[Senate Hearing 107-552]
[From the U.S. Government Publishing Office]
S. Hrg. 107-552
TOBACCO'S DEADLY SECRET: THE IMPACT OF TOBACCO MARKETING ON WOMEN AND
GIRLS
=======================================================================
HEARING
before the
OVERSIGHT OF GOVERNMENT MANAGEMENT,
RESTRUCTURING, AND THE DISTRICT OF COLUMBIA
SUBCOMMITTEE
of the
COMMITTEE ON
GOVERNMENTAL AFFAIRS
UNITED STATES SENATE
ONE HUNDRED SEVENTH CONGRESS
SECOND SESSION
__________
MAY 14, 2002
__________
Printed for the use of the Committee on Governmental Affairs
U.S. GOVERNMENT PRINTING OFFICE
80-599 WASHINGTON : 2003
___________________________________________________________________________
For Sale by the Superintendent of Documents, U.S. Government Printing Office
Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512-1800
Fax: (202) 512-2250 Mail: Stop SSOP, Washington, DC 20402-0001
COMMITTEE ON GOVERNMENTAL AFFAIRS
JOSEPH I. LIEBERMAN, Connecticut, Chairman
CARL LEVIN, Michigan FRED THOMPSON, Tennessee
DANIEL K. AKAKA, Hawaii TED STEVENS, Alaska
RICHARD J. DURBIN, Illinois SUSAN M. COLLINS, Maine
ROBERT G. TORRICELLI, New Jersey GEORGE V. VOINOVICH, Ohio
MAX CLELAND, Georgia THAD COCHRAN, Mississippi
THOMAS R. CARPER, Delaware ROBERT F. BENNETT, Utah
JEAN CARNAHAN, Missouri JIM BUNNING, Kentucky
MARK DAYTON, Minnesota PETER G. FITZGERALD, Illinois
Joyce A. Rechtschaffen, Staff Director and Counsel
Richard A. Hertling, Minority Staff Director
Darla D. Cassell, Chief Clerk
------
OVERSIGHT OF GOVERNMENT MANAGEMENT, RESTRUCTURING, AND THE DISTRICT OF
COLUMBIA SUBCOMMITTEE
RICHARD J. DURBIN, Illinois, Chairman
DANIEL K. AKAKA, Hawaii GEORGE V. VOINOVICH, Ohio
ROBERT G. TORRICELLI, New Jersey TED STEVENS, Alaska
THOMAS R. CARPER, Delaware SUSAN M. COLLINS, Maine
JEAN CARNAHAN, Missouri THAD COCHRAN, Mississippi
MARK DAYTON, Minnesota PETER G. FITZGERALD, Illinois
Marianne Clifford Upton, Staff Director and Chief Counsel
Kelly O'Brien, Senator Durbin's Staff
Andrew Richardson, Minority Staff Director
Julie L. Vincent, Chief Clerk
C O N T E N T S
------
Opening statements:
Page
Senator Durbin............................................... 1
WITNESSES
Tuesday, May 14, 2002
Cassandra Coleman, Chicago, Illinois, accompanied by daughter,
Nzingha Coleman................................................ 4
Dr. Elizabeth Whelan, President, American Council on Science and
Health, New York, New York..................................... 6
Charles King III, J.D., Ph.D., Assistant Professor, Harvard
Business School, Boston, Massachusetts......................... 8
Dr. Cristina Beato, Deputy Assistant Secretary for Health, U.S.
Department of Health and Human Services, Washington, DC........ 17
Diane E. Stover, M.D., FCCP, Head, Division of General Medicine,
and Chief, Pulmonary Service, Memorial Sloan-Kettering Cancer
Center, New York, New York, on behalf of the Amrican College of
Chest Physicians............................................... 21
Matthew L. Myers, President, Campaign for Tobacco-Free Kids...... 23
Alphabetical List of Witnesses
Beato, Dr. Cristina:
Testimony.................................................... 17
Prepared statement........................................... 89
Coleman, Cassandra:
Testimony.................................................... 4
King, Charles III, J.D., Ph.D.:
Testimony.................................................... 8
Prepared statement with an attachment........................ 74
Myers, Matthew L.:
Testimony.................................................... 23
Prepared statement........................................... 105
Stover, Diane E., M.D., FCCP:
Testimony.................................................... 21
Prepared statement........................................... 97
Whelan, Dr. Elizabeth:
Testimony.................................................... 6
Prepared statement with attachments.......................... 33
TOBACCO'S DEADLY SECRET: THE IMPACT OF TOBACCO MARKETING ON WOMEN AND
GIRLS
----------
TUESDAY, MAY 14, 2002
U.S. Senate,
Oversight of Government Management, Restructuring,
and the District of Columbia Subcommittee,
of the Committee on Governmental Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 10:07 a.m., in
room SD-342, Dirksen Senate Office Building, Hon. Richard J.
Durbin, Chairman of the Subcommittee, presiding.
Present: Senators Durbin and Carper.
Staff Present: Marianne Upton, Majority Staff Director;
Kelly O'Brien, office of Senator Durbin; and Andrew Richardson,
Minority Staff Director.
OPENING STATEMENT OF SENATOR DURBIN
Senator Durbin. Good morning. The hearing will come to
order.
I apologize for being tardy, but I was on the floor of the
Senate making a speech, deathless prose, which you will all get
to read in the Congressional Record at your leisure.
I am pleased to welcome you all to today's hearing before
the Senate Subcommittee on Oversight of Government Management,
focusing on ``Tobacco's Deadly Secret: The Impact of Tobacco
Marketing on Women and Girls.''
Since 1950, there has been a 600 percent increase in
women's death rate from lung cancer. Lung cancer is now the
leading cause of cancer deaths among women, surpassing breast
cancer. Cardiovascular disease is the number one killer of
women of all ages. More women than men die of stroke. Within
the next few years, researchers believe that more women than
men will die from chronic obstructive pulmonary disease, COPD.
How did we reach this point? For starters, all of these
life-threatening conditions have one thing in common. Smoking
is a key risk factor for developing these illnesses. And on top
of this, the tobacco industry has been pushing this deadly
product on women for decades. Numerous studies have documented
that tobacco industry marketing is a key factor influencing the
susceptibility to and initiation of smoking among girls.
As early as the 1920's, the tobacco industry started
targeting women, taking advantage of social trends to make
their point. Ads have been dominated by themes of social
desirability and of independence. They feature slim,
attractive, athletic, and famous models. They target women from
a variety of ethnic backgrounds. They make misleading health
claims.
In fact, we know that increases in smoking rates among
women and girls can be directly linked to these slick ad
campaigns and to historical increases in the level of
advertising aimed at females.
In 1968, Philip Morris launched its first woman-specific
brand of cigarette--Virginia Slims--with its ``You've Come a
Long Way, Baby'' campaign. Six years after the introduction of
Virginia Slims and other brands aimed at women, the smoking
initiation rate of 12-year-old girls had increased by 110
percent. And now Virginia Slims has launched a new slogan:
``Find Your Voice.''
Today, after decades of targeting lite and low-tar brands
to women, women are more likely than their male counterparts to
smoke lite and ultra-lite cigarettes, and women are more likely
than men to switch to these cigarettes.
We are here to counter years of marketing that have
resulted in addicting generations of women with the facts about
the epidemic of smoking-related disease among women. The
cigarette companies continue to target women using the same
themes in their advertising. New products are picking up where
lite and low-tar left off. The image of smoking being tied to
independence, weight control, sophistication, and power
continues in many popular women's magazines.
Unfortunately, still far too few voices are countering the
messages these ads send and still fail to inform women of
health risks of smoking. It has been shown that the number of
tobacco ads in magazines compared to the number of articles
about health risks and smoking has been astonishingly
disproportionate.
Recently, some companies have reduced their magazine
advertising budgets, yet advertising and marketing directed at
women and kids remains very high. The industry continues to
sponsor and support women's professional and leadership
organizations, domestic violence programs, and the arts. This
attempt of the tobacco industry to position itself as an ally
of women should not silence the critics. We need to do more to
set the record straight.
One place we can start is magazines, where many women get
their health information. Just open a popular women's
magazine--this one is called First For Women--and try to find
an article about the dangers of smoking--or, worse yet, note
the articles that actually do talk about women's health risks
and see if they mention smoking as a contributing factor.
In this women's magazine called First For Women, the
February 11, 2002 issue, this page talks about ``Five Ways to
Cut Your Risk of Stroke.'' They list: ``eat more veggies;
prevent fluid retention; drink moderately; get more calcium;
and take vitamin C.''
Is there something missing from this list? Not one of these
listed causes has anything to do with tobacco or smoking,
despite the fact that cigarette smoking is the key preventable
risk factor for stroke.
We have a fact sheet here that was issued by Family
Physicians, in which they talk about the risk factors for
stroke. Compare it to the women's magazine. Instead of veggies,
fluids, vitamin C, and calcium, they talk about diabetes, high
blood pressure, high cholesterol, smoking, heart disease, and a
variety of other specific medical problems.
Is this just a coincidence that this women's magazine would
not even mention not smoking as one of the things you can do to
avoid stroke?
Incidentally, this same magazine has a very nice ad on the
back for Doral cigarettes, showing a very sophisticated woman
in a leopard suit.
Perhaps as a result of this shortage of articles covering
the health risks of smoking, women do not have the facts about
the health threats they face and the ways to prevent them. Just
last year, a survey found that only 13 percent of women were
aware that lung cancer is responsible for the major of cancer
deaths among women. Last Sunday in Chicago and across the
United States, we had the ``Why Me Run.'' And thank goodness--
had a great organization, focusing on breast cancer. I have so
many friends who are involved in this, and they come forward
every year to focus on this tragedy, this scourge of breast
cancer across America.
Yet I am certain that you could stop virtually anybody
involved in that effort and ask them point blank, what is the
No. 1 leading cancer cause of death among women in America, and
they would get it wrong. It is lung cancer. Sadly, it is lung
cancer. And it is because women's magazines and other sources
of information for women just have not delivered this message.
Another survey revealed that women lack understanding of
the dangers of heart disease and stroke. Only 8 percent of
women in America believe that heart disease and stroke are the
greatest health threats to women.
This lack of understanding about the serious health threats
facing women needs to be overcome if we are to reduce the
burden of these diseases. Approximately 22 percent of American
women and at least 1.5 million adolescent girls still smoke,
with prevalence ranking highest among American Indian and
Alaskan Native women. Smoking among girls actually increased in
the 1990's, increasing from 27 percent in 1991 to 34.9 percent
in 1999. And despite increased knowledge of the adverse health
effects of smoking during pregnancy, estimates of women smoking
during pregnancy currently range from 12.9 percent to as high
as 22 percent. This has to stop. We need to do more.
We need to provide women with accurate information about
the health risks of tobacco. We need to ensure that the FDA has
the power it needs to regulate ads that make unfounded health
claims and ads that target kids. We need to make more resources
available to help addicted women quit. Smoking cessation
programs must be more accessible and affordable.
I hope that this hearing will be a wake-up call. I was told
that a hearing focusing the smoking-related health epidemic
among women would not get much attention from the media. That
alone is a perfect example of why we are watching lung cancer
rates among women on the rise.
I challenge the media and magazines across America to talk
straight with American women about this issue and to print the
real truth: Smoking is killing women.
I would like to welcome our first panel of witnesses.
Cassandra Coleman, of Chicago, along with her daughter Nzingha
are here. I want to thank you especially for making the trip to
Washington.
You may see in the back that there is a wall entitled
``Their Story.'' This wall was created by the National
Coalition for Women Against Tobacco. It was designed as a
documentary for the real consequences of tobacco use for women.
The wall will be in Illinois on June 5, and Ms. Coleman has
volunteered to participate in the project. Your courage will
certainly help others.
Nzingha, you are welcome to come up and join your mom at
the table.
Dr. Elizabeth Whelan, of the American Council on Science
and Health, is here, as well as Dr. Charles King, of the
Graduate School of Business at Harvard University.
I thank you all for coming. We are looking forward to your
testimony this morning.
It is customary in this Subcommittee--in fact, it seems to
be the rule--that we swear in all the witnesses. Therefore, if
I could ask you to please stand and raise your right hands.
Do you swear the testimony you are about to give before
this Subcommittee is the truth, the whole truth, and nothing
but the truth, so help you, God?
Ms. Coleman. I do.
Miss Coleman. I do.
Ms. Whelan. I do.
Mr. King. I do.
Senator Durbin. Thank you.
Let the record note that the witnesses, including Nzingha,
have answered in the affirmative.
I would like to ask you if you would now make an opening
oral statement, and if you could limit it to around 5 minutes,
your entire written statement will be made part of the record,
and we may have a few questions to follow from there.
Ms. Coleman, would you like to start?
TESTIMONY OF CASSANDRA COLEMAN, CHICAGO, ILLINOIS, ACCOMPANIED
BY DAUGHTER, NZINGHA COLEMAN
Ms. Coleman. Yes. Good morning, Chairman Durbin and Members
of the Subcommittee.
Let me begin by thanking you for holding this hearing and
for inviting me to testify here today.
My story is also the story of two wonderful children--my
13-year-old son Nijell, and my 10-year-old daughter Nzingha,
who is with me today.
My son's name means ``success'' in Swahili, and Nzingha is
named for a 16th century African queen who fought with strength
and courage to free her people from the slave trade. I never
realized how well I had named them until they helped me to stop
smoking, because Nzingha and Nijell truly helped me quit
smoking and helped free me from the addiction to nicotine.
Growing up as a young girl in Chicago, most of the women
around me smoked. One of my role models was my sister-in-law, a
tall, beautiful woman with long hair. She smoked, and she was
gorgeous. I remember thinking that I wanted to be just like
her.
I also remember watching television with my friends and
seeing all the sophisticated and sexy ladies on my favorite
programs; they all smoked, too. So everyone seemed to be
smoking cigarettes, and I could not wait to try them.
I was about 11 years old when I started smoking. My friends
and I would buy cigarettes from the vending machines. In those
days, a pack of cigarettes cost 50 cents. If anyone asked us
what we were doing, we just said we were buying them for our
parents.
I had problems carrying Nzingha when I was pregnant with
her, and she was born 5 weeks early. She had a low resting
heart rate and other problems that placed her in the intensive
care unit after her birth for 3 days. I remember seeing her
with so many tubes running into her tiny body. It reminded me
of a poster I had seen at Cook County Hospital just 4 days
before her birth; it warned pregnant women what smoking could
do to their children, and there was a picture of a little baby
with all kinds of tubes, just like the ones in my daughter.
Nzingha got out of the hospital and came home, but I kept
smoking.
In the months that followed, I had to take her to the
emergency room over and over with breathing problems. The
doctors told me she had upper airway disease. By the time she
was 6 months old, she was getting nebulizer treatments four
times a day.
This went on year after year, and the doctors told me to
quit smoking, but I kept on smoking.
When Nzingha was almost 4, I took her to the emergency room
with an especially bad asthma attack. They told me that her
condition was so bad that if I had arrived just 5 minutes
later, she probably would have died. A nurse pulled me aside
and told me, ``You are killing her with your cigarettes.'' But
I kept on smoking.
Instead of quitting, I put air cleaning machines around my
house and started smoking in the bathroom to try and keep the
smoke away from my kids. But that did not help much. When
Nijell was about 8 years old, he developed asthma and joined
his sister in getting regular nebulizer treatments.
And me? I just kept on smoking.
Then, a couple of years ago, I began to have breathing
problems of my own. I constantly felt weak, low on energy,
short of breath, and I developed a cough that made me feel like
there was always something in my lungs. When I went to get
checked out, the medical people could never find anything
really wrong with me. They would just tell me to slow down with
my smoking. I remember one of the doctors found out how much I
smoked and asked me, ``Do you want to live or die?''
Well, of course, I wanted to live, but I also wanted to
keep on smoking. So I did.
And I continued to feel worse and worse. Finally, in
January of last year, I was coming out of the bathroom after
having a cigarette when I saw my daughter curled up on her bed,
crying. When I asked her what was wrong, she said, ``Get away
from me. You stink. You are trying to kill me with
cigarettes.''
Imagine hearing that from your own child. I promised her
and myself then and there that I would quit smoking--and I knew
I needed help. I called Cook County Hospital and made an
appointment for the smoking cessation program. I went the next
week--and I was motivated. I kept seeing Nzingha's face, and I
knew I had to do it for her and for Nijell.
I had the help of a wonderful doctor, Dr. Arthur Hoffman,
who worked with me and taught me breathing techniques. He
taught me how to relax and how to resist the urge to smoke.
It was not easy, but I did it. I quit, cold turkey. I am
proud to tell you that after 25 years of smoking two packs of
cigarettes a day, I have not had a cigarette in a year, and I
am never going to have one again.
I am now working part-time in the smoking cessation program
at Cook County Hospital, trying to help others quit. I cannot
tell you how much better I feel every day. I had gotten to the
point where I could not even walk up the steps to my house
without difficulty. Now I can almost run up those steps. I
walk, I exercise more, and I do not have coughs and colds like
I used to.
My children could not be happier. Nijell and Nzingha are
doing so much better, and we have not been to the emergency
room in over a year. And because I have quit, the rest of my
life is going to be a lot longer than it would have been. That
means more years raising and loving my children, and more years
that I can help other women and girls avoid my mistakes.
We have to help the women, but it is the girls we really
have to talk to. I tell as many girls as I can that smoking is
a nasty and dangerous habit, and I tell them how hard it is to
quit. Sometimes in the smoking cessation program, I talk to
people who have abused hard drugs, and they have told me that
it is easier to kick a heroin or a cocaine habit than it is to
quit smoking cigarettes.
I also feel that young women need to resist the messages we
get every day about smoking from the media; whether it is a
soap opera or a magazine ad, images that make cigarettes seem
attractive only lead women to an early grave.
Again, Mr. Chairman, I would like to thank you for this
opportunity to tell you my story. I hope that together, we can
prevent many more women from becoming victims of tobacco.
Senator Durbin. Thank you--really--thank you for coming. I
will have some questions for you, and I will have a question or
two for your daughter, too.
Dr. Whelan.
TESTIMONY OF DR. ELIZABETH M. WHELAN,\1\ PRESIDENT, AMERICAN
COUNCIL ON SCIENCE AND HEALTH, NEW YORK, NEW YORK
Dr. Whelan. Good morning. I am Elizabeth Whelan, and I am
president of the American Council on Science and Health, which
is a consumer education and advocacy group in New York City. My
background includes master's and doctoral degrees in
epidemiology and public health from the Harvard School of
Public Health and the Yale School of Medicine.
---------------------------------------------------------------------------
\1\ The prepared statement of Dr. Whelan with attachments appears
in the Appendix on page 33.
---------------------------------------------------------------------------
I really appreciate the opportunity to address this
critical issue here today, related to women's magazines and
their dubious record in reporting on the dangers of cigarette
smoking.
Back in the mid-1970's, I began regularly contributing
health-related articles to the popular magazines. Since
cigarette smoking was then and is now the leading preventable
cause of death in the United States, I necessarily had to
include many references to smoking in my articles.
I was astonished, at least at first, that my articles were
regularly edited, and that the pejorative references to smoking
were taken out. Sometimes the articles were simply spiked. For
example, on one occasion, I was assigned a piece called
``Protect Your Man from Cancer.'' Of course, I focused on the
role of smoking in the causation of lung, bladder, pancreatic,
oral, and esophageal cancers.
The piece was returned to me with full payment, noting that
there were too many ads in the magazine that month to run such
a piece.
With this personal experience on the difficulty of placing
anti-smoking messages, I decided to take a very close
quantitative look at the extent of coverage--or the lack
thereof--of cigarette-related issues in these women's
magazines.
The first survey that my organization did was published in
the early 1980's. We examined health-related articles in 18
magazines dating back to 1965 and found that although the
magazines covered an array of health-related issues, there was
a near complete lack of coverage of smoking and health in most
of the magazines. Only one-third of the magazines--the ones
that did not take cigarette ads--covered this topic; the
majority failed to mention the facts at all.
This was happening at a time when there was an explosion of
information in the medical literature about the dangers of
smoking, so this finding was particularly disturbing.
Following that, we did surveys in the 1980's and 1990's,
and they only reinforced our findings. Incredibly, while
ignoring cigarettes as a health risk, these magazines regularly
warned women about remote or purely hypothetical risks such as
reducing your risk of cancer by keeping your alarm clock 3 to 5
feet from your bed so you are not exposed to the
electromagnetic field, or they would warn us about the health
risks of lead wrappers on wine bottles--but nothing about
smoking.
Surveys between 1997 and 2000 showed that there was a
gradual improvement, but still relatively little coverage of
smoking and health.
In 1997, ACSH found that cigarette ads outweighed anti-
smoking ads 6 to 1. In 1998, the ratio doubled to 11 to 1. In
2000, even with the addition of some anti-tobacco ads, the
ratio of cigarette ads to anti-smoking messages was 10 to 1.
In the year 2000, there were some 2,400 health-related
articles published; cigarette smoking and health represented 1
percent of that total.
These magazines are guilty both of omission and commission.
What I mean by that is they do not cover cigarette-related
diseases in general. But in terms of commission, they edit out
cigarette smoking mentions where it would otherwise typically
be. For example, Glamour's list of ``Eight Simple Health
Savers'' would include advice about taking calcium supplements
and working out, but no mention of smoking. Elle's ``New Year's
Resolutions'' made no mention of it, either.
Our last survey was in the year 2000, a year that marked
the beginning of the American Legacy anti-smoking ads and the
withdrawal by Philip Morris of cigarette ads from some 41
magazines. It will be interesting to see how these changes in
advertising affect editorial content. There is reason to
believe that things may improve. For example, just looking at
the 2002 issue of Self Magazine, it contains a two-full-page
article on smoking cessation.
But we should keep in mind also that the presence of
cigarette ads is just one factor--although an important one--in
explaining why magazines have not covered cigarette hazards
extensively. The topic of cigarette-related disease is a real
downer, and these magazines seek to entertain.
In conclusion, while the coverage may be improving--and
this is yet to be seen--we must recall the astounding blackout
on coverage demonstrated in our surveys between 1965 and 2000.
Women who today are in their mid-fifties are being diagnosed
with lung cancer, emphysema, and more, caused by cigarette
smoking. These are the same women who were reading magazines in
the 1960's and 1970's, magazines which withheld and distorted
the health risks of smoking while using their pages to promote
cigarettes as glamorous, sexy, and yes, even safe. Thank you.
Senator Durbin. Thank you, Dr. Whelan. Dr. King.
TESTIMONY OF CHARLES KING III, J.D., Ph.D.,\1\ ASSISTANT
PROFESSOR, HARVARD BUSINESS SCHOOL, BOSTON, MASSACHUSETTS
Mr. King. Mr. Chairman, distinguished Members of the
Subcommittee, my name is Charles King. I am an Assistant
Professor at the Harvard Business School, and I am here today
to talk about cigarette advertising to children.
---------------------------------------------------------------------------
\1\ The prepared statement of Mr. King with an attachment appears
in the Appendix on page 74.
---------------------------------------------------------------------------
Cigarette smoking is the leading cause of preventable death
in the United States. Reducing smoking among adolescents is
therefore a public health priority.
According to the Centers for Disease Control and
Prevention, (1) approximately 80 percent of adult smokers
started smoking before the age of 18; (2) every day, nearly
5,000 young people under the age of 18 try their first
cigarette; and (3) more than 6.4 million children living today
will die prematurely because of a decision they will make as
adolescents--the decision to start smoking cigarettes.
In 1998, the attorneys general of 46 States signed a Master
Settlement Agreement with the four largest tobacco companies in
the United States. The agreement prohibits tobacco advertising
that targets people younger than 18 years of age. Last year,
Dr. Michael Siegel of the Boston University School of Public
Health and I published a study in the New England Journal of
Medicine analyzing the effect of the Master Settlement
Agreement on the exposure of young people 12 to 17 years of age
to cigarette advertising in magazines. Our analysis was based
on magazine advertising before and after the tobacco settlement
by 15 major cigarette brands in 38 leading national magazines.
What we found was disheartening. The Master Settlement
Agreement appears to have had little effect on cigarette
advertising in magazines and on the potential exposure of young
people to these advertisements in the 2 years after it was
signed.
Our study showed that nearly all cigarette brands in our
sample reached large numbers of young people in the United
States with their magazine advertisements. ``Reach'' is a
standard measure of audience penetration used in media planning
and buying. It represents the percentage of a particular
population that has at least one opportunity to see an
advertisement in a magazine, not the percentage that actually
does see the advertisement.
Two years after the settlement, 11 of the 15 cigarette
brands studied still reached more than two-thirds of all young
people.
Could I have Figure 1, please? Thank you.
Comparing the reach of the three cigarette brands most
popular among young people--Marlboro, Newport, and Camel--with
the 12 other brands in our study, we found that on average,
these three brands reached a significantly larger percentage of
young people.
Figure 1 presents the trends in the average proportion of
young people reached by magazine advertisement for the three
cigarette brands most popular among young people and the 12
other brands from 1995 to 2000.
In the 2 years after the settlement, Marlboro, Newport, and
Camel on average continued to reach more than 80 percent, or
18.4 million young people.
We also found that the three brands most popular among
young people consistently devoted a larger share of their
magazine advertising budgets to youth-oriented magazines. For
the purpose of our analysis, we defined ``youth-oriented
magazines'' as those with more than 15 percent young readers or
more than 2 million young readers.
Could I have Figure 2, please? Thank you.
Figure 2 presents the trends in the proportions of
expenditures for magazine advertising of the three most popular
brands and of the other cigarette brands that were allocated to
youth-oriented magazines for 1995 to 2000.
During the 2 years following the Master Settlement
Agreement, Marlboro, Newport, and Camel continued to devote
most of their advertising dollars to advertising in youth-
oriented magazines.
For the 15 brands of cigarettes studied, overall
expenditures for advertising in the 38 magazines studied
actually rose 33 percent in 1999--the first year after the
settlement was signed--to their highest levels during 1995 to
2000.
Despite reductions in expenditures for cigarette
advertising in youth-oriented magazines in the second year
after the settlement, the overall level of exposure for young
people to this advertising remained high.
The decline in advertising in youth-oriented magazines in
2000 reflects in part Philip Morris' decision to discontinue
advertising in youth-oriented magazines starting in September
2000. Brown and Williamson also reduced its level of
advertising in magazines with a high proportion of youth
readers, but neither RJR Reynolds nor Lorillard substantially
changed its level of advertising in youth-oriented magazines
during the first 2 years after the settlement. Last month, a
California superior court began hearing a lawsuit alleging that
RJR Reynolds had violated the Master Settlement Agreement by
targeting young people with its advertising.
The voluntary policy adopted by Philip Morris does not
appear adequate to protect young people from substantial
exposure to cigarette advertising in magazines. If Philip
Morris had eliminated youth-oriented magazines for all of 2000,
we estimated that Marlboro would still have reached more than
57 percent of young people, or 13.1 million young people, with
its magazine advertising.
Finally, magazine advertising remains but one small part--
4.6 percent--of the tobacco industry's total marketing
expenditures of $8.2 billion in 1999. Other marketing tools
include coupons, direct mail, internet advertising, newspaper
advertising, point-of-sale advertising, promotional allowances
to retailers, sponsorship of public entertainment, retail
value-added programs (such as buy-one-get-one-free), the
distribution of samples and the distribution of specialty
items.
Many of these promotional techniques have previously been
found to have great appeal for young people. Yet most of them
are neither measured nor monitored outside the tobacco
companies. This makes the Master Settlement Agreement's
prohibition against targeting young people difficult to
enforce.
No effort to reduce smoking among young people will succeed
without a complete understanding of the entire marketing mix
available to tobacco companies and the ability to monitor it.
I would like to conclude with three main points. One, the
goal of the national tobacco settlement to reduce the exposure
of young people to tobacco marketing has not been met. Two,
although the settlement explicitly prohibits targeting youth,
young persons continue to be bombarded by cigarette advertising
in magazines. And three, magazine advertising represents less
than 5 percent of the total marketing and promotional
expenditures of tobacco companies. Yet most of the other 95
percent, which can also be directed at children, is not
monitored.
Thank you, Mr. Chairman, for this opportunity.
Senator Durbin. Thanks, Dr. King. I appreciate it. Let me
ask a few questions if I can.
Could I start with you, Nzingha? Would you mind if I asked
you a question or two?
Could you tell me how old you are?
Miss Coleman. Ten.
Senator Durbin. And where do you go to school?
Miss Coleman. Thomas Jefferson Elementary School.
Senator Durbin. And where is that located?
Miss Coleman. In Chicago.
Senator Durbin. South Side, West Side, North Side?
Miss Coleman. West side.
Senator Durbin. OK. So you are 10 years old--would that put
you in the fourth grade?
Miss Coleman. Yes.
Senator Durbin. A pretty good guess.
Do any of your fellow students at school smoke now?
Miss Coleman. Yes.
Senator Durbin. How many do you think?
Miss Coleman. I know there are two in my class who smoke--
--
Senator Durbin. You are not going to get them in trouble--
just give us the numbers.
Miss Coleman. There are two people in my class who smoke.
Senator Durbin. Two people who smoke in the fourth grade.
Were they smoking in the third grade?
Miss Coleman. Yes.
Senator Durbin. In the second grade?
Miss Coleman. Yes.
Senator Durbin. When did they start smoking?
Miss Coleman. I would say when we were in first grade.
Senator Durbin. In first grade they started smoking, and
they are still smoking. Are they boys or girls?
Miss Coleman. Boys.
Senator Durbin. Boys in this situation.
Do they ever talk to you at school about smoking and
tobacco and how dangerous it is?
Miss Coleman. Are you talking about the teachers?
Senator Durbin. Yes.
Miss Coleman. Yes.
Senator Durbin. They do. OK. And do you think they tell a
pretty good story about the danger of tobacco?
Miss Coleman. Yes.
Senator Durbin. How many of your fellow students in your
class do you think have problems with asthma?
Miss Coleman. Me and this other boy, Martel.
Senator Durbin. And how big is your class--how many
students?
Miss Coleman. I would say about 20.
Senator Durbin. OK. I learned when I went to the University
of Chicago Hospital a few years ago that the No. 1 diagnosis
for children in emergency rooms is asthma, which I did not know
and have since learned.
So as you have been growing up, you have been aware of the
problem that tobacco smoking can create for children with
asthma; is that right?
Miss Coleman. Yes.
Senator Durbin. OK. Do you realize what a big role you
played in your mom's important decision?
Miss Coleman. Yes.
Senator Durbin. You should be very proud that you gave your
mother the will to go through this very difficult change in her
life.
Miss Coleman. I am very proud that my mom quit smoking.
Senator Durbin. You should be.
Ms. Coleman, it is a tough addiction. You have talked
about, and I have seen it in my family, up close, and I realize
just how painful it is to go through it, but it takes that one
event, that one thing that just scares you into quitting. For
one of my parents, it was a diagnosis of lung cancer, and it
was too late. But you were fortunate in that Nzingha got you to
the point where you could change.
Ms. Coleman. Yes.
Senator Durbin. And you now work at the cessation clinic?
Ms. Coleman. Yes. I have been there since May of last year,
and I have another month. I am working on a grant right now,
and the grant will be running out.
Senator Durbin. How many clients participate in the smoking
cessation program?
Ms. Coleman. I would say that we make appointments for at
least 50 new people a month; at least 50 people a month come in
to get help for smoking.
Senator Durbin. And how do they find the program?
Ms. Coleman. From advertising; a lot of the pharmacists at
Walgreen's let them know about the program; and basically,
word-of-mouth.
Senator Durbin. You must hear a lot of stories about
women--and men, too, for that matter--who have gone through the
kind of experience you have where they make this decision. What
can you tell us about their experiences?
Ms. Coleman. I just recently met a young man, 33 years old,
who had had three heart attacks, and they were all due to
smoking. He never drank, never did drugs, he worked out--
everything. It was from smoking.
Since I have been there, I have also met a young lady, 32
years old, who has had three open heart surgeries, and they all
extended from smoking. She told me she was 27 years old when
she had her first heart attack.
I meet a lot of people with lung cancer.
Senator Durbin. Could I ask your daughter one last
question?
Nzingha, do you ever go to the movies?
Miss Coleman. Yes.
Senator Durbin. Do you ever notice some of the actors
smoking in those movies?
Miss Coleman. Yes.
Senator Durbin. I have noticed a lot of that, too. What do
you think about that?
Miss Coleman. I think it is making more people smoke.
Senator Durbin. It kind of makes it look more glamorous,
doesn't it?
Miss Coleman. Yes.
Senator Durbin. I think that was what your mom was saying
earlier, that when she got started, she thought it was a
glamorous thing to do.
Thank you for being here. We appreciate it very much.
Miss Coleman. You are welcome.
Senator Durbin. Dr. Whelan, your surveys have been going on
for a few years, and you have seen some changes. In fact, some
magazines that were the bad actors in days gone by have started
to change their policies in terms of the advertising and also
in terms of the articles that they publish concerning lung
cancer. What do you think is bringing this about?
Dr. Whelan. Well, I think that bringing attention to the
paucity of coverage over the years has quite frankly
embarrassed them. I think more and more readers are bringing
this to their attention.
This is a very tricky issue in the sense that I think we
have to separate what I call the omission versus the
commission. Starting with the commission, what is most
egregious is the example like the one you just gave about
stroke, where they take on a health issue, they choose to take
it on, and then they absolutely misrepresent the role of
smoking. They can do an article on 100 ways to live a long and
healthy life, and there will be no mention of smoking. I think
this has become quite intolerable, and hopefully, we will see
less of those.
The second topic, though, is the omission of articles on
cigarette-related disease. This is going to be trickier
because, No. 1, the magazines are under no obligation to cover
this topic. On the other hand, given that they have chosen to
cover all topics, it seems odd that they are leaving this out.
But the question they will ask, and they have asked me, is how
much is enough. They say that we assume our readers are
intelligent adults and know the dangers of smoking, and we do
not want to be their nanny.
So we need to find a balance here, but the most important
thing is I think they learned their lesson about omitting
references to smoking when it is glaringly obvious that they
should be there.
Senator Durbin. I mentioned earlier, and I want to make
sure it is clear for the record--I was comparing breast cancer
and lung cancer. It is my understanding that breast cancer is
the most prevalent cancer among women, but lung cancer is the
most prevalent cause of cancer deaths among women. So both are
extremely serious, and I don't want to diminish one for the
other; they both should be focused on.
But let me ask you a question relative to that. Do you find
these same women's magazines writing more articles about breast
cancer than lung cancer?
Dr. Whelan. Oh, definitely. The ratio is probably 10 or 15
to 1 the coverage of breast cancer over lung cancer. But that
is true in many aspects of disease prevention in terms of the
marches that you mentioned, the campaigns. They are focused on
breast cancer or women's cancers, which by their definition
means ovarian and breast cancer.
Lung cancer, as you correctly pointed out, is definitely a
woman's cancer and deserves that attention. It is the No. 1
leading cause of cancer death in American women.
Senator Durbin. I am trying to draw a conclusion here as to
why they reach this point in their policy about health
articles, and certainly, it appears that money had something to
do with it at some point when ad revenue may have been
jeopardized by articles about lung cancer among women. But is
it also a situation that, when you are talking about lung
cancer, you are talking about changing your personal life
style, that is the kind of scolding or nagging part that they
do not want to engage in, as opposed to breast cancer where,
sadly, we are still stretching and looking for connections
between environment and life style that might lead to breast
cancer?
Dr. Whelan. Yes. First of all, there is no doubt in my mind
that the cigarette advertisements play a major role in the
failure to cover this topic over the last 50 years. This was
clear when we looked at magazines that did not take cigarette
ads. Reader's Digest comes to mind right away; they took a
leadership role beginning in 1952, bringing these facts to
their readers.
But beyond the revenue, which plays a major role, is that
so-called nanny factor, that magazines do not want to take on
this nagging kind of role. And certainly, lung cancer is
perceived and should be perceived as largely self-induced
through smoking morbidity, and it is something that they have
difficulty covering.
Senator Durbin. How can we influence magazine editors to
tell the whole story?
Dr. Whelan. They are doing that now. We are influencing
them. The American Council on Science and Health surveys have
influenced them for over 20 years. They are well aware that we
are watching and counting and looking, and I think that type of
putting a light on it is the way that we have to do this. But I
think the magazine editors are focusing on the reality that
there is something enormously inconsistent about taking on the
role of providing health information and telling your
constituency that you are dedicated to helping them have good
health and then to fill your magazine with advertisements for
the leading cause of preventable death. There is a disconnect
there, and I think they realize that.
Senator Durbin. Can you give us a list of the good
magazines when it comes to these issues and those that have a
bad record?
Dr. Whelan. It is really hard to do that other than to list
magazines like Good Housekeeping or Reader's Digest, which are
magazines that do not take cigarette ads. It is difficult
because it changes from year to year.
Self Magazine, for example, has generally covered more
smoking-related issues than have, for example, Vogue or Glamour
or Harper's Bazaar, but again, there is variation.
Senator Durbin. We are going to have testimony later from
Dr. Beato from the Department of Health and Human Services that
smoking prevalence is higher among women living below the
poverty line--nearly 30 percent of those women smoke--but level
of education also plays a key role here.
In your magazine research, have you ever examined the
readership of women's magazines to determine more specifically
which populations they reach?
Dr. Whelan. We have not done so by poverty or income level,
but only in terms of demographics. These magazines are very
much targeted toward a young audience, and we can see from the
models that the young women are the target of the ads. Middle-
aged women, sadly, are addicted and perhaps do not need as much
advertising to keep them smoking.
Senator Durbin. Most of these magazines have websites. If
some of those who are following this hearing or this issue
wanted to send email messages to the magazine editors, asking
why they have not written more articles about the No. 1 cause
of cancer death among women--lung cancer--do you think that
might have an impact?
Dr. Whelan. It will have an enormous impact. Even one
letter, the editors have told me, catches their attention; five
letters causes a meeting. Definitely I would encourage people
to go to the websites and express this view. We just want the
facts, that is all.
Senator Durbin. That is a good point, and maybe if there is
something positive I can recommend to the CSPAN viewers who are
watching this, it is if you have a favorite magazine, and you
have not seen an article in it about cancer and women that you
can remember, get on the website and send a letter to the
editor of that magazine. I might recommend that.
We are going to have to recess so I can go vote on the
floor. I am sorry that I am going to have to step away probably
for about 10 or 15 minutes, so we will stand in recess until I
return.
Thank you.
[Recess.]
Senator Durbin. The Subcommittee hearing will resume. My
apologies for the vote on the floor, but I made it.
Dr. Whelan, we were just talking about magazine websites.
If the readers have a concern about the issue that we are
discussing at this hearing, whether the magazine that they are
subscribing to is covering in a fair and comprehensive way the
cancer threats to women and whether it has enough focus on
smoking and lung cancer, that the readers should get on the
website to the magazine and send an email to the editor. I
agree with you completely. As you said, one gets their
attention, five calls for a meeting, so 10 may change editorial
policy. So let us make a point of recommending that to those
who are following this.
Dr. Whelan. We encourage that.
Senator Durbin. Definitely. Thank you.
Dr. King, let me thank you for your testimony. Your study
shows that even though some adult magazines may not have much
of a youth readership, their advertising reach was significant
enough to expose a large number of young people to tobacco ads
that they carried. Give me an example of the kind of magazine
you are talking about.
Mr. King. We classify magazines like Cosmopolitan and
Glamour, for example, as being adult-oriented magazines because
they fail the 15 percent/2 million rule. But if you look at the
number of young readers that those magazines have, Glamour has
1.95 million young readers, and Cosmopolitan has 1.79 million
young readers. Although they are adult magazines, those numbers
are much larger than the absolute numbers of young readers that
we find in all of the youth-oriented magazines that we include.
Elle, Mademoiselle, and Vogue all have fewer absolute numbers
of youth readers.
So many of what we classify as adult-oriented magazines in
fact, because of their large subscription base and large
readership, have, although a much smaller percentage of young
readers, much larger numbers in absolute terms.
Senator Durbin. Is it accurate to say that according to
your findings, some of the most significant expenditures for
tobacco advertising of youth brands took place among women's
magazines?
Mr. King. Certainly the women's magazines represent a
significant amount of advertising, particularly if you are
concerned with exposure to young women, because these are
magazines that are targeted. I am sure that not many women read
Hot Rod, and I am also sure that not many young men read
Mademoiselle and Elle--although, of course, there will be a few
exceptions.
So in terms of exposure to young women, these are magazines
of particular interest.
Senator Durbin. Is it accurate to say that since the Master
Settlement Agreement, magazine advertising expenditures for
youth brands of cigarettes have actually risen in both adult-
and youth-oriented magazines?
Mr. King. Yes. We found that for the three brands most
popular among young people--Marlboro, Newport, and Camel--that
in the 2 years following the settlement, their advertising
expenditures in both the adult-oriented magazines and the
youth-oriented magazines increased over the levels prior to the
settlement.
Senator Durbin. And what do you infer from this finding?
Mr. King. I infer from this finding that the Master
Settlement Agreement has not met its goal of reducing exposure
to adolescents and children.
Senator Durbin. Are the tobacco companies spreading
themselves thinner but wider in their effort to sustain their
access to kids?
Mr. King. I think that is a little bit difficult to tell
from the nature of the studies such as the one we have done
here. Remember that we only sample 38 magazines, and the
tobacco companies typically advertise in between 100 and 150
magazines. So we do not actually see all the magazines in our
sample. It is certainly possible.
Senator Durbin. Well, I thank you all for testifying. I
particularly want to thank Ms. Coleman and her daughter
Nzingha. When I came back into the hearing room, there was a
lady standing outside who said, ``Nzingha Coleman stole the
show in there,'' and that is exactly the way it should be,
because we are talking about the impact that this advertising
has on people your age. And again, thank you for missing a day
of school and coming out to testify. It wasn't a bad day, was
it?
Miss Coleman. No.
Senator Durbin. We are glad you could be with us today.
Ms. Coleman, your story is an important one, and we thank
you for sharing it with us.
Dr. Whelan, we will continue to work with you.
Dr. King, thank you for your analysis, too.
Let me at this point invite the next panel to come up to
the table.
Dr. Cristina Beato is Deputy Assistant Secretary for
Health, U.S. Department of Health and Human Services.
Dr. Diane Stover is head of the Division of General
Medicine and Chief of the Pulmonary Service at Memorial Sloan-
Kettering Cancer Center in New York City--one of the best.
And an old friend and colleague of mine, Matt Myers, is
president of the National Center for Tobacco-Free Kids.
Now that you have all comfortably sat down, I am going to
ask you to stand for the oath.
Please raise your right hand. Do you swear that the
testimony you are about to give to this Subcommittee is the
truth, the whole truth, and nothing but the truth, so help you,
God?
Dr. Beato. Yes.
Ms. Stover. Yes.
Mr. Myers. I do.
Senator Durbin. Let the record note that the witnesses
answered in the affirmative.
At this point, I will invite you to give your opening
remarks. Dr. Beato, if you would proceed first.
TESTIMONY OF DR. CRISTINA BEATO,\1\ DEPUTY ASSISTANT SECRETARY
FOR HEALTH, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES,
WASHINGTON, DC.
Dr. Beato. Thank you, Mr. Chairman.
---------------------------------------------------------------------------
\1\ The prepared statement of Dr. Beato appears in the Appendix on
page 89.
---------------------------------------------------------------------------
Good morning, and thank you for inviting me to participate
in this panel. My name is Cristina Beato, and I am the Deputy
Assistant Secretary for Health. Before joining the Department
of Health and Human Services, I served as the Associate Dean
for Clinical Affairs and the Medical Director at the University
of New Mexico Health Sciences Center.
President Bush and Secretary Thompson have made women's
health, prevention, and eliminating health disparities a top
priority. As the 2001 Surgeon General's Report on Women and
Smoking indicated, smoking-related diseases have truly become a
women's health issue. Women who smoke are subject to all the
same risks as men, including cancer, cardiovascular disease,
and chronic obstructive pulmonary disease. In addition, women
are at risk of infertility, adverse reproductive outcomes,
altered menstrual function, lower bone density leading to
osteoporosis, and increased fracture risk.
As you are very well aware and have brought to our
attention, Mr. Chairman, lung cancer surpassed breast cancer as
the leading cancer death among women in 1987, and this is a
totally preventable illness.
However, we know what works to prevent initiation and
promote cessation of smoking, and we believe that, working
together, we can achieve the administration's goals of reducing
the prevalence of smoking among women to 12 percent or less and
among girls to 16 percent or less.
We have seen some successes. The prevalence rate of smoking
among women has declined since it peaked at 33.9 percent in
1965. By the year 2000, smoking prevalence among women was at
21 percent. Most of this decline occurred from the years 1974
to 1990. While the decline slowed in the early 1990's, the
rates have begun to decline more rapidly in recent years.
Smoking prevalence is higher among women living below the
poverty level--nearly 30 percent--as compared to those women
above the poverty level--20 percent. The education level among
women plays a key role. Among women with 9 to 10 years of
education, there is a 31 percent prevalence; among women with
over 16 years of education, there is only an 8 percent
prevalence.
Prevalence rates among racial and ethnic populations adds
another dimension to our need to better understand women and
smoking. In the year 2000, 42 percent of American Indian or
Alaska Native women, 22 percent of Caucasian women, 21 percent
of African women, 13 percent of Hispanic women, and 8 percent
of Asian women were still current smokers.
The prevalence rates among women are still much too high,
but we believe that through our expertise, programs, and
funding, we are continuing to work on lowering these rates. The
Surgeon General's Report on Women and Smoking includes a number
of practical recommendations that will move us toward these
goals. Today I would like to share with you just some of the
ongoing and planned activities at the national and state levels
that are designed to implement these recommendations.
Addressing the burden of tobacco within specific
populations is essential if we are to achieve the President's
and the Secretary's goals and eliminate the disparities that
exist in tobacco use and tobacco-related disease. This is one
of the reasons why the Surgeon General recommended expansion of
the diverse constituency that is working on tobacco issues.
Women of all ages, races, and ethnic backgrounds are
affected by tobacco. To this end, the Department has engaged in
collaborations with a number of nonprofit organizations through
our Centers for Disease Control and Prevention National
Networks Program. These networks represent priority populations
to prevent and reduce the use of tobacco and exposure to
secondhand smoke. These nonprofit organizations reach women and
girls, and one organization focuses exclusively on women.
In addition, the CDC funds seven tribal-serving
organizations. They have been funded to begin to build capacity
in our Native American/Alaska Native community, where the
prevalence of tobacco use among women is the highest.
The Surgeon General's Report on Women and Smoking states
that success in reducing tobacco use will require
implementation of programs that focus on prevention and
cessation. Women who stop smoking greatly reduce their risk of
dying prematurely, and quitting smoking is beneficial at all
ages.
The Task Force on Community Preventive Services provides a
solid scientific foundation upon which to build our efforts to
promote cessation among women. We know that women are more
likely than men to be willing to access assistance when they
try to quit, and that using assistance increases the likelihood
of success. Therefore, the Department and its partners are
working to improve the availability of cessation treatments to
all of the women who smoke.
Some States have developed quit lines that are designed to
increase access and reduce the cost of cessation treatments.
States are also taking steps to ensure that an increasing
number of women have access to these services. Research has
demonstrated that behavioral counseling is effective alone and
can enhance the efficacy of pharmaceutical treatment; however,
rates of utilization and most counseling options have been very
low. Experience has shown us that smokers are more likely to
use a telephone quit line than to attend classes. Telephone
counseling is attractive because it is more accessible and also
more private. Counseling by telephone has also been shown to
reduce the ethnic disparities in the use of smoking cessation.
In California, African American and Hispanic smokers are active
participants in a statewide quit line, with the latter
encouraged by the availability of Spanish language services and
materials.
Very particularly, smoking can affect a woman's ability to
get pregnant, increasing the risk of conception delay and
infertility. The good news is that smoking among pregnant women
has declined 19 percent, from 89 percent to 13 percent in 1998.
Sadly, however, 13 percent is still too many pregnant women and
girls who continue to smoke.
Infants born to smoking women have a lower than average
birth weight. Women smokers are also less likely to breastfeed
their infants. It is estimated that eliminating material
smoking may lead to a 10 percent reduction in all infant deaths
and a 12 percent reduction in deaths from perinatal conditions.
Furthermore, because women are more likely to stop smoking
during their pregnancy than at any other time in their lives,
it is vital that we seize the opportunity to reach out to women
during pregnancy and assist them in quitting for good.
The age of initiation of smoking is an important indicator
of smoking behavior. Smoking initiated at an early age
increases the risk of smoking-related illness or death. The
risks associated with smoking at an early age makes it
imperative that we focus on young girls and make sure that they
never start smoking.
Comprehensive programming at the State level plays an
important role in reducing smoking among women. The CDC has
come out with ``Best Practices for Comprehensive Tobacco
Control Programs,'' an evidence-based analysis that can help
States determine their funding priorities, plan and execute
effective comprehensive tobacco control and prevention
programs.
Following the start of the statewide tobacco control
program in 1989, the lung cancer rate among women in California
has declined, even though it is still increasing for the rest
of our country. This decline underscores the importance of
investing in tobacco control at the State level. Other States
are seeing dramatic results as well. For example, in the State
of Massachusetts, the rates of smoking during pregnancy have
dropped sharply from a prevalence of 25 percent in 1990 to 13
percent in 1996. Most of the decline occurred after 1992, when
the Massachusetts Tobacco Control Program was implemented with
funds from an increase of the tobacco excise tax. Nationwide
prevalence of smoking during pregnancy declined much more
slowly during the same period.
Several of the Surgeon General report recommendations focus
on increasing awareness of the health effects of tobacco on
women and on boosting knowledge that non-smoking is the norm
among women. Without increasing this type of awareness, we are
unlikely to see expanded efforts that address this growing
epidemic at either the individual or the societal levels.
At the State and local levels, activities designed to
promote awareness are increasing. For example, the Wisconsin
Tobacco Control Board, drawing on the revenue from Wisconsin's
settlement with the tobacco industry, funds the Wisconsin
Women's Health Foundation to implement the First Breath
Program, which offers counseling to pregnant women at regional
prenatal care units, coordinated with the Department of
Agriculture's Women, Infants, and Children sites. The program
includes educational materials, information about how to use
the telephone quit line, and opportunities for pregnant women
to join local support groups. These program sites have been
established in all the regions of Wisconsin, including two
tribal clinics. These initiatives are implemented on a pilot
basis.
The Department continues to be a leader in tobacco counter-
marketing efforts and is pleased to have enlisted the aid of
numerous celebrities in our counter-marketing initiatives. This
year, we unveiled a new poster campaign featuring celebrity
spokes-model Christy Turlington. The poster is entitled,
``Smoking is Ugly.'' It illustrates that lung cancer kills more
women than breast cancer, uterine cancer, and ovarian cancer
combined.
We are also proud of our forthcoming television public
service campaign staring Esai Morales of NYPD Blue. This new
initiative, which will be launched later this month, will be
aimed at decreasing tobacco use in our Hispanic communities.
Secretary Thompson has urged the entertainment industry to
expand its role in discouraging women, and girls in particular,
from smoking. In a speech before the National Council for
Families and Television in January of this year, the Secretary
stated: ``We need help in reaching our young women with a very
simple message: Smoking is not glamorous, smoking is deadly,
and we as a society must not glorify smoking--ever. The
television industry and the Federal Government can be powerful
partners in delivering that message to women and girls
throughout America and around the world.''
In conclusion, there are some exciting innovations in
tobacco prevention and cessation that have already begun to
reap results. However, many challenges remain. Nowhere is this
more clear than in the area of research. The National
Institutes of Health, and in particular the National Cancer
Institute, are leading the research effort for the Department.
To move the research effort forward, NCI is working with both
public and private partners to set priorities and promote
action on effective intervention strategies. These efforts
include the Transdisciplinary Tobacco Use Research Centers,
which are public-private collaborations, at seven sites around
the country, to understand the biological, behavioral, and
cultural factors that explain why women smoke and, most
important, if they do, how to help them quit. In addition, we
will encourage the reporting of gender-specific results from
studies of factors influencing smoking behavior, smoking
prevention and cessation interventions, and the health effects
of tobacco use, including new products. The Surgeon General's
report reviewed some of the literature on women and smoking,
but there is still much more that needs to be done.
As science advances, I think it is critical that we
continue to address this totally preventable women's health
issue. President Bush, Secretary Thompson, and the Department
with all of our partners can be successful in meeting the
challenges ahead.
We appreciate your interest in this very serious issue, and
we are looking forward to working with you. I would be happy to
answer any questions.
Senator Durbin. Thank you very much, Dr. Beato. Dr. Stover.
TESTIMONY OF DIANE E. STOVER, M.D., FCCP,\1\ HEAD, DIVISION OF
GENERAL MEDICINE, AND CHIEF, PULMONARY SERVICE, MEMORIAL SLOAN-
KETTERING CANCER CENTER, NEW YORK, NEW YORK, ON BEHALF OF THE
AMERICAN COLLEGE OF CHEST PHYSICIANS
Dr. Stover. Mr. Chairman and Members of the Subcommittee,
good morning.
---------------------------------------------------------------------------
\1\ The prepared statement of Dr. Stover appears in the Appendix on
page 97.
---------------------------------------------------------------------------
I am pleased to have the opportunity to appear before you
today and to address the serious threat to women's health of
smoking and the marketing effects of the tobacco industry.
My name is Diane Stover, and I am Chief of the Pulmonary
Service and Head of General Medicine at Memorial Sloan-
Kettering Cancer Center in New York City. I appear before you
today on behalf of the American College of Chest Physicians and
its philanthropic arm, the CHEST Foundation. And I am proud
that the College and the CHEST Foundation were able to sponsor
Ms. Coleman and her daughter's first trip to Washington to be
here with you today.
Senator Durbin. Thank you for that.
Dr. Stover. The ACCP is a 15,000-plus-member international
and multi-specialty medical society comprised of
pulmonologists, cardiologists, thoracic surgeons, intensivists,
and many other members of the health care team. We are the
physicians who treat people worldwide suffering from lung
disorders, the majority of which are caused by tobacco use.
As a physician working on the front lines, I have seen
first-hand how lung cancer can ravage a life, both a man's as
well as a woman's. The number of women we are treating is
increasing at an alarming rate, and in fact, the saying ``Smoke
like a man, die like a man,'' is becoming more and more of a
reality.
I must confess that I am here today not only as a
professional but as a parent. Several years ago when I was
driving my daughter to middle school, there, standing outside
the school were many of her classmates--smoking. These were the
same children who several years before were in grammar school,
thought it was disgusting, and were begging their parents to
stop.
I knew then, not only as a physician but as a parent, that
I had an obligation not only to my daughter and her friends but
also to all girls and women, to educate them on the disastrous
and devastating health impact of tobacco.
It was at that time that the ACCP created the Task Force on
Women, Girls, Tobacco and Lung Cancer, whose mission simply is
to make women and girls tobacco-free worldwide.
Smoking-related disease among women is truly a fullblown
epidemic. As cited by the Surgeon General, smoking among high
school girls in the 1990's increased to a high of 35 percent.
Why should we care? Because along life's continuum, smoking
impairs the ability of girls and women to fully realize their
potential--in the classroom, as mothers, in the workforce, and
at life's end.
There is accumulating data to suggest that, cigarette-for-
cigarette, females may be more susceptible than males to the
cancer-causing agents of tobacco, putting women at nearly twice
the risk of men to develop lung cancer. In recent years,
mortality among men has decreased, yet in women it continues to
increase dramatically.
Smoking among women and girls causes unique health problems
and diseases throughout their lives. As you have heard, among
adolescent girls and women who smoke, they can have reduced
rates of lung growth; increased rates of wheezing and asthma;
and they are more likely to have menstrual abnormalities.
Women of childbearing age have reduced fertility, and if
they take birth control pills, a greatly increased risk of
heart attack and stroke, particularly if they are over the age
of 35.
During pregnancy, the incidence of spontaneous abortions
and many other catastrophes are increased. The fetuses of women
who smoke or who are exposed to secondhand smoke are more
likely to suffer growth retardation, premature birth,
stillbirth, and neonatal death. There are higher rates of
sudden infant death syndrome, bronchitis, asthma, and ear
infections in their children, as you have very well heard from
Ms. Coleman and her daughter.
Older women who smoke are more likely to suffer early onset
of menopause, higher rates of osteoporosis, and an increase in
lung cancer and many other cancers. In fact, one-third of all
cancers are related to smoking.
In response to this horrific epidemic, the Women's Task
Force, with the support of the ACCP and the CHEST Foundation,
have launched many educational initiatives. These include a
speaker's kit which is now on CD-ROM, with an accompanying
website which is a versatile educational tool addressing four
key audiences: Health care professionals and lay educators,
girls, teens, and adult women.
We have created a Speakers Bureau of more than 400 ACCP
members, and we have developed school-based pilot programs
which educate kids through various methods about the dangers of
tobacco use.
Let me close by saying a few words about smoking cessation
programs. These include self-help programs, behavior
modification techniques, clinical interventions with nicotine
and non-nicotine replacement therapy, as well as community and
educational-based efforts.
Although quitting on one's own is the choice made by many
smokers--as you know it, ``cold turkey''--smoking cessation
programs with or without nicotine replacement therapy can
increase the success rate of smoking cessation many-fold. And
although studies show that there are no major differences
between men and women when it comes to the effectiveness of
smoking cessation methods, women may have a higher relapse
rate.
Pregnant women who smoke offer a unique opportunity to
emphasize the smoking cessation message since these women never
had more frequent contact with the health care system than
during this particular life event. The American College of
Obstetricians and Gynecologists has advised that a five-step
counseling session, together with pregnancy-related educational
materials, increases success rates by 30 to 70 percent.
But as underscored by the Surgeon General's report, there
is a need for more research to determine the effect of nicotine
replacement therapy on pregnant women and their offspring.
As a physician on behalf of my patients and as a parent on
behalf of the children, I would like to thank you for bringing
attention to and raising awareness of this horrific epidemic of
nicotine addiction and tobacco use--the No. 1 preventable cause
of disease worldwide and the No. 1 cause of lung cancer in both
men and women worldwide.
We are hopeful that with your support and the support of
your colleagues, we can save the one out of three children who
start smoking today and who will die as adults sometimes 30 to
40 years prematurely solely because they smoked.
Thank you again for this opportunity to address this
distinguished Subcommittee. I would be happy to answer any
questions.
Senator Durbin. Thanks, Dr. Stover.
Matt Myers is President of the Campaign for Tobacco-Free
Kids, and as long as I have been fighting this battle on
Capitol Hill, he has been my ally and friend.
Matt, we want to welcome you to the Subcommittee and invite
your testimony.
TESTIMONY OF MATTHEW L. MYERS,\1\ PRESIDENT, CAMPAIGN FOR
TOBACCO-FREE KIDS
Mr. Myers. Thank you, Mr. Chairman.
---------------------------------------------------------------------------
\1\ The prepared statement of Mr. Myers appears in the Appendix on
page 105.
---------------------------------------------------------------------------
It is a particular pleasure to be here. It is a particular
pleasure to be here because you have been a leader as long as
we have been working on this issue. And one of the things that
distinguishes your leadership is that it always translates into
action, so that we have faith that the words we speak today
will be translated into something that will make a difference
in people's lives.
And Senator Carper, we are also delighted that you are
here. You have been a long-time leader as well, first as
Governor and then as a member of the board of the American
Legacy Foundation. So we appreciate your interest.
I will ask that my whole statement be put in the record and
will instead just focus on a couple of key points since I am
the last witness in a long hearing.
The three points that I really would like to make are that,
first, looking at today's marketing and advertising, despite
the rhetoric of the tobacco industry, the problem of tobacco
marketing targeting women is no less severe today than it has
been in all of the historic ads that you showed, Senator
Durbin, during your earlier presentation.
Second, we have a potentially new and emerging crisis with
regard to women and smoking, and that is, while women have not
yet learned that low-tar tobacco products are not safer, the
tobacco industry is already introducing a whole new generation
of products that are designed to keep America's women smoking,
because America's women switch to low-tar in much greater
numbers than men out of a concern for their health and safety.
Third, we need to focus on solutions, and we have solutions
that this body can address as well as the kind of important
voluntary solutions that we have discussed earlier in terms of
reaching directly out to magazines and others that affect
women, and I would like to talk about each of those.
Let me start with today's marketing. We have heard a good
deal of rhetoric from the tobacco industry subsequent to the
Master Settlement Agreement that they do not want to target our
children, that they do not want to target nonsmokers. From Dr.
King, we have seen that the numbers do not tell the same story;
but when you look beyond the numbers, it is even worse.
When you look at the themes that we see in tobacco
marketing today targeting women, they are even more offensive
and even more blatant than those we saw before. It was after
the Master Settlement Agreement that Philip Morris introduced
the ``Find Your Voices'' campaign. Not only is that theme
disturbing, its targets were disturbing. It was targeted at
ethnic women from populations that have traditionally not
smoked.
Those ads were not designed to get people to switch brands;
those ads were to reach new ethnic populations with low smoking
rates among women and designed to get them smoking.
When confronted with that advertising theme in a court
case, a Philip Morris executive switched the theme, but not the
overall message. ``Find Your Voices'' simply became ``A Voices
Campaign.'' The message was still designed to associate smoking
with freedom, independence, and the types of themes that
emerging populations would care about most.
Second, we wish that the move of the tobacco manufacturers
out of magazines represented a real decline in their targeting
of women. It does not. It represents a switch in their
marketing dollar. In the most recent Federal Trade Commission
report on tobacco marketing, not only does it show an increase
in tobacco marketing in magazines--it shows a 67 percent
increase in the kind of promotional expenditures and free
giveaways that have the greatest impact on our young people.
What kinds of things am I talking about? Go to a local
store. We picked this up just about 3 weeks ago. It is from
Camel--``Buy Two Packs, Get One Free''--but with the imagery
that is clearly designed and aimed at men or women of that age
population. There is no question whom these are targeted at,
and there is no question that the ``Buy Two, Get One Free'' is
part of a very broad marketing campaign designed to make these
cigarettes both more attractive and more accessible to our
young people, with the tragic results that you have heard from
all of the others.
This is just the tip of the iceberg. I hope that today's
hearing is the start of a long-term focus on how the tobacco
industry is targeting our young men and women.
There is a second issue that I hope this Subcommittee will
focus on, and that is the fact that the National Cancer
Institute last November found that lite and low-tar cigarettes
actually produce no health benefit to our population. What the
report did not focus on but what is important for this hearing
is the fact that it is women who switch in much greater numbers
to lite and low-tar tobacco products because they believe that
these products are safer.
Eighty-seven percent of the cigarettes smoked in this
country today are lite and low-tar; over 60 percent of the lite
and low-tar smokers are women. They were concerned about their
health, and they did something about it that they thought would
make a difference. It did not.
We are about to emerge on the same crisis all over again.
With the release of the National Cancer Institute report, the
tobacco industry has taken a new tack--new products. It is not
lite and low-tar; it is a whole host of new products with broad
promises. You showed some of them in your presentation.
Omni cigarettes--what does a full-page ad for Omni
cigarettes look like? ``Name another brand that significantly
reduces carcinogens as much as Omni, the only cigarette to
significantly reduce carcinogens that are among the major
causes of lung cancer.''
The tobacco company says that that is not a health claim.
Find me a consumer who will not take away the message that says
you have a choice not to quit, just as you did 40 years ago
with lite and low-tar cigarettes.
Another one is Advance cigarettes--``All of the taste, less
of the toxins.'' If history is a predictor of the future--and
we know that it is--it is women who will switch in massive
numbers to these products designed to do something about their
health and safety.
That is why we get to solutions, and that is why we truly
ask this Subcommittee's help. First and foremost, these things
would not happen if we had meaningful FDA regulation over
tobacco products. If the regulations that the FDA proposed in
1996 were in place today, the kinds of ads that we have seen
would not have been allowed today. They would not be allowed in
magazines with heavy youth readership. If the FDA had authority
over tobacco, before they made outrageous claims like these,
they would have to substantiate them, so that when people who
were concerned about their health and safety switched, they
would know that those products were in fact safer, and there
would be restrictions on the advertising to make sure it was
not designed to encourage young people and young children to
start.
There is a second area that we would ask this Subcommittee
to focus on, and you have been a leader, Senator Durbin. That
is to ensure that poor people who want to quit smoking are not
prevented from doing so because they lack the resources. We
need to ensure that smoking cessation is covered by our
Medicare and Medicaid programs. We cannot afford not to do
that. Medicare and Medicaid costs are skyrocketing. Smoking is
a significant portion of those costs. It is the poor people in
our country who smoke at disproportionate rates. If we are
concerned about health care costs, there is nothing we can do
that would help drive those costs down and save the American
taxpayer money more effectively than to pass the legislation
you have proposed to provide smoking cessation coverage.
Last, we would ask you to work with us to do just as you
have said--to have a joint effort, to ask those who advertise
tobacco products to do so in a more responsible manner, to
ensure that these stories are covered and to ensure that
advertisers take the voluntary steps that they could take on
their own to decrease youth exposure and the exposure of young
women to tobacco products.
We conducted a survey only 1 month ago looking at youth
exposure to tobacco marketing. We had hoped that over 3 years
after the Master Settlement Agreement, we would see a
significant decline. Sadly, we did not. Youth are still exposed
to tobacco marketing at three times the rate as adults. And if
you look at the cigarette brands that are up at the top, they
are the same ones that our kids smoke, and Marlboro, smoked by
more young girls and more young boys than all other brands
combined, tops the list.
There are things that we can do to address this problem,
and we thank you for your leadership in holding this hearing
today as a next step. Thank you.
Senator Durbin. Thanks a lot, Matt.
Mr. Myers. Senator, can I just add one thing which is
really quite important--and this relates to Senator Carper as
well; he can take some credit.
Senator Durbin. Yes.
Mr. Myers. There are some good things happening that we
have not talked about. We have talked a lot about magazines. In
this month's issue of Good Housekeeping is the beginning of a
new campaign by the American Legacy Foundation which I think is
very important for people to understand.
This is called The Letters Campaign, featuring real people
with real problems, suffering from tobacco use, designed to
encourage women to smoke. It is accompanied, fortunately, by a
first-rate editorial in Good Housekeeping talking about these
issues. It is the American Legacy Foundation using the power of
our advertising dollar to get magazines to do the right thing.
We will never be able to match the tobacco companies dollar-
for-dollar, but our hope is that women's magazines will take
this opportunity to liberate themselves from the slavery of
tobacco marketing and use this as an opportunity to begin to
send the right message to our citizens.
Senator Durbin. Thank you.
Dr. Beato, let me say that you have made a compelling
argument in your testimony for a bill that I have introduced,
and I would like to ask you to comment on it.
We know that a significant percentage of women on Medicaid
smoke and that indeed the smoking prevalence among pregnant
women on Medicaid is 23.8 percent, nearly twice that of all
pregnant women.
Are you aware of the fact that Medicaid does not require
State Medicaid programs to cover smoking cessation therapies or
smoking cessation counseling?
Dr. Beato. Some States do not, Senator, but there are other
States that do, through a HRSA program--there are 67 programs
currently around the country--in 37 States--that do offer
smoking cessation programs. ACOG's Five Steps counseling
session is covered under their prenatal care.
Senator Durbin. Do you think it should be a requirement
that all State Medicaid programs offer smoking cessation
programs and counseling?
Dr. Beato. I believe that States should strongly be
encouraged to follow that, yes.
Senator Durbin. But strong encouragement and making it
mandatory are two different things. Do you think it should be
mandatory?
Dr. Beato. I believe for a public health issue, yes, States
should make this mandatory.
Senator Durbin. OK. Let me ask you about another aspect of
this which you alluded to in your testimony. When Nzingha
Coleman was up here, I asked her about the prevalence of
smoking in movies and on television, which drives my wife
crazy. She said, ``I cannot believe that the producers in
Hollywood are letting this happen in movies that kids are
seeing.'' It just glamorizes smoking to see some beautiful
young actress smoking.
I know we have a tricky assignment here in dealing with our
historic constitutional protections of free speech and so on,
but what do you think we can do, Congress working with this
administration, to highlight and deal with this challenge?
Dr. Beato. I think really trying to approach it as a
public-private partnership, as Secretary Thompson has alluded
to; also, I believe, exploring more the in-depth research on
behavior science, especially among adolescents. We know that
adolescents who get adequate and very good information still
choose to smoke or do other unhealthy behaviors. How do we
study that problem from a behavioral aspect to address that.
I think there is a lot of promise looking at those research
components, and NCI is going to have some of that in their
gender-specific studies for particularly women and smoking. But
I have a 14-year-old daughter and I, like my colleague sitting
next to me, am very concerned about the messages that our
children are getting. And I can tell you that when the movie
``Erin Brockovich'' came out, and Julia Roberts was lighting up
all the time, that was a very powerful message that swayed
girls in the wrong direction, because this was a liberating
film, you might say, but was certainly giving the wrong message
in that way.
Senator Durbin. I think I am going to write Julia Roberts a
letter. She and I do not correspond regularly, but she was here
just last week on Capitol Hill testifying about her concern
about Rett's syndrome, a very serious disease. I would like to
suggest to her that she also take a look at this public health
issue. We need an actress like her to step up and say something
publicly. It could make a difference.
Dr. Beato. I think those kinds of partnerships are what
will give us success.
Senator Durbin. Dr. Stover, the most compelling part of
your testimony--and I was not aware of it, and I have studied
this issue a lot--is the suggestion that women are more
susceptible to lung cancer with the same exposure to tobacco as
a man. Has this been tested and written about over a long
period of time?
Dr. Stover. The data are accumulating and they suggest that
women may be more susceptible. There are epidemiologic data,
and now there are molecular biologic data emerging. It is
really not understood why, but the theory is that the
carcinogens in tobacco smoke are handled differently between
the sexes, and generally, there are two things that can happen
to the carcinogens, the cancer-producing substances. They can
be excreted, or they can be changed into more cancer-producing
materials.
Men are thought generally to excrete them more easily, and
women are thought to hold onto them for a longer period of time
and change them into more cancer-producing products. And
hormones are thought to perhaps play a role; androgens make
them go out in the urine, and estrogens make them go the
opposite way, to be changed or transformed into more serious
substances.
Senator Durbin. This seems like a very significant fact.
Again, when we talk about women's magazines that focus on
health, this would seem to be an obvious issue that they should
highlight to their readers to let them know that if you smoke
the same number of cigarettes as your husband, for example,
according to the studies, you are more likely statistically to
develop lung cancer than he is. I think this is worth pursuing,
and I hope that the chest physicians will consider contacting
some of the leading women's magazines to see if they would
accept an article on this subject. I think that would be a
valuable thing to do.
I might also add parenthetically, since Dr. Beato and you
have both made reference to your adolescent children, that I
have said during the course of debating this issue over the
years that I have never met a parent who has said, ``I got the
greatest news last night--my daughter came home and told me she
started smoking.'' I have never heard a parent say that,
because we all live in dread of that possibility. Luckily, my
wife and I raised three who do not smoke, and we are very happy
with that outcome, as most parents would be.
Matt, I am going to save my questions because Senator
Carper has arrived, and I want to give him a chance to ask some
questions.
OPENING STATEMENT OF SENATOR CARPER
Senator Carper. Thank you, Mr. Chairman, and to each of our
witnesses, thanks for joining us today. I know some of you by
reputation, and the reputations that you have are good ones. We
are mindful of your contributions on these fronts and very
appreciative.
Senator Durbin and I came to the House together almost 20
years ago, and almost from day one, he made his mark as a
champion in the House of Representatives, and now in the Senate
and across the country, to discourage people from smoking and
for those who do, to try to get them to stop. I do not know how
many lives have been saved because of your efforts, but my
guess is quite a few.
He and I kid a lot about all kinds of things, but on a very
serious note, I would say thank you for a wonderful
contribution in this area.
As Mr. Myers suggested, I got to be involved a little bit
in the American Legacy Foundation as outgoing chairman of the
National Governors Association. The American Legacy Foundation
was created under the Master Settlement Agreement, and about
$1.5 billion was to be directed to the efforts of the American
Legacy Foundation to try to convince young people, just like
these young people sitting right over here to our left along
the wall, from ever starting to smoke, or if they are getting
started, to try to convince them to stop.
I served as the founding vice chairman of the American
Legacy Foundation for about a year and a half, and it was a
great privilege to be a part of that start-up. seeing the two-
page advertisement that you just showed us, Mr. Myers, reminds
me of why were we excited when we got that going.
I called the American Legacy Foundation in preparation for
this hearing and asked if they had any recent statistics on
teen smoking. I had read about some encouraging statistics in
the media, and I called Shelley Hilton, who was the president,
to congratulate her and the Foundation. They sent me over some
information, and I just want to read it into the record if I
can, because I find it encouraging that the numbers on teen
smoking, after going the wrong way for a number of years, are
now going the right way.
``In December 2001, the principal investigators of
`Monitoring the Future,' a national youth survey conducted
annually since 1977, reported the continued decline of
cigarette smoking among youth in grades 8, 10, and 12.''
Let me just ask the young people over here what grade you
are in. Eighth grade. OK. I have an eight-grader at home, 13
years old.
Anyway, the data from the survey indicated that current
smoking rates among students in grades 8, 10, and 12 have been
declining since 1977 and that smoking among younger students
like the ones who are here today began to decline in the
previous year, in 1996.
Let me just mention a couple of the numbers. Current
smoking among students in grade 12 declined from 31.5 percent
in 2000 down to 29.5 percent in 2001. Among eighth-graders and
tenth-graders, smoking declined from about 14.6 percent among
eight-graders to 12.2 percent, and from 24 percent among tenth-
graders down to 21 percent. That is in a span of a year.
Now, those may not sound like huge drops, but to see that
kind of decline literally in the space of a year suggests to me
that something positive and something good is happening. I
think it is a combination of things--the efforts of some of the
people who have been before us here, and certainly the efforts
of our Chairman, but also, as States scrap for dollars to try
to balance their budgets, one of the places they look is sin
taxes, and one of the sin taxes that comes to mind for a lot of
people is the tax on tobacco. In Delaware, we are trying to
balance our budget, and one of the places we are going to do it
is to significantly increase the tax on tobacco products. So
that is going on.
We have cigarette companies themselves that have raised
prices in order to pay for the cost of the Master Settlement
Agreement. And we have seen some very, very effective media
campaigns. To our young people here, I would say that the
American Legacy Foundation does not rely on guys like Senator
Durbin and me to come up with ideas to connect with young
people--they rely on the young people. The young people
literally conceive the ideas and help direct the creation,
whether it is stuff we put on the website or TV ads, radio ads,
and even some of the print media. It comes from the young
people, who are better able to figure out how to connect. And
the long and short of it is that it is working.
Every now and then, I do not know that we need to stop and
smell the roses, but we need to stop and realize that something
good is happening here, and I just wanted to underline that
fact today.
Mr. Myers, you mentioned the FDA proposal from 1996 that
was not adopted. Do you have any idea what the position of the
Bush Administration is on those broad proposals or some
portions of them?
Mr. Myers. I am not a representative of the Bush
Administration, so I would hesitate to speak for them.
Secretary Thompson has said that he generally supports FDA
regulation, but he has made that statement on his personal
behalf.
We would hope that this would be an issue that we could all
unite behind. If there is one thing we ought to be able to
agree on, it should be that the most deadly product in this
country should not be the least regulated product. And at the
same time, the kind of marketing that counteracts the work of
the American Legacy Foundation and counteracts the money that
the States are spending to discourage tobacco use should not be
permitted. We ought to have those kinds of controls over it so
that when a mom and dad sit across the kitchen table from their
kids, they should not have to face $22.5 million of tobacco
advertising that is giving the opposite message.
Senator Carper. Yes, Dr. Stover.
Dr. Stover. I would just add that nicotine is definitely a
drug, and it not only has psychologic effects but definite
physiologic effects on the body. And it is a very addicting
drug, as we all know.
Senator Carper. Thank you.
Mr. Chairman, thanks for your good work, and thanks for
holding this hearing. And thanks to each of you for being here
today.
And to the young people, those eight-graders who showed up
to join us at this hearing, we are delighted that you are here
and hope that you will be setting the right kind of example for
my eighth-grader and my sixth-grader.
Thank you.
Senator Durbin. Thanks, Senator Carper.
Dr. Stover, you made reference to a website. Can you tell
us what that is, so that those who are following this hearing
may access it for the Chest Physicians program?
Dr. Stover. The speakers kit is speakerskitchestnet.org.
But the Chest Foundation and the ACCP also has a website.
Everything is on the CD-ROM, which you can get on the table
here.
Senator Durbin. OK. I just thought you might be able to
read it into the record; maybe you might want to search for it
for a moment while we proceed with some other questions. I will
go to Mr. Myers, and maybe we can come back to you.
Matt, let me ask you about the one advertisement that you
showed us, the full-page advertisement for Omni. This is
amazing, and I think most people need to be reminded why we are
talking about FDA regulation. Here, we have a full-page ad--and
where was that published?
Mr. Myers. This one is in USA Today, but they have run
these full-age ads everywhere in the country.
Senator Durbin. So imagine for a minute that this company--
whoever makes this cigarette--is saying that they are selling a
product that causes less cancer, contains less cancer-causing
agents, than other products.
Mr. Myers. Correct.
Senator Durbin. Now, we have the strange situation in
American law where tobacco is treated neither as a food nor as
a drug; it is somehow in between, exempt from regulation. If I
wanted to put an advertisement together for apples that I was
growing in my orchard that said ``has fewer cancer-causing
agents than other apples,'' I would have to go through rigorous
testing to establish the truth of that claim before I could
possibly publish it without having some repercussions; is that
not correct?
Mr. Myers. That is absolutely correct, and the other thing
that they, of course, do not tell us is that there are 69 known
carcinogens. They have taken out four. What about the other 65?
And in this case, they have added a metal called palladium
metal which people are smoking. Do we have tests about the
health effects of that?
Think of yourself as a food manufacturer or a drug
manufacturer. If you added palladium metal and then smoked it,
you would have to tell the Federal Government how much you have
added, and you would have to do tests on it, you would have to
disclose it to the public before you could market it let alone
make these kinds of totally unsubstantiated claims.
Senator Durbin. So this is the only product in America
where they can make claims like this without any truth or any
background testing, where they do not have to disclose
ingredients, including ingredients that may be lethal or toxic,
and they are totally above any government regulation in that
activity.
Mr. Myers. That is the law today, sir.
Senator Durbin. And of course, that is one that we have
been battling for a long, long time.
Dr. Stover, you have seen the net result of all of this
when you have people who turn to this product and end up in
your hospital.
Dr. Stover. Yes. One of my teachers, a very astute man,
said of the low-tar cigarettes ``If you are run over by 10 mack
trucks or 100, you are still dead.'' I think that says it all.
Senator Durbin. Dr. Beato, speak to this issue for a moment
if you will. I know this may be a little delicate for you to
talk about new FDA jurisdiction, and I do not know if you come
here with any message from your Secretary on the issue. But you
can understand from what we have said here the concern we have
that if we do not take over some form of regulation of this
industry that this kind of advertising, this kind of activity,
this lack of disclosure to consumers, is going to continue on
to the peril and danger of young people and men and women
across America.
Dr. Beato. You are absolutely correct. The first thing, Mr.
Chairman, the Department of Health and Human Services has a
website as well for women, and that is www.4women.gov, where we
also have preventive measures of which smoking cessation is
one. So I wanted to make that available for women in the
audience or other family members to use that.
Second, to answer your question, it is definitely a
sensitive issue. There is a Supreme Court ruling that also
complicates the picture. So I think it is a very complex
picture, but I can certainly assure you that from a public
health perspective, this Secretary and this President want
public health and prevention to be a priority.
The issues of the legal component are left up to you, sir,
and your colleagues, but we certainly welcome anything that we
can help with to really bring out the message that this is a
cancer-causing event and we want to emphasize prevention.
Senator Durbin. Let me mention something else that may come
as a surprise to some. There is not unanimity among the tobacco
companies on the FDA issue. There are some tobacco companies,
major tobacco companies, that support FDA regulation and others
that oppose it. So to say that they have put a united front
against this concept of FDA regulation is not a fact, and I
know that personally, having spoken to some of their
executives. It was a strange day when a tobacco company
executive asked for an appointment in my office some months ago
and came in to tell me that; I did not know what to expect, but
I was encouraged by it.
So I think it really opens the door for us to be more
forthright in addressing this issue, and I hope we can work
with the administration to do that. Secretary Thompson's
statements on this subject have been very encouraging, so we
hope we can work with you on that.
Dr. Stover, did you find your website?
Dr. Stover. Yes, I did. It is www.chestnet.org.
Senator Durbin. Thank you.
Matt, I will give you the last word on this since you have
followed this for so long and you were in on these negotiations
leading up to the Master Settlement Agreement. Can you comment
on the way you see it today, the progress that Senator Carper
noted and the challenges ahead?
Mr. Myers. Mr. Chairman, we have seen real progress in the
last 4 or 5 years, but we have a long way to go. If we are
going to succeed, we do need the administration's help to pass
good and meaningful FDA jurisdiction. It is good that Philip
Morris supports one form of FDA jurisdiction, but what they
propose is riddled with loopholes, as you know.
We think that working together, we can do something about
this kind of advertising of these kinds of products in a way to
protect the American public, but it is going to require
everyone to support meaningful and effective FDA jurisdiction,
passed promptly. With your leadership, we are really hopeful
that maybe we can get it done.
Senator Durbin. Thank you all very much. I thank this
panel.
I also want to thank my staffers, Kelly O'Brien and
Marianne Upton, who worked very hard to put this hearing
together.
The Subcommittee will stand adjourned.
[Whereupon, at 12:05 p.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
-