Tobacco Documents Online

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