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80–599 PDF 2003

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

(

(II)

COMMITTEE ON GOVERNMENTAL AFFAIRS

JOSEPH I. LIEBERMAN, Connecticut, Chairman

CARL LEVIN, Michigan

DANIEL K. AKAKA, Hawaii

RICHARD J. DURBIN, Illinois

ROBERT G. TORRICELLI, New Jersey

MAX CLELAND, Georgia

THOMAS R. CARPER, Delaware

JEAN CARNAHAN, Missouri

MARK DAYTON, Minnesota

FRED THOMPSON, Tennessee

TED STEVENS, Alaska

SUSAN M. COLLINS, Maine

GEORGE V. VOINOVICH, Ohio

THAD COCHRAN, Mississippi

ROBERT F. BENNETT, Utah

JIM BUNNING, Kentucky

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

ROBERT G. TORRICELLI, New Jersey

THOMAS R. CARPER, Delaware

JEAN CARNAHAN, Missouri

MARK DAYTON, Minnesota

GEORGE V. VOINOVICH, Ohio

TED STEVENS, Alaska

SUSAN M. COLLINS, Maine

THAD COCHRAN, Mississippi

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

(III)

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

(1)

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 indeVerDate 11-MAY-2000 08:26 Mar 17, 2003 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 C:\DOCS\80599.TXT SAFFAIRS PsN: SAFFAIRS
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pendence. 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 cholesVerDate 11-MAY-2000 08:26 Mar 17, 2003 Jkt 000000 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 C:\DOCS\80599.TXT SAFFAIRS PsN: SAFFAIRS
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terol, 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.

4

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-yearold 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.

5

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 appointVerDate 11-MAY-2000 08:26 Mar 17, 2003 Jkt 000000 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 C:\DOCS\80599.TXT SAFFAIRS PsN: SAFFAIRS
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1The prepared statement of Dr. Whelan with attachments appears in the Appendix on page

33.

ment 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.

7

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 antismoking 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 examVerDate 11-MAY-2000 08:26 Mar 17, 2003 Jkt 000000 PO 00000 Frm 00011 Fmt 6633 Sfmt 6633 C:\DOCS\80599.TXT SAFFAIRS PsN: SAFFAIRS
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1The prepared statement of Mr. King with an attachment appears in the Appendix on page

74.

ple, 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.

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

9

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

10

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-getone-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.

11

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.

12

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, wordof-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

13

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 cigaretterelated 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.

14

But beyond the revenue, which plays a major role, is that socalled 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 smokingrelated 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

15

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

16

brands of cigarettes have actually risen in both adult- and youthoriented 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.

17

1The prepared statement of Dr. Beato appears in the Appendix on page 89.

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.

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

18

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.

19

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,

20

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.

21

1The prepared statement of Dr. Stover appears in the Appendix on page 97.

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.

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.

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22

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.

23

1The prepared statement of Mr. Myers appears in the Appendix on page 105.

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.

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.

24

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.

25

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 lowtar; 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.

26

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.

27

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 canVerDate 11-MAY-2000 08:26 Mar 17, 2003 Jkt 000000 PO 00000 Frm 00031 Fmt 6633 Sfmt 6633 C:\DOCS\80599.TXT SAFFAIRS PsN: SAFFAIRS
28

cer-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

29

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 tenthgraders, smoking declined from about 14.6 percent among eightgraders 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.

30

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.

31

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.

32

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.]

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