 mm, filter * Denotes varieties not available during market sampling Mar. 1975. 1.2 1.2 1.2 * 1.4 1.3 * * 1.2 1.3 * * 1.6 * 0.6 0.7 1.2 1.2 1.1 0.8 1.1 0.8 * 0.8 1.1 1.1 * * 0.9 0.2 0.2 * * 0.9 1.4 1.4 1.5 0.8 0.7 1.2 1.2 1.5 * * 1.2 1.2 1.5 1.2 1.1 1.4 1.7 * * 0.6 0.7 1.4 1.3 0.8 0.8 1.0 1.1 1.5 1.1 1.0 * 1.2 1.2 1.3 1.3 1.1 1.1 1.0 0.9 1.2 1.2 1.1 l.l * * * 0.6 1.3 1.3 1.1 1.1 1.3 1.3 1.1 1.1 * 1.5 1.5 1.5 * 1.6 l.4 1.4 1.2 1.2 1.1 1.1 1.3 1.2 1.2 1.1 * 1.6 1.4 1.4 * 1.5 1.2 1.3 1.6 1.5 1.4 1.4 * * 1.6 * 0.7 0.7 0.6 0.6 0.7 0.7 0.6 0.3 1.3 1.2 1.2 1.3 0.9 1.0 1.1 1.2 1.1 1.0 1.0 1.0 0.9 0.8 0.7 0.8 1.1 1.1 1.1 1.0 0.8 0.8 0.8 0.7 0.7 0.8 * 0.9 0.9 0.8 0.8 1.1 1.1 1.1 1.0 1.1 1.1 1.1 1.0 * 1.2 1.2 1.3 * 1.3 1.2 1.3 * * * * * * * * * * * * * * 0.5 0.6 * 0.5 0.5 0.9 0.9 0.9 * 1.3 1.4 1.3 1.3 1.5 1.7 1.5 1.5 1.6 1.7 1.6 1.6 0.8 0.8 0.8 0.8 0.7 0.7 0.7 0.7 1.1 1.1 1.2 1.2 1.2 1.2 1.2 1.2 1.3 1.4 1.4 1.4 * * 0.1 0.1 * 0.1 0.1 1.2 1.2 1.1 1.1 1.2 1.1 1.1 1.2 1.5 1.5 1.4 1.5 1.2 1.2 1.2 1.2 1.1 1.1 1.1 1.2 1.4 1.3 1.3 1.4 1.7 1.7 1.6 1.6 rr * 1.5 * * * 1.2 1.2 0.7 0.7 0.6 0.5 0.7 0.7 0.7 0.5 1.4 1.4 1.4 1.4 1.2 1.2 1.2 1.2 0.8 0.8 0.8 0.6 0.9 0.9 0.8 0.6 1.1 1.0 0.9 0.7 1.2 1.1 1.0 1.1 1.4 1.4 1.3 1.4 1.1 1.0 1.1 1.0 1.0 0.9 0.9 0.9 1.3 * TIMN 432103

151 . Listing of Nicotine Values for Five (5) Testing Periods SRAND Phoenix Ficavune F : ed:uont Flavers F+aIe1gh Raieigh Raleigh Lights Raleigh Raleigh Extra Mild St. Moritz St. Mosltz Safari Salem Salem Salem Extra S,,1em Lights Sa1em Sa:er.. Long Lights Sano Saratoga Saratoga Silva Thins Silva Thins Spring 100's Stratford Stratford Super M Tall Tall Iare}-ton Tareyton Tempo Tramps Tramps True Irue True 100's True 100' s Twist Vanguard Vanguard Vantage Vantage Vello Vello Viceroy Viceroy Extra Mild Viceroy Virginia Slims Virginia Slims Virginia Slims Virginia Slims Winchester Winchester Winston 4: inston Winston Lights Winston f.inston Zack Zack Z ack TYPE 120 mm, filter, menthol reg. size, non-filter reg. size, non-filter reg. size, non-filter, (hard pack) king size, non-filter king size, filter king size, filter 100 mm, filter king size, filter 100 mm, filter 100 mm, filter, menthol 100 mm, filter king size, filter, menthol, (hard pack) king size, filter, menthol king size, filter, menthol king size, filter, menthol 100 mm, filter, menthol 100 mm, filter, menthol reg. size, non-filter 120 mm, filter, (hard pack) 120 mm, filter, menthol, (hard pack) 100 mm, filter 100 mm, filter, menthol 100 :nm, filter, menthol king size, non-filter king size, filter 100 mm, filter, menthol 120 mm, filter 120 mm, filter, menthol king size, filter 100 mm, filter king size,- filter king size, filter king size, filter, menthol king size, filter king size, filter, menthol 100 mm, filter 100 mm, filter, menthol 100 mm, filter, lemon/menthol king size, filter king size, filter, menthol king size, filter king size, filter, menthol king size, filter king size, filter, menthol king size, filter king size, filter 100 mm, filter 100 mm, filter 100 mm, filter, menthol 120 mm, filter, (hard pack) 120 mm, filter, menthol, (hard pack) king size, filter king size, filter, menthol king size, filter, (hard pack) king size, filter king size, filter 100 mm, filter 100 s®, filter, menthol king size, filter, (hard pack) king size, filter king size, filter, menthol * Denotes varieties not available during market sampling Mar. 1975 * 1.5 1.5 2.1 1.4 1.0 * 1.2 0.9 1.1 1.2 1.4 1.3 1.3 1.3 * 1.3 * 0.8 * * 1.2 1.1 1.2 * * 1.2 * * 1.3 1.3 0.8 1.1 0.9 0.6 0.7 0.7 0.8 1.2 * 0.8 0.8 * * 1.0 0.9 1.1 1.0 1.1 * * 1.3 1.2 1.3 1.4 1.0 1.3 1.4 * * * Sept. 1975 Apr. 1976 Nov. 1976 * 1.6 1.4 2.0 1.3 1.0 * 1.1 0.8 1.2 1.2 1.3 1.3 1.3 1.3 * 1.3 * 0.7 1.0 1.0 1.2 1.1 1.1 * * 1.1 * * 1.4 1.4 0.7 1.1 1.1 0.6 0.6 0.7 0.7 1.3 * 0.7 0.7 * * 1.0 0.9 1.1 1.0 1.0 * * * * 1.3 1.3 1.0 1.2 1.3 1.2 1.3 * * 1.5 1.4 2.1 1.5 1.1 * 1.2 0.9 1.2 1.2 1.4 1.3 1.3 * * 1.2 * 0.7 1.1 1.1 1.3 1.1 1.1 * * 1.1 * * 1.4 1.4 0.8 1.1 1.0 0.6 0.7 0.7 0.7 1.3 * * 0.7 0.8 * * 1.1 0.9 1.2 1.0 1.0 * * * * 1.2 1.3 0.9 1.2 1.3 1.2 1.3 1.2 1.3 1.4 1.3 2.2 1.4 1.1 * 1.3 1.0 1.1 1.1 * 1.2 1.2 * 0.8 1.2 * 0.6 1.0 1.0 1.2 1.1 1.0 1.0 1.3 1.2 1.5 1.4 1.3 1.3 0.6 * * 0.4 0.4 0.8 0.8 1.3 1.0 * 0.7 0.7 0.7 '0.7 1.0 1.0 1.3 0.9 0.9 1.0 1.0 * * 1.2 1.2 0.9 1.2 1.2 1.2 1.2 1.1 -iunn_ 1977 * 1.4 1.3 2.5 1.4 1.1 1.0 1.2 t 1.0 1.1 * 1.2 1.2 * 0.8 1.3 0.7 0.6 1.0 1.0 1.3 1.1 1.1 1.1 1.1 * 1.4 1.3 1.2 1.2 0.5 * * 0.4 0.4 0.8 0.8 1.3 1.0 0.9 0.7 0.8 0.7 0.7 1.0 1.0 1.3 0.9 0.9 * * * * 1.2 1.2 0.9 1.3 1.2 * * * ( ! TIMN 432104