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Report on 6th World Conference on Smoking and Health, Tokyo, November 9 - 12, 1987 Part I

Date: Nov 1987 (est.)
Length: 248 pages
TIMN0448463-TIMN0448710
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REPORT ON 6TH WORLD CONFERENCE ON SMOKING AND HEALTH, Tokyo, November 9-12, 1987 PART I List of Contents 1. Programme 2. Abstracts 3. List of participants 4. The Conference Recommendations 5. Daily summaries from the monitoring team 6. Preliminary appraisals by a member of the monitoring team from Australia and by the monitoring team as a whole 7. Inventory of hand-outs collected from the Press and Exhibition rooms 8. "A world strategy •against the Source of the Tobacco Problem" including a strategic planning chart (A. Chesterfield-Evans, Australia) ,rIMN 448463
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1. Programme `TIMN 448464 '
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t r,, : PROGRAM November 9--> 12,1987 Tokyo, Japan TIMN 448465
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I Sponsored and organized by: Japan Anti-Tubercluosis Association Japan Cancer Society Japan Heart Foundation Japan Health Promotion & Fitness Foundation American Cancer Society . Supported by: World Health Organization International Union Against Tuberculosis and Lung Disease International Union Against Cancer International Society and Federation of Ca~diology International Union for Health Education Ministry of Health and Welfare Ministry of Education, Science & Culture Ministry of Labor Management and Coordination Agency Tokyo Metropolitan Government The Japan Medical Association Japan Dental Association Japan Public Health Association National Assembly for Youth Development
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TIMN 448467
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ORGANIZING COMMITTEE ADVISORY BOARD President: Kjell Bjartveit Norway Yoshizane Iwasa John Crofton U.K. (Japan Heart Foundation) Nigel Gray Australia Vice-Presidents: Haruto Haneda Japan Masayoshi Yamaguchi Katsumi Kanemitsu Japan (Japan Anti-Tuberculosis Association) Chuichi Kawai Japan Toichiro Hitotsuyanagi Michael Kunze Austria (Japan Cancer Society) Toshio Kurokawa Japan Kohkichi Yanase Hin Peng Lee Singapore (Japan Health Promotion Et Fitness Charles A. LeMaistre U.S.A. Foundation) Hisao Manabe Japan Harmon J. Eyre R. Masironi Switzerland (American Cancer Society) Hiroshi Nakajima The Philippines Secretary General: Sadayoshi Kitagawa Japan Suketami Tominaga David Nostbakken Canada Deputy Secretary General: Sherif Omar Egypt Michinobu Kitani Lars M. Ramstrom Sweden Members: Jaime L. Rios Dalenz Bolivia Masakazu Aoki Tadao Shimao Japan Yuichiro Goto Jeremiah Stamler U.S.A. Yoshio Gyoten Jan Stjernsward Switzerland Shigeaki Hinohara Takashi Sugimura Japan Shigeru Hisamichi L. Tomatis France Heizaburo Ichikawa Xin-Zhi Weng China Hitoshi Kasuga Chieko Kino SCIENTIFIC ADVISORY BOARD Tachio Kobayashi . Shohji Kohchi Tsuneo Konno Koichi Nagashima Takeo Nakajima Genshi Ohishi Fujio Ohtani Yasutaro Owaku Takao Shigematsu Masato Takigawa Kyozo Yuasa PROGRAM COMMITTEE Chairman: Masakazu Aoki Members: Makishige Asano Yoshiro Isayama Keiko Ito Fujio Ohtani Nobuo Onodera Shiro Kira Atsuaki Gunji Yuichiro Goto Takao Shigematsu Masahiro Takaishi Taro Nagasaki Shuichi Hatano Takaharu Hayashi Toru Mori Takeshi Hirayama Japan Kazuolwai Japan Yoshio Komachi Japan Tamotsu Takishima Japan GENERAL AFFAIRS COMMITTEE Chairman: Masato Takigawa Members: Heizaburo Ichikawa Hitoshi Kasuga Chieko Kino Tsuneo Konno Tachio Kobayashi Yasutaro Owaku FINANCIAL COMMITTEE Chairman: Kyozo Yuasa Members: Genshi Ohishi Shohji Kohchi Koichi Nagashima PUBLIC RELATIONS COMMITTEE Chairman: Shigeru Hisamichi Members: Yoshio Gyoten Takeo Nakajima Shigeaki Hinohara TIMN 448468
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i 6 th WORLD CONFERENCE ON SMOKING AND HEALTH %619 pAM OPENING CEREMONY 0 H ~ ~Ek A • November 9, Monday, 1987 •RA-Tp 62 If- 11 A 9 Q( A) 15 : 00 - 16 : 25 Keidanren Hall. 15R~f - 16Fl=,f25x,~- TIMN 448469
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I 6th WORLD CONFERENCE ON SMOKING AND HEALTH Program of the Opening Ceremony Monday, November 9, 1987, 15 : 00-16 : 25 Hall, Keidanren Kaikan Opening Declaration Opening Remarks Masayoshi Yamaguchi Vice-President 6th World Conference on Smoking and Health President, Japan Tuberculosis Association. Yoshizane Iwasa President, 6 th World Conference on Smoking and Health President, Japan Heart Foundation. Address en T)AVlT) SSIA1PSdIV Chair n, International Liaison Group on Smoking and alth. Address Congratulatory Address Harmon J. Eyre President, American Cancer Society Takao Fujimoto The minister of Health and Welfare MQ. it1AG.4 SAK~ _ Congratulatory Address Shunichi Suzuki -D i R GEN [3 F" PV13 L.r Gover or of Tok o CS~ oT~ ~~ Congratulatory Address n y ~~~ ~ ~,, MN ~7 p -f-0 1.C q o Haruto Haneda Message Film Message President, Japan Medicel Association Halfdan Mahler Director-General, World Health Organization Everett C. Koop Surgeon General, Public Health Services U. S. A. TIMN 448470
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, Contents j Conference Schedule ....................................... 1 Layout of Conference Site ............................... 3 Scientific Program Nov. 9 ............................................ 4 Nov. 10 .......:.................................... 8 Nov. 11 ............................................ 18 Nov. 12 ............................................ 36 General I nformation ........................................ 40 Access to Conference Site from Each Hotels ................................. 44 TIMN 448471
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Conference Schedule Date & Nov. 9 Nov. 10 Time Room P. M. A. M. P. M. 15:00 16:30 16:45 17:55 12:30 9:45 14:00 17:00 HALL r V ~ OPENING LECTURE i Chairperson: E. Wynder PL-1 T. Hirayama Chairperson: D. Nostbakken WR-1 R. Masironi WR-2 T. Shimao (14F) z .7 Z[+.t ChairPerson Chairperson: J. Crofton pL-2 L hi Ramstrom Chairperson: H. Kasuga W~ Allan Erickson O U . . PL-3 D.M. Shimp WR-3 A. Herrera Omar WR-4 S . WR-5 R. Weisberg International Confdrence Room (I 1 F) 14:00 16: 4 2 Room FP-1-1 FP-1-2 1001 Chairpersons: Chairpersons: (1 OF) ks R Fairban M D is S K w K. Fukuda 14:00 16:42 Room FP-2-1 FP-2-2 1002 Chairpersons: Chairpersons: (I OF) I. Asmussen Y. Goto S. Kagamimori T. Shigematsu 14:00 16:54 Room FP-3-1 FP-3-2 901 Chairpersons: Chairpersons: (9F) J.W. Cullen M.R. Pandy T. Hoshi S. Watanabe 14:00 16:54 Room FP-3-3 FP-3-4 904/905 Chairpersons: Chairpersons: (9F) S. Kawano K. Iwai Y. Mochizuki K. Yamanaka 14:00 15' 12 15:30 16:30 Room FP4 FP-5 906 (9F) Chairpe rsons: ht. Russel Chairpersons: G.N. Connoly T.'dori H. Ogawa 1 TIMN 448472
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i Nov. 11 Nov. 12 A.M. P.M. A.M. 9 :40 10:30 11:00 12:30 14:00 15:00 15:30 17:00 9:40 12:00 12:30 c p a E E q Chairperson: M. Aoki Chairperson: Shimao T Chairperson: S. Hinohara p Report ¢ nn y y q °' qX SL-1 T. Sugimura . SL-6 S Glantz y w ~ Special U _L ~ SL-2 1. Asmussen SL-3 G.N. Connolly SL 4 M. Russel SL-5 J. Cullen . SL-7 E. Gritz z ~ Sessions ~ W V q L a SL-8 E. Wynder V P, 11:00 12:29 14:00 17:12 SS-1 SS-1 Smoking Cessation-1 Smoking Cessation-2 Chairpersons: Chairpersons: M. Kunze J. Crofton M. Kunze J. Crofton T. Hayashi K. Miyazaki T. Hayashi K. Miyazaki 11:00 13:05 14:00 17:29 SS-5 SS-7 I Smoking Control Media Strategies Smoking and Women Chairpersons: Chairpersons: M. Daube N. Onodera J. Mackay K. Itoh ~ 11:00 12:41 14:00 15:48 SS-8 SS-8 Smoking and Children-1 Smoking and Children-2 Chairpersons: Chairpersons: K. Bjartveit M. Takaishi K. Bjartvett M. Takaishi R. Masironi T. Kawabata R. Masironi T. Kawabata 11:00 12:41 14:00 16:48 SS-6 SS-6 Smoking Control Legislation-1 Smoking Control Lcgislation-2 Chairpersons: Chairpersons: J. F. Banzltoff IB W. Nelder J.F. Banzhoff III W. Nelder T. Shiraishi A. Gunji T. Shiraishi A. Gunji 14:00 15:45 17:26 11:00 12:41 15:36 SS-2 SS-3 Passive Smoking Non-smoker's Rights Chairpersons: Chairpersons: M. Asano D.R. Shopland : J. Weigum Y. lsayama 11:00 12:53 14:00 17:?9 SS-i Smoking and Economics SS-9 Smoking Control in Developing Countries TIlV Chairpersons: S.K. Teoh N. Maeda Chairpersons: S. Omar J.L. Rios-Dalenz T. Mori S. Hatano i N 448473 2
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Layout of Conference Site 9F IOF 12F 14F Rounge ;~ ® Keldenren Hall w Rounge 11F 3 TIMN 448474
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TIMN 448475
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15:00 --16:30 OPENING CEREMONY 16:45 --17:55 OPENING LECTURE 16:45 17:05 Keidanren Hal/ (14F) Keidanren Hall (14F) Chairperson: A. Erickson (U.S.A.) SMOKING AND ITS CONTROL IN WESTERN PACIFIC REGION COUNTRIES H. Nakajima (Philippines) THE COALITION ON SMOKING OR HEALTH: AN EXAMPLE OF THE BENEFITS OF COALITION BUILDING TO INFLUENCE NATIONAL POLICY H.J. Eyre (U.S.A.) 17:20 SMOKING CONTROL MEDIA ADVOCACY AND COALITION BUILDING M. Pertschuk (U. S.A. ) 17:35 REMARKS ON THE 6TH WORLD CONFERENCE ON SMOKING AND H EALTH S. Tominaga (Japan) 6 TIMN 448476
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TIMN 448477
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9:45-10:30 PLENARY LECTURE Keidanren Hal/ (14F) Chairperson: E. Wynder (U.S.A.) 9:45 PL-1 HEALTH EFFECTS OF SMOKING T. Hirayama (Japan) 11:00 --12:30 PLENARY LECTURE Keidanren Hal/ (14F) Chairperson: J. Crofton (U.K.) 11:00 PL-2 SMOKING AND CHILDREN L. M. Ramstrom (Sweden) 11:45 PL-3 PROTECTING NONSMOKERS' HEALTH RIGHTS: THE MOST EFFECTIVE SMOKING CONTROL D. M. Shimp (U.S.A.) 14:00 -15:00 WORLD REPORT Keidanren Ha// (14F) - P ;. . vtL4- J L FttiC\ Chairperson: D-r-Ellostbakken=( 14:00 WR-1 WORLD TRENDS IN SMOKING R. Masironi and K. Rothwell (Switzerland) 14:30 WR-2 SMOKING AND ITS CONTROL IN JAPAN T. Shimao (Japan) mnanfe , 10 TIMN 448478
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15:30 --17:00 WORLD REPORT Keidanren Hall (14F) Chairperson: H. Kasuga (Japan) 15:30 WR-3 PUBLIC HEALTH FOUNDATION. ANTISMOKING PROGRAM 1987. C. A. Herrera (Argentina) 16:00 WR-4 SMOKING AND ITS CONTROL IN MIDDLE EAST AND AFRICAN COUNTRIES S. Omar (Egypt) 16:30 WR-5 TRENDS IN CONSUMPTION OF CIGARETTES IN THE U.S. R. Weisberg (U.S.A.) 14:00-15:12 FREE COMMUNICATION 1 (Part 1) Room 1001 (10F) Chairpersons: L. Fairbanks (U.S.A.) K. Fukuda (Japan) 14:00 FP-1-01 SMOKING STATUS OF A UNIVERSITY STUDENTS AND ITS IMPLICATIONS FOR ANTI-SMOKING EDUCATION S. Sakihara, H. Sato, H. Higa, K. Kina and T. Miyagi (Japan) 14:12 FP-1-02 CAN MEDICAL STUDENTS TAKE THE LEADERSHIP OF SMOKING CESSATION? S. Ryu and H. Kinebuchi (Japan) 14:24 FP-1-03 SMOKING AMONG MEDICAL STUDENTS B. Mahesh, P. Thirumalaikolundusubramanian and S. Shanmuganandan (India) 14:36 FP-1-04 SMOKING AMONG THE STAFF OF A MEDICAL SCHOOL HOSPITAL H. Kawane and R. Soejima (Japan) 14:48 FP-1-05 THE IMPACT OF BANNING SMOKING ON A HOSPITAL WARD N. A. Rigotti, B.H. Pikl and P.D. Cleary (U.S.A.) 15:00 FP-1-06 SMOKING HABITS OF BELGIAN PHYSICIANS: EFFECTS OF CONSONANCY AND OF AGE L. Joossens, M. Demedts, J. Prignot, A. Gyselen and P. Bartsch (Belgium) 11 TIMN 448479
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15:30 -16:42 FREE COMMUNICATION 1 (Part 2) Room 1001 (10F) Chairpersons: R. M. Davis (U.S.A.) I. S. Kim (Korea) 15:30 15:42 FP-1-08 15:54 FP-1-09 SMOKING HABITS OF NORWEGIAN DOCTORS 1952-1984 H. L. Thurmer, K. Bjartveit and A. Hauknes (Norway) TRENDS IN TOBACCO CONSUMPTION IN CANADA N. E. Collishaw (Canada) SMOKING IN THE UNITED STATES: RACIAL AND SOCIO- ECONOMIC DIFFERENCES T. E. Novotny, K. Warner and J. Kendrick (U.S.A.) FP-1-07 16:06 FP-1-10 SMOKING AND HEALTH AMONG REINDEER HERDERS IN NORTHERN FINLAND L. Hirvonen, S. Nayha and J. Hassi (Finland) 16:18 FP-1-11 SMOKING HABITS AND ATTITUDES AMONG NEWLY- QUALIFIED DOCTORS IN HONG KONG K. K. Cheng and T. H. Lam (Hong Kong) 16:30 FP-1-12 THE WHO GUIDELINES FOR STANDARDIZATION OF SMOKING SURVEYS L. M. Ramstrom (Sweden) 14:00 --15:12 Room 9002 (90F) FREE COMMUNICATION 2 (Part 1) .. "~ r ,'-'~7 Jd NJ Chairpersons: 1-~[sser3-(-Denmark) S. Kagamimori (Japan) 14:00 SMOKING AND CORONARY HEART DISEASE G. Parkaridis, G. Louridas, G. Giannoglou and T. Karoulas (Greece) FP-2-01 14:12 FP-2-02 LONG TERM PROGNOSIS OF INFARCTED SMOKERS: IS IT AFFECTED BY SMOKING CESSATION? A. Leone (Italy) 14:24 FP-2-03 SMOKING CESSATION AS THE FACTOR REDUCING THE RISK OF REINFARCTION AND SUDDEN DEATH IN THE FIVE YEARS FOLLOW-UP STUDIES K. W. Moczurad, A. M. Curylo and J. P. Dubiel (Poland) 14:36 FP-2-04 SMOKING AND ACUTE MYOCARDIAL INFARCTION P. Thirumalaikolundusubramanian, R. Alagappan and S. Shan- muganandan (India) 14:48 FP-2-05 PRACTICAL EXPERIENCES COLLECTED IN THE COURSE OF ECHOCARDIOGRAPHYCAL INVESTIGATIONS OF SMOKERS T. Perenyi, E. Bartha, G. Buday and Gy. Kerkovits (Hungary) 12 TIMN 448480
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15:00 FP-2-06 HAEMODYNAMIC AND HUMORAL EFFECTS OF CIGARETTE SMOKING P. Miiller, R. Schlosser, U. C. Dubach, A. Sioufi and P. Imhof (Switzerland) 15:30 --16:42 Room 1002 (10F) FREE COMMUNICATION 2 (Part 2) Chairpersons: Y. Goto (Japan) T. Shigematsu (Japan) 15:30 FP-2-07 NICOTINE STIMULATES HUMAN PREGNANT UTERUS IN VITRO P. G. Adaikan, O. A. C. Viegas, L. C. Lau, S. Arulkumaran and S. S. Ratnam (Singapore) 15:42 FP-2-08 CHRONIC EFFECT OF MATERNAL SMOKING ON THE AUTONO- MOUS NERVOUS SYSTEM OF THE FETUS V. M. Kariniemi and J. Rosti (Finland) 15:54 FP-2-09 QUANTITATING CYTOLOGICAL AND BIOCHEMICAL MARKERS FOR CARCINOGEN EXPOSURES IN THE BRONCHI OF SMOK- ERS, EX-SMOKERS AND NON-SMOKERS H. F. Stich, B. P. Dunn, D. A. Enarson, B. Nelems, R. R. Miller, D. Ostrow and P. Champion (Canada) 16:06 FP-2-10 CIGARETTE SMOKING AND MAXILLARY SINUS CANCER K. Fukuda and A. Shibata (Japan) 16:18 FP-2-11 A QUANTITATIVE ESTIMATE OF NONSMOKERS' LUNG CANCER RISK Z.-X. Zhang, X.-y. Xing, J. Ai and L.-x. He (China) 16:30 FP-2-12 TOBACCO MOSAIC VIRUS ALTERING NEUROTRANSMITTER RECEPTORS A. P. Singh, M. Singh, H. N. Verma and V. M. L. Srivastava 14:00 -15:24 Room 901 (9F) FREE COMMUNICATION 3 (Part 1) Chairpersons: J. W. Cullen (U.S.A.) T. Hoshi (Japan) . 14:00 FP-3-01 LONG TERM FOLLOW-UP OF THE WATERLOO SMOKING PREVENTION TRIAL B. R. Flay (U.S.A.), S. Thompson, S. Santi, J.A. Best and S.K. Brown (Canada) 14:12 FP-3-02 THE DEVELOPING ROLE OF THE PHYSICIAN IN SMOKING CES- SATION: PRELIMINARY RESULTS OF INTERVENTION TRIALS IN THE U.S. T. Glynn (U.S.A.) 13 TI1VIN 448481
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14:24 FP-3-03 COALITION BUILDING M. Maile and A. S. Hanson (U.S.A.) 14:36 FP-3-04 SMOKING AND HEALTH: POLICIES OF THE AMERICAN MEDI- CAL ASSOCIATION W. R. Hendee (U.S.A.) 14:48 FP-3-05 TOWARD A TOBACCO FREE YOUNG AMERICA J. R. Seffrin ( U. S.A. ) 15:00 FP-3-06 A NATIONAL PROGRAM TO REDUCE TOBACCO USE IN CANADA B. Ouellet (Canada) 15:12 FP-3-07 TOBACCO CONTROL IN CANADA N. E. Collishaw (Canada) 15:3D -r 16:54 FREE COMMUNICATION 3 (Part 2) Room 901 (9F) Chairpersons: M. R. Pandy (Nepal) S. Watanabe (Japan) 15:30 FP-3-08 INNOVATIVE SOCIAL MARKETING TECHNIQUES AND STRATE- GIES IN THE FIELD OF TOBACCO PREVENTION IN CANADA J. H. Mintz (Canada) 15:42 FP-3-09 COMPREHENSIVE SMOKING PROGRAMS FOR CHILDREN G. E. Gray (Canada) 15:54 FP-3-10 SMOKING CESSATION PROGRAMMES. THE MEXICAN EX- PERIENCE F. G. Puente-Silva, G. Lopez, G. L. Henao, M. Garcia and H. Gavald6n (Mexico) 16:06 FP-3-12 THE SOCIAL CONDITIONS OF SMOKING J. V. Troschke (F.R.G.) 16:18 FP-3-13 THE DUTCH NO SMOKING APPROACH B. Baan (The Netherlands) 16:30 FP-3-14 (NON-)SMOKING AND CHILDREN IN THE NETHERLANDS J. G. M. Nelissen (The Netherlands) 16:42 FP-3-15 A NEW METHOD TO INCREASE THE MOTIVATION TO STOP SMOKING A. Hjalmarson and K. Frostom (Sweden) 14 , TIMN 448482
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14:00 --15:24 Room 904/905 (9F) FREE COMMUNICATION 3 (Part 3) Chairpersons: S. Kawano (Japan) Y. Mochizuki (Japan) 14:00 FP-3-16 EFFECTIVENESS OF NICOTINE POLACRILEX IN PATIENTS WITH 14:12 FP-3-17 PULMONARY DISEASE D. P. L. Sachs, N. L. Benowitz and K. J. Silver (U. S.A. ) POLITICAL WILL OR LACK OF SUCH POLITICAL DETERMINA- 14:24 FP-3-18 TION IN THE FIGHT AGAINST SMOKING IN PUBLIC J. Tostain (France) THE GREAT NEW ZEALAND SMOKE-FREE WEEK 14:36 FP-3-19 J. D. Gaiser (New Zealand) INTERNATIONAL COOPERATION AGAINST TOBACCO - AN 14:48 FP-3-20 ASIAN EXAMPLE J. M. Mackay (Hong Kong) SMOKING CONTROL IN HONG KONG 15:00 FP-3-21 E. Chung (Hong Kong) ANTISMOKING EDUCATION INCLUDED THE LUNG CANCER 15:12 FP-3-22 SCREENING PROGRAM T. Hoshi, N. Onodera and N. Maeda (Japan) ANTI-SMOKING ACTION IN KINKI DISTRICT OF JAPAN H. Nogami, M. Kakutani and K. Miyazaki (Japan) 15:30 -16:54 Room 904/905 (9F) FREE COMMUNICATION 3 (Part 4) Chairpersons: K. Iwai (Japan) K. Yamanaka (Japan) 15:30 FP-3-23 THE PRACTICAL ACTIVITIES IN THE ANTI-SMOKING EDUCA- 15:42 FP-3-24 TION BY THE LOCAL MUNICIPAL MEDICAL ASSOCIATION K. Tanaka, 0. Seo and R. Nishimura (Japan) THE DEVELOPMENT OF ANTI-SMOKING VOLUNTARY ACTIVI- 5:54 P-3-25 TIES AND THE PRESENT MEMBERS' ATTITUDES TO SMOKING S. Igarashi, S. Kagamimori, S. Murotani; S. Marukawa, T. Igarashi and K. Kanaoka (Japan) URGENT NEED OF LEGISLATION AGAINST SMOKING IN JAPAN 16:06 FP-3-26 M.M. Kawano (Japan) THE TRUE STATE OF AFFAIRS ABOUT TOBACCO'S SLOT 16:18 FP-3-27 (VENDING) MACHINES NEAR THE SCHOOL AND STUDENTS Y. Fujiu and M. Kobayashi (Japan) NON-SMOKING EDUCATION FOR CHILDREN BY PHYSICIANS AND SCHOOL TEACHERS I. Mizutani and B. Yokota (Japan) 15 TIMN 448483
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16:30 FP-3-28 SURVEY ON YOUTH SMOKING IN FOREIGN COUNTRIES BY USE OF A QUESTIONNAIRE GIVEN TO FOREIGN STUDENTS AT HIROSHIMA UNIVERSITY M. Murakami (Japan) 16:42 FP-3-29 ANTI-SMOKING INTERVENTIONS IN THE BROADER CONTEXT ' OF HEALTH PROMOTION M. A. Orlandi, A. McAlister and E. Wynder (U.S.A.) 14:00-15:12 FREE COMMUNICATION 4 Room 906 (9F) Chairpersons: M. Russel (U.K.) T. Mori (Japan) 14:00 FP-4-01 EFFICACY OF NICOTINE CHEWING GUM K. 0. Fagerstrom (Sweden) 14:12 FP-4-02 A SMOKERS CLINIC STUDY USING PLACEBO CONTROLLED NICORETTE 4 MG T. Blondal (Iceland) 14:24 FP-4-03 A NEW MEASURE OF NICOTINE DEPENDENCE - THE WEST- MEAD NICOTINE TOLERANCE SCALE E. A. Digiusto, D. Small, V. Seres and R. Batey (Australia) 14:36 FP-4-04 LONGTERM EFFECTS OF TRANSDERMAL NICOTINE SUBSTITU- TION IN BEHAVIORAL SMOKING CESSATION G. Buchkremer, H. Bents and K. Opitz (F.R.G.) 14:48 FP-4-05 2MG AND 4MG NICOTINE CHEWING GUM IN SMOKING CESSA- TION: WHO PREFERS WHICH P. Hajek (U.K.) 15:00 FP-4-06 SMOKING CESSATION WITH NICOTION CHEWING-GUM, A DOUBLE-BLIND CLINICAL TRIAL IN THAILAND W. Areechon (Thailand) 16 J TIMN 448484
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15:30-16:30 FREE COMMUNICATION 5 Room 906 (9F) Chairpersons: G. N. Connoly (U.S.A.) H. Ogawa (Japan) 15:30 FP-5-01 AN INTERNATIONAL SURVEY OF SMOKELESS TOBACCO - AN 15:42 FP-5-02 UPDATE M. J. Fisher (U.S.A.) CHARACTERISTICS AND CORRELATES OF SMOKELESS TOBAC- 5:54 P-5-03 CO USE BY TEEN AND ADULT MALES H. H. Severson, E. Lichtenstein, D. V. Ary and E. G. Eakin (U. S.A. ) SMOKELESS TOBACCO USE IN THE UNITED STATES, 1970-1985 16:06 FP-5-04 W. R. Lynn (U.S.A.) SMOKELESS TOBACCO: A PRODUCT FOR THE NEW GENERA- 6; P:5-05 TION OF TOBACCO USERS. DIPPING AND CHEWING IN THE NORTHWEST TERRITORIES, CANADA AND ITS GLOBAL RELEVANCE. J. S. Peterson, L. Barreto (Canada) and K. Brunnemann (U.S.A.) MEANS AND ME'1-HOD FOR AIDING INDIVIDUALS TO STOP - ~ SMOKING--'° ~ % I. Coope~ (U.S.A.) ..• 17 TIMN 448485
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TIMN 448486
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9:40 -10:30 PLENARY LECTURE Keidanren Hall (14F) I Chairperson: D. Simpson (Australia) 9:40 AN OVERVIEW OF SMOKING CONTROL M. Daube (Australia) P L-4 11:00 -12:30 SPECIAL LECTURE Keidanren Hal1 (14F) Chairperson: M. Aoki (Japan) 11:00 HETEROCYCLIC AMINES IN CIGARETTE SMOKE CONDENSATES T. Sugimura (Japan) S L-1 SMOKING AN ~EN TOBA~C05MOKING DU,RLNG PREGNAN CY: EPID LOGICA~B'1GjORPHOLO ASPECTS (D k L ~ssen enm~r 12:00 SL-3 SMOKELESS TOBACCO: HEALTH HAZARDS AND REGULATORY ISSUES G. N. Connolly (U.S.A.) Ji .1ILMN 448487 20
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11:00-12:29 International Conference Room (11F) SPECIAL SESSION 1 Smoking Cessation - 1 Chairperson: M. Kunze (Austria) Co-chairpersons: J. Crofton (U.K.) T. Hayashi (Japan) K. Miyazaki (Japan) 11:00 INTRODUCTION 11:05 SS-1-01 SMOKING CESSATION IN SPAIN, REVIEW AND EVALUATION 1:17 S-1-02 OF DEFERENT APPROACHES (1980-1986) D. T. Marin, E. Castellvi, C. Iniesta, C. Muriana, J. Gonzalez, T. Salvador and A. Agusti (Spain) SMOKING CESSATION: DATA FROM THE 1986 ADULT USE OF 11:29 SS-1-04 TOBACCO SURVEY T. E. Novotny, W. Lynn, D. Maklan and R. Davis (U. S.A. ) LONG-TERM MODIFICATION OF CHRONIC SMOKING BE- 11 SS~05 HAVIOR: A PARADIGMATIC APPROACH H. A. Lando (U.S.A.) ~ DREAMINCfUT SMOKINCj A~`TER G1NG~UP ~ P. Haje~ .K.) 11:53 SS-1-06 PRECURSORS OF RELAPSE DURING SMOKING WITHDRAWAL . 12:05 SS-1-07 A. J. Norris (U.K.) BIOBEHAVIORAL LINKAGES BETWEEN SMOKING CESSATION 2:17 S-1-08 AND THE RETURN TO HEALTH: PULMONARY CYTOLOGIC FEEDBACK G. E. Swan, G. B. Schumann, T. Roby and K. Sorensen (U.S.A.) EFFECTIVENESS OF THE 5-DAY PLAN TO STOP SMOKING IN JAPAN K. Miyazaki, H. Ogawa and T. Hayashi (Japan) 21 TIMN 448488
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11:00 -13:05 Room 1001 (1OF) SPECIAL SESSION 5 Smoking Control Media Strategies Chairperson: M. Daube (Australia) Co-chairperson: N. Onodera (Japan) 11:00 INTRODUCTION 11:05 S S-5-01 THE CONTRIBUTION OF PUBLICITY TO THE FASTEST DECLINE 1:17 S-5-02 IN CIGARETTE CONSUMPTION IN THE WESTERN WORLD D. J. Reid, L. Seymour, J. Hitchins, P. Linthwaite, S. Hagard and D. Simpson (U.K.) B.U.G.A. U.P. - THE LESSONS LEARNED FOUR YEARS ON 11:29 SS-5-03 A. Chesterfield-Evans (Australia) DOC: A PRIMER FOR SOCIAL/HEALTH ACTIVISM 11:41 SS-5-04 J. W. Richards, A. Blum, T. Houston and P. Fischer (U.S.A.) USING THE MEDIA 11:53 SS-5-05 M. M. Daube (Australia) THE WEST AUSTRALIAN SMOKING AND HEALTH PROJECT: 2:05 S-5-06 THREE YEARS OF MASS MEDIA SMOKING CESSATION CAM- PAIGNS M. G. Swanson and H. Brown (Australia) THE USE OF TELEVISION FOR SMOKING CESSATION: AN ON- 2:17 S-5-07 GOING PLANNED TRIAL R. B. Warnecke, B. R. Flay, T. D. Cook, K. Crittenden, J. Vidmar, C. Manfredi and R. Mermelstein (U.S.A.) EVALUATION FRAMEWORK TO DESIGN AND FINE TUNE A ME- 12:29 SS-5-08 DIA CAMPAIGN D. J. Reading, D. Hill, J. Houston and D. Jolley (Australia) SMOKING CESSATION IN RADIO AND TV IN NORWAY 12:41 SS-5-09 P. Schioldborg (Norway) STOPPING THE TV GAME - A CAMPAIGN TO CUT CIGARETTE ADVERTISING ON BBC TV IN TOBACCO SPONSORED SPORT 1985-1987 12:53 SS-5-10 J. L. Roberts (U.K.) TIME TO QUIT: A COMMUNITY-BASED TELEVISION AND PRINT MEDIATED SMOKING CESSATION PROGRAM D. Nostbakken and C. Moyer (Canada) TIMN 448489 22
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11:00-12:41 Room 1062 (70F) SPECIAL SESSION 8 Smoking and Children-1 Chairpersons: K. Bjartveit (Norway) Co-chairpersons: R. Masironi (Switzerland) M. Takaishi (Japan) T. Kawabata (Japan) 11:00 INTRODUCTION 11:05 SS-8-01 SMOKING HABITS OF SCHOOL CHILDREN IN REYKJAVIK, ICELAND, 1974-1986 11:17 SS-8-02 S. Magnusson, S. Johnsen and T. Ornolfsson (lce/and) CHANGES IN SMOKING BEHAVIOUR AMONG SYDNEY 11:29 SS-8-03 ADOLESCENTS J. P. Pierce, J. Aitken, P. Macaskill and A. Barratt (Australia) SMOKING IN CHILDREN 11:41 SS-8-04 T.B.B.S.V. Ramanaiah, P. Thirumalaikolundusubramanian and S. Shanmuganandan (India) EPIDEMIOLOGICAL STUDY OF TOBACCO SMOKING BE- 1:53 S-8-05 HAVIOUR AMONG YOUNG PEOPLE OF NEPAL WITH SPECIAL REFERENCE TO ATTITUDE AND BELIEFS M. R. Pandey, S. R. Venkatramaiah, R. P. Neupane and A. Gautam (Nepal) THE EFFECTS OF SCHOOL LIFE ON SMOKING BEHAVIOR IN 12:05 SS-8-06 YOUTH ~ Y. Hiraoka, J. Tanaka, F. Sugimoto and H. Okuda (Japan) SMOKING HABITS AND INDICATORS OF SOCIOECONOMIC 2:17 S-8-07 STATUS AMONG SCHOOL CHILDREN IN EUROPE. A WHO CROSS NATIONAL SURVEY 1985-86 L. E. Aaro (Norway), B. Wold and L. Kannas (Finland) 'SCRAMBLE-AN-AD' - COMPETITION FOR CHILDREN AGAINST 12:29 SS-8-08 SMOKING J. M. Berry (U.K.) SMOKING EDUCATION FOR TEENAGERS - THE DEVELOPMENT OF A RESISTING SOCIAL PRESSURES CURRICULUM E. M. Gray and P. Gammage (U.K.) 23 TIMN 448490
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11:00-12:41 SPECIAL SESSION 6 Smoking Control Legislation-1 Room 901 (9F) , Chairpersons: J. F. Banzhoff (U.S.A.) Co-chairpersons: W. Nelder (U.S.A.) T. Shiraishi (Japan) A. Gunji (Japan) 11:00 11:05 INTRODUCTION SS-6-01 STATE LAWS RESTRICTING SMOKING IN PUBLIC PLACES IN THE USA: AN ANALYSIS OF THEIR PREVALENCE AND CONTENT N. A. Rigotti (U.S.A.) 11:17 SS-6-02 TOBACCO PRODUCTS LIABILITY LITIGATION AS A PUBLIC HEALTH STRATEGY R. A. Daynard (U.S.A.) 11:29 SS-6-03 NEW LEGAL RESPONSES TO THE OLD PROBLEMS OF SMOKING D. W. Garner (U.S.A.) 11:41 SS-6-04 THE MINNESOTA PLAN FOR NONSMOKING AND HEALTH: THE LEGISLATIVE EXPERIENCE M. E. Moen, K.C. Harty and A.S. Hanson (U.S.A.) , 11:53 SS-6-05 OBSTACLES TO A NATIONAL SMOKING CONTROL PROGRAMME T. Egsmose and L. Egsmose (Denmark) 12:05 SS-6-06 EQUAL ACCESS ADVERTISING: GUARANTEEING THE PUBLIC'S RIGHT TO KNOW AS AN ALTERNATIVE TO BANNING TOBAC- CO ADVERTISING D. Burton and B. R. Flay (U. S.A. ) 12:17 SS-6-07 IMPLEMENTATION AND IMPACT OF A CITY'S REGULATION OF SMOKING IN PUBLIC PLACES AND THE WORKPLACE: THE EX- PERIENCE OF CAMBRIDGE, MASSACHUSETTS N. A. Rigotti, M. Stoto, M. Kleiman and T.C. Schelling (U.S.A.) 12:29 SS-6-08 THE POLITICAL PATH TO A SMOKE-FREE WORKPLACE W. E. Nelder (U.S.A.) TIMN 448491 24
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11:00 -12:41 Room 904/905 (9F) SPECIAL SESSION 2 Passive Smoking Chairpersons: M. Asano (Japan) Co-chairperson: BrR--Stroptan&( TERR~I F, pr'~HA~r ,.' ~ u5A 11:00 INTRODUCTION 11:05 SS-2-01 A STUDY ON PHYSIOLOGICAL RESPONSES TO PASSIVE 1:17 S-2-02 SMOKING BY STANDARD AND NICOTINELESS CIGARETTES, WITH SPECIAL REGARD TO SMOKING HABIT IN YOUNG HEALTHY MALES M. Asano and C. Ohkubo (Japan) WORKSITE SURVEYS: EMPLOYEE REPORTS OF PASSIVE 11:29 SS-2-03 SMOKE EXPOSURE R. K. Addison (U.S.A.) PASSIVE SMOKING: ATTITUDES AND EXPOSURE IN THE 11:41 SS-2-04 UNITED STATES T. E. Novotny, W. Lynn, D. Maklan and R. Davis (U.S.A.) EFFECTS OF IMPLEMENTING A RIGOROUS WORKPLACE 11:53 SS-2-05 SMOKING POLICY IN A LARGE PUBLIC HEALTH AGENCY V. S. Bales (U.S.A.) EFFECT OF PASSIVE SMOKING BY HUSBAND ON PREGNANCY 2:05 S-2-06 OUTCOMES - A POPULATION-BASED PROSPECTIVE STUDY FROM JAPAN M. Nakamura, T. Hiyama, A. Oshima, N. Kubota, K. Wada and K. Yano (Japan) PASSIVE SMOKING AND HEALTH RISKS TO CHILDREN: A 12:17 SS-2-07 REVIEW OF THE EVIDENCE A. Charlton (U.K.) EFFECTS OF FAMILY SMOKING ON ACUTE RESPIRATORY 12:29 SS-2-08 DISEASE IN CHILDREN J. K. Park and I. S. Kim (Korea) SMOKING AND PASSIVE SMOKING AS RISK FACTORS FOR LUNG CANCER IN HONG KONG CHINESE WOMEN T. H. Lam, I. T. M. Kung, C. M. Wong, W. K. Lam, J. W. L. Kleevens, D. Saw, C. Hsu, S. Seneviratne, S. Y. Lam, K. K. Lo and W. C. Chan (Hong Kong) 25 TIMN 448492
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11:00--12:53 SPECIAL SESSION 4 Smoking and Economics Room 906 (9F) Chairperson: S. K. Teoh (Malaysia) Co-chairperson: N. Maeda (Japan) 11:00 11:05 INTRODUCTION SS-4-01 SOCIO-ECONOMIC PROBLEMS OF SMOKING IN A DEVELOPING COUNTRY S. K. Teoh (Malaysia) 11:17 SS-4-02 SMOKING AND THE REDUCTION IN WELFARE J. H. Hagen (The Netherlands) 11:29 SS-4-03 KNOWLEDGE AND ATTITUDES ABOUT TOBACCO AMONG PHAMACISTS WHO DO AND WHO DO NOT SELL TOBACCO J. Slade, L. Davidson and C. L. Stang (U. S.A. ) 11:41 SS-4-04 SMOKING HABITS AND MEDICAL EXPENDITURE IN A MALE EMPLOYEE POPULATION R. Kondo (Japan) 11:53 SS-4-05 TOBACCO AND UNITED STATES TRADE SANCTIONS G. N. Connolly (U. S.A. ) 12:05 SS-4-06 SUING THE TOBACCO COMPANIES IN THE U.S.: PROBLEMS & PROGNOSIS ~tN Z•'•,t 12:17 SS-4-07 TOBACCO ADVERTISING AND MAGAZINE COVERAGE OF TOBACCO AND HEALTH: AN EMPIRICAL STUDY K. E. Warner (U.S.A.) 12:29 SS-4-08 THE IMPACT OF CIGARETTE ADVERTISING ON THE DEMAND FOR CIGARETTES J. Chetwynd, P. Coope, R. Brodie and E. Wells (New Zealand) 12:41 SS-4-09 EFFECTS OF SMOKE FREE WEEK AND LARGE TAX RISE IN NEW ZEALAND D. Kent (New Zealand) 14:00 -15:00 SPECIAL LECTURE Keldanren Hall (14F) Chairperson: T. Shimao (Japan) 14:00 NICOTINE REPLACEMENT IN SMOKING CESSATION M. Russell (U.K.) S L-4 14:30 SL-5 NATIONAL CANCER INSTITUTE'S SMOKING, TOBACCO, AND CANCER PROGRAM FOR THE YEAR 2000 J. W. Cullen (U.S.A.) TIMN 448493 `6
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15:30 --17:00 Keidanren Hall (14F; SPECIAL LECTURE Chairperson: S. Hinohara (Japan) 15:30 SL-6 THE IMPACT OF THE NONSMOKER'S RIGHTS MOVEMENT S. Glantz (U.S.A.) 16:00 SL-7 THE MEDIA AND THE ANTI-SMOKING CAMPAIGN - THE GREAT AMERICAN SMOKEOUT _&=Gr4z (U.S.A.) J . Sf-i=FR l /V 16:30 SL-8 SMOKING AND HEALTH: THE TIME OF APPLICATION E. Wynder (U.S.A.) 14:00 -17:12 International Conference Room (11 F) SPECIAL SESSION 1 Smoking Cessation-2 Chairperson: M. Kunze (Austria) Co-chairpersons: J. Crofton (U.K.) T. Hayashi (Japan) K. Miyazaki (Japan) 14:00 SS-1-09 BROAD-BASED SMOKING CESSATION SELF HELP MANUAL K. D. Monaco, B. Strecher and B. Rimer (U. S.A. ) 14:12 SS-1-10 EVALUATION OF A SELF-HELP SMOKING CESSATION MANUAL: STEPWISE VS. ACCELERATED PROCEDURE T. Abelin, U. F. Bloch, C. H. Minder (Switzerland) 14:24 SS-1-11 THE ROLE OF SELF-EFFICACY IN ENCOURAGING SMOKERS TO QUIT J. M. Shelley and J. P. Pierce (Australia) 14:36 SS-1-12 THE SMOKING ENLIGHTENMENT AND WITHDRAWAL FOR TEENAGERS AND ADULTS T. A. Luukkanen and L. Hirvonen (Finland) 14¢48 SS-1=13 "BREATHE-F13EE"- NEW CESSATION STRATEGIES FOR A ~ / CHANGI OPULATION OF SMOKERS E. E dams (U.S.A..)-'' 15:00 SS-1-14 SMOKING CESSATION IN CARDIAC PATIENTS: PROCESSES OF CHANGE J. L. Kristeller, J. Ockene, J. Prochaska, S. Barrett, P. Merriam, J. Klar, I. Ockene and R. Goldberg (U.S.A.) 15:12 SS-1-15 SMOKING CESSATION IN PATIENTS WITH ARTERIAL DISEASE AND THE EFFECTS OF CONTINUED SMOKING IN THESE PA- TIENTS W. M. Castleden, K. Bertei and Y. Wallman (Australia) 27 TIMN 448494
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15:24 SS-1-16 SMOKING CESSATION IN PATIENTS WITH SMOKING-RELATED 15:36 SS-1-17 DISEASES I. A. Campbell (U.K.) SMOKING CESSATION INTERVENTION TRIAL FOR PREGNANT 15:48 SS-1-18 WOMEN R. A. Windsor, L. Artz, J. Lowe and L. Contreas (U.S.A.) THE ROLE OF HEALTH PROFESSIONALS IN HELPING PEOPLE 16:00 SS-1-19 TO STOP SMOKING: SPANISH PROGRAMME T. L. Salvador, J. Gonzalez, D. Marin and A. Agusti (Spain) TRAINING FAMILY PHYSICIANS IN SMOKING CESSATION 6:12 S-1-20 COUNSELING J. A. Best, D. M. Wilson, J. R. Gilbert, D. W. Taylor, E. L. McIn- tyre, D. Williams and J. Singer (Canada) A RANDOMIZED COMMUNITY TRIAL FOR SMOKING CES- 16:24 SS-1-21 SATION T. F. Pechacek (U.S.A.) HOW 50,000 PEOPLE QUIT SMOKING ON A SINGLE DAY: THE 6;36 S-.t'~2 EFFECTS OF NATIONAL NO SMOKING DAY IN THE UNITED KINGDOM AND THE REPUBLIC OF IRELAND D. J. Reid, P. Linthwaite, L. Seymour and D. Simpson (U. S. ) THE 1986 HHS ffCRETARY~' -COMM~NI-F<EALTH PROMO- ~ / TION AW fi'DS PROGRAiGI ,- R. A. sco ( U. S.A 16:48 SS-1-23 THE INFLUENCE OF BUSINESS LEADERSHIP ON SMOKING 1~00 SS~1=24~ CESSATION IN THE UNITED STATES A. J. Wells (U.S.A.) / THE EFFECT OF SMOKING BEHAVIOUFj.~'bF THE PERSONS o' FROM THE SURROUNDINGS ON _Tl;AfRESULTS OF DISAC- CUSTOMING-T REATMENT OF SKiIOKERS T. Gbrs Zolnowski an~Z!Murowaniecki (Poland) TIMN 448495 28
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14:00--17:29 Room 1001 (10F) SPECIAL SESSION 7 Smoking and Women Chairperson: J. Mackay (Hong Kong) Co-chairperson: K. Itoh (Japan) 14:00 INTRODUCTION 14:05 SS-7-01 SMOKING AND DEATH RATES IN TWO-THIRDS OF A MILLION 14:17 SS-7-02 WOMEN L. Garfinkel and S. D. Stellman (U.S.A.) ON THE RELATIONSHIP BETWEEN CIGARETTE SMOKING AND 14:29 SS-7-03 FEMALE LUNG CANCER G. Y. Geng, Z. H. Liang, A. Y. Zhang and G. L. Wu (China) WOMENS SMOKING AND LUNG CANCER IN ICELAND 14:41 SS-7-04 S. Arnason and J. Ragnarsson (/celand) MATERNAL TOBACCO USE AND REPRODUCTIVE OUTCOME- 14:53 SS-7-05 POTENTIAL PUBLIC HEALTH IMPACT IN INDIA, BANGLADESH S. Krishnamurthy and K. Krishna (India) BREASTFEEDING AND URINE COTININE IN NEWBORNS WHOSE 5:05 S-7-06 MOTHERS SMOKE M. Labrecque, J. P. Weber, S. Marcoux, J. Fabia and L. Ferron (Canada) WOMEN AND SMOKING; THE CONTRIBUTION OF A NATIONAL 5:17 S-7-07 WORKING GROUP OF WOMEN TO THE CAMPAIGN TO REDUCE SMOKING AMONG WOMEN E. C. Crofton (U.K.) IMPACT OF INTERVENTION ON THE REVERSE SMOKING HABIT 15:29 SS-7-08 OF RURAL INDIAN WOMEN M. B. Aghi, P. C. Gupta and F. S. Mehta (India) A SELF-HELP SMOKING CESSATION PROGRAM FOR 15:41 SS-7-09 REGISTERED NURSES E. R. Gritz, A. C. Marcus and B. A. Berman (U.S.A.) WOMEN PHYSICIANS AND SMOKING 15:53 SS-7-10 M. A. Cromer (U.S.A.) PREGNANCY AND CHILDBIRTH: AN OPPORTUNITY FOR SMOK- 6:05 S-7-11 ING INTERVENTION M. A. Stoto, N. A. Rigotti, M. A. Schuster and C. L. Pashos (U.S.A.) FACTORS WHICH MAKE PREGNANT WOMEN CONTINUE 6:17 S-7-12 SMOKING H. Shimizu, Y. Akaike, S. Hisamichi, S. Tayama and J. Shoji (Japan) SMOKING AMONG YOUNG WOMEN IN JAPAN 16:29 SS-7-13 R. Saito (Japan) ATTITUDE TO SMOKING AMONG FEMALE STUDENTS IN A PROVINCIAL CITY IN JAPAN H. Kinebuchi and S. Ryu (Japan) 29 TIMN 448496
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16:41 SS-7-14 DEVELOPMENT TRENDS IN SMOKING AMONG WOMEN IN SWEDEN - AN ANALYSIS M. Haglund (Sweden) 16:53 SS-7-15 INTEGRATION OF SMOKING CESSATION INTO PUBLIC PRENA- TAL CARE IN THE U.S.A. - RANDOMIZATION WITHOUT REVOLT M. E. Dalmat, N. Miller, N. Salas and J. Stine ( U. S.A. ) 17:05 SS-7-16 SMOKING CESSATION DURING PREGNANCY - A CONTROLLED TRIAL OF THE IMPACT OF NEW TECHNOLOGY AND FRIENDLY ENCOURAGEMENT P. A. Gillies, R. Madeley and L. Power ((J.IC ) 17:17 SS-7-17 SMOKING AND FEMALE REPRODUCTIVE FUNCTIONS V. V. Subbarao (Nigeria) 14:00--15:48 SPECIAL SESSION 8 Smoking and Children-2 Room 1002 (10F) Chairperson: K. Bjartveit (Norway) Co-chairpersons: R. Masironi (Switzerland) M. Takaishi (Japan) T. Kawabata (Japan) 14:00 S S-8-09 A COMPREHENSIVE SMOKING PREVENTION PROGRAM A. Biglan (U.S.A.) 14:12 SS-8-10 EVALUATION OF A SCHOOL-BASED PREVENTION PROGRAM ON REDUCING SMOKELESS AND CIGARETTE USE BY TEENS H. H. Severson, R. Glasgow, R. Wirt and E. Lichtenstein (U.S.A.) 14:24 SS-8-11 PRE-SCHOOL NON-SMOKING PROGRAM C. Moyer and L. Ouimet (Canada) 14:36 SS-8-12 ATTITUDE OF TEACHERS, SCHOOL NURSE TEACHERS AND SCHOOL PHYSICIANS TOWARD SMOKING PREVENTION EDU- CATION K. Minagawa and N. Nishioka (Japan) 14:48 SS-8-13 THE SCHOOL AND SMOKING PREVENTION: THE ROLE OF SCHOOL ENVIRONMENT K. S. Brown, S. Santi and J. A. Best (Canada) 15:00 SS-8-14' METHODOLOGIES AND RESULTS OF AN ANTISMOKING PRO- GRAM IN SCHOOLS C. E. Arciti, B. Doglio, L. Gogioso, F. Giorgi and L. Santi (Italy) 15:12 SS-8-15 A DUTCH SMOKING PREVENTION RPOGRAMME: DEVELOP- MENT, IMPELMENTATION AND RESULTS H. de Vries, M. Dijkstra and G. J. Kok (The Netherlands) 15:24 SS-8-16 EVALUATION OF A FAMILY-LINKED SMOKING INTERVENTION PACKAGE FOR 9-YEAR-OLDS A. Chariton (U.K.) 15:36 SS-8-17 TOBACCO AND CHILDREN R. Masironi and H. Geizerova (Switzerland) TIMN 448497 30
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14:00 --16:48 Room 901 (9F1 SPECIAL SESSION 6 Smoking and Control Legislation-2 Chairperson: J. F. Banzhoff (U.S.A.) Co-chairpersons: W. Nelder (U.S.A.) T. Shiraishi (Japan) A. Gunji (Japan) 14:00 SS-6-09 CURRENT CIGARETTE ADVERTISING TRENDS IN THE UNITED 14:12 SS-6-10 STATES R. M. Davis (U.S.A.) SMOKING AND HEALTH: 1990 OBJECTIVES FOR THE UNITED 14:24 SS-6-11 STATES J. L. Bagrosky (U.S.A.) ATTITUDES FOR SOCIAL SMOKING CONTROL AND GOVERN- 14:36 SS-6-12 MENT'S ROLE Y. Sawasaki and C. Kawata (Japan) THE ROLE OF ADVOCACY AS A COST-EFFECTIVE PATH TO 14:48 SS-6-13 SMOKING CONTROL LEGISLATION G. C. Mahood and D. Sweanor (Canada) PROPOSAL FOR THE NEW PROVISION IN THE NORWEGIAN 15:00 SS-6-14 TOBACCO ACT A. Kjonstad (Norway) PROGRESS IN SMOKING CONTROL IN AUSTRALIA 15:12 SS-6-15 S. D. Woodward (Australia) TOBACCO TAXES PAID BY AUSTRALIAN SCHOOL CHILDREN 15:24 SS-6-16 M. H. Winstanley (Australia) NEW HEALTH WARNINGS ON TOBACCO PACKAGES 15:36 SS-6-17 S. D. Woodward and M. H. Winstanley (Australia) SMOKE-FREE HOSPITALS BY 1990 15:48 SS-6-18 S. A. Hanson, T. E. Kottke and J. M. Knapp (U.S.A.) SMOKING CONTROL LEGISLATION IN SWEDEN - THE 16:00 SS-6-19 TOBACCO INDUSTRY'S RESPONSE P. Nordgren (Sweden) A WORLD STRATEGY AGAINST THE SOURCE OF THE 16:12 SS-6-20 TOBACCO PROBLEM A. Chesterfield-Evans and G. O'Connor (Australia) SUCCESS AND FAILURE OF THE LEGISLATIVE ACTION 16:24 SS-6-21 AGAINST SMOKING IN BELGIUM L. Joossens (Belgium) SMOKING CONTROL AND HEALTH, SOCIAL AND ECONOMIC INDICATORS - WITH REFERENCE TO HEALTH WARNINGS ON CIGARETTE PACKETS K. Yamanaka, M. Miyao, M. Furuta, K. Takihi and S. Yamada (Japan) 31 TIMN 448498
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16:36 SS-6-22 CANADA'S FIRST BY-LAW TO REGULATE SMOKING IN PUBLIC PLACES AND THE WORKPLACE: A REVIEW OF THE STRATEGIES S. Thompson, G. Rowlands and F. Bass (Canada) 14:00 -15:36 SPECIAL SESSION 2 Passive Smoking Room 904/905 (9F) Chairperson: M. Asano (Japan) Co-chairperson: D. R. Shopland (U.S.A.) 14:00 PASSIVE SMOKING AND LUNG CANCER IN WOMEN R. Inoue and T. Hirayama (Japan) S S-2-09 14:12 SS-2-10 PASSIVE SMOKING AND LUNG CANCER IN TWO SWEDISH STUDIES G. Pershagen and C. Svensson (Sweden) 14:24 SS-2-11 PASSIVE SMOKING AND ADULT MORTALITY A. J. Wells (U.S.A.) 14:36 SS-2-12 THE HEALTH CONSEQUENCES OF INVOLUNTARY SMOKING: OVERVIEW AND CONCLUSIONS OF THE 1986 SURGEON GENERAL'S REPORT D. R. Shopland (U.S.A.) 14:48 SS-2-13 -BKfdid+NB-r&I>1}C~RiC =~FH E-AE} SF-R-AL-+/kN. EX- PERIENEE AYt-r.q ~l .~Y.;PI-:-.- ~.1C ~ /y,r~`L•:,•t~.e ~~..ri.Jy ~f' S'b'cCA:~c7r„ 1i' N C p ~ ( %~ C t1/4 ...~zwarGyA~(~.ustraGa) g , F• O 1 c 1. ~ w;r ; ~.dzvJ ~4.0-~-•..rt 1 15:00 SS-2-14 THE SMOKE-FREE XV OLYMPIC WINTER GAMES - CALGAR /Y J. H. Read (Canada) 15:12 SS-2-15 DEVELOPING SMOKE-FREE ORGANIZATIONS - A MODEL PROCESS FOR CHANGE A. S. Hanson (U.S.A.) 15:24 SS-2-16 THE POSITIVE IMPACT OF 100% SMOKE-FREE HOSPITALS L. L. Fairbanks (U.S.A.) TIMN 448499 , 32
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15:45 -17:26 Room 904/905 (9r SPECIAL SESSION 3 Non-smoker's Rights Chairperson: J. Weigum (U.S.A.) Co-chairperson: Y. Isayama (Japan) 15:45 INTRODUCTION 15:50 SS-3-01 THE IMPACT OF THE NON-SMOKERS' RIGHTS MOVEMENT 0~ 16:02 SS-3-02 SMOKING HABITS IN THE U.S. C. L. Gouin (U.S.A.) NON-SMOKERS' RIGHT AND. PUBLIC HEALTH 16:14 SS-3-03 N. Onodera (Japan) CITIZEN NONSMOKERS' GROUPS AS LEADERS FOR CHANGE 16:26 SS-3-04 R. L. Carlson (U.S.A.) A STUDY ON THE RELATION BETWEEN A LAWSUIT TO 6:38 S-3-05 PROMOTENON-SMOKERS' RIGHTS AND THE CITIZENS' MOVE- MENT ADVOCATING SUCH RIGHTS Y. Isayama (Japan) AMERICA'S NONSMOKERS' REVOLUTION: EFFECTS AND IM- 16:50 SS-3-06 PLICATIONS J. F. Banzhaf III (U.S.A.) ACTIONS TO BE UNDERTAKEN BY MILITANT NON-SMOKERS 17:02 SS-3-07 IN SOCIAL LIFE J. Tostain (France) THE PROBLEM OF THE CIGARETTE SMOKING IN THE OFFICE 17:14 SS-3-08 FOR MY CASE K. Niwayama (Japan) NON-SMOKERS' RIGHTS IN SWITZERLAND I. K. Spillmann (Switzerland) 14:00--17:29 • Room 906 (91 SPECIAL SESSION 9 Smoking Control in Development Countries Chairperson: J. L. Rios-Dalenz (Bolivia) Co-chairpersons: S. Omar (Egypt) T. Mori (Japan) S. Hatano (Japan) 14:00 INTRODUCTION 14:05 SS-9-01 SMOKING, A SERIOUS HEALTH PROBLEM IN CHINA X. Z. Weng (China) 33 TIMN 448500
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14:17 S S-9-02 SMOKING PICTURE IN CHONBURI, THAILAND 14:29 SS-9-03 C. Bowonwatanuwong, K. Tongyai, T. Amphunpong and S. Palaruk (Thailand) SMOKING, HEALTH AND BEHAVIOUR: A CASE STUDY OF 14:41 SS-9-04 RURAL POPULATION S. Shanmuganandan and P. Thirumalaikolundusubramanian (India) AN EDUCATIONAL INTERVENTION STUDY FOR TOBACCO 4:53 S-9-05 CHEWING AND SMOKING HABITS AMONG INDIAN VILLAGERS P. C. Gupta, F. S. Mehta, J. J. Pindborg, M. B. Aghi, R. B. Bhonsle and P. R. Murti (India) EPIDEMIOLOGICAL STUDY OF TOBACCO SMOKING BE- 5:05 S-9-06 HAVIOUR AMONG ADULTS IN NEPAL WITH SPECIAL REFER- ENCE TO ATTITUDE AND BELIEFS M. R. Pandey, S. R. Venkatramaiah, R. P. Neupane and A. Gautam (Nepal) WHY CIGARRETTE? PAST, PRESENT AND FUTURE, YOUTH 5:17 S-9-07 PROFILE M. Adrianza, F. Jimenez, R. Merenfeld, R. Rizquez, B. Lopez and H. Cedeno (Venezuela) SMOKING HABITS OF KING SAUD UNIVERSITY STUDENTS IN 15:29 SS-9-08 RIYADH A. M. Taha, A. Benner and M. S. Noah (Saudi Arabia) TOWARDS A NATION OF NON-SMOKERS A NATIONAL SMOK- 15:41 SS-9-09 ING CONTROL RPOGRAMME FOR SINGAPORE B. R. Vaithinathan and L. Lee (Singapore) SMOKING AND COFFEE DRINKING IN STUDENTS 15:53 SS-9-10 F. I. Chaniotis, D. Chaniotis, I. Butsikakis and E. kanellos (Greece) TOBACCO CONSUMPTION AND HEALTH CONSEQUENCES FOR 6:05 S-9-11 MEXICO AT THE YEAR 2000 F. G. Puente-Silva, M. Baizaretti, E. Gonzalez, G. Espino and A. Ocampo (Mexico) KEY HEALTH PROFESSIONALS' SMOKING IN RELATION TO 6:17 S-9-12 THE POPULATION'S SMOKING: THEIR ROLE IN SMOKING CONTROL POLICIES H. P. Adriaanse and J. van Reek (The Netherlands) IMPLICATIONS OF DIFFERENTIAL POPULATION SIZE AND 6:29 S-9-13 GROWTH BETWEEN DEVELOPED AND DEVELOPING COUN- TRIES FOR GLOBAL TOBACCO INDUSTRY MARKETING AND PUBLIC RELATIONS STRATEGIES S. F. Chapman (Australia) HEALTH AND ECONOMIC IMPLICATIONS OF TOBACCO 6:41 S-9-14 GROWTH AND CONSUMPTION IN SELECTED DEVELOPING COUNTRIES T. Glynn (U.S.A.), R. Masironi, K. Rothwell, D. Patchett, M. Thomas (Switzerland), M. Sheridan and L. Young (U.S.A.) WORK OF THE TOBACCO AND HEALTH COMMITTEE, INTER- 6:53 S-9-15 NATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE J. W. Crofton (France) NO SMOKING DAY CAMPAIGN FOR DEVELOPING COUNTRIES N. Nithiyananthan (Malaysia) TIMN 448501 lu
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17:05 SS-9-16 USING THE MORAL DIMENSIONS OF TOBACCO TO EFFECT 17:17 SS-9-17 SOCIAL CHANGE D.M. Shimp and E.B. Shimp (U.S.A.) PROGRAM AGAINST THE HABIT OF SMOKING H. Rubio-Monteverde, M. Labrandero-Inigo and C. Gutierrez-de- Velasco (Mexico) 35 T-IMN 448502
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TIMN 448503
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9:40--12:00 REPORT OF SPECIAL SESSIONS (by chairpersons) Keidanren Hall (14F) Chairperson: T. Hirayama (Japan) 9:40 9:55 10:05 - 10:15 ~ -10:50 u -11:00 ~ 11:15 11:25 11:40 11:55 SMOKING CESSATION PASSIVE SMOKING NON-SMOKER'S RIGHT SMOKING AND ECONOMICS S S-1 SS-2 SS-3 S S-4 Coffee Break SS-5 SMOKING CONTROL MEDIA STRATEGIES SS-6 SMOKING CONTROL LEGISTLATION SS-7 SMOKING AND WOMEN SS-8 SMOKING AND CHILDREN SS-9 SMOKING CONTROL IN DEVELOPING COUNTRIES CONCLUDING REMARKS 12:00--12:30 GENERAL DISCUSSION Keidanren Hall (14F) Chairperson: M. Kunze (Austria) RECOMMENDATIONS ANNOUNCEMENT OF THE 7TH WORLD CONFERENCE ON SMOKING AND HEALTH ~ D. Nostbakken (Canada) CLOSING REMARKS S. Tominaga (Japan) TIMN 448504
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TIMN 448505
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CONFERENCE SITE Keidanren Kaikan 1-9-4 Otemachi, Chiyoda-ku, Tokyo 100, Japan Phone: 03-279-1411 REGISTRATION DESK The Registration Desk will be open during the following hours: Hours: Nov. 9 (Mon.) 13:00-19:00 14F Lounge Nov. 10 (Tue.) 9:00-17:00 14F Lounge Nov. 11 (Wed. ) 9:00-17:00 14F Lounge Nov. 12 (Thu.) 9:00-12:00 14F Lounge NAME TAG EXH I B ITI ON Name Tags are issued to all registered participants. Ceremony, sessions and social events can only be attended by those wearing name tags with the following colors: Active Participants: Name Tag Accompanying Person: Name Tag with red dot Secretariat: Name Tag with green dot Hours: Nov. 9 (Mon.) 13:00-17:00 Room 1102 Nov. 10 (Tue.) 9:00-17:00 Room 1102 Nov. 11 (Wed.) 9:00-17:00 Room 1102 WELCOME RECEPTION Date: November 9 (Mon.) Time: 18:30- 20:30 Place: "Diamond Hall" Keidanren Kaikan 12F Dress: Informal 42 TIMN 448506
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Access to Conference Site from Each Hotels Palace Hotel 7 min. walk Hotel Grand Palace 6 min. by subway (Tozai Line) & 5 min. walk Marunouchl Hotel 5 min. walk Ochanomizu Hotel Juraku 3 min. by subway (Chiyoda Line) & 3 min. walk Hotel Universe 3 min. by subway (iozai Line) & 5 min. walk AwaJicho Green Hotel 3 min by subway (Chiyoda Line) & 3 min. walk Asia Center of Japan 12 min. by subway (Chiyoda Line) & 3 min. walk JURAKJ~ ?iia Y AA r.: TIMN 448507
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V': 2. Abstracts TIMN 448508
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ABSTRACTS November 9-> 12,1987 Tokyo, Japan TIMN 448509
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~ TIMN 448510
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TIMN 448511
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THE COALITION ON SMOKING OR HEALTH: AN EXAMPLE OF THE BENEFITS OF COALITION BUILDING TO INFLUENCE NATIONAL POLICY *H. yre, M. . President of the American Cancer Society; Professor of Medicine, University of Utah, 84132, U.S.A. In March 1982 the American Cancer Society, the American Heart Association, and the American Lung Association came together to form a coalition for the purpose of more effectively influencing America's tobacco and health related policy on a national level. Prior to formation of the Coalition, the U.S. Congress had not considered legislation to discourage the use of tbbacco. Acting togetheT' through the Coalition, three Coalition member organizations sought to refocus our federal government's attention on tobacco by working for stronger, diease specific health warnings, an increase in the cigarette excise tax and decreased federal financial support for the growth of tobacco. Each goal was accomplished. In 1982 the federal excise tax on cigarettes was doubled. In 1986 this increase was made permanent. In 1984 Congress mandated new stronger health warnings on cigarette advertisements•and packs, and in 1986 Congress for the first time required all smokeless tobacco products to carry health warnings in a circle and arrow format. The success of the coalition structure has allowed the three voluntary health organizations to expand their anti-smoking public policy agenda. The Coalition has successfully pushed for reform on tobacco use in the military, tax on smokeless tobacco products, and increased public attention to the problem of cigarrette advertising"and promotion and the promotion of tobacco to our nation's youth, women and minorities. 1.: 448512 1 5
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6 SMOKINC; CONTROL MEDIA ADVOCACY AND COALITION BUILDINr Mic ael Pertsc u, Co-Director, The A vocacy Institute, 1730 M Street, N.W., Washington, DC 20036, USA The paper presents highlights of two guides, sponsored by the American Cancer Society, drawn from the learning and experience of leading smoking control advocates assembled at the First International Smoking Control Summit Meeting, Washington, DC, Sentember, 1985. The guides draw upon the oresentations made at the Summit meeting, as well as suonlementary writings and orivate communications among the international network off smokinq control leaders. In general, the guides are based on the conclusion that the highest nriority for smoking control in the next decade must be given to (1) strateqic nlanninq, sharing and diffusion off successful initiatives, coordination, and community mobilization: (2) the need to track systematically, analyze dispassionately, and respond in a timely, coordinated manner to the organized resistance of the tobacco and related industries both to the grc::th qf :,ubli,c awareness of smoking as a priority public health issue, and to the annropriate mobilization of the community, and (3) to maximize oDpOrtunities for advancing smoking control through the mass ipedia, a •: TIM.N 448513
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TIMN 448514
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HEALTH EFFECTS OF SMOKING *T. Hirayama Institute of Preventive Oncology, Shinjuku-ku, Tokyo 162, Japan There is sufficient evidence that tobacco smoke is carcinogenic to humans. Smoking is considered to be the most important cause of cancer in man. Large-scale cohort studies conducted in Japan and in other countries demon- strated significantly elevated mortality rates for cancer of all sites and cancers of selected sites such as lung, larynx, pharynx, esophagus, stomach, liver, pancreas, and urinary bladder in daily cigarette smokers compared to nonsmokers. For most of these cancers a clear-cut dose-response relationship was observed. The earlier the age at which smoking had started, the higher was the risk of these cancers. In these cohort studies the mortality rates in daily smokers tended to approach the level of nonsmokers within five to ten years after smoking cessation. Similar tendency was also observed for selected other major causes of death such as ischemic heart disease, peri- pheral artery disease, peptic ulcer and chronic obstructive lung disease. The mortality of 91,540 nonsmoking wives was examined for 17 years in relation to their husbands' smoking habit in a cohort study in Japan and passive inhalation of tobacco smoke was shown to significantly raise the risk of selected diseases such as cancers of lung, nasal sinuses, brain tumor and ischemic heart disease. The risk of breast cancer of postmenopausal age was also observed to significantly go up. In addition, other serious smoking hazards such as to the health of fetus, infants, children and teen-agers have clearly been demonstrated. Effects on chromosomes were also shown. All of these phenomena are interpreted as the result of prolonged inhalation of carcinogens and other toxic substances rich in tobacco smoke. To prevent catastrophe worldwide programs for smoking control must urgently be formulated and resolutely be implemented. SMOKING AND CHILDREN Lars M. Ramstrom NTS, National Smoking and Health Association a n d WHO Collaborating Centre for Reference on Smoking and Health, Wenner-Gren Centre, Stockholm, Sweden Reduction of cigarette use requires both cessation of smoking and preven- tion of onset. These two aspects are actually closely interrelated, because children who see many smokers stopping will be less prone to start themaelves. As a background for directly prevention-oriented measures one can identify three main educational tasks: 1) strengthening the perception of benefits related to non-smoking (e.g. better fitness and wellbeing, cleaner environ- ment, smarter appearance); 2) weakening beliefs in alleged benefits related to smoking, e.g. by explaining why smoking is an act of dependency rather than of freedom; 3) creating understanding of the negative effects of smoking (e.g. impairment of fitness and health, pollution of the indoor environment, produc- tivity losses that reduce the economic welfare of the society). Since children at different age have widely different views and experiences, different age groups have to be addressed separately and in different ways. Older children will often meet powerful pro-smoking peer pressure, so they will need specific skills to cope with that. This requires both an expansion of educational content to include "everyday psychology" and an expansion of educational practices to include more student-activating procedures, e.g. role-playing. Application of the above principles will require participation by both parents and a wide range of institutions (e.g. kindergarten, primary school, secondary school, child health services, all kinds of youth organizations). Each one of the many professional groups involved will need specific training and special educational aids to be provided by appropriate expert agencies. Smoking in children can be prevented. E.g., in Sweden teenage smoking rates were cut down by 50 % in a 10 year peri0d. PL-1 • PL-2 TIMN 448515 9
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PL-3 PROTECTING NONSP.YD:;ERS' HEALir, ::IGHTS: The Most Effective Smokinq Control *Donna M. Shimp Environmental Improvement Associates, 109 Chestnut Street, Salem, N. J. 08079, U.S.A. PL-4 History has proven that societal pressure to change smoking into an unacceptable public behaviour can best be effected by focusing on the health rights of those who do not wish to inhale either mainstream or sidestream tobacco smoke. Individual ac- tions, citizen action group activities, and the response of government are all demonstrated to be effective weapons in the battle to reduce the number of smokers and control public smok- ing. The role of nonsmokers' health protection efforts in uniting public health forces; both governmental and voluntary health agencies, is examined as a model for developing countries. The chalienge of the U. S. Surgeon General for a Smoke-Free Society by the year 2000 is shown to be a unifying force, bring- ing together in common cause those traditionally more concerned about smoking intervention/cessation and those whose primary focus is protecting nonsmokers. Based on 11 years of intensive involvement as the first organ- ization to deal exclusively with smoking control in the work- place, the experience of Environmental Improvement Associates and colleagues around the world is reviewed. Workplace smoking control is demonstrated to be a vital and practical program..one which will impact the most of all smoking intervention efforts. AN OVERVIEW OF SMOKING CONTROL (Tentative) M. Daube, Australia TIMN 448516 10
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~~'i~c:~IrA~Ptt ~_,~,y., `~a TIMN 448517
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WORLD TRENDS IN SMOKING * R. :lasironi and K. Rothwell Tobacco or Health Programme, World Health Organization, Geneva, Switzerland Cigarette smoking is a major cause of illness and premature death in countries where it is widespread. It is the cause of about 400 000 deaths in the US, 140 000 in the Federal Republic of Germany, 100 000 in the UK, 90 000 in Italy, 53 000 in France. Thanks to antismoking campaigns the percentage of male smo- kers is decreasing in most industrialized countries. Among women and youth the rapid increase of a few years ago is now flattening out. Overall, cigarette consumption in the industrialized world is decreasing by about 1 % per year. On the contrary, it is increasing by more than 2 7% per year in the Third World, where it outstrips population growth. In Asia, cigarette consumption has grown 7 7. faster than population, in Latin America by 7 % as well, and in Africa by a sizeable 18 7, thus meaning a rapid increase in per capita consumption. Japan is characterized by a very high smoking prevalence, the highest among the industrialized countries, with 66 7 of male smokers. Per capita consumption is also among the highest in the world: 3270 cigarettes per adult per year. S!^.OKIFi.^-. AND ITS CONTROL IN JAPAN T. Shimao Director Emeritus, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Associatio:,, Kiyose-shi, Tokyo 204, Japan The author intends to make a general review on smoking problems and its control in Japan. The smoker's rate of adult male in Japan has been decreasing gra- dually, but the rate in 1986 was still 62.5%, which was highest in technically advanced countries. The rate of adult female was low (12.6%), however, it has been increasing in the age groups 20 to 39. Several epidemiological studies carried out in Japan confirmed the health hazards ofsmoking, which were already reported in the world liteature. Regarding smoking control measures, the first legislation to prohibit smoking in minority below 20 years of age came in act already in 1900. In the same year, it was also legislated to prohibit smoking in trains and railway statio:,s of the Japanese National Railways. 7%arning on possible health hazards of heavy smoking on cigarette package was introduced in Japan in 1972, and a no-smoking car was introduced to SHINKANSEN, a bullet train, in 1976. No-smoking seats were introduced to domestic air `lights in 1978. However, we are far behind many technically advanced coun- tries regarding active control measures of'smoking habits, and there is no restr_ction at present about the advertisement of cigarette on mass media -nc1;:a'ing television, news papers, weekly and monthly journals. An ad hoc committee on smoking and health of Public Health Council of the S:inistry of Health was organized in 1986. The committee summarized health hazards 6f smoking, and reported them recently. Based on this,report, it is expected to intensify and to take more active measures to control smoking habits in Japan. WR-1 WR-2 TIMN 448518 13
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WR-3 WR-4 14 PUBLIC HEALTH FOUNDATION. ANTISMOKING PROGRAM 1987. Carlos Alvarez Herrera, M.D. MPH Paraguay 2034 - Buenos Aires - Argentina the promotion of Comunity Health. The main purpose of the Public Health Foundation Programme is to develop the necesary actions leading to decrease the incidence of tabacco consuption on the population's health, establishing preventive measures. The programme includes the following projects: 1.- Reduction of potential smokers prevalence. a) Education anjRecreation actions. b)Directed to the population of elementary schools (first step), ar high schools (second step). 2.- Reduction of smokers. a)Courses on smoking cessation. b) Conferences c) Physical activities. 3.- To turn the whole population aware of the hazards involved in tabacco consuption. Actions: diffusion by means of articles published in newspapers and journals, audiovisual means, posters in the streets, autoadhesives, etc., with anti-smoking advertisements. 4.- Building an Antismoking Institutional Front Actions on the way: coordinat interaction with public and private, voluntary and scientifical, institution: towards common goals. This Antismoking Program is intented for the Nation and renews a former one operate 1978-83, when got a 26%decrease in total sales of cigarettes. Since 1983, after interruption of that program without other actions being taken by any agency the sales_stopped the decrease trend and regarned the previous figures. It is important that advertising was unrrestricted until 1 year ago, and it was/is impressive. The Public Health Foundation is a voluntary non-prosit institution aimed t SMOKING AND ITS CONTROL IN MIDDLE EAST AND AFRICAN COUNTRIES (Tentative) S. Omar, Egypt TIMN 448519
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TRENDS IN CONSUMPTION OF CIGARETTES IN THE U.S. ,1. k'eis erg, M. . Medical Director, Sister Mary Phillipa Clinic, St. Mary's Hospital, San Francisco, CA 94117, U.S.A. Cigarette smoking among adult males in the United States dropped from 52% in 1965 to 33% in 1985. The drop •in the percentage of smokers among women was more modest - from 34% to 30%. It is estimated that 40,000,000 Americans have quit smoking. Doctors and other health professionals can serve as exemplars. In the American Cancer Society's Cancer Prevention Study II, only 16% of physicians smoking, and 14% of dentists. Nurses have also reduced their smoking considerably from previous years. Low tar cigarettes have gained in popularity in the United States. Cancer Prevention Study II data shows that 35% of American men and 51% of women smoke cigarettes with less than 12 mg of tar. Previous studies have shown that low tar cigarettes reduce lung cancer risk. Some studies have found that over a short period of time smokers who switch to low tar cigarettes tend to smoke more. CPS I data found that over a 12 year period, most smokers t:h-j switch to lower tar cigarettes tend to smoke the same number per day and a;e more likely to quit smoking. WR-5 TIMN 448520 15
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TIMN 448521
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HETEROCYCLIC AMINES IN CIGARETTE SMOKE CONDENSATES SL-1 T. Sugimura National Cancer Center, Tsukiji 5-1-1, Chuo-ku, Tokyo ]04, Japan The presence of carcinogens such as hydrocarbons and N-nitroso compounds in cigarette smoke condensate (tar) has been well documented. However, there is much more mutagenic activity in the basic fraction of tar than is explained by the known carcinogens. Recently Dr. D. Yoshida and his associates, Central Research Institute of Japan Tobacco Inc. and my colleagues, National Cancer Center have isolated potent new mutagens from this fraction. They were heterocyclic amines represented by amino-tx-carboline. Imidazoquinoline, which was originally identified from charred fish meat, was also recovered from cigarette tar. These heterocyclic amines are mutagenic towards Salmonella and cultured mammalian cells. They are carcinogenic to rodents. The presence of relevant DNA adducts was demonstrated in viscera of rodents and monkeys fed on a diet containing heterocyclic amines. Some heterocyclic amines produce atrophy of salivary glands and pancreas. Calcium deposits on the pericardium are enhanced by feeding mice with a diet containing heterocyclic amines. This evidence provides a new scientific basis for understanding the effects of smoking on development of cancer and other diseases in humans. SMOKING AND WOMEN TMC OK NG RING PREGNANCY: EPIDEMIOLOGICAL AND MORPHOLOGICAL ASPECTS. INGER ASMUSSEN MD UNIVERSITY OF COPENHAGEN DENMARK With time the lifestile and smoking habits of women have become similar to those of men. Likewise women smoke during pregnancy. Epidemiological studies seem to indicate that women when pregnant do not alter their smoking habits. Thus the question arises whether or not smoking during pregnancy have any influence upon the development of pregnancy, child, and consequences for the next generation. The obstetrical complications and clinical neonatal consequences of smoking during pregnancy seem well established.Morphological studies of placenta and cord have shown major alterations in vasculature and tissue maturation. Follow-up studies of children born to smokers are scant, but point at the necessity for such research as to elucidate possible consequences to the next generation due to maternal smoking during pregnancy. SL-2 TIMN 448522 19
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SL-3 SMOKELESS TOBACCO: HEALTH HAZARDS AND REGULATORY ISSUES G. N. Connolly Office for Nonsmoking and Health, Massachusetts Department ofPublic Health 150 Tremont Street, Boston, MA 02111 United States of America Smokeless tobacco use has reemerged among male adolescents in North America and Scandinavia. These products have also been popular for centuries in India, Pakistan, and other Asian nations resulting in some of the highest oral cancer rates in the world. A rise in use of smokeless tobacco will result in a signi- ficant increase in oral cancer, nicotine dependence, and gum diseae among a new generation of tobacco users. Transnational tobacco manufacturers have recently initiated programs to market smokeless tobacco worldwide. Other products including the R.J.Reynolds "smokeless cigarette" are being developed as a way to halt the decline in smok- ing in the United States. This paper will examine the reemergence of oral smokeless tobacco use among young people, describe the product including the "smokeless cigarette" and assess the health implications associated with this rise. Marketing and advertising of smokeless tobacco will be discussed and regulatory and educa- tional activities that can be taken by different countries to address this problem will be presented. SL-4 NICOTINE REPLACE"fENf IN SMOKING CESSATION ~~M.A. H. Russe Addiction Research Unit, Institute of Psychiatry, London SE5 8AF, UK The principles, practice and development of nicotine replacement as an aid to smoking cessation will be outlined. Data will be presented on blood nicotine levels from nicotine chewing gum together with its capacity to relieve withdrawal symptoms and enhance success rates at specialised clinics and in family physician and other settings. To obtain good results, the need for adequate instructions on correct clinical use will be emphasised. Blood nicotine data and preliminary clinical experiences with other forms of nicotine replacement will be described, including a nasal nicotine solution, transdermal nicotine via skin patches and inhalation of nicotine vapor through smoke-free cigarettes. 20 TIMN 448523
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NATIONAL CANCER INSTITUTE'S SMOKING, TOBACCO, AND CANCER PROGRAM FOR THE YEAR 2000 *J. l. Division of Cancer Prevention and Control, National Cancer Institute National Institutes of Health, Department of Health and Human Services Bethesda, Maryland 20892-3100, U.S.A. In 1982, the National Cancer Institute (NCI) initiated a wide-scale smoking intervention research effort through its Smoking, Tobacco, and Cancer Program (STCP). The STCP was designed to achieve part of the prevention objectives of the NCI goal that was established to reduce the cancer mortality rates 50 percent by the year 2000. As the largest intervention research program in the world, the STCP encompasses some 57 trials that involve the testing of several smoking prevention and cessation approaches (i.e., school- based interventions, mass media interventions, physician/dentist-delivered interventions, self-help strategies, and conmunity-based interventions), and emphasize their application in special target populations (i.e., ethnic minorities, women, youth, smokeless tobacco users, and heavy smokers). Of special note is the recent addition to the STCP of the first community-based intervention trials that are designed to test strategies for long-tern smoking cessation among heavy smokers. Collectively, the STCP intervention trials tinpact over 10 million people in over 25 states and 200 cities and have the objective of identifying the most effective strategies to reduce smoking prevalence in the United States. This paper will present information on the STCP trials as well as NCI's plans to move from science to applications in applying the results of the trials for broad public health impact. THE IMPACT OF THE NONS9OKERS' RIGHTS MOVEMIIJP *S. Glantz Division of Cardiology, Department of Medicine, University of California, San Francisco, CA 94143, USA In the West, where cigarette smoking has been around and well-established for the last century, the development of the nonsmokers' rights movement came relativeley late in comparison with concerns related to the effects of primary smoking on the smoker. Because of this, the health community tended to view nonsmokers' rights as a luxury that only deserved attention after all possible steps directed directly towards smokers (such as smoking cessation) had been fully put in place. It is now clear that the nonsmokers' rights movement is not only tremendously important because of the need to protect nonsmokers from the dangers of involuntary smoking, but it also provides the key to undermining the social acceptability of cigarette smoking. These effects on the social environment undercut cigarette advertising and facilitate smoking cessation efforts. i•lore attention ought to be paid to the nonsmokers' rights issue in develcping countries where the tobacco industry has not yet firmly established smoking as normal behavior. SL•5 SL-6 TIMN 448524 21
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4 SL-7 SL-8 THE MEDIA AND THE ANTI-SMOKING CAMPAIGN - THE GREAT AMERICAN SMOKEOUT *E. Gritz Division of Cancer Control, Jonnsson Eomprehensive Cancer Center at UCLA, Los Angeles, California, U.S.A. The Great American Smokeout sponsored by the American Cancer Society has been a prime opportunity to involve millions of smokers in a quitting ef- fort. Surveys by the Gallup organization conducted on an annual basis indi- cate that in 1986 the Smokeout helped 7 million smokers to quit for 24 hours - and days later thousands were still abstaining. Over 17 million smokers tried to quit for part of the day. This involved over 40 percent of adult smokers. The Day also serves to make the total public aware of the smoking problem, to attract people to quit-smoking programs available in 'the local community and to interest many more people in taking action against this issue. Spurred by events generated by local affiliates of the Society the media uses the occasion to report on what's happening in the anti-smoking campaign - what are the successes, the failures, what legislation is being proposed to deal with further controls. And what is the cigarette industry doing to counter the efforts of the anti-smoking forces? All of this generates news in the press, radio and television and this furthers public interest and greater involvement. •The approach of the Smokeout to the smoker is friendly, empathetic and helpful. The enemy is the cigarette. The victim is the smoker. Thus companies, schools, hospitals, public institutions all participate in individual, creative ways. SAYJY.ING AND HEALTH • THE TIME OF APPLICATION E.L. Wynder Division of Epidemiology, The American Health Foundation, 320 East 43 Street, New YoYk, New York 10017, United States The ultimate goal of those concerned with tobacco-related diseases is the ' reduction of that proportion of the diseases known to relate to tobacco usage. Towards this end we have launched a 3-point program which, in increasing order' of effectiveness, includes the low-yield cigarette, tobacco use cessation, and tobacco use prevention. The first involves modification of tobacco products; the second, adult health education and social marketing, and the third, in addition to the benefits of social marketing requires extensive school health education. The presentation will deal with these parameters stressing both the obstacles and opportunities. 22 TIMN 448525
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TIMN 448526
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SMOKING CESSATION IN SPAIN, REVIEW AND EVALUATION OF DIFFERENT APPROACHES (1980-1986) • D. Marin, E. Castellvi, C. Iniesta, C. Muriana, J. Gonzalez, T. Salvador, A. Agusti. Hospital Clinic i Provincial de Barcelona. Servei de Pneumologia. C/ Villarroel, 170. 08036-Barcelona. Spain. Many smokers give up tobacco withouc specialized help, others gave great difficulties in achieving abstinence on their own. The "Pilot Unit of smoking cessation" (HCPB) offers specific help to those smokers with a need for support i giving up. The study presents an evaluation of results from three pe;iods of the Unit. In periode I treatment included groups support therapy alone. In periode II the group support therapy was identical but it was added 'che administration of nicotine chewing gum and feed back. In periode III, a double blind randomised trial with group support plus feed back, plus nicotine chewing gum active and placebo was developed. The study spans the years 1980-1986 and a total of 644 smokers. Abstinence at the end of treatment was 63% for period I, and 85% for periode II. At one year follow-up were still abstinents 18% of ss. in periode I and 47% of as. in periode II. Results from periode three were as follow: a'L:• the end of treatment no significant differences were seen between the ouLcone of the active and placebo groups (69,5% for active and 57,3% for placebo). A significant difference (0,005) was found at one year follow- up (43,8% for the active group versus 27,1% for the placebo group). SfiOKING CESSATION: DATA FROfi THE 1986 ADULT USE OF TOBACCO SURVEY AT. Novotny, W. Lynn, D. Maklan, and R. Davis Office on Smoking and Health, Centers for Disease Control, Washington, D.C. United States of America We report preliminary data from the 1986 Adult Use of Tobacco Survey on methods used for quitting smoking by former and current smokers. This population-based telephone survey sampled 13,032 persons (age >1/ years) in the U.S. using a modified Waksberg random digit dialing technique. Of these, 4700 were current smokers and 3715 were former smokers. Among current smokers, 64% had made a serious attempt to quit smoking, and of these, half had made > 3 attempts to quit. An additional 24% had thought about quitting. Most former smokers relied on self-directed, abrupt cessation or a gradual decrease in smoking; only 2.5% used organized programs. Current smokers were slightly more likely to use organized programs (6.5%). Friends' quitting was important for 7% of former smokers and 5% of current smokers' attempts. Less than 2% of both groups used nicotine gum in quit attempts. Among former smokers, only 26% reported receiving advice to quit from a physician; 44% of current smokers had received this advice. When asked if they would be smoking in 5 years, almost half of current smokers responded "probably not" or "definitely not". These data indicate that smokers are still more likely to quit by abrupt cessation and cutting down than by formal cessation programs. More direct involvement by physicians may be helpful. This data set ioill permit more detailed analysis of cessation efforts among those making successful and unsuccessful quit attempts. SS-1-U1 SS-1-02 TIMN 448527 25
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SS-1-03 SS-1-04 BEHAVIORAL MOTIVATION FOR SMOKING RECONSIDERED *J. C. Brengelmann Max Planck Institute of Psychiatry, Department of Psychology, Munich, FRG Recent literature has thrown doubt on certain assumptions as regards the psychological motivation for smoking. Eysenck's two-phase theory, which has received considerable attention in the literature, states that extraverts smoke'more than introverts for reasons of stimulation and that persons with high neuroticism scores smoke more than those with low scores in order to counteract stressful experience. Several authors have questioned this theory on the basis of inconsistent results. it has been argued that other personal factors should be considered in order to explain more fully why people smoke. in several studies the present author has found that a host of other behaviors may be eligible for this. These findings also throw new light on the process of smoking which may necessitate a reformulation of the concept of pleasure or dependency as recards smoking for two reasons. Firstly, the development of smoking is determined by individual differences in such a way that several processes may be thought of as controlling smoking instead of only one or two. Secondly, smoking relates to other consumption habits, such as drinking alcohol or coffee, taking stimu- lating drugs and/or gambling. Apparently, there are several independent consumption factors which are useful in describing the nature of habituation beyond nicotine. The knowledge of this will expand our understanding of smoking in a wider framework and will help to structure and delineate the meaning of habituation of which smoking is a part. LONG-TERM MODIFICATION OF CHRONIC SMOKING BEHAVIOR: A PARADIG?fATIC APPROACH *Harry A. Lando Department of Psychology, Iowa State University, Ames, Iowa 50011, USA This is an update concerning the activities of a paradigmatic program of smoking cessation research. Previous reports were presented at the 4th and 5th World Conferences on Smoking and Health. The research program has followed a number of themes including: 1. isolation of initial treatment techniques. 2. establishing of maintenance procedures. 3. factorial assessment of treatment components. 4. development of alternatives to aversion. 5. community dissemination of treatment programs. Current research directions include studies of group cohesiveness and nicotine chewing gum. Increasing emphasis is being placed upon developing a range of interventions from self-help manuals through inpatient treatment programs. Pilot work in progress is directed toward recycling of nonabstinent participants from previous clinic studies. Future goals include participating in larger-scale projects that reach nontraditional populations (e.g., less motivated smokers) and that achieve community wide penetration. 26 rIMN 448528
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Dreaming a_bout saoking after giving up *P.Hajek Institute of Psychiatry, Addiction Research Unit, 101 Denmark Hill, London SE5 8AF, England Some smokers who have given up report having dreams in which they smoke and feel alarmed and guilty afterwards. 200 smokers atten3ing the P4audsley Smokers Clinic filled in an end-of-treatment questionnaire enquiring about their smoking-related dreams. Over 30% had had such a dream. A study of dream's deterrrinants and its relationship to other withdrawal symptoms and to long-term abstinence will be presented. PRECURSORS OF RELAPSE DURING SMOKING WITHDRAWAL *A. J. Norris Department of Psychology, Walsall Health Authority, Walsall, U.K. On any single attempt, most smokers who try to quit do not succeed. The purpose of this study was to clarify why giving up is so difficult. The study examined the last relapse episode in 185 smokers. Subjects were classified by smoking behaviour and demographic factors; they were also given a standard, detailed interview. The most freqently cited prescursor of relapse was stress (35%) followed by cravings (28%). Significant results also included the findings that women were more likely to cite emotional precursors of relapse, while men were more likely to cite social factors. Heavier smokers were more likely to report cravings preceding their relapse. It is concluded that these results have implications both for the design of smoking withdrawal programmes and for the selection of participants in such programmes. Advice and preparation for withdrawal should be sex-appropriate, and the central role of nicotine addiction in smoking must be taken into account in smoking withdrawal treatment. SS-1-05 SS-1-06 v •: . TIMN 448529 27
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,.; SS-1-07 BIOBEHAVIORAL LINKAGES BETWEEN SMOKING CESSATION AND THE RETURN TO HEALT' PULMONARY CYTOLOGIC FEEDBACK #G. Swan, G.B. Schumann, T. Roby and K. Sorensen CytoSciences, Inc., Cupertino, California 95014, U.S.A. SS-1-08 28 Numerous epidemiological surveys conducted in the U.S. and around t} world document a relationship between smoking and increased risk fc.. morbidity and mortality due to cancer and chronic obstructive pulmonary disease. While the epidemiological findings mentioned above provide impetr^ to much of the current cessation effort, difficulty remains in providir a clear and observable link between the ex-smoker's abstinence and reduction in risk for pulmonary disease. Such a demonstration could lead 'to enhanced motivation to quit and stay quit. This paper will present a new methodology, using sputum cytology, to bridge the current gap betwee biological cha~ges and behavioral changes in ex-smokers. Known as t} Trend Cytogram this pulmonary cytologic assessment is obtained using a three-day pooled sputum specimen. Simultaneously, eight morphologic components known to be associated with oulmonary irritation or diseae are quantitated in the ex-smoker's pulmonary environment. Data will 2 presented concerning patient compliance with the collection procedures, physician acceptance of the new technology, the reliability of the cytologic rating system, and the sensitivity and specificity of the approach. EFFECTIVENESS OF THE 5-DAY PLAN TO STOP SMOKING IN JAPAN Kyoichi MIYAZAKI1), Hiroshi OGAWA2), and Takaharu HAYASHI3) 1) Japan Health and Temperance Association, 4-33 Uegahara-Yonbancho, , Nishinomiya City, 662 Japan, 2) Division of Epidemiology, Aichi Cancer Center Research Institute, 3) Tokyo Sanitarium Hospital The 5 Day Plan to Stop Smoking had been held in eight locations in Japan, 1984. The film, medical lecture, and mental talk were presented in about 90 minute session for consecutive five days. 148 volunteers responded to the questionnaire at the first day. Among them, 134 volunteers responded to the follow-up survey by mail or telephone after one year. One year success rate was 32.4% where the un-followed 14 volunteers were regarded to the failed Interpersonal relationship, dinner party with alcohol drinking, emotional un- stability, and boredom were the major reported reasons for failure. Discrimi- nant function analysis revealed that the volunteer tended to succeed when he had perceived the attitudes of his family members or co-workers toward his intention to quit smoking as neither cooperative nor critical, but as indif- ferent. It was also found that volunteer with higher self-esteem and better health practice tended to succeed. TIMN 448530
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BROAD-BASED SMOKING CESSATION SELF HELP MANUAL SS-1-O 9 *K. Monaco Manager, Smoking or Health, American Lung Association, New York, U.S.A. V. Strecher, University of North Carolina, Chapel Hill, N.C., B. Rimer, Fox Chase Cancer Center, Philadelphia, PA. The American Lung Association has developed a self-help smoking cessation program entitled FREEDOM FROM SMOKING (R) For You And Your Family. Printed self-help materials appear to have the greatest potential for reaching the widest audience of smokers at the least cost, particularly when mediated through health care settings, worksites and other community settings. The new manual includes state-of-the-art cessation methods presented in a simple format at a fifth grade reading level. Full color graphics are vivid and persuasive with full racial, age and sex representation. Cessation tochniques are presented via case histories with "real" people telling their success stories. Pre-testing included the use of focus group techniques similar to those used by the advertising industry and marketing experts. Initial results among a broad range of smokers in three U.S. cities produced excellent results. In the next year, the program will be evaluated in several settings including an industrial, blue collar population and physician offices pro- viding the manual to patients who receive a prescription for nicotine gum. The American Lung Association wishes to explore potential use of this manual outside the United States, including translation and adaptation to a variety of cultures. EVALUATION OF A SELF-HELP SMOKING CESSATION MANUAL: STEPWISE VS. ACCELERATED PROCEDURE *Th. Abelin, U.F. Bloch, Ch.E. Minder Department of Social and Preventive Medicine, University of Berne, CH-3012 Berne, Switzerland Self-instructional materials are a widely used but little evaluated adjunct in the promotion of smoking cessation. A questionnaire was sent to 1'187 per- sons in Switzerland having ordered a German translation of the American Lung Association self-instructional manual "Freedom from smoking in 20 days". Response rate among those reached was 33.2 7% for the mailed questionnaire, and 97.2 % in a telephone interview survey of a sample of non-responders. Weighted overall estimates of 12-month'abstinence rates range from 15.4 to 19.8 % de- pending on assumptions. In a multiple logistic function analysis, among those completing the questionnaire, 12-month abstinence rates for those using the stepwise proce- dure representing the principal method recommended in the manual were no different from those among buyers not stopping spontaneously and not using the manual at all (relative risk = 1.06), whereas•they were considerably increa- sed for the immediate stoppers (11.9, p <.02) and those using the "Quit Cold Option" suggested as an alternative option (8.7, p <.02). Other factors inde- pendently associated with 12-moth abstinence rates will also be discussed. The results suggest that self-administered smoking cessation manuals are more likely to be of help, if they emphasize a "Quit Cold" strategy rather than a procedure suggesting stepwise reduction of the number of cigarettes smoked. SS-y-1 U TIMN 448531 29
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\ SS-1-11 SS-1-12 30 T:-F ROLE OF SELF-EFFICACY IN ENCOURAGING SLd0i4.RS TO CLUIT Shelley and J.P. Pierce Department of Public Health, University of S;~dney, N.S.W. 2006, Australia Recent studies have shown that self-efficacy is a stror.F precictor of bo- initiation and maintenance of smoking cessation, and that smo):ers' self- efficacy can be enhanced, at least experimentally. Perceived self-efficacy was measured in a random population sam--le of 426 smokers interviewed in their homes in two Australian cities in _!ay 1983. 200 of these smokers were re-interviewed 12 months later. In this cohort, self-efficacy was the ma.;or prec.ictor of a later attempt to quit smo):in,-. Only 36;0 of smokers considered themselves sure of their ability to remain abstinent if they did stop smokinE. ?:en were more likely to report high sel: efficacy than women. Likelihood of high self-efficacy increased with increasin, duration of any previous attemgt to stop smoking, and was inversely associated with number of cigarettes smoked per day. Contrary to ei:uectation, level of perceived self-efficacy was not associated with s.okers' deCree of contact with other smokers, nor with their perceptions of the prevalence of smoking in the wider cor,:unity. These findings suggest that en.hancement of smokers' self-efficacy through anti-sL:okinC campaigns has the potential to bring about chan„e in smol:ir:C 'behaviour in a large proportion of smokers, and indicates that such efforts sh0uld be directed, in particular, towards women, heavy smokers, and those who have never tried to quit. THE SMOKING ENLIGHTENMENT AND WITHDRAWAL. FOR TEENAGERS AND ADULTS *T. Luukkanen and L. Hirvonen Deparment of Physiology, University of Oulu, Kajaanintie 52 A, SF-90220 Oulu, Finland ETRA-LIITTO RY, PL 2, SF-20721 Turku, Finland In 1964 we were the first ones in Finland answering demand for a withdrawal service (Five-Day Plan to Stop Smoking for Adults, McFarland and Folkenberg). Our chairman the professor of Physiology, Leo Hirvonen, MD, has widenly studied the results of our courses. Information on the 1800 participants was collected by questionaries during the courses and one year later in 1973-1980. A publicly advertized cessation course was participated in by 0.2 to 3 people per 1000. Abstinence rate at the end of the five-day period was 81.7 among those who were present at the final session and 57.2 ; of the total number of participants. One year later 32.6 % of these abstainers or 18.7 R of all participants were ex-smokers. The results were more favourable in amal I than large groups. (Publications of the National Board of Health. Finland. Health Education. Series Original Reports 2/1985) For instance, in 1985 the head physisian Paivi Laitinen and the under- signed held a course at which in the fifth evening were present 16 people. After a year 13 out of them had been without smoking. TIMN 448532
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"BREATHE-FREE" -- NEW CESSATION STRATEGIES FOR A CHANGING POPULATION OF SMOKERS *E. Adams Department of Health and Temperance, Seventh-day Adventist Church World Headquarters, 6840 Eastern Avenue, N.W., Washington, D.C. 20012 "Breathe-Free" is a new smoking cessation program which has replaced the 5-Day Plan to Stop Smoking. It contains several major changes over the old program. Smokers in the United States who are trying to quit smoking need help at a different level than in the past. Changes in attitudes about smoking in public and in the work place and now general awareness of the harmful effects of smoking creates a much different climate than 5 years ago. The reasons for quitting are changing. "Breathe-Free" incorporates changes addressing these changes. SMOKING CESSATION IN CARDIAC PATIENTS: PROCESSES OF CHANGE *J. Kristeller, J. Ockene, J. Prochaska, S. Barrett, P. Merriam, J. Klar, I. Ockene and R. Goldberg Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA 01655 The process of quitting and maintaining abstinence may be different for smokers at high risk, such as cardiac patients (pts), compared to healthier smokers. This paper presents data for a population of pts with coronary artery disease (CAD) recruited after a cardiac catheterization to an ongoing random- ized smoking intervention trial. Baseline assessment included a measure of readiness for quitting using the Process of Change Questionnaire (PCQ) (Prochaska & DiClemente, 1983). All pts are monitored at 6 months. PCQ scores were compared to published norms for a relatively healthy population of smokers and non-smokers. In comparison to a general population, CAD pts (n=109 to date) who were still smoking or had recently quit ( 2 mos), were significantly (p .05) higher on 4 of the 10 PCQ scales, indicating greater awarenss of anti-smoking information in the environment, greater concern with the effects of smoking on others, feeling they have support for changing their smoking habits, and a greater sense of social pressure to quit. CAD pts rated lower (p .05) than general quitters on the PCQ scale measuring self-efficacy and positive commit- ment to stopping smoking. For 63 pts evaluated to date at 6-mos follow-up, 3 scales are related to abstinence: greater social support, less awareness of anti-smoking information, and less dependence on external rewards. The group differences may reflect the increased motivation for quitting for CAD patients, marked by their greater use'of the change processes characteris- tic of a period of decision-making. At the same time, predictors of 6-mos abstinence are consistent with those for healthier smokers. SS-1-13 SS-1-14 TIMN 448533 31
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SS-1-15 SS-1-16 ` 32 SMOKING CESSATION IN PATIENTS WITH ARTERIAL DISEASE AND THE EFFECTS OF CONTINUED SMOKING IN THESE PATIENTS W. M.'Castleden, K. Bertei and Y. Wallman University Department of Surgery at the Repatriation General Hospital, Nedlands, Western Australia, 6009. We have previously reported the devastating effects of continued smoking on the survival of patients with peripheral arterial disease (PAD). This study was designed to assess the value of intensive quit smoking advice in these patients. 83 patients with proven PAD were invited to .enter a research protocol in which they completed a questionnaire, had a physical exbmination and gave blood for various blood tests, one of which was a carboxyhaemoglobin (CoHb) estimation. All patients were followed up at 8 and 16 weeks and their blood tests (including CoHb) were repeated. 52% of the patients were smokers when first seen, 42% were ex-smokers; only 5 patients were life-long non-smokers and 4 of these were diabetics. All 43 current smokers were given intensive quit smoking advice. 9 patients (21%) stopped smoking and their CoHb levels returned to normal. A further 5 patients stated that they had quit but their CoHb levels remained elevated. The results of this study reinforce the difficulties in persuading elderly smokers to quit, even when they are suffering from a smoking- caused disease. Those patients who did quit had haematological changes which might reduce blood viscosity and thrombogenicity. Changes were seen within six weeks of quitting. SMOKING CESSATION IN PATIENTS WITH SMOKING-RELATED DISEASES I A CAMPBELL FOR BRITISH THORACIC SOCIETY RESEARCH COMMITTEE Sully Hospital, Cardiff, South Wales, United Kingdom, CF6 2YA From October 1984 to June 1986 67 physicians entered 1415 patients into this multi-centre trial comparing physician's advice alone (Control Group) with an intervention strategy in which the advice was reinforced by a signed agreement to try to stop smoking, two visits by a health •• visitor and repeated postal encouragement (Treatment Group). Those studied were new out-patients attending hospital because of smoking- related diseases. COHb and plasma thiocyanate were measured to validate claims of non-smoking at 6 months. Mean age was 51 years (SD13.4) and 846 were male. Lung disease accounted for 88%, cardiovascular disease only 8%. Average number of cigarettes smoked daily was 17(SD10). Of 710 patients in Control Group 9.9% were validated non-smokers at 6 months compared with 13.5% in Treatment Group (p<0.05). Males did twice as well as females (14.8% vs 7.0%, p<0.0001) and Lhis applied in both Treatment and Control Groups. Abstinence increased with age and there was a suggestion of an interaction between age and treatment (p=0.06), with treatment proving more effective in patients over 60. Differences in abstinence rates between those with lung diseases (11.5%), cardio- vascular diseases (14%) and other diseases (10.3%) were not statistically significant and there was no interaction between diagnosis and Lreatment. Follow-up continues to 12 months: if the difference is maintained hospital physicians will have, for the first time, a strategy which is superior to advice alone and which can be routinely applied to large numbers of patients. TIMN 448534
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SMOKING CESSATION INTERVENTION TRIAL FOR PREGNANT WOMEN SS•4,1'l *Richard A. Windsor, Lynn Artz, John Lowe, and Linda Contreas University of Alabama at Birmingham, School of Public Health, Birmingham, AL 35224 Over the last thirty years numerous reports have confirmed the detrimental effect of cigarette smoking during pregnancy. The principal investigator will present a discussion of a recently funded 5-year trial by the National Cancer Institute to develop a multi-component smoking cessation intervention for pregnant women and to evaluate its impact on cessation rates at delivery and 12-month post delivery. A prospective, randomized design will be used of 1000 pregnant smokers, 500 will be randomly assigned to an intervention group and 500 to a control group. Self-reports and cotinine samples will be collected from all subjects. The results of this trial will provide an insight not currently available in the literature about the effectiveness and durability of smoking cessation interventions in public health maternity clinics. THE ROLE OF HEALTH PROFESSIONALS IN HELPING PEOPLE TO STOP SMOKING: SPANISH PROGRAMME * T. Salvador, J. Gonzalez, D. Marin, A. Agusti. Health Promotion Service. P4 Lluis Companys, 7. 08003-Barcelona. Spain. The purpose of this programme is to face the persisting lack of a compre- hensive Health Promotion Policy in Spain responsible of a 150% increase of smo king Consumption in the last 30 years, while population has increase only a 22%. A representative simple of Spanish doctors was surveyed in 1985, showing that 62% are smokers, have no awareness about their role as "models", and don't have skills to help people to quit. The description of the survey as well as the results of it are presented as a rational for a tryining pro- gramme for Health Professionals of PHC, aim to: 1) Clarify to HPs the importan ce of their role as a "model" group. 2) Promote smoking cessation among HPs. 3) Provide HPs with effective skills to help patients to quit. 4) Support na- tional and local efforts to implement an effective policy on smoking. A des- cription of target groups, methodology, ways of evaluation and two pilot pro- grammes are presented. SS-1-y 8 TIMN 448535 33
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SS-1-19 - SS-1-2o 34 TRAINING FAMILY PHYSICIP.NS IN SMOKING CESSATION COUNSELING J.A. Best, Waterloo Smoking Projects, Canada The Waterloo-McMaster Family Practice Smoking Cessation Project random- ized 70 physician practices to one of three experimental conditions: (1) Usual Care, in which physicians approached smokers in their usual way; (2) Gum Only, wherein physicians advised smokers to quit and offered a nicotinc -bearing chewing gum prescription; and (3) Gum Plus physicians, who were trained with a 3-hour continuing medical education session in a multifacet- ed counseling protocol, including advice, support, nicotine-bearing chew- ing gum, a target date, take-home tip sheets, and a negotiated commitment. A representative sample of 1947 smokers age 16-65 were recruited, and followed 2-month and 12 months post recruitment. Formative evaluation me- thods included monitoring of office and recruitment procedure, a patient research chart, exit phone interviews with a random 15% subsample, taping of simulated physician/patient encounters, and physician focus groups. Analyses of covariance adjusted for pretreatment variables, and saliva cotinine-validated 1-year sustained cessation rates showed significantly better outcomes for Gum Plus patients (8.8%), versus Gum Only (6.1%), and Usual Care (4.4%). Significant predictors of success were identified. Prc -cess analysis identified continuing major compliance problems with nico- tine-bearing gum use, and implications for clinical practice are discussed. The trial is the first large, successful, North American randomized controlled trial of physician counseling for smoking cessation, and the first effectiveness trial using nicotine-bearing chewing gum in which pat- ients paid for their prescriptions. Results suggest the efficacy of cont- inuing medical education in smoking cessation methods, and highlight strengths and limitations to the use of nicotine-bearing chewing gum in routine family practice. A RANDOMIZED COMMUNITY TRIAL FOR SMOKING CESSATION *T. I'echacek for the Community Intervention Trial for Smoking Cessation Investigator Group Smoking, Tobacco & Cancer Program, Division of Cancer Prevention and Control, National Cancer Institute, Bethesda, Maryland 20892-4200, USA The Community Intervention Trial for Smoking Cessation (CO:L*1IT) is a $35 million effort of the National Cancer Institute (NCI) to develop and test.a community based intervention protocol which can be disseminated nationwide to reduce rapidly smoking prevalence in line with NCI's goal to reduce cancer mortality by 50 percent by the year 2000. Heavy smokers (smoking 25 or more cigarettes per day) are emphasized due to their greater cancer risk and diffi- culty in quitting. The two year baseline and planning phase began in October, 1986. The four year intervention phase will begYn in October, 1988. The COMMIT design has 11 pairs of communities matched in size, demogra- phics, and location, with a community from each pair to be randomized to the intervention or comparison condition in 1988 following the baseline surveys. The primary trial endpoint is the smoking cessation rate in each communitv, observed and biochemically validated annually in randomly selected heavy and light-to-moderate snioker cohorts (n=500 in each cohort in each of 22 sites). The intervention will be blinded to cohort identity and directed at all s:nok- ers in the community. Changes in community smoking prevalence also will be monitored annually by cross-sectional surveys. Community coalitions are emphasized in planning and implementing the prot_ col. Interventions will include on-going community-wide (media campaigns, prevention programs, and smokefree policy inititates) and individually-direc- ted (physician advice, self-help and clinic options, and a telephone referrt network) methods coordinated into semi-annual community-wide c,2ssation event . Events will emphasize organizational involvement and peer group support. TIMN 448536
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HOW 50,000 PEOPLE QUIT SMOKING ON A SINGLE DAY: THE EFFECTS OF NATIONAL NO SS-1-21 SMOKING DAY IN THE UNITED KINGDOM AND THE REPUBLIC OF IRELAND *D.J. Reid, P. Linthwaite, L. Seymour and David Simpson. No Smoking Day Committee, 78 New Oxford Street, LONDON WC1A 1AH, UK. National No Smoking Day, organised by a coalition of Government funded agencies and leading health charities, has been a major national event in Britain and Ireland since 1984. Evaluation has revealed widespread support for the event among smokers, over 2.5 million of whom take part annually. A major'three month follow-up study in 1986 revealed that up to 50,000 smokers may have given up smoking as a result at an estimated cost of US$1.60 per year of life saved (compared to $1280 per year for a coronary bypass). Details of this and other studies will be presented, together with practical advice on how to organise a National No Smoking Day for maximum effectiveness at minimum cost. THE 1986 HHS SECRETARY'S COMMUNITY HEALTH PROMOTION AWARDS PROGRAM *R. Lasco Division of Health Education, Centers for Disease Control, Atlanta, Georgia 30333, U.S.A. The 1986 Secretary's Award Program reviewed 197 projects submitted from 52 U.S. States and Territories. Since many of the states selected projects for submittal after a rigorous state review, these projects represent to some extent the best health promotion programs in the U. S. From the 197 projects submitted, 56 were selected to receive the Secretary's highest award, The Award For Excellence. This paper will present a review of the projects submitted which addressed the area of smoking. Specifically, 22 projects addressed smoking in general, 24 projects addressed cessation methods, 5 addressed smoking education programs, and 2 addressed smokeless tobacco. The results of the review will indicate current state of art methods in cessation programs, methods being used in the area of smokeless tobacco, and methods that are of most use to disadvantaged high risk populations. SS_1-22 TIMN 448537 ~ 35
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SS-1-23 THE INFLUENCE OF BUSINESS LEADERSHIP ON SMOKING CESSATIOII IN TIiE UNITED STATES 'A: Judson Wells American Lung Association, 1740 Broadway, New York, NY 10019, U.S.A. The purpose of this paper is to review the development of smoking policies and smoking cessation programs that have come about because of the interest ano backing of business and industrial leadership in the United States. On the basis of information gathered at an international meeting in Washington, D.C. in 1985 it was inferred that relatively little activity of this type was going on in countries other than the U. S. Therefore, a review such as this might bE helpful in get:ting similar activities started in other countries. Forty percent: of the larger companies in the U. S. now have some kind of smoking policy to protect nonsmokers from tobacco smoke compared to only ten percent five years ago. Many of these larger companies sponsor smoking cessa- tion programs paid for entirely or in part by the companies. Examples of such activities in specific well known companies will be given. The effects of group interaction and peer pressure on smoking reduction will be discussed. Legislation passed in many states and smaller subdivisions has aided in this effort, but substantial activity has t:aken place even where no legis]ation is yet in place. It is concluded that the enlistment of business leadership is an important component of a successful national smoking reduction program. SS-1-24 36 TIE EFFECT 0"r' SMOKING BEHiVIOUaS 02 T::i. Pi:aSG*IS ?'ROI•9 T?'F: SUR~ POUNDING;i 014 TIIi: it@:SUL`1S 0.:' ])1St:CCU;i•PUiIII;G `f•t'tE/:Tl.ii.IJT 0y S;'iO.Ki:3S T. Gors.i, Z. Zo3nows i, Z. ;urowaniecci National Antismoking Center, 90-368 hdd:i, Poland The disaccustoming drug, a derivative of lobeline, was exam- ined in 88 men and placebo in 77. In the group of those using the drug 18 persons /10,9;0/ gave up smoking, placebo 12 /7,3;`)/: Although the obvious effect of the drug was not found, 30 pa- tients together gave up smoking /18,2;0/, 135 patients /81,8;;/ stil]. smoked. Both these and the others paid on the average nearly the same number of visits at the doctor's: 3,1 and 3,0 per 4 planned ones. However, 4 visits were more often paid by these who gave up smoking /a6,6';•o/ than by these who still smoked /34,8;5/. After the treatment the patients were inquired into this matter at home in order to determine the results of the treatment, the reasons of giving up the treatment and the effect of smoking behaviours of the persons from the surroundings. It was found out that nonsmoking of cigarettes by spouses, children and superiors had a de.:inite.efi'ect on the results oC the treat- ment. Among the persons, who r,-ave up smoking and these who still smoked, spouses smoked relatively in 20,0,5 and 3i,2;;, children in 0,0;~ and 11,9;'t' and the superiors in 33,3,,; and 41,5i~. As the reason of giving up the treatment they eave the lack ol' time for it and the lack of strong will. r,. TIMN 448538
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A STUDY ON PHYSIOLOGICAL RESPONSES TO PASSIVE SMOKING BY STANDARD AND NICOTINE- LESS CIGARETTES WITH SPECIAL REGARD TO SMOKING HABIT IN YOUIG HEALTHY MALES xM. Asano and C. Ohkubo Department of Physiological Hygiene, the Institute of Public Health, Minato-ku, Tokyo 108, Japan The present study was performed to elucidate the physiological responses to acute exposure to the secondhand smoke with and without nicotine component. In an experimental chamber of which ventilation rate was kept at 0.3 x/h, respec- tive six young healthy male nonsmokers and habitual smokers were subjected to the passive smoking with standard cigarettes(Exp. 1) and nicotineless ones(Exp. 2), and to control experiment without smoke(Exp. 3)• In one trial respective three nonsmokers and smokers, generating the secondhand smoke, were asked to stay together at rest in the chamber. Concentrations of the smoke in the chamber produced by smoking six cigarettes during one hour reached maximal levels of 25ppm of carbonmonoxide and 3.0mg/m3 of total particulate matter for both Exps. 1 and 2. Under these conditions in all subjects, blinking rates increased markedly both in Exps. 1 and 2, though decreased in Exp. 3. The extent of increases in blinking rates in nonsmokers was significantly higher in Exp. 1 than Exp. 2. Heart rates, diastolic blood pressures, and Katz indexes in nonsmokers increased also significantly both in Exps. 1 and 2, as compared with those in Exp. 3, although there was no significant difference between the changes obtained in Exps. 1 and 2. The increased blinking rates were signifi- cantly higher for nonsmokers than for habitual smokers both in Exps. 1 and 2, while, of course, the changes in the other objective parameters were much higher for the smokers. These findings indicate that the secondhand smoke cause definite effects on physiological parameters regardless of its nicotine content of the extent of the changes is largely dependent on the presence of nicotine and the habituation to smoking,`respectively. 1dORKSITE SURVEYS: EMPLOYEE REPORTS OF PASSIVE SMOKE EXPOSURE *R. Addison, M.A. New England Deaconess Hospital, 25 Deaconess Road Boston, Massachusetts, 02215 U S.A. Reducing smoking at the worksite is a major priority of current smoking control efforts. Objective data were lacking to verify the widespread nature of employee health problems associated with worksite passive smoke exposure. Such data were necessary to clarify the problem for administrators and employers. Employee surveys were designed to include questions about worksite passive smoke exposure and these related symptoms: eye irritation, coughing, sinus problems, headaches, nausea, runny nose, difficulty in doing their work and offensive (odor, mess). The surveys included two hospitals (a Harvard Medical School teaching facility and a suburban community hospital) and two private companies (one with offices across the country). The total employee population was nearly 57,000. Survey data showed that between 76%-899 of the nonsmoking respondents reported having one or more symptoms. The results were widely reported throughout the hospitals and companies and were a major factor in demonstrating the need and importance of worksite no-smoking policies to those in control. These policies are in place today. SS-2-01 SS-2-02 TIMN 448539 37
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SS-2-03 SS-2-04 38 PASSIVE SMOKING: ATTITUDES AND EXPOSURE IN THE UNITED STATES *Ti Novotny, W. Lynn, D. Maklan, R. Davis Office on Smoking and Health, Centers for Diatlnne Control, Washington, D.C., United States of America We report results from the 1986 Adult Use of Tobacco Survey regarding attitudes about and exposures to passive smoke in the U.S. Thi.L important population-based telephone survey sampled 13,032 persons (age >17 years) in the U.S. using a modified Waksberg random digit dialing teachnique. Respondents included 3715 never smokers, 4700 current smokers and 4617 former smokers. Overall, 62% reported annoyance at passive smoke, including 83% of never smokers, 71% of former smokers, and 38% of current smokers. Overall, 72% believed passive smoke to be a health hazard, including 87% of never smokers, 80% of former smokers, and 69% c current smokers. One-third of current and former smokers reported that the effect of smoke on others was an important reason for quitting. Although 30-40% of worksites in the U.S. have restrictive smoking policies, over half of working respondents said they were exposed to, smoke at the workplace. Only 2% of respondents reported that smoking was prohibited at the workplace. In choosing nonsmoking vs smoking seating sections, 81% of never smokers, 68% of former smokers, and 13% of current smokers actively choose nonsmoking seating. These results show that passive smoke exposure is widely regarded as a health problem by both smoking and nonsmoking Americans. Therefore, policies that restrict passive smoke exposure may be effective and acceptable public health measures in workplaces and other settings. EFFECTS OF IMPLEMENTING A RIGOROUS IdOR}:PLACE SMOKING POLICY 114 A LARGE PUBLIC IIEALTH AGENCY *Virginia S. Bales Center for Health Promotion and Education, Centers for Disease Control, Atlanta, Georgia 30333, United States In 1987, the Centers for Disease Control, the lead public health prevention agency of the United States government, developed and implemented a rigorous new smoking policy affecting its 4,000 employees in six distant geographic settings and numerous facilities. This rigorous policy was developed through a CDC-wide working group that involved both employees and management. The process helped to assure widespread acceptance among employees despite difficulties attributable to the diverse population of workers, geographic distance, and facility design. The resulting impact of this new policy on the smoking practices of CDC employees will be described from data collected in random sa ~nies of the employee population before (July 1986) and after (July 1937) the new policy was implemented. Overall, before the policy, in 1986, the smoking prevalence among CDC employees (18%) was well below tiie national prevalence (30%). The methods employed to implement a new workplace smoking policy and the measured effects on smoking prevalence of the population provide valuable insights and models for other employers considering inplementation of rigorous workplan policies. TIlVIN 448540 ~
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EFFECT OF PASSIVE SI4OKING BY HUSBAND ON PRE)GNANCY OU'I'GOMFS - A POPULATION- BASED PROSPECTIVE STUDY FROi4 JAPAN *t•9.Nakamura, T.Hiyama, A.Oshima, N.Kubota, K.Wada, K.Yano Kadana Health Center, Kadoma, Osaka 571, Japan The aim of this study is to examine the effect of passive smoking by husband on pregnancy outcomes. Between July 1, 1984 and June 30, 1986, 3,706 women reported on their pregnancies to the city office in Kadoma, Osaka, in accordance with the Maternal and Child Health Law. Of these, 3,478 women filled in a self- administered questionnaire on prior reproductive and medical history, demographic characteristics, smoking and alcohol use. Information of pregnancy outcomes was obtained by certificates of live birth and stillbirth. Of 2,891 women for whom pregnancy outcomes were asertained, 2,837 newborns were delivered alive, and of these, 2,821 were singleton deliveries. Using the data on 2,821 women who were delivered live-born singleton infants, we examined the effect of passive smoking by husband on low birth weight (<2,500g), preterm delivery(<37 weeks gestational age) and low birth weight in term deliveries(>36 weeks gestational age). Among the nonsmoking pregnant women, the crude rate of low birth weight significantly increased from 3.8% to 5.6% with pasive smoking by husband ( relative risk(RR)= 1.5, 90% confidence interval(CI)= 1.01-2.21 ). The crude rate of preterm delivery and rate of low birth weight in term deliveries slightly increased with passive smoking by husband from 3.2% to 3.7% ( RR= 1.2, 90% CI= 0.75-1.80 ), from 2.9% to 3.5% ( RR= 1.2, 90% CI= 0.78-1.96 ), respectively. PASSIVE SMOKING AND HEALTH RISKS TO CHILDREN: A REVIEId OF THE EVIDENCE A.Charlton Cancer Research Campaign Education and Child Studies Research Group, University of Manchester, Kinnaird Road, Manchester M20 9QL, England, U.K. The health risks of passive smoking to children are now unequivocally proven. This paper reviews the research evidence available under the following headings: 1. immediate and short term risks; 2. long term respiratory and other physiological problems other than lung cancer; 3. long term risks with special reference to lung cancer. Research evidence for increased incidence of coughs, colds, influenza, ear, nose and throat infections, asthma, wheeze, impairment of lung function, pneumonia, generally increased admissions to hospital, and possibilities of increases risk of heart and circulatory diseases and lung cancer in the future will be assessed. Since the evidence was at first largely related only to very young children and infants, but there is now increasing research with positive findings related to older children, the paper will consider children from birth to the age of 16 years. The relative risks of passive smoking caused by mothers' and fathers' smoking will be assessed, and the reasons for differences analysed. It is necessary at a World Conference such as this to take stock of the present situation and this paper aims to do that with regard to passive smoking and children. SS-2-05 SS-2-06 TIMN 448541 39
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SS-2-07 SS-2-08 40 EFFECTS OF FAMILY SMOKING ON ACUTF. RESPIRATORY DISEASE IN CIIILDREw *Jong Ku Park and 11 Soon Kim Department of Preventive Medicine, Yonsei University Wonju College of Medicine, llsan-dong, Wonju 220, Korea and Department of Preventive Medicine, Yonsei University College of Medicine, Seodaemoon-gu, Seoul 120, Korea A household interview survey of 3,651 children aged 0 - 14 years was performed in February - June 1985 to assess the relationship between family smoking and acute respiratory disease(cough) in children. Period prevalence of coughing for the past two weeks was 12.3%. Family smoking(risk variable) was measured by using six variables which were: number of smokers in the family, parental smoking, number of smokers in the same room, number of cigarettes consumed daily by all family members, number of cigarettes consumed daily by parents and number of cigarettes consumed daily by the same room members. For multiple logistic analysis, three confounding variables were selected among 21.potential confounding variables through discriminant analysis which were: child's age, coughers in the family and morning phlegm production in the family. Then six logistic models were estimated with each of the six risk variables and the three confounding variables. The range of estimated relative odds of six risk variables was between 1.26 and 3.00. However, three risk variables showed significant negative interactions with coughers in the family. So, if there were coughers in the family, the relative odds of these three risk variables were reduced to around 1. This study does not offer a conclusion that family smoking directly contributes to the development of acute respiratory disease in children. However, this study does suggest the possibility of direct or indirect causal relationship between them. SMOY.IA10 AND PASSIVE SMOKING AS RISK FACTORS FOR LUNG CANCER IN HONG KONG CHINESE :701:.e,;~! *T.H. Lam, 1.T.M. Kung, C.M. Wong, W.K. Lam, J.W.L. Y.leevens, D. Saw, C. Hsu, S. Seneviratne, S.Y. Lam, K.K. Lo, W.C. Chan Department of Community Medicine, University of Hong Kong, 5 Sassoon Road, Hong Kong In a case control study in Hong Kong, 445 cases of Chinese female lung cancer patients all confirmed pathologically were compared with 445 Chinese female healthy neighbourhood controls matched for age. The predomir.ant cell types were adenocarcinoma (47.5%) and squamous cell carcinoma (20.8%). 54.5% of the cases were ever-smokers and 45.5% were never-smokers. The relative risk (RR) in ever-smokers was 3.81 (F<0.001). The R.R's were statistically significantly raised for all major cell types (squamous call carcinoma 8.10, small cell carcinoma 12.00, adenocarcinoma 1.87 and large cell carcinoma 6.d3) with significant trends between RR and amount of tobacco s:noked daily by the cases. The results show that smoking is a risk factor for all major cell types of lung cancer, including adenocarcinoma which :ras previously thought to be unassociated with smoking in Hong K.cng. Among never smoking women, RR for passive smoking due to a smoking husband was 1.65 (P<0.01) with a significant trend bet:reen FIR and amount smoked dai:;; by tY.e husband. When broken dor:n by cell.t;.res, the nu:abers were substantial only for adenocarcir.ema. The RR was significantly raise 3 for adenoca:•cinc::.a (RP.=2.12, F<0.01) with a significant trend but not for other cell t; r-,es. The results suggest that passive smoking is a risk factor for lung cancer, particularly adenocarcinoma in Chinese wepen who never smoked. TIMN 448542
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PASSIVE SMOKING AND LUNG CANCER IN WOMEN * R. Inoue,** T. Hirayama*** Kanagawa Cancer Center, Asahi-ku, Yokohama 241, Japan** Institute of Preventive Oncology, Shinjuku-ku, Tokyo 162, Japan*** (1) A Case-Control Study on husbands smoking and lung cancer risk in non-smok- ing wives was conducted in Kamakura and Miura cities in Kanagawa prefecture, Japan. 37 cases of lung cancer and 74 cases of age, residence matched cont- rols ( selected from deaths for cerebrovascular diseases ) were compared. Out of these 22 and 47 cases were non-smokers respectively. (2) Non-smoking wives whose husbands smoke up to 19 cigarettes a day ( case 3, control 11 ) and more than 20 cigarettes a day ( case 15, control 19 ) were found 1.2 ( 0.3 - 4.8 ) times and 3.4 ( 1.2 - 9.7 )times respectively more likely to suffer from lung cancer than women married to non-smokers ( case 4, control 17 ) ( chi-square value for trend 4.06, two sided P-value = 0.044 ). (3) The lung cancer risk for women who smoke ( case 7, control 7 ) was 4.25 ( 1.2 - 14.8 ) times higher than non-smoking women with non-smoking husbands. (4) Household survey conducted in the same prefecture in 1986 revealed that 100 % of heavy smokers ( a pack or more a day ) and 80% of other smokers ( less than a pack a day ) smoke cigarettes at home, those smoking 6 or more chiga- rettes at home being 83.9% and 40.8% respectively. (5) Smoking at home should therefore strictly be restricted in order to prevent non-smoking members of the family unnecessarily suffer from lung cancer and other selected diseases. PASSIVE SMOKING AND LUNG CANCER IN TWO SWEDISH STUDIES * .Pershagen and C.Svensson Department of Epidemiology, National Institute of Environmental Medicine, Box 60208, S-10401 Stockholm, Sweden The relation between passive smoking and different histological forms of lung cancer was investigated in two Swedish case-control studies. One study was nested in a cohort of 27409 nonsmoking women in which 77 lung cancer cases were identified during follow-up. Information on smoking habits of study subjects and spouses was obtained from questionnaires. The other study was a population based case-control study which included 36 women with lung cancer who had never smoked. Exposure data were obtained at interviews before diagnosis. Both studies showed an increased risk of squamous and small cell carcinomas in women married to smokers with an overall relative risk of 2.0. The increased risk was statistically signi- ficant (p<0.05) in one study and positive dose-response relationships were indicated. Neither of the studies showed an increased risk for other histo- logical types. Our findings suggest that exposure to environmental tobacco smoke is related primarily to those forms of-lung cancer which show the highest relative risks in smokers. SS-2-09 SS-2-10 TIMN 448543 41
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SS-2-11 AA-2-Z 2 42 PASSIVE SMOKING AND ADULT t10RTALITY "°A. Judson Wel ] s tlational Council for Clean Indoor Air, 316 Pennsy]vania Ave., S.E., Suite 400, Washingt:on, D.C. 20003, U. S. A. The purpose of this paper is to estimate the number of adult: deat.hs per year in the U. S. from passive smoking. The epidemiological literature on passive smoking and adult: mortalit•y and cancer and heart morbidity is re- viewed. Combined reJat:ive risks for lung cancer, cancers ot:her than lung and heart: disease are calculated for each sex and disease category. These dat:a along with estimat:es of nonsmoker death rates and populations exposed a]]ow calculation of annual deaths in each category. The resulrs are updated from a similar analysis that was presented at the June, 1936 meeting of the Air Pollution Cont:rol Association (U. S.) by (1) including data from epidemio- ]o~ical studies published since December, 1985 (particularly the new heart studies), (2) using a more refined analysis that takes into account reduced relative risk and reduced exposure at: older ages, (3) using heart nonsmoker death rates that: reflect: the dramatic reductions of the last 20 years, and (4) expanding the age range from 45-79 to 35-84. Alt:ooet.her, 47,400 deat:hs per year were calculated consisting of lung cancer, 2500, other cancer, 22,700, and heart disease, 22,200. Reasons why such high estimates for ot:her cancer and heart disease may be possible are ex.plored. It: is concluded that exposure to environmental tobacco smoke can have adverse long term healt:h effect-s that are more serious than previously thought. THE HEALTH CONSEQUENCES OF INVOLUNTARY S?tOKING: OVERVIEW AND CONCLUSIONS OF THE 1986 SURGEON GENERAL'S REPORT *D.R. Shopland Office on Smoking and Health, Centers for Disease Control, 5600 Fishers Lane, Rockville, MD 20857, USA The health effects of active smoking have been extensively documented in 17 previous reports of the U. S. Surgeon General. The possible health consequences of "passive smoking" have only been the subject of serious scientific investigation in the past 10 years. Between 1981 and 1986, 13 epidemiological studies examining an increased risk of lung cancer in nonsmoking spouses of smokers have appeared in the published lit- erature. Eleven of these studies noted a positive association, six of which observed statistically significant results. Several studies found a dose- response relationship. The epidemiologic studies reinforce data related to environmental levels of tobacco smoke constituents and measures of nicotine absorption in nonsmokers, which suggest that nonsmokers are exposed to levels of environmental tobacco smoke that would be expected to generate a lung cancer risk. Published estimates indicate that between several hundred and several thousand cases of lung cancer among nonsmokers can be attributed to passive smoking. The Report of the National Academy of Sciences indicated that approximately 2,400 such cancers occur annually in the U.S. This compares to between 1,300 and 1,700 new cancer cases as a result of general air pollu- tion in the U.S. environment from both stationary and nonstationary sources. ~-IMN 448544
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BANNING, SMOKING AT WORK - THE AUSTRALIAN EXPERIENCE C. Fitzwarryne Health Advancement Division, Dept of Health, Canberra, Austra]ir.i A smoking ban was implemented in all Australian Health Departmcunt buildings on lst December 1986, because of the strength of the National Health & Medical Research Council's recommendations in Juno~ 1986 on passive smoking. The powers of a Departmental head to institute a ban are clear. The implementation strategy used included departmental assistance to smokers, incentive schemes, a 5 months back-up time to resolve conflict, and guidelines for supervisors on their role in counselling and ensuring compliance. An education strategy which confronted issues of concern (ventilation, smoking rooms, time-off to smoke, and civil rights) was undertaken. Staff complied with the ban. Supervisors employed a flexible approach regarding individual gradual adaptation and staff going outside in their own time for a smoke. 2 voluntary surveys were undertaken, one six weeks after the announcement of the policy, and the second 5 months after the ban was instituted. The first provided information of use in planning strategies to assist smokers. The second provided information on the smoking status of employees and residual problems, analysis of which is useful in providing guidance to other Australian workplaces. The Health Department strategy is now being adopted by large numbers of workplaces throughout Australia. T HE S.MORE-FREE XV OLYMPIC WINTER CAD!ES - CALGARY *J.H. Read Department of Community Health Sciences, Faculty of Medicine, The University of Calgary, Alberta, Canada The first-ever Smoke-Free-Olympic Program developed for the Calgary Winter Olympics and supported by the Canadian Council on Smoking and Health and Physicians for a Smoke-Free Canada will be presented. Critical incidents in gaining approval for the program include 60 letters of support from athletes, health organizations, non-smokers rights groups and government officials. The objectives of the program are: (1) primacy for the athlete by providing smoke-free Olympic spaces; (2) protection of the non-smoker from second-hand smoke; (3) enhancement of the healthful image and the dignity of the Olympic games. The Smoke-Free spaces will include the athletes' villages, Olympic vehicles and public transportation, all competition sites, medal presentations and banquets. Each of 7 venues will have designated smoking areas. Sale of tobacco products will be limited and no sponsorship of tobacco products will be allowed. The program will consist of (1) signage; (2) providing information packages for all winter Olympic countries and all Sports Federations; (3) assigning venue managers to oversee the provision of smoke-free spaces. A method of evaluating the effectiveness of the program will be described. Delegates to the 6th World Conference will be asked to spread the word! SS-2-13 SS-2-14 TIMN 448545 ' 43
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SS-2-15 SS-2-16 DEVELOPING SMOKE-FREE ORGANIZATIONS - A 1!ODEL PROCESS FOR CHANGE *A. Stuart Hanson, N.D. Department of Pulmonary Medicine, Park Nicollet Medical Center, 5000 West 39th Street, Minneapolis, Minnesota 55416, U.S.A. Park Nicollet Medical Center, a multi-specialty group practice with 19 offices, 280 physicians and 2,000 employees in Minneapolis and St. Paul, Plinnesota; followed a seven step process to become a totally smoke-free organization and environment. It used management methods to develop staff attitudes and acceptance of a smoke-free buildings and grounds policy for patients, visitors and employees. The methods included the following steps: (1) Governing body commitment; (2) an identified person in charge (called the prime mover); (3) a representative implementation task force, including smokers and nonsmokers; (4) employee surveys; (5) a formal communications plan; (6) a written policy implementation plan; and (7) a follow-up evaluation. Over a two year period, a comprehensive smoke-free policy was implemented prohibiting smoking in all buildings and grounds and preferentially hiring nonsmokers. Smoking rates in employees fell dramatically and documented support for a total ban grew during the two year process. kfien the final smoking areas were removed January 1, 1986, there was no significant resistance. This model process of organizational culture change prohibiting smoking has been used successfully by hospitals, schools, businesses and public agencies in ?:innesota to create more smoke-free organizations. THE POSITIVE IMPACT OF 100% SMOKE-FREE HOSPITALS L. Fairbanks, Indian Health Service, U.S.Public Health Service, Phoenix, Arizona, U.S.A., Member:U.S. National Advisory ComQnittee on Smoking & Health The December, 1986, U.S. SURGEON GENERAL's REPORT ON SMOKING & HFALTH:THE HEALTH CONSEQUENCES of INVOLUNTARY SMOKING, has combined with the already very sig- nificant impact of the studies on"Passive Smoking" from Japan & other nations, to make a leadership role by health care professionals & hospitals, even more crucial than ever in leading the way to healthier smoke-free environments. The Indian Health Service(IHS),a division of the U.S.Public Health Service,de- cided in 1985 to develop a policy of total indoor smoking bans at all of its over 200 hospitals/clinics/administrative offices located in 25 states.(U.S.A.) An extensive educational campaign first prepared:employee staff,patients & American Indian/Alaska Native leaders as to the logical reasons for the policy: health/safety, cost savings,air quality/cleanliness & health promotion credi- bility. There was widespread endorsement& participatory involvement on the implementation planning committees. Employee unions were specifically invited to have important roles in the plans for timing and phasing of the steps to reach the final smoke-free goal.Time needed to reach the goal varied at differ- ent facilities between 1-24 months. 6-12 months seemed to be the ideal timing. Smoothness of achievement was directly proportional at each facility to the role model leadership shoam,and degree of commitment to the goal. There were few problems, all of which could be overcome, and many positive, shared experi- ences by employee staff,patients, & community representatives,as the smoke-free goal was reached at each facility.Positive commendations were given.Private hospitals also joined in the smoke-free movement, as did schools & businesses. We were mutually helpful and supportive to one another.Indoor smoking pollutes! The 100% smoke-free hospital is a realistic, attainable goal. It has a posi- tive leadership impact on the rest of society, as we seek better health for all. 44 TIMN 448546
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r THE IMPACT OF THE NON-SMOKERS' RIGHTS MOVEMENT ON SMOKING HABITS IN THE U.S. AC. Gouin Group Against Smokers' Pol lution (GASP) Inc., P. 0. Box 632, College Park, Maryland 20740, U. S. A. This paper reviews how the non-smokers' rights movement has become one of the most effective means to reduce the incidence of smoking in the United States. It examines how non-smokers, motivated to protect their own health from ambient tobacco smoke, have become an active force in promoting a smoke- free society. Public pressure on smokers, regulations limiting places where smoking is allowed, legislation protecting non-smokers, and the resulting increase in public awareness of the issues have made smoking much less socially acceptable in the 1980s than it was in the previous decade. The percentage of smokers has declined, from 37 percent of the adult population 10 years ago, to 30 percent today. Not only is the per capita consumption of cigarettes down (from 12 per day in 1965 to 9 per day in 1986), but so is the total production of cigarettes (from a high of 634 billion in 1981, to below 600 billion in 1986). Smokers are smoking less when there are smoking restrictions in public places and in workplaces, and when smoking is discouraged in social situations; they are also finding it easier to quit. For decades, cigarette advertising promoted smoking as a socially desirable activity and smoking increased; now, society is viewing it as an undesirable activity, and smoking is decreasing. There is a definite correlation between the rise of the non-smokers' rights movement and the decline in smoking. Together with public education, health warnings, and cessation programs, it is an effective tool in the anti-smoking campaign. iti(lli_Si9t)KtItSt RICIII 0113 Pl1Bl IC ili Al IL H Qllu(iel'il, i)(11411'tihellt of hill)I i(: I10"WII• i.'1O IIISt Itllle of PUIII iC Ileal III,G-1 Slll I'Ok111e+1i1I, 4-1:1101110. I•Illil l 0-I((I, 101(y0 1()u, Jilllilll iile i41SiC cOnCCUtS Uf t!lIS StudY 1Yi15 to cUll5llier Ille IIISt01•iCitl i)ntl SOCiO- cliturill rclaliunshiu hr,tu., r.cu nun-smolcerg'right an(1 publie hcaltll Oil Ihc I,asc of humiln nncds and uorms.PubIiC hoaltll ilas v(:rY ilnpoftiult role for thc urolnotion Of thC 1I11i1111Y of ':ifc IIII'O(It,Jll the ilCtivilleS \tith IoI1J process i111Q II(1111111 cor,sOnsus.In order to establish lhe Ine exl+ectetl ileillIh polir.y,this study had IIW f1Ula,iil I1eIliIVIUuI' i11U1 I101'lu aplll•OCheS,effICIU1ICY nli/l COlllpill'iS011 ilUpl'OilClleS, orpaIUin tion and f.ontemlcncy approilches oH tilc asVects 1lealth p011CV sci(:ncc lo nn;liyse hislnricill ;lucl socio-(:uilurill Iracl(grauncl for non-smolters'rillhl and pr.lbllC Ile+lllh. SS-3-01 SS-3-02 TIMN 448547 45
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i SS-3-03 SS-3-04 46 CITIZEN NONSIIOKERS' GROUPS AS LEADERS FOR CHANGE *Regina Carison New Jersey GASP (Group Against Smoking Pollution), 105 Mountain Avenue, Summit, New Jersey 07901, U.S.A. Unlike traditional health-promotion organizations, nonsmokers' groups are small, independent, local, flexible, single-issue organizations, primarily comprised of individuals motivated by their reactions to secondhand smoke. In 1974 citizens created New Jersey GASP (Group Against Smoking Pollution),. Strategies have included news releases, conferences, public hearings, guest editorials, art exhibits, confronting tobacco promotions, advertisements, legal actions, press conferences, pi-oviding unique information, public demonstrations, documenting sales to children, supporting legislation, and radio and TV interviews. Using volunteers and spending little, New Jersey GASP has encouraged New Jersey to become a leader in creating a smoke-free society. Coinciding with GASP's activities are several measures of impact: GASP has been interviewed for hundreds of reports in local, state, national and international media. Numerous polls show increased social support for control of smoking in New Jersey. Nine state laws limiting smoking have been passed. Hundreds of employers, restaurants and others in the private sector have created nonsmoking areas. Throughout the United States the greatest social, legislative and private sector changes on smoking are correlated with the existence of local citizen nonsmokers' groups. A STUDY ON THE RELATION BE'IWEEN A LAWSUIT TO PROPK7PENON-SMOKERS' RIGHTS AND THE CITIZST7S' NOVEf4LNT ADVOCATING SUCH RIGHTS Y. Isayama Attorney-at-Law, Yotsuya Law Office, Ito Bldg. 2, Yotsuya 1-chome, Shinjuku-ku, Tokyo 160 Ja?an This study evaluates the efficacy of a lawsuit to promote non-smokers' rights as a rmans to advance a citizens' movement advocating the same, and takes the kenenken lawsuit as an example. In 1978 Japanese citizens conerenced various actions to promcte non-smokers' rights. At that time, smoking was allowed in every car of every Japanese National Railway ("JNR") train except for urban trains and certain Tokaido bullet trains, in which one non-smoking car was provided. Babies, pregnant wcxnen and passengers with respiratory troubles wkare confined in a train filled with smoke. The citizens filed petitions and complaints asking to be provided with non-smoking cars, but to no avail. At last, they instituted a lawsuit as a strategy to promote the citizens' movenent. The strategy proved successful. Six months after the lawsuit was filed with the Tokyo District Court, JNR provided one non-smoking car in all Tokaido bullet trains and in November, 1932 ,ecided to provide non-smoking cars in all long-distance and medium-distance trains. Conclusion: The very pursuit of a lawsuit, regardless of the judgment, has proved to be an effective means to attain the particular goal of the citizens' movement to promote non-smokers' rights. - TIMN 448548b
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AMERICA'S NONSMOKERS' REVOLUTION: EFFECTS AND IMPLICATIONS *John F. Banzhaf III, Esq., Executive Director & Chief Counsel, Action on Smoking and Health (ASH), and Prof of Law, National Law Center, George Washington University, Washington, D.C., USA As Executive Director of ASH, the organization which first started the Nonsmokers' Rights Movement in the U.S., Mr. Banzhaf summarizes what has already happened in his own country, and how the Nonsmokers' Rights Movement has already become the most important single factor in per- suading people either to quit or not take up smoking. He suggests the arguments and techniques for creating or strengthening the movement in other countries. ACTIONS TO BE UNDERTAKEN BY MILITANT NON-SMOKERS IN SOCIAL LIFE: Jean Tostain, Ligue Contre la Fum6e du Tabac en Public, 14, reu du Petit Ballon 68000 Colmar, France. Summary : 1) our militant action is based on the assumption that in places used collectively, the air should be clean and more particularly free tobacco smoke; the non-smokers should be aware of their rights and have them aknowledged by smokers. 2) The militant does everything on his behalf to make the exis- ting regulations work and possibly to improve them. He calls out for well isolated smokers' rooms, smokers being in far smaller numbers than smokers. To this effect he takes initiatives with : - local authorities, M.P.s (Members of Parliament), ves or any elected bodies, - professional and medical authorities, - newsmen in the press, the radio an TV. representati- 3) The French Non-smoker association will make available as soon as possible a practical guide for non-smoker militants tc help them ensure that existing regulations are put into practice. 4) our Non-Smoker association 'asks the French government and National Health Services for a substantial grant for prevention purposes : its action helps prevent the whole population from be- ing intoxicated by unhealthy air. SS-3-05 SS-3-06 TilVIN 448549 47
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SS-3-07 THE PROBLEM OF THE CIGARETTE SMOKING IN THE OFFICE, FOR MY CASE * K. Niwayama Tokyo Metropolitan Research Laboratory of Public Health, Shinjuku- ku, Tokyo 160, Japan For cigarette smoking in the office, I have been disturbed to' the health and the efficiency of the work. I claimed to improve on the circumstances of the office to The Secritaritate to Personnel Commission of Tokyo Metropolitan Government, 1983 September. The Commission have advised to my office to correct smoker for neglecting non-smoker s health in 1985 May, however, I could not escape the influences from the bad and uncomfortable air of smoking. Then, now I have claimed again to the commission for making the smoking room where non-smoker never use in 1986 July. And it has been under consideration. SS-3-0 $ NON-SMOKERS' RIGHTS IN SWITZERLAND *Ingela Spillmann Swiss Association for Non-smoking, SAN, P.O.Box T43, CH-8029 Zurich, Switzerland The Swiss Association for Non-smoking, SAN, was founded in 1977 as a people's movement to activate and engage everybody for a non-smoking way of life by means of non-smoking rights. This study will show different ways to promote non-smoking rights at places of employment, in restaurants, in public places and in public transport. In Switzerland there are now both recommendations and laws to protect tne non-smokers. Conclusions: Recommendations may be as valuable as laws; important is the compliance. Non-smokers' rights are not only of interest to non-smokers but also an important step toward a decrease in tobacco consumption. 48 TIMN 448550
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SOCIO-ECONOMIC PROBLEMS OF SMOKING IN A DisVELOPING COUNTRY *S. K. TEOH Action on Smoking or Health, Malaysian Medical Association, Kuala Lumpur, Malaysia Many developing countries, such as Malaysia, have an important tobacco agriculture which often presents a strong lobby against the anti-smoking campaign. Duties on cigarettes also provide a significant portion of government revenue. Malaysia's 40,000 tobacco farmers earn about US$25 million. The annual turnover of cigarette sales came to about US$600 m, half of which goes to the government as duties. However, the cigarette industry is 95% controlled by 3 multinationals, thus leading to loss in foreign exchange. 40% of the tobacco consumption is still imported. There are also losses from treatment of smoking-related diseases, fires and pollution. SMOKING AND THE REDUCTION IN'WELFARE ------------------------------------ J.H.Hagen Hofpoort Hospital, Polanerbaan 2, 3447 GN Woerden, The Netherlands Economic growth, measured in terms of national income, especially in rich countries is greater than increase in the subjective wel- fare of the people. One reason for this -among others- is the increase in the negative effects of production and consumption. This paper explaines the relation between smoking and subjective welfare in this respect: smoking brings about an increase in 'objective- national income due to the consumption of cigarettes and anti-bads as health care but subjective welfare decreases as a result of smoking related negative welfare effects. It will be argued, that as a consequence of prevention of smoking an increase in subjective welfare will occur in spite of a decrease in production and-consumption. A slight negative effect on national income will be offset by the growth of subjective welfare. SS-4-Oy SS-4-02 TIMN 448551 49
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SS-4-03 KNOhTLEDGE AND ATTITUDES ABOUT TOBACCO AMONG PHARAfACISTS h'HO DO AND WHO DO NOT SELL TOBACCO i + L. Davidson, *J. Slade, and C.L. Stang College of Pharmacy, Rutgers University and UPIDNJ-P.obert Wood Johnson 23edical School, New Brunswick, New Jersey 08903, U.S.A. While pharmacists are being encouraged to intervene with their patients who smoke, the knowledge and attitudes which pharmacists have about tobacco have received little attention. Personal interviews were conducted among two groups of pharmacists: 14 working in drug stores which sell tobacco, and 13 working in tobacco-free pharmacies. Both groups were similarly well-informed about which specific illnesses'are caused by smoking cigarettes, but the tobacco-selling pharmacists substantial- ly underestimated the amount of illness and death caused by tobacco compared to other causes of preventable illness (p=0.03). Pharmacists who worked in stores which did not sell tobacco exhibited a significantly greater degree of self-confidence (enhanced sense of self-efficacy) that their counseling would be helpful in fostering the cessation of tobacco use among their patients (p=0.04). Pharmacists working in stores which did not sell tobacco had a more realis-', tic perspective of the harm caused by tobacco and their attitude towards helping people quit was more positive than that of those working in stores which sold to~acco products. The sale of tobacco products in health care facilities such as hospitals and pharmacies is often condemned as unethical. The absence of tobacco products from such facilities may have an additional benefit: in the present survey, this characteristic was associated with a positive attitude by the staff towards promotion of a tobacco-free lifestyle. SS-4-04 SMQKIHO HA@ITS AHD MEDICAL EX2EHDITIIRE IN A HALE EHQLOXEE eDEllLATIQH R. Kondo Medical Department, Mobil Sekiyu Kabushiki Kaisha, P. 0. Box 5010, Tokyo Int. 100-31, Japan How do smoking habits relate to medical expenditure? Do smokers spend more than non-smokers? Do heavy smokers spend oore' than light smokers? To answer the questions, the author examined correlations among smoking habit, other habits, physical charac- teristics. ER data, and medical expenditure of 952 male employees (468 non-smokers and 484 smokers) of a company. The medical expenditure was examined by analyzing the bills sent from hospi- tals to the health insurance society. Unexpectedly, it was the light smokers who spent most, follved by the non-smokers and the moderate smokers; the heavy smokers spent least. Medical costs per head in a year were 77,200, 85,120, 71,390, and 63,340 yen for the non-smokers, the light smokers, the moderate smokers, and the heavy smokers, respectively. Physical characteristics and health check ratings did not differ among the moking habit groups. The light smokers drink moderately, exercise a lot, do not eat too much, work overtime not so much, and take a lot of vacation; whereas the heavy smokers drink a lot, exercise only a little, pay little concern for eating habits, and work very hard. These data suggest that in this healthy employee population, the medical expenditure of the smoking habit groups depends more on the attitude toward health (health consciousness) than on morbidity or health status. 50 TIMN 448552
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TOBACCO AND UNITED STATES TRADE SANCTIONS Gregory N. Connolly DMD MPH Director, Office for Non-Smoking and Health, Massachusetts Department of Public Health, United States of America The United States has used the threat of trade sanctions to require Japan, Taiwan and Korea to remove trade barriers which restrict import of cigarettes produced by transnational companies based in the United States. The three countries have or recently had state owned tobacco monopolies that are protected from foreign competition by high tariffs on imported cigarettes and other trade restrictions. In absence of competition, the monopolies do little advertising, and in Taiwan and Korea a harsher native tobacco is smoked. In 1986 Japan agreed to remove its tariff and eliminate distribution problems. Taiwan followed suit and also agreed to allow cigarette advertising. Greater access by transnational cigarette companies will result in changing how cigarettes are made and advertised. Lighter tobacco which is easier to inhale should become more popular and cigarettes will be advertised heavily. Based on the United States experience these changes will result in more smoking by women and adolescents. This paper will describe how transnational companies influence United States trade policy and how public health officials in these countries can counteract the marketing efforts. SUING THE TOBACCO COMPANIES IN THE U.S.: PROBLEMS & PROGNOSIS Athena Mueller, Esq., General Counsel, Action on Smoking and Health (ASH), Washington, D.C., USA From her perspective as General Counsel of the Organization which serves in the U.S. as the legal-action arm of the antismoking community, Mrs. Mueller describes the history of litigation by smokers and others against the tobacco industry, the legal theories under which they can and often are proceeding, and how a"new wave" of such lawsuits has captured the public's attention and renewed their interest in smoking-related issues ' such as the huge public costs and the addictive nature of nicotine. As a former English Barrister, Mrs. Mueller also notes possible parallels in other common-law countries. SS-4-05 SS-4-06 TIMN 448553 51
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5 SS-4-07 TOBACCO ADVERTISING AND MAGAZINE COVERAGE OF TOBACCO AND HEALTH: AN EMPIRICAL STUDY *K. Warner School of Public Health, Univ. of Michigan, Ann Arbor, MI, USA 48109 Many observers argue that U.S. magazines' dependence on tobacco advertising revenues causes the magazines to suppress coverage of tobacco and health. To date, this conclusion has derived from anecdotal evidence and simple correlation studies. In the present study, the relationship is investigated through multiple regression analysis comparing detailed data on magazine ad revenues and coverage of tobacco and health, controlling for magazines' types, size, readership demographics, general health coverage, etc. Data sources include a computerized index of over 400 magazines, dating back to 1959, and ad-specific information for close to 150 magazines. Regression results (not available as of this writing) will be presented. SS-4-08 THE IMPACT OF CIGARETTE ADVERTISING ON THE DEMP.ND FOR CIGARETTES *J.Chetwynd, P. Coope, R. Brodie, E. Wells Christchurch School of Medicine and University of Canterbury, Christchurch, New Zealand. The tobacco industry have always claimed that advertising of cigarettes influences only brand choice and does not increase overall demand for cigarettes. During the last five years, several international studies have been publish- ed, some of which support the industry's claim and some of which do not. This study, using New Zealand data since 1973, models the demand"for cigarettes, taking into account price, wage and expenditure on cigarette advertising (in print media). It explores both linear and log models and both statia and dynamic models. It examines the relationships using monthly, quarterly and annual data. The results present consistent evidence that cigarette advertising does have the effect of increasing aggregate demand for cigarettes. Furthermore, the dynamic models suggest there is a long term carry-over effect. The advertising elasticities differ slightly between models but are aroe:nu 0.08. The results also suggest some reasons for inconsistencies in previous research findings. The policy impi.ications of these findings in terms of the need fer further restrictions on cigarette advertising will be discuczed. '' IMN 448554 52
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EFFECTS OF SMOKE FREE WEEK AND LARGE TAX RISE IN NEW ZEALAND Deirdre Kent Director of ASH (NEW ZEALAND), PO BOX 8667 Symonds Street, Auckland A 55% increase in the price of cigarettes was imposed in 'late July 1986, resulting in a 16% decrease in the sale of cigarettes for the nine month period after the price rise, compared with a similar nine month period the previous year. The climate for the large tax increase was set by a year-long campaign for tax increases conducted by the health agencies, and a national high profile Smoke Free Week which took place in early July. It is postulated that the Smoke Free Week which had an awareness of 96% and an approval rate of 84% created a favourable political climate for the largest tax increase in 103 years. There was no tax increase in 1987, election year, or in 1985. Because of the twin events in mid 1986 mens' smoking rate dropped from 30% to 25% while the prevalence of women rose from 29% to 31%. THE CONTRIBUTION OF PUBLICITY TO THE FASTEST DECLINE IN CIGARETTE ~ CONSUMPTION IN_THE WESTERN WORLD *Donald Reid, Linda Seymour, John Hitchins, Peter Linthwaite, Spencer Hagard and °David Simpson. *t3ealth Education Authority (HEA), 78 New Oxford Street, LONDON WC1A 1AH, UK and °Action on Smoking and Health (ASH), 5-11 Mortimer Street, LONDON W1N 7RH, UK. Between 1980 and 1986, the number of cigarettes sold annually in Britain fell from 120,000 million to 92,000 million, the fastest decline ever recorded in a major industrialized country. The purpose of the paper is to explain why this occurred. The two main causes were tax increases and the launch in 1980 of a major health education programme by the Health Education Authority, in conjunction with Action on Smoking and Health. The programme, funded by an annual grant of US$3.2 million from the British Government, included a broad ranging prevention strategy, involving school curriculum projects and advertising campaigns aimed at teenagers and their parents. These contributed to a significant decline in smoking among children. In addition, maximum use was made of creative publicity techniques, including the publicarion of localized data on smoking-related harm, and a series of highly effective successful annual No Smoking Days. The paper will provide assessments of effectiveness and implications for national programmes elsewhere. SS-4-09 SS-5-01 TIMN 448555 53
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SS-5-02 r advertising techniques so as to survive after advertising bans. Aspects of this tactical struggle from both the Industry and B.U.G.A. U.P's. recent campaigns and their consequences are discussed. 0 B.U.G.A. U.P. - THE LESSONS LEARNED FOUR YPARS ON Arthur Chesterfield-Evans P.O. Box 80, Strawberry Hills 2010, Australia B.U.G.A. U.P. (Billboard Utilising Graffitists Against Unhealthy Prcmotionn has been widely viewed as a non-smoking activist group. In fact it is a group that has asked for responsibility in advertising. Its greatest claims to fame were in the willingness of its members to engage in civil disobedience, its use of satire and the media, and its identification of the Industry and its advertising as the keys to the problem. Perhaps because of the unique Australian attitude to authority the civil disobedience has not spread as widely as might have been hoped, but the feeling of militancy of the non-smokers rights movements has increased. Many groups now recognise the Industry as the source of whole tobacco problem and attack it, though this simple concept is still not universally recognised. The place of satire limiting the effect of advertising has not been fully recognised and must be further used. The Industry is using more subtle SS-5-03 DOC: A PRIMER FOR SOCIAL/HEALTH ACTIVISM J. Richards, A. Blum, T. Houston, P. Fischer DOC (Doctors Ought to Care), HH101, Medical College of Georgia, Augusta, GA 30912, USA Using humor, ridicule, and parodies of USA tobacco campaigns to help de-mystify smoking and show young people how they are being used by the tobacco interests, DOC (Doctors Ought to Care)--the largest physician-led smoking deterrent organization in the world, approaches smoking in several unique ways: (1) organizing physicians and other health professionals as activists; (2) using media campaigns countering the fake claims of cigarette ads, "selling" good health with appeals to love, looks and money; (3) calling attention to the socio-political problems of smoking and helping traditional "organized" medical groups deal with these areas in an effective manner. Since organizing in 1977, DOC has expanded across the United States and well could be a model for other countries. This presentation will discuss the deceptive marketing practices of the tobacco industry, image-based counter advertising, and the role of health professionals as activists by highlighting the techniques and examples DOC has successfully employed over the past ten years. 54 TIMN 448556
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USING THE MEDIA SS-5-04 Y M. Daube, Executive Director, Health Promotion and Education Services, Health Department of Western Australia, 60 Beaufort Street, Perth, Western Australia. This paper reviews some approaches taken to use of the media in smoking control programmes. It considers recent develop- ments in smoking control in Western Australia, and presents the case for a well funded media programme that is carefully planned, but also flexible and opportunistic, as an essential component of a comprehensive smoking control programme. THE WEST AUSTRALIAN SMOKING'AND HEALTH PROJECT: THREE YEARS OF MASS MEDIA S~10KING CESSATION CAMPAIGNS Maurice Swanson, Co-ordinator, Smoking and Health Project, Services Branch, Health Department of Western Australia. Heather Brown, Co-ordinator, Research and Evaluation, Services Branch, Health Department of Western Australia. Health Promotion Health Promotion In 1984, 1985 and 1986, the Smoking and Health Project, Health Department of Western Australia, implemented statewide campaigns to motivate and assist adult smokers to' quit. The campaigns have employed a range of strategies, including: a paid advertising schedule using television, radio and press; a comprehensive and planned public relations programme; a specially designed minimal intervention kit for General Practitioners; financial assistance for existing smoking cessation programmes within the community; a broad range of supportive community educational activities; and distribution of a variety of smoking cessation publications. The impact of the campaigns has been assessed through market research techniques. Por each campaign, a cohort of smokers was interviewed before the campaign commenced; selected sub-samples were followed during the campaign, immediately after the campaign, and for a period of up to 8 weeks after the campaign ended. These results will be discussed with reference to their implications for the effectiveness of different strategies. SS-5-05 TIMN 448557 55
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SS-5-06 SS-5-07 THE USE OF TELEVISION FOR SHOKII.C CESSATION: AN ONGOING PLANNED TRIAL *Richard B. uarneeke, University of Illinois, Chicago, Illinois USA Brian R. Flay, University of Southern California, Los Angeles, CA, USA Thomas D. Cook, Northwestern University, Chicago, Illinois, USA Kathleen Crittenden, Charles L. Cruder, Fred Kviz, Patricia Langenberg, John Vidmar, University of Illinois, Chicago, Illinois, USA Clara Hanfredi, Illinois Cancer Council, Chicago, Illinois, USA and Robin Hermelstein, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL, USA A recent review suggests that television can be used effectively for smoking cessation "self-help clinics." However, all previous evaluations of these programs have been flawed in several ways: including following only known viewers or people who requested written materials with which to follow the program. Thus, the reported results could have been due to self-selection factors. In a planned trial in Chicago, Illinois, we attempted to overcome the self-selection problem. A random sample of smokers were interviewed by phone twice prior to the promotion of the program. This panel of potential viewers and an additional panel of requesters were interviewed during the weeks immediately following the completion of the program, and will be assessed again at six, 12 and 18 months. Thus, population estimates of viewing of the prograsning, requesting of material, participation in program activities, and behavior change have been, or will be obtained. Further- more, selection to view or request written materials will be modelled -- that is, characteristics of the viewer and requester populations will be compared with characteristics of the population of smokers. The program consisted of two, three-to-five minute television segments per day for 20 days, following the-American Lung Association self-help manual. Viewers could request the manuals in response to promotion before programaing corrnented on March 21, 1987. Immediate post-?rogram data were collected April 15-4ay 28, 1987. . The study, program, and preliminary resulcs will be presented and discussed at the conference. EVALUATION FRAMEWORK TO DESIGN AND FINE TUNE A MEDIA CAMPAIGN *D. Reading, D. Hill, J. Houston and D. Jolley Victorian Smoking and Health Program Evaluation Committee, Anti-Cancer Council of Victoria, 1 Rathdowne Street, Carlton South, Australia, 3053. In 1985 the Victorian Health Department and the Anti-Cancer Council of Victoria began a jointly funded health education campaign to dissuade people from smoking. It involved mass media advertising, public relations activity, community development among health centres, doctors, pharmacists, hospitals etc. and a schools program, at a cost of approximately A$750,000 for the first year. In 1987 the budget for this campaign is nearly A$1.2million. The population of the State of Victoria is approximately 4 million of whom approximately 900,000 adults are smokers. We chose a multi-focus evalution framework, including an annual population survey on smoking status, incorporating recent quitting and intention to quit; campaign approval and awareness; action triggered by the campaign; and various health beliefs (N=2,600). Separate studies are also conducted on response to a telephone Quitline (N=82,000) follow up of smokers helped during the campaign (N=500), and involvement of various health professionals. Data from 1985 surveys was used to plan the content, style and duration of the 1986 TV advertising campaign. Further data collected in 1986 influenced the duration of various components of specific TV advertisements and the planning of the "media buy". Cost of advertising, rating of programs and responses to action suggestions in the ads were analysed to identify the best predictor of the target behaviours viz. smokers ring the Quitline recorded telephone message. 56 TIMN 448558
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Sh1C.KIPJG CESS ATIDN IN R^DIO AND TV IN PdGRt1AY 'Schioldborg, (-. Institute of f'sychology, University of Oslo, f;orway. Smokino cessation based on cognitive behavior therapy was practised in eight wee2cly programmes of fifteen minutes dura- tion nationwide in radio in 1984 and 1905, and in TV in 1986. The intervention administered by the therapist included self control techniques (nicotine fading, self monitoring, stimulus control), change in skill attribution (from ability to task), and model learning (wellknoum radio- or TV-reporter quitting jointly with listeners/viewers). Effect evaluation on a representative population sample (n=1200) at the end of the radio and TV series gave as result a reduction in sioaretze consumption among daily smokers to nearly a half by i2a snd 16;0, respectively, while 4;~ and 5~ quit smoking, respectively. The quitting rate was found to be ten times larger than base rate. No sex differerce wzs observed. While 20:' ~ of the smokers attended to four or more radio program- mes, 50;3 did so to the TV programmes. Relapse assessed after four months from the radio series proved to be 501c"' which is significantly smaller than ordinary relapse rate among self-quitters for this period; 85;S. A similar 12 months relapse analysis from the TV series is presently car- ried out. (Data on conference). The results thus confirm the im- portance of use of media in smoking prevention znd health pro- motion. STOPPING THE TV GAME - A CAMPAIGN TO CUT CIGARETTE ADVERTISING ON BBC TV IN TOBACCO SPONSORED SPORT 1985-1987 *J L Roberts Regional Prevention Manager, North Western Regional Health Authority, Gateway House, Piccadilly South: Manchester M60 7LP, and Lecturer, University of Manchester Community Medicine Department, United Kingdom. In 1984, there were 360 hours of tobacco- sponsoredsport on British TV - 97% on BBC despite the fact that cigarette advertising was officially banned on TV in 1965. A system of monitoring the extent and nature of this new form of advertising was set up in 1985 with the aim of pressing for cuts in BBC TV coverage. This was part of Project Smoke Free - and jointly-financed by the North Western Regional Health Authority and the Health Education Council UK (now Health Education Authority). Results of monitoring were published in national news media, the professional broadcasting press, and direct to the Governors and Advisory Council of the BBC. Action taken by the BBC to curb excessive exposure of tobacco company images was followed up and further pressure applied. Methods developed in the monitoring involved routine assessment of the nature and extent of tobacco advertising images, and the compilation of a photographic dossier of case material. There are likely to be valuable tools in other countries with similar problems; in Britain, the campaign has resulted in an 80% reduction in the visibility of tobacco company brand names in BBC TV sport over two years. Sponsorship of TV sport by tobacco companies is not expected to continue in UK beyond 1990. SS-5-08 SS-5-09 TIMN 448559 57
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SS.5.10 TIME TO QUIT: A COMMUNITY-BASED TELEVISION AND PRINT MEDIATED SMOKING CESSATION PROGRAM *D.Nostbakken Ph.D., and C.Moyer Canadian Cancer Society, 77 Bloor Street W., Toronto, Ontario, Canada SS-6•U1 The aim was to study the effectiveness of a replicable comprehensive intervention for cessation among heavy smokers aged 25-45. The intervention included six half-hour highly-produced television programs, a community mobilization program, a publicity program and a self-help guide. Two comparable central Canadian cities served as experimental and control sites. The study included efficacy analysis of all elements of intervention pre-pilc testing; baseline data collection one year in advance of intervention; community mobilization observational study; a post-post cohort study among 800 smokers one week and six months following the intervention; one year follow-up. After one year there was a 16.5% reduction in the target group in the experimental city, and 8.6% in the control city. On the basis of this successful pilot testing, TIME TO QUIT was conducted in most of Canada's major cities. STATE LAWS RESTRICTING SMOKING IN PUBLIC PLACES IN THE USA: AN ANALYSIS OF THEIR PREVALENCE AND CONTENT. *NA Rigotti, Institute for the Study of Smoking Behavior and Policy, tlarvazd University, Cambridge, MA 02138 USA. The evidence about the health risks of involuntary smoking has triggered wave of policies restricting smoking in public places and the workplace. In the USA, smoking in public places has been regulated primarily by legislation at the state and local levels. I analyzed the prevalence and content of laws enacted between 1970 and 1985. The prevalence of state laws increased sharply between 1970-85. In 1970, laws restricting smoking in one or more public place were in force in 14 (28b) states; by 1986, all but 9 states had enacted laws (82% prevalence). 80% of the US population in 1985 lived in states with a smoking law, compared with - in 1971. The prevalence of laws varies by geographic area; Southern states are less likely to have legislation (p<.05). The language of current laws varies widely. The number of places covered varies from 1 to 16. States most often restrict smoking in public transportation (35 states); hospitals (33); elevators (31); auditoriums (29); and schools (27). Restaurants and retail stores are covered in 18 states; the private workplace is covered in 9 state To measure the comprehensiveness (COMP) of legislation, I developed a 4- category index and classified each state since 1970. Findings ware (1) Mean COMP of laws more than doubled between 1972 and 1985; (2)COMP varies by geo- graphic region; Southern states have less restrictive laws (p<.05); (3) COMP in the 6 major tobacco-producing states is less than in other states (p<.001) State laws are a growing trend which may have long-term impact on smoking behavior and warrant a closer analysis. The restrictiveness inda:c is a way te classify the strength of policies; it may aid in the analysis of their impaci 58 TIMN 448560
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TOBACCO PRODUCTS LIABILITY LITIGATION AS A PUBLIC HEALTH STRATEGY *Richard A. Daynard Northeastern University School of Law, 400 Huntington Avenue, Boston, riA 02115, USA The Tobacco Products Liability Project was formed in 1984 to encourage and help coordinate lawsuits against tobacco companies on behalf of afflicted smokers and their families. This strategy is designed to reduce smoking among teenagers by making the price of tobacco products rise to reflect their full social cost, by obtaining dramatic publicity for the plight of diseased smokers, by obtaining detailed disclosure of the industry's efforts to cover up the dangers, and by forcing the industry to cease their deceptions so as to reduce their risk of future punitive damages. The Project has established a network of plaintiffs' attorneys and public health professionals throughout the USA, with contacts beyond, held 3 annual conferences, spawned the Tobacco Products Litigation Reporter, and attracted worldwide professional and media attention. Industry diversification and restructuring efforts have been ascribed to fear of successful lawsuits. As of May 1987 there were 125 cases pending, with 3 major trials expected in September. A 1987 legal victory is anticipated. The tobacco industry is paying dearly to defend these suits, since its potential legal liability is almost unlimited. Any victory will likely produce thousands of US case filings, with UK, Canada, Australia and perhaps others following soon. NEW LEGAL RESPONSES TO THE OLD PROBLEMS OF SMOKING *D. Garner Southern Illinois University School of Law Carbondale, Illinois 62901 National smoking legislation in the U.S. has been delayed and curtailed due to effective lobbying by tobacco companies. But at the local level of governm ent innovative new ordinances are being passed. The focus of this paper is on four types of city smoking ordinances that require no new taxes, involve little enforce- ment difficulty, and yet effectively promote public health. They are: (1) Clean Indoor Air Acts that require smoke-free air not only in public areas but also in • workplaces. San Francisco, California was the first to enact such an ordinance. (2) Anti-Sampling Ordinances that control or eliminate public distribution of tobacco products. Minneapolis, Minnesota recently outlawed public sampling of all tobacco products. (3) Civic Noncooperation Ordinances that withdraw municipal permission for tobacco companies to advertise on city property or to sponsor city- authorized events such as street races and ballgames. Newport Beach, California in 1986 disallowed cigarette sponsorship of bike and foot races. (4) Y outh Protection M easures that limit children's access.to tobacco products. Chicago, Illinois at one time outlawed vending machines to prevent children from purchasing cigarettes but no city has comprehensively dealt with children's access to tobacco. City councils will often be receptive to the health concerns of local citizens and health groups given that pro-tobacco influence is not usually well entrenched. Local ordinances of the types proposed in this paper are politically feasible, constitutionally sound, conveniently enforced, inexpensively administered and effective in promoting the goal of a smoke-free urban environment. SS'6-02 SS•6•03 TIMN 448561 59
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SS-6-04 SS-6-05 60 THE MINNESOTA PLAN FOR NONSMOKING AND HEALTH: THE LEGISLATIVE EXPERIENCE Michael E. Moen, M.P.H., Kathleen C. }larty, M.Ed., and *A. Stuart Hanson, M.L Minnesota Department of Health, 717 S.L. Delaware Street, Minneapolis, MN 55414, U.S.A. The Minnesota Department of Health has successfully introduced nonsmoking legislation which was enacted by the Minnesota Legislature in June, 1965. Ihe legislation raises the excise tax on tobacco products and appropriates a percentage of the excise tax revenues to fund multiple programs comprising a coordinated nonsmoking initiative. Specific appropriations fund statewide tobacco-use prevention curricula targeted for adolescents; a continuum of nonsmoking education from kindergarten through grade 12; a multi-media public education and communications campaign; competitive special project grants to community health service agencies and nonprofit organizations for community- level and statewide smoking prevention programs; and peer-reviewed program evaluation. The legislation was initiated after a comprehensive statewide smoking control plan was developed by an expert committee with wide-ranging expertise Support for the legislation was enhanced through coalition-building among organizations concerned with the health and economic effects of tobacco. Detailed health and economic impact arguments, using Minnesota data, provided a clear problem statement, key points of testimony, and compelling justifica- tion for nonsmoking legislation. The results after one year show a 9R reduction in smoking and cigarette sales. A five year comprehensive evaluation is in progress. OBSTACLES TO A NATIONAL SMOKING CONTROL PROGRAMME + Tage Egsmose, Lisbeth Egsmose Institute of Social Medicine, University of Copenhagen, DK-2200 Copenhagen; Danisk National Institute of Social Research, Copenhagen, Denmark. It has been established beyond doubt that tobacco smoking can do serious harm to health. This goes for active smoking as well as passive smoking. The chemical substances in the smoke affect almost all parts of the human body.' The tobacco industry has so far been unwilling to accept this scientific fact and continues to escalate its sales"promotion in a number of countries, espec- ially in the third world. Legislative initiatives can bring down the increas- ing tobacco marketing and consequently the manufacturing of tobacco. Unfortu- nately, legislation has not as yet materialized in many countries due to strong resistance from the tobacco companies. Other important obstacles to le- gislation are: The medical profession-s rather passive role with regard to solving the problem even though most medical journals repeatedly have publish- ed scientific articles on the health consequences of smoking. The continuing low level of knowledge in the population has been revealed in a survey from 1984: Only 63% of the Danes believed that the connection between smoking and lung cancer had been "firmly proven", correspondingly 44% with regard to chronic bronchitis and 28% for myocardial infarct. The'mass media are eccnom- ically dependent upon the tobacco industry as advertiser. Therefore the media are often not inclined wholeheartedly to participate in an efficient communi- cation of the tobacco problem. The legislation in a country reflects the will of its people. Without a determined and consequent approach by the medical profession and the media, the politicians in ouX parliaments will be reluctant to introduce the necessary legislation. Experience concerning atter.:pts to im- plement tobacco legislation in Denmark in 1970, 1981 and 1987 will be nresen- ted. - TIMN 448562
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EQUAL ACCESS ADVERTISING: GUARANTEEING THE PUBLIC'S RIGHT TO KNOW AS AN ALTERNATIVE TO BANNING TOBACCO ADVERTISING *Dee Burton and Brian R. Flay Institute for Prevention Research, University of Southern California, 35 N. Lake Ave., Pasadena, California 91101, USA Equal access advertising is proposed as an alternative to banning tobacco advertising. From a public health perspective, data suggesting the superiority (in decreasing tobacco use) of addin anti-tobacco adver- tising (counter-advertising) over removing tobacco advertising are presented. The philosophical perspective is presented, using the United States as a case study, and discussing equal access to advertising within the frame of reference of First Amendment principles. The First Amend- ment, intended to guarantee the public's right to know, states that Congress shall make no law that limits freedom of speech. Examples are given of ways in which the public's right to know is currently restricted indirectly by tobacco advertising, largely through informal censorship of anti-tobacco information by recipients of tobacco advertising revenues. It is put forth that the most direct approach to correcting this problem is to remove the censorship of anti-tobacco communications, rather than removing or altering tobacco communications. A mechanism for ensuring equal access to all communication channels, to be initiated on a case-by- case basis by petition of any individual or group, is proposed and des- cribed, and alternative suggestions for its implementation and financing are offered. Data on the most effective forms of communication that might comprise the increased anti-tobacco advertising which would accom- pany an equal access advertising mechanism are reviewed. Finally, a list of possible pitfalls of equal access advertising are presented and com- pared, point by point, with those of the alternative of a tobacco ad ban. IMP1.ENENTATION AND IMPACT OF A CITY'S REGULATION OF SMOKING IN PUBLIC PLACES AND THE WORYPLACE• THE EXPERIENCE OF CAMBRIDGE, MASSACHUSETTS. *NA Rigotti, M Stoto, M Kleiman, TC Schelling, Institute for the Study of Smoking Behavior and Policy, Harvard University, Cambridge, MA 02138 USA. To protect nonsmokers from passive smoke exposure, many US cities and states are adopting restrictions on smoking in public places and the workplace. There has been little formal assessment of the political or public health impact of these laws. Their ease of implementation and level of compliance have not been described, nor has their impact on air quality or the attitudes and behavior of smokers and nonsmokers been measured. Such information would be useful to the growing number of groups considering these laws. We are studying the city of Cambridge, MA, to examine the effect of a new no-smoking ordinance. In December 1986, the city approved a strict restriction of indoor smoking in all places to which the public was admitted and all worksites except the smallest. The law took effect March 9, 1987. To assess its impact, we conducted a telephone survey of a random sample of city residents to measure awareness, approval, attitudes, and behavior and did direct observations of the level of ordinance compliance (smoking, signs) prior to the law's implementation; these measures will be repeated 3 months after the law takes effect. At 3 months, we will survey employers to assess workplace compliance. We are interviewing city officials to assess their implementation strategy. Five institutions--a corporate headquarters, a university, a hospital, a hotel, and the city government offices--are being studied in detail to examine how they respond to smoking regulations. The goal is to draw lessons from the experience of Cambridge to help other minicipalities considering or implement- ing smoking regulations and to help institutions in the process of responding to such regulations. We will report the highlights of our findings. SS-6-O6 SS-6-07 ,,. TIMN 448563 61
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SS-6-08 SS-6-09 62 THE POLITICAL PATH TO A SMOKE-FREE WORKPLACE *Honorable Wendy Nelder Member, San Francisco Board of Supervisors San Francisco, California, U.S.A. In order to assure to every San Franciscan the right to choose whether to run the health risks associated with inhaling tobacco smoke, in 1982 Supervisor Wendy Nelder authored the toughest American smoking ordinance ever considered at that time. The tortuous path of the San Francisco Workplace Smoking Ordinance wound from legislative hearings, to mayoral approval, to ultimate success at the ballot, but only after strenuous and well-financed opposition from the Tobacco Institute which mounted an unprecedented, multi-million dollar public relations campaign to overturn the law at the polls. Prior to the passage of the San Francisco ordinance, talk of the dangers of second-hand smoke was dismissed as fanatical and scientifically unsound. Subsequent to the heated public debate which preceded the law's success at the ballot, not only are politicians free to propose smoking controls without savage political repercussions, but, additionally, the rights of non- smokers to breathe smoke-free air are now on par with the rights of smokers to consume tobacco products in an office setting. The San Francisco ordinance has heightened public awareness of the dangers of second-hand tobacco smoke and has since been copied throughout the United States and in other countries; it is widely acknowleged as the single most important factor in the new and increasing acceptance of non-smokers' rights as a health concern, not just a source of social discord. CUxRtNT CIGARF'TTi; AUVEKTISING TRENDS IN THE U1:ITEl) STATES *k.Pi. Davis Uffice on Smoking and Iiealth, Centers for Disease Control, 5600 Fishers Lane, Rockville, AIU 20857, USA The purpose of this stuay was to examine in detail current trends in cigarette advertising in the United States. According to the U.S. Federal Trade Commission, total cigarette advertising and promotional expenditures reached $2.1 billion in 1984. From 1974 through 1984, total expenditures increased approximately sevenfold, or threefold when expenditures are adjusted to account for inflation. In 1985, cigarette advertising expenditures accounted for 22.3%, 7.1%, and 0.8% of total advertising expenditures in outdoor media, magazines, and newspapers, respectively. In a ranking of all products and services by national advertising expenditures, cigarettes were first in outdoor media, second in magazines, and third in newspapers. The proportion of total cigarette advertising and promotional expenditures devoted to promotional activities has increased steadily from 25.5% in 1975 to 47.6% in 1984. The proportion of expenditures for cigarettes yielding 15 mg. or less "tar" has increased' substantially and has consistently exceeded the domestic market share of these cigarettes. Several advertising campaigns have targeted women, minorities, and blue-collar workers. The stuoy ot these marketing trends should assist health ofticials in idehtifying and predicting patterns of cigarette consumption and in developing health promotion programs that counteract the influence of advertising by incorporating similar, effective techniques. TIMN 448564
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SMOKING AND HEALTH: 1990 OBJECTIVES FOR THE UNITED STATES *J.L. Bagrosky Office on Smoking and Health, Centers for Disease Control, 5600 Fishers Lane Rockville, MD 20857, USA In 1979, the U.S. Public Health Service launched a decade-long initiative to develop a set of Health Status Objectives for The Nation. Two hundred twenty-six objectives were developed that addressed measures to improve health status and reduce risks to health in 15 areas of mortality, morbidity, preventive intervention, and health-related behaviors. Seventeen objectives related to cigarette smoking were developed as one of the 15 priority areas. In 1985, at the five-year mark, the Public Health Service conducted a Mid- Course Review to assess progress toward achieving these national objectives. The review provided health-policy makers, health providers, and others an opportunity to assess the progress and to consider changes to the overall strategy. As of 1985, four of the 17 smoking objectives have already been achieved, eight are on track and one is unlikely to be achieved. For the remaining four objectives, data are not available to measure progress toward their achievement. The 1990 Smoking and Health Objectives for the Nation have proven to be a valuable framework upon which to develop a national smoking and health strategy. Other countries may find this process useful to define the extent of the smoking problem, to identify informational needs, and to plan appropriate interventions. ATTITUD£S FOR SOCIAL SMOKING CONTROL AKfr GOYER,\1MEtiT'S kULE '1'.Sawasaki, C.Kawata Department of Health Sociology, Faculty of Medicine, The l'niversity of Tokyo. Bunkyo-ku, Tokyo 113, Japan The aim of this study was to clarify the relationship between the status of smoking and the attitudes toward social smoking control and the government's role therein. Attitudes on social smoking control:questions concernig restric- tions on smoking places, vending machines, advertising, raising cigarette prices, and the government's role in smoking control aere put to 490 male employees. The status of smoking was divided into three categories: I)smoke or not, 2)heavy smoker(20 or more per day) or light. smoker(below 20 per day), 3)having intention to quit smoking or not. The results obtained were as follows: 1)The idea of restrictions on smol,ing places, vending machines. advertising and raising cigarette prices were resllec- tively supported by 81.4,w, 67.2Z, 49.11, 19.1% of all those quest.ioned.lt H•as supported by significantly more non-smokers than smohers, more IightI smokers than heavy smokers, and more of those that have intention than those that do not. 2)52.1% of all thought thatt the government should develop suitable poli cies of smoking control as have many other countries. And G7.2N thought that. the government should inform the people of tiie hazards of smoking,thouglr the rates were different according to the status of the respondents as above. These showed that there were large differences of the attitudes on social smoking control and government's role according to the status of smoking. and it seemed that the attitudes on social smoking control were still develop ing in Japan. SS-6-10 SS-6-11 TIMN 448565 63
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SS-6-12 SS-6-13 • THE ROLE OF ADVOCACY AS A COST-EFFECTIVE PATH TO SMOKING CONTROL LEGISLATION *Garfield Mahood, Executive Director and David Sweanor, Counsel, Non-Smokers' Rights Association, 344 Bloor Street, West, Toronto, Canada M5S 1W9 The aim of the project is to promote, with limited funding, legislation by the federal government to regulate the largely unregulated Canadian tobacco industry. Following up on the call by world health authorities for legislative initiatives to combat the tobacco epidemic, for the purpose of this paper, this project assumes that restricted industry activities will lead to reduced tobacco-caused morbidity and mortality. Successive Canadian governments have protected the tobacco industry with a series of exemptions under statutes which normally would regulate addictive or lethal products. We hypothesize that principles of "social change theory" may be used cost-effectively in social and political advocacy designed to promote comprehensive legislation. This paper examines the role of advocacy played by Canada's major anti- tobacco organization at various stages of agitation for change leading up to the tabling of both the Tobacco Products Control Act and the Non-smokers' Health Act, in Parliament. This paper will review strategical approaches used including education (utilizing the mass media to dramatize the social, medical and political dimensions of the issue), neutralization (de-legitimizing the tobacco industry and removing its credibility), polarization (forcing prin- cipal actors to abandon passive positions) and mobilization (activating in- dividuals and organizations). The strategies will be illustrated by tactics used by the Non-Smokers' Rights Association in the campaign to promote these federal statutes. The paper will show that social and political advocacy is a cost-effective approach to fighting the tobacco epidemic. PROPOSAL FOR THE NEW PROVISION IN THE NORWEGIAN TOBACCO ACT A. Kjonstad, Universitetet i Oslo, Norway Norway is often cited abroad as a pioneer country as regards legislation to combat damage from tobacco. it has also been pointed out that the Norwegian authorities have been successful in preventing the tobacco industry from circumventing the ban on tobacco advertising. The Tobacco Act solves the question of advertising by imposing a total ban on advertisements for tobacco products. The Norwegian population is effectively protected against advertising for such products. As regards the question of protection against exposure to other people's tobacco smoking, however, we are still at about the same stage as when the Tobacco Act entered into force For the population in general, the ban on tobacco advertising represents the freedom from exposure to influences which encourage smoking. A similar freedom should apply to exposure to other people's tobacco smoke. A general provision should be incorporated into the Tobacco Act giving the right to smoke-free air in all indoor localities open to the public, and in canteens and other common rooms at work. In general, the air should also be smoke-free in buses, trains, aircraft and taxis. Certain exceptions could be made to this principle. 64 TIMS 448566
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PROGRESS IN SMOKING CONTROL IN AUSTRALIA SS'-6-1 4 S D Woodward ASH (Australia) (Action on Smoking and Health), 3rd Floor, 18 Queen Street, Melbourne, Victoria, Australia. At the time of the last world conference on smoking and health in 1983, bans on Cigarette advertising were the main focus of activity in Australia. Bills to ban all forms of tobacco advertising were being considered by four out of seven state parliaments. All of these legislative thrusts were defeated. Since 1984 anti-smoking campaigns in Australia have taken a new direction. By far the major issue of importance is passive smoking. It was deliberately put on the public agenda of debate in a campaign by the non-government National Heart Foundation of Australia in 1985. Since that time, the debate has been fuelled and largely won because of the emergence of other supportive reports. Bans on smoking at work are now commonplace in Australia, and it likely that by the time of the next world conference, smoking will be prohibited in all public and private work places in Australia. Substantial expenditures on mass media education programmes are continuing, funded by state governments. The Australian Federal Government contributes virtually nothing to anti-smoking education despite receiving over a billion dollars in tobacco tax revenue each year. This year a new push against tobacco advertising is being led by a millionaire businessman, who is also one of Australia's most popular personalities. Lessons learned from the failed advertising campaigns and the successes of the passiv )smoking campaigns will be discussed. TOBACCO TAXES PAID BY AUSTRALIAN SCHOOI, CHILDREN 14 H Winstanley ASH (Australia) (Action on Smoking and Health), 3rd Floor, 18 Queen Street, Melbourne, Victoria, Australia. Data collected in a national survey on children's smoking rates are analysed with a view to determining the amount of money spent by children on cigarettes in 1984. The amount of money gathered by Federal and State governments through federal excise and state tobacco licence fees are calculated. Retailers' earnings from sales to children are quantified, and the amount made by tobacco companies from smoking children estimated. The amount of tar, nicotine and carbon nomoxide delivered to children by their smoking is calculated on the basis of Australian Government Analytical Laboratory analyses. The findings of this study show that across Australia children contribute monies to government far in excess of what those governments in turn spend on health education campaigns designed to discourage smoking among children. Australian children contribute as much in tobacco tax as the four tobacco companies operating in Australia are reputed to contribute to sponsorship of sport. SS-6-15 ,rIMIS 448567 65
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SS-6-16 NEW HEALTH WARNINGS ON TOBACCO PACKAGES S D Woodward, M H Winstanley ASH (Australia), (Action on Smoking and Health), 3rd Floor, 18 Queen Street, 1•7elbourne, Victoria , Australia. SS'6'17 66 Placing health warnings on tobacco packages is not a new recommendation fc public education, but provided that the warnings are clearly seen and understood, it remains an effective one. In most states of Australia during 1987 a new system of four rotating health warnings on all tobacco packages wil: commence. The warnings will appear on the front and rear of tobacco package; occupy 15 per cent of the surface area, and will state one of "Smoking cause: lung cancer", "Smoking causes heart disease", "Smoking damages your lungs", anc "Smoking reduces your fitness". The ultimate appearance of the new health warnings on all packages will ma the end of three years of strenuous tobacco and health lobbying where two ott warnings, "Smoking kills" and "Smoking is addictive" were defeated. Much has been learned from this campaign which may be applicable to lobbying for health warnings in other countries. This paper will discuss the criteria and means selection for the most effective health warnings possible, and the work done health groups behind having the warnings proposals accepted, and the counter lobbying by tobacco interests. SMOKE-FREE HOSPITALS BY 1990 *A. Stuart Hanson, M.D., Thomas E. I:ottke, M.D., Judy M. Knapp, M.P.H. Minnesota Coalition for a Smoke-Free Society 2000, 2221 University Ave., Suite 400, Minneapolis, MN 55414 A smoke-free hospital strengthens the r.iessage that cigarette smoking is serious health threat and protects the health and safety of patients, staff and visitors by providing an environment free from tobacco smoke. A one-year randomized trial of 104 Minnesota hospitals was conducted in 1986 to determine effective methods of assisting hospitals to successfully adoptsmo free policies. Hospitals were enlisted into the study through recruitment of hospital personnel and community volunteers who selected a hospital they would assist in becoming smoke-free. Hospitals were randomized into one of two groups: an intervention (workshop) group or a control (materials) group The intervention group received a one-ciay training workshop, a Clean Air Health Care manual, and consultations. The control group received only the Clean Air Health Care manual. It is hypothesized that the intervention group will result in more progress toward developing g and implementin;; a smoke- free policy than the materials group. Baseline telephone surveys of hospitc administrators were conducted in March 1986. Follow-up surveys were conducteu in December 1986 to determine progress toward a smoke-free policv. Onsite hospital visits will validate self-reported changes in polirv. Questionnaires were administered to volunteers to collect information on social conditions which help or inhibit the process of developing a s-oke- free policy. 'rIMN 448568
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SMOKING CONTROL LEGISLATION IN SWEDEN - THE TOBACCO INDUSTRY'S RESPONSE * P. Nordgren Division of Health Education, National Board of Health and Welfare, S-106 30 Stockholm, Sweden Two important pieces of smoking control legislation in Sweden are the To- bacco Labelling Act (which became effective in 1977) and the Tobacco Adverti- sing Act (effective from 1979). The Tobacco Labelling Act states that all to- bacco packages have to carry health warnings. Cigarette packages have to car- ry declarations of contents as well. Health warnings on cigarette packages are varied, so that at each point•in time there is a set of several warnings appearing in rotation. This information system has been evaluated. The Tobacco Advertising Act constitutes a strong partial ban on tobacco advertising. Certain forms of advertising are totally forbidden. In ordinary newspapers, advertisements for tobacco products are restricted in size. The content of the advertisements must be confined to factual information on the product. Each advertisement must contain a health warning and, when cigarettes are advertised, a declaration of contents. The regulations for marketing of tobacco products were given a more stringent interpretation in 1986. The tobacco industry has reacted in several ways to this legislation. In 1985 one company complained to the government about a new set of health war- nings, particularly texts about the health risks of passive smoking. The dec- larations of contents have been used in the marketing of low-tar cigarettes, perhaps giving the impression that these are very much "safer" than other ciga- rettes. In reaction to the advertising ban, the industry has developed new ad- vertising strategies, partly making use of sophisticated circumvention tech- niques. The implications for future legislative measures are discussed. A WORLD STRATEGY AGAINST THE SOURCE OF THE TOBACCO PROBLEtit Arthur Chesterfield-Evans and Gavin O'Connor Non-Smokers Movement of Australia Trades Hall, 4 Goulburn Street, Sydney 2000, Australia Since 1951 health authorities have fought with relatively little success to reduce the toll of the smoking epidemic. Tobacco companies have denied the problem and used a combination of corporate power and innovative promotion to continue sales virtually unimpeded. In the eyes of the Tobacco Industry the 5th World Conference was a failure for the non-smokers as it did not lead to a coherent strategy directed against the Industry. The lesson from this is clear. The epidemic could have been ended if the Industry had not continued to promote smoking. Hence the answer to the prob- lem is a world strategy that must have at its heart political action across all nations and at all levels within nations. All groups from health depart- ments, the medical and education professions, charities, consumer groups, activists, and protest groups have a part to play. The coalition must act at all levels, health, media, education, econanics and politics. This 6th World Conference must not repeat the errors of the 5th and must put in place the network to co-ordinate the ca.7mign and strateqies to be employed. The tasks of various groups and the tactical aoproaches are dis- cussed, including international comparisons and some successful approaches. SS-6-18 SS-6-19 . TIMN 448569 67
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SS-6-20 SS-6-21 SUCCESS A.\D FAILURE OF THE LGGISLATII'E ACTION AGAINST SMOKING IN BELCICM L. Joossens Onderzoeks- en Informaticcentrum van de Verbruikersorganisaties, Opperstraat 28, B - 1050 Brussels, Belgium Koordinatiekomitee Anti-Tabak, S. Stevinstraat 8 - Bus 30, B - 1040 Brusse Belgium Success : In 1985 the Flemish Coordinating Comitee against Tobacco laun- ched a large campaign with the slogan "Two out of three" : two persons out of three want a smoking ban in public places. In 1987 a Royal Decree promul• gated a smoking ban in most public places from September 1. Offenders will be liable to fines of up to 18.000 BFr (500 S). Failure : In Belgium tobacco advertisements may only contain functional information. The purpose of this legislation was to break the link tobacco products have acquired with attractive values such as friendship and adven- ture and to avoid for instance the Marlboro cowboy and the Camel traveller. However, as we will show on different slides of advertisements, the cowboy and the traveller reappeared in advertisements for matches, lighters, etc.. In order to avoid a useless legislation, we want to stress that a legisla- tion on tobacco advertisement must provide : 1) a ban on indirect advertisement of tobacco products. 2) a easy enforcement and high fines. 3) a ban on the sponsorship of cultural and sport events by the tobacco industry. SMOKING CC)N'IROL AND HEALTH, SOCIAL AND ECONOMIC INDICATORS - WITH REFERENCE TO HEALTH WARNINGS ON CIGARbTI'E PACKEI'S *K. Yamanaka, M. Miyao, M. Furuta, K. Takihi and S. Yamada Department of Public Health, Nagoya University School of Medicine, Showa-ku, Nagoya 466, Japan The aims of this study were two-fold. The first was to clarify the prese situation in almost all countries of the world concerning health warnings on cigarette packages and legislative provisions. The second was to determine the relationship between the level of smoking control and health, social a econo:nic indicators. The questionnaires were sent to 104 I7nla3ssies and a Consulate General in Tokyo on December 23, 1985. Ninety-one replies to the questionnaires were obtained. The situation in Japan was added, and the total number of countri whose replies were analyzed was 92. Sorne statement of the warnings which w obtained frcm other sources was added to the information frcm the F7nbassies. The percentage of countries with health warnings or information on cigarette packages was 65.2% (60 out of 92 countries). Health warnings we required by legislation in 48 out of 60 countries. Besides health warnings, tar level indications were required in ~ countries, nicotine level 10, and carbon monoxide 2. There were several countries which used alternative health warnings. The percentage of countries in which TV or radio cigarette advertising w banned, or the sale or handing over of cigarettes to a young person was bann_.y by law was 42.7% and 26.4% respectively. As shown above, there were differences in the level of smoking control in the various countries. It seems likely that these differences are related health, social and econcmic indicators. 68 rU4N 448570
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CANADA'S FIRST BY-LAW TO REGULATE SMOKING IN PUBLIC PLACES AND THE WORKPLACE: A REVIEW OF THE STRATEGIES AS. Thompson, G. Rowlands, F. Bass British Columbia Lung Association, Vancouver, British Columbia, Canada Vancouver's by-law on clean indoor air was the first adopted in Canada to regulate smoking in the workplace. The cooperative effort to adopt this legi5lation joined municipal government, private industry, the public sector, and the British Columbia Lung Association. This paper will describe the collaborative and methodical approach, including social marketing, identifying and mobilizing key stakeholders in the community, obtaining media coverage and maintaining effective relationships with specific community organizations. After its initial consideration, but prior to passage of the by-law, guidelines for implementation of workplace policy were developed by the Lung Association and presented at numerous seminars for employers. Our paper describes the guidelines in detail; the health, economic and legal implications of adopting a clean indoor-air policy; sample employee-survey instruments, and sample policies. The details of implementation and enforcement, the difficulties encountered, and the overall impact of the by-law are also described. SMOKING AND DEATH RATES IN TWO-THIRDS OF A MILLION WOMEN L. Garfinkel and -S.D. Stellman Amer2can Cancer Society, 4 West 35th Street, New York, NY 10001, USA. A prospective mortality study of 676,589 American women was begun in 1982. After 2 years of follow-up, with 99.2% traced, 8,385 women had died, Age- standardized mortality ratios for specific causes of death were tabulated according to various smoking intensity parameters. Compared with women who had never smoked cigarettes regularly, current smokers withi:o histotv ofcancer or other serious illness at time of enrollment experienced at least twice the death rates for total mortality (E42 deaths), ischaemic heart disease (173 deaths), cerebrovascular disease (83 deaths), COPD (19 deaths), total cancer (317 deaths), and cancers of the lung, larynx, mouth, esophagus, bladder, and pancreas. Death rates for each of these causes increased with duration of. smoking cigarettes, number smoked per day, depth of inhalation, and daily tar exposure, and decreased with years of cessation in ex-smokers. This is the largest prospective study (1.3 million woman-years of experience) uver to present in a uniform manner detailed dosage parameters for women for so many causes of death and sites of cancer. The data demonstrate clearly that intensity of exposure to cigarette smoke plays much the same role in women as in men, both qualitatively and quantitatively, and provide,direct evidence that the increasing mortality rates for lung cancer and certain other tobacco-related diseases in American women are due to increases in smoking over the past decades. SS-6-22 SS-7-01 TIMN 448571 69
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SS-7-02 02•I TIL RT?LITIOI•ISTIIF Bi;T';!B':IT CIGARBTT:. ST••":OKIiiC I1I7D 17I:LILB LUNG CAI' CrR ''~Geng,Gun.n-yi,Li^r~T Z.H. et al. Department of Bpidemiology,Tir.njin Medical Colle~e,Tin.njin,P.R. SS-7-03 70 China Mortality rate of lung cancer of women in Tianjin(29.15/105) is higher than other 49 countries and regions.The prevalence rate of cigarette smoking among women in Tianjin is the hi--hest in China. We had conducted a case-control study to elucidate the relation&•. ship between smoking and female lun, cancer. We selected 157 fe- male lung cancer cases and 157 controls. The OR of lung cancer of smoking is 3•05,95;'~CI=1.77-5•3• The exposure rate of the case3 is 65.5 p',the AR;b is 57.4;0. The OR of non-:,moY.ers with pisrive smokir from her husband is 2.16. AR;, is 37.2;fa. The OR of smokers with smokinr husband is 3.88, AR`,o is 71 .5 5• Ri:,k of f.emzle lun.- cancer increased with number of ciCarette smokcd,duration of s:^.olcin;, earlier aae at starting smokin,;,do;;ree of inhalation. A si;nifi- cant dose-response effect was observed between lung cancer risk and duration of exposure to husband's smokin,;,daily number of hus- band's ci,-arette consumption. I'rom the data of present study it is presivned that about 70 ; oj female lung cancer in Tianjin city is associated to active and passive smoking. WOMENS SMOKING AND LUNO CANCER IN ICELAND. Sigurdur Arnason M.D. (*) and Jonas Ragnarsson * Dept. of Oncology, University Hospital, Reykjavik, Iceland- ** Icelandic Cancer Society. Although smoking amongst Icelandic women has signif:ic- antly decreased during the last 10-15 years the percent- age of smokers is still one of the highest in the worl as 35% are daily cigarette smokers -compared to 2i amongst the Icelandic males. This difference is clearly reflected by the fact that the incidence of lung cance^ in Icelandic women is one of the highest in tne world i spite of Z!ie fact that IcelancE is a low pollution arc., with very few heavy industry plants. A 30 year epidemio- logical lung cancer ntudy will be presented and comparr°' to the smoking pattern and tobacco sales with speci: reference to smoking and lung cancer in Icelandic womer,- The male/female ratio in lung cancers is now (1986) 1 to 1.2. TIMN 448572
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MATERNAL TOBACCO USE AND REPRODUCTIVE OUTCOME-pOTENTIAL PU- BLIC HEALTH IMPACT IN INDIA, BANGLADESH. *S.Krish:,amurthy and @ K.Krishna. *National Cancer Registry Project (ICMR), Tata Memorial Hospital, Bombay-400 012; @Pune, India Three Indian studies on maternal tobacco chewing and bidi smoking and pregnancy outcome are available. Tobacco chew- ers' offspring compared to nonchewers' show: increased still- births per 1000 livebirths (58 vs 17.4), decreased birth- weights (by 100-200 gm to 395 gm), increased male foetus was- tage (80 male per 100 female vs 108.5 male per 100 female), and increased placental weights (by 66 gm). An estimated 10-13% of reproductive age Indian women chew, and 2% smoke (bidis mostly), tobacco. 1981 census projections and Bombay city stillbirth rates suggest an estimated 2.3 to 3 million livebirths and 130,000-174,000 stillbirths in 1986 were in tobacco chewing women. At a threefold risk of still- birth in chewers'offspring, 17-21% of all the population stillbirths are attributable to tobacco chewing in pregnancy and 3,8% to smoking. Thus, 117,000-145,000 stillbirths are attributable to maternal tobacco chewing and 26,000 to smok- ing. Indirect effects of such tobacco use include high infant mortality due to prematurity, diversion of income from nutri- tional needs to tobacco. In Bangladesh, perinatal mortality rates in bidi smoking mothers' children are cited to be twice those in nonsmokers'. We conclude prevention of maternal tobacco chewing and bidi smoking may prevent a large proportion oi premature and still births and impact on infant & perinatal mortality. BREASTFEEDING AND URINE COTININE IN NEWBORNS WHOSE MOTHERS SMOKE. *i•9. Labrecque, JP. Weber, S. Marcoux, a ia ana erron Department of Social and Preventive Medicine, Faculty of Medicine Laval University, Quebec, Canada Between eight and twenty percent of Quebec (Canada) newborns are exposed to tobacco by a breastfeeding mother who smokes. Uri- ne cotinine is useful to measure this tobacco exposure. This study evaluates whether urine cotinine excretion in newborns ex- posed to maternal smoking is higher for breasfed than bottle-fed babies. Among 915 babies born in Quebec City during the 1985-8-6 winter, 216 (24%) had a mother who smokes. Complete data was ob- tained for 172 of them, including a questionnaire completed by a nurse during a home visit and a urine sample taken from the ba- by's diaper with blotter paper. A milk sample was taken from the mothers who breastfed. Urine cotinine was measured with gas- liquid chromatography. The breastfed babies (n=38) had a mean of 584 ng of cotinine per mg of creatinine whereas the bottle-fed newborns' cotinine averaged 261 ng/mg (p <.001). Similar diffe- rences were observed for each level of maternal smoking indepen- dently of the presence of other smokers in the home. In both groups, the cotinine increased with the daily number of cigaret- tes smoked by the,mother. Urine cotinine of the breastfed babies increased with higher concentrations of cotinine in the mothers' milk. The mean urine cotinine of breastfed babies is comparable to that reported in very light smokers. Although the long-term effects of this exposure are not fully known,it is yet argument against maternal smoking. SS-7-04 SS-7-05 TIMN 448573 71
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SS-7-06 WOMEN AND SMOKINGt THE CONTRIBUTION OF A NATIONAL WORKING GROUP OF WOMEN TO THE CAMPAIGN TO REDUCE SMOKING AMONG WOi•tEN *Eileen Crofton Action on Smoking and Health (ASH), UK, 5-11 Mortimer Street, London WiN 7RH, UK. SS-7-U7 Following the 5th World Conference, where priority was given to women's smoking, and a number of initiatives previously undertaken, Action on Smoking and Health set up a working group in autumn 198+ consisting of women active in different parts of the UK. The group aims to achieve greater emphasis on women's smoking in health education proo ammes at local, national and international levels; to follow up contacts already made with women's organizations and professionals and to produce materials suitable their needs; to provide a forum for discussion of research projects and health promotion initiatives undertaken by members; and to campaign for smoking control policies which will be helpful for women• The following examples will be presented, persuasion of official health education agenci to put greater stress on women; production of a booklet for women's organizations suggesting ways in which they can participate actively in smoking control; and stimulation of research projects to'take account of sex differences. IMPACT OF INTERVENTION ON THE REVERSE SMOKING HABIT OF RURAL INDIAN 1•:OMEN. Mira F3. Aghi, Prakash C. Gupta, Fali S. Mehta. Basic Dental Research Unit, Tata Institute of Fundamental Research, Homi Bhabha Road, Bombay 400 005, India. In a house-to-house survey of 19 villages in Srikakulam district of Andhra Pradesh •6045 men and 599?2 women were found to be tobacco users. Among these 15.1% men and 99.2" women were reverse chutta smokers. These individuals wer exposed to a responsive and tailor-made educational interven- tion program regarding their tobacco habits. This health education program utilized one-to-one interaction betwee' members of the target population and social scientist trained specifically for the project, film, posters, folk drama, special :lide exhibits and individualized cessation camps. After eight years of educational efforts and annual follow-ups, significantly higher percentage of women ha stopped their reverse smokinq habits, comoared to men (18 vs. 12%, P4.001). Thus educational intervention was more effective for women although it was very helpful to men as well. 72 TIMN 448574
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A SELF-HELP SMOKING CESSATION PROGRAM FOR REGISTERED NURSES SS.7.® 8 *E.R. Gritz, A.C. Marcus and B.A. Berman Division of Cancer Control, Jonsson Comprehensive Cancer Center at UCLA, Los Angeles, California, U.S.A. This study was designed to expand understanding of smoking among nurses and to measure the effectiveness of a targeted self-help smoking 'cessation program, supplemented by a supportive "quit smoking" environment, among registered nurses. At an initial meeting, demographic information, smoking history and patterns, motivation to quit and job related stress were obtained on a baseline questionnaire for 212 R.N.s and other employees recruited on a voluntary basis at 15 Los Angeles area hospitals. At this time enrollees received American Lung Association smoking cessation self-help materials supplemented by modules emphasizing weight control, managing break time at work, and use of a "buddy" support network, designed specifically for nurses. A supportive 4 month "blitz" (i.e., posters,."Great Nurses Smokeout Day," newsletter, etc.) was initiated in the nursing service environment. At one year 19% of the subjects were point prevalence abstainers and 13% were continuous abstainers. These results compare favorably to a 6% annual spontaneous quit rate for the 4 years prior to this study, obtained from a survey of all nurses (N=2290) at 6 of the participating hospitals (response rate=72%, N=1690). Smoking status, degree of difficulty in quitting and, where applicable, individual and situational factors surrounding relapse to smoking were also assessed. WOlSEN PHYSICIANS AND SMOKING *~M.A. Cromer, M.D., Pediatrician Somerville Hospital, Somerville, Massachusetts 02143, U.S.A. Women physicians were surveyed on their knowledge, attitudes, and behavior in regards to smoking. Periodic questionnaires were used to measure the effect of antismoking workshops offered to the American Medical Women's Association's (ArIWA) 10,000 members. The ANWA is the first women's organization in the U.S.A. to focus its membership on the problem of women and smoking. Regional workshops were scheduled throughout the continental U.S. to train female medical students' and physicians for a three fold anti-smoking intervention in their communities: prevention (primary school smoking education), cessation (adult patient population), and smoke free environment (public policy formation/ legislation). The baseline questionnaires demonstrated: 1) a lack of knowledge of the effects of passive smoke, particularly on the spouse and on the fetus; 2) there was unanimous agreement for the need to ban smoke from hospitals, commercial airlines, as well as the elimination of tobacco advertising; 3) the legislative process as a means for obtaining controls on smoking was rarely attempted. SS-7-09 ,rgMN 448575 73
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SS'7-y U SS'7'11 74 PREGNANCY AND CHILDBIRTH: AN OPPORTUNITY FOR SMOKING INTERVENTION *M. A. Stoto, N. A. Rigotti, M. A. Schuster, and C.L. Pashos Institute for the Study of Smoking Behavior and Policy, Harvard Universit„ Cambridge, MA 02138, U.S.A. The aim of this paper is to analyze the possibilities for smoking int vention during pregnancy. A number of factors suggest that pregnancy is good opportunity for smoking interventions that would benefit both the mother and her child. First, concern for the health of the fetus already leads some pregnant women to stop smoking, and studies have shown that as many as 50 percent in total can be convinced to stop. Second, although m, of those who quit currently resume smoking postpartum, interventions by pediatricians, hospital policies, and the realization that women who have foregone smoking for almost 9 months have overcome the worst part of smok4- cessation should make it possible to substantially decrease recidivism. Third, unlike other smoking interventions later in life, a relatively yout„ pregnant woman who quits smoking should have almost a full life expectancy. Putting these factors together (assuming that 50 percent of female smokers quit every time they get pregnant and that 50 percent of those who quit ` remain abstinent postpartum) there would be only half as many smokers at a 45 and above as there are now, and the excess mortality in women due to smoking would also be cut in half. In addition, the children of these wome: would benefit both directly and indirectly through the lack of a smoking role model. In addition to explicitly quantifying these effects, this pa) discusses the changes in health institutions needed to bring these changes about. FACTORS WHICH MAKE PREGNANT WOMEN CONTINUE SMOKING *H. Shimizur, Y. AkaiY.e~ S. Hisamich_r, S. Tayama2, and J. Shoji2 IDepartment of Public Health, Tohoku University School of Medicir Seiryomachi, Sendai 980, Japan 2Sendai-Minami Health Center, Nagamachi, Senda. 980, Japan To get the idea for making pregnant women stop smoking, we compared sevex characteristics between the pregnant women who continued to smoke and thosi( who stopped smoking after the pregnancy. A total of 451 women obligatorily reported their pregnancy to the Senda Minami Health Center from May to August, 1986. Health nurses routine interviewed all of them about the history of marriage and pregnancy and some- other demogra,phic data. We also asked all of them to fill in the questionnaire about smoking and drinking histories except when the surrogat answered (14 cases) or the sub7ects refused to answer (19 cases). Among t remaining 418 women, 79 had ever smoked; 18 were current smokers (Group A) a,,.. G1 (77%) had stopped smoking after the pregnancy (GrouE B). The mean ages were 27 years in both Groups A and B, and the mean ages at marriage were " and 24 years respectively. The number of cigarettes smoked per day before pregnancy in Group A w,._ larger than that in Group B (13.8 vs 9.2). However, no differences were. observed between Group A and B for the age at first smoking, duration ~r smoking and smoking history of husband. About a half of Group B reported th. they were expecting to have the first baby, but 72% had one or more ch.tldr. in Group A. The proportion of the women, reporting their failure in contraception was 39% in Group A and 10% in Group B. The grade of mornina sickness in Group A was higher than that in Group B. No other remarkab. differences were observed between Groups A and B in this analysis. TIMN 448576
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SMOKING AMONG YOUNG WOMEN IN JAPAN *Reiko SAITO,M.D. Direct.or,F.bisu Health (:enter,Tokyo Metropolitan Govcrnment, Ebisu, Shibuya-ku, Tokyo, JAPAN In spite of the enforcement of' the prohibitive law of juvenile smoking under twenty years old, smoking amoog• young girls in particular seems impressively inereasing recently in Japan. In this study the author will report the results of the survey by questionnaire on the motivations and related circumstances of young female smokers including teenagers. The survey was done' to the 1960 first-year college students, from 17 to 21 years olds in the Tokyo metropolitan area. The results of the survey reveals 17% of the freshwomen smokes every day, and high incidence of their smoking frequencies and occasions. In the families, the smoking ratio of the fathers,56%, is the highest figure, while that of the mothers is low at 3%. If an elder sister is a timuker, it shows the highest correlations. In addition, the survey includes the starting age of smoking, the posture of the parents to smoking and whether or not to keep smoking. It, is concluded that smoking of' young women 'starts from their teenage-days, and smoking of the other members of the family has given a great deal of influence on juvenile smokers. In order to keep young women, who may bear and foster their children, away from smoking, not only direct education on non- smoking to juveniles is needed, but also the whole family should be guided to non-smoking from the aspect of the health of them all. ATTITUDE TO SMOKING AMONG FEMALE STUDENTS IN A PROVINCIAL CITY IN JAPAN "H. Kinebuchi and S. Ryu Department of Environmental and Occupational Health, Kochi Medical School, Nankoku, Kochi 781-51, Japan Excepting young women, the prevalence of smoking among Japanese has showed a yearly decrease. We investigated actual status of smol; ing or the attitude toward smoking among the female students in Kochi, a provincial city of Japan. A questionaire was carried out on knowledge (ex. the percentage of female smokers in Japan, or diseases caused by smoking), attitude (ex. toward the smoking behavior of future husband), opinion (ex. toward the regulation of smoking by law) and so on. Further- more we asked them how to get impressions of the male smokers who were near to them, by using semantic differential method. The number of respondents was 518, and smokers among them were only 20 (3.9%). The prevalence of present survey is less than that of aver- age in Japanese women (14%). It may reflect a conservative custom of provincial society. The initiation of a few smokers is mainly by curio- sity. About the attitude toward smoking behavior of future husband, only 15% of respondents answered that they would not like to marry smokers, and more than half was generous to smoking behavior of their future hus- bands. However, 70% of respondents answered that they would approve of the legal regulation of smoking. It is interesting that these female students are generous to their husbands but strict to others. Results suggest that smoking behavior of young women in provincial society will also decrease in future. SS-7-12 SS-7-13 . TIMN 448577 ' 75
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SS-7-14 SS-7-15 76 DEVELOPPLF:NT TRENDS IN SMOKING AMONG WOrfEN 'I1d SWf:DEN-AN ANALYSIS. r:. ti~nd National Swedish Board of Health and Welfare,106 30 Stockholm,Sweden One hundred years ago in Sweden as in many other countries smoking was part of mens world.For women at the beginning of this centure there was a definitr rule,women must not smoke. That was the situation up till World War II. Afte: the war a big increase in smoking habits among women took place. The women's smoking habits seem to have developed in two different phases. In the first phase a big increase occured up till the 1970's.Back in 1963,23 percent of the women were smoking compared to 9 percent in 1946.In the secon phase which covers mainly the second half of 1970's, the smoking habits of w, men and men apparently grew more similar.Smoking among men declined sharply, but nothing comparable occured among women.In the 1980's we have got a declinP in smoking habits even among women in Sweden. It is mainly the younger women who have cut down their smoking,.while the changes among the rest of the women are less marked. This is a reflection of the fact that the percentage of the smokers has dropped sharply since the earl. 1970's when it was at the highest level.The main explanation of this trend mi lie in the big effort that has been made in Sweden in the last 20 years with the aim of cutting down tobacco smoking.The generation that has grown up recei ving information from many sources about tobacco shows a very.positive develop ment,with ever fewer boys and girls acquiring the smoking habit. The difference between the sexes as regards smoking is gradually disappea) ing now in Sweden. At the same time there are increasingly clear signs that smoking is more common among pepple on the lower educational levels than on th higher ones.Thus we have begun to see a difference in smoking habits which dc not seem to depend on sex,except that women generally are lower educated and have smaller income than men. INTEGRATION OF SMOKING CESSATION INTO PUBLIC PRENATAL CARE IN THE U.S.A.-- RANDOMIZATION WITHOUT REVOLT *M. Dalmat, N. Miller, N. Salas, J. Stine Division of Reproductive Health, Centers for Disease Control (CDC), Atlanta, Georgia, 30333, U.S.A. The aim of this National demonstration research project is to show that effective smoking cessation programs can be integrated into prenatal care statewide on a sustained basis using only existing health resources. The stat health departments of Colorado, Maryland, and Missouri are collaborating wit' CDC in this effort. Local health department clinics were randomly assigned either the enhanced intervention condition or to a control condition--what ib currently being offered by clinics. The enhanced intervention was developed considering both the patient and provider perspectives as to what helps wome- stop smoking, both of which were assessed using focus group analyses. Questionnaires are administered to patients and urinary cotinine is tested a, enrollment, 32 weeks' gestation, and 6 weeks' postpartum to validate self- reporting of smoking cessation or continuation. Our findings to date underscore that when "underpaid and overworked" public health workers are committed to, and involved in demonstrating that they are effective in chang their patients' smoking behavior, meaningful evaluation can be done in non research settings. Involving maternity nurses and physicians in each stage of of the project has been critical to winning their support in enhancing risk reduction efforts during early prenatal care. We have also learned that the long-term survival of the enhanced intervention depends on the sustained collaboration of multiple, and largely autonomous, levels of government as wel as volunteer organizations and academia. TIMNI 448578
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SMOKING CES5ATION DURING PREGNANCY - A CONTROLLED TRIAL OF THE IMPACT OF NEW TECHNOLOGY AND FRIENDLY ENCOURAGEMENT •Pamela Gillies, Richard Madeley and Lindsay Power Department of Community Medicine and Epidemiology, University Hospital and Medical School, Nottingham, England This paper describes the impact of an intervention designed to help women stop or reduce smoking during pregnancy and for the first six months after giving birth. 500 women attending an antenatal clinic in the City of Nottingham, England, were identified as smokers and recruited into the intervention group. During the same time span, a comparable group of 500 women smokers were recruited from the remaining antenatal clinic in the city and formed the control group. This latter group received their normal anti-smoking advice and information during the course of their pregnancies, butwere not involved in the 'Nottingham Mothers Stop Smoking Project'. The intervention comprised a newly designed carbon monoxide monitor which mothers could use themsleves to check their own progress in reducing consumption, an antenatal booklet, self-help group opportunities and a friendly, encouraging facilitator working in the clinic. Data were collected in each group prior to the intervention, mid-way during the pregnancy and immediately after giving birth. A standard questionnaire was used on all three occasions. In addition, a random sub-sample of 100 experimental women were interviewed post-birth. The project had a significant impact on smoking cessation rates. The findings are discussed in the light of cost-effectiveness and practicability. F,'iCl;IP:3 AtiD F-Y.!:Li' R:'.Pl:QD',!CTI\•'^ F'J?:C`_"I!'NS- V.V.Subbarae Departr.,ent of Physiology,Otafemi Aerolo:ro College of Health ciences Ogun State University, Aso-It'oye, Nigeria The aim of this preser,tation is to implicate sr.,ck=nj with reproductive Physiological disturbances in fers:;le s::^okers. Several clinical reports have correlated tobacco s:nel:ing with decreased pregnr-.r.cy rates,increased abortion rates,infar.t r.•:ortality and lower r.,ean birth r!eights. P.ats vere exposed to tobacco smoke anc the horr:cr.al chanrCes ^:ere studied to correlate the human reprociuctive dycfunctions.Cn the basis of the results it is expl:•,ined the reasons of sro!:ers enrlier ex.ncriencc of rneno,_.ausal sycir,tore.s.This r•resc-ntr,tion ;:lsc considers the health h; z: rds of t, king the pill and s.:,oki ng in child bea?•in5 ycars.On the basis of the horsonal alterations due to _~:;o:;ir.;;,the effect of s^~o_ting durinF lactation that reduce thc• euclity of milk and the quantity of its pr:;duction is explained. SS-7-16 SS-7-17 TIMN 448579 77
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SS-8-01 SS-8-02 78 SMOKING IIAI3ITS OF SC!IOOi. C:IITLDRI•:N TN Rf:YF:JAVTK, TCF•1.Ai•11) 1D74-IO-m *S.Mngnussonl), S.Johnsen2), '1'.Ornolfssonl) 1) Reykjavik Cancer Society, Skogarhlid R, Reykjavi.k, Iceland. 2) Reykjavik City Medical Office The objective of this survey was to determine the incidence of smokin; among school children in Reykjavik. Teachers of students aged 9-16 distributed nnonymous questionnaires to t.heir students, that asked about their smoking habits and the smoking habits of nthers in their homes. These questionnaires were first distri.buted in 1974, and, nsin<; the s: method, have been di.strihuted at four-ycar intervals sincn. There wns an 813% response rate in the most recent survey in April, 1936, wi.th a total number of 7255 students replying. The daily incidence of cigarette smokin¢ off students 12-16 years old I• steadily dropped, it was 22.8% in'1974, 17.19: in 1978, 14.6% in 1932 and 9.2*X in 1986. The total number of smokers has dropped from 32.C1•'•, in 1974 to 12.6% of responders in 1936. The survey shows that, from age 13 up, girls smoke more than boys. The qreatest difference occurs in the 15 year old age group, where 29.3y of the girls smoke as against 21.1' of the boys. As to the rc]ations off the smoking hahits of the studcntc and others i- the family, the hishest correlation is between the smoking !iabitti nf the students questioned and their brothers and sisters. It is our opinion that the campaign against smokin„ that has been carric out in the schools in Reykjavik by the Reykjavik Cancer Society and the Committee for Tobacco Use Prevention has borne results among younger and middle level school children. CHANGES IN S190KING BEHAVIOUR Ah]ONG SYDNEY ADOLESCENTS J.P. Pierce, J. Aitken, P. Macaskill and *A. Barratt Department of Public Health, University of Sydney, NSW, 2006. Australia. As cigarette smoking almost exclusively begins in adolescence it is important to identify means of preventing uptake and maintenance of smoking among adolescents. Although many predictors of adolescent smoking have been identified the causal relationships still remain poorly defined. We undertook a longitudinal study of 750 Sydney teenagers to try to clarify the factor that trigger adolescents to begin smoking, or conversely, to quit. The study was unusual because it was community based and not confined to school students. Nine percent of boys and eleven percent of girls took up smoking ove the twelve month period of the study. A significant age and sex • interaction was found. After adjusting for age and sex, uptake was best predicted by the number of friends who were smokers. Other significant predictors were disagreement with health arguments about smoking and student status. Five percent of boys and three percent of girls quit over the year and the best predictors of quitting were ability to resist peer pressure and student status. These predictors suggest approaches that may be effectively used in campaiEns to prevent adolescents taking up smoking. TIMN 448580
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5M N:A1 ; :N ~ ;_ and S •si)r-7::.:urc:nandcn. .._.,.,.,:ul i•i; C.:1Cai College and Ik: _artt..Gl"a of GCOc_"•=, 1)", i:alit`Sal_ aa..taraj Univcrsity, - 625 002 Three hundred childrcn (arell to 14 y• arc; 11`_'~ e:: ,Jloyed a::d 175 3tucying in schools) h]ho 1]F21'Ce the hai;it of s:.ioaln~' :.Je?'e i....:GrviCHCCt. ).:r,):~ioyeCi Cc111C1'iL useU ijCCdi (L:Cl'Ca5 GC;)001 :;ing c:1:.lc;re:': uced 'uecd (15-4;5)a::~ Cigarettes ;Dy t:•!e rectr i:•tcy zEC: 3 to 1. becc:ri o:- Ciea:-ettes ...' t::c:.. uccc. cir_c!r or c::cro .:ts • They _%referreci c ima ~est c igarc tte's -::d ';Dcedi' in viot) of - t:c cost. iven for trens; ort cr ^urchaso of sci:ool; a-cr":cls or as poc.:ct e::?enses were used• ..^_c t:ior. 60 school c:7i'Circra US~:G! u:::0::1711.~r ::.Cter:al 'by thC-r =ri-::Cis• L'::E: ttlirC. :)_ t.lc C:ii'_d_^~.1: Used beteinUt afts J c., to Lic,£i: cGi ~iP.g T~L"oC! mouth. They inG ~1rC(: t.1C il';Y'.:Cr= S::.C.:i ^^ ir ... SriCl'ICZS( 34) , peer ,Jrou:: (107 ) "•`re:':tc (11) enc ot.er soarce.,(14E•) and started s:io:cing with a se.:sc o= c::all- en c:c = =un gaining i-ane fror, 'his peer grou: or to wcr:: more. ihcy felt tnat ti;e ir ?arents and fa; tily rcrt-ers v: il l not e.r-ree to sc:o',:ing anci ti~e~• did not sno;ce in _ront o'_ z;~e~• iney ~tere arJ=_re that s'3oi:inCt'_DroC'luces cough anCl heart diseases. -n view Df ttcle res.ect, they have ~cr elders, their grou's are a7lenc;:le for rehebil it_t i~)n • EPIDEMIOLOGICAL STUDY OF TOBACCO SMOKING BEHAVIOUR AMONG YOUNG PEOPLE OF NEPAL SPECIAL t U E N B L *M.R. Pandey, S.R. Venkatramaiah, R.P. Neupane, Akshaya Gautam, Mrigendra Medical Trust, Kathmandu, Nepal A cross sectional survey of 1157 young individuals between the ages of eight and nineteen years living in a rural community of the hill region of Nepal was carried out with the help of the WHO standardized smoking survey questionnaire for young people. There was a very high response rate (96.1 per cent). Special care was taken in interviewing the younger boys and girls to overcome the problems of concealment of information and inhibition in reporting the smoking habit. The overall prevalence of daily smoking was found to be 12.6 per cent (17.3% for boys and 6.7% for girls). The prevalence increased with age for both sexes. In addition there was a large number of weekly and experimental smokers especially in the younger age groups. Young persons who are not in school constituted a vulnerable group. Education was found to be beneficial and helped to form a favourable attitude including public action against smoking. A major deterrent factor seemed to be strong peer pressure in school. Attitudes of parents, siblings and friends were also assessed, and results indicated that peer pressure had more influence against smoking on non-smokers than on smokers. Practical suggestions and recommendations are made, based on the findings of the present study, to help diminish the increasing smoking rate in Nepal. SS-8-03 SS-8-04 TI1VI~'T 448581 79
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'rv S S.8.0 5 THE EFFECTS OF SCHOOL LIFE ON SMOKING BEHAVIOR IN YOUTH *Y. Hiraoka, J. Tanaka, F. Sugimoto, and H. Okuda Department of Hygiene, Hiroshima University School of Medicine, Minami-ku, Hiroshima 734, Japan In order to determine whether school life has an effect on the smoking behavior of youths, a questionnaire survey was carried out in July 1985 to 1451 1st- and 2nd-grade college or university students. The percentage of students who were currently smoking or who had smoked in the past was 75.9% of male students and 35.97% of females, 46.77% of male students and 45.6% of females having smoked for the first time when they were at high school. On the other hand, 36.7% of males and 31.0% of females had first smoked when they were junior high school students. The most commor situation associated with the first experience of smoking was that students had tried smoking a cigarette out of curiosity or as a prank at their own home or that of a friend. The percentage of current smokers among 1st- and 2nd-grade students was 55.3% of males and 8.37% of females. The incidence of students who had developed a smoking habit while at college or universit was the highest, followed by those who had done so at high school. From an analysis according to Hayashi's quantification theory, it was found that extracurricular activities, recognition of the harmfulness of smoking, awareness of smoking as an antisocial activity, the smoking environment around the students, will to learn and so on, are related to the formation of the smoking habit. These results suggested that a smoking habit in youth was mainly formed at school and that school life had an effect on the formation of the smokin- habit. Therefore, in order to prevent youths from smoking, it seems neces- sary for teachers and parents to help students lead full lives during theit time at school. SS•8-06 80 SMOKING HABITS AND INDICATORS OF SOCIOECONCMIC STA'IUS AMONG SCHOOL CHILDREN IN EUROPE. A WHO CROSS NATIONAL SURVEY 1985-86 *L.E.Aaro, B.Wold, and L.Kannas Department of Social Psychology, University of Bergen, Norway Department of Health Sciences, University of Jyvaskyla, Finland The aim of this presentation is to describe the relationship between smoking habits and indicators of socioeconomic status among school children from 11 European countries. The presen- tation is based on analyses of data which were collected in 198`. 86. Questionnaires were filled in by pupils in class, normally administered by form teacher. The teachers applied a standard ' procedure for the collection of data ensuring anonymity. The questionnaires used in each country contained questions which were translations from an international version in English. The samples comprised at least 3000 pupils in each country. The samples were statistically representative of whole countries or of large geographical and administrative units. In general, weekly as well as daily smoking is more widespree among children who report their parents to belong to high-status groups. Further, the probability of being a daily or a weekly smoker increases when the pupil reports: (1) To dislike school, (2) that school performance is below average, and (3) not to pla for further education after basic school. The findings form a clear and consistent pattern which may indicate even larger differences between low-status and high-status groups in prevalence of smokers in Europe towards the year 2000. TIMN 448582
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'SCRAMBLE-AN-AD' - COMPETITION FOR CHILDREN AGAINST SMOKING SS'.8.0 7 *J. Berry Executive Director, Project Smoke Free, North Western Regional Health Authority, Gateway House, Piccadilly South, Manchester M60 7LP, U.K. As a British response to B.U.G.A.U.P., children under 16 in the U.K. in 1985 were invited to submit parodies of current cigarette advertisements, using similar ideas and graphics but with an anti-smoking message. The idea was pre-tested by the.North West U.K. Branch of Action on Smoking and Health and then run as a national competition by Project Smoke Free sponsored jointly by the North Western Regional Health Authority and the Health Education Council, U.K. 1600 schools participated nationwide, submitting over 20,000 entries; parodies covered all leading brands of cigarettes, cigars and tobacco- sponsored sporting events. Over 100 prizes were awarded with national, regional and local TV and press coverage. Two touring exhibitions of posters now visit schools, libraries and health service premises. A 1987 calendar and a poster featur- ing 30 of the best entries was produced and copies were distributed to every Member of Parliament and Local Government and Health Authority. Full page colour advertisements of the calendar appeared in the national press and over 7,000 copies have been sold yielding an income of over £16,000. New Scramble-an-Ad competitions are now being organised in Britian and abroad. SMOKING EDUCATION FOR TEENAGERS - THE DEVELOPMENT OF A RESISTING SOCIAL PRESSURES CURRICULUM 'E. M. Gray and P. Gammage School of Education, Universi•ty of Bristol, Bristol BS8 1HP, England The aim of this curriculum development project was to ascertain the acceptability of a resisting social pressures approach (learning to say 'N0' to cigarettes) to smoking education. The work has involved the adaptation of an American curriculum guide for use in British schools. Teachers, education advisers and health education officers have collaborated in the development of 'SMOKING AND ME', a pilot version of a teacher's guide to five lessons on smoking for 12-13 year olds in which the children themselves take an active part in leading discussions, listening to and countering arguments about smoking and in role-playing saying 'NO' to cigarettes. A formative evaluation has been carried out in 75 schools involving 198 teachers and 5,371 children. The results show that the material' has been favourably received by both teachers and children who appear to value group work which places greater responsibility upon the children and which particularly emphasises opportunities for'the children to practise saying 'NO' to cigarettes. The results suggest that the strategies employed for developing skills for resisting the influences to smoke could usefully be adopted for other,areas of substance abuse. SS-8-08 TIMN 448583 ~ 81
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SS-8-U 9 A COMPREHENSIVE SMOKING PREVENTION PROGRAM *Anthony Biglan, Ph.D. Oregon Research Institute, Eugene, Oregon, U.S.A., 97401 This presentation will describe the comprehensive smoking prevention program that has been developed at Oregon Research Institute during the 7 years of research. The program is an elaboration of one that has been previously found to reduce adolescent smoking (Biglan et al., 1987; Bigla, et al., in press). It consists of curricular materials for grades 6 through 12, as well as activities designed to change the school culture related to the use of tobacco. Video-taped materials are an integral p", of the curriculum at each grade level. The program is being evaluated in 37 schools in the state of Oregon. Smoking and smokeless tobacco use, as well as the consumption of other substances are evaluated annually. Self-reports of the use of these substances are obtained and samples of expired air carbon monoxide are us- to increase the accuracy of self-reports and to corroborate those reportc The presentation will provide an overview of the intervention and thE results of the evaluation of the effects of the first year of the intervention. $$-$-1U EVALUATION OF A SCHOOL-BASED PFEVENTION PROGRAM ON REDUCING SMOKELESS ANC CIGARETTE USE BY TEENS *Herbert Severson, Ph.D., Russell Glasgow, Ph.D., Roger Wirt, Ph.D. & Ed Lichtenstein, Ph.D. Oregon Research Institute, Eugene, OR 97401, U.S.A. Results of our ongoing tobacco use prevention program are presented. it federally funded project involved intervention in middle (7th grade) and hi schools (9th or 10th grade). Twenty-three schools (13 middle and 10 high schools) were matched to treatment or control condition based on a brief classroom survey of student drug use. A total of 4048 students in grades 7-11 were assessed prior to intervention via a questionnaire. Subjects als provided expired air and saliva samples as a bogus pipeline procedure. T' ~ subjects' use of smokeless tobacco, cigarettes, alcohol and marijuana was assessed, along with use and offers by peers. The prevention curriculum involved 7 class periods and was taught by health teachers assisted by same-age peer leaders. The teaching of "refusal skills" was the core of ~` curriculum. Other topics included health risks of using tobacco products decision making, advertising as an influence to use tobacco, review of tobacco use rates, making a public commitment to not use tobacco and conducting interviews with adults about their tobacco use. The program u« video tapes to teach teens to refuse offers. Results of the one-year follow-up assessment include attrition of subjects, use patterns of cigarettes and chew, transition from one tobacco product to another, and th effects of the curriculum on reducing tobacco use. This is the first prevention program that focuses on both cigarettes and smokeless tobacco. 82 TIMN 448584
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PRE-SCHOOL NON-SMOKING PROGRAM SS-$-11 *C. Moyer and L. Ouimet Canadian Cancer Society, 1702-77 Bloor Street West, Toronto, Ontario M5S 3A1 Cana0a, and Health Promotion Directorate, Health & Welfare Canada, Ottawa, Ontario K1A 1B4 Canada The purpose of this study was to pilot test a smoking prevention educational program aimed at preschoolers (children aged three to six). The program materials include three short T.V. segments (or films), related print materials and teacher's guide. The program was tested in childcare facilities chosen at random and compared to control groups. Awareness levels and attitudes of the children in both groups were measured before the treatment through interviews. Other data collection methods included self-completion questionnaire surveys of the teachers/caregivers for the treatment group and of their parents; and daily or weekly logs of activities completed by teachers/caregivers during the treatment period. Very high levels of awareness of smoking and recognition of tobacco products were found among the respondants. Involvement in the pilot program did not significantly increase these levels. The most important finding was that the program was successful in reducing the proportion of children who intended to smoke. This dropped by 22 percentage points for the treatment groups compared to 13 percentage point for the control group. The pilot identified key improvements such as information for parents and improved durability of materials. The most important conclusion was that the program was effective in reaching its objectives and was appropriate for national distribution. ATTITUDE OF TEACHERS, SCHOOL NURSE TEACHERS AND SCHOOL PHYSICIANS TOWARD Si:O KIP+G PREVENTION EDUCATION *K. I•lir,agawa and N. Nishioka Depar•tment of School Health, Faculty of Education, Niigata University 2-8050 Ikarashi, Niigata 950-21, Japan The purpose of the study was to assess the attitudes of school personnel toward smoking prevention education of school-aged youth. The study was a survey of kindergarten, elementary, secondary, high-school and university personnel in Niigata Prefecture, Japan. A questionnaire on cigarette smoking and its related items was given to 975 teachers, 180 school nurse teachers'and 368 school physicians. Forty-eight percent of the male and 3.4% of the female respondents were current smoker. There were significant differnces in the attitudes of smokers and nonsmokers toward the health consequences of smoking, smoking regulations, adult role models as exemplars for the young, and the need of smoking prevention education. Also, almost none of them were received smoking prevention curricula in the training university of teachers and doctors. In addition, both srokers and nonsmokers largely refused to deny or confirm smoking of teacher but said no to smoking of children. All of the three parties, however, generally agreed that smoking education should be ir,cluded in school curricula and smoking restrictions should be performed within the school. The following conclusions are offered: (1) Smoking education is poorly ` integrated within the elementary and secondary school curricula. (2) Smoking education to teachers, school nurse teachers and school physicians must play a active role and also the curricula concerning smoking should be set up at the stage of their training course of university. (3) Enlightenment for the persennel of smokers in schcols is most crucial to promote smoking education. SS-8-12 TIMN 448585 83
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SS-8-y 3 SS-8-14 THE SCHOOL AND SMOKING PREVENTION: THE ROLE OF SCHOOL ENVIRONMENT K.S. Brown, S. Santi, J.A. Best Waterloo Smoking Prevention Projects, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1 The Waterloo Smoking Prevention Project - Study 2 is a longitudinal evaluation of a social influence smoking prevention curriculum, and a study of the social, psychological and environmental factors related to smoking onset. Approximately 1800 students from 42 elementary schools, about two-thirds of whom received a smoking prevention curriculum in Cr 6 (age 11), have been followed into 31 secondary schools and to the end . Grade 10 (age 15). Information on smoking habits, psycho-social factors and environmental influences has been obtained at least once per year o- the course of the study. This paper will focus on the environmental influences on a child's initiation of smoking. Using an adaptation of Moos' classroom environment scales to assess school environment, the importance of teache: support, school rules, and student involvement as well as smoking habitt of school personnel are examined using time-to-event methods of data analysis, which make use of data from all assessment times. We show that measures of school environment are important in modelling smoking onset rates even after adjusting for the effects of psycho-social variables. The implications of these environmental influences in the development ar evaluation of smoking prevention curricula will be discussed. METHODOLOdIES AND'RE5UL'TS OF AN ANTISMOK•ING PROGRAM IN SCHOOLS Arciti C.,Doglio B.,Gogioso L.,Giorgi F.,Santi L. Istituto Scientifico per lo Studio e la Cura dei Tumori,16132 Genova,It._ In Liguria the percentage of smokers is 34% and the mortality rate f lung cancer is singularly elevated.Thus it seemed necessary to institut a•program aimed at preventing damages from tobacco smoking,to be addresse to young students. This program has been in effect since 1981.The metho dology and some data have already been published,but the present work i concerned with modifications of the methodology and audiovisual materiai and new evaluations performed using questionnaires. The courses for school doctors on health education,cancer prevention and on damages of smoking have-%bben- intensified. Also the courses for teachers have been extended and the first course exclusively pertaining the numerous aspectc of tobacco smoking has been held. Examination- of the questionnaires, performed during the second year, has confirmed the results of the firs one on the two groups - sample and control - of 3500 students.In the group that took part in the program,only 2% of the students started smoking-whereas 30% of those already smoking stopped. In the correspondent control group the percentage of smokers was 19% ar. only 1% stopped smoking.Another investigation was started in 1985 on two groups of young students subdivided according'to sex. A year after the participation to the program 36% of male and 14% of female smokers had given up the habit. 84 TIMN 448586
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A DUTCH SMOKING PREVENTION PFOGRAPPIE: DEVEIAPMENT, IMPLEMEtv'TATION AND SS-8-1 5 RESULTS 7H. de Vries, M.Dijkstra, G.J.Kok Department of Health Education, University of Limburg, P.O.Box 616, 6200 MD Maastricht, The Netherlands The development of the Dutch Smoking Prevention Project has been preceeded by an analysis of the determinants of both regular and initial smoking in Dutch adolescents. The results of the determinants study show a.o. that initial smoking is connected, with short term effects and that non smokers have to deal with (indirect) social pressures. Based on these results a video peerled programne has been developed. In this approach active learning of students is stimulated. Moreover, a teacher does not have to follow a special training. Every lesson has the following structure: a. an introduction of the theme on video; b. peer-led activities; c. continuation of the lesson on video; d. peer-led activities. The evaluation of content, structure and effects has been assessed. It appears that the method is appealing for both students and teachers because of the alternation of video and activities. The effects concerning the behaviour are measured in May and December 1987. EVALUATION OF A FAMILY-LINKED SMOKING INTERVENTION PACKAGE FOR 9-YEAR-OLDS A. Charlton Cancer Research Campaign Education and Child Studies Research Group, University of Manchester, Kinnaird Road, Manchester :120 9QL, England, U.K. A baseline survey of 16,000 children carried out in 1982 funded by the Cancer Research Campaign (Charlton, 1984), showed that the boys in the north of England reached a peak of experimentation with cigarettes at the age of 9 years, and girls reached this peak at the age of 10. Therefore as part of a three phase smoking intervention programme for schools it was decided to aim the first unit at this critical age group. The materials used were the Brigantia Smoking-Prevention Programme, Unit I for Primary Schools, and the evaluation was funded by the Cancer Research Campaign. Three separate controlled-trial evaluations were carried out between 1985 and 1987, in the north of England, the south of England and in the Republic of Ireland with 1213 children in all. The pattern of evaluation was that of a pre-test questionnaire; teaching of the lessons by the class teachers; a three to four month gap; post-test questionnaires. The materials consisted of a story, a biology lesson related to the story, and a parental leaflet. Parents could reply to the school asking for help in stopping smoking, having read the story and the leaflet with their children. The results were very promising. Two thirds of the smoking parents requested help with stopping smoking; in the north there was a significant decrease in the number of.fathers smoking as well as a significantly lower uptake of smoking among the children. In all three evaluations there were significant increases in knowledge and positive changes in opinion. SS-8-y 6 TIMN 448587 85
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SS-8-17 SS-9-U1 86 TOBACCO AND CHILDREN *R. Masironi, H. Geizerova Tobacco and Health Programme, World Health Organization, 1211 Geneva 27, Switzerland This paper summarizes current tobacco use in all its forms in youth worldwide. Following a period of growth, cigarette consumption among adolescents has started to decrease in some countries. This decrease has been partially offset by an increase in the use of smokeless tobacco especia in the U.S. Young tobacco users apparently perceive the smokeless tobacco as a safer and more modern habit than cigarette consumption. Smokeless tobacco is a serious health hazard as a cause of nicotine addicition, cancer of mouth cavity and other diseases. WHO urges an immediate developmet of intervention programmes that would assist young people in avoiding tobacec use in all its forms. SP10KIPJG, 1'. SF"RTOII i HEAI TH PRf1C1Lrf9 IN CHINA *Xin Zhi IJeng Smoking and Health Section, Oeijing Heart, Lung and Blood Vessel Medical Center, Anzhenii, AnWai, Beijing, China The smoking rate among Chinese male is very high, being 68.9;,", at the age of 20 and above. Male doctors and teachers have rather high smoking rate of 56.74~ and 50.09',1' respectively. But the smoking quitting rate is only 4.78% Por both sexes, 68.35;' owing to illness. China is the number one cigrette production country in the world, with progressively rapid increment. Since 1952 to 1986 the production of cigrettes had increased 13.64 times. In the recent three years annual increment amounted to about if)"•'•. Chinese cigrettes contain high tar (24-34.4 nig) and nicotine (1.08-1.40 mg). Owing to above situation, the smoking- related diseases are on rapid increase. The mortality of the malignant tumors, cardio-vascular and cerebro-vasr_ular diseases, which were 36.9, 47.2 and 39.0 per hundred thousand in 1957, rose to 116.18, 124.614 and 116.27 per hundred thousand in 1984 in the urban areas of China. Thouqh Chinese Government has launched an anti-smoking campaign in 1978, yet little achievement has been made, because of lack of smoking control organization, state legie lation, limited channels for communication, conflicting economic policies and general diffculty of modifying behaviour and belief about smoking. TMN 44S5S8
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SMOKING PICTURE IN CHONBURI, THAILAND •C. Bowonwatanuwong, K. Tongyai, T. Amphunpong, S. Palaruk Respiratory care unit, Chonburi Hospital, Chonburi, Thailand To illustrate the cigarrette smoking habit in the population of Chonburi province, Thailand before the smoking control was in effect. The randomized sampling study was used in the questionaire as follows : 1) Former generation (1000 cases of over 60 years of age). 2) Present generation (age between 20 and 60 years old). The study was directed towards the behavior and attitude of smoking as compared among the various different roles and occupations in the society namely; farmers, labourer, drivers, office workers, civil servants, businessmen, teachers, policemen, physicians and monks. 3) New coming genera- tion (age group under 20 years old). In this group, the study was confined mainly to the onset and the reason of smoking among students, university students in comparison to another group with no opportunity to continuing education due to low socioeconomic status. The results of this study revealed the characteristic, properties and reason for smoking in each group; and led to concrete basis in planning to control smoking in the future. Key words: smoking habit, various groups, smoking control - G' _ S_~.~'= r't ^~ :G= L~ _=CrI: *s . $11an :.tuC1nTlc.r:C:an and t :'': urt- r::e~~o= Gcorra:hy,l:a';Ltrai ::a:~araj Univercity.;'aci_ rai-o25002. L`1:/L -.. - The ai:ii of this present study was to analyse ti;cincidence of sriokinr, habits,perceived health conditions and behavioural alterations ar:ong the rural -,:;o?uiation of I•laciLlrai district. 7A health screening questionnaire administered ar.nng 1190 res.Don- cients of t::e rural areas of 13durai District deals ;•Iith :X-rcei ved T.lOrbi-:,i].ty cJnditiJns,habit of s[.lo:"l.ni:,acfG- at initiation of behav iour of health care fac i l it ies , soc io- ceol;CStic c;7arC:cteristics of t:Ie S:.IO::ers in rel2.tion to their ierceived mcr;Didity conditions and thc=cctors that ic=luencc the beilC:v-our c_ ti•e rural ; o=u-'ct ion tJelards :'::inCti • 1t is o;Dsc•-vc-d the stut':y t:jat tije rurcl arc merely : ro.:e to '' _uic-s' cr:,oi:inn and t'.ic ir recuc- _y oi: c:-,0:Cincf is :]1crC.uCCC (uuri::': tf7Ci: t?Jr::,cJnvGrG<=tiOn and at ti:~eG of tl:in- .LP.j ?:Jrr-Cs etc.,. = is 21s0 rC;n'Jrted S:ro:.l ti7e tl?C:V that '- I.=CCt' tne irc:c~;~enc~~ of ,uci~ ea res?i_r~•~ory i ~:s _k.:c cr:cst ;~in.colc .. t's~ cnest •;~•i:-I E_:u cou~:h, locs otVa:~- ts.tc, c:el:ta_ d:~c:3louratio.: :icvc i::crcascG ::~G1iiV Ci ti:C CCSCG, i:ehc?.V1orC1 _F--.tcrn Oi'.rthe (~<<`.iGi;t ;.iGi;t; ^re C$n 0 C:ic_teC: 19-t1I _1t:r -r ~~ 1'i.te, incOT.le C.=c= Ct•I0~'L-'=5 C:'`e to C.iIIEs [C7~3C:?a cCi.l: a1C:1s. + SS-9-02 SS-9-03 TIMN 448589 87
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SS-9-04 SS-9-05 88 AN EDUCATIONAL INTERVENTION STUDY FOR TOBACCO CHEWING AND SMOKING HABITS AMONG INDIAN VILLAGERS. Prakash C.Gupta, Fali S. Mehta, J.J.Pindborg, M.B. Aghi, R.B.Bhonsle, P.R. Murti. Basic Dental Research Unit, Tata Institute of Fundamente' Research, Homi Bhabha Road, Bombay 400 005, India. In a baseline survey in Ernakulam district in Kerala few selected villages were screened and 12000 reguler tobacco users age 15 years and over were selected as target population. The individuals were visited annually by a team consisting c dentists, social scientists, and interviewers and provided with health education by personal communication as well as mass media. Specially produced documentary films, posters, newspaF articles,radio programs etc. were used. The control group we provided by an earlier study in the same population but among different individuals using the same methodology but without an educational intervention. Follow-up results showed that th intervention was effective in several ways: 1) a significant] higher percentage of habituees stopped or reduced their tobacco habit, 2) a lower percentage increased their tobacco usage, 3) the incidence rates of oral precancerous lesions decrease by a significant factor and 4) a lower percentage of children intervention area acquired tobacco habits. This study demon- strates feasibility and practicability of health education programs for tobacco smoking and chewing control in developir countries and consequent decrease in the risk of tobacc related cancers. EPIDEMIOLOGICAL STUDY OF TOBACCO SMOKING BEHAVIOUR AMONG ADULTS L M. . an ey, S.R. Ven atramaiah, R.P. Neupane, A shaya autam, Mrigendra Medical Trust, Kathmandu, Nepal A cross sectional survey of 1506 adult aged 20 years and over of both sexes living in a rural community of the hill region of Nepal was carried c with the help of the WHO standardized smoking survey questionnaire for adults A high response rate (94.1%) was recorded. A very high prevalence rate of tobacco smoking 85.4% among men and 62.4% among women was found. There was increase of 4.9% in the overall prevalence rate over.the 68.8% recorded in 1980 survey conducted by us in the same area. A large proportion of adult males and females were aware of the hazard of smoking but did not have any concern for the possible harmful effects of their tobacco smoking on their own and on other's health. Similarly large proportion of smoker adults had thought about quitting smoking but only those who had made a serious attempL have been able to quit smoking for some time. There was some evidence that people have favourable attitude and beliefs.towards public action against smoking, this seems to be heavily iniiuenced by higher educational status a better caste status in the community. It was concluded that there is an urcent need to introduce appropriate smoking control measures in Nepal. Practical suggestions and recommendations are made based on the findings of the present study. TIMN 448590
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whu C.Cqahhe.Ltc? Pae.t, prc6crt and 6u-tu.2e, You1h prn6,iCe, SS-9-06 nnee: 'M. Adh,i.anza; F. J.un6nez; R. Meh.en¢e.Ed; R. R.i,eoucz; S. L6pez: H. Cedeno. Div.i,eion de Ensea.rnedadet. Cn6nica.d- b{t n,i,bten.i.o dc Sanidud-bt A£godona,C - Caha.ca6 V en e.zue,en. ih.c.a papen n.eeume .thhee que6tionaA,i.ea. The 6.ih.at wae done by the Venezue.fn CanceA Soc.i.e,ty Ln 7980. They ma.i,eed queeti:onan,Lea the echoo.f'b pup.c;Ea and .LeacheAz o6 the Centtn.e weet and ewus aecti.on o6 the countn.y. l.t echowed thcLt 69% o6 the a.tuden,te. Fnom the pup.i,P.a anewene h~.ghz pe~.cen.tage o~ 21.7 neven,the.beee aome os .them azan,ted at 9 un.a. o.ed. 28.4% stvA,ted at 14-1.5 unz, o.Cd. Abou.t wh,i.ch med.i.a .Ln6.euenee the an- ewen.a wen.e T.l'. 63.t%, c.i_nema 26.5%; newapapen 16.1. Poazca.a, pn,i..wLted papen 13,5 pu b.Ei.c ttinnepon.tn,t.Lon 72.5 and 6.inaPty pnomo.Li.on by d.inec.t obaequ,i.orvsneee .in cLnema epeetateh. Second euAvey ea.a the VICC qucet.(.onana. 4+e deve.Coped .i..t in Venezuekn .tn 19b4 Jc.t 85$ o6 the who.ee eouwth.y 6nom .tow,ea ovcr. 1.000 inhab.i,tan,t .it iz .to eau .in utban anen.6. Peop£e of 72 to 15 yn.a 47,6 boy4 and 52.4 gi4,U, on2y 6.7% ,ep.f.Led YES when aeked .i.6 they had even emohed and ¢hom .theee on,£.y 20; had dDnc SC bor, over~ 5 mo.t.Ces. They emohe 83% o6 manu¢aatured {.i,fte,-Ls c,i.aaKe~ted and 66.7$ emohe ha.C~ a p,~ched a day and on.P~.r 16.7o emoked mon.e .than one pach.ed. The Ja,ther, ini.Euence .i.e 6o$ doubLe than the mo.theh and the etden bnoa:heh .iz 400. 730 o{ .them be.fi.eve .tha,t .the,, heae.th wiEf be :a66ected,vnky sin 'they :emoke. daiYy 'and• -Z6. 7 0.zAe' awon.e .o 6the xe f'ut,ior, o(, coanhirig tid •c i..ga pettet. Th,itd 4hom 1984 to 19E5 1•'.i.nutii.y oL4 You.th n.eati.ced a eunveu amoge high achoo.f etu- den,t bhowed pencen,taoeh of amoheh S.tudent higheh in pk,i.va.te in.a.L~on .than o6 pu- bf.ic. PeAcen,tages o¢ emo<er~ incvicenae 6nom 71 to 79 yhd. In both cazegonv o~ .iywti- tu.Lon bn.om 3% to 36~, and 1% to 30% hebpec.ti.vaty. Compan,i.ng the ave~nge coraumption oj the gn.oupeb 71-72 to 75-76 oJ th,i.a euhvey w.i,th eecond euhvey we tound good conne- .fn.t.i.on'16.7$). SMOKING HABITS OF KING SAUD UNIVERSITY STUDENTS IN RIYADH *Ahmed Taha, Abdul-bari Benner and Mohamad Noah Department of Medicine, King Abdul Aziz University Hospital P.O. Box 245, Riyadh, Saudi Arabia The aim of this study was to evaluate the smoking habits of students in one of the biggest Saudi university, since such a study has not been conducted in Saudi Arabia. A simple random sample of 2264 students were selected from 25,000 students in six colleges which are exclusively for male students. The participants were asked to answer a self-administered questionnaire. Thirty seven percent of the students were found to smoke, and over a half of them smoked more than 15 cigarettes per day. Cigarettes were the main form of tobacco used by the smokers. The majority of the smokers knew about the hazards of smoking through the media and have the desire to stop smokino. Religious consideration and non-smoking parents were the most important reasons for not smoking among non-smokers. To reduce the prevalence of smoking, a public health campaign is strongly recommended. SS-9-07 TIMN 448591 89
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SS-9-08 TOWARDS A NATION OF NON-SMOKERS A NATIONAL SMOKING CONTROL PROGRAM"fE FOR SINGAPORE *B. Vaithinathan and L. Lee Training and Health Education Department, Ministry of Health, Sinqapore ' On 1 December 1986 the Ministry of Health, Singapore, launched a Nation Smoking Control Programme with the theme "Towards a Nation of Non-Smokers". It aimed at reducing smoking rates in the population by creating a social climate which is not conducive to smoking, through education and informati, establishment of no-smoking areas, provision of services to assist smoking cessation, increasing taxation and strengthening legislation for smoking control. 42 government organisations and private firms were selected as mai participants through whom the Programme would be mobilised to reach all sectors of society. An intensive 3-month mass media campaign which include a national Smoke-Free Week and mailing of free "quit kits" to 12,000 smokers and 10,000 "helpers", elicited a 937% local awareness and international interest. Community activities have been held workplaces, schools and educational institutions, hospitals and clinics, armed forces camps and comrnunity centres. Many workplaces voluntarily established no smoking area,. Currently legislation is being reviewed. The Programme is ongoing until the target of reducing smoking rates and bringing the number of new smokers to near zero is reached. SS-9-09 SMOKING_AND COFFEE DRI_NKING IN STUDENTS_ F.Chaniotis, D.Chaniotis, I.Butsikakis, E.Kanellos T.E.I. of Athens The aim of this study was to clarify the relationship betweE cigarette smoking and coffee drinking in students. A health screening questionnaire with questions on smoking and coffee•• drinking was given to II4$ students aged 20,5±SD I,5 yrs. This random sample was consisted from men(25%)and women (75%). We found that 77% drunk coffee and 52% smoked.The incidence of smoking in both sexes was similar.Daily cigarette consumption in men was II.I6*SE 2.40 vs 6.70±SE 0,76 in women (p<0.05), No important difference was found in the incidence of coffee drinking in both sexes. A strong positive relationship was four between smoking and coffee drinking (p=0.00I). All smokers drunx coffee,while 29% of coffee users did not smoke at all. We conclude that there is a strong positive relationship betwee smoking end coffee drinking. r •: 90 TIMN 448592
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TOBACCO CONSUMPTION AND HEALTH CONSEQUENCES FOR MEXICO AT THE YEAR 2000 #F.G. Puente-Silva, M. Balzaretti, E. Gonzalez, G. Espino and A. Ocampo Mexican Committee for the Study and the Control of Smoking (COMEC- TA), Apartado Postal 22-421, Tlalpan 14000, Mexico, D.F., Mexico This study discusses the tobacco consumption in Mexico at the present and its correlation with the demographic structure. An analysis of the financial politics which promotes the production of tobacco is discussed. The economical dependency due to tax re- venue and its consequences are considered. Some considerations are made of the 22000 tobacco tons which are exported at present with the situation of a progressive decrement of tobacco consumption in developed countries. In a few years this will lead to an excedent that the transnational tobacco companies will try to place in the Mexican market. The progressive consumption of tobacco is consider ed. The 20% yearly increment is mentioned (2500 million cigarrette packs sold in 1984; in 1985, 3000 million packs of cigarrettes were sold). It is underlined the vulnerable situation of underdeveloped countries, i.e. 51% o the Mexican population is underage; 14 mil- lions are between 14-18 years old, age period in which most people start to smoke. In spite of the family planning programmes, the population growth continues. It is expected that Mexico will have in the year 2000, 106 million people, 26 million more of the pre- sent population. In spite of having a new health law, the implemen ted actions are few, i.e.: the television commercials for tobacco are still legal. Tobacco is between the 3-4th product which has more publicity in television, in 1986 one to two million. KEY HEALTH PROFESSIONALS' SMOKING IN RELATION TO THE POPULATION'S SMOKING: THEIR ROLE IN SMOKING CONTROL POLICIES * H.P.Adriaanse and J. van Reek Dept. Health Education, Univeristy of Limburg, P.O.Box 616, 6200 MD Maastricht, The Netherlands The purpose of this secondary analysis of the literature on tobacco consumptipn among teachers, nurses and physicians is to delineate trends in smoking prevalences overtime, to detect their influence on the smoking behavior of the population at large and to specify roles for key health professionals in anti-smoking strategies. Approx. 200 surveys on key health professionals' smoking, originating from about 40 countries, . carried out in the period 1951-1987 were located. Average professionals' lead on the population and average prevalence changes in the population were compared by country and by gender. Teachers and male physicians in most countries smoked less than the population. Nurses appeared to smoke as much as, or sometimes even more than, the female population. Among the many factors determining a given population's smoking behavior, teachers and male physicians' influence was shown to contribute to smoking control, while nurses' influence was not. Within the model of socio- cultural dynamics of smoking, roles for key health professionals as model, educator, researcher, lobbyist and direct manager of smoking cessation are outlined. Examples of efforts guided by clearly positioned health professionals' organizations show the need for international coordination and (N)GO -support to effectively counteract similar activities by the international tobacco industry aiming at tobacco promotion. SS-9-10 SS-9-11 TIMN 448593 91
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SS-9-1 2 IMPLICATIONS_OF_DIFFERENTIAL_POPULATION_SIZE_AND_GROWTH_BETWEEN_DEVELOPE AND_DEVELOPING_COUNTRIES_FOR_GLOBAL_TOBACCO_INDUSTRY_MARKETING_AND_PUBLI RELATIONS---- STRATEGIES ---------------- SIMON CHAPMAN Ph.D Consultant, UICC Smoking Control Program The forcast smoker populations of selected developed and developing countries and their tobacco consumption trends will be compared. The conclusion that the aggregated markets of developing countries provide vastly greater sales opportunities than in developed countries will be examined. The extent of smoking control policy and programs in develope. countries is far greater than in nearly all developing countries. The size, organization and influence of the coalitions of groups working to control tobacco use is similarly much greater in developed countries. This combination of larger markets, less political opposition and weaker smoking-control forces, produces a global scenario that suggests the com- parative advantages of the industry concentrating expansionist roles in developing nations and attempting to retard patterns of decline in con- sumption and pro-smoking social climates in the developed countries. The role of legislative controls and vigorous smoking control policies in developed countries as exemplary models for developing countries will be discussed, as will the concept of a global industry strategy of pre-occupying major smoking control efforts in the compar- atively small markets of the First World, while it quietly proceeds with its major ambitions in the Third World. Appropriate directions for strat- egic response by the international smoking control 'community' will be discussed. SS-9-13 92 Health and Economic Implications of Tobacco Growth and Consumption in Select, Developing Countries *T. Glynnl, R. Masironi2, K. Rothwell2, D. Patchett2, M. Thomas2, M. Sheridan- and L. Young3 1U.S. National Cancer Institute; 2World Health Organization; 3Georgetown University Institute for Health Policy Analysis The purpose of this investigation is to develop an objective analysis of the projected impact of tobacco growth and consumption in selected developinF countries, with a special emphasis on cancer. The study focuses on the health effects and attendant economic impact of tobacco growth and consumptic.. in three developing countries, in Asia, South America, and Africa. Methods include consolidation of information related to health and economic effects of tobacco growth and consumption in developed countries; identification and evaluation of existing and potential data bases in developing countries; development of an analytic framework for such studies; collection of data within each of the study countries; and development of estimates of health and economic costs of tobacco growth and/or consumption in those countries. Preliminary results suggest that decisions concerning the encouragement of tobacco growth and production in these countries may have deleterious effects in the future which outweigh the potentially short term gains which may be realized from involvement with tobacco in the present. TIMN 448594
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a., WORK OF THE TOBACCO AND HEALTH COMMITTEE, INTEIiNATIOML UNION AGAINST SS-9-14 TUBF-.t?CUL IS AIvD LUNG DISEASE *John Crofton Chairman, Tob3cco and Health Committee, IUATLD, 199 rue des Pyrenees, 75020, Paris, France. This Committee began work in 1984. Its main aim is to help to stem the smoking epidemic in the Third World. The Union's strength is its 5000 members, mostly doctors, in nearly 120 countries. Accordingly we have prepared a booklet for these members, briefly outlining diseases due to smoking, detailing suggestions for action by doctors and asking members to register their interest in the problem; 250 doctors in 70 countries have so far done so. We also, jointly with the International Union against Cancer (UICC), distributed a leaflet suitable for politicians/decision makers, with a guide to its use. A pilot survey of medical students' smoking habits and attitudes has been carried out in 5 countries (coordinated by Professor Freour and Dr Tessier, Bordeaux University, France) and is now being extended, with WHO help, to 50 centres throughout the world. Sessions on the tobacco problem are now held at all meetings of the Union. A tobacco Information Bulletin (Editor: Dr J. Pedersen, Denmark) is being sent annually to all members of the Union. The Committee is cooperating closely with WHO, the UICC and the International Organization of Consumer Unions (IOCU); increasingly with the International Society and Federation of Cardiology (ISFC). NO SMOKING DAY CAMPAIGN FOR DEVELOPING COUNTRIES *N.Nithiyananthan Malaysian Medical Association, 4th Floor MMA House, 124 Jalan Pahang, 53000 Kuala Lumpur, Malaysia The No Smoking Day is a low budget campaign that could be successfully utilised by developing countries in particular, to promote smoking control issues. A unique feature of this campaign is that it enables the community to participate in it. Any organisation - governmental or non-governmental - or individual, could organise and publicise their smoking control activities in conjunction with the campaign in their workplace or at the community level. This enables greater access to the population and media coverage. More importantly, it reduces operating expenditure and manpower needs. A post No Smoking Day survey in Malaysia in 1986, highlighted that 80.2% of those surveyed were aware of the Day. 62.7% of smokers attempted to give up smoking for the Day. 45.5% of non-smokers persuaded their smoking friends/ relatives to give up the habit for one day with 41.77, of smokers attempting to follow their advice. SS-9-15 TIMN 448595 93
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SS-9-16 , USING THE MDRAL DIMENSIONS OF TOBACCO TO EFFECT SOCIAL CHANGE *D. M. Shimp, E. B. Shimp Environmental Improvement Associates, Salem, N.J.08079 USA The focal point of this small survey of varied Christ- ian/Judaeo clergy throughout the U.S. was a Study Paper entitled "Moral Dimensions of Tobacco" prepared by the North Carolina Council of Churches in 1984. Question- naires with questions designed to educate while seeking information were sent with the study paper and a cover I e t t e r seeking clerical support of the Smoke-Free 2000 goal. Based on the majority response, indicating a•lack of activities designed to assist the addicted smokers in •the congregation or actively support comnunity health efforts to control public smoking, strategies need to be developed to publicize the moral concerns of the North Carolina study paper such as Third World Marketing Issues. Harnessing the power of the organized main stream church in any culture should be a priority of any heaJth-oriented entity in the public or private sector. SS-9-17 94 PROGRAM AGAINST THE HABIT OF SMOKING H. Rubio-Monteverde, M. Labrandero-Inigo and C. Gutierrez-de-Velasco Instituto Nacional de Enfermedades Respiratorias, Mexico, D.F., Mexico. The population of Mexico is close to 80 million. There are approximately 20 million of smokers and this figure is increasing rapidly. The mexican government, through the ministry of health, prepared and launched a national . program against the habit of smoking, seeking the participation of all members• of our society. The program contemplates different legislative actions, as well as activities on education, public health and research. There are some significant achievements so far, like the regulation of publicity, prohibiting the sale of tobacco to minors, and a modification of the warning legend on cigarette packages. The main developments in research are related to perinatal risk and to the synergic effect of the smoking habit and the atmospheric pollution. Training activities have been directed to medical and paramedical personnel in health care units. For chronic smokers there are clinics against the habit of smoking, which are using therapeutic programs based on education and behavioural changes. TIMN 448596
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TIMN 448597
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3MOKING STATUS OF A UNIVERSITY STUDENTS AND ITS IMPLICATIONS FOR ANPI-0t0KING EDUCATION 'S. Sakihara, H. Sato, H. Higa, K. Kina and T. Miyagi Department of Health Sociology, School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-01, Japan The purpose of this study was to confirm if any difference are there among students of three faculties, e.g.,. Education, Medicine(composed of School of Medicine and School of Health Sciences), and Law & Literature of a national University in smoking status and knowledge on health effects of cigarette smoking. As teachers-to-be, health professionals-to-be, and 2eaders-to-be in the field of general business and public services, their behavior and attitudes towards smoking are very important for anti-smoking education at schools, health service settings, and at societies in general. A questionnaire was given to those students who took annual health exami- nation at May 1986. Of the total subjects 3,088, 2,588 (87.3%) had took health examination and 2,260 of them had responded. As 40 respondents had incomplete items, analysis was finally made for 2,220 (male 1,305; female 915). As a result, difference of smoking status among male students was signifi- cant between students from Faculty of Medicine and those from Faculty of Education, and Faculty of Law & Literature. Current smokers were 22.Xb, 38.5% and 36.1% respectively. For female students, current smokers were quite few, e.g., 2'/ for those of medicine and health science major, 3% for those of education major, and 1.8% for those of law & literature. Its implications for anti-smoking education will be discussed. .AN MEDICAL STUDENTS TAKE THE LEADERSHIP OF SMOKING CESSATION ? 'S. Ryu and H. Kinebuchi Department of Environmental and Occupational Health,Kochi Medical School, Oko-cho, Nankoku-shi,781-51, Japan Medical Students who will undertake the responsibility of health education as physician in the near future, should be expected to play an important role in smoking cessation. Therefore, a questionaire survey was conducted to medical students on initiation, attitude, opinions and background of smoking behavior. The prevalence of smokers was 28.7%(144/501) among all respondents. . But there was a significant difference in prevalence between men and wemen, 34.4% (141/410) and 5.6% (3/89) respectively, so data from men were available to this study. Respondents were divided into three groups; smoking in present, quitting to smoke and never smoked. Most students, including smoking group, had negative attitude towards smoking status, especially towards smoking habit of the wife-to-be in case of pregnancy and even proposal for marriage. The main initiations to smoke were by curiosity and temptation. About 70% among smoking group had tried to quit by having a fear of health hazard in future, however, failed in the ..-c..pt. Smoking group was more generous towards legal regulation, but stra^Se to say, had more agreement of collaboration to education'of smoking cessation than others. Quitting group had a tendency to think that decision making to smoke or not was due to private affairs. Results suggested difficulties to organize them as leaders of smoking cessation. FP-1-01 FP-1-02 TIMN 448598 97
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FP-1-03 FP-1-04 SMOKIN,_ AVIONG MEDICAL STUDENTS: P. Thirumalaikolunousubramanian, *B. Mahesh and S. Shanmuganandan. Madurai Medical College, and Department of Geography, Madurai Kamaraj University, N'.adurai - 625 002. INDIA. Smoking habit was studied among 250 medical students (Madras Medical - 100, Maourai Medical - 100,Thinneveli-50). Cigarette was preferred in general but beedi is used at times of scarcity of money. They started smoking during ragging time and continued when offered cigarettes by seniors. In 74 students, one of their family members were smokers. They smoked while reading and concentrate during their work. All of them were aware of the hazards of smoking and willing to stop after graduation. No women smokers were identified jn these three medical colleges. SMOKING AMONG THE STAFF OF A MEDICAL SCHOOL HOSPITAL *H. Kawane and R. Soejima Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Kurashiki City, Okayama 701-01, Japan The purpose of this study was to investigate smoking prevalence and attitudes among the staff of Kawasaki Medical School Hospital. A survey questionnaire with 14 questions was given to 128 male physicians (lecturers and professors), 368 nurses (all females) and 83 laboratory technicians (22 males and 61 females). The response rate was 60.9%, 62.5% and 75.9%, respectively. The percentage of smokers among physicians stood at 12.8%, ex-smokers, 44.9% and non-smokers, 42.3%; for nurses, these percentages were 6.1%, 2.2% and 91.7%, respectively. As for the technicians, the percentages of men and women who smoked were 50.0% and 2.1%, respectively The overall prevalence of cigarette smoking was 8.9%, much lower than the prevalence among the general population. Our survey also revealed a higher prevalence of current smokers among males (19.1%) than among females (5.4%). It is interesting to note that most Japanese women, even those on our paramedical staff, do not smoke. Although according to a previous survey, the rate of smoking in men among our medical students and the residents in our hospital was estima:ed to be about 50%, we hope that a smoke-free medical school and hospital can be achieved by the year 2000. 98 TIIVIN 448599
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THE IMPACT OF BANNING SMOKING ON A HOSPITAL WARD *NA Rigotti, BH Pikl, PD Cleary, Mass. General Hospital and Institute for the Study of Smoking Behavior and Policy, Harvard University, Cambridge, MA, USA. Policies restricting smoking in hospitals are being widely adopted to pro- tect nonsmokers, but their acceptability and impact are not known. To assess the effects of adopting such a policy, we surveyed nurses before and 4 and 12 months after smoking was banned on the Mass. General Hospital Pediatric Ser- vice (POL group). Response was 808(N-11.2) at baseline and 72%(N-93) at 1 year. Nurses on the medical service, where no policy change occurred, were controls. Awareness and approval of the policy were high. 99% of nurses knew where smoking was not permitted. 72% favored the policy at baseline; this increased to 86% at 1 year (p<.05). The policy was less popular with smokers, but their approval rate doubled (35% to 67%) over the year. The policy did not alter established patterns of employee turnover. Air quality improved, according to nurses' subjective meetings. POL nurses rated air as less smoky at 4 and 12 months than at baseline (p<.001); control nurses noted no change. Noncompliance did occur: 57% of smokers admitted >_ episode in one year. POL nurses noted smoky air on 20% of days worked. Smoky air or smoking was noted most often in stairways and bathrooms, rarely in patient rooms. At baseline, 18% of POL and 20% of CON nurses smoked. There was no signif- icant change in smoking prevalence, number of quit attempts, or cessation rate in either group at follow-up. POL nurses smoked less at work (mean cigarettes per shift decreased from 5.0 to 2.7, p<.01), but overall daily cigarette use did not change (13.5 to 14.6). Cigarette use was unchanged in controls. We conclude that the smoking ban was well accepted and improved air quality with little noncompliance. The policy reduced nurses' smoking at work but had little effect on overall smoking habits. SMOKING.HABITS OF BELGIAN PHYSICIANS : EFFECTS OF CONSONANCY AND OF AGE L. Joossens(2~ , M. Demedts (2), J. Prignot , A. Gyselen , P. Bartsch (1) Onderzoeks- en Informatiecentrum van de Verbruikersorganisaties, Opperstraat 28, B - 1050 Brussels, Belgium (2) Belgisch Nationaal Werk ter Bestrijding der Tuberculose, Eendracht- straat 56, B - 1050 Brussels, Belgium A survey of a randomized sample of Belgian physicians in 1983 yielded 32 % smokers, 33 7% ex-smokers and 35 7 non-smokers. Smoking was less pre- valent among the younger physicians (P < 0.05). Our attention was drawn to the fact that 26 7Z of the smokers presented a consonant behaviour, i.e. ' they declared that they don't want to stop smoking and have never tried to do so. Consonant smokers agreed that smoking is harmful, but changed their smoking habits : they inhale less, smoke smaller amounts and prefer cigar or pipe in contrast to dissonant smokers. FP-1-05 FP-1-06 TIMN 448600 99
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FP-1-07 SA]Ot:Ii7G HABITS OF NORWEGIAN DOCTORS 1952 - 1984 *!i. ThUrmer, K. Bjartveit, A. Hauknes National Council on Smoking and Health, Box 8025 Dep 0030 OSLO 1, Norway FP-1-08 The aim was to compare smoking habits of Norwegian doctors in 1984 with 1952 and 1974, and to see what effects doctors' smoking have on their infor- mation to patients. A questionnaire was sent to a stratified sample of 1238 doctors, 773 male and 465 female, 91% responded. There has been a substantial decrease in daily smoking among male Norwegian doctors, from 74% in 1952 to 35/0' in 1974 and to 18.65 in 1984. Of few female doctors in 1952 44% were smokers. This figure has been reduced to 22% in 1974 and to 11.4% in 1984. In the age adjusted general population 46% of males and 41% of females were smokers in 1984. 46i+ of smoking doctor: have quit smoking, main reasons for quitting were general health effects (34',., and own disease (200). The reduction in doctors' smoking habits is also due to markedly lower smoking rates among younger doctors. All doctors say they discuss smoking when a patient has a smoking related symptom, but nonsmoking doctors are more involved in general smoking and hea: education. GP's were more active on a smoking and health information index than were hospital doctors, younger doctors more than older, neve=smokers more than exs=okers and nonsmokers more than smokers. -f the presentd trend continues, all ::orwe6ian doctcrs will be nonsmokers 1 1996. This is four years before the "deadline" set by the :+orwegian Medical Association of a smokefree society by ti:e year 2000. The population will bene- fit from reduced doctor smoking. Doctors see 90$ of the popu'_atiorn in a 5- year period and should be encouraged to concerted act"-on against smoking. TRENDS IN TOBACCO CONSUMPTION IN CANADA *Ncil E. Collishaw Tobacco Products Unit, Room 137, Environmental Health Centre, Department ot National Health and Welfare, Ottawa, Canada, KIA 0L2 The purpose of this study is to review trends in tobacco consumption ii Canada from 1966-86. Trends in smoking prevalence, per capita consumption and per smoker consumption are examined with suitable adjustments for age and sex, and survey data inaccuracies. There was a substantial decline in smoking prevalence among men and a smaller decline among women. Per capit consumption declined slightly from 11 to 9 cigarettes per day while per smoker consumption increased from 22 to 27 cigarettes per day. It is con- cluded that apparent public health benefits that result from declining pre valence of smoking are partially offset by increased rates of tobacco con- sumption among those that continued to smoke. TIMN 448601 100
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SMOKING IN THE UNITED STATES: RACIAL AND SOCIOECONOMIC DIFFERENCES *T. Novotny, K. Warner, and J. Kendrick Centers for Disease Control, Atlanta, Georgia 30333, USA. We studied racial and socioeconomic determinants of smoking in the U.S. using the combined 1983 and 1985 National Health Interview Surveys (n=54,129). Smoking prevalence was higher among blacks than whites (37% vs.31x), and higher among blacks in all age groups except women aged 18-24 (whites, 34% vs blacks, 27X). In adults aged 25-64, we examined smqking by education, employment, income, marital status, and poverty in4ex. in terms of occupation, blue collar workers (operatives, service, anq laborers) had higher smoking prevalence than white collar workers (pdofessionals, administrators, and clerical). Smoking prevalence was highest among unemployed persons. A strong inverse association between smoking and education was observed in both races (p<0.05, Chi-square for trend). Those below poverty level were more likely to be smokers than thcse above poverty level. After controlling for education, poverty level, employment, and marital status in a logistic regression model, we observed no difference in smoking rates between blacks and whites (O.R. 1.02, 95% C.L. 0.95-1.1). Using this large data set and multivariat.e 'analyses, we have shown that the widely reported black-white differences in smoking in the U.S. may be explained by differences in educational, employment, marital, and economic status. Smoking is most common in persons who have the least income, who are the least educated, who are divorced or separated, who work in bliue-collar jobs, or who are unemployed. Similarities may be anticipated in developing countries as they become more industrialized. SMOKING AND HEALTH AMONG REINDEER HERDERS IN NORTHERN FINLAND *L. Hirvonen, S. Nayha and J. Hassi Departments of Physiology and Public Health Science, University of Oulu, and Oulu Regional Institute of Occupational Health, Oulu, Finland As a part of a study on the way of life and work of reindeer herders their smoking habits and state of health were recorded by a questionnaire. This is a sample of 2629 men from this population representing the herding associa- tions in Northern Finland. Reindeer herding was the main occupation of 46.5 % and a secondary one for the rest of them. 18 % of them did herding more than 120 days, 44 % 31-120 days and the rest less than 31 days per year. 78 % of them worked more than 4 hrs daily out-of-doors. The racial background of 17 % was totally or partially Lappish. Married men represented 58 %, single 32 % and 10 % other groups of marital status. The smoking status: never smoked 35 %, irregular smokers 7%, daily smokers 28 % and ex-smokers 29 %. The percentage of the non-smokers decreased and that of ex-smokers increased with age. The smoking rate was highest in the age group of 30 to 39 yrs (43 %). The subjective state of health was best among non-smokers and worst among regular smokers using 20 cigarettes or more daily. Various circulatory and respiratory symptoms and diseases were about twice as common among regular smokers as among non-smokers. Only minor differences were noted between non- smokers and irregular smokers and between regular and ex-smokers correspond- ingly. Excessive coffee drinking, abundant use of salt and non-use of fresh vegetables, berries and fruits were most common among the regular smokers. Reindeer flesh was the most favoured meat (65 %) among all subgroups of the series. The reindeer herders are exposed to many harmful factors in their life and work and a comprehensive programme to improve the situation is planned. FP-1-09 FP-1-10 TIMN 448602 101
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FP-1-11 FP-1-12 102 SMOKING HABITS AND ATTITUDES AMONG NEWLY-QUALIFIED DOCTORS IN HONG KONG *K.K. Cheng and T.H. Lam Department of Community Medicine, University of Hong Kong, Sassoon Road, Honb Kong. The habits and attitudes of doctors towards smoking are believed to be influential on whether and how doctors advise their patients. Adopting the questionnaire of that used in the international study on medical students' smoking habits and attitudes organized by the International Union Against Tuberculosis and Respiratory Diseases, a survey was conducted on 151 doctors who graduated at the University of Hong Kong in the year 1986. In June, 198: each of them was sent the questionnaire. 124 of them returned the completed questionnaire and the response rate was 82.1%. The average age of the respondents was 25.1 years and there were 98 men and 26 women. Among the respondents, 98(79.0%) have never smoked and of the rest, only eight smoke daily now, making a smoking rate of 6.5% which was much lower than that of the general population of the same age. It is noteworthy that none of the female respondents had ever smoked for six or more months. Of those who smoke dail3 five said that they would most certainly/probably smoke daily in five years whereas all the other 119 respondents stated that they would most certainly not smoke daily then. 90.8% of the respondents strong•ly agreed that smoking was harmful to health. The knowledge of smoking as aetiological agent for various diseases was assessed to be satisfactory and most respondents felt their current knowledge sufficient as a basis for counselling. It is encouraging to note that most of our newly-qualified doctors were ready to advise their patients against smoking and they were generally supportive for various legislative measures to reduce smoking. THE WHO GUIDELINES FOR STANDARDIZATION OF SMOKING SURVEYS Lars M. Ramstrdm NTS, National Smoking and Health Association a n d WHO Collaborating Centt for Reference on Smoking and Health, Wenner-Gren Centre, Stockholm, Sweden The World Health Organization is trying to assist investigators and publi health authorities in assessing the extent of the smoking problem in countriE and in designing, monitoring and evaluating national smoking con•trol programmes. In a resolution by the World Health Assembly the Director-General of WHO was requested "to promote the standardization of definitions measurement methods and statistics concerning smoking behaviour and tobacc consumption." In response to this, a meeting with a group of experts was held and a report was issued by WHO Geneva in 1983 (document WHO/SMO/83.4). This report dealt with surveys of the general population. Surveys among healt professionals were discussed at a following meeting held in collaboration wit the International Union Against Cancer and the American Cancer Society. A report was issued by WHO Geneva in 1984 (document WHO/SMO/84.1). According to recommendations in the above documents, adult smokin behaviour should be reported in three main categories with respect to th situation at the timepoint of the survey: "Daily smokers", "Occasiona.L smokers" and "Non-smokers". The category "Daily smokers" could be broken down in subgroups such as "cigarettes only", "cigarettes and other smokin material" and "other smoking material only". "Ex-smokers" are defined as subgroup of non-smokers: those who have previously smoked daily for at least u months but do now not smoke at all. For adolescent smokers a four category system is suggested. Examples of questionnaires'by which all the recommende-' categories can be identified are attached to the above mentioned reports. A supplement containing further guidelines for data presentation (mode_ tables etc.) is being planned. TIMN 448603
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SMOKING AND CORONARY HEART DISEASE. ^°G. Parkaridis, G. Louridas, G. Giannoglou and T. Karoulas Division of Interventional Cardiology, University of Thessaloniki, Thessaloniki, Greece. The aim of this study was to assess the correlation between smoking and coronary heart disease (CHD) using invasive methods. Therefore 383 Greek patients (pts) mean 53 ± 4 years, 372 men and 11 women with CHD were studied with coronary angiography and left ventriculography. Forty of the pts had no predisposing factors, 128 were smokers (>20cig/day) with no other predisposing factors and the remaining 215 had more than one predisposing factors - smoking, hypertension, high serum lipids and diabetes. Pts < 40 and > 70 years of age were smoking more than pts between 40 - 70 years of age (p<0.05)• Smoking was not found to correlate with ejection fraction or other functional parameters of the left ventricle. Only in pts > 60 years of age with smoking as the only predisposing factor was a relationship found between smoking and the number of lesions or the percentage of the stenosis (p<0.01). Therefore in older Greek people the habit of smoking is more prevalent and is related to the number oflesions and percentage of stenosis. FP-2-01 LONG TERM PROGNOSIS OF INFARCTED SiIOKERS:IS IT AFFECTED BY SMO- FP-2-02 KING CESSATION ? ;~A. Leone Division of Medicine, City Hospital, Pontremoli, N,S, Italy The aim of this study was to clarify long-term prognosis of 1167 smoker patients who survived a first attack of myocardial infarction. All patients, aged from 30 to 70 years, were male. 724 patients (62.3%) stopped smoking (Group A) and 443 (37.7%) continued smoking (Group B). These two groups were followed up to a maximum period of 6.5 years with regard to reinfarction and death.These parameters were statistically compared and a P,L 0.05 was considered significant. The why of smoking cessation was also investigated for the Group A. Group A: 289 cases of reinfarction (39%), death in 124 instan- ces (17%). Smoking cessation was due to fear of rein£arction (264 cases- 36Y), will-power of relatives (187 cases- 26°(), repu- gnance for the tobacco (248 cases- 34°_), something else (25 cases 4%). Group B (smokin average of 16 cigarettes a day): 200 cases of reinfarction (45°~•~ and death in 88 cases (20%). AA significant lower reinfarction (P 40.05) occured for the Group AA if it was compared with Group B, but no difference with regard to death. Infarcted patients who stop smoking seem to have a quality of life better than those who continue smoking. No higher survival rate (P >0.05) was seen. TIMN 448604 103
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FP-2-03 FP-2-04 104 SMOKING CESSATION AS THE FACTOR REDUCING THE RISK OF REIIlFARC TION AND SUDO N DEATH IN THE FIVE YEARS FOLL01•1-UP STUDIES *K. Moczurad, A.M. Curylo, J.P. Oubiel Department of Social Cardiology and I Department of Cardiology. Institute of Cardiology, Academy of Medicine, Cracow, Poland The group of 392 patients, aged 34 - 65 years, after first myocardial infarction ( MI ) was.studied for 5 years with res - pect to the effects of smoking cessation on the reinfarction rate and sudden death in comparison with other atherosclerotic and ischemic risk factors, hypertension ( 362 patients ) and hypercholesterolemia ( 454 patients ) in the same age group. Sudden deaths and non-fatal reinfarctions were less frequent in 212 patients who had stopped smoking after MI when comparec with 180 patients continuing smoking. Statistically significan, differences ( P<0.01 ) were shown between these groups. Such a significant difference did not occur between a group of 126 treated hypertensives and 242 normotensives after first MI Similarly, no significant differences in the mortality rate occurred between patients with an elevated or non-elevated cholesterol level in the group of 264 and 290 patients after 14T, respectively. Therefore smoking cessation'seems to be the most significant factor reducing mortality and the risk of sudden death in pa - tients after first MI. SMOKING AND ACUTE MXOCAFtDIAL INFARCTION *P. Thirumalaikolundusubramanian, R. Alagappan and S. Shanmugananoan. Madurai Medical College and Department of GEography,l'adurai Kamaraj University, Maciurai - 62D 002. INDIA. One thousand males admitted and treated for Acute Nyoca - dial Infarction(AMI) at intensive medical care unit,Govern- -ment Rajaji Hospital, Nradurai were screened to find out th= association between smoking and AK:I.920 cases (92%) were smokers. In 47% of them, smoking was the only risk f actor All young (below 45 years) l:yocardial infarct cases were smokers. The occurrence of other complications such as cardiac dysrrhythmias congestive failuxe, embolisetion and death were among smokers. From the study it is concluded that smoking predisposes ischaemic heart disease(IHD) and,if a smoker develops IHD, the chance of developing complica-, tions are more in them. In view of the cost involved in tt management of these cases and risk involved,it is mandator,~, that the hazaros of smoking must be brought to the community at the youngest age so as to prevent this malady. TgMN 448605
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PRACTICAL EXPERIENCES COLLECTED IN THE COURSE OF ECHOCARDIO- GRAPHYCAL INVESTIGATIONS OF SMOKERS ?% T. Perenyi, E. Bartha, G. Buday, Gy. Kerkovits Cardiological Department of Bajcsy-Zsilinszky Hospital, 'Budapest Hungary The results of echocardiographycal examinations of 30 smokers were compared with 30 non-smokers. Picker Echoview System 80 C M mode and a Picker Digital Sectorview were used for investigations In the course of measuring the cardiac cavities definitely larger right ventricle was found in smokers. Moreover also paradox septal movement, pulmonal regurgitation and end-diastolic plateau for- mation of tricuspid valves /as the sign of increased right ventricular end-diastolic pressure/.were detected. Relying upon these findings smoking produces both systolic and diastolic overload of right ventricle. Moreover smoking makes more difficult the echocardiographical recognition of other organic heart diseases, because the emphysematous lung absorbs the major share of ultrasound energy. HAEMODYNAMIC AND HUMORAL EFFECTS OF CIGARETTE SMOKING *Ph. MUller, R. Schlosser, U.C. Dubach, A.. Sioufi and P. Imhof Human Pharmacology Lab. and Biopharmaceutical Research Centre, CIBA-GE1GY Ltd and Medical Out-patients Department, Cantonal Huspital, Basle, Switzerland A first study in 8 hc:althy male smokc:rs aimed at evaluating various non- invasive methods to assess,the effects on hac:modynamics and on plasma catechol- arnines of hourly cigarette smoking throughout one day. Pre-smoking nicotine (n) pl asma levels rose from 3 to 10 ng/ml and each cigarette induced a rapid increase in n concentrations by 10 ng/ml. This rise in n plasma levels was paralleled by significant haemodynamic changes such as a rapid decrease in total skin blood flow (Laser Doppler flowmetry), skin temperature and finger- pulse amplitude indicating vasoconstriction. Blood pressure and heart rate increased and stroke volume (impedance cardiography) decreased. In a second study aimed at defining parameters to assess haemorheological differences between smokers and non-smokers, haematocrit and blood viscosity (rotational viscosimeter) were found to be significantly elevated in smokers. Plasma viscosity and platelet aggregability were not altered. Acute haemodynamic effects of nicotine can readily be measured by various non-invasive methods; they follow the n plasma levels. As markers for chronic exposure to cigarette smoke, haematocrit and blood viscosity proved to be easily measurable parameters. FP-2-05 FP-2-06 TIMN 448606 105
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FP-2-07 FP-2-08 NICOTINE STIMULATES HUMAN PREGNANT UTERUS IN VITRO P. G. Adaikan, *0. A. C. Viegas, L. C. Lau, S. Arulkumaran and S. S. Ratna Department of Obstetrics and Gynaecology, National University Hospital, Lower Kent Ridge Road, Singapore 0511 Maternal smoking has been associated with retardation of fetal growth and it was suggested that this may be due to release of toxins or through hypoxia. It has also been reported that maternal smoking is linked to increase in antepartum haemorrhage, premature rupture of the membranes ane premature delivery. We tested the effect of nicotine (NIC) directly on the strips of four pregnant (P) (at term) and seven non-pregnant (NP) human myometrium (HM) in vitro. As low as 40 ng/ml NIC produced marked contractions in three out of four PHM. Tone, intensity and frequency of contractions were significantly increased; these effects lasted between 30 and 60 mins. NIC at 40 ug/ml (1000 times the dose for pregnant HM) produced very little contractions of the NPHrf. Alpha adrenoceptor blocking agent phentolamine (at 1 ug/ml) completely blocked the contraction of the uterus produced by NIC. It is likely that NIC-induced contractions are due to a release of a noradrenaline-like substance acting on alpha-adrenoceptors in the uterus. This may contribute to the poorer obstetric outcome in smoking women. CHRO`:IC EFFECT OF MATERNAL SMOKING ON THE AUTONOMOUS NERVOUS SYSTEM OF THE FETUS *V. Kariniemi and J. Rosti *University of Helsinki, Department of Ob/Gyn, Helsinki City Hospital, Sofianlehdonkatu 5, Helsinki 61 and Salo District Hospital, Salo 24, Finland We have demonstrated previously that maternal smoking during pregnancy has an acute effect on the autonomous nervous system of the fetus, expressed as a transient decrease of the beat-to-beat variability (differential index DI) of the fetal heart rate (FHR). The aim of the present study was to find out the possible chronic effect of maternal smoking on the fetal"nervous system. All mothers were asked about their smoking and drinking.habits on admission to the obstetric unit of Salo District Hospital. DIs were computed on-line from ten- minute samples of fetal electrocardiogram as a screening method throughout labors. The material consisted of 388 female and 380 male fetuses in labor. The indices of FHR variability and other relevant data were handled by the BMDP system of the University of California. The stepwise regression analysis was used to search the factors behind variation of mean DIs during first stage of labor. Male and female fetuses had different patterns of factors in this respect: maternal smoking and gestational age at birth were major increasing factors of mean DIs of female fetuses, while duration labor and oxytocin usage were two significant decreasing factors. These four variables together explained 13.2% of variation of mean DIs of female,fetuses. Maternal age was the sole significant, and decreasing, factor behind DIs of male fetuses in labor. It explained only 1.5% of variation of mean DIs. The following factors did not have effect on mean DIs of either sex: birthweight,placental weight, use of medication for pain relief, cord entanglement, FHR decelerations, parity and maternal alcoho]l consumption during pregnancy. 106 Th~N 448607
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QUANTITATING CYTOLOGICAL AND BIOCHEMICAL MARKERS FOR CARCINOGEN EXPOSURES IN THE BRONCHI OF SMOKERS, EX-SMOKERS AND NON-SMOKERS *H.F. Stich, B.P. Dunn, D.A. Enarson, B. Nelems, R.R. Miller, D. Ostrow and P. Champion British Columbia Cancer Research Centre, and Lung Cancer Research Group, Vancouver General Hospital, Vancouver, B. C., Canada Relevant, simple and reproducible cell markers are needed to quantitate early carcinogenic effects in tissues which are targets for the action of car- cinogens and from which carcinomas will actually develop. A switch must be made from mere estimating the exposure to carcinogenic mixtures such as ci- garette smoke to the actual measurements of the "biologically effective dose". The quantitation of carcinogen-induced genotoxic effects has been achieved by analysing types, levels and numbers of DNA-adducts with a highly sensitive postlabelling procedure and by estimating the frequency of micronuclei. In this paper we report about (a) the quantitative association of levels of DNA-adducts and micronuclei in the bronchial mucosa and exposure levels to cigarette smoke, (b) the varying levels of DNA-adducts and micronuclei in primary and secondary target tissues, and (c) the rate of disappearance of DNA-adducts and micronuclei following cessation of smoking. Particular em- phasis was placed on the relationship between levels of DNA-adducts and mi- cronuclei and levels of chemopreventive agents including beta-carotene, lyco- pene and retinol in the bronchial m;:cosa. Thus the level of carcinogen-indu- ced damage and the levels of chemopreventive agents can be quantitated in the same tissue specimens. The feasibility of using these markers which were validated in biopsies, bronchial brushing and sputum as predictors of risk to develop carcinomas and as "intermediat endpoints" in intervention trials will be discussed. CIGARETTE SMOKING AND MAXILLARY SINUS CANCER *K. Fukuda and A. Shibata Department of Public Health, School of Medicine, Kurume University, Kurume city, Fukuoka 830, Japan The aim of this study was to elucidate the relationship between cigarette smoking and maxillary sinus cancer. A case-control study approach was performed in Hokkaido. Cases of all types of cancer of the nasal sinus were periodically collected from 1982 to 1984. During the three years, 170 cases were diagnosed. Of them 140 cases were the maxillary sinus cancer ( men 84%, women 87%). By limiting the study case's age to from 40 to 79, 120 cases were eligible for inclusion. Using the telephone directory, we selected ten potential community controls for each case at random. We posted questionnaires to the cases and the potential controls requesting information regarding their families, education, residence and history of nasal diseases, occupation, smoking habits, passive smoking, and domestic heating systems. If necessary, telephone calls were made to obtain additional information. We repeated the random sampling of potential controls and the posting of questionnaires until we had obtained two community controls for each case matched for sex age (within five years), and residence (same health center region). Finally, we obtained information from 116 cases and 232 community controls. Univariate and multivariate analyses showed that current or past smoking habits was one of the independent risk factors for developing maxillary sinus cancer in men. FP-2-09 FP-2-1 0 TIMN 448608 107
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FP-2-1 1 A QUANTITATIVE ESTIMATE OF NONSMOKER9' LUNG CANCER RISK FROM PASSIVE SMOKING i Zhang Zhi-xue; Xing Xi-yuan, Ai Jun, He Lan-xin Institute of Oncology, Hebei Province, P.R.C. This paper reported a quantitative estimate of nonsmokers' lun, cancer risk from passive smoking by Repace JL and LowroySAN method: in the People's Republic of China. The crowd of nonsmokers' of pa- ssive smoking , including about 315 millions of 29 Provinces ( Cit; or Autonomous regions ) in China. It is estimated that P.R.C. non- smokers are exposed to 1.0 mg of tobacco tar per day. A phenomenic logical exposure-response relationship Is derived, yielding 5 lunf cancer deaths per year per 100,000 persons exposed, per mg daily tar exposure. This relationship yields lung cancer mortality rates and mortality ratios for a P.R.C. cohort which are consistent to within 5% with the results of both of the large prospective epidemiological studies of passive smoking and lung cancer in the United States and Japan. Aggregate exposure to ambient tobacco smoke is estimated to produce about 15,700 lung cancer deaths per year in P.R.C.nonsmoker aged =:35 yr. This estimation sugl;osAted an information and provide an important basis• for control lung cancer from smoking to concer- ned the departments of public health. FP-2-1 2 TOBACCO MOSAIC VIRUS ALTERING NEUROTRANSMITTER RF:CEPTORS *A,i'. Singgh, Madhav Singh, H.N. Verma' and V.bT.L. Srivastava+. Department of Biochemistry, Lucknow University, Lucknow 226 007. 'Department of Botany, Virology Laboratory, Luckno w University, Lucknow 226 007 and + Divisior. of Biochemistry, C.D.R.I., PO Bo 173, J/I.G. 1.targ, Lucknow 226 001, India. Tobacco Ifosaic Virus (TMV) is present in all the varieties o tobacco which is used in the m anufacture of different brands of cigarettes, cigars and chewing tobacco. It is not only found in the sputum of smokers but also that of non-smoi;ers who accquire it through the side stream smoke. In view of TMV seeking entry inside the body, its effect on various neurotransmitter recepto was investigated by inoculating (i.p) male rats (120 gm) with 20/.tgm'of TD!V per day for two weeks. In the treated synaptosomal urenarations there was a signific uit increase in the specific bindin, of donaminergic, ': -adrenerGic and muscarinic cholinergi, receptors. Scatchard analysis showed no change in the i:R values. However there was a tremendous increase in the number om these receptors. As receptor modulation in terms of qualitative and Guantitativz measures provide a basis for understanding the interaction of xenobiotics, from the present study it can be concluded that T:'V may effect central nervous System by producing supersensitivity in the neuronal receptors. TIMN 448609 1nR
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k LONG TERM FOLLOW-UP OF THE WATERLOO SMOKING PREVENTION TRIAL •lirian R. Flay, University of Southern California, Los Angeles, CA, USA Shirley•Tho~ son Susan Santi, J. Allan Best, and Stephen K. Brown, University of Waterloo, Ontario, Canada The first large-scale randomized trial of the social influences anp roach to smoking prevention was initiated in Waterloo, Canada in 1979. At that time, 22 schools with grade 6 students (age 11-12f were randomly assigned to receive or not receive a social influences smoking nrevention curriculum. Students in the 11 program schools received a o-session curriculum from research staff. Booster sessions were provided at the end of grade 6, two sessions in grade 7, and one session in grade 8. Students in both program and control schools were assessed by questionnaire, with biochemical validation of self reports of smoking behavior, at pretest (T1), immediately after the core proq ram (T2), at tha end of grade 6 (T3), at the be9 inning and end of orade 7 (T4 and T5), at the end of grade 8(T6), and in grades 11 (T7) and 12 (T8). Results from TI through T6 have been reported previously. They indicated that the program was successful at preventing the onset of -~xperimental smoking up to the end of grade 8, especially for those ,tudents who were at high risk for becoming smokers because their :.arents, siblings, and friends were smokers. By grade 12, however ac-re were no longer significant differences between the program an6 control students -- approximately 33% were regular smokers. There was 0 noticeable difference in the proportion of regular smokers between :hose subjects still in school (28%) and those who had dropped out of .~chool (68%), though no significant program effect for either group. it appears that the Waterloo pro~ram was not successful at preventing ;ne onset of regular smoking at he high-school level. These results suggest a need to assess further the value of the social influences ipproach for preventing the onset of regular (as opposed to experimental) smoking. ` The Developing Role of the Physician in Smoking Cessation: Preliminary Results of Intervention Trials in the U.S. *T. Glynn Smoking, Tobacco, Program, National Cancer Institute, Bethesda, Maryland, U.S.A. The aim of this paper is to discuss the rationale for focusing on physician-delivered smoking cessation activities, review the evolution of the physician's role in smoking cessation, and present early findings from the $10 million physician-based smoking cessation intervention trials supported by the U.S. National Cancer Institute since 1984. The rationale discussion focuses on the importance of preventive medicine, the physician/patient relationship, the opportunity for frequent patient contact, the wealth of data demonstrating physician effectiveness in smoking cessation counseling, and the signifiant potential for broad public health impact. The discussion of the physician role in smoking cessation focuses on four periods in the development of this role in the U.S. from 1950 to the present. Finally, preliminary findings from five intervention trials involving nearly 40,000 patients and 700 physicians, supported by the U.S. National Cancer Institute begining in 1984 and scheduled to end in 1989, are reviewed. Among the major, early findings of these trials are that a direct relationship is seen between extent of physician involvement and cessation success rates, the active involvement of all office staff is essential, use of nicotine gum signifiantly enhances cessation if explicit directions in the use of the gum are given, additional incentives are necessary to attract large numbers of physicians to delivery of smoking cessation information, and designation of specific quit dates and smoking-only follow-up visits are essential. - FP-3-01 FP-3-02 TIHN 448610 109
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FP-3-0 3 COALITION BUILDING Pt. Maile, M.S., Executive Director, A. S. Hanson, M.D., President Minnesota Coalition for a Smoke-Free Society 2000 FP-3-04 Routinely we receive calls from around the United States inquiring about how to organize a local coalition. The Minnesota Coalition for a Smoke-Free Society 2000 was organized on a very informal basis by interested parties in 1981. In September, 1984, 501(c)3 status as a non-profit corporation was received from the Internal Revenue Service. The primary focus of the Coalition is to reduce the incidence and prevalence of smoking by Minnesota residents. This is accomplished through committees comprised of representa- tives of member agencies who donate their time and talents. Presently the Coalition is comprised of 35 member agencies representing over 250,000 Minnesotans. Marketing and legislative efforts and assisting Minnesota hospitals to become smoke-free are examples of the major Coalition accomplish- ments thus far. Preliminary data indicates a 9% reduction in consumption of cigarettes due to state legislative efforts of the Coalition. SMOKING AND HEALTH: POLICIES OF THE AMERICAN MEDICAL ASSOCIATION *Nilliam R. Hendee, Ph.D. Vice President for Science and Technology, American Medical Association, 535 North Dearborn, Chicago, Illinois 60610 USA Since the 1950's, when the Journal of the American Medical Association banned advertising of tobacco products in its pages, the American Medical Association (AMA) has taken a multi-faceted approach toward educating the medical profession, the public and policy makers about the dangers of tobacco use. An AMA policy analysis showed that an advertising ban coupled with a significant increase in tobacco excise taxes would significantly reduce the likelihood of young persons starting to smoke. As a result, AMA helped draft and has worked hard for the passage of legislation that would ban tobacco advertising. AP1A's professional and public media routinely report on all aspects of tobacco use, and continue to identify ways that the Association can contribute to reductions in smoking and tobacco use in general. Recent activities of the Association directed against tobacco use include urging physicians to more actively encourage their smoking patients to quit, supporting legislation banning smoking on passenger aircraft, discouraging the advertising of smokeless tobacco products on television, and identifying the objective of a tobacco-free society by the year 2000. These efforts, coupled with the sustained position of the Association against tobacco use over the years, have clearly identified the American ?!edical Association worldwide as one of the leading opponents of tobacco use. TIMN 448611 110
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TOWARD A TOBACCO FREE YOUNG AMERICA ,/.R. Seffrin Vice President, American Cancer Society, 90 Park Avenue, New York, New York, 10016, United States of America The American Cancer Society's agenda for the future is a Tobacco Free Young :lmerica- by the Year 2000. The Society has mobilized the resources of four program areas to reach five target groups. The target groups are Vocational/ Technical High School Students, Preschool Children, Early Adolescents, Expectant Parents, and Health Care Professionals. The Society also has joined :he American Heart Association and the American Lung Association in a partnership. The Tobacco Free Young America project has already won the support of schools, parent's organizations and health-care leadership, and promises to return major health benefits to our nation. i,i:ATIONAL PROGRAM TO REDUCE TOBACCO USE IN CANADA *L'. Ouellet Chief, Tobacco Programs, Health Promotion Directorate, Health and Welfare Canada, Ottawa, Ontario, Canada K1A 1B4 The aim of this paper is to describe the Canadian approach to creating a comprehensive and coordinated plan to reduce tobacco use. In 1985, federal and provincial governments and seven national health organizations joined together to establish a National Program to Reduce Tobacco Use. In June, 1987, the National Program Steering Committee released a directional framework which is intended to guide future .. program planning at the national, provincial and local level. The directional framework describes current major tobacco issues (eg. smoking among children and women and involuntary exposure to second hand smoke), three goals, a set of long and short-term objectives (which address both individual and environmental issues) and a comprehensive set of strategies including education, information, promotion, legislation, policy coordination, community action and research. In November 1986, the Minister of National Health and Welfare released a discussion paper entitled Achieving Health For All: A Framework for Health Promotion. The presentation will focus on the goals and direction being taken through Canada's National Program to Reduce Tobacco Use to address two of the major tobacco-related challenges to achieving health for all - inequities in health risks among segments of the population (eg. children, youth, women), and prevention of risk exposure (due to both tobacco use and passive smoking) In describing implementation to date, in certain National Program strategies, particular emphasis will be placed on the federal government's particular role in the program and its recent program and policy initiatives. FP-3-05 FP-3-06 TIMN 448612 „1
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FP-3-0 7 TOBACCO CONTROL IN CANADA *Neil E. Collishaw Tobacco Products Unit, Room 137, Environmental Health Centre, Department of National Health and Welfare, Ottawa, Ontario K1A OL2, Canada FP-3-08 The purpose of this report is to review briefly the history of tobacco pro- duct control policies in Canada and to highlight policy developments that have occurred in 1987. The tobacco industry's voluntary advertising code, in place since 1972 has been increasingly viewed as unsatisfactory. In April, 1987, the federal government announced its intention to pursue a comprehensive health-oriented tobacco policy. Its main provisions are: - protection from involuntary exposure to tobacco smoke in all workplaces under federal jurisdiction - ban on smoking on all airline flights of two hours or less - financial assistance to tobacco farmers who wish to pursue alternative economic activities - legislated ban on tobacco advertising - legislated requirement for strong health warnings and toxic substance information on tobacco product packages It is concluded that this policy will, in Canada at least, respond signi- ficantly to the World Health Organization's call for a global public health approach and action now to combat the tobacco pandemic. Innovative Social Marketing Techniques and Strategies In The Field Of Tobacco Prevention in Canada *J. Mintz Chief, Marketeting & Cartnunications, Health Pranotion Directorate, Health & Welfare Canada, Ottawa, Ontario, Canada K1A 1B4 The aim of this paper is to describe the Social Marketing initiatives takeri in the National Program To Reduce Tobacco Use in Canada frcm 1985 to 1987. Break Free For A Generation of Non-Smokers (1985-87), which followed an earlier governrrrnt program Generation of Non-Smokers (1982-88), has utilized innovative advertising and pranotion techniques to: persuade young people to maintain non-smoking attitudes and behaviour as they pass fran childhood to their adolescence, position non-smoking as the norm and smoking as the abnormal activity, establish that non-smoking is the socially acceptable behaviour and influence peer group pressure to this end. Since 1985 the irrpact and effectiveness of the Break Free campaign has been evaluated through the use of a yearly survey of approximately 1500 young Canadians carried out by the Canadian Gallup Poll Limited. Scme of the key results of the 1985-87 surveys will be presented in this paper to elucidate the impact of this major social marketing initiative. Recent results indicate that 57% of the target group 12-17 years of age were aware of the campaign and that there was a significant decrease (of 5 percentage points) from 1985 to 1986 in the proportion of young people who say they will be smoking in five years. >•: 'TI1.V~N 4.48613 112
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CO:1PREHL•i2SIVE SMOKING PROGRAMS FOR CIIILDREN )r. Gerald E. Gray, Faculty of Education, University of Regina, Regina, Saskatchewan, Canada, S4S OA2 The aim of this paner is to identify successful school smoking Programs and to suggest comprehensive methods to introduce children to a healthful lifestyle. The synthesis of a suggested program is based on over 25 years of research, teaching, writing and curriculum development. The author will identify the current results of the health knowledge .ittitud2s and behaviour of Canadian children specifically in the drug and smoking area as identified in the monumental Canadian Health Knowledge and Canadian Health Attitude and Behaviour Survey. The results of three complimentary community-school based programs, "Smoke Free Spaces for Children" and "Jump Rope for Heart" as developed and researched for the Canadian Heart Foundation as well as the Minister of •Iealth's "Smoke Free School" program will be examined. Conclusion It is often abhorrent to see the lack of quality in materials .:nd orograms developed for school use. Pronerly designed and implemented ~;chool based materials and programs can make a difference in students' -:noirlcd;e, attitudes, and behaviour. FP-3-09 SMOKING CESSATION PROGRAMMES. THE MEXICAN EXPERIENCE FP-3•1 0 * F.G. Puente-Silva, G. L6pez, G.L. Henao, M. Garcia and H. Gavald6n ?texican Committee for the Study and the Control of Smoking (COMECTA), Apartado Postal 22-421, Tlalpan 14000, Mexico, D.F., Mexico The present study show the results of each of three smoking ces- sation programmes in Mexico City. The first with general population, the second with cronic cardiorespiratory patients and the last with pregnant women. All of them have a base line evaluation and a follow up of six months. The programme with general population, in spite of being asymptomatic, 90% showed obstruction restriction in the funct- ional respiratory test. Four types of interventions were studied (re gular nicotine chewing gum and self monitoring; esporadic nicotine chewing gum and self monitoring; regular vitamin C and behavioral and health education; regular vitamin C and self monitoring). All of them stopped smoking in around 70% rate. In the group with chronic diseases two types of interventions were decided to increase the treatment ad- herence including smoke cessation: behavioral health educational programme; cognitive reestructuring (cr) programme in spite that the two groups showed similar (65%) abstinence rates in the follow up studies the cr seemed superior. The last programme was carried out with pregnant women. A health educational behavioral programme and a behavioral modification intervention were used. The two programmes obtained similar results. No differences were found in the follow up. In this paper we discuss the implications of having smoking cessation programmes Sn underdeveloped countries (i.e. Mexico). The cost benefit is reviewed since smoking will be ip few years time one of the priori ties in public health of countries of the Third World as well. TIMN 448614 113
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FP-3-1Z THE SOCIAL CONDITIONS OF SMOKING °J *J.v.Troschke Division of Medical Sociology, Albert-Ludwig-University, Stefan-Meier-Straf3e 1Z, 7800 Freiburg, Federal Republic of Germany FP-3-13 114 The various theories explaining why people smoke are presented and discussed in conjunction with current empirical data. It becomes clear that while health risks are always highlighted the subjective factors are being neglected. The fact that health education measures have been so ineffectual in their attempts to reduce smoking can be explained by the insufficient consideration given to individual motives within the context of the social environment. New attempts at a comprehensive theoretical and empirical treatment of the problem are here outlined. THE DUTCH NO SMOKING APPROACH B. Baan Stichting Volksgezondheid en Roken, Frederik Hendriklaan 34A, The Hague, The Netherlands The Stichting Volksgezondheid en Roken (the Smoking and Health Foundation) pursues the Netherlands Government's policy to discourage smoking. Its aim is one of total elimination, so that society will ultimately be free of tobacco. This total elimination policy comprises both legislation and education. The Tobacco Act was passed in 1987. This act imposes restrictions on the sale and advertising of tobacco and lays down regulations for the protection of the non-smoker from exposure to smoke. The influence of the tobacco industry is gradually on the decline. The Smoking and Health Foundation supplies information about (non) smoking and conducts ongoing campaigns to this end among the youth, young adults and high risk groups on the advantages of not smoking and campaigns for the pro- tection of the non-smoker. The public information is based on the fact that smoking is harmful and aims to give non-smoking a positive image. One of the main tasks of the Smoking and Health Foundation is to exert a sustained influence on organizations and persons who can play an important part in the no smoking approach, such as Parliament, the Government, the Press, health organizations and educators. TIMN 448615
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(NON-)SMOKING AND CHILDREN IN THE NETHERLANDS J.G.M. Nelissen Stichting Volksgezondheid en Roken, Frederik Hendriklaan 34A, The Hague, The Netherlands The Smoking and Health Foundation carries out research in The Netherlands, including into the smoking'habits of children. At the same time, research is going on into the significance of smoking to the various age groups. This information is the foundation of the campaigns it has developed: A. "Don't play with fire" A series of lessons for children aged from 10 to 12, to be given in primary schools. Aim: . To increase the amount of exact information about the risks of smoking To make children aware of the factors influencing smoking To encourage logical thinking which regards non-smoking as the norm. B. "Smoke...why should I?" A direct media campaign for 13 to 18 year olds. Aim: . To undermine the image of smoking by communicating a motivating and positive image. Not to smoke is adult, pleasant, adventurous etc. and anyway you will live longer to enjoy it. A.NEW METHOD TO INCREASE THE MOTIVATION TO STOP SMOKING. *A. Hjalrrarson and K. Frostr&n. Smoking Cessation Clinic, Department of Medicine I, Sahlgren's Hospital, 413 45 Goteborg, Sweden. In Gothenburg, Sweden, a study is going on to find simple and effective methods to help workers in the construction industry to stop smoking. As a part of this study we are trying to find new ways to increase the motiva- tion to stop smoking. The study group consists of workers attending their regular health check- up, which is repeated every second year. One group is offered the opportuni- ty to watch-a video program. The other group, similar in size, is not. The video program consists of interviews with five construction workers who have all stopped smoking. The intention of these interviews is that ex-sma- kers could serve as models for their smoking colleagues. At the health check-up a nurse asks the smokers about their willingness to see a nurse educated in smoking cessation. We started the study by the 1st of October 1986. We plan to continue for another 12 months. Preliminary results are promising: 25% (n=11/45) of those having watched the video program were interested in a visit to the smoking cessation nurse. In the group that didn't'watch the video only 18% (n=88/469) wanted to see her. FP-3-14 FP-3-15 TIMN 448616 11
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FP-3-1G EFFECTIVENESS OF NICOTINE POLACRILEX IN PATIENTS WITH PULMONARY DISEASE *David P.L. Sachs, M.D., Neal L. Benowitz, M.D., Kenneth J. Silver, M.D., D.D.S. Division of Pulmonary Medicine, Case Western Reserve University Hospitals, Cleveland, OH; Department of Medicine, University of California Medical Center, San Francisco, CA; Smoking Cessation Research Institute, Palo Alto, CA, USA. FP-3-17 Because controversy exists whether nicotine polacrilex (Nicorette) can ef- fectively treat tobacco dependency in chronic obstructive pulmonary disease (COPD) patients, we enrolled 71 smokers with COPD. They were split into an active comprehensive treatment condition (ACT) and a control condition (CC). ACT consisted of physician stop smoking advice, instruction in nicotine pola- crilex use, and regular medical follow-up for the entire duration of medica- tion use. CC patients received the same extensive medical intake evaluation, but were then placed on a waiting list and did not receive physician stop smoking advice, instruction in nicotine polacrilex use, or regular medical follow-up until the study was completed. Nonsmoking status was objectively confirmed by venous COHb, serum nicotine, cotinine, and thiocyanate levels. Smoking cessation success was defined as sustained abstinence from treatment end through the entire duration of the 18.9±3.5mo long-term follow-up period. Any lapse rendered the subject a treatment failure. Within the ACT, success- ful long-term quitters used nicotine polacrilex for 8.0±9.5mo compared with 2.6±3.7mo for those who did not stop (p<0.o1), and tended to use more 2 and 4mg doses, compared with those who had not stopped: 6.6±4.0 vs 6.2±5.5 2mg pieces (p=ns); 8.8±1.5 vs 7.8±4.0 4mg pieces (p=ns). 27% (12/44) in ACT showed sustained abstinence through the entire 18.9±3.5mo long-term follow-up period compared with 0% (0/27) in CC (p<0.005). We conclude that a struc- tured nicotine polacrilex treatment plan following the traditional medical model can achieve good, long-term,sustained smoking abstinence for patients with COPD. POLITICAL WILL OR LACK OF SUCH POLITICAL DETERMINATION IN THE FIGHT AGAINST SMOKING IN PUBLIC : Jean Tostain, Pr6sident, Ligue Contre la Fum6e du Tabac en Public, 14, rue du Petit Ballon 68000 Colmar, France. Summary : The law of July 9th 1976, named "VEIL ACT", against smoking in public place, was unanimously passed by the French Par- liament, but 11 years later it is hardly enforced. Neither Magistrates nor public Authorities have been able, or have dared or even wanted to compel the financial and'commercial power related with tobacco-drug to abide by the law. It is the tobacco-lobby who imposes its own views. If existing regulations are given little heed by members of the public in public and privates places,this is due to the indiffe- rence and careless attitude of the people in command. Non-smokers are the victims of their refusal to enforce regulations. But things are particulary bad in the media where tobacco in- dustries violate the law with impunity. The "NICO-DOLLARS" acgui- red from fraud and drug sales are laundered through the sponsoring of cultural and sports events. Let us wish that political determination is only temporarily in this state of lethargy ! 116 TIMN 448617
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THE GREAT NEW ZEALAND SMOKE-FREE WEEK FP•3-1 8 *J Gaiser Cancer Society of New Zealand Inc., P 0 Box 1724, Auckland, New Zealand The object was to encourage smokers to quit during the week 30 June to 6 July 1986, and to stay stopped. It is believed that this is the first time such a national campaign has been extended over the week. Strategies included a mass-media campaign, involvement of family doctors, schools and communities, and a telephone counselling service for smokers with quitting problems. The campaign philosophy was that 'smokers are nice people too'. Community awareness of the campaign was 96%, almost 50% of smokers tried to quit during the week and 13% said they intended to stay stopped after the week. Four weeks later, there was a new Government tax which increased retail prices by around 53%. Some parliamentarians believed the tax would not have been so high without the apparent public approval of the campaign. Six months after the week, cigarette sales were down 25%. At a cost of NZ$600,000 (US$300,000) for a population of 3.3 million, such campaigns are expensive and demand dedicated staff. Evaluation, however, should not be confined to a measurement of smoking behaviour and can, as in this example, have positive effects on the attitudes of legislators. INTERNATIONAL COOPERATION AGAINST TOBACCO - AN ASIAN EXAAIPLE ~'r Judith Mackay, FRCPE n}l0 Expert Advisory Panel on Smoking and Health Riftswood, 9th milestone, 147 Clearwater Bay Road, Kowloon, Hong Kong Since 1982 the Hong Kong government has instigated a strong and comprehensive policy of legislation, education and publicity, in the presence of major tax increases on tobacco products. The reaction of the international tobacco industry has been extreme, with extensive political lobbying; recruitment of business and trade associations; flying teams of tobacco 'experts' to Hong Kong; persuading influencial U.S. senators to write threatening letters to the government when the intention to ban smokeless tobacco was announced; and even planning to beam in television tobacco advertising from nearby Macau to circumvent the Hong Kong ban. The Hong Kong health authorities were fortunate that support came from many international health bodies, overseas anti-smoking and cancer organisations and health politicians, in the form of written representation, attending hearings in Hong Kong and giving unstintingly of time and advice. The tobacco industry is now organised on a global basis with coordinated strategies to resist health initiatives, to lobby governments and to influence the media. Remarkably similar battles are being fought all over the world. There is a crucial need to share international expertise 'in countering the tobacco industry at political, legislative, media and community level. FP-3•7 9 TIMN 448618 11
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FP-3-20 FP-3-21 118 SMCKING CONTROL IN'HCNG KONG +~ Ms. Elaine Chung Deputy Secretary for Health and Welfare, Hong Kong Government Government Secretariat Oth Floor Main Wing) Lower Albert Road Hong Kong This paper is complementary to that by Dr. Mackay "International Cooperation Against Tobacco", which focuses on the international element involved in both sides of the smoking control issue with Hong Kong as an example. It outlines the Hong Kong Government's approach to smoking cbnfrol including(a)legislation(b)public education and publicity and (c)taxes. Hong Kong's special circumstances, such as crowded living conditions, the tradition of laissez-faire and the influence of a free media, are referred to in the analysis. But the conclusion to be drawn is that the notable success of smoking control in Hong Kong - a 20j6 reduction in smokers 1982-6 - is the result of active Government involvement at the side of concerned health specialists. ANTISMOKING EDUCATION INCLUDED THE LUNG CANCER SCREENING PROGRAM *Hoshi,T. Onodera,N. Maeda,N. Department of Public Health, Public Health Institute,Tokyo, Japan. The purpose of this study is to evaluate the effects of antismoking education. A change of a non smoking rate was followed up 1 year after intervention in two groups divided by whether participated in antismoking education or not. As for the subjects, number of the antismoking education participants were 316, and those of non participants were 130. One year after a non smoking success rate of the subjects that participated in antismoking education was 11.3% , and 20.9% in one month later. On the other hand those of the non participants were 9.2% and 6.2%. We could find significant difference of non smoking rate in one month later but not one year later. The subjects of antismoking education were derived from the subjects who had received both the multiphasic mass screening and the lung cancer screening conducted by Health Center of Katushika word. The control groups were consisted of those who had not receive the lung cancer screening. The contents of antismoking education were made up of a lecture, a group discussion, and a question and answer. Antismoking education time was, about one hour. It should be realized that we could not generalize these results in general, because the subjects were not selected at random. However, one hour antismoking education effects on the subjects who had the lung cancer screening were 11% after one year,and 20% after one month. It should be desirable for the public cancer prevention program to join the lung cancer screening program and the antismoking education. TIMN 448619
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ANTI-SMOKING ACTION IN KINKI DISTRICT OF JAPAN *H.Nogami, M.Kakutani, K.Miyazaki Kinki Council on Smoking and Health, Osaka 590-01, Japan The aim of this report is to mention the non-smoking and anti-smoking movement in Kinki district of Japan, which consists of six prefectures around Osaka, for these several years. In 1982, we had started our grass-roots movement for smoke-free society, and had issued our periodical action report "Tobaccoless" in Osaka. We would like to change the atmosphere to be tolerant of smoking in Japan. We have put our stress on introducing smoke-free area or segregation of smoking area in all public places and workplaces. And cooperating with public health organizations and administrative organs, we have been instituting a propaganda for the smoking prevention of pupils and against the smoking in public places and workplaces by putting up posters. We have made a survey of measures against smoking in Kinki district. There are several smoke-free workplaces, non-smoking seats in restaurants in most of hotels and department stores, and non-smoking time of rush hours in most of stations, but few in liners, highway buses and taxies. The rate of smokers has been gradually declining, and non-smoking areas have been steadily increasing. We are now bending every effort to attain to segregation of smoking area in each workplace, and to make the tobacco companies use self-control over their advertising. r PRACTICAL ACTIVITIES IN THE ANTI-SMOKING EDUCATION BY THE LOCAL tnUNICIPAL MEDICAL ASSOCIATION. - K. Tanaka, 0. Seo,and R. Nishimura Amagasaki Medical Association,Amagasaki-city, Hyogo 661, Japan, Amagasaki Medical Association has been making an effort for 10 years to educate the citizens about the ill effects of smoking with an emphasis on those who are affected by passive smoking. Stress has been placed on voluntary measures for not smoking based on consideration for others creating empathy among smokers for those who abstain. Consequently we found that this aproach has proved more effective than informing smokers of their own health problem. General practitioners with direct contact with citizens are greatly responsible for health education in the community in regard to the influence of diet and smoking for the comming aged society. Examples of Amagasaki's activities for promoting no-smoking include 1)An encouragement of no-smoking among physicians, 2)prohibition of smoking in the consulting and waiting rooms and all meetings at the medical center and in the public health administration department, and 3)nealth education to the citizens. FP-3-22 FP-3-2: TIMN 448620 11
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FP-3-24 FP-3-25 120 THE DEVELOPMENT OF ANTI-SMOKING VOLUNTARY ACTIVITIES AND THE PRESENT MEMBERS' ATTITUDES TO SMOKING S. Igarashi, "S. Kagamimori, S. Murotani, S. Marukawa, T. Igarashi and K. Kanaoka No Smoking Club, Shinminato City, Toyama Prefecture, 934, Japan A physician eagerly persuaded parents to stop smoking and to save funds of the gymnasium for their school children. After his individual actions against smoking, he formed "No smoking club" in December, 1970 for developing a social pressure against smoking. Physicians, teachers and leaders of local communi- ties were invited as members of this club. Furthermore, his neighbors were also requested to join this club. Some physicians established their branches of the club. Through the bulletins, educational meeting and so on, the members were encouraged to keep their voluntary spirits. These days activities of the club were focussed on passive smoking and teen-agers' one. The core members are now giving talks about smoking to teachers and school children. According to the survey on the member's attitudes, it has been demonstrated that they have the lower percentage of current smokers (21% of 198 members) and the higher one of ex-smokers (52%), and the higher one of criticism against smoking physicians (70%) and teachers (40%) compared with control groups. In addition to the results of this survey, we are able to find the fruits of our voluntary activities over 20 years. URGENT NEED OF LEGISLATION AGAINST SMOKING IN JAPAN Martin M. Kawano Kyushu Anti-Smoking Society, 9-13 Hoeicho, Nagasaki, Japan 852 There has been some progress in smoking control in Japan since the last World Conference in Winnipeg, but the present legislation is far from ideal compared with other developed nations. Intention of this presentation is to introduce legislations in other nations to find out the practical lessons for ideal legislation against smoking in Japan. Since 1975 Sweden advocated strict regulations to control smoking along with public and chool education on smoking, and many other countries followed this example in Northern Europe. Regulation against smoking developed in the United States since the President Kennedy called attention to the harm of smoking. Recent Progress ig remarkable, particularly in the states of California and New York where smoking is restricted in work place and public places including transportation. The ban of smoking in the Army and Federal buildings indicates the strong concern of policy makers of the nation. As recommended by WHO, Japan also should establish much more severe legal control of smoking to protect people from the growing harmful effects of direct and indirect smoking of cigarettes. `TIMN 448621
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T11E TRUE STATE OF AFFAIRS ABOUT TOBACCO'S SLOT (VENDING) MACHINES NEAR THE SCHOOL AND STUDENTS. *Y. FUJ I U AND M. KOBAYASHI Anti-Smoking Education Voluntary Service,Kougakuin University High School, Nakano-machi,Hachiouji-shi,Tokyo 193,Japan. Knowledge of the Anti-Smoking Education is essential for enjoying their school life and all their life. The students should learn as much as possible about the dangers of smoking and threatened death if ca~ght using tobacco. But they were seriously affected by tobacco's slot(vending) machines near the school,even In the school shop . 1.352 students In our school filled out questionnaires about Smoking. The more students know about the Anti-Smoking Education,the more successful their true education for life will be. ti0?!-S?tOKING EDUCATION FOR CHILDREN BY PHYSICIANS AND SCHOOL TEACHERS B. Yokota and *I. Plizutani Toyonaka Association of Physicians and School Teachers for Smoking Prevention of Children, Toyonaka City, Osaka 560, Japan This association was established in May, 1985. It is a voluntary organization. The members consist of physicians, dentists, teachers of primary and junior high schools, and members of school boards in Toyonaka city. Present total membership are of 80 physicians and dentists, and 180 teachers and members of school boards. This association aims at protecting children from harmful effects of smoking in cooperation with doctors and teachers. The current activities are as follows: 1. organizing members' workshops, 2. publication of the minutes and exchange of information with related organizations, 3. survey on smoking around the Toyonaka area, 4. providing lectures on smoking, 5. research and collection of teaching materials about anti-smoking education, 6. support of the counseling corner about smoking in annual city health exhibition, etc. FP-3-26 FP-3-27 IIlV1.l'a 448622 121
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FP-3-28 FP-3-29 122 SURVEY ON YOUTH SMOKING IN FOREIGN COUNTRIES BY USE OF A QUESTIONNAIRE GIVEN TO FOREIGN STUDENTS AT HIROSHIMA UNIVERSITY *M. Murakami Leader of Anti-smoking Committee of Hiroshima Prefectural Medical Association Kannon-hon-machi 1-1-1, Nishi-ku, Hiroshima-shi 733, Japan Questionnaires were given to 102 foreign students attending Hiroshima Uni- versity to investigate the smoking habits of the youth in their respective countries. The students, given the questionnaire, were from 24 countries with 14 of the countries being in Asia. The most of the students, given the questionnaire, were those from mainland China followed by those from Indonesia, Taiwan, Malaysia, South Korea, Bangla- desh, the Philippines, Burma, India, Iran, Hong Kong, Thailand, Sri Lanka and Pakistan with the number of students being in that order. According to the results of the survey, children smoking from the time they were 10 years old or less can be seen in Bangladesh, China, Malaysia and the Philippines among the asian countries. The survey showed that for youth of 10 and more all countries had youth that smoked. Many of the students from the Asian countries answered that they think it necessary to amend the present conditions of smoking regarding minors in their own countries. On the other hand, however, it was found that a lot of students locked the conception that smoking is harmful, although most of the foreign students were highly intelligent. It is considered necessary for WHO not only to further promote anti-smoking campaigns for the youth more actively but also to recommend that tobacco com- panies in developed countries stop their tabacco exports to developing coun- tries. "Anti-Smoking Interventions in the Broader Context of Health Promotion." Mario A. Orlandi, Ph.D., M.P.H., American Health Foundation Alfred i•icAlister, Ph.D., University of Texas, Health Science Center at Houston Ernst Wynder, M.D., American Health Foundation Although cigarette smoking is a major threat to public health, it is not the only important target for action and it may not best be addressed in isolation. Community programs for cessation and prevention of smoking may be more effective in the long-term if they are conducted as a part of broader efforts to control other risks such as alcohol and drug abuse, imprudent nutrition, chronic stress and social isolation. Broad community support for program adoption and maintenance can be best achieved when the, entire range of health threats are addressed together. Smoking should not be considered in isolation, as copious evidence indicated interrelationships between smoking and other health-related personal behaviors such as alcohol use or eating habits. Data from community and school-based anti-smoking programs in New York and Texas will be presented to show how population impact on smoking and community support for program adoption and maintenance is maximized when it is carried out as part of a broad effort to meet all si.-nificant perceived needs for public health promotion. ,TIMIS 448623
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EFFICACY OF NICOTINE CHE,TING GUM * Karl Olov Fagerstrom Leo Lakemedel AB, Helsingborg, Sweden The available controlled studies with nicotine chewing gum in: a) Long-term srtbking cessation, and b) Short-term withdrawal symptom studies, are reviewed. In smoking cessation studies the effect of nicotine gum is analysed separately for different control conditions, placebo, no-gum, and other smoking cessation treatments. The blood nicotine levels obtained under nicotine substitution with gum is evaluated as well as the interaction of efficacy with the patient's degree of nicotine dependence. It has been found that adding nicotine gum to a smoking cessation treatment programme almost doubles the chances to quit smoking and to stay quit. From the comparison with other treatments it has been seen that nicotine gum is as effective as the other, often more time-consuming treatments. In general, nicotine gum also alleviates withdrawal symptoms although not consistent and reliably. The effect on the complex meaning of concepts like desire to smoke, urges and cravings, is not impressive, probably because these phenomenons are conditioned responses to environmental cues and work relatively independently of the internal physical state. Nicotine levels with nicotine gum are laaer than when smoking. The 4mg preparation of the gum produces higher levels than the 2mg preparation, about two thirds, and one third of the smoking nicotine levels respectively. I A SMOKERS CLINIC STUDY USING PLACEBO CONTROLLED NICORETTE 4 MG *T. BlSndal Department of Lung Diseases and Tuberculosis, Reykjavik Health Center, 101 Reykjavik, Iceland The aim of this study was to estimate the effect of adding 4 mg nicotine chewing gum to a smoking cessation program. The 182 participants filled in various data. Gum use was infrequent after six months. Quitting success was confirmed by exhaled air carbon monoxide measurements. The one-year abstinence rate was 43,5% among the 92 individuals using nicotine chewing gum compared to 27,8% in the placebo group (n=92). The difference is significant. The nicotine dependence was measured according to the Fagerstrom scale ranging from 0-11. The score and the amount of tobacco smoked was inversely related to quitting success at one year. For the 72 individuals with high score (7-11) on the questionnaire scale the figures were 40,9% vs 3,6% respectively again a significant difference. For the 110 individuals who scored low (0-6) the figures were 45,8% and 38,7%. Nicotine chewing gum has a specific effect over and above supportive measures applied in a conventional smoking cessation program. FP-4-01 FP-4-02 ,rIWIN 448624 123
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FP-4-03 FP-4-04 124 A HER MEASURE OF NICOTINE DEPENDENCE - THE HESTMEAD NICOTINE TOLERANCE SCA'•. AE. Digiusto, D. Small, V. Seres, R. Batey Department of Community Medicine, Restmead Hospital, Hestmead 2145 Austral Clinical trials of Nicorette have shown conflicting outcomes, but have suggested that it has specific clinical value, at least for highly nicotin dependent smokers Rho try to quit. The Fagerstrom Tolerance Scale is xide used to measure individual smokers' degree of nicotine dependence. Boaever, the items in the scale are poorly validated and the scale itself is psychometrically inadequate. The present study xas designed to develop an improved measure. 270 smokers were randomly allocated to receive Hicorette or placebo in a behavioural cessation program. Prior to treatment, subjects ansxered 31 questions believed to be related to nicotine dependence. These questioi Here validated against three objective indicators of nicotine dependence - baseline cotinine levels, rate of Nicorette/placebo tablet use after quitting smoking, and mood change after quitting. Hicorette Ras found superior to placebo in relieving subjective nicotine rrithdraAal symptoms but, overall, not different from placebo in relation tc cessation of smoking. Hultivariate analysis identified a subset of questions xhich form a better tolerance measure than the Fagerstrom Scale. The use of the Restmead Tolerance Scale xill help clinicians to identify those smokers Rho are most likely to benefit from using Nicorette uhen they try to quit. The study also demonstrates a new approach for developing assessment procedures for matching smokers optimally to treatments. LONGTERM EFFECTS OF TRANSDERMAL NICOTINE SUBSTITUTION IN BEHAVIORAL SMOKING CESSATION EG. Buchkremer, H. Bents, K. Opitz Clinic for Psychiatry of the University of Miinster, 4400 MUnster, F.R. Germany Effects of transdermal nicotine substitution on psychologi cal smoking cessation were investigated in a double-blind prospective study. 131 smokers have been randomly assigned to three treatment conditions. All smokers underwent nin weeks of self-controlled smoking reduction. During six week one group was additonally treated witki nicotine patches continuously releasing nicotine through the skin into the blood circuit. A second group received placebo patches; . third group was treated with behavioral training alone Treatment effects have been monitored by recording daily cigarette consumption during treatment and in follow-up measures six and twelve months post treatment. Short term ae well as longterm results indicate that the nicotine treatec subjects reached significantly higher abstinence rates thar. both placebo and control subjects. Besides the diminuition of withdrawel symptoms during cessation aversive effects of transdermal nicotine supply on cigarette taste have beerr shown by self-assessment. In summary, our results demon- strate that transdermal nicotine substitution significantly enhances the effectiveness of behavioral smoking cessation methods. TIMN 448625
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2MG AND 4MG NICOTINE CHEWING GUM IN SMOKING CESSATION: WHO PREFERS WHICH FP-4-0 5 ~P. Hajek Addiction Research Unit, Institute of Psychiatry, London SE5 8AF, England The choice between 2 types of nicotine chewing gum containing 2mg and 4mg of nicotine (2G and 4G) was examined in a free choice situation. Both preparations were offered to 185 smokers seeking help with giving up. Among the 128 subjects who provided useable data on gum use, 19% were using 4G alone, 41% combined 4G and 2G, and 32% were using 2G only. There was little difference in short-term quit rates between these groups (83%, 87% and 85% respectively). Subjects using 4G (alone or in combination with 2G) were older (p<.05). Those of them who managed to quit did so much later than the other successes (p<.001), which suggests that 4G was chosen by those with most difficulty in stopping smoking. Multivariate predictions of gum preference and gum use will be made after ccmpletion of blood sample analyses: Further data on various cognitive variables, dependence and withdrawal will be presented. S'•;OKING CESSATION WITH NICOTION CHEWING-GUM,A DOUBLE-BLIND CLINICAL TRIAL IN THaILAND *W.Areechon M.D. Centtral Chest Hospital,Nonthaburi 11000,Thailand One fifth of Thai population smokes,72 percent are males,a higher percentage than in many developed countries. Anti-smoking campaigns in recent years have alerted the public to the dangers of smoking. The purpose of this study was to determine whether there is any difference between the long term smoking abstinence rate in Thailand and previous studies in developed countries,whether this product should be introduced onto thp market in Thailandand lastly if there would be any adverse effect on the subjects. A double-blind,placebo-controlled trial with-199 healthy subjects was conducted at outpatient clinic,the Central Chest Hospital. Of 98 subjects receiving active gun (2mg.Nicorette), 56(57.2%) had given up smoking when examined at the six-month follow-up.In contrast,only 37(36.6%)of 101 subjects taking placebo were able to give up.Recarding nicotine dependence,the results clearly,ehowed that active nicotine chewing-gum helped highly•dependent smokers overcome their habit whereas there was no difference between the active and placebo groups of low dependent smokers. Mild and transient unwanted effects were found in 10 subjects in both groups. The results can draw a conclusion that the active gum group achieved a higher abstinence rate at six-month follow-up with a statistical difference of p < 0.01. The gum could be used as an effective tool in smoking cessation irn developing country. FP-4-06 TIMN 448626 125
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FP-5-01 AN INTERNATIONAL SURVEY OF SMOKELES_S TOBACCO -- AN UPDATE *M. Fisher ~ Health and Lifestyle Specialist, 2079 Deer Ridge Drive, Stone Mountain, Georgia 30087, U.S.A. The aim of this study was to exhibit the relationship between the utiliza- tion of smokeless tobacco and various physical maladies. A detailed analysis of 400 studies worldwide was made that included research indicating the healt} effects of smokeless tobacco over the past 25 years. The results indicate an increased prevalence of usage of smokeless tobacco and various deletorious health effects, such as carcinogenesis, noncancerous and precancerous oral health effects, and the pharmacokinetics, addiction, and other physiologic effects of the chemicals in smokeless tobacco such as nicotine exposure. Scientific data associates the use of snuff with cancer in humans, and the strongest evidence of causality is shown for cancer of the oral cavity. Excess risk of cancer of the cheek and gum was also concluded. The develop- ment of oral leukoplakia, which can transform into dysplasia, and to cancer was evident. Gingival recession was found to be the most common outcome among users. The smokeless tobacco products contain such potent carcinogens as nitrosamines, polycyclic aromatic hydrocarbons, and radiation-emitting polonium. Smokeless tobacco is addictive, ]oading to dependence, and it has been implicated in supporting the pathogenesis of coronary artery and peripheral vascular disease, hypertension, peptic ulcers, and fetal mortality and morbidity. FP-5-0 2 CHARACTERISTICS AND CORRELATES OF SMOKELESS TOBACCO USE BY TEEN AND ADULT MALES *Herbert Severson, Ph.D., Ed Lichtenstein, Ph.D., Dennis Ary, Ph.D. & Elizabeth Eakin Oregon Research Institute, Eugene, Oregon, U.S.A., 97401 The aim of this study was to determine the current use and history of both cigarette and smokeless tobacco use for both a teen and adult sample. The : assessment was done via individual interviews with each subject. Topics included prior quit attempts, possible interactions between chewing, smoking, knowledge of health consequences, and their motivation to quit. Study one involved recruiting 100 adult (age 18-70) males who used smokeless tobacco (snuff or chew) on a daily basis for at least one year. The subjects were interviewed for one hour each on patterns of smokeless use, use of other drugs, smoking of cigarettes, and history of initiation and use. Particular attention was on situational prompts for uses or use. This analysis is critical to development of coping strategies for cessation. A second sample of 251 adolescent males (age 11-18) was individually interviewed and called monthly for 6 months. Subjects were selected that were current users of cigarettes or chewing tobacco. Phone interviews were also conducted with the parents of 229 students to ask about their smokeless or cigarette use and rules for use in the home. The analysis of smokeless tobacco use and quit attempts will be related to other drug use, years of use, level of current use, and use of cigarettes. Results of these interviews will promote a better understanding of smokeless tobacco use with the goal of developing effective cessation programs. 126 PTIMN 448627
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S,mOKELESS TOBACCO USE IN THE UNITED STATES, 1970-1985 *William R. Lynn Office on Smoking and Health, Centers for Disease Control, 5600 Fishers Lane, Rockville, MD 20857, USA According to the 1986 U.S. Surgeon General's Report on The Health Consequences of Using Smokeless Tobacco, smokeless tobacco can cause oral cancer, oral leukoplakias and other oral conditions, and addiction to nicotine. This paper examines the changes in prevalence of use of smokeless tobacco products among the adult U.S. population as measured by the 1970 National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics,and the 1985 Current Population Survey (CPS), conducted by the Bureau of the Census. Both surveys involved national probability samples of U.S. households. In each of these surveys, one respondent per household provided information on all household members (17 years and older - 1970 NHIS, and 16 years and older = 1985 CPS). In the 1970 NHIS, data were collected on •approximately 77,000 individuals from 37,000 households. In the 1985 CPS, data were collected on approximately 120,000 persons in 58,000 households. The data demonstrate a substantial increase in the overall prevalence of use of both snuff and chewing tobacco among the younger age males. The 2.9 perqent prevalence of current use of snuff among young males reported in 1985 represents an almost ten-fold increase in the prevalence of current snuff use among the younger aged males reported in 1970. Declines in the prevalence of current users are noted in.the.over. 50 age group. There are now an estimated 5-6 million regular users of smokeless tobacco products in the U.S. representing an approximate 20 percent increase in the number of users since 1970. U.S. smokeless tobacco manufacturers are aggressively seeking to open markets for their products in other countries. SI10,Y.ELESS TOBACCO: A PRODUCT FOR THE NEhI GENERATION OF TOBACCO USERS. DIPPING AND CHEWING IN THE NORTHUEST TERRITORIES, CANADA AND ITS GLOBAL RELEVANCE. *J. Peterson (a), L. Barreto (a), K. Brunnemann b a) Department of Health, Government of the Northwest Territories, Box 1320, Yellowknife, N.W.T. X1A 2L9 Canada b) Naylor Dana Institute for Disease Prevention, American Health Foundation, Valhalla, New York U.S.A. 10595 The use of smokeless tobacco appears to be a socially acceptable behaviour among certain ethnic and cultural groups in developing and developed countries. Some native groups in the Northwest Territories have traditionally used smokeless tobacco. With the visits of the merchant supply ships-to the Northwest Territories in the early 1950's, a wider commercial variety of smokeless tobacco began to be used. Of great concern is the generation of Canadian children and adolescents who start this habit and become addicted to smokeless tobacco during their primary and secondary school years. Smokeless tobacco is reemerging as a popular form of tobacco among children and adolescents in Canada, the United States (including Alaska), Scandanavia and Britain. Chemical analysis of samples of smokeless tobacco from six countries has revealed that moist snuff obtained from Gjoa Haven, Northwest Territories (inported from the United States) had the highest levels of tobacco-specific nitrosamines (TSNA) of 228,400 and 240,100 parts per million. If these levels were found in any other consumer product today, it would he banned from the marketplace. The relatively high levels of potentially carcinogenic TSNA in the saliva of users, together with current popularity of snuff use by children and teenagers, is of particular concern. Evidence indicates that the use of smokeless tobacco will lead to an increased incidence of cancers of the mouth, pharynx, larynx, and esophagus. Clearly smokeless tobacco poses a threat to the 'health of children and youth throughout the world. FP-5-03 FP-5-04 P •: TIMN 448628 127
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FP-4-05 MEANS AND METHOD FOR AIDING INDIVIDUALS TO STOP SMOKING •Irving Cooper, M.D. 20 Westgate Road, Newton Centre, Massachusetts 02159 U.S.A. A program that produces immediate cessation of tobacco use due t^ physiological addiction and psychological dependence in ambulatory patients. The treatment of nicotine addiction by the administration of a total daily dosage of .2 milligram clonidine and 15 milligrams of phentermine resin (U.S. patent #4255439) for a two-week period prevented the nicotine withdrawal syndrome immediately and without recurrence. Psychological techniques were used to eliminate psychological dependence and to reduce recidivism. Approximately 400 patients were contacted. 145 questionnaires were returned. 73% of the patients did not smoke for three months following the program. 56% of the patients did not smoke for a year or more following the program. Adverse reactions to the medication included dryness of the mouth, mild fatigue and some insomnia in a small percentage of patients. No adverse reaction necessitated the premature termination of treatment. The effectiveness and safety of the combination of medications for combating nicotine withdrawal syndrome immediately and the effectiveness of the behavioral modification program is strongly supported by this study. 128 TIMl®T 448629
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APPENDIXES SS-2-13 CREATING A SMOKE-FREE WORKING ENVIRONMEVT - THE AUSTRALIAN EXPERIENCE *A.F. DICK, C. FITSWARRYNE Health Advancement Division, Cormlonwealth Department of Cortmunity Services and Health, P.O. Box 100, Woden, Australian Capital Territory, 2606 Australia The principle that an employer has an obligation to provide a working environment for his employees that is safe and without risks to health is widely accepted in Australia and is set in legislation in sane States. Now that authoritative reports has indicated that passive smoking is a xisk to health some employers org_anisations have moved to create a smoke-free working environment. While in the private sector there has been little progress, there have been significant gains in the public sector. The strategy undertaken in the successful implementation of a smoke-free policy in the Ccsrmonwealth Department of Health has acted as a catalyst for establishing a smoke-free Australian Public Service by March 1988. F P-5-6 SMOKELESS TOBACCO IN AUSTRALIA ~ *A.F. DICK Health Advancement Division, Comnonwealth Department of Corimunity Services and Health, P.O. Box 100, Woden, Australian Capital Territory, 2606 Australia Smokeless tobacco is not currently widely used in Australia but evidence of its increasing use elsewhere in the world and the promotion of oral smokeless tobacco in Australia has prcmpted action to prevent its use here. Twu States, Tasmania and Western Australia have effectively banned oral smokeless tobacco by placing it on a Poisons Schedule, thus requiring supply only by a registered pharmacist on a doctor's order. A third State, South Australia, has banned sucking tobacco by Act of Parliament. Nationally, a ban on the importation, manufacture and sale of oral smokeless tobacco products is currently awaiting Ministerial decision. This move would obviate the need for State and Territory legislation or regulation. TIMN 448630
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i TIMN 448631 The Conference was supported with a subsidy from the fund of the Commemorative Association for the Japan World Exposition (1970).
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:.e 3. List of participants TIMN 448632
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. LIST OF PARTICIPANTS November 9---> 12,1987 Tokyo, Japan TIMN 448633
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N A b1 E A D D R E S S ALVAREZ HERRERA, CARLOS E. FUNDACION SALUD PUBLICA ERRERA, LVAREZ PARAGUAY 2034 IER PISO 1121 BUENOS AIRES ARGENTINA COODINATING COMMITTEE ON ACON, AVID . SMOKING CONTROL C;0 ARGENTINIAN LEAGUE AGAINST CANCER LA PAMPA 2976-70 BVENOS AIRES-1428 ARGENTINA 31 RYAN I'LACE BARRATT, ALEXANDRA BEACON HILL NSV 2100 AUSTRALIA DEPT. OF PUBLIC HEALTH BLDG. A27 UNIV. OF SYDNEY N. S. k'. 2006 CAMPBELL, JOHN Id. CASTLEDEN, k 1-LLI Ald M. CHAP6iAN, SIMON CHESTERFIELD-EVANS, ARTHUR DAUBE, MICHAEL M. AUSTRALIA 95 ANTHONY ST. ASCOT BRISBANE OLD. 4007 AUSTRALIA THE UNIV. OF VESTERN AUSTRALIA DEPT. OF SURGERY AT THE REPATRIATION GENERAL HOSP. NEDLANDS 6009 AUSTRALIA DEPT. OF COMMUN I TY MED. WESTitIEAD HOSP. k'ESTt:1EAD, 2145 NSW AUSTRALIA 69 ROBERTS ST. - NEitTOF;N 2042, N. S. Y;. AUSTRALIA HEALTH PROMOTION & EDU. SERV. HEALTH DEPT. OF WESTERN AUSTRALIA 60 BEAUFORT, ST PERTH k'A 6000 AUSTRALIA ,ri?AN 448634 1
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N A ll E ARSENAULT. BARR, BEI)ARD, BEST, BROtN, ELLIOT.T, FORBES, ;RAY, .ABRECOUE. ANDItE DONG MICHEL J. K. COLLEEN GERALD MICHEL A. S. F. E. . A DI)R E S S MONTREAL HEART 1 NST. 5000 BELANGER ST. EAST MONTREAL. OUEBEC. HIT 1C8 CANADA CANADIAN CANCER SOCIETY 11 BLOOR ST. WEST SUITE 1702. TORONTO ONTARIO M5S 3AI CANADA SMOKERS' FREEDOM SOCIETY 8G15 ST. LAWRENCE BLVD. OFFICE 300 LIONTREAL, OUEBEC H2P 2119 CANADA. M'ATERL00 SMOKING PROJECTS 175 COLUMBIA ST. fEST A'ATERL00, ONTARIO N2L 3G1 CANADA DEPT. OF STATISTICS & ACTUARIAL SCIENCE UN I V. OF WATERLOO Y'ATERL00. ONTARIO N2L 3G1. CANADA CANADIAN CANCER SOCIETY 77 BL00R ST. WEST SUITE 1702 TORONTO, ONTARIO M5S 3A1 CANADA DEPT. OF STATISTICS UNIV. OF WATERLOO Y'ATERL00, ONTARIO N2L 3G1 CANADA FACULTY OF EDUCATION UNIV. OF REGINA REGINA SASKATCHEYAN S4S OA2 CANADA LAVEL UNIV. 2705 BOUL. LAURIER STE FOY, P.O. G11' 4G2 CANADA N A W E LUNDELL. MAII00D. MICAY. M1NTZ, OUELLET. ANDERS GARFIELD JACK JAMES CHERYL DAVID GASTON BARBARA 0. C. H. A. L. A D D R E S S MERRELL DOE PIIARHACEUTICALS (CANAI)A) INC. 380 ELGIN HILLS RD. EAST RICIIMOND HILL ONTARIO L4C 5112 CANADA NON SMOKERS' RIGHTS ASSOC. SUITE 308 344 BLOOR ST. t'EST TORONTO. ONTARIO R5S IW9 CANADA 131 ALBANY AVE. TORONTO. ONTARIO H5R 3C5 CANADA HEALTH ANI) WELFARE CANADA HEALTH PROMOTION DIRECTORATE RH. 478. JEANNE MANCE BLDG. TUNNEI" S PASTURE OTTAWA. ONTAR I O CANADA CANADIAN CANCER SOCIETY 77 BLOOR ST. WEST SUITE 1702 TORONTO. ONTARIO M5S 3A1 CANADA UICC SMOKING CONTROL PROGRAM - AFRICA C/0 BERKELEY STUDIO 315 QUEEN ST. EAST TORONTO. ONTARIO. M5A IS7 CANADA 122 JASPER TO*iN OF MOUNT ROYAL MONTREAL H3P 1J9 CANADA HEALTH AND WELFARE CANADA HEALTH PROMOTION DIRECTORATE RM. 444. JEANNE IIANCE BLDG. TUNNEY'S PASTURE OTTAY.'A. ONTARIO CANADA 5
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F N A p E PhTERSON, REAI). SEABORN, STERLING. STIC11. TSUJI. GENG, JIABAO. JAMES JOHN JOHN THE0D0R HANS TERESA GUAN-YI ZHENG S. R. D. F. A D D R E S S DEPT. OF HEALTH GOVERNMENT OF TIIE NORTHVEST TERRITORIES BOX 1320 1'ELLO['KNI FE N. i'. T. XIA 2L9 CANADA DEPT. OF COMMUNITY IIEALTII SCIENCES FACULTY OF MEDICINE UNIV. OF CALGARY 3330 HOSPITAL DR. N.li. CALGARY ALBERTA T2N 4N1 CANADA HEALTH EDUCATION DIV. CALGARY HEALTH SERVICES 320 - 17 AVE. S. iC. P.O. BOX 4016, STATION C CALGARY. ALBERTA T2T 5T1 CANADA SCHOOL OF COMPUTING SCIENCES FACULTY OF APPLIED SCIENCES SIMON FRASER UNIV. BURNABY, B. C. 1'6J 2E2 CANADA B. C. CANCER RES. CENTRE 601 Y`EST 10TH AV. VANCOUI'ER. B:C. V5Z 1L3 CANADA MERRELL DOK' PHARMACEUTICALS (CANADA) INC. 7777 KEELE STREET UNIT 10 CONCORD, ONTARIO L4K IY7 CANADA DEPT. OF EPIDEMIOLOGY TIANJIN MEDICAL COLLEGE TIANJIN CHINA SHANGHAI INST. OF HEALTH EDU. SHANGIIA 1 CHINA N A 11 E HALHGREN. VENG, XINGFA, YU, 11ARKIDES, HAASE, HELBOE. ANDERS XIN-ZHI GAN JING-JIE A. INGER OLE TAGE SVEND GRETHE E. A D D It E S S SI'ICRO J IANGUO IIOTEL. Rl.l. 121 JIANGUO:IF.NY'A1. DAJIE BEIJING CII I NA 9-5-1. GONG REN T11'U CHANG DONG LU CHAO-YANG DISTRICT. BEIJING CII I t:A SHANGHAI HEALTH BUREAU SHANGHAI CHINA SEC. OF HEALTH EDUCATION MINISTRY OF HEALTH 44. HOU HAI BEI YAN BEIJING CHINA MEDICAL AND PUBLIC HEALTH SERV MINISTRY OF HEALTH NICOSIA CYPRUS FALKONER ALLE 53 APT. 616 DK-2000 COPENHAGEN F DENRAItK DANISH CANCER SOCIETY ROSEN VAENGETS HOVEDVEJ 35 2100 COPENHAGEN 0 DENMARK INST. OF SOC IAL MEDICINE UNIV. OF COPENHAGEN PANUM INST. BLEGDAtdSI'EJ 3 2200 COPENHAGEN N DENMARK DANISH CANCER SOCIETY ROSEN VAENGETS HOVEDVEJ 35 2100 COPENHAGEN 0 DENMARK H. LUNDBECK A/S OTTILIAVEJ 7-9 2500 VALBY DENtdARK 7
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N A II E A D D R E S S N A H E A D D R E S S STRANI). HERETE TIIUESEN PEDERSEII, JIM IBRAHIM, AMAL OMAR, SHERIF BOPP. ULRICH BRENGELMANN, JOHANNES BRUCKNER. ERNST BUCHKREMER, GERHARD JUNGE. BURCKHARD S. C. DANISH CANCER SOCIETY ROSEN VAENGETS HOVEDVEJ 35 2100 (:01'ENHAGEN 0 DENMARK DE.1'T. OF RESPIRATORY MED. AALBORG SYGF.IIUS SYD 9000 AALBORG DEKMARK PROF. OF EPIDEMIOLOGY NATIONAL CANCER INST. FOM El KHALIGUE CAIRO EGYPT CAIRO UNIV. 11 BOLLUS HANNA ST. DOKKY, CAIRO EGYPT MINISTERIUM FUR ARBEIT GESUNDHEIT, FAMILIE UND SOZIALORUNUNG BADEN- A'URTTEMBERG. ROTEBUHLPLATZ 30 7000 STUTTGART 1 F. R. G. MAX PLANCK INST. OF PSYCHIATRY DEPT. OF PSYCHOLOGY KRAEPELINSTR. 2 D-8000 MUNICH 40 F.R.G. AM OBSTGARTEN 8 2000 OSTSTEINBEK 2 F. R. G. KLINIK FUR PSYCHIATRIE Y:ESTF. WILHELMS-UNIVERSITAT ALBERT-SCHY'EITZER-STRASSE 11 4400 MUNSTER F. R. G. FEDERAL HEALTH OFFICE INST., F. SOCIAL MEDICINE AND EPIDEMIOLOGY THIELALLEE 88-92 D-1000 BERLIN 33 F.R.G. MONL. OPITZ, ROEPER. VON TROSCHKE, RAFAI, HIRVONEN, KARINIEMI, LUUKKANEN, TUOMINEN, HANS KLAUS ['OLFBAM JURGEN AISEA LEO VEIKKO TAUNO JAR 1' J. H. P A. L. u. A. P. ZDF GESUNDIIEITSCAGUZIN PRAXIS D-G500 MAINZ 31 F. R. G. INST. OF PIIARGIACOLOGY AND TOXICOLOGY UNIV. OF kIU\STER GOERLITZER STRASSE 102 1)-4400 HUNSTER F. R. G. LENTERSYEG 21 D-2000 HAMBURG 63 F.R.G. ABTEILUNG FUR HEDIZINISCHE SOZIOLOGIE DER ALBERT- LUDNIGS-UNIVERSITaT FREIBURG STEFAN-MEIER-STRASSE 17 7800 FREIBURG F. R. G. DEPT. OF HEALTH HEALTH OFFICE BOX 45, LAUTOKA FIJI DEPT. OF PHYSIOLOGY UNIV. OF OULU KAJAANINTIE 52 A SF-90220 OULU FINLAND DEPT. OF OBSTETRICS AND GYNECOLOGY HELSINKI CITY HOSPITAL SOFIANLEHDONKATU 5 00610 HELSINKI FINLAND ETRA-LIITTO RY CASTRENINKATU 12 A 15 00530 HELSINKI FINLAND TECHNICAL RES. CTR. OF FINLAND FOOD RES. LAB. BIOLOGINKUJA 1 02150 ESPOO FINLAND 81 9
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s N A 11 E TOSTAIN, SANCHEZ, CATTON, CHENG, CIIUNG. FARUOI, JEAN tlAlll' GEOFFREY KAR-KEUNG ELAINE ABDUL JENNY JAN TAI-HING J. L. R. K. H S. A D D R E S S 28 BD. DE LA REPUBLIOUE 78000 VERSAILLET FRANCE BUREAU OF COMMUNITY HEALTH NURSING SERVICES C/O DEPT. OF I'UBLI.C HEALTH AND SOCIAL SERVICES P.O. BOX 2816 AGANA GUAM HONG KONG ADVENTIST HOSP. 40 STUBBS RD. HONG KONG DEPT. OF COMMUNITY MED. UNIV. OF HONG KONG LI SHU FAN BLDG. 5 SASSON RD. HONG KONG HONG KONG GOVERNMENT HEALTH AND WELFARE BRANCH GOVERNMENT SECRETARIAT MAIN WING. 7TH FLOOR LO['ER ALBERT ROAD HONG KONG MERRELL DOii PHARMACEUTICALS PACIFIC LTD. 39F. SUN HUNG KAI CTR. 30 HARBOUR RD., ]l'ANCHAI HONG KONG FLAT 15 B 12 DEEP YATER BAY DR. HONG KONG 15/F., BLOCK 7. FLAT F CITY GARDEN. NORTH POINT HONG KONG DEPT. OF COMMUNITY MED. UNIV. OF HONG KONG LI SHU FAN BLDG. 5 SASSON RD. HONG KONG N A R E L0. MACKAY. MACKAY, IPINOKUR, PERENYI, ARNASON, BLONDAL, JOHNSEN, MAGNUSSON, ORNOLFSSON. KAI-CHEUNG JUDITH JUDITH IIATTHEk THOMAS SIGURDUR THORSTEIN ARNI SVEINN THORVARDUR H. L. N. A D D R E S S MERRELL DOC PHARMACEUTICALS PACIFIC LTD. 39F. SUN HUNG KAI CTR. 30 HARBOUR RD. . CANCIIAI HONG KONG RIFTSVOOD, 9TH MILESTONE LOT 147. CLEARt'ATER BAY RD. SA1 KUNG. KOC'LOON HONG KONG RIFTSG'OOD. 9TH MILESTONE DD 229. LOT 147 CLEARk,1TER BAY RD.. KOrLOON HONG KONG APARTMENT NO. 137 CRAIGIE COURT HARBOUR CITY 15 CANTON RD.. K0WLOON HONG KONG SZARVAS GABOR UT 7. H-1125 BUDAPEST HUNGARY TOMASARHAGI 49 107 RE1'KJAI'IK ICELAND UNIV. HOSPITAL LANDSPITALINN HEILSUYERNDARSTODIN REYKJAI'IK ICELAND RITUHOLAR 5 REYKJAVIK ICELAND REYKJAI'IK CANCER SOCIETY HEILSUGAESLAN GARDAFLOT 16-18 210 GARDABAER ICELAND P.O. BOX 5420 125 REYKJAVIK ICELAND 11 :
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N A ll E AG111 , DESaI, GUPTA. LUTHRA. SIIANMUGANANDAN, SING11. SINGH, SUBRAMANIAN, ARIId0ERT1, ' 111 R A N I I;IESH PRAKASH USHA S. AJAI IIANOJ P. HOEPOEDIO B. G. C. K. P. K. T. A D D R E S S P-14 GREEN PARK EXTENTION NEY' DELH1 110 016 INDIA NATIONAL INST. OF MENTAL HEALTH AND NUERO SCIENCES POST BAG NO. 2900 BaNGALORE 560 029' IND1A BASIC DENTAL RESEARCH UNIT TATA INSTITUTE OF FUNDAMENTAL RESEARCH HOHI BHABHA RD. BOMBAY 400 005. INDIA ADDITIONAL DIRECTOR-GENERAL AND DIRECTOR CYTOLOGY RES. CTR INDIAN COUNCIL OF MEDICAL RES. ANSARI NAGAR NEV DELHI 110029 INDIA LECTURER IN GEOGRAPHY DEPT. OF GEOGRAPHY MEDURAI KAMARAJ UNIV. ALAGAR KOIL RD. MADURAI 625 002. TAMILNADU INDIA 3 i'AZIR HASAN ROAD LUCKNO_1C 226 001 INDIA SENIOR RES. OFFICER DELHI CANCER REGISTRY I. R. C. H. A 1 1 EIS NES' DELHI 110 029 INDIA 11ADURAI MEDICAL COLLEGE MADL'RA1 625 020 IND1A JL. PASEBAN N0.32A JAKARTA PUSAT INDONESIA N A H E SAN1, CARLA, EURIALO, LEONE, AKAIKE, AOK1, AOK1, AOKI, ASAKAGE, ASANO, AULiA ARCITI GIOVANNINI AURELIO YOKO KUNlO MASAKAZU NOBUAKI AKIRA lIAK1SHIGE A D D R E S S IIEART FOUNDATION INDONESIA JALAN TEI'KU UMAR N0.8 JAKARTA 10350 INDONESIA ISTITUTO SCIENTIFICO PER L0 STUDIO E LA CURA DEI TUMORI CIALE BENEDETTO XV N 10 16132-GENOVA ITALY INDUSTRIA FARMACEUTICA SERONO S. P. A. CORSO MATTEOTTI N.3 20121 IIILANO 1TALY VIA PROVINCIALE 27 COLOIIB 1 ERA 19030 CASTELNUOVO MAGRA (SP) ITALY 1-1-53-609. KASHIY'AGI SENDAI-SHI. MIYAGI JAPAN DEPT. OF PREVENTIVE MED. NAGOYA UNIV. SCH. OF MED. 65 TSURUMAI-CHO. SHOY'A-KU NAGOYA-SHI. AICHI 466 JAPAN THE RES. INST. OF TUBERCULOSIS 3-1-24, 11ATSUYAMA KIYOSE-SHI. TOKYO JAPAN 2-56-3, IIATAGAYA SHIBUYA-KU. TOKYO JAPAN LEO BURNETT-KYODO CO.. LTD. AKASAKA TtIN TOk'ER 2-17-22. AKASAKA M1NAT0-KU. TOKYO 107 JAPAN DEPT. OF PHYSIOLOGICAL HYGIENE THE INST. OF PUBLIC HEALTH 4-6-1. Sl11ROKANEDAI MINATO-KU. TOKYO 108 JAPAN 1:'
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N A 11 E AYLOTT. BELLE. FUJI110T0, FUKUDA, FUKUNAGA, C0T0, GUNJ1, GYOTEN, 11ICIIAEL GERALD EDkARD KATSUHIRO TAKERO YUICHIRO ATSUAKI YOSHIO V. P. K. A I) I) R E S S MERRELL DOC PHARMACEUTICALS K.K. IMPERIAL T0TER 8F. 1-1-1. UCIIISAICA1-CIIO CH11'ODA-KU. TOKYO 100 JAI'AN MERRELL I10Y PHARMACEUTICALS K.K. IMI'ERIAL TOTcER SF. 1-1-1, UCHISAII.'AI-CHO CHIYODA-KU. TOKYO 100 JAPAN HEALTH EDUCATION DEPT. TOKYO ADVENTIST IIOSPITAL 3-17-3. AIIANUMA SUGINAMI-KU.•TOKYO 167 JAPAN I1EPT. OF PUBLI C HEALTH SCH. OF MED. KURUME UNIV. 67 ASAHI-MACHI KURUME-SHI, FUKUOKA 830 JAPAN KITAMURA BLDG. 285-5. KOGANEDA HOJYO HIMEJI HYOGO 670 JAPAN TOKAI UNIV. SCH. OF MED. BOSEIDAI, ISEHARA-SHI KANAGAY'A 259-11 JAPAN HEALTH ADMINISTRATION FACULTY OF MED. UNIV. OF TOKYO 7-3-1, HONGO BUNKYO-KU, TOKYO 113 JAPAN 188 SAKURAGAOKA HODOGAYA-KU. YOKOHAMA-SHI 240 JAPAN, N A H E IIABARA. HAGA, IIANEDA. HARADA. HASHIZUME, HATANO, HAYASHI, HAYASHI, HAYASHI. HINOHARA, KI111K0 TOSII I H I KO HARUTO YUK 10 TERUYOSHI SHUICHI HIROFUMI A D D R E S S OKAI'Al1A BRANCH JAPAN ANTI-TUBERCULOSIS ASSOCIATION 3-3-1, KOUSEI-CIIO OKAYAIIA-SII 1. OK AYAHA 700 JAl'AN DIRECTOR TOKYO NATIONAL CHEST IIOSPITAL 3-1-1. TAKEOKA KIYOSE. TOKYO 204 JAPAN JAPAN MEDICAL ASSOCIATION 2-5, KANDA-SURUGADAI CHIYODA-KU. TOKYO 101 JAI'AN 1-40-14. NER114A NERIMA-KU, TOKYO 176 JAPAN MERRELL D0C PHARMACEUTICALS K.K. IMPERIAL TOi'ER 8F. 1-1-1. UCHISAIFAI-CHO CHIYODA-KU, TOKYO 100 JAPAN THE INST. OF PUBLIC HEALTH 4-6-1. SHIROKANEDAI MINATO-KU. TOKYO 108 JAPAN FACULTY OF EDUCATION SHIZUOKA UNIV. 836 OHYA SHIZUOKA-SHI SHIZUOKA 422 JAPAN ADVENTIST MEDICAL CENTER 868 KOUCHI, AZANISHIHARA-CHO NAKAGAMI-GUN. OKINAIFA 903-01 JAPAN TOKYO SANITARIUM HOSPITAL 3-17-3, AMANUMA SUGINAMI-KU, TOKYO 167 JAPAN ST. LUKES COLLEGE OF NURSING 10-1 AKASHI-CHO CHUO-KU. TOKYO 104 JAPAN 15
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N A H E IIIRAOKA. HIRATA, HIRAYALIA, HISARICIII, HITOTSUYANAGI, 110NG0, HOSH1, YUK10 TERUAKI TAKESHI SHIGERU TOICHIRO TOIIOH 1 KO HASARU K.4ZUHIKO TANJ I A1) DRF.SS HIROSIIIHA UNIV. SCH. OF MEDICINE 1-2-3, KASUMI pINAGII-KU HIROSHIMA 734 JAPAN HEALTH PROMOTION DIV. DEPT. OF HEALTH H1'0G0 PREF. GOVERNMENT 5-10-1. YAMATED0UR1 CIIUO-KU. KOBE 650 JAPAN INSTITUTE OF PREVENTIVE. ONCOLOGY HI BLDG. 1-2 ICHIGAYA-SADOHARACHO SHINJUKU-KU. TOKYO 162 JAPAN TOHOKU UNIV. SCH. OF MED. 2-1. SEIR1'0-61ACHI SENDAI-SH1. MIYAGI 980 JAPAN 7F ASAHI BLDG. 6-6-7. GINZA CHUO-KU. TOKYO JAPAN DEPT. OF FIELD RES. CENTER FOR ADULT DISEASE 1-3-L_ NAKAlI1CH1 HIGASHINARI-KU, OSAKA 537 ' JAPAN A1CHi PREFECTURE LUNG CANCER CENTRAL ASSOCIATION 1-15-31. A01. HIGASHI-KU NAGOYA-SHI, AICHI 461 JAPAN 3-17-3. A61ANl:MA SUG I NA111-KU. TOKYO 167 JAPAN DEI'T. OF PUBLIC HEALTH THE INST. OF PUBLIC HEALTH 4-6-1. SHIROKANEDAI MINATO-KU. TOKYO 108 JAPAN N A H E IIOZUHI , ICII IKAk'A. 1KEDA. INOUE, INOUE, IREI, ISAYA6IA, TADAO HEIZABURO SHU REIKO SHOZO HIK10 YOSHIO A D D Ii E S S NAGASIIIHA S OIINO TORAYA 13LDG. 4-9-22. AKASAKA !I 1 NATO-F:U. TOKYO 107 JAI'AY NATIONAL CANCER CENTER HOSP. 5-1-1. TSUKIJI (:HUO-KU. 7'OKYO JAPAN 69 EBIE. SHINIII\ATO-SHI TOYAMA 933-02 JAI'AN EBIE. SHINMINATO-SHI TOYAMA 933-02 JAPAN hEPT. OF CIRCULATORY DISEASES SAPPORO NATIONAL HOSP. 4-J0. 2-CHOIIE. K 1 KUSU I SHIROISHI-KU. SAPPORO JAPAN Kl'0D0 ADVERTISING CO. HIBIYA CHUNICHI BLDG. 2-1-4. UCHISAIt:AI-CHO CHIYODA-KU. TOKYO 100 JAPAN C/0 KANAG,IG'A CANCER CENTER 54-2 NAKAO, ASAHI-KU YOKOHAMA. KANAGAY'A 241 JAPAN HYOGOKEN SOGOHOKEN KYOKAI 2-3-34. HONMACHI HYOGO-KU, KOBE 652 JAPAN OKINAC'A CHUBU HOSPITAL 208-3. MIYASATO GUSHIKAVA-SHI. OKINAw'A 904-22 JAPAN YOTSUl'A LAIF OFFICE 7TH FLOOR, ITO BLDG. 1-2 YOTSUI'A SHINJUKU-KU, TOKYO 160 JAPAN 17 (2\ ~_A
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I N A H E ITO. 1T0, IT01, 19'AI. l li'ASA . JINNO, KAGAMIMORI, KANDA, 18 KIEKO KEIKO 11AS:10 SIIIGEI'UKl KAZURO YOSHIZANE SATORU SADANOBU TOSHIO A D D R E S S 3-1-721. IIIKAGISIII 3-J 0. 18-CIIOLIE TOYOIIIRA-KU, SAI'I'ORO 062 JAPAN SEISHYONEN FUJIN SHITSU AICHI f'REFECTURE GOVERNMENT 3-1-2. SaNNOMARU. NAKA-KU NAGOYA-Sill. AICHI *460 JAPAN INAZAIA I'l'BLIC HEALTII CENTER 2200-11 OTSUKA-CIIO 1NAZe1WA-SHI. AICHI 492 JAPAN 1-8-106. KAYANDO-CHO NISHINO1fIYA-SHI. HY0G0 662 JAPAN RESEARCH I NST. OF TUBERCULOS 1 S JAPAN ANTI-TUBERCULOSIS ASSOC. 3-1-2d, MATSUYAMA KIYOSE-SII1. TOKYO 204 JAPAN CHAIRMAN JAI'AN HEART FOUNDATION 603 MARU-BLDG. 2-4-1. MARUNOUCHI CHIYODA-KU. TOKYO 100 JAPAN OKINACA CHUBU HOSPITAL 208-3, MIl'AZATO GUSHIKAWA-SH1. OKINAWA 904-22 JAPAN 1)EPT. OF COMMUN I TY MED. TOYAMA MED. & PHARMA. UNIV. 2630 SUGITANI TOYAMA-SHI, TOYAMA 930-01 JAf'AN LEO BURNETT-KY0D0 CO., LTD. AKASAKA TWIN TOWER 2-17-22. AKASAKA M1NAT0-KU, TOKYO 107 JAPAN N A M E KANEHITSU. KASUGA. KATSUMI H1T0SH1 NORIKO MASAAKI TETSURO lIASARU CHUICHI GISABURO HIROSHI MASASHICHI A D 1) R E S S EXECUTIVE 1)IRECTOR JAPAN PUBLIC IIEALTJI ASSOC. 1-29-8. SIIINJUKU SHINJUKU-KU, TOKYO 160 JAPAN DEPT. OF PUBLIC HEALTH TOKAI UNIV. SCII. OF MED. 259-11 BOSEIDAI ISEIIARA-SII1. KANAGAY'A 259-11 JAPAN 3-1. K0. OKUBO MURAYAMA-SHI. YAMAGATA 995-01 JAPAN 1-23-8. SUGIMURA K1TA-KU, NAGOYA-Sill AICHI 462 JAPAN FAC. OF EDUCATION UNIV. OF TOKYO 7-3-1. HONGO BUNKYO-KU. TOKYO 113 JAPAN 6-1-3. ll I NAJI I 19-JYO CHUO-KU. SAPPORO 064 JAPAN 3RD INTERNAL MED. FACULTY OF MED. KYOTO UNIV. KONOE-CHO. YOSIIIDA SAKYO-KU. KYOTO 606 JAPAN SHIMANE MEDICAL ASSOCIATION 1-31. SODESHI-CHO MATSUE-SHI. SHIMANE 690 JAPAN DIV. OF RESPIRATORY DISEASES DEPT. OF MEDICINE KAWASAKI MEDICAL SCHOOL KURASHIKI-SH1, OKAYAMA 701-01 JAPAN K1'OSYU ANTI-SMOKING SOCIETY 9-13. HOEICHO, NAGASAKI 852 JAPAN 19
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N A M E KA4ATA. K I Kl'Clll , K I NEBUCII I , KINO. KI01, KIRA, KITABAYASHI, KITAGACA, KITAI. KITANI. CHIEKO REIKO HIDEO CHIEKO SATORU SHIRO AKIRA SADAYOSIII AKIKO 11 I CII I NOBU A D D R E S S DEPT. OF HEALTH SOCI OI.OGY FACULTY OF MEDICINE THE UNIV. OF TOKYO 7-3-1. HONGO BUNKYO-KU. TOKYO 113 JAPAN MERRELL DOV PHARMACEUTICALS K.K. IMPERIAL TOFER 8F. I-1-1. UCIIISAIFAI-CHO CHIYODA-KU. TOKYO 100 JAI'AN DEPT. OF ENVIRONMENTAL & OCCUPATIONAL HEALTH KOCHI MEDICAL SCHOOL NANKOKU. KOCIII 781-51 JAPAN RES. 1 NST. HOSP. JAPAN ANTI-TUBERCULOSIS ASSOC. 3-1-24. MATSUI'AMA K1YOSE-SHI. TOKYO 204 JAPAN THE SECOND DEPT. OF INTERNAL MEDICINE NIIGATA UNIV. SCH. OF MEDICINE 1-754 ASAHIMACHIDOURI NIIGATA 951 JAPAN DEPT. OF RESPIRATORY MED. JUNTENDO UNIV. SCH. OF MED. 2-1-1. HONGO BUNKYO-KU. TOKYO 113 JAPAN 1-9-40. ODAFARA SENDAI-SHI 983 JAPAN DIRECTOR GENERAL HEALTH SERVICE BUREAU 1-2-2. 1:ASUHIGASF.KI CHIYODA-KU. TOKYO 100 JAPAN SEC. OF HEALTII & PREVENTION SAITAMA PREFECTURAL GOVERNMENT 3-15-1. TAKASAGO URAk'A-Slll, SAITAMA 336 JAPAN JAPAN HEART FOUNDATION 603 MARU-BLDG. 2-4-1. MARUNOUCHI CHIYODA-KU. TOKYO 100 JAPAN N A 11 E K1YA11A. KOBA1'ASH1. KOBAS'ASH I . KOGAYA, KOHCHI. KOMACHI. KOMATSU, KONDO. KONNO, 11ASAHIKO KANJ I TACHIO YOSHIE SHOHJ I YOSHIO KI ICHI RYO TSUNEO A D D It E S S THE CTII. FOR ADULT I)I SEASES. OSAKA 1-3-3. NAK.IHICHI HIGASIIINARI-Kl'. OSAKA 537 JAPAN 685 O1BaRA, MISATO-MACH1 GUNMA-GUN. GU\HA JAPAN 2-30-22. JINGUIIAE SHIBUYA-KU. TOKYO 150 JAPAN HEALTH CARE CENTER MAZDA MOTOR CORP. 3-1. SHINCHI FUCHU-CHO. AKI-GUN H I ROSI1 I HA JAPAN THE JAPAN ANTI-TUBERCULOSIS ASOC. 1-3-12. MISAKICHO CHIYODA-KU. TOKYO 101 JAPAN INST. OF COMMUNITY MED. UNIV. OF TSUKUBA 2-1-1 AMAKUBO SAKURAIIURA. NIHARI-GUN 305 JAPAN KOMATSU KIICHI LAY' OFFICE 2-10-26-1203. ICHIBANCHO SENDAI. MIYAGI 980 JAPAN MOBIL SEKIYU K.K. C. P. 0. BOX 862 TOKYO 100-91 JAPAN THE JAPAN ANTI-TUBERCULOSIS ASOC. 1-3-12. MISAKICHO CHI1'ODA-KU. TOKYO 101 JAPAN 21
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N A 11 E KUUO, KUROSII, MAEDA,. MAEDA. HANABE. MASUDA. TAEKo DAI lCllI IIIROSIII TOSH10 TOSHIRO TOKUHEI KAZUHO NOBUO HISAO HIROYOSHI A D D R E S S 21-G87. NARUKAHI [AKAYAMA-SII I . 4'AKAI'AMA 640 JAPAN C/O NIPPON KINEN YUAIKAI 3392 NISIIIKI-CHO INA-SHI. NAGANO 396 JAPAN SAITAIIA MEDICAL ASSOC. 3-5-1. NAKA-CHO URAf'A-SHI. SAITAMA 336 JAPAN CANCER INST. HOSP. 1-37-1. KAMI-1KEBUKURO TOSHIHA-KU. TOKYO 170 JAPAN t:UROKI LAY' OFFICE MINAMI-ODORI BLDG. 10 NISHI ODORI CHUO-KU. SAPPORO JAPAN KUROSU HOSP. 2650 UJIIE. UJIIE-MACHI SHIOYA-GUN, TOCHIGI JAPAN DEPT. OF EPIDEMIOLOGY SCH. OF HEALTH SCIENCES UNIV. OF TOKYO 7-3-1, HONGO BUNKYO-KU, TOKYO 113 JAPAN THE INST. OF PUBLIC HEALTH 4-6-1, SHIROKANEDAI MINATO-KU, TOKYO 108 JAPAN NATIONAL CARDIOVASCULAR CTR. 5-125 FUJISHIRODAI SUITA-SHI 565 JAPAN MERRELL DOSI PHARMACEUTICALS K.K. IMPERIAL TOTER SF. 1-1-1. UCHISAIitAI-CHO CHIYODA-KU. TOKYO 100 JAPAN N A M E MASUDA. MATSUI. IIATSUK I , MATSUMOTO, 11ATSUYAMA, MIURA. SACIIIO SII I GEO HIDEAKI SACHIE EIKICHI KAZUO HICHIYUKI KOH-E1 IIASAAKI KAZUHIKO A p D R E S S 4-4-26. AYARAGIIIONMACIII SHIMONOSEKI. YAMAGUCIII JAI'AN JAPAN AIR CURTAIN CO.. LTD. 699-1. MINAIII USHIROYA YASHIO-SIII. SAITAMA 340 JAPA14 DEPT. OF PUBLIC HEALTII TOKA1 UNIY. SCH. OF MED. 259-11 BOSEIDAI ISEHARrI-SI]I. KANAGAwA 259-11 JAPAN NTT TOKYO NTT TORANOMON BLDG. 3-S-S. TORANOMON MINATO-KU. TOKYO JAPAN TOKYO KOSEI NENKIN HOSPITAL 23 TSUKUDO-CHO SHINJUKU-KU, TOKYO 162 JAPAN 4-112. KUSHIHARA-CHO KURU11E-SHI. FUKUOKA 830 JAPAN FUKAGAKA MUNICIPAL HOSP. 5-6-10. FUKAGATA-SHI HOKKAIDO 074 JAPAN FAC. OF EDUCATION NIIGATA UNIV. 2-8050 IKARASHI NIIGATA 950-21 JAPAN THE HUMAN RESTORATION HEADOUARTERS 1-7-2. SHOTO SHIBUYA-KU. TOKYO JAPAN JAPAN JUVENILE EDUCATION ACADEMY 1-32-15. TAKADANOBABA SHINJYUKU-KU. TOKYO 160 JAPAN 23
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NAME M 11•AZAK I • 1111•AZAKI , 11I YOSII I • MIZUNO. MIZUTANI• MOCHIZUKI• MORI. MORITANI . MURAKAMI• Ml'ROTANI. KUNIHIKO K1•O1CHI Y1'J 1 YASUO ISAMU YOSHIKATSU TORU YOSHIAKI MOTOCHIYO SHIZUO A D 1) R E S S 6-78. NAKAMURA-CIIO NAKAMURA-KU NAGOI•A-Slll. AICHI JAPAN JAPAN IIEALTH AND TEMPERANCE ASSOCIATION 4-33 UEGAIIARA-YONBANCHO NIS111NOIIIYA-SIII. HYOGO 662 JAPAN THE MEIJI MUTUAL LIFE INSURANCE COMPANY 2-1-1. MARUNOUCIII CHI1•ODA-KU. TOKYO 100 JAPAN 1147-3. SIIITSUKAWA SHIGENOBU-CHO ONSEN-GUN. EHIME 791-02 JAPAN 1-9-1• OKAMACHI-KITA TOYONAKA-SHI, OSAKA 560 JAPAN DEPT. OF PUBLIC HEALTH ASAHIKAW'A MEDICAL COLLEGE 4-5-3-11, NISHIKAGURA ASAHIKAWA-SHI. HOKKAIDO 078 JAPAN RES. INST. OF TUBERCULOSIS JAPAN ANTI-TUBERCULOSIS ASSOCIATION 3-1-24• MATSUYAMA KIYOSE-SHI• TOKYO 204 JAPAN OKAYAMA BRANCH JAPAN ANTI-TUBERCULOSIS ASSOCIATION 3-3-1. KOUSEI-CHO OKAYAMA-SH1, OKAYAMA 700 JAPAN 4-2-3. ZIGOZEN HATSUKAICHI-CHO SAIKI-'GUN• HIROSHIMA 730 JAPAN 275 HIGASHIIW'ASE-MACHI TOYAMA-SHI. TOYAMA 931 JAPAN N A 11 E NAGASHIMA• NAKAJIMA, NAKAMURA, NAKANO• NAKAZIMA, NANJYO, NEMOTO, KOICHI TAKEO 11ASAKAZU NOBUKO EIZI K01•U 11ASAJ I A D I) li E S S MEDICAL MEDICINE SECTION NIGATA PREFECTURE I SIIINKO-CIIO. NIGATA 950 JAPAN BOOTH HEHOR I AL IIOSp. TIIE SALVATION ARMY 1-40-5. >;ADA SUGINAMI-KU. TOKYO 166 JAPAN OKAYAIIA BRANCH JAPAN ANTI-TUBERCULOSIS ASSOCIATION 3-3-1. KOUSEI-CHO OKAYAMA-SHI. OKAYAMA 700 JAPAN JAPAN CANCER SOCIETY ASAHI BLDG. 7TH F. 6-6-7, GINZA CIIUO-KU. TOKYO 104 JAPAN JAPAN ANTI-TUBERCULOSIS ASSOC. 1-3-12. MISAKI-CHO CH I1•ODA-KU, TOKYO 101 JAPAN OSAKA CANCER DETECTION AND PREVENTION CENTER 1-6-107. MORINOMIYA JOTO-KU• OSAKA 536 JAPAN 1-7-5• NISHIHARA SHIBUYA-KU. TOKYO 151 JAPAN 11 BUNKO-CHO. SHARI-CH0 HOKKAIKO JAPAN CANCER DETECTION CENTER OF MIYAGI CANCER SOCITY 5-7-30. KAMISUGI SENDAI. MIYAGI 980 JAPAN 1966 KAMIKAi'AI-CHO ASAHI-KU• YOKOIIAMA 241 JAPAN 25
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N A 11 E NIHURA, OHISHI. OKAMOTO, O11AE. YASUIIARU KUNIKO HIROSHI HIROSIII GERSHI FUJ10 HAJ I ME SHlZU0 TAKESHI TERUO A D D R E S S NATIONAL CARDIOVASCULAR CENTER RES. 1 NST. 5-7-1, FUJISIIIRO-DAI SUITA. OSAKA 565 JAPAN 3-13-7-803. TAIHEI SUMIDA-KU. TOKYO 130 JAPAN 4-2-3. NIL"ASIIIRODAI SAKAI, OSAKA 590-01 JAI'AN DIV. OF EPIDEMIOLOGY AICHI CANCER CTR. RES. INST. 1-1. KANOKODEN. CHIKUSA-KU NAGOYA-SHI, AICIII 464 JAPAN JAPAN HEALTH PROMOTION & FITNESS FOUNDATION TORANOMON 34 MORI BLDG. 6TH F. 1-25-5. TORANOMON MINATO-KU. TOKYO 105 JAPAN 9-5-24, AR1HA MIYAMAE-KU. KAA•ASAKI-SHI KANAGAF.4 JAPAN HOKEN-DOIIJINSHA INC. 2-12-2, FUJIMI CH11'ODA-KU. TOKYO JAPAN ANTI-TUBERCULOSIS ASSOCIATION OSAKA BRANCH 2-19. YOKOBORI HIGASHI-KU, OSAKA 541 JAPAN MERRELL DOY' PHARMACEUTICALS K.K. I MPER I AL TOk'ER SF. 1-1-1. UCHISAIitAI-CHO 'CHIYODA-KU, TOKYO 100 JAPAN NATIONAL CARDIOVASCULAR CTR. 5-7-1. FUJISHIRODAI SUITA, OSAKA 565 JAPAN N A H E O11UItA. ONODERA. OOTAKI, ORIUCHI. OSAKA, OSHIHA. •OTOKURA, O1:AKU, RYU, SAITO. TOSIIITAKA NOBUO AK1RA TAKASHI YASUTARO SHUHEI REIKO A D D R E S S DEPT. OF 1'lBL I C IIEALTH AKITA UNIV. SCII. OF MED. 1-1-1. IIONDO AKITA-SIII. AKITA 010 JAPAN THE INST. OF PUHLIC HEALTH 4-6-1. SHIROKANEDAI MINATO-KU. TOKYO 108 JAPAN 7-22 GORYOKAKU-C110 HAKODATE-SHI 040 JAPAN 2-3-19. ASABU-CHO KITA-KU. SAPPORO 001 JAPAN C/O NIPPON KINEN YUAIKAI 3392 NISHIKI-CHO INA-SH. NAGANO 396 JAPAN THE OSAKA CANCER PREVENTION AND DETECTION CTR. 1-6-107, MORINOMIYA JOTO-KU. OSAKA 536 JAPAN OKAYAMA BRANCH JAPAN ANTI-TUBERCULOSIS ASSOCIATION 3-3-1. KOUSEI-CHO OKAYAMA-SHI. OKAYAMA 700 JAI'AN EXEC. DIR. & SECRETARY GENERAL JAPAN HEART FOUNDATION 603 MARU-BLDG. 2-4-1, MARUNOUCHI CHIYODA-KU. TOKYO 100 JAPAN KOCHI MEDICAL SCHOOL KOHASU OKO-CHO NANKOKU-S111. KOCHI 781-51 JAPAN 2-38-1-417, HATAGAYA SHIBUl'A-KU. TOKYO 151 JAPAN 27 r•
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t ~ ~ ~ N A H E SAKlIlA1tA. SARUV'A, SATO. SACAS.AEI, SHI)dURA. 28 SEIZO AKIRA HASAHI YASUSII I AKIRA TAKAO TADAO HIROYUKI AKIMITSU AU1)RESS SCII. OF IIEALTII SC 1 ENCES UNIV. OF TIIE RYUKYUS 207 UF.11:1RA. NISHIIIARA OK 1 NAFt1 903-01 JAPAN SARUYA LAC OFFICE 605 KOJ I IdACII l ROl'AL BLDG. 4-7. KOJIHACHI CIIIYODa-KU. TOKYO 102 JAPAN 1994-259. HAZAEIA-MACHI HACHI OJ I-SIII . TOKYO JAI'AN DEPT. OF HEALTH SOCIOLOGY FACULTY OF MEDICINE THE UNIV. OF TOKYO 7-3-1. HONGO BUNK1'0-KU. TOKYO 113 JAPAN DEPT. OF PUBLIC HEALTH KURUME UNIV. SCH. OF MED. 67 ASAHI-1dACH1 KURU61E-SNI, FUKUOKA 830 JAPAN DEPT. OF PUBLIC HEALTH SCH. OF MED. FUKUOKA UNIV. 7-45-1. NANAKUIIA JONAN-KU. FUKUOKA 814-01 JAI'AN 1-14-9. KOHYAIIA NERI6IA-KU. TOKYO 176 JAPAN DEPT. OF PUBLIC HEALTH TOIIOKU UNIV. SCH. OF MED. 2-1 SEIRY061ACHI SENDAI. 11IYAG1 980 JAPAN C/O CIIIBA ANTI-TUBERCULOSIS ASSOCIATION 1-1-20. HIV'.AKO-CHO CHIBA-SII1. CHIBA 280 JAI'AN N A H F. SIIIItA1Sl11 . SII0J1, SOBUE. SUGIHURA. SUNAHI, SUZIiHURA. TAGASHIRA. TAJIHA, TAKAGI, TAKAIIASH I , TAKASHI HASAKI TOHOTAKA TAKASHI YURO SHiNGO JUN KAZUO YOSHIAKI SHIGE0111 A D 1) R E S S ALI. JAI'AN ANTI-SMOKING LIASON COUNCIL 1 11 1. JINGUMAE SII I BUYA-KU. TOKYO 150 JAPAN 24-9 TEN\OUOI7;AKE-NISI11 TENNOU-CHO. HINA1d1A1:ITA-GUN JAI'AN THE CTR. FOR ADULT DISEASES. OSAKA 1-3-3. NAKAIIICHI HIGASIIINARI-Kl4 OSAKA 537 JAPAN NATIONAL CANCER CTR. 5-1-1. TSUKIJI CHUO-KU. TOKYO 104 JAI'AN C/0 CHIBA ANTI-TUBERCULOSIS ASSOCIATION 1-1-20. IIIYAKO-CI10 CH1BA-SH1. CHIBA 280 JAPAN 3-35-15-401. KUGAYAMA SUGINAHI-KU, TOKYO 168 JAPAN HEALTH DEPARTMENT KOBE ADVENTIST HOSP. 8-4-1. ARINODAI. KITA-KU KOBE-SHI. HYOGO 651-13 JAPAN DI1'. OF EPIDEMIOLOGY AICHI CANCER CTR. RES. INST. 1-1. KANOKODEN. CHIKUSA-KU NAGOYA-SH 1. A 1 CII I 4 64 JAPAN 4-145-1. KIRISII161A ld I YAZAK 1-SH 1. FI I1'AZAK I 880 JAPAN PERSONNEL DEPT. MINISTRY OF POSTS AND TELECO)d).IL'N I CAT I ONS 1-3-2. KASUHIGASC•KI CIIIYODA-KU. TOKYO 100 JAI'AN 29 S
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I N A M E A 1) I) H E S S TAKAISIII. 11:ISAII I R0 TIIE INST. OF PUBLIC IIEALTH 4-6-1. SHIROKANEDAI H1N.4T0-KU. TOKYO 108 JAI'AN TAKIGAkA, 11:1SAT0 JAPAN HEALTH PROMOTION ~ FITNESS FOUNDATION TORANOMON 34TH 110R1 BLDG. 6F. TORANOHON 1-25-5 . Ii1NAT0-KU. TOKYO 105 JAPAN TAKISIIIM,1. TARIOTSU TIIE 1ST DEPT. OF INTERNAL MED. T0110KU UNIV. SCH. OF MED. ANIICHI. ENJ1 1-1. SEIR1'0-CBO SENDAI-SHI. MIYAGI JAPAN MIYANOMORI GARDEN CO.. LTD. 1-15 MIYANOMORI CHUO-KU. SAPP0R0 HOKKAIDO JAPAN TOMINAGA. SUKETAHI DIV. OF EPIDEMIOLOGY AICHI CANCER CTR. RES. INST. 1-1. KANOKODEN, CHIKUSA-KU NAGOYA-SH1. AICHI 464 JAPAN TOHIYASU, T0M0YOSIi1, TSUBOI. TSUNOKANE. YOSHIKO TADAO EITAKA SHUSUKE 5-23-33. SHIMOTOMINO KOKURAKITA-KU. KITAKYUSHU 802 JAPAN DEPT. OF UROLOGY SHIGA UNIVERSITY OF MEDICAL SCIENCE SETA-TSUK I NOR'A-CI10 OTSU 520-21 JAPAN TSUBOI MEMORIAL CANCER INST. 1-10-13. NAGAKUBO ASAKA-MACHI. KORIYAMA-SHI FUKUSHIMA 963-01 JAPAN HACIIINOHE KOGYO UNIV. DA 1 I C 111 111 GR SCIIOOL MIGI-IY'ABUCHI-D0R1 SII I ROGANE-MACH I HACHINOIIE-SH1. A0M0RI 031 JAPAN N A u E A D D R E S S TSURUTANI. KUNIKO 3-29-14. DENF.NCIIOFU OTA-KU. TOKYO 145 JAPAN fSUTSUlI l . TOSHIHIKO MITSUBISIII CORP. 2-6-3. MARUNOUCIII CIIIYODA-KU. TOKYO 100 JAI'AN 1CIIIDA, SAKI 2-7-22. OGURO SHIZUOKA-SIfI. SIIIZUOKA JAI'AN EDA, TAKESHI 205-KACATANI 3-15-39. SEKIMACIII-MINAMI NERIMA-KU. TOKYO 177 JAPAN ADA, HASAYA PUBLIC HEALTII BUREAU NAGOYA CITY 3-1-1. SANNOMARU ATANABE, SHAtf NAKA-KU, NAGOYA 460 JAPAN EPIDEMIOLOGY DIV. NATIONAL CANCER CENTER RES. INST. 5-1-1. TSUKIJI CHUO-KU. TOKYO 104 JAPAN AMAGUCHI, AMAGUCHI, 4MAM0T0. 411AHOT0. MASAYOSIII TOMOMICHI KATSUSHI MAS.4AK1 JAPAN ANTI-TUBERCULOSIS ASSOC. 1-3-12. 11I SAI:I-CHO CHIYODA-KU. TOKYO 101 JAPAN JAPAN ANTI-TUBERCULOSIS ASSOCIATION SHIBUYA CLINIC 1-20-24, SHIBUYA SHIBUYA-KU. TOKYO 150 JAPAN 5-5-19. SHIMOITOZU KOKURAKITA-KU KITAKYUSHU-SHI 803 JAPAN 4-34-14. SETA SETAGAYA-KU. TOKYO 158 JAPAN
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N A H E YAlfANAKA. 1'ANASE, YASUI. YASUHI. YAZAKI. YOSHIDA. 1'OSH 11 . YOSII I OKA , YCtASA. KATSUMI KOIIK ICII I MASOYA KOSAKA KENJI MASAYA ISAO SHINICHI KYOZO A 1) D H E S S DEI'T. OF PUDL I C HEALTH NAGOYA UNIV. SC'II. OF MEDICINE 65 TSUItU1111-CIIO. SIIOTA-KU NAGOYA, AICIII 466 JAPAN JAPAN HEALTII PROMOTION & FITNESS FOUNDATION TORANOMON 34TH MORI BLDG. 6F. 1-25-5. TORANOHON MINATO-KU. TOKYO 105 JAPAN KOBE ADVENTIST HOSP. 8-4-1. ARINODAI. KITA-KU KOBE. H1'OGO 651-13 JAPAN 3-IIOTOKAJ ISH I-CHO HACIIINOHE. AOMORI JAPAN OUMAGARI NAKADORI HOSPITAL 4-3 KAMISAKAE-CIIO OUM.4GARl-SH1. AKITA 014 JAPAN MARUZEN KASEI CO., LTD. 2-6-7. EBISU-NISHI SHIBUYA-KU. TOKYO 150 JAPAN CHIBA PREFECTURAL MED. ASSOCIATION 3-13-B. MINAMI-CHO CHIBA-SHI. CHIBA JAPAN 2-6-15-1. NIINO, TSUSHIMA OKAYAMA-SHI, OKAYAMA. JAPAN PRESIDENT JAPAN HEART FOUNDATION 603 MARU-BLDG. 2-4-1. MARUNOUCIII CHIYODA-KU, TOKYO 100 JAPAN, N A ll E PULOKA, ALMUMEN, NiTI11YANANTHAN, OUEK, SINGH, TEOH, PUENTE-SILVA, PANDEY, SIOELI HUSAIN NESADURAI DA1' I D JIT KEE FEDERICO M. T. . A. K. L S. G. R. A D D It E S S PUBLIC IIF.ALTII DIV. MINISTRY OF IIEALTII YA I OLA 110SP. P.O. BOX 59 NUEU'ALOFA. TONGA K I NGD011 OF TONGA P.O. BOX 5342 SAFAT 13054 KUWAIT MALAYSIAN MED. ASSOCIATION 4TI1 F. , MSIA HOUSE 124 JALAN PAHANG 53000 KUALA LUIIPUR MALAYSIA 4 JALAN SETIAKASIH SEMBILAN DAMANSARA HEIGHTS 50490 KUALA LUMPUR MALAYSIA MINISTRY OF HEALTH JALAN DUNGUN. OFFICE COMPLEX BLOCK E. BUKIT DAMANSARA 50490 KUALA LUMPUR MALAYSIA IPOH SPECIALIST CENTER 26 JALAN TAMBUN 30350 IPOH MALA1'SIA MEXICAN COM. FOR TIIE STUDY & THE CONTROL OF SMOKING APARTADO POSTAL 22-421 TLALPAN 14000 MEXICO. D.F. MEXICO P.O. BOX NO. 2587 THAPATHALI. KATHMANDU NEPAL 00 33
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N A H E CIIETW'YND. GAISER. KENT, LAUOESON, THOIIPSON. AJIJOLA, OSHOKE, SUBBARAO. AARO, JANE JOHN DEIRDRE MURRAY LI ICHAEL E. PATRICK VELUYALI LEIF U. L. J. 0. A. V. E. A D D R E S S DEPT. OF COMMUNITY IIEALTH CHFUSTCIIURCH CLINICAL SCII. OF HED. UNIV. OF OTAGO P.O. BOX 4345 CHRiSTCHURCII NEC ZEALAND AUCKLAND CA5CER'SOCIETY P.O. BOX 1724 AUCKLAND NEg ZEALAND ASH P.O. BOX 8667 SYMONDS ST.. AUCKLAND NEW ZEALAND DEPT. OF HEALTH P.O. BOX 5013 WELLINGTON NEW ZEALANI) P.O. BOX 1071 AUCKLAND 1 NEW ZEALAND LACMAN SERVICES P.O. BOX 4404 IKEJA-LARGOS STATE NIGERIA NIGERIA P.O. BOX.246 61AKURDI. BENUE STATE NIGERIA DEPT. OF PHYSIOLOGY OGUN STATE UNIV. AGO-I R'OYE P.O. BOX 887 IJEBU-ODE NIGERIA DEPT. OF SOCIAL PSYCHOLOGY UNIV. OF BERGEN OISTEINSGATE 3 N-5007 BERGEN N A H E BJARTVEIT. BUKER, FLATEN, FURULUND, HAUG, HAUKNES, KJONSTAD, KOEFOED. LODRUP, LUND, KJELL Afi I LU HUGO SOL1'E I G KJELL ARNE ASBJORN NINA INGER KARL E. E. E. A D D R E S S NATIONAL COUNCIL ON SMOKING AND HEALTH P.O. BOX 8155 DEP. 0033 OSLO I NORWAY NATIONAL COUNCIL ON StdOKING A\D HF.ALTH BOX R025 DEP 0030 OSLO I NORWAY BEDRIFTSLEGEKONTORET GRONLAND RUTEBILSTASJON GRONLAND TORG 0188 OSLO I NORWAY NATIONAL COUNCIL ON SMOKING AND HEALTH BOX &025 DEP 0030 OSLO I NORWAY INST. OF GENERAL MED. UNIV. OF BERGEN ULRIKSDAL 8C 5009 BERGEN NORWAY NATIONAL COUNCIL ON SMOKING AND HEALTH P.O. BOX 8025 DEP. 0030 OSLO 1 NORWAY ARNULF OVERLANDSVEI 247 0764 OSLO 7 NORWAY NORWEGIAN CANCER SOCIETY HUITFELDTSGT 49 0253 OSLO 2 NORN'AY SOLBERGVN 2020 SKEDSMOKORSET NORWAY NATIONAL COUNCIL ON SMOKING AND IIEALTH BOX 5025 DEP 0030 OSLO I NORWAY 35
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D 1) R E S S N A R E N A M E A A D D R E S S ---- --- GEE. NAKAJIMA, ROBLES, TAN, GORSKI, PER HAN\E DAIS RODERICK IIIROSHI EM11A DANIEL TADEUSZ L. 1.K INST. OF PSYCIIOLOGY UN 1 Y. OF OSLO BOX 1094 BLINDERN NOR\AY NATIONAL MASS SCREENING SERV. BOX 8155 DEP. 0033 OSLO 1 NORICAY A/SMO NON-COMMUNICABLE DISEASES DEPT. OF HEALTH HO HOHOLA P.O. BOX 3991. BOROKO PAPUA NEk GUINEA kORLI) HEALTH ORGANIZATION UNITED NATIONS AVE. P.O. BOX 2932 MANILA 2801 PHILIPPINES R'ORLD HEALTH ORGANIZATION UNITED NATIONS AVE. P.O. BOX 2932 MANILA 2801 PHILIPPINES NON-COt.1MUNICABLE DISEASES CONTROL SERVICE DEPT. OF IIEALTH SAN LAZARO COMPOUND RIZAL AVE., MANILA PHILIPPINES UNIV. OF THE EAST RAMON MAGSAYSAY MEMORIAL MEDICAL CTR. AURORA BOULEVARD OUEZON CITY PHILIPPINES HEAD OF NATIONAL ANTISMOKING CTR. 90-3G8 LODZ. UL P 10TR KOG'SKA 194 POLAND JI:DIiYCI101iSK 1 . KIM, TOELUPE. AL-BEDAH, TAHA. VAITHINATHAN, YIEGAS. !2~ CIESLAY IL-SOON JONG SUCK-V00 PALANITINA ABDULLAH AHlIED BHARATHI OSBORN K. M. N 11. R. A. C DEPT. OF EPIDEMIOLOGY INST. OF SOCIAL MEDICINE MEDICAL SCHOOL IN KRaKOC 7 t:OPERNIRA ST., KRAKOW POLAND GRADUATE SCII. OF HEALTH SCIENCE S MANAGEMENT YONSEI UNIV. C. P. 0. BOX &044 SEOUL 120 REPUBLIC OF KOREA YONSEI UNIV. WONJU COLLEGE OF MEDICINE z1G2, ILSAN-DONG 1'•ONJU-S1. K.4NGk'ON-DO 220 REPUBLIC OF KOREA HEALTH EDUCATION DIV. MINISTRY OF HEALTH AND SOCIAL AFFAIRS 335-1, BUKAJADON SEDAEMUN-KU, SEOUL REPUBLIC OF KOREA HEALTH. EDUCATION UNIT HEALTH DEPT. APIA. SiESTERN SAMOA SAMOA P.O. BOX 2664 AL-KHOBAR 31952 SAUDI ARABIA DEPT. OF MEDICINE KING ABDUL AZIZ UNIV. HOSP. P.O. BOX 245 RIYADH 11411 SAUDI ARABIA MINISTRY OF HEALTII. SINGAPORE TRAINING k HEALTH EDU. DEPT. HYDERABAD RD. SINGAPORE 0511 SINGAPORE 56, COLLEGE GREEN SINGAPORE 1129 SINGAPORE ~ 37 00 CIN ~ N
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N A H E A D D R E S S SAI.1'ADOIt. 00'dEY'ARDENA. KARUNARATNE, LARABI. TERESA . F. AJITHA OIH1. A. LL. . e. 1. HEALTH PROMOTION SER1'. P LLUIS COHI'ANY. 7 05003-BARCELONA SPAIN a0J1 ~IJERAMA HA4ATIfA COLOMBO 7 SRI LANKA I DIAS 1'LACE PEPIPIVANA RD. NUGEGODA SRI LANKA SUDAN ANTI-SMOKING SOCIETY NDERSSON, RHEDEN. ILLEMOR ARS . . P.O. BOX 8025 ALAMARAT-KHARTOUM SUDAN NTS YENNER GREN CENTER VAN 22 113 46 STOCKHOLM SWEDEN AKTIEBOLAGET LEO BOX 941 CURVALL, MARGARETA S-251 09 HELSINGBORG SWEDEN RES. DEPT. SY'EDISH TOBACCO CO. P.O. BOX 17007 DAl' I DSON . ETTNER. ENZELL. INGRID O CURT 11.M . H R. S-104 62 STOCKHOLM SWEDEN BYGGHALSAN ANDERS PERSONSG 18 S-41140 GOTHENBURG SREDEN BACKAVAGEN 4 25484 11ELSINGBORG SWEDEN RES. DEPT. SY:EDISH TOBACCO CO. P.O. BOX 17007 S-104 62 STOCKHOLM SWEDEN N A 11 E A I) D R E S S FAGERSTROM, KARL 0. AB LEO BOX 941 FROSTROM. REGNE•R, AGLUND. JALMARSON. ARSSON, KURT OZZE ARGARETIIA GNETA AN-ERIC 11. S-253 72 HELSINGBORG SIEDEN Bl'GGIIALSAN ANDERS I'ERSONSG 18 S-411a0 GOTIIENBURG SWEDEN B.G. VISION AB GOKETORPSGATAN 15 S-416 56 GOTHENBURG S4'EDEN DIV. OF HEALTH EDUCATION NATIONAL BOARD OF HEALTH AND ViELFARE 106 30 STOCKIIOLM SFEDEN SMOKING CESSATION CLINIC SAIILGREN'S HOSPITAL 413 45 GOTHENCURG SWEDEN A SMOKE FREE GENERATION BOX 9025 MOHLIN, AGNETA S-102 71 STOCKHOLM SF'EDEN AB LEO BOX 941 NORUGREN, ERSHAGEN, PAUL ORAN S-251 09 HELSINGBORG SWEDEN NATIONAL BOARD OF HEALTH AND k'ELFARE S-106 30 STOCKHOLM SWEDEN NATIONAL INST. OF ENVIRONMENTAL MEDICINE BOX 60208 RAMSTROM, LARS lf. S-104 01 STOCKHOLM SWEDEN NTS Vi'ENNER-GREN CENTER 22ND FLOOR S-113 46 STOCK1fOLM Sl'EDEN 39
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N A II E A D D R E S S SAE•TRE, SA4E. HELGE URBAIN A. V. IITS I KTSI'AGEN 16 S-7913I FALUN SI:EDEN AKTIEBOLAGET LEO BOX 941 SJOHOLM. ANDERS S-251 09 HELSINGBORG SR'EDEN AB LEO BOX 941 SORELIUS, LENNART S-251 09 HELSINGBORG S4'EDEN AB LEO BOX 941 SVANBERG. HAKAN S-251 09 HELSINGBORG SWEDEN A SMOKE FREE GENERATION BOX 9025 1tESTLING, AGNETA S-102 71 STOCKIIOLII SGEDEN V:ESTLING PSYKOLOG - 0CH UTBILDNINGSBYRA HB NYIIALAI'AGEN 170 S-fi2G 00 SODERHAMN SM'EDEN N A H E A D D R E S S 61ASIRONI, ROBERTO YORLD HEALTII ORGANIZATION Cll 1211 GENEVA SWITZERLAND 61ULLER. PHILIPf' CIBA-GIEGY LTD. K-125. 12. 1t CH-4002 BASLE S9ITZERLAND OZOR 10. , C• D:IUND P. D1Y. OF PUBLIC INFORMATION & EDUCATION FOR HEALTH lURLD HEALTII ORGANIZATION CH-1211 GENEVA SWITZERLAND SCHILLING. GUIDO AG LEO DUBENDORFSTRASSE 2 POSTFACH CH-8051 ZURIC'H SWITZERLAND SPILLldANN-THULIN, INGELA SAN SPILLMANN SEESTR. 222 CH-8700 KUSNACHT SWITZERLAND CHENG. DEAN SY JOHN TUNG'S FOUNDATION 12F. -3. N0. 57 k'ESTLING, BELIN. BENGT HEODOR E. UN I1'. OF UPPSALA PSYCHIATRIC RES. CTR. ULLERAKER HOSPITAL S-750 17 UPPSALA SWEDEN DEPT. OF SOCIAL AND PREVENTIVE MEDICINE UNIV. OF BERNE F 1 NKENIfUBELYEG 11 CH 3012 BERNE UAN, EE. ING-YUAN ONG-HSIN FU HSING N. RD. TAIPEI TAIX'AN 5TH F. 41. LANE 110 KIN SHAN S. RD. TAIPEI TA 14'AN DEPT. OF HEALTH EXECUTIVE YUAN P.O. BOX 91-103 BIUll, KONRAD SWITZERLAND C/0 KREBSLIGA Y'ILFRIEDSTR. 7 8032 1URICH U. IKE . TAIPEI TAIIIAN TUNHUA ROTARY CLUB 12F-3. NO.57. FU-HSING MAHLER. HALFDAN SWITZERLAND YORLD HEALTH ORGANIZATION GENEVA SWITZERLAND N. RD.. TAIPEI TA I G'AN 41
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I N A 11 E A 1) 1) R E S S 1'ANG, VAN-FA JOHN TUKG'S FOUNDATION 12F. -3. N0. 57 FU IIS I NG N. RD. TAIPEI TA11'AN YEN. DAY1D D. JOHN TONG'S FOUNDATION 12F. -3. N0. 57 REF.CHON, OVONVATANUVONG. URANATREI'EDHYA. MAMORN. OTHISIRI. ATHESATOGKIT, DRIAANSE, AITH HUREERATANA TTAPOL RACHA AKDEE RAKIT ANS . FU IISING N. RD. TAIPEI TAI~AN 6 TEPNIMIT 2 BANGKOK-NONTHABURI RD.. BANGKOK 10800 THAILr1Nf) INTERNAL MEDICINE DEPT. CHONBURI HOSPITAL CHONBURI 20000 THAILAND MERRELL DOw' DIl'. OLIC (THAILAND) LTD. 3223 SUKHUMVIT RD. BANGNA. BANGKOK 10260 THAILAND THE FOOD 8 DRUG'ADLiINISTRATION MINISTRY OF PUBLIC HEALTH DEVAVES PALACE. SAMSEN RD. BANGKOK 10200 TfIAILAND THE FOOD & DRUG ADMINISTRATION MINISTRY OF PUBLIC HEALTH DEVAVES PALACE. SAMSEN RD. BANGKOK 10200 THAILAND DEPT. OF MEDICINE RAMATIIIBODI HOSP. RAMA 6 RI). BANGKOK 10400 THAILAND DEPT. HEALTH EDUCATION UNIV. OF LIMBURG P.O. BOX 616 6200 MD MAASTRICHT TIIE NETIIEItLANDS 42 N A H E BAAN. DE VRIES, NELISSEN, GEYER, CIIAMELY, AIIOS. BERRY, BOYSE, BEN HEIN JOHN LEON GEORGE AMANDA JUDITH SHARON G.M J. H. A D D R F. S S DUTCII SMOKING k IIEALTII FOUNDATION FREDERIK IIENDRIKLAaN 34A 2582 BC THE HAGUE THE NETHERLANDS DEPT. OF HEALTH EDUCATION UNIV. OF LIMBURG P.O. BOX 616 6200 FID M4ASTRICHT THE NETHERLANDS I)UTCH SMOK 1 NG fi HEALTH FOUNI)ATION FREDERIK HENDRIKLAAN 34A 2582 BC THE HAGUE THE NETIIERLANbS MINISTRY OF 1'ELFARE HEALTH & CULTURAL AFFAIRS P.O. BOX 5406 2280 HK RYSI'1'K THE NETHEftLANDS C/O TRINIDAD & TOBACO CANCER SOCIETY 157A TESTERN MAIN RD. ST. JAMES TRINIDAD AND TOBAGO LECTURER 1N HEALTH EDU. DEPT. OF COMMUNITY MEDICINE MEDICAL SCH. TEYIOT PLACE EDINBURGH EFiS 9AG U. K. PROJECT SMOKE FREE NORTH WESTERN REG I ONAL HEALTH AUTIIORITY GATEG'AY )IOUSE PICCADILLY SOUTH MANCHESTER. MGO 7LP U. K. 53. ENNING RD. CANNING TOkN LONDON E16 4NE U. K. 43
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N A H E A D D 11 E S S CAIII'BELL. IAN A. SULLY HOSPITAL 1'ENARTII WALES. CF6 2YA U. K. CIIARLTON. ROFTON. ANNE ILEEN . CANCER RES. CAMPAIGN ED. !i CHILI) STUJ)IES RES. DEPT. OF EP 1 DEJIIOLOGY fr SOCIAL 0\COLOGY CHRISTIE HOSPITAL MANCHESTER 1120 90L U. K. 13 SPl'LA[' BANK RD. EDINBURGH EH13 OJY U. I:. GRP. CROFTON. ELl', YRES. JOHN ROBERT TEPHEN Y'. L. . 13 SPYLA4' BANK RD. EDINBURGH E1113 OJR U. K. 21 THE CROFT EAST HAGBOURNE NR DIDCOT. OXON OX 11 9LS U. K. FOREST BONDC'AY HOUSE 3/9 BONDVAY LONDON S1CS ISJ U. K. NARE A D I) R E S S GRICE, 1AJF.K. IURST, ENDALL. EE. ITC:HELL. IIUGII ETER 0M UTII ETER ARAH B. . . . STOCKS SI'INFIELD LANE MARLO[. BUCKS SL7 2LB U. K. I NST. OF I'SYCII l ATR1' ADDICTION RES. UNIT 101 DE\HaRK HILL LONDON SE5 8,1F U. K. 20 GRANGE MEADOG BANSTEAD SURREY SId7 3RD U. K. GLASGOE 2000 20 COCIiRANE ST GLASG01 61 L'. K. P. N. LEE STATISTICS AND CONPUTING LTD. 25 CEDAR RI). SUTTON. SURREY SM2 5DG U. K. LUNDBECK LTD. LUNDBECK 110USE HASTINGS ST.. LUTON BEDFORDSHIRE LUI 5BE U. K. GILLIES. PAMELA A. DEPT. OF COMMUNITY MEDICINE AND EPIDEMIOLOGY UNIV. HOSP. AND MEDICAL SCH. UNIV. OF NOTTINGHAM CLIFTON BOULEVARD MORE, WILLIAM J. LUNDBECK LTD. LUNDBECK HOUSE HASTINGS ST.. LUTON BEDFORDSIIIRE LU1 5BE U. K. RAHAM. EFFREY I. NOTTINGHAt.1. NG7 2UH U. K. RM. C314 MORGAN, ALUN LUNDBECK LTD. LUNDBECK IIOUSE HASTINGS ST.. LUTON RAY, LSPETH 1. ALEXANDER FLEMING HOUSE ELEPIIANT AND CASTLE LONDON SEI 6BY U.K. SET PROJECT ORRIS. LLAN . BEDFORDSIIIRE LU1 5BE U. K. MOOR HOUSE 55 MOOR GREEN LANE MOSELEY SCHOOL OF EDUCATION UNIV. OF BRISTOL 22 BERKELEY SOUARE BRISTOL BSB 1HP U. K. XBERRI', DF'ARD . BIRMINGHAM B13 SNE U.K. 3 FOX110RE ST. LONDON. SY'lI U. K. 45
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N A 11 E REID. REID. ROBERTS, ROPLAND, RUSSELL, SIIIPSON, STEELE, TELLER, ADAMS. DONALD JOHN JOHN DAVID MICHAEL DAVID CHRIS NEYILLE ELVIN J. L. W. A. H R. S E. A U D R E S S HEALTH EI)UCATION AUTIIORITY 78 NEC OXFORD ST. LONDON WC1A IAH U. K. THE MANOR 110USE OVING. AYLESBURY BUCKS HP22 4HR' U. K. REGIONAL PREVENTION DEPT. NORTH CESTERN REGIONAL HEALTH AUTHORITY GATEWAY HOUSE PICCADILLY SOUTIi MANCHESTER. 6160 7LP U. K. 23. LINKS COURT COLBERT AVE. THORPE BAY SOUTIIEND ON SEA ESSEX SS1 3BW U. K. ADDICTION RES. UNIT INST. OF PSYCHIATRY 101 DENMARK HILL LONDON SE5 SAF U. K. 5-11. MORTIIIER ST. LONDON W1N 7RH U. K. 363 WILMSLOW RD. FALL06'F 1 ELD MANCHESTER M14 6XU U. K. DEPT. OF HEALTH AND SOCIAL SECURITY RM. C211 ALEXANDER FLEMING HOUSE ELEPHANT AND CASTLE LONDON SE1 6BY U. K. SEVENTH-DAY ADVENTIST CHURCH 6840 EASTERN AVE. N. W. WASHINGTON. DC 20012 U. S. A. N A H E ADDISON. AVIADO, BAGROSKY, BALES. RITA DOMINGO JOHN VIRGINIA K. U. L. S. A D D R E S S CLEAN AIR ASSOCIATES 25 DEACONESS RD. BOSTON. MA 02215 U. S. A. ATMOSPHERIC HEALTH SCI., INC. 152 PARSONAGE HILL RD. P.O. BOX 307 SHORT HILLS. NG 07078 U. S. A. OFFICE ON SMOKING AND HEALTH CENTER FOR HEALTH PROM. S ED. CENTERS FOR DISEASE CONTROL 5600 FISHERS LANE PARK BLDG. RM. 1-10 ROCKVILLE. IID 20857 U. S. A. CENTERS FOR DISEASE CONTROL CENTER FOR HEALTH PROM. & ED. BLDG. 3. RM. 117. MS A37 1600 CLIFTON RD. N. E. ATLANTA. GA 30333 U. S. A. BANZHAF. JOHN F. ACTION ON SMOKING AND HEALTH 2013 H ST.. N. W. WASHINGTON, DC 20006 U. S. A. BERGER, PETER L. ISEC BOSTON UNIVERSITY 118 BAY STATE ROAD BOSTON. MA 02215 U. S. A. BIGLAN, ANTHONY OREGON RES. INST. 1899 CILLAMETTE ST. EUGENE. OR 97401 U.S.A. SUITE 2 BLUM, ALAN If. BAYLOR FAMILY PRACTICE CTR. A5510 GREENBRIAR HOUSTON. TX 77005 U. S. A. BRUTON, JOHN W. MERRELL DOW PHARMACEUTICALS INC. LINCLAY BLDG. 10123 ALLIANCE RD. P.O. BOX 429553 CINCINNATI. Off 45242-9553 U. S. A. A7
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N A H E A D D R F. S S BUUETTI, URTON. PETER EE SUBCOMMITTEE ON IIEALTII AND T11E ENVIRONMENT. THE U.S. IIOUSE OF REPRESENTATIVES THE CAPITOL yASII1GNTON. D. C. 20515 U. S. A. INST. FOR PREVENTION RES. UNI1'. OF SOUTHERN CALIFORNIA 35 N. LAKE AVE. 2ND F. N A R E DAVIS. DAYNARU, RONALD RICHARD M. A. A i) U R E S S OFFICE ON SMOKING & HEALTH CTR. FOR HEALTH PROM. & ED. CENTERS FOR DISEASE CONTROL 5600 FISHERS LANE PARK BLDG. RU. 1-10 ROCKVILLE. MD 20857 U.S.A. NORTHEASTERN UNIV. SCH. OF LAC PASADEN.4. CA 91101 400 IIUNTINGTON AVE. CAI'ARO' JOSEPH U. S. A. 5680 YINTHROP L'OSTON. MA 02115 U. S. A. . CARLSON, ONNOLLY, EGINA REGORY . . INDIANAPOLIS. INDIANA 46220 U.S.A. NE[' JERSEY GROUP AGAINST SMOKING POLLUTION 105 MOUNTAIN AVE. SUMMIT. NJ 07901 U. S. A. DIRECTOR DIV. OF GENTAL HEALTH THE COM1.10NWEAI,TH OF MASS. DEPT. OF PUBLIC HEALTH 150 TREMONT ST. BOSTON. MA 02111 U. S. A. ERICKSON, VANS. YRE. ALLAN ALLY ARMON C. . . AMERICAN CANCER SOCIETY 90 PARK AVE. NEB YORK. NY 10016 U. S. A. D1Y. OF MERRELL DOW PHARMACEUTICALS LAKESIDE PHARMACEUTICALS 10123 ALLIANCE RD. CINICINNATI. OH 45242 U. S. A. UNIV. OF UTAH 50 NORTH MEDICAL DRIVE SALT LAKE CITY UTAH 94132 COOPER. IRVING 20 Y'ESTGATE RD. NEFTON.CENTER MASSACHUSETTS 02159 U. S. A. FAIRBANKS, LELAND L. U.S.A. OFFICE OF CONTINUING EDUCATION CLINICAL SUPPORT CTR. INDIAN HEALTH SERVICE 4212 N. 16TH ST. BLDG. 5 CROIIER, MARY A. EAST SOMERVILLE HEALTH CTR. 61 GLEN ST. SOMERVILLE MA 02145 PHOENIX. AZ 85016 U. S. A. . U. S. A. FALKIER'ICZ, ANDREW i. 6 BROOKLANDS APARTMENT 3-D CULLEN, JOSEPH i. DIV. OF CANCER PREVENTION AND CONTROL NATIONAL CANCER INST BRONXYILLE. NY 10708 U. S. A. ALMAT, ICHAEL . . 9000 ROCKVILLE PIKE BETHESDA. MD 20892-3100 U. S. A. CENTERS FOR DISEASE CONTROL 1600 CLIFTON RD., N. E. FISHER, FLAY, MILLARD BRIAN J. 2079 DEER RIDGE DR. STONE MOUNTAIN, GA 30087 U. S. A. IPR/USC 35 N. LAKE AVE. MAIL STOP C06. 1-4419 ATLANTA. GA 30333 U.S.A. PASADENA. CA 91101 U. S. A. 49
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N A 11 E FORCES. GARNER. GLANTZ. GLYNN, GOUIN. RIPLEY DONALD STANTON THOMAS CLARA 1. A. J. L. A D D R E S S SUBCOMMITTEE ON HEALTH AND TIIE ENVIRONMENT. THE U.S. HOUSE OF REPRESENTATIVES THE CAPITOL MASIIINGTON. D.C. 20515 U. S. A. SOUTHERN ILLINOIS UNIV. SCII. OF LAC' CARBONI)ALE, IL 62901 U. S. A. DIV. OF CARDIOLOGY BOX 0124 UNIV. OF CALIFORNIA SAN FRANCISCO, CA 94143 U. S. A. NATIONAL CANCER INSTITUTE BLAIR BLDG. RM. 427 9000 ROCKVILLE PIKE BETHESDA, kID 20892-4200 CI, S. A. GROUP AGAINST SMOKERS' POLLUTION (GASP), INC. P.O. BOX 632 COLLEGE PARK. MD 20740 U. S. A. N A M E A D D R E S S HOUSTON. THOMAS 1'. THE UNIV. OF KANSAS . SCH. OF HEDICINE-WICIIITA FAMILY PRACTICE RESIDENCY OY'ARD, LOEPFER. JR. KNAPP. OOP, )ONALD ILLIAH JUDY VERETT . . . PROGRAM AT WESLEY MEDIC'AL CTR. 3243 E. MURDOCK. SUITE 303 WICHITA, KS 67208 U. S. A. ASSOC. FOR NONS110KERS-MINESOTA 1421 PARK AVE. S. MINNEAPOLIS. hIN 55404 U. S. A. 3523 I(AMLET PLACE CHEVY CHASE. HD 20815 U. S. A. DIV. OF CARDIOLOGY DEPT. OF MEDICINE UN1V. OF MINNESOTA BOX 508 MAYO 420 DELA4'ARE ST. MINNEAPOLIS. MN 55455 U. S. A. PUBLIC HEALTH;SERVICES 2000 INDEPENDENCE AVE. S.W.. WASHINGTON D. C. 02138 GRITZ. NSON, ARRIS. ELLEN UART ONALD R. . JONSSON COMPREHENSIVE CANCER CENTER UNIVERSITY OF CALIFORNIA LOS ANGELES 10920 WILSHIRE. BLVD. SUITE 1106 LOS ANGELES. CA 90024-1781 U. S. A. PARK NICOLLET MEDICAL CENTER 5000 Y'EST 39TH ST. MINNEAPOLIS, MN 55416 U.S.A. 166 HIGH ST. HASTINGS-ON-HUDSON NY 10706 KRISTELLER, ANDO. ASCO, JEAN ARRY ICHARD L. . . U. S. A. DIV. OF PREVENTIVE AND BEHAVIORAL MEDICINE UNIV. OF MASS. MEDICAL CTR. RORCESTER, MA 01655 U.S.A. Y'016 LAGOMARCINO HALL PSYCHOLOGY DEPT. IOAA STATE UNIV. AMES. IA 50011 U. S. A. U. S. DHHS CENTERS FOR DISEASE CONTROL OEL, ONALD . U. S. A. 613 WEST 114T11 TERRACE KANSAS C1TY. MO 64114 U. S. A. YNN, ILLIAII . 1600 CLIFTON RD. ATLANTA. GA 30333 U. S. A. 1568 DOCKSIDE DRIVE FREDERICK. lID 21701 U. S. A. 50 51
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N A 11 F. MAILE. HICHAEL F. A D D It E S S MINNESOTA COALITION FOR A SMOKE-FREE SOCIETY 2000 HEALTH ASSOCIATIONS CTR. SUITE 400 N A M E PECNACEK. TERRY F. A D D It F S S SMOKING. TOBACCO & CANCER PROGRAM RM. 628 BLAIR BLDG. 9000 ROCKVILLE PIKE 2221 UN I V. AVE. S. E. M I NNE APOL I S. MN 55414 U. S. A. BETHESDA. MD 20892-4200 U. S. A. MONACO. UELLER, KAREN THENA D. SMOKING Olt IIEAL'fll AMERICAN LUNG ASSOCIATION 1740 BROADWAY NET YORK. NY 10019 U. S. A. ACTION ON SMOKING AND HEALTH 2013 H ST.. N. W. `i'ASHINGTON. DC 20006 U. S. A. PERSAUD, ERTSCHUK, OST, ALBERT ICIIAEL ARRY . TRINII)AD & TOBAGO CANCER SOCIETY 157A Y'ESTERN MAIN RD. ST. JAMES. TRINIDAD. f.l. U. S. A. ADVOCACY INSTITUTE 1730 11 STREET, NW WASHINGTON. DC 20036 U. S. A. 4715 MELVIN AVENUE NELDER. 'k'ENDY SAN FRANCISCO BOARD OF SUPERVISORS RM. 235. CITY HALL SAN FRANCISCO. CA 94102 AUCH, ARRY . ANCHORAGE, ALASKA 99517 U. S. A. PSC 3. BOX 16283 U. S. A. APO SAN FRANCISCO 96432-0006 NOVOTNY, THOMAS E. CHPE DHE BEEB 3-121 CENTERS FOR DISEASE CONTROL 1600 CLIFTON RD.. N. E. ATLANTA, GA 30333 U.S.A. RICHARDS. JOHN i. U. S. A. DEPT. OF FA1dILY MEDICINE MEDICAL COLLEGE OF MEDICINE HII-101 OREL, RLANDI. AULOS, JEANNETTE ARIO ANLEY V. . . SMOKE-TRAPPER INC. 10501 li' i LSH I RE BLVD. SUITE 2305 LOS ANGELES. CA 90048 U. S. A. AMERICAN HEALTH FOUNDATION 320 EAST 43RD ST. NEC YORK. NY 10017 U. S. A. MERRELL DOW PHARMACEUTICALS INC. P.O. BOX 429533 1G0TT1, ONGEY, ANCY HARLES . . MEDICAL COLLEGE OF GEORGIA AUGUSTA, GA 30912 U. S. A. INST. FOR THE STUDY OF SMOKING BEHAVIOR AND POLICY HARVARD UNIY. J. F. KEN\EDY SCH. OF GOVT. 79 JFK ST. CAMBRIDGE. MA 02138 U.S.A. MERRELL DOW PHARMACEUTICALS INC. 10123 ALLIANCE RD. 10123 ALLIANCE RD. P.O. BOX 429553 CINCINNATI. OH 45242-9533 U. S. A. ROSENGARTEN. SERGIO CINCINNATI, OH 45242-9553 U.S.A. MERRELL DOW PHARMACEUTICALS 2801 PONCE DE LEON BLVD. CORAL GEBLOS. FR 33134 U. S. A. 53
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t N A M E A D D R E S S SCIIYiARTZ, SEFFRIN. JERRY JOIIN L. R. 746 IIAtTIIORN LANE DAVIS. CA 95616 U. S. A. DEI'T. OF APPLIED HEALTII SC1. INDIANA UNI1'. IIPER SCHOOL 116 BLOOMINGTON, IN 47405 U. S. A. SEYERSON, HERBERT H. OREGON RES. INST. 1899 i'ILLAMETTE ST. SUITE 2 EUGENE, OR 97401 SHIMP, BENJAMIN E U. S. A. ENVIRONMENTAL IMPROVEMENT IIIMP, IIOPLAND. ONNA ONALD . . . ASSOC. 109 CHESTNUT ST. SALEM. N.J. 08079 U. S. A. ENVIRONMENTAL IMPROVEMENT ASSOC. 109 CHESTNUT ST. SALEM. N.J. 08079 U.S.A. OFFICE ON SMOKING AND HEALTH CENTER FOR HEALTH PROM. & ED. CENTERS FOR DISEASE CONTROL 5600 FISIIERS LANE PARK BLDG. RM. 1-10 SLADE, JOHN ROCHVILLE. MD 20857 U. S. A. 166 MONTGOMERY RD. SKILLMAN, NJ 08558 U. S. A. STELLMAN. STEVEN D. AMERICAN CANCER SOCIETY 4 WEST 35TH ST. NEV YORK. NY 10001 STOTO, 111CHAEL A. U. S. A. INST. FOR THE STUDY OF SMOKING BEHAVIOR & POLICY HARVARD UNIV. J. F., KENNEDY SCH. OF GOVT. 79 JFK ST. CAMBRII)GE, MA 02138 U.S.A. 54 N A M E STAN. VARNECKE, rARNER, 11'EIGUM, WE I SBERG , 1PELLS, IFESTERB£CK, M'111ST, Si1NDSOR, i'1'NDER, GARY RICHARD KENNETH JEANNE RAYMOND A. GREGORY ANDREt' RICHARD ERNST E. B. E. L. J. J. A. L. A D D I2 E S S CYTOSCIENCES. INC. 1601 SARATOGA-SUNNYVALE ROAD CUPERTINO. CALIFORNIA 95014 U.S.A. SURVEY RES. LAB. UKIY. OF ILLINOIS AT CHICAGO P.O. BOX 6905 CHICAGO. IL 60680 U. S. A. 1716 MORTON AVE. ANN ARBOR. 111 48104 U. S. A. 1647 LAUREL SAINT PAUL. MN 55104 U. S. A. SISTER MARY PHILLIPA CLINIC ST. MAR1"S HOSPITAL 2235 HAYES ST. 5TH FLOOR CLINIC SAN FRANCISCO, CA 94117 U. S. A. 102 KILDONAN GLEN 1ILMINGTON. DE 19807 U. S. A. MERRELL DOW PHARMACEUTICALS INC. LAKESIDE PHARMACEUTICALS P.O. BOX 429553 CINCINNATI. OH 45242-9533 U.S.A. I PIERREPONT ST., #4B BROOKLYN HEIGHTS. NY 11201 U. S. A. UNIV. OF ALABAMA AT BIRMINGHAM SCHOOL OF PUBLIC HEALTH DEPT. OF HEALTH BEHAVIOR 114 BIOMEDICAL SC L BLDG. BIRMINGIIAM, AL 35294 U. S. A. AMERICAN HEALTH FOUNDATION 320 EAST 43RD ST. NET 1'ORK. NY 10017 U.S.A. 55
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N A II E ZIMMERMAN, LEANN GOMILE. G. E. GORDON, 1 RIdA I . A D D R E S S 904 VALLEY LANE RIVERSIDE, MO 64150 U. S. A. MEDICAL TRAINING CTR. P.O. BOX 1142. MBEYA UNITED REPUBLIC OF TANZANIA Prof. Dr. HELMUT KASDORF C/O Ms. IRMA GORDON BUSCHENTAL AVE. 3467 MONTEVIDEO URUGUAY GEIZEROVA, HELENA C/O DR. GERER IMRICH ti'H0 P.O. BOX 177 PORT VILA 1'ANUAT ADRIANZA. MANUEL INST. NACIONAL DE TUBERCULOSIS APARTADO 1100 - CARACAS VENEZUELA MERENFELD, RUBEN VENEZUELAN ANTI-CANCER SOCIETY CANO NIGOS A ESPERANZA, 43 CARACAS 1010 VENEZUELA LE, DINH-CONG DEPT. OF HYGIENE AND EPIDEMIOLOGY MINISTRY OF HEALTH HANOI 1'IET NAM ALI, h{, Y. DlBBS, DCTD MPH (USA) P.O. BOX 1385 Ck'ERU ZINBABk'E 56 TIMN 448661
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6 TH WORLD C ON F E REN C E ON SMOK2 NG ANID HEALTH P ART = C I P ANT S L 2 S T ( S upp 1 ima n t) 11 As of Novembor 4 , 1 987 TIMN 448662
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' Name Address AUSTRALIA FITZWARRYNE, CAROLINE N. HEALTH PROMOTION & DEVELOPMENT BRANCH HEALTH ADVANCEMENT DIV. COMMONWEALTH DEPT. OF HEALTH P.O. BOX 180 WODEN 2606 AUSTRALIA PIERCE, JOHN P. DEPT. OF PUBLIC HEALTH BLDG. A27 UNIV. OF SYDNEY NSW 2006 AUSTRALIA BANGLADESH ISLAM, NURUL 63, CENTRAL RD., DHANMONDI DHAKA-1205 BANGLADESH CANADA COLLISHAW, NEIL E. TOBACCO PRODUCTS UNIT RM. 137 ENVIRONMENTAL HEALTH CTR. DEPT. OF NATIONAL HEALTH AND WELFARE CANADA OTTAWA. ONTARIO K1A OL2 CANADA LIEPOLD, HEIDI U.I HEALTH & WELFARE CANADA 4TH F.. JEANNE MANCE BLDG. TUNNEY'S PASTURE OTTAWA. ONTARIO K1A 1B4 CANADA THOMPSON, SHIRLEY E. BRITISH COLUMBIA LUNG ASSOC. 906 W. BROADWAY VANCOUVER, B. C. CANADA CHINA ZHANG, ZHI-XUE FOURTH AFFILIATED HOSPITAL OF HEBEI MEDICAL COLLEGE SHIJIAZHUANG.HEBEI CHINA FINLAND GASTRIN, GISELA A. STAHLBERGSVAGEN 6 F 55 00570 HELSINKI FINLAND TI141Y 448663
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Name Address Name Address FRANCE JAPAN 0'NEILL. REECE IAN K. INTERNATIONAL AGENCY FOR RES. OF CANCER 150 COURS ALBERT THOMAS 69372 LYON CEDEX 08 FRANCE EGUCHI, UJIU, ATSUII ISA OSHIHIRO 6-3-7. SIIIMOMEGURO MEGURO-KU. TOKYO 153 JAPAN KOUGAKUIN HIGH SCIIOOL 2647 NAKANO TOKYO 192 HACIIIOUJI CHANIOTIS. ARKARIDIS. NDIA FRANGISKOS EORGE I. 18 PRIKONISOU ST KERATSINI 187 55 PIRAEUS GREECE 82 EGNATIAS ST. THESSALONIKI. 546 23 GREECE FURUKAWA. ' AGIWARA. TOYOKI OBUHIKO . JAPAN 225-5. SANRAKU-CHO KITAMI-SH1. HOKKAIDO 090 JAPAN DOHOKUKINiKYO ICHIJYODORI HOSPITAL 1-1. TOYOOKA ASAHIKAWA-SHI. HOKKAIDO 078 KRISHNAMURTHY, SARALA 10 B ANAND MAHAL PALI RD. BANDRA BOMBAY 400 050 HANO. HIROYUKI JAPAN NIHON SHINYAKU CO. 8-JO KUDARU RAMANAIAH. HIRUMALAIKOLUNDUS, TALY T. B. B. S. V. . INDIA MEDURAI MEDICAL COLLEGE AND DEPT. OF GEOGRAPHY HEDURAI KAMARAJ UNIV. ALAGARKOIL RD. HEDURAI 625 002 INDIA ASST. PROF. OF MEDICINE WARD 115 GOVT. RAJAJI HOSPITAL MADURAI 625 020 TAMII NADU INDIA ASEBE, IGUCHI, CHIKI. AKAKO OSHITAKE IDEO NISHI-OIIJI-DORI MINAMI-KU. KYOTO JAPAN YASUDA LIFE INSURANCE COMPAN~ 3-35-1. TAKADA TOSHIMA-KU. TOKYO JAPAN 5-2-7. OHTEMACHI SHIBATA-SHI. NIIGATA JAPAN 5-6. YAMANOGUCHI-MACHI KAGOSHIMA-SHI. KAGOSHIMA 892 JAPAN . ARCITI, APAN CARLA E. ISTITUTO SCIENTIFICO PER 10 STUDIO E LA CURA DEI TUMORI VIALE BENEDETTO XV N 10 16132 GENOVA ITALY INOUE, AWAGUCHI. HIDENORI YOHEI YOSHIDA HOSPITAL 4 4-JO-NISHI ASAH1KAWA-SHI JAPAN KANAGAWA PREFECTURE MEDICAL ASSOCIATION AOYAMA. BIHARA, ICHIRO UKIO 49-8. BUNKYO-CHO ITAYANAGI-MACHI KITA-GUN. AOMORI 038-36 JAPAN 44 NISHI-SENDO-CHO SHIBANO. KITA-KU. KYOTO 603 JAPAN OSAKA. EISON 4-104. HANASAKI-CHO NISHI-KU. YOKOHAMA-SHI KANAGATA 220 JAPAN NIHON KINEN YUAIKAI 3392 INA OHAZA INA-SHI. NAGANO JAPAN -3- -2-
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JAPAN KUMAGAI. KU.MAGA I . KURASHIGE, KUWABARA, MATSUMOTO, MURAMATSU. SAKURADA. Name FUKUO TOYOJ I TSUNEJI MITSUKO RYOICHI YOSHIKI MINORU RYOKO Address 306 ISIIIKARI-CIIO ISIIIKARI-GUN. IIOKKAIDO JAPAN SAPPORO A1'UMI-NO-SONO 483-3. SHINEI TOYOHIRA-KU. SAPPORO JAPAN 2-1-36. HIROMACHI SHINAGAWA-KU. TOKYO JAPAN 798 TAKAYANAGI, YOOKA-CHO YOBU-GUN, HYOGO JAPAN JAPAN WOMAN'S CHRISTIAN TEMPERANCE UNION 2-23-5. HYAKUNIN-CHO SHINJUKU-KU. TOKYO 160 JAPAN DEPT. OF HEALTH SCIENCE AICHI UNIV. OF EDUCATION 1 HIROSUWA. IGAYA-CHO KARIYA-SH1. AICHI JAPAN YOSHIDA HOSPITAL 4 4-JO-NISHI ASAHIKAWA-SHI JAPAN AMAGASAKI MEDICAL ASSOCIATION 3-15-20. MIZUDO-CHO AMAGASAKi-SHI. HYOGO 661 JAPAN 303 GUMYOJI MINAMI-KU. YOKOHAMA JAPAN NIPPON SIIINYAKU CO.. LTD. TOKYO LIAISON BUREAU 3-5-14. NIHONBASHI-HONCHO CHUO-KU. TOKYO 103 JAPAN MIYAGI CANCER SOCIETY 6-281. UESUGI SENDAI-SHI. MIYAGI JAPAN •Name JAPAN . ' SHOJ I . SUZUKI. TANAKA. TSUDA. UESHIMA, WATANABE. YAMAMOTO, YANAGIDAIR4.• YANAGITA. YOSHIE ' HIROSHI 'AKERI KAZUMI YOSHITOSHI HIROTSUGU oUNGAKU KATSUJI ..SAKAN KIUtKO •TERUKAZU . Address UJI CITY ASSEMBLYMAN 33 BIWA. UJI UJI-SII1. KYOTO 611- JAPAN 2-11-9. HORIDOME-NISHI WAKAYAMA-SH1. WAKAYAMA 641 JAPAN AMAGASAKI MEDICAL CTR. 3-15-20. MIZUDO-CHO AMAGASAKI-SHI. HYOGO 661 JAPAN SHIZUOKA PREF. MEDICAL ASSOCIATION 1034 SHUZENJI TAGATA-GUN. SHIZUOKA 410-24 JAPAN DEPT. OF PREVENTIVE MED. NATIONAL CARDIOVASCULAR CTR. 5-7-1. FUJISHIRODAI SUITA-SH1. OSAKA 565 JAPAN TOBACCO PROBLEMS INFORMATION CTR. 1-11-16. HAKUSAN BUNKYO-KU. TOKYO 113 JAPAN 5-5-19. SHIMO-ITOZU. KITA-KU KOKURA. KITA-KYUSHU-SHI 803 JAPAN 2-10-25. M1TA MEGURO-KU. TOKYO 153 JAPAN 10-17. HIGASHI-MACHI MIYAKONOJO-SHI MIYAZAKI 885 JAPAN " R&D INST. TOKYO GAS CO.. LTD. 1-16-25. SHIBAURA MINATO-KU. TOKYO 105 JAPAN
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Name Address Name Address MEXICO U. S. A. RUBIO, HORACIO INST. NACIONAL DE ENFERMEDADES RESPIRATORIAS. SSA CALZADA DE TLALPAN NO. 4502 COL. SECCION XVI C.P. 14080. MEXICO D.F. BAOUET. CLAUDIA R. . PROGRAM DIRECTOR MINORITY FIELD PROGRAM. DCPC NATION,AL CANCER INST. NTII. BLAIR BLDG. RM. 1A01 9000 ROCKVILLE PIKE POLAND MEXICO BETHESDA. MD 20892-4200 U. S. A. MOCZURAD, EPUBLIC OF KOREA KRZYSZTOF W. DEPT. OF SOCIAL CARDIOLOGY ACADEMY OF MEDICINE UL. KOPERNIKA 17 31-501 CRACOW POLAND GARFINKEL. ENDEE. LAWRENCE ILLIAM . AMERICAN CANCER SOCIETY 4 WEST 35TH ST. NEW YORK. NY 10001 U. S. A. VICE PRESIDENT FOR SC1. a TECH AMERICAN MEDICAL ASSOCIATION CHUNG. UN. ' INGAPORE KWANG-MO AIK . CONSUMERS UNION OF KOREA 272-1. HANNAM-DONG YONGSAN-KU. SEOUL REPUBLIC OF KOREA KOREA CANCER CTR. HOSP. KOREA ADVANCED ENERGY RES. INST. 215-4. GONGNEUNG-DONG DOBONG-KU. SEOUL REPUBLIC OF KOREA OTTKE. KLAN HOMAS VID . 535 NORTH DEARBORN CHICAGO. ILLINOIS 60610 U. S. A. UNIV. OF MINNESOTA DEPT. OF MEDICINE CARDIOVASCULAR DIV. BOX 508 MAYO MEMORIAL BLDG. 420 DELAWARE ST. S.E. MINNEAPOLIS. MN 55455 U. S. A. WESTAT. INC. ADAIKAN. PAIN P. DEPT. OF OBSTETRICS AND GYNAECOLOGY NATIONAL UNIV. HOSPITAL 5 LOWER KENT RIDGE RD. SINGAPORE 0511 SINGAPORE . OEN, ICHAEL . 1650 RESEARCH BLVD. ROCKVILLE. RD 20850 U. S. A. MINNESOTA DEPT. OF HEALTH 717 S. E. DELAWARE ST. MINNEAPOLIS. MN 55414 U. S. A. MARIN. WITZERLAND DOLORS T. HOSPITAL CLINIC I PROVINCIAL DE BARCELONA SERVEI DE PNEUMOLOGIA C/ VILLARROEL. 170 08036-BARCELONA SPAIN SACHS. DAVID P. L DIRECTOR SMOKING CESSATION RES. INST. 1101 WELCH RD.. SUITE A-2B PALO ALTO. CA 94304-1974 U. S. A. ORSINI. HE NETHERLANDS MARIE ANTOINETT C. A. S. 1. N. 11A. AVE. DE LA PAIX 1202 GENEVA SWITZERLAND HAGEN. J. H. HOFPOORT HOSPITAL POLANERBAAN 2 3447 GN WOERDEN THE NETHERLANDS -7- -6-
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Name Address JAPAN TSURUTANI, KUNIKO 3-29-14, DENENCHOFU OTA-KU, TOKYO 145 JAPAN TSUTSUMI, TOSHIHIKO MITSUBISHI CORP. 2-6-3, MARUNOUCHI CHIYODA-KU, TOKYO 100 JAPAN UCHIDA, SAKI 2-7-22, OGURO SHIZUOKA-SHI, SHIZUOKA JAPAN UEDA, TAKESHI 205-KAWATANI 3-15-39, SEKIMACHI-MINAMI NERIMA-KU, TOKYO 177 JAPAN WADA, MASAYA PUBLIC HEALTH BUREAU NAGOYA CITY 3-1-1, SANNOMARU NAKA-KU, NAGOYA 460 JAPAN WATANABE, SHAW EPIDEMIOLOGY DIY. NATIONAL CANCER CENTER RES. INST. 5-1-1, TSUKIJI CHUO-KU, TOKYO 104 JAPAN YAMAGUCHI, MASAYOSHI JAPAN ANTI-TUBERCULOSIS ASSOC. 1-3-12, MISAKI-CHO CHIYODA-KU, TOKYO 101 JAPAN YAMAGUCHI, TOMOMICHI JAPAN ANTI-TUBERCULOSIS ASSOCIP.TION SHIBUYA CLINIC 1-20-24, SHIBUYA SHIBUYA-KU, TOKYO 150 JAPAN I YAMAMOTO, KATSUSHI 5-5-19, SHIMOITOZU KOKURAKITA-KU KITAKYUSHU-SHI 803 JAPAN YAMAMOTO, MASAAKI 4-34-14, SETA SETAGAYA-KU, TOKYO 158 JAPAN This is a replacement for the page 31 of the List of Participants. TIM"N 448667
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4. The Conference Recommendations ,rgMN 448668
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Recommendations of the 6th World Conference ; . .. on Smoking & Health, Tokyo November 9-12, 1987 1. IMPLEMENTATION OF PREVIOUS RECOMMENDATIONS The Conference urges implementation of all previous recommendations of WHO Expert Committee Reports and previous World Conferences. 2. TOBACCO CONTROL IN DEVELOPING COUNTRIES a) Each country should set up a national coordinating body on tobacco control. Further recommendations are for regional and global coordination of such bodies. ' b) Governments in developing countries should stop.the transnational tobacco industry targetting these countries. c) As a minimum, no promotion should be allowed that is illegal in the country of origin. Tobacco should cease to be used as a political leverage in trade matters, ' d) Non-government organizations in developed countries should work to assure their own governments do not contribute to the promotion of tobacco use in develope!e-countries. e) Preventiohould be the primary objective of national and international tobacco-control programs. 3.. ENFORCED SMOKING AND NON-SMOKERS' RIGHTS 3.2,All countries should work toward establishing smoke-free environments in all enclosed public places, particularly ' worksites, transport, health-care facilities, schools, and child-car facilities. ~.f ~~e-k__a~ 35 . 4. LEGISLATION AND PRODUCT LIABILITY SUITS a) Tobacco-control legislation should be seen as an integral part of a comprehensive tobacco-control policy. b) Scientific and medical organizations should be urged to help, support and encourage groups that are freer to lobby and take a more activist role. c) The Conference endorses the legitimacy of victims and victims' families of tobacco-induced diseases to obtain compensation from tobacco manufacturers through judicial processes. Governments should seek reimbursement for all medical and other relevant costs which they have : to bear by taking care of the victims of tobacco use. TIMN 448669
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5, SMOKELESS TOBACCO G'"`ak' /LR-e Smokeless tobacco should b banned in all countries where it is not yet an establish habit. In countries where traditional new forms of smokeless tobacco are established, all possible restrictions on advertising, promotion, and sale, linked with health education and tax policy, should be introduced immediately. 6. TOBACCO AND ECONOMICS a) Pro-health organizations should review the socio- economic and health costs of tobacco use to the individual and to the society. b) All countries should regularly increase taxation on tobacco products*as a health policy measure. c) All appropriate bodies should consider higher insurance rates for smokers to reflect the true socio-economic and health costs of smoking. 7. TOBACCO AND WOMEN c The issue of women and smoking should be integrated into local, national and international tobacco-control strategies and health education programs, with women serving on all anti-tobacco committees. , 8. TOBACCO AND CHILDREN a) There should be increased international cooperation on research into tobacco use by children, especially regarding influences on smoking behavior, with a specific recommendation for international workshops on this topic. b) The Conference proposes that,on a country an.d globall basis, the number of children alive today who will be unnecessarily killed by tobacco be estimated and these f igures:..xnade public. 9. TOBACCO CESSATION .~ Every country should recognize the complex nature of tobacco use and should implement appropriate and demonstrably effective cessation techniques. 10. WHO Delegates from each country should request that their health ministers support a larger and more dynamic role for the WHO Program on Tobacco or Health. ~jM-S 448670
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11. PROMOTION i a) All forms of tobacco advertising, sponsorship and any other direct and indirect forms of promotion in all media be banned in all countries. This Conference urges governments to ban television tobacco advertising as a first step toward a total ban. b) The Conference recommends that all sporting events be smoke-free and free from all tobacco advertising and promotion. In particular it is.noted that promotion of tobacco products in Olympic Games violates the Olympic Charter and whereas enforced smoking is known to be detrimental to athletic performance and inconsistent with the healthful image of the Olympic Games, the Sixth World Conference on Smoking and..Health recommends to the International Olympic Committee that all 'future 'summer and winter Olympic Games adopt the smoke-free model of the 1988 Calgary Winter Games. -------------------------------- ..M 3.1 Each country should conduct education programs for smokers and non-smokers, especially regarding the effects of passive smoking on children. TIMN 448671
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5. Daily summaries from the monitoring team TIMN 448672
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Dail_y_Summary__Dr_aft Mondayl_Novembe_r_9 Tokyo, November 9--In a packed, 570-seat meeting hall and before a half dozen television cameras, Japanese dignitaries and leaders in the antismoking movement opened the Sixth World Conference on Smoking and Health today. The advance registration list included some 575 names, 350 from about 55 countries other than Japan. Largest delegations are from the USA (90), UK(30), Canada (26), Sweden (23), Australia (22), Norway (13), India and Hong Kong (11 each), and from other countries ten or fewer. David Simpson, director of Action on Smoking and Health (ASH) in Britain, drew sustained applause when he noted the presence of "many people from the tobacco industry." "While we are amazed by their apparent lack of shame in abusing the hospitality and the policy of openness so warmly offered by our esteemed Japanese hosts, by presenting themselves here at a health conference, we should perhaps remember, as expressed in one World Health Organization report, that each of these people now lives under the terrible moral burden of having to bear some personal responsibility for some of the unnecessary suffering from disease and needless premature deaths caused by their activities, " he said. On behalf of the organizing committee, Simpson 'announced that the Seventh World Conference on Tobacco and Health would occur in early 1990 in Perth, at the invitation of the Western Australia state government, followed by the Eighth conference in Buenos Aires in 1992. He said the "urgency of the problem and the demand for increased attention to it" indicated the need for a reduction in the four-year conference intervals in the past. At a short session following the opening, John Banzhaf, director of ASH in the U.S., offered a motion to eject industry representatives '"out into the muck where they belong." He said the presence of unidentified industry people is dangerous, as they "snoop about overhearing important conversations" and inhibiting discussions. His motion was seconded, but the session chairman said the question would be dealt with at the 1990 conference. - 1 - TIM10T 448673
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The afternoon ended with "opening lectures." Nakajima, Director of the WHO Western Pacific Regional Office said that 200 million smokers in 15 Pacific nations are threatened, that home- grown tobacco in those countries is dangerous, but imported cigarettes are more dangerous. He said smokeless tobacco is a new threat, pridefully prohibited in Hong Kong. He recommended that WHO coordinate efforts in tobacco growing countries to help solve what he called the short-term problem of crop substitution. Eyre, the current president of the American Cancer Society, said the voluntary health associations in the U.S. have five million volunteers, and said those groups were responsible for six years of antismoking achievements, with more to come. The successes which he listed included recent American cigarette tax increases, stronger warning labels, an antismoking campaign in the military services, smoking restrictions in government buildings, airline smoking restrictions recently voted in the U.S. Congress, and even the industry's voluntary advertising restraints. U.S. delegate Michael Pertschuk declared that the "powerful Tobacco Institute" in his country directs worldwide industry activities in fighting tobacco issues. He introduced new booklets from the American Cancer Society -- "Smoke Fighting" and "Smoke Signals", which he described as guidebooks to antismoking strategies, and "Not Far Enough", a takeoff on the "You've Come a Long Way" slogan, dealing with women,and smoking. Earlier, WHO Director Mahler.claimed success in making tobacco smoking unacceptable. "Tobacco or Health--Choose Health" was the theme of his speech, in which he repeated the• familiar charge that smoking causes 2,500,000 deaths each year. The last speech at the opening session was delivered on video tape by U.S. Surgeon General Koop, who reiterated the conclusions of his 1986 report on environmental tobacco smoke. Evening news coverage on Tokyo's principal- channel was perfunctory and not substantive. Only one story appeared in today's press which, for the most part, was observing a traditional annual publishing holiday. That one report, in Japan's leading business newspaper, contrasted the relatively slight antismoking policies in Japan with those in effect elsewhere in developed countries. Delegate registration kits included a gift card bearing a commemorative postage stamp issued in Japan to salute the conference. It depicts a playing card, with a healthful appearing queen at the top holding a bird on her finger, and at the bottom, upside down, a bluefaced, pallid king smoking a cigarette. . 2 TIMN 448674
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An exhibit space adjacent to the conference hall held only one important exhibit, furnished by the manufacturer of Nicorette chewing gum who has at least five staff members attending the conference. The day ended with a reception for delegates. Tomorrow's schedule calls for a very full day of meetings and presentations. From the INFOTAB staff for now, good night from Tokyo. - 3 - TIMN 448675
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\ Dail_y_Summary_Draft Tues_day_N_ov___10 Tokyo, Nov. 10--Japan's Hirayama was the first speaker as the second day of the sixth World Conference on Smoking and Health began here. He was introduced to a full audience by Wynder of the U.S. Hirayama presented old data from his epidemiologic survey about smoker's health, and with respect to ETS he said that "the weight of evidence has increased" since the 1984 Vienna ETS symposium, thus ignoring the consensus regarding ETS and lung cancer of last week's seminAr here (see below) in which he took part. Stanton Glantz, activist leader of Californians for Nonsmokers' Rights, af-terward paid tribute to Hirayama, whereupon session chairman Wynder suggested that members of the audience confine themselves to scientific questions or observations. He stated his opinion that focus should be kept on active smoking, having seen in his life, he said three other (than ETS) weak associations, between coffee and stomach cancer, saccharine and bladder cancer, and alcohol and breast.cancer. Lars Ra~strom of Sweden followed, urging action to promote smoking cessation, prevent onset, and establish a nonsmoking social climate. He called for steps to weaken peer pressures and for prohibition of tobacco advertising. And he urged expansion in educational content and shape, range, functions, goals and targets. Ra~strom lingered over a slide depicting advice (rejected) from an advertising agency to an American cigarette company years ago which urged cigarette promotion to youngsters. He called it evidence of industry policy, failing to note that the company won a $5 million lawsuit against a U.S. TV commentator who had alleged the same thing. That a substantial amount of information about smoking incidence is not trustworthy seemed implicit in other remarks by Ramstrom, who reported WHO recommendations for international classifications of smokers, nonsmokers and former smokers, and which kinds of tobacco products are pertinent. Late in the morning, to an audience which dwindled as she spoke, Donna Shimp, who successfully sued the telephone company in New Jersey to gain a smoke-free workplace for herself, echoed yesterday',s demand that what she called the "merchants of death" be banned from future conferences. She apologized for the prevalence of cigarette commercials on Japanese TV because so - 1 - TIM1v 448676
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many of them are sponsored by American companies. Shimp said she has heard from people all over the world trapped in "smoke-filled office ghettos" and said controlling workplace smoking should be a concentrated effort. Getting just "one person to fight", she said, can be a key to success. She ended her speech with a request for a moment of silence for movement leaders Luther Terry, the former U.S. Surgeon General, and Betty Carnes, a U.S. antismoking activist, who have died since the last conference in Winnipeg in 1983. Shimp now runs a commercial antismoking company called Environmental Improvement Associates. Maseroni, WHO's chief antismoking spokesman, catalogued world trends in smoking incidence--growth in the Near East, and reduction particularly in EEC countries with more. severe marketing restrictions. He said lung cancer in women is now nearly equal to the rate for breast cancer and that, worldwide, the current number of 600,000 new cases of lung cancer is expected to rise to two million by 2000. Disease patterns in underdeveloped countries, he said', are becoming similar to those in the developed countries. Maseroni noted the alacrity with which governments restrict harmful pharmaceutical products, and their lack of it regarding tobacco. He predicted increases in prevalence of diseases associated with smoking until it is brought under control. Judith Mackay, M.D., executive director of the newly formed Hong Kong Council on Smoking and Health, observed that the tobacco industry is well organized internationally to fight antismokers. She traced political developments in her country in the past few years, noting industry resistance, saying she saw "rather familiar faces from the tobacco industry in the audience. I'm giving a political speech, which is probably why they're here." Carlos Herrera of Argentina reviewed antismoking progress in Latin America--and thanked the tobacco industry' for bringing about helpful cooperation on health issues among the countries in the region. A Minnesota, U.S., delegate reported on the successful efforts of a coaliton of 35 organizations and 250,000 volunteers to reduce smoking incidence, but a member of the audience stood up and observed that the incidence in that state was the same as the U.S. average. Shimano, a Japanese, outlined smoking demographics in his country, reviewed highlights of a white paper on smoking issued last month by the health ministry, listed a number of needed 2 TIMN 448677
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control actions including vending machine restrictions, pointed out difficulty in persuading the ministry of finance and the Diet of the need for controls, and deplored the Japan-U.S. agreement which has permitted cigarette brand competition and greatly increased TV advertising. A' U.S. researcher described a very long, expensive experiment in Waterloo, Canada, to educate youngsters not to smoke. At the end, smoking incidence among students was the same as among the controls. the experimental Rigotti of Massachusetts General Hospital reported that a smoking ban there had no effect on smoking incidence among nurses. In a relatively rare scientific session, some 60 delegates heard presentations about nicotine mostly on the efficacy of nicotine gum. Certain data presented appeared to weaken support for the nicotine addiction theory. One listener suggested the gum is too expensive for developing countries. Another responded that a cost-benefit analysis would prove the contrary. An emphatic •antismoking editorial appeared this morning in Asahi, Japan's second largest newspaper. Citing yesterday's remark by WHO Director Mahler that smoking deaths are the equivalent of all passengers being lost in 20 jumbo jet plane crashes each day, the paper compared smoking and drinking: Drinkers can refrain during work hours (except alcohoics) but habitual or heavy smokers cannot; and smoking has ill effects on others. Many advanced countries have taken stern measures against smoking. Where tobacco costs twice as much as in Japan, per capita smoking is halved. And so on. Other news coverage was light--three- or four-paragraph references to the fact that the conference is under way, with brief references to yesterday's speeches. Mainichi carried a column of brief reviews of five new books about smoking. One of them was "Smoking and Society--Towards More Balanced Evaluation," the symposium edited by Robert Tollison. Said the reviewer, "14 American scholars disclose their assertion as to such themes like passive smoking, human rights and advertisement which are now the socially controversial issues. Its stance is 'is smoking really harmful?' There's a unique analysis on 'sociologic view of antismoking phenomena.'" The volume has been published here in Japanese. Last week, about 100 scientists compared notes on indoor air quality and environmental tobacco smoke at a seminar sponsored in Tokyo by Japan's Conference on Environment and Health and chaired by Dr. Kasuga of Tokai University. 3 TIMN 448678
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An English translation of Kasuga's summary news release became available this morning. It noted that at the three-day seminar "Many reports ...expressed the opinion that the relationship between passive smoking and lung cancer, if any, is extremely low, and probably difficult to prove at the present time. On the other hand, opinions strongly affirming the relationship were also stated." Observers said the latter were in the minority. "Given the low probability of proving such a relationship, however, opinions were expressed as to the need to give priority to solving many other public health.problems," the statement said. Signed by ten of the participating scientists, the release concluded that the effect on human health of various factors in our environment, the quality of air being just one, must be evaluated. We think that scientific research and study on the health hazards, if any, present in these various factors, not just ETS or 'passive smoking', must be promoted." At this stage as at similar past conferences, it is clear that participants are ambivalent in identifying their adversary as smoking or the tobacco industry. An illustration of the latter occurred when Mintz, a Canadian health and Welfare Department official, referred to "the drug dealers in suits, better known as the tobacco industry." An "ooooh" was heard from the audience. And with that, at mid-evening in Tokyo, your INFOTAB reporting team signs off for the night. 4 - TIMN 448679
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Tokyo, Nov. 11--Where does the antismoking movement go from here? "To war," according to Michael Daube, the anti-tobacco professional, former director of Britain's ASH, now a Western Australia bureaucrat. Daube was the plenary session wake-up speaker on the third morning of the Sixth World Conference on Smoking and Health, predicting that the tobacco industry will fight the movement every inch of the way. He said resistance to the movement can be diminished by overcoming the political and economic power of the tobacco industry, persuading politicians of the scale of the smoking problem, emphasizing nonsmokers' rights, raising prices with taxation and securing prohibition of smokeless tobacco and tobacco advertising. Daube said industry influence and credibility is waning at the same time the antismokers are gaining in professionalism. He noted the absence at the conference of some 100 developing countries, but said he regards major nations without smoking controls as "developing countries" too. He seemed to contradict the usual antismoker assessment that the purpose of cigarette advertising is to expand the overall market when he pointed out a need for the movement to spend substantially in media and promotional work, noting that industry "is seeking for tiny shifts in the market while we are looking for a major change." At a lively session on media strategies, one speaker, Evans of Australia, began his remarks "Ladies and gentlemen and scum bags," identifying the latter as an Australian Tobacco Institute staffer and a representative of FOREST in U.K. Evans showed amusing slides of defaced cigarette adversisements, accused tobacco executives of potitical bribery and advocated enlistment of grieving relatives of dead or dying smokers in the antismoking campaign. Other speakers at the generally well-organized session were more to the point. Reid of U.K. urged repeated health scares to get attention. "Use the same old data," he urged, "there is nothing new...Every sentence in the media means someone pauses before lighting up." Blum of the U.S. showed familiar parodies of cigarette advertisements, urging participants to "ridicule and laugh the pushers out of town." Daube of Australia talked about using "creative epidemiology" -to get media attention--new twists 1 TIMN 448680
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on old data. Stellman of the American Cancer Society disclosed mortality and smoking data among nearly 8,400 deceased women in the female population of 677,000 in the second major ACS study which began five years ago. He said the study shows intensity of smoking plays much the same role in women as in men, and that increasing death rates among women for lung cancer and other ailments are due to increased smoking by women in past decades. Stellman did not present any mortality data related to ETS exposure, although questionnaires used in the study attempted to quantify it. A Mobil Oil company researcher reported a tabulation of a year's medical insurance bills among 952 male employees. "Unexpectedly", he said, the heavy smokers cost least. The average tab: $622 (US) for light smokers; $564 for nonsmokers; $521 for moderate smokers and $463 for heavy smokers. His conclusion: Medical expenditures depend more on health consciousness than on health status. Predicting that reduced trade barriers in Japan, Korea and Taiwan will result in more female and youth smoking, Massachusetts activist Gregory Connolly accused multinational cigarette companies of "softening up" new markets with bootlegging. He said tobacco should be excluded from bilateral trade negotiations. U.S. attorneys Banzhaf and Daynard discussed product liability litigation, the latter predicting trials of "some" cases next year, but regretting new legislation in several states which he said would do away with suits against manufacturer. Both men outlined various theories of liability and ..urged delegates to bring lawsuits which cari get media attention and "free" anti-tobacco publicity. They also urged employee suits against employers to gain smoke-free workplaces. Sigimura, a noted scientist, may have disappointed some listeners when, in addition to reporting that certain heterocyclic amines may be the potent carcinogens in cigarette smoke, they are also present in charred foods, and although most delegates wish to abolish smoking, he thought it more important to try to identify the problem. U.S. researcher Ernst Wynder urged multiple approaches to disease prevention, saying low tar cigarettes are better with respect to lung cancer but cholesterol control is better for heart disease. He noted a survey of 8-10-year-old youngsters in New York among whom only two percent smoked, 11 percent were more than 20 percent overweight, 28 percent had high cholesterol and 32 percent had poor recovery time from exercise. - 2 - TIMN 448681
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A respectful audience listened to presentations on "passive smoking", including a new study by Lam of Hong Kong Chinese women. He concluded that active and passive smoking together account for 75 to 80 percent of the women's high rate of lung caner, and said the rest may be caused by their parents' smoking and by diet. He also said a high rate of adenocarcinoma among the nonsmokers may be caused by the different composition of sidestream smoke. Read of Calgary, Canada, described plans for smoke-free Olympic winter games in that city. He said outdoor athletes are bothered by tobacco smoke around slopes. But he agreed with a member of the audience who questioned why efforts on behalf of athletes are not directed instead to tackling drug and alcohol abuse problems. Meetings on "smoking control legislation" featured an array of 16 leading activist speakers who offered little new information but who did inject moments of, invective and confusion. Estimates of the "social costs" of smoking were offered, for example, at anywhere from $.82 to $2.17 (US) per packet, depending on who was speaking. One scientist reported discovery of asbestos in cigarettes. An attorney said the 1986 U.S. Surgeon General's report contains "overwhelming intellectual firepower." A Canadian said the tobacco industry employs a "catalogue of deception" and, with reference to industry observers present, remarked that tobacco companies do not send their brightest people overseas. "You will meet some phenomenally stupid individuals," she said. Another speaker welcomed the delegates and the "p,imps and mercenaries from the tobacco industry." A session on smoking control in developing countries produced reports on smoking and illness in China, India, Thailand, Nepal, Venezuela and Saudi Arabia. Among other observations: The most popular cigarettes in China and Thailand are high in tar yields and there are few imports; problems such as malaria and undernourishment are commanding most attention, but smoking health education is gaining; many political leaders smoke and that induces inertia. The smoking cessation topic was dealt with more lightly than at previous World Conferences. One U.S. official here did report that surveys show a declining percentage of Americans who say they wish to quit smoking, and that most of those who do quit do so independently of any help. A U.K. researcher described a study showing that quitters who relapse cite stress as the reason more often than craving. And a U.S. physician, with an apparent contradiction, advocated that authorities need to be convinced of 3 TIMN 448682
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nicotine addiction, yet observed that 93 percent of quitters do so quite easily. Chairing a session on children, Bjartveit of Norway said until recently the tobacco industry has been winning the battle "over our chilren's future." Speakers who followed reported studies showing many kinds of motivations for youth smoking. Virtually none mentioned cigarette advertising,. but several gratuitously recommended its prohibition. Smokeless tobacco was discussed at one session late yesterday. An Australian report noted that two states have required that chewing tobacco can only be obtained by doctor's order, blaming the sinister role of U.S. producers f.or its presence. A U.S. speaker indicated that smokeless tobacco use is increasing as the social acceptability of smoking declines. At another late session, a Dutch delegate complained of lack of antismoking action by his government, saying that information and education alone cannot produce a smoke-free society, and that government support is needed to silence.the tobacco industry. And-at another of the rare "scientific" sessions, observers reported rather severe audience criticism of the quality of work which lay behind reports on various ailments assertedly associated with smoking. Old anti-tobacco hand M.A.K. Russell of U.K. put in a plug for nicotine replacement (including gum) and said he ..was "depressed by the tone of the conference because it stresses prohibition rather than dealing with nicotine dependence:" Special note should be taken that Judy Knapp, of the Minnesota Coalition for a Smoke-free Society, suggested that hospitals could replace revenues from prohibited cigarette vending machines by replacing them with condom machines. A descriptive list of current WHO monographs on "Environmental Carcinogens" was distributed in the conference press room. The summary of one volume stated that "The carcinogenic potential of passive smoking (exposure to environmental tobacco smoke, ETS) has been the subject of many recently published and on-going epidemiological studies. The results, however, have not been consistent..." Evening papers reported nothing about the conference, but one of the longest morning stories reported extensively on findings by Japanese researchers that nonsmokers blink their eyes more frequently than smokers in the presence of smoke. 4 TIMN 448683
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Sankei daily wrote up the Banzhaf demand (see the Nov. 9 report) to oust industry delegates: "The secretariat of the conference were alarmed by the fierce look of the person because they had originally prepared to accept participation of pro- smokers or people from tobacco industries and even thought about setting up a panel discussion." The account said that at an urgent meeting following the Banzhaf outburst, it was decided to exclude industry delegates at the conference scheduled in Perth in 1990. Sankei's Teheran correspondent reported that the Iranian parliament adopted a resolution calling for drafting of legislation to prohibit import, cultivation, production and distribution of tobacco. The dispatch noted that the Islamic nation bans drinking, but predicted that any tobacco legislation would be controversial. Another paper_ran two paragraphs on an assertion by Japan's Hirayama that heavy smokers are 2.4 times more likely than nonsmokers to die of Alzheimer's disease. The story -said Hirayama based his finding on a dose-response study of 180 persons between 1966 and 1982. Quantities of handout material are available daily to conference participants--antismoking leaflets, book promotions (perhaps enhancing royalties for certain authors who are delegates), and promotional documents for Nicorete chewing gum, Nicorettel material is the most abundant among them. SPECIAL REQUEST: Your reporting team urgently needs copies of any conference-related news stories which may be appearing in your country. Please forward to us not later than 3 p.m. Tokyo time on Thursday, Nov. 12. Our FAX number is (03) 505 4229. Our TLX number are J 24633 (IFTBJ) and J 24555 (IFTBJ). Our telephone is (03) 505 4228. All.told, presentations of more than 200 papers and speeches are scheduled at this four-day conference, including many concurrent sessions. To keep you advised of highlights, the INFOTAB team includes monitors from the national manufacturers' associations in Australia, Japan, New Zealand, U.K., U.S. and West Germany, and from BAT, Philip Morris, Reemtsma, R.J. Reynolds and Rothmans. This concludes their report for today. 5 TIMN 448684
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4t Tokyo, Nov. 12--The Sixth World Conference on Smoking and Health concluded today with a package of recommendations approved by acclamation. Takeshi Hirayama of Japan drew the chore of presiding at.the final session. With a change of name, as reported earlier, the Seventh World Conference on Tobacco and Health was scheduled for Perth in early 1990. Australia's Michael Daube, who will be chairman, announced that tobacco industry representatives will be excluded. Delegates resolved, among other things: That tobacco promotion should be banned and multinational company activity should be curbed in developing countries. That environments should be smoke-free and both smokers and nonsmokers should be educated on health effects of ETS. That tobacco control legislation must be sought, with scientific and medical organization support, that tobacco victims must sue producers and governments must be reimbursed for medical costs of smoking. That smokeless tobacco must be banned where it is not established. That social costs of smoking must be assessed, tobacco taxes increased, and higher insurance rates must be charged to smokers. That each country's delegates should seek more support by health ministers for a larger, more dynamic WHO program on tobacco or health. That all tobacco advertising, promotion and sponsorship must be banned everywhere, and all sporting events must be smoke-free. Earlier, selected spokesmen summarized nine major topical discussions at the Conference: Smoking Cessation (Kunze of Austria): Presentations covered pharmaceutical (nicotine replacement), mass media and motivational approaches. Physicians need more training to integrate cessation into therapy for tobacco-related ailments. There is no miracle cure for smoking. 1 TIMN 448685
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Smoking Control Media Strategies (Daube of Australia): Two themes emerged--the use of unpaid media and the encouraging reception by the media. Larger sums of money must be devoted to media campaigns along with greater opportunism in unpaid media activities. A new professionalism is emerging in use of the media. Journalists are constantly on the lookout for news. Our job is to help them out. Smoking and Economics (Teoh of Malaysia): Beware of short- term gains for farmers, who gain little of the economic benefit of tobacco, compared with its long-term health costs. Be careful not to make imprecise claims, which can be refuted by economists and tobacco interests, about social costs. Taxation, though'it often hits poor smokers, can reduce smoking but it takes time because of addiction. Government money from tobacco is no better than from opium, from which colonical powers derived income. Eliminate the new colonialists, the multinational corporations who profit from the drug, tobacco. Smoking Control Legislation (Banzhaf of the U.S.): We've come a long way, baby, in 20 years since the first conference. Look at the controls in country after country. Workplace smoking bans are the most important factor in persuading smokers to quit. Push for higher taxes, but countries, like people, can become addicted. Keep suing. Adopt the slogan, "Sue the Bastards," and get at those who sullied an otherwise perfect conference. Don't use the expression ETS--perhaps involuntary smoking or respiratory rape. Passive Smoking (Asano of Japan): Summarized the types and sources of the papers which had been given, leading chairman Hirayama to say that passive smoke is an historic event, changing the smoking issue from personal.hygiene to a problem of public health. Workplace nonsmokers must be protected, he insisted. Nonsmokers' Rights (Weigum of the U.S.): Cessation activities are a waste of time; they can't keep up with industry recruiting. The energy, enthusiasm, people and politics of the movement must be combined with the professional expertise, money, range of programs and activities of the -major health organizations. The tobacco industry is most vulnerable in public policy areas. Together, we are winning the war. Smoking and Women (Mackay of Hong Kong): Small but increasing in underdeveloped countries, rising in developed countries. Lung cancer rates correspond. Promotion directed to women particularly vicious. Successful intervention rates with pregnant women give hope. Recognize and include the problem in all antismoking programs. 2 TIMN 448686
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Smoking and Children (Bjartveit of Norway): Environmental factors persuading children to smoke are peer pressure, parent approval, school environment and school achievement. Successful intervention programs were reported. There can be no peaceful coexistence between health authorities and' the tobacco industry. Children are in the middle. "We shall fight you because we don't want you to have our children." Smoking Control in Developing Countries (Dalenz of Bolivia): A central committee should be established to coordinate programs in developing countries. Many more will be present at Perth. Mainichi daily newspaper reported this morning on a disclosure by Sugimura, president of Japan's National Cancer Center, that 63 percent of the executive office staff are smokers, the same as the nation's adult male average. "Making a lame excuse," the story said, Sugimura stated that "there are no doctors or scientists in the executive department." The paper also reported that delegates from eight countries got together last night and decided to form a worldwide antismoking organization ("WASH") by 1990. Ten of the movement leaders will fly west tomorrow to Kita- Kyushu for a kind of post mortem, mini-"International Symposium for a Smoke-Free New Century," where they will give speeches for two days to any audience whose members wish to pay $22 admission, or $51 with dinner included. The entourage includes Daube, former ASH director in U.K. and now with the Western Australia health department; Kendal, who describes herself as project director for "Glasgow 2000"; Gaiser, head of the cancer society in Auckland; Fairbanks, with the Indian Health Service in Arizona; Carlson, head of GASP in New Jersey; Shimp, who runs an antismoking counseling company called Environmental Improvement Associates in New Jersey; Wigum, of'the Association for Nonsmokers' Rights in San Francisco, and Hirayama, the Japanese epidemiologist. All of the talks will be similarly propagandistic to those delivered this week in Tokyo. Kita-Kyushu is the city announced four years ago as the venue for the Sixth World Conference, later reportedly rejected by the city fathers. 3 TIMN 448687
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Preliminary Appraisal INFOTAB will provide in due course more formal synopsis of the conference proceedings and implications. Meanwhile, the monitoring team has met and noted, after discussion, some immediate impressions. Evolving since the first conference 20 years ago, the focus has distinctly receded from the primary smoking and'health issue and has been replaced with the ETS issue. Similarly, the shift has been away from science and into politics. The approaches, activities and emphases of the world antismoking movement leaders indicate an emerging professionalism. They are increasingly efficient and effective. They are ahead of their'industry counterparts in long-range planning, setting the public affairs agenda, and appreciating the long-haul, long-march nature of their mission. Divisions and misunderstandings remain to some extent between scientists and activists in the movement. Its radical fringe, while occasionally provocative, is tolerated and used. While the movement is and should be identified as an elite establishment, it is making headway in the western world particularly, increasing pressures on smokers with social and economic restraints, and on the industry through lobbying and litigation. It especially takes advantage of industry advertising and promotion techniques and of a probable lack in some industry quarters of a full understanding of the movement's potential. And so, with no regret and a'deep bow, your INFOTAB team in Tokyo says !'sayonara." 4 `rI1dIN 448688
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6. Preliminary appraisals by a member of the monitoring team from Australia and by the monitoring team as a whole TIMN 448689
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i REPORT 6TH WORLA CGNk''ERENCE ON SM4RING XIh HSP;LTH TOKYO 9 - 12 NOVEMBEFt 1987 I Introduction Reports were dispatched from Tokyo each day of the conference so it is not proposed to canvass in detail the speeches or speakers. Rather it is proposed to offer some observations and note some of the more significant points to emerge. Not everything said at the conference was new, in fact very little was new at all but the conference should be seen by the tobacco industry as a benchmark of where the anti- smoking movement is at present and a point at which to evaluate its own position. It highlighted where their activitias will focus in the future and therefore provided the tobacco industry with an insight into what it should be doing to combat them. Points to Emerge Three major points emerged: 1. The anti-smoking movement displayed at the conference a new maturity and this has resulted in an extremely professional approach to the issue. Gone are most of the rathag radicals and if they were there, they were there in their suits along with the professionals. While they recogttised 4 role for the more extreme elements, it was cleai that these groups should be carefully controlled and used as part of an overall strategy. 2. The emphasis is now almost totally political with the target the tobacco industry. Nua:erous spealters said, that smoking cessation and control program:~ were a waste of time, that the movement should f orget about scientific research and that the focus should be on tobacco companies and their executives. 3. The anti-smoking movement is in this for the Lorig haul. They have a long term plan and have the patience to implement it totally. If they don't succeed on one aspect this year, they are happy to have a shot at it again next year and will keep going until victory is theirs. TIMN 448690
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The leaders of the anti-smoking movement are efficient and effective. This is evident in the number of victories they have scored in Australia in recent times. They are ahead of the tobacco industry in long- range planning and are now setting the public affairs agenda. The Anti'Smoking Movement's Immediate Focus Given the broad range of anti-gmoking groupsF there are likely to be numerous fronts for attack and numQrous subjects chosen. However three areas were identified more than the others. Not surprisingly they were: 1. Environmental Tobacco Smoke 2. Economic Issues 3. Focussing attack at the State and Local Government levels. 1. ETS It is clear that the focus has shifted away fror the primary health issue and on to that of ETS. The anti-smoking movement was floundering until a decade ago when the E'S'S argument was hit upon. •It provided new li.f e to •the movement andd opened up a whole new range of issues on which campaigns could be mounted, such as laws restricting public smoking. ! It r.an be expected that the antis will rely on several pronouncements by Hirayama at the conference such as; . the weight of evidence against ETS has increased and ETS is likely to have an effOct on e& broader range of human conditions. He is convinced ETS is carcinogenic to humans and theref ore more smoking contro7l programs arq needed worldwide. 2. ECONOMIC ISSUES Considerab]•e emphasis was placed on the lack of competent economists active in the anti-smoking' movement at present and the need for them to be recruited. Participe.nts :vere urged to lodge submissions or. the "costs" of smoking to every inquiry possible, particularly those cor.3ucted by governments. TIMN 448691
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3. FOCUSBINa ATTACK A7,' THE, 3TATE A,N7a LQCP,L GOVMiNNiEtVT LEVELS The observation was made that the tobacco ind.ustry was most vulnerable at the public policy area, particularly at lower levels of government. is where the effort, activities and resources should be concentrated. This 4. GENMAL There was a call for the antis to become more controversial, f ollowing a lack of success with the reasonable approach. i The need to involve scientists, doctors and health professionals in political activism was expressed, i.e. the direct lobbying of politicians. Education programs should be dispensed with, they are useless and a waste of scarce resources. Papers which dealt with smoking initiation fail.dd to identify advertising as a significant factor, instead, the following were cited: • peer pressure was predominant • parental approval . school env{ronment . school achievement Smoking cessation programs, while not receiving unanimous support, still received considerable attention. Significantly, one-third of the papers presented on this subject took a pharmaceutical approach, i.e. nicotine replacement, sometimes combined with other methcds. Legal action will continue to be mounted wherever an opportunity presenta itself, not only on ~he primary issue (product liability) but on anything that may arise. "Sue the Bastards" at every opportunity. The use of the media by the anti--smoking movement, both paid and unpaid, has become more profesmioAal. They have become adept at capitalising on events,which might occur out of the blue, eg, Yul Brynner ad ban and have taken an extremely professional approach with paid media, eg, researching massages before publication and evaluation of public opinion shif ts af. terwards , Great importance 67as placed on the use of research in framing and evaluating media campaigns. TIMN 448692
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CONgIDEfiATIQNS Fo23 TI"iE TOBACCO INDUSTRY 1. Greater need for long term planning in the tobacco industry and a movement away from the "knee-jerk" and "ham-fisted" approach to issues. 2. There is a need for a more professional approach to communications with a greater use of research in formulating and evaluating communications campai_gn$. 3. It is now more important that marketing departments of companies consult more with and take advice from corporate affairs departments. 4. Greater resources are needed if the tobacco industry is going to be able to at least hold the line on the numerous f ronts of attack, particularly at the state and local government level. David Bacon 17 November 1987 TIMN 448693
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We can expect many more stories based. on "cree.ti;ve epidemiology", such as those••now coming from WA on the number of organs removed as a. renult of sraoking related diseases. Groups were urged to "rework *he old figures" to gain headlines. There was strong recognition that access to the editorial columns by the tobacco industry was now limited. An insight into the cLrrent thinking of the anti- smoking movement is provided in the three attached documents; "A worldd strategy agai.r.st the source of the tobacco problem" by Arthur Chesterf ield-fi'vans "Szmoke Fighting" from the American Cancer Society t "Smoke Signals" from the American Cancer Society A copy of the Recommendations of the 6th World ' Conference is also attached. TIMN 448694
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Observations and Recommendations from the Monitoring Group at the 6th World Conference, Tokyo, November 12, 1987 1. Attention was drawn to the crucial influence of the medical profession which gives credibility to the anti-tobacco activists. Industry should maintain contact with leading doctors and provide, them with factual information on tobacco issues. 2. All pronouncements from the antis which reduce their credibility should be exploited. 3. It was apparent that the Conference did not believe that "no smoking" was achievable by the year 2000. 4. Youth The Conference avoided any reference to the previously oft-repeated allegation that cigarette advertising motivates smoking among the young. The subject was treated as an emotional appeal: "Don't let them get at our children." (Bjartveit) 5. ETS The issue was treated with a contempt for scientific findings which might otherwise hamper their campaigns. Even doctors said: "We don't need more science, facts are no longer relevant." They feel they have identified the way to reduce smoking and ETS is the vehicle. The term "enforced smoking" proved very popular and at the extreme end John Banzhaf coined the term "respiratory rape". ./2 ,rIMN 448695
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Page 2 As both the medical profession and the activists gain confidence and their coordination increases, politicians will take account. Therefore, industry should commence, or continue to have, dialogue with members of parliament to present them with objective scientific findings. This should also be pursued at the lower legislature (country, town). 6. Smokeless tobacco Heavy emphasis was placed on this subject and repeated calls were made to get the product banned. Probable reasons: a) If the antis can achieve the prohibition of smokeless tobacco, they believe attacks on the legality of other tobacco products could succeed. b) The presence of smokeless tobacco deprives the antis of the ETS issue. c) The antis fear that more cigarette smokers will switch to smokeless tobacco as the attacks on cigarette smoking are intensified. In countries where substantial quantities of smokeless tobacco are used (e.g. Sweden, USA) and where it is claimed that anti-smoking campaigns have adversely affected tobacco sales, these claims usually refer to cigarette volume only. If smokeless tobacco volume is included in the statistics, there is often little or no evidence that total tobacco consumption has dropped. ./3 ,,, TIMN 448696 1
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Page 3 7. Social "costs" It was apparent that the Conference felt uneasy about putting figures to alleged social "costs" of smoking. ("We don't have enough economists, be careful of social costs".) 8. Smoking Cessation Hardly any reference was made to the great majority of people who have quit smoking without professional help. This point should be emphasised by the industry, particularly in view of the fact that the theme of the 1988 US Surgeon-General's Report will be "ADDICTION". 9. Product Liability and Litigation US attorneys Banzhaf and Daynard discussed product liability litigation, the latter predicting trials of "some" cases next year, but regretting new legislation in several states which he said would do away with suits against manufacturers. Both men outlined various theories of liability and urged delegates to bring lawsuits which can get media attention and "free" anti-tobacco publicity. They also urged employee suits against employers to gain smoke-free workplaces. 10. Long-Term Planning Since it was recognised that the anti-smoking movement displayed an increasing professionalism and coordination in their activities, and also appreciated the long-haul nature of their mission, it was considered imperative that industry develop long-term plans for the main issues, notably ETS. It was suggested that "issue advertising" form part of these plans with a long-term commitment to adequate funding. HGV/nvm TIMN 448697 November 25, 1987
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7. Inventory of hand-outs collected from the Press and Exhibition rooms TIMN 448698
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Hand outs at the 6th World Conference, Tokyo Australia - B.U.G.A. U.P. (Billboard-utilising graffitists against unhealthy promotions): Sheet showing colour prints of defaced billboards B.U.G.A. U.P.: "AD children - 60 pages EXPO", a self-defence course for B.U.G.A. U.P.: "Four Years On" (description of their origins and methods, the spread of its philosophy and tactics, examples of its social and political effects 4 page pamphlet, 1987) "The Clean Air Clarion": Non-Smokers' Movement of Australia - 20 pages (Sep. - Nov., 1987) "A World Strategy against the source of the tobacco problem" with Strategic Planning Chart - 6 pages - A. Chesterfield-Evans, Non-Smokers' Movement of Australia (Nov. 1987) Bangladesh - "Smoking in Bangladesh", N. Islam, President ADHUNIK - 10 pages (1987) Canada - The XV Olympic Winter Games Calgary '88: Fresh Air Policy - 6 pages (Nov. 1987) 12 page pamphlet on City of Vancouver Health By-Law (May 1986) France - Two 6-page pamphlets (in French): (Caisse Nationale de l'assurance, Maladie des travailleurs salarigs) a) Chronic Bronchitis b) Tobacco and the Respiratory System Indonesia - "Action on Smoking", Indonesian Cancer Society - 8 pages in English (Nov. 1987) ./2 '~~~-N 44$699
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Page 2 Ja an 1. Abstract (and tables): "A Research on Smoking of Pregnant Women" (4 pages - B4 format) - ITARU KOBAYASHI, Ph.D. Dept. of Maternal and Child Health, School of Health Sciences, Faculty of Medicine, University of Tokyo no date but estimated Sep. 1987 2. Teaching Material for Maternal and Child Health Education (envelope) (Mothers' & Children's Health & Welfare Association, Tokyo) 3. Osaka Cancer Prevention Campaign 1987 - Aims & Objectives - 4 pages 4. Resolution to protect the Health of Asian Children - 1 page (Women's Action on Smoking, Japan) 5. Various non-smoking stickers 6. Programme of International Symposium for a Smoke-free New Century, Kita-Kyushu, November 13-14, 1987 - 2 page brochure (Kyushu Anti-Smoking Society) 7. Japanese Women's Action on Smoking - 10 pages 8. "Topics in Japan" - 42 pages of anti-smoking press cuttings 1987 in English) Tobacco Problems Information Center 9. Recommendations to the Japanese Government (11/11/87) by Yoshio Isayama, President Lawyers' Organisation for Non-smokers' rights (1 page - B4 format), 10. Report on No Smoking Movement in Shizuoka Prefecture, Japan (Nov. 6, 1987) - 8 pages with tables 11. Press release advertising "Great Expectorations" by Simon Chapman and how to order it in Japan,- 1 page 12. Large anti-smoking poster (in Japanese) (Kinki Council on Smoking and Health and Osaka Cancer Prevention and Detection Center, Japan) 13. Various English-language newspaper cuttings from Japan ./3 TIMN 448700
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Page 3 Malaysia - "Organising a National No Smoking Day" (Ideas for a campaign), Dr. Teoh Soong Kee (Education and Research Association for Consumers) and Wong Wai Leng (IOCU, Penang) - 25 pages in English (Nov. 1987) Norway - "Smoking Control in Norway", National Council on Smoking and Health (Bjartveit) - 4 page pamphlet in English (Nov. 1987) Sri Lanka - "Health Hazards of Tobacco Smoking", Dr. W.A. Karunaratne, National Federation on Smoking & Health - 27 pages, March 1987 Sweden - "Vigor" (Swedish Health), National Board of Health and Social Welfare - 24 pages in English "Tobacco Control in Sweden", National Board of Health and Social Welfare - 16 pages in English (1987) "NICORETTE" - several booklets on how/when to use this nicotine chewing gum Taiwan - "A Study of Sociopsychological Origins of Smoking Behavior", Institute of Public Health, National Yang-Ming Medical College - 16 pages in English (Nov. 1987) U.K. "Project Smoke-Free": NW Regional Health Authority - 8 page newsletter (April 1987) "Glasgow 2000": 4 page newsletter (Summer 1987) Health Education Council: Women & Smoking - A handbook for action (advertising pamphlet only) "The Name of the Game": pamphlet advertising a 45-page report on "codebusting" by tobacco companies (from Project Smoke-free, NW Regional Health Authority) ./4 ,CIWIN 448701
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Page 4 U.S.A. - SMOKE FIGHTING (20 pages) and SMOKE SIGNALS (28 pages) Two brochures containing strategies to combat the tobacco industry. (Michael Pertschuk and Allan Erickson for the American Cancer Society) Laws on Smoking and Tobacco in New Jersey - 6 page pamphlet (New Jersey GASP Inc. and the American Lung Association of New Jersey) ASH pamphlet - 12 pages DOC (Doctors Ought to Care) Newsletter - 16 pages (Summer 1987) DOC - An Overview (6 pages) Pharmacologic Treatment of Tobacco Dependence (8 page Report from an International Congress, Nov. 3-5, 1985 in New York, edited by the Institute for the Study of Smoking Behavior and Policy, Harvard University) Annual Report 1986 from New Jersey GASP Inc. (including Achievements May 1986 - April 1987) - 8 pages Environmental Improvement Associates (A voluntary tax-exempt organization working to eliminate tobacco smoke as an occupational health hazard) - 8 page pamphlet, Executive Director Ms. Donna M. Shimp, New Jersey National Cancer Institute: "Smoking, Tobacco and Cancer Program - Year 2000" - 40 pages "Toward a Smoke-free Workplace" - A Handbook for the Business Community (24 pages - booklet) New Jersey G.A.S.P. A Reader's Digest reprint of "The Man Behind the Ban on Cigarette Commercials - John F. Banzhaf III" (4 page pamphlet) Anti-smoking pamphlets/sticker on MERIT cigarettes and COPENHAGEN Snuff (The Badvertising Institute, Bonnie Vierthaler) Dept. of Health & Human Services: Summary of Community Intervention Trial for Smoking Cessation - 8 pages (July 1987) ./5 TIMN 448702
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Page 5 WHO Press kit on World's lst No Tobacco Day - 7th April 1988 (62 pages) IARC (International Agency for Research on Cancer) (WHO): - 2 page pamphlet advertising 12 volumes on Environmental Carcinogens (methods of analysis and exposure measurement) with short descriptions of each volume content. Volume 9 is entitled "Passive Smoking". :.r HGV/nvm November 25, 1987 `TIMN 448703
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8. "A world strategy against the Source of the Tobacco Problem" including a strategic planning chart (A. Chesterfield-Evans, Australia) TIMN 448704
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A WORLD STRATEGY AGAINST THE SOURCE OF THE TOBACCO PROBLEM 6th World Conference on Smoking & Health, Tokyo, November 1987. Arthur Chesterfield-Evans, Non-Smokers' Movement of Australia, Box 6, Trades Hall, 4 Goulburn Street, Sydney NSW 2000, AUSTRALIA. Summary The Tobacco Industry is the source of the tobacco problem. Without its• media, marketing and political campaigning the smoking epidemic would have ended years ago. Smokers, most of whom have been recruited since the harmful effects of smoking were known, are merely the Industry's victims. Non-smoking groups have not been effective against the Industry. They must develop an information exchange network and a political strategy which aims to destroy the tobacco industry and which spans groups, states and nations. The strategy must be practical and it must be acted upon. Elements of the strategy are: 1. To recognise the Tobacco Industry as the source of the problem; 2. To seek a political solution: 3. To define a strategy composed of campaigns so that groups can adapt their tactics; 4. To create a formal network for coordination. ` A matrix is suggested which lists groups on one axis and campaigns on another so each group can define its part in the overall strategy. The Present Situation The belief that the industry is being beaten is not true enough. Tobacco consumption continues to grow in'the developing world, and though sales drop a few percent in the developed world, the Industry's profits keep climbing. The idea that the Industry is the source of the problem is not new - it was enunciated by Mike Daube and others (1, 2 , 3, 4) at the end of the 4th World Conference, but non- smoking activity has remained dominated by research meetings and the medical model - a focus on the victims. The non-smoking movement as a whole has been strategically flabby, without clear goals, without cooperation within itself and without actions to back its rhetoric. Protest groups such as BUGA UP (5) and Non-smokers' Rights groups have urged a more Industry-oriented approach and lobbyists such as Califano, Pertschuk and Sir George Young have fought it as a political war (6) . The bulk of non-smoking industry has had too much research and too many presentations which lead only to eminence for the researcher. We must look at our 'faite- etre' - to save lives. That means reducing smoking dramatically and that means a co- ordinated anti-industry strategy - now! The function of this Conference is of great importance. It is an opportunity which happens only once every 4 years. A meeting of this magnitude must not merely be individuals giving their results or ideas. This is fine when the outcme required is for individual practitioners to act alone, such as in discussing medical treatments or engineering designs. But when what is needed is a political action plan, a Conference must become a workshop to produce sufficient consensus for coordinated, directed and sustained action. This paper attempts to present a concept that will form the basis for such action. The Basic Requirement What each individual needs to contribute is the desire to help the world's health by reducing smoking and a willingness to be part of a coordinated network. The individual must pursue his or her own efforts but also contribute information, time and action to the network. In turn the individual would gain information and support from it. 1 TIMN 448705
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We must recognise that other individuals and groups will not necessarily approach the smoking issue from the same perspective, nor have the same priorities or methods. If what they are doing is likely to help our cause they are allies who must be respected and encouraged. We cannot produce a recipe and expect everyone to follow it but we can produce a general direction and strategy and encourage everyone to look for their own place in it and contribute as they can. Priorities Priorities will vary among non-smoking workers according to their culture, perspective or,job. But having struggled unsuccessfully with a victim-oriented model for years the new strategic directions suggested are:- 1. To identify the Tobacco industry as the source of the tobacco problem. 2. To recognise that smoking is a political problem that needs a political solution. 3. To develop and implement strategies with elements such that each group can see and discuss its function within the action framework. 1 4. To set up a worldwide network to coordinate the necessary exchange of ideas and information. The Industry as Renegade Corporations The identification of the Industry as the source of the problem involves both the conceptual step but also to convince governments that the Industry is a legacy of the unacceptable face of nineteenth century capitalism or 'Social Darwinism' where the achievement of a profit justified all unscrupulous actions. The political corollary of this is that the Industry must be isolated as renegade corporations - out of step with modern ideas of social responsibility, product liability and advertising honesty. Two important Canadian initiatives must be mentioned here. Firstly the 'Equal Treatment Campaign' which identified tobacco and nicotine as poisons which were inappropriately not on the Poisons Register. They should be given 'equal treatment' with other poisons with proscribed'advertising and labelling (7)., Secondly the RODDS group (Relatives and Friends of Dead and Dying Smokers) (8) which attempts to turn the anguish of relatives into political action against the Industry •and shifts the onus from the inadequacy of the individual who couldn't quit to the Industry that had spent millions to encourage initiation of the habit and 'retain its social acceptability., A Political Imperative The financial might of the Industry has defied all attempts to beat them in the publicity war, outspending all Australian Quit campaigns by approximately 100 to 1. The flaw in the Western legal system is that money is so important in victory that Tort law has not been able to sheet home the liability of deaths and the Industry which resisted health warnings but has now escaped liability, because of them. •Given the financial and legal situation only governments have sufficient power to defeat the industry and they will only do so if the Public Relations battle against the Industry has been won. Despite scepticism about governments, respect for the law ensures that what is enshrined in legislation becomes the benchmark for 'normal' behaviour. This is why non-smokers' rights legislation is so important. The Need for Strategies The concept of an Industry-oriented strategy is not new but in practice smoking campaigns have centred on individual smokers because the public still see diseases from an individual rather than an epidemiological perspective and because individual-oriented campaigns are politically easier. Government campaigns have been run to gain votes rather than seriously to affect sales. Health charities such as Cancer Councils and Heart Foundations have also been conservative, partly because of the nature of their illness- 2 TIMN 448706
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oriented academic management and partly because of fear of offending conservative corporate sponsors. Activist groups tend to choose their campaign priorities based on what seems the biggest problem or the most achievable object at a point of time. Rarely is this organised into an overall strategy and rarely do any of these groups cooperate in a strategic or even tactical sense. The Challenge of Sharing The challenge is to develop an overall concept of struggle against the Industry and to define for your own particular group or organisation a role within that struggle. It Is a matter of one's own struggle being seen as part of a wider context. Each organisation must support other organisations respecting others' roles and adapting their own in relation to the others. tkl THE POLITICAL BALANCE OF HEALTH The political effect of different groups depends on both their weight and their distance from the, fulcrum. Protest groups and non-smokers' rights groups have trouble with funding and information access but have great freedom to act without being shackled by need for governmental approval. They can thus have a catalytic function and serve to define the most radical pole of the political spectrum. If theyzare both vociferous arid radical it allows groups such as Health Charities or Medical Associations to take more aggressive stances without being perceived as radical. These more conservative bodies should not directly criticise activists but should if pressed say things like "We don't always agree with their methods but we can understand their frustration at the seriousness of the problem and the government's lack of action." Thus the two groups reinforce each other and then the Health Department can take a more radical stand within the government. The principle is that the government will not move far from the centre of the perceived political spectrum so by shifting a pole one redefines the position of the centre. Groups must develop networks in a number of ways. They must develop them geographically even if this means breaking out of an academic, bureaucratic or activist subculture. A first step is to exchange addresses and newsletters with all interested parties and then to have informal contact with all groups that would be interested in or could contribute to a local initiative. There is no substitute for personal contact. Contacts with groups further away should be with groups who have the same outlook or functions so that work is not done which merely duplicates that already done elsewhere. Political or media ideas can also be adapted to local circumstances. 3 TIMN 448707
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Groups not directly involved in the smoking issue but which are likely to be sympathetic can be targeted as a subculture and recruited as allies. Feminist groups are concerned about women and smoking, boy scouts or parent and citizens' groups will be interested in child smoking or cinema advertising, environmental groups will be interested in deafforestation, pesticides or air pollution. Service clubs are usually looking for interesting speakers and take a pride in overall community welfare. The important thing Is to tailor each presentation to the concerns of that group, so that the aspect of smoking that most concerns them is emphasised. The cultivation of journalists, the writing and timing of press releases, the methods of keeping statements short and quotable so that they will be included in news bulletins are all part of the general topic of 'media management' which must be addressed by any group seriously Interested in smoking control. Ultimately• the object is to influence legislators and the non-smoking cause must achieve this. Clearly the protest groups whose shrill criticism of government inactivity is so useful to attract media attention may not then be the best ones to meet the politicians face to face. But there must be a network with a sensitivity for timing so that other citizens or groups can make the approach. Too often, if an activist criticises a politician's inactivity the only person to approach the politician is an Industry lobbyist who reassures him that the activist is just a disorderly minority and no action is needed. Coordination is as vital as political and media action. The Strategic Matrix The last concept to discuss is the division of the action strategy into distinct campaigns. A matrix is suggested that lists non-smokers and allied groups on one axis and campaign priorities on the other. The resulting chequerboard allows individual to consider their campaigns as part of a wider concept and to ask themselves if they could cooperate with other groups or in other areas without overtaxing their resources. This matrix is only an initial one - the concept can be refined and new campaigns, tactics or allies added. The important idea is that we must all think beyond our own local efforts and recognise we can be part of a movement working in different ways but cooperating for better effectiveness and support to beat the greatest killer of all time. References: 1. Daube, M.: Summing Up 4th World Conference on Smoking and Health. 2. Gray, N. and Daube, M.: Guidelines for Smoking Control (2nd Edition), International Union against Cancer, Geneva (1980). 3. Chapman, S.: The Lung Goodbye (2nd Edition) IOCU (1986) 4. Warner, K, et al.: Circulation Vol 73, No. 2. February 1986. 5. BUGA UP; Box 80, Strawberry Hills, NSW 2012, AUSTRALIA. 6. Taylor, P.: Smoke Ring - The Politics of Tobacco , Bodley Head (1984) 7. Non-Smokers' Rights Association, Suite 308, Bloor Street West, Toronto, CANADA M5S 1W9. Press release. 8. RODDS, Ridge Road, Box 3020, Picton Ontario KOK 2T0, CANADA. 4 TIMN 448708
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COMBATTING THE TOBACCO CAMPAIGN LONG TERM MEDIUM TERM ACTIVIST GROUPS CONSUMER EDUCATION STRATEGIC OBJECTIVE GROUPS GROUPS OBJECTIVE FORMAL E)CCISE Very high taxation on 50% rise in next budget Publicise effects of tax rise widely to more Push excise ideas tobacco products. 'respectable' bodies through economics • and commerce school. maths textbooks etc. PACKAGING 1) Large Warnings Warnings 20% and new Document and publicise which brands and sizes Teach importance of 2) Sizes restricted so researched warnings kids smoke. • packaging and Image not affordable by every two years. Protest easy accessibili of vendin machines. children. Packets of more than 20 ci arettes• Demand listed additives. NON•SMOKERS'RIGHTS Non-smoking as the Public awareness of Protests, demos. Publicise effects of Emphasise individual - Planes norm with some passive smoking Test legal cases, passive smoking to rights not to be - Public buildings smoking areas, arguments. members. Emphasise assaulted. - Workplace additives. - Restaurants Transoort s to advertising contr Write letters of complaint about tobacco promotion 't~T1ON PROt , • Giveaways • Prepare material for legal cases to be run in Competitions Banned association with health groups. Media education prog. Sponsorships • • Document the farce of sel(•regulation. ramme in all schools. roducts Parallel • Satirise tobacco promotions. kids to analyse an Get p - Conventional ads Total ban on all Picket cigarette satirise advertising - Television tobacco promotion• giveaways. techniques. - Magazines - Encourage protests such - Outdoor • as coughing during Point of sale cinema ci arette ads. EDUCATION Comprehensive media School project in place Educate other allied Use press contacts Educate teachers on education in schools and by next school year. groups in facts about to disseminate inform- tobacco related diseas community projects. Advertising ban tobacco use and ation about effects of their and the effect-of essential to allow free promotion. smoking. own examples to' access to media. children. RESEARCH Orientated to Health 150% increase in health Be sure that research Support research Package research con economics, cessation economics research done is politically relevant to consumers and the end of the next budget• relevant. Debunk ind• e.g. pesticides etc. in tobacco oroblem. ustr •funded research. tobacco. CONSUMER BOYCOTTS Very strong on groups Attacking groups Produce lists of tobacco Urge boycotts of Emphasise individuals associated with involved in tobacco associated companies- tobacco associated power to withhold lh6 Industry. promotion. companies, dollars from amoral grouos. LEGAL Strong consumer Success of a product Run test cases or use injunctions (cheaper but protection and product liability suit• provide same publicity value), liabilitv action. INDUSTRY Identified as BAD. Isolate industry in the Continually attack industry. Executives resigning. community. - - oL c~ ,• • ' G cW rTINd•N 448709
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{'; PROBLEM - A STRATEGIC PLANNER COMMUNI'TY GOVERNMENT HEALTH MEDICAL INDIVIDUALS SPORTING GROUPS SPECIAL INTEREST DEVELOPIPIENT MEDIA CHARITIES COLLEGES HEALTH GROUPS: EDUCATION CAMPAIGNS ASTHMATICS, DIABETICS, CYSTIC FIBROSIS Put in submissions and enquiries to government Write letters to Ask for some of excise Speak out on health costs parliamentarians, for health promotion. Organise allies e.g. Write submissions to governments seeking Protest to Parliament. Service Clubs, Parents , stronger health warnings. a Citizens, Boy Scouts to fight tobacco litter Protest easy accessibility of vending machines to underage smokers. Use activia t techniques Use 'experts' and give Emphasise the strength of the passive smoking Demand smoke-free are Declare sports facilities Emphasise special of satire ea far as them publicity on passiv argument. wherever you go. smoke-free as much as problems and need for politically Possible. smoking effects. Press for smoke-free areas in immediate possible. , legislative protection. Get activitists 10 environment to set a good example. address Community groups. .bodies and circulate to other interested groups. Use media Znd Protest at continued legality of cigarette Speak to people involved Discourage sponsorship. marketing techniques promolions. and criticise sponsored Stop advertising at to gain attention and - Visit politicians, sports and promotional sports grounds. make campaigns less venues. Complain to ex ensive, politicians. Criticise tobacco industry campaigns. Watch acti Yist techniques Quit Campaigns/ Smoke Out Days. Allies recruited for all of these. Comprehensive medical Ask school groups to Emphasise detrimental education on pathology; educate children effect of smoking on counselling for quitting. Talk to people you fitness. Have medical courses come into contact with. dealing with tobacco disease as a whole. r i sions for maximum media and educational effect. Gradual switch to more politically relevant Use status as 'experts' subjects. - to gain media coverage for research on passiv smokin . State to shopkeepers why you do not buy certain products. Discuss with friends. Some financial support Find plaintiffs through Support activist for activist cases, medical profession, i nitiatives. Find laintifis. ~ TIMN 448710

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