Mental Health Administration, National Institute on Drug Abuse. DHHS Publication No. (ADM) 85-1334, 1985b. pp. 67-l 12. FLAY 1 B.R. Mass media linkages with school-based programs for drug abuse prevention. Jour- nal ofSchool Health 56(9):402406, November 1986. FLAY. B.R. Mass media and smoking cessation: A critical review. American JournalofPuhlic Health 77(2): 153-l 60, February 1987a. FLAY. B.R. Selling the Smokeless Society: 56 Evaluated Mass Media Programs and Cam- paigns Worldn,ide. Washington. D.C.: American Public Health Association, 1987b. FLAY, B.R.. BRANNON. B.R., JOHNSON. C.A., HANSEN, W.B., ULENE, A.L., WHIT- NEY-SALTIEL. D.A.,GLEASON,L.R., StiSSMAN,S..GAVIN,M.D.,GLOWACZ, K.M., SOBOL, D.F.. SPIEGEL, D.C. The Television School and Family Smoking Prevention and Cessation Project. I. Theoretical basis and program development. Preventive Medicine 17:5X5-607, 1988. FLAY, B.R., D'AVERNAS, J.R.,BEST, J.A., KERSELL, M.W., RYAN, K.B. Cigarette smok- ing: Why young people do it and ways of preventing it. In: McGrath, P., Firestone, P. (eds.) Pediatric andAdolescent Beha\ioralMedicine, Volume IO. New York: Springer Publishing, 1983, pp. 132-183. FLAY, B.R., HANSEN, W.B., JOHNSON, C.A., COLLINS, L.M., DENT, C.W., DWYER, K.M.. GROSSMAN, L., HOCKSTEIN, G., RAUCH, J., SOBEL, J.L., SOBOL, D.F., SUSSMAN, S.. ULENE, A. Implementation effectiveness trial of a social influences smok- ing prevention program using schools and television. Health Education Research 2(4):385- 400, 1987. FLAY, B.R.,RYAN, K.B., BEST,J.A., BROWN, K.S., KERSELL,M.W.,D'AVERNAS,J.R., ZANNA. M.P. Are social-psychological smoking prevention programs effective? The Waterloo Study. Journal ofBehavioral Medicine 8( 1):37-59, March 1985. FLAY, B.R., SOBEL, J.L. The role of mass media in preventing adolescent substance abuse. In: Glynn, T.J., Leukefeld, C.G., Ludford, J.P. (eds.) Preventing Adolescent Drug Abuse: Intervention Strategies, NIDA Research Monograph 47. U.S. Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administra- tion, National Institute on Drug Abuse. DHHS Publication No. (ADM) 85-1280, 1983, pp. 5-35. FLAY, B.R., THOMPSON, S., SANTI, S., BEST, J.A., BROWN, S.K. Long-term follow-up of the Waterloo Smoking Prevention Trial. Paper presented at the 6th World Conference on Smoking and Health, Tokyo, November 9-12, 1987. FOOD AND DRUG ADMINISTRATION. Letter from Mark Novitch for Jere E. Glyan, Com- missioner of Food and Drugs, to John F. Banzhaf III and Peter N. Georgiades. Action on Smoking and Health, November 25, 1980 (Docket Nos. 77P-0185 and 78P-0338/CP). FOOD AND DRUG ADMINISTRATION. Smoking deterrent drug products for over-the- counter human use; establishment of a monograph. FederalRegister 47:49&500, January 5. 1982. FOOD AND DRUG ADMINISTRATION. Smoking deterrent drug products for over-the- counter human use; tentative final monograph. Federal Register 50:27552-27557, July 3, 1985. FREDERIKSEN, L.W., PRUE, D.M., ORLANDI, M.A., EDELMAN, B.R., WYNDER, E.L. Development of a Computer Assisted Smoking Treatment Program: A Preliminary Report. Cambridge, Massachusetts: Institute for the Study of Smoking Behavior and Policy, John F. Kennedy School of Government, Harvard University, February 1988. FRIEDMAN, K.M. Public Policy and the Smoking-Health Controversy. A Comparative Study. Lexington, Massachusetts: D.C. Heath, 1975. 451 FRITSCHLER, A.L. Smoking and Politics: Policymaking and the Federal Bureaucracy, Second Edition. Englewood Cliffs, New Jersey: Prentice-Hall, 1975. FULLER. J.A. Smoking withdrawal and acupuncture. Medical Journal of Australia 1:28-29, 1982. GARDNER, J.W. In Common Cause. New York: W.W. Norton, 1973. GARFINKEL, L.. STELLMAN, S.D. Cigarette smoking among physicians. dentists, and nurses. CA-A Cancer Journal for Clinicians 36( 1):2-8, January-February 1986. GILCHRIST. L.D.. SCHINKE, S.P. Improving smoking prevention programs. Journal of Psychosocial Oncology 3( 1):67-78, Spring 1985. GILCHRIST, L.D., SCHINKE, S.P., NURIUS, P. Reducing initiation of habitual smoking among women. Preventive Medicine, in press. GLASGOW, R.E., LICHTENSTEIN. E. Long-term effects of behavioral smoking cessation in- terventions. Behavior Therapy 18:297-324, 1987. GLASGOW, R.E., ROSEN, G.M. Behavioral bibliotherapy: A review of self-help behavior therapy manuals. Psychological BuUetin 85(l): l-23, January 1978. GLASSMAN, A.H., JACKSON, W.K., WALSH, B.T., ROOSE, S.P., ROSENFELD, B. Cigarette craving, smoking withdrawal, and clonidine. Scienre 226:864-866, November 16, 1984. CLASSMAN, A.H., STETNER, F.. WALSH, T., RAIZMAN, P.S., FLEISS, J.L., COOPER, T.B., COVEY, L.S. Heavy smokers, smoking cessation, and clonidine: Results of a double- blind, randomized trial. Journal of the American Medical Association 259( 19):2863-2866, May 20, 1988. CLOVER, E.D. Conducting smokeless tobacco cessation clinics. American Journal of Public Health 76(2):207, 1986. GLYNN, K., LEVENTHAL, H., HIRSCHMAN, R. A cognitive developmental approach to smoking prevention. In: Bell, C.S., Battjes, R. (eds.) PreventionResearch: Deterring Drug Abuse Among Children and Adolescents, NIDA Research Monograph 63. U.S. Department of Health and Human Services, Public Health Service. Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Drug Abuse. DHHS Publication No. (ADM) 85- 1334, 1985,~~. 130-152. GLYNN, T.J. Essential elements of school-based smoking prevention programs: Research results. Journal of School Health, in press. GORI, G.B., LYNCH, C.J. Toward less hazardous cigarettes. Journal of the American Medi- cd Association 240( 12): 1255-1259, September 15, 1978. GREEN, L.W., GREEN, P.F. Intervening in social systems to make smoking education more effective. In: Steinfeld, J.. Griffiths, W., Ball, K., Taylor, R.M. (eds.) Smoking and Health. II. Health Consequences, Education, Cessation Activities. and Governmental Action. Proceedings ofthe 3rd World Conference on Smoking and Health. U.S. Department of Health, Education, and Welfare, Public Health Service, National Institutes of Health, National Can- cer Institute. DHEW Publication No. (NIH) 77-1413, 1977, pp. 393-401. GRITZ E., CARR, CR., MARCUS, A.C. Unaided smoking cessation: Great American Smokeout and New Year's Day quitters. Journal of Psychosocial Oncology. in press. GRITZ, E.R. Gender and the teenage smoker. In: Ray, B.A., Braude, M.C. (eds.) Women and Drugs: A Nenl Erufor Research, NIDA Research Monograph 65. U.S. Department of Health and Human Services, Public Health Service, Alcohol. Drug Abuse, and Mental Health Ad- ministration, National Institute on Drug Abuse. DHHS Publication No. (ADM) 86-1447, 1986, pp. 70-79. HALL, R.G.. SACHS, D.P.L., HALL, S.M., BENOWITZ, N.L. Two-year efficacy and safety of rapid smoking therapy in patients with cardiac and pulmonary disease. Journal of Con- sulting and Clinical Psychology 52(4):574-58 I, 1984a. 452 HALL, S.M.. RUGG, D.. TUNSTALL, C., JONES, R.T. Preventing relapse to cigarette smok- ing by behavioral skill training. Jour-nul ofconsulring and Clinical Psychology 52:373-382, 1984b. HALL, S.M.. TUNSTALL, C.D., GINSBERG. D., BENOWITZ, N.L.. JONES, R.T. Nicotine gum and behavioral treatment: A placebo controlled trial. Journul of Consulting and Clini- d Psycho/o,q 55(4):603-605. 1987. HAMILTON. J.L. The demand for cigarettes: Advertising. the health scare. and the cigarette advertising ban. Review* of Economics cmd Sraristirs 54:401~11, November 1972. HAMM. A.C. Massive antismoking intervention trial to begin in the fall. Journal ojthe Nu- finnal Gamer Instirute 80( IO):7 17-718. July 20, 1988. HAMMOND. E.C., HORN, D. Smoking and death rates-Report on forty-four months of fol- low-up of 187.783 men. I. Total mortality. Journal of the American Medical Association 166(10):1159-I 172. March 8, 1958. HANSEN, W.B. Behavioral predictors of abstinence: Early indicators of a dependence on tobacco among adolescents. Internarional Journal ofthe Addicrions 18(7):9 13-920, 1983. HANSEN, W.B., COLLINS. L.M., JOHNSON. C.A.. GRAHAM, J.W. Self-initiated smoking cessation among high school students. Addictive Behaviors 10:26.5-271, 1985. HARVEY, L., SHUBAT, S. Public opinion on health issues. In: AMA Survey ofPhysician and Public Opinion on Healrh Care Issues. 1987. Chicago: American Medical Association, April 1987. HERBOLD, J.R. Smoking habits of U.S. military personnel. Military Medicine 1.52(4):194- 195, April 1987. HJALMARSON, A.I.M. Effect of nicotine gum in smoking cessation. A randomized, placebo- controlled, double-blind study. Journal of the American Medical Association 252(20):2835- 2838, November 23-30, 1984. HOPS, H., WEISSMAN, W., BIGLAN, A.,THOMPSON, R.,FALLER, C., SEVERSON, H.H. A taped situation test of cigarette refusal skill among adolescents. Behavioral Assessment 8:145-154, 1986. HUGHES, G.H., HYMOWITZ, N., OCKENE, J.K., SIMON. N., VOGT, T.M. The Multiple Risk Factor Intervention Trial (MRFIT). V. Intervention on smoking. Prevenrive Medicine 10(4):476500, July I98 I. HUGHES, J.R., MILLER, S.A. Nicotine gum to help stop smoking. Journal ofrhe American Medical Association 252(20):2855-2858, November 23-30, 1984. HULBERT, J. Cessation among youth: Experiences in selected secondary schools in Iowa. In: Schwartz, J.L. (ed.) Proceedings of Inrernational Conference on Smoking Cessation. New York: American Cancer Society, 1978, pp. 335-337. HUNT, W.A., BESPALEC, D.A. An evaluation of current methods of modifying smoking be- havior. Journal of Clinical Psychology 30:43 l-438, 1973. HURD, P.D., JOHNSON, C.A.. PECHACEK, T., BAST, L.P., JACOBS, D.R., LUEPKER, R.V. Prevention of cigarette smoking in seventh grade students. Journal of Behavioral Medirine 3( 1): 15-28, 1980. IGLEHART, J.K. The campaign against smoking gains momentum. Nen, England Journal of Medicine 314(16):1059-1064, April 17, 1986. IMS. Nicorette. New Products Digest, August 1984. INSTITUTE FOR THE STUDY OF SMOKING BEHAVIOR AND POLICY. The Policy Im- plications of the 1986 Surgeon General's Report on Involuntary Smoking. Cambridge, Mas- sachusetts: Institute for the Study of Smoking Behavior and Policy, John F. Kennedy School of Government. Harvard University, 1988. 453 IVERSON, D.C., KOLBE, L.J. Evolution of the national disease prevention and health promo- tion strategy: Establishing a role for the schools. Journal ofSchool Health 53(5):29&302, May 1983. JAMROZIK, K., FOWLER, G., VESSEY, M., WALD, N. Placebo controlled trial of nicotine chewing gum in general practice. British Medical Journal 289(6448):794-797, 1984. JARVIK, M.E., CULLEN, J.W., GRITZ, E.R., VOGT, T.M., WEST, L.J. (eds.) Research on Smoking Behavior, NIDA Research Monograph 17. U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administra- tion, National Institute on Drug Abuse. DHEW Publication No. (ADM) 78-581, December 1977. JARVIS, M.J., RAW, M., RUSSELL, M.A.H., FEYERABEND, C. Randomised controlled trial of nicotine chewing-gum. British Medical Journal 285(6341):537-540, December 21.1982. JASON, L.A., MOLLICA, M., FERRONE, L. Evaluating an early secondary smoking preven- tion intervention. Preventive Medicine 11:96-102, 1982. JOHNSON, CA., HANSEN, W.B., COLLINS, L.M., GRAHAM, J.W. High-school smoking prevention: Results of a three-year longitudinal study. Journal ofBehavioral Medicine 9(S): 439+52,1986. JOHNSTON, L.D., O'MALLEY, P.M., BACHMAN, J.G. National Trends in Drug Use and Related Factors Among American High School Students and Young Adults, 1975-l 986. U.S. Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Drug Abuse. DHHS Publication No. (ADM) 87-1535, 1987. KILLEN, I.D. Prevention of adolescent tobacco smoking: The social pressure resistance train- ing approach. Journal ofChild Psychology and Psychiatry 26(1):7-15, 1985. KILLEN, J.D., MACCOBY, N., TAYLOR, C.B. Nicotine gum and self-regulation training in smoking relapse prevention. Behavior Therapy 15(3):234-248, 1984. KING, AC., FLORA, J.A., FORTMANN, S.P., TAYLOR, CB. Smokers' challenge: Im- mediate and long-term findings of a community smoking cessation contest. American Jour- nal of Public Health 77( lO):I340-1341, October 1987. KLESGES, R.C., VASEY, M.M., GLASGOW, R.E. A worksite smoking modification com- petition: Potential for public health impact. American Journal of Public Health 76(2):198- 200, February 1986. KOLBE, L.J., GILBERT, G.G. Involving the schools in the national strategy to improve the health of Americans. In: Proceedings of Prospects for a Healthier America: Achieving the Nation's Health Promotion Objectives. U.S. Department of Health and Human Services, Public Health Service, Office of Disease Prevention and Health Promotion, 1984, pp. 57-69. KOLBE, L.J., IVERSON, D.C. Comprehensive school health education programs. In: Matarazzo, J.D., Weiss, SM., Herd, J.A., Miller, N.E., Weiss, S.M. (eds.) BehavioralHealth: A Handbook of Health Enhancement and Disease Prevention. New York: John Wiley and Sons, 1984, pp. 1094-l 116. KOTTKE, T.E.. BATTISTA, R.N., DEFRIESE, G.H., BREKKE, M.L. Attributes of success- ful smoking cessation interventions in medical practice. A meta-analysis of 39 controlled trials. Journal of the American Medical Association 259:2883-2889, May 20, 1988. KRASNEGOR, N.A. (ed.) Cigarette Smoking us a Dependence Process, NIDA Research Monograph 23. U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Drug Abuse. DHEW Publication No. (ADM) 79-800, 1979a. KRASNEGOR, N.A. (ed.) The Behavioral Aspects of Smoking, NIDA Research Monograph 26. U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug 454 Abuse, and Mental Health Administration, National Institute on Drug Abuse. DHEW Publi- cation No. (ADM) 79-882. 1979b. LEVENTHAL, H., CLEARY, P.D. The smoking problem: A review of the research and theory in behavioral risk modification. Psycholo~icalBullerin 88(2):37wO5, 1980. LICHTENSTEIN, E., BROWN, R.A. Smoking cessation methods: Review and recommenda- tions. In: Miller, W.R. (ed.) The Addictive Behaviors: TreatmcntofAIcohoiism,Drug Abuse, Smoking. and Obesity. Oxford: Pergamon Press, 1980. LICHTENSTEIN, E., BROWN, R.A. Current trends in the modification of cigarette depend- ence. In: Bellach, A., Hersen, M., Kazdig, A.E. (eds.) International Handbook ofbehavior Modification, Volume 2. New York: Plenum Press, 1983. LICHTENSTEIN, E., DANAHER, B.G. Modification of smoking behavior: A critical analysis of theory, research, and practice. In: Hersen, M., Eisler, R., Miller, P.M. (eds.) Prgqress in Behavioral Modification, Volume 3. New York: Academic Press, 1976. LICHTENSTEIN. E., GLASGOW, R.E., ABRAMS, D.B. Social support in smoking cessation: In search of effective interventions. Behu\ior Therapy 17:607419, 1986. LOHRMANN. D.K., GOLD, R.S., JUBB. W.H. School health education: A foundation for school health programs. Journal of Sc hool Health 57( 10):420425, December 1987. LUEPKER, R.V., JOHNSON, C.A., MURRAY, D.M., PECHACEK, T.F. Prevention of cigarette smoking: Three-year follow-up of an education program for youth. Journal ofBe- huviorul Medicine 6( 1):5362, 1983. LUNDBERG, G.D. The AMA, policy follows science: A case history of tobacco. Journal of the American Medical Assocation 253(20):300 l-3003, May 24-3 1, 1985. LUNDBERG, G.D., KNOLL, E. Tobacco: For consenting adults in private only. Journul of the American Medical Association 255(8):1051-1053, February 1986. MACHOVEC, F.J., MAN, S.C. Acupuncture and hypnosis compared: Fifty-eight cases. American Journal of CIinicul Hypnosis 21(1):45-47, July 1978. MARLA'IT, G.A., GORDON, J.R. Relapse Prevention: Maintenance Strategies in the Treat- ment of Addictive Behaviors. New York: Guilford Press, 1985. MARSTON, A.R., BE'ITENCOURT, A. An evaluation of the American Lung Association's home video smoking cessation program. American Journal of Public Health 78(9): 1226- 1227, 1988. MARTIN, G.P., WAITE, P.M.E. The efficacy of acupuncture as an aid to stopping smoking. New Zealand Medical Journal 93:42 l-423, June 24, 1981. MARTIN, M.J., FEHRENBACH, A., ROSNER, R. Ban on smoking in industry. (Letter.) New EnglandfournuiofMedicine 315( 10):647-648, September 4, 1986. MCALISTER, A., GORDON, N.P. Attrition bias in a cohort study of substance abuse onset and prevention. Evaluation Review 10(6):853-859, December 1986. MCALISTER, A.L., PERRY, C., KILLEN, J., SLINKARD, L.A., MACCOBY, N. Pilot study of smoking, alcohol and drug abuse prevention. American Journal of Public Health 70(7): 719-721, July 1980. MCALISTER, A.L., PERRY, C., MACCOBY, N. Adolescent smoking: Onset and prevention. Pediatrics 63:650-658, 1979. MCCAUL, K.D., GLASGOW, R.E. Preventing adolescent smoking: What have we learned about treatment construct validity? Health Psychology 4(4):361-387. 1985. MCFARLAND, M.I. When five became twenty-five. A silver anniversary of the five-day plan to stop smoking. Adventisf Heritage 1 I( 1):57&t, 1986. MERKI, D.J.,CRESWELL, W.H., STONE, D.B., HUFFMAN, W., NEWMAN, I. Theeffects of two educational methods and message themes on rural youth smoking behavior. Journal of School Health 38:448-l54, 1968. 455 MINNESOTA DEPARTMENT OF HEALTH. The Minnesota Nonsmoking initiative. June, 1985-December 1986. A Report to the 1987 Legislature. Minnesota Department of Health, Center for Nonsmoking and Health, 1987. MITCHELL, V. Instant answers for students on what smoking does to the body. American Lung Association Bulletin 64(8):69, October 1978. MOSKOWITZ, J.M. Preventing adolescent substance abuse through drug education. In: Glynn, T.J., Leukefeld, C.G., Ludford, J.P. (eds.) Preventing Adolescent Drug Abuse, NIDA Research Monograph 47. U.S. Department of Health and Human Services, Public Health Ser- vice, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Drug Abuse. DHHS Publication No. (ADM) 85-l 280, 1983. pp. 233-249. MULTIPLE RISK FACTOR INTERVENTION TRIAL RESEARCH GROUP. Multiple Risk Factor Intervention Trial: Risk factor changes and mortality results. Journal ofthe American Medical Association 248( 12): 1465-1477, September 24, 1982. MURRAY, D.M. Dissemination of community health promotion programs: The Fargo-Moor- head Heart Health Program. Journal ofSchool Health 56(9):375-38 I, November 1986. MURRAY, D.M., JOHNSON, CA., LUEPKER, R.V., MITTELMARK. M.B. The prevention of cigarette smoking in children: A comparison of four strategies. Journal ofApplied Social Psychology 14(3):274-288. 1984. NATIONAL CANCER INSTITUTE. Utili:ing Physicians, Dentists, and Pharmacists as Health Exemplars to Help Smokers Quif-A Case Study. National Cancer Institute, Office of Cancer Communications, April 1982. NATIONAL CANCER INSTITUTE. Smoking. Tobacco, and Cancer Program. Annual Report 1983. U.S. Department of Health and Human Services, National Cancer Institute. NIH Pub- lication No. 84-2687, September 1984. NATIONAL CANCER INSTITUTE. Smoking, Tobacco, and Cancer Program. 1985 Report. National Cancer Institute. U.S. Department of Health and Human Services, Public Health Ser- vice, National Institutes of Health. NIH Publication No. 86-2687, April 1986a. NATIONAL CANCER INSTITUTE. Integrating tobacco education into the school system. Request for research grant applications: NIH-NCI-DCPC-HPSB-CA. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute, 1986b. NATIONAL DIFFUSION NETWORK. Final Report: Adoption Data. Hampton, New Hampshire: National Diffusion Network Technical Assistance, April 1988a. NATIONAL DIFFUSION NETWORK. Educational Programs That Work. A Collection of Proven Exemplary Educational Programs and Practices, Fourteenth Edition. Longmont, Colorado: Sophis West, 1988b. NATIONAL HEART, LUNG, AND BLOOD INSTITUTE. Smoking Education Program Overview. National Heart, Lung, and Blood Institute, Office of Prevention, Education, and Control, 1988. NATIONAL HEART, LUNG, AND BLOOD INSTITUTE, NATlONAL INSTITUTES OF HEALTH. Protocolfor the Study of Early Intervention for Chronic Obstructive Pulmonary Disease. National Heart, Lung, and Blood Institute, Division of Lung Diseases, 1986. NATIONAL INSTITUTES OF HEALTH. Announcement. Prevention and cessation of use of smokeless tobacco. NIH Guide for Grunts and Contracts 15(3):3841. February 28, 1986. NATIONAL INTERAGENCY COUNCIL ON SMOKING AND HEALTH. Cookbook for u Smokeless Diet. U.S. Department of Health, Education, and Welfare, Public Health Service, Centers for Disease Control, Bureau of Health Education, National Clearinghouse for Smok- ing and Health. 1977. 456 NATIONAL INTERAGENCY COUNCIL ON SMOKING AND HEALTH. Final Report: Youth Leadership in Smoking Controls Program. CDC 200-78-0815. National Interagency Council on Smoking and Health, September 30, 1979. NATIONAL SCHOOL BOARDS ASSOCIATION. No Smoking: A Board Member's Guide to Nonsmoking Policies for the Schools. Alexandria, Virginia: National School Boards As- sociation, June 1987. NEWSWEEK. The kick-the-habit business: Corporations pay big money to help smokers quit. tv'eu,sn,eek, August 29, 1988. pp. 42-43. NUEHRING, E., MARKLE. G.E. Nicotine and norms: The re-emergence of a deviant behavior. Sotiul Problems 21:513-526, 1974. O'ROURKE. T., NOLTE, A.E., SMITH, B.J. Improving anti-smoking education: Profiling the ex-smoker. Journal ofDrug Education 15(1):7-22, 1985. OCKENE. J.K. Physician-delivered interventions forsmokingcessation: Strategies forincreas- ing effectiveness. Pre~entiveMedicine 161723-737. 1987. OCKENE. J.K., HOSMER, D.W.. WILLIAMS. J.W., GOLDBERG, R.J., OCKENE, I.S., BILIOURIS, T., DALEN, J.E. The relationship of patient characteristics to physician delivered smoking cessation advice. Journal of General Internal Medicine 2:337-340.1987. OCKENE, J.K., HYMOWITZ. N., SEXTON, M., BROSTE, S.K. Comparison of patterns of smoking behavior change among smokers in the Multiple Risk Factor Intervention Trial (MRFIT). Preventive Medicine 11:62 l-638, 1982. OCKENE. J.K., QUIRK, M.E., GOLDBERG, R.J.. KRISTELLER, J.L., DONNELLY, G., KALAN. K.L., GOULD, B., GREENE, H.L., HARRISON-ATLAS, R., PREASE, J., PICK- ENS, S.. WILLIAMS. J.W. A residents' training program for the development of smoking intervention skills. Archives of Internal Medicine 148: 1039-I 045, May 1988. OEI, T.P.S., FEA, A. Smoking prevention program for children: A review. Journal of Drug Education 17(l):] l-42, 1987. OMENN. G.S.,THOMPSON, B.. SEXTON, M., HESSOL, N.. BREITENSTEIN, B., CURRY, S., MICHNICH, M., PETERSEN, A. A randomized comparison of worksite-sponsored smoking cessation programs. American Journal of Preventixje Medicine 4(5):261-267.1988. ORLANDI, M.A. The diffusion and adoption of worksite health promotion innovations: An analysis of barriers. Preventive Medicine 15:522-536, 1986. ORLEANS, C.S., SHIPLEY, R.H. Worksite smoking cessation initiatives: Review and recom- mendations. Addicti~~eBehaviors 7:1-16, 1982. PARKER, S., WARNER, K.E. Smoking policies in the workplace: Research needs and poten- tial applications, Nen' York State Journal of Medicine 89(1):2-4, January 1989. PATTERSON, J.T. The Dread Disease. Cancer and Modern American Culture. Cambridge, Massachusetts: Harvard University Press, 1987. PECHACEK, T. A randomized community trial for smoking cessation. In: Aoki, M., Hisamichi, S., Tominaga, S. (eds.) Smoking and Health, 1987. Proceedings of the 6th World Conference on Smoking and Health, Tokyo. November 9-12, 1987. Amsterdam: Excerpta Medica, 1988. pp. 241-243. PECHACEK, T.F. Modification of smoking behavior. In: Krasnegor, N.A. (ed.) The Be- havioral Aspects of Smoking. NIDA Research Monograph 26. U.S. Department of Health, Education, and Welfare. Public Health Service. Alcohol, Drug Abuse, and Mental Health Ad- ministration, National Institute on Drug Abuse. DHEW Publication No. 79-882, August 1979, pp. 127-188. PERRY, C.L., KILLEN, J., SLINKARD, L.A., MCALISTER, A.L. Peer teaching and smok- ing prevention among junior high students. Adolescence 15(58):277-28 1, 1980. 457 PERRY, C.L., KILLEN, J., TELCH, M., SLINKARD, L.A., DANAHER, B.C. Modifying smoking behavior of teenagers: A school-based intervention. American Journal ofPublic Health 70(7):722-725. 1980. PERRY, C.L., MURRAY, D.M. Enhancing the transition years: The challenge of adolescent health promotion. The Journal ofSchool Health 52(5):307-3 II, 1982. PERRY, C.L.. TELCH, M.1.. KILLEN, J., BURKE, A., MACCOBY, N. High school smoking prevention: The relative efficacy of varied treatments and instructors. Adolescence 18(7 1): 561-566,1983. PERTSCHUK, M. Giant Killers. New York: Norton, 1986. PRIG, R.M. JR., BAILEY, W.J., SEFFRIN, J.R., TORABI, M.R., LAVE, J.S. Evaluation of American Cancer Society elementary school public education programs. Journal ofSchool Health 55(4):157-160, 1985. PIRIE, P.L., MURRAY, D.M., LUEPKER, R.V. Smoking prevalence in a cohort of adoles- cents, including absentees, dropouts, and transfers. American Journal of Public Health 78(2):17&178, 1988. POLICH, J.M., ELLICKSON, P.L., REUTER, P., KAHAN, J.P. Strategies for Controlling Adolescent Drug Use. Santa Monica, California: Rand Corporation, 1984. POWELL, D.R., MCCANN, B.S. The effects of a multiple treatment program and maintenance procedures on smoking cessation. Preventive Medicine 10:94-104, 1981, PROCHASKA, J.O., DICLEMENTE, C.C. Stages and processes of self-change of smoking: Toward an integrative model of change. JournolofConsultingondClinica/ Psychology5 l(3): 390-395, 1983. PUSKA, P., BJORKQVIST, S., KOSKELA, K. Nicotine-containing chewing gum in smoking cessation: A double blind trial with half year follow-up. Addictive Behaviors 4:141-146, 1979. RAMIREZ, A.G., MCALISTER, A.L. Mass media campaign-A Su Salad. Preventive Medicine 17(5):608-62 1, September 1988. REIF, A.E. Public information on smoking. An urgent responsibility for cancer research workers. Journal of the Notional Cancer Institute 57(6): 1207-1210, December 1976. ROPER. A Study of Public Attitudes Toward Cigarette Smoking and the Tobacco Industry in 1978, Volume 1. Roper Organization, May 1978. ROSEN, G.M.. LICHTENSTEIN, E. An employee incentive program to reduce cigarette smok- ing. Journal of Consulting and Clinical Psychology 45(5):957, 1977. ROSENBERG, 1. The AMA tackles smoking: "A Strong Stand." New York State Journal of Medicine 83(13):1363-1365, December 1983. RUSSELL, M.A.H., MERRIMAN, R., STAPLETON, J., TAYLOR, W. Effect of nicotine gum as an adjunct to general practitioners' advice against smoking. British Medical Journal 287(6407):1782-1785, December 10, 1983. RUSSELL, M.A.H., WILSON, C., TAYLOR, C., BAKER, C.D. Effect of general practitioners' advice against smoking. British Medical Journal 2(6184):231-235, July 28, 1979. ST. PIERRE, R.W.. SHUTE, R.E., JAYCOX, S. Youth helping youth: A behavioral approach to the self-control of smoking. Health Education 14( 1):28-3 1, January-February 1983. SCHINKE, S.P.,GILCHRIST. L.D., SNOW, W.H., SCHILLING, R.F. Skills-building methods to prevent smoking by adolescents. Journal of Adolescent Health Care 6:439-444, 1985. SCHNEIDEMAN, 1. Acupuncture and smoking. (Letter.) New Zealand Medical Journal 94(693):276, October 14, 1981. SCHNEIDER, N.G., JARVIK, M.E., FORSYTHE, A.B. Nicotine vs. placebo gum in the al- leviation of withdrawal during smoking cessation. AddictiveBehaviors 9(2): 149-156, 1984. SCHNEIDER, N.G., JARVIK, M.E., FORSYTHE, A.B., READ, L.L., ELLIOTT, M.L., SCHWEIGER, A. Nicotine gum in smoking cessation: A placebo-controlled, double-blind trial. Addictive Behaviors 8(3):253-261, 1983. SCHWARTZ, J.L. A critical review and evaluation of smoking control methods. Public Health Reports 84(6):483-506, June 1969. SCHWARTZ, J.L. Review and Evaluation of Smoking Cessation Methods: United States and Canada, /976-/9RS. U.S. Department of Health and Human Services, Public Health Ser- vice, National Institutes of Health. NIH Publication No. 87-2940. April 1987. SCHWARTZ, J.L., RIDER, G. Revienv and Evaluation of Smoking Control Methods: The United States and Canada, 1969-1977. U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, Bureau of Health Education. HEW Pub- lication No. (CDC) 79-8369, 1978. SEFFRIN, J.R., BAILEY, W.J. Approaches to adolescent smoking cessation and education. Special Sentices in the Schools 1(3):25-38, 1985. SEVERSON. H., JAMES, L.E., LACHANCE, P.-A., EAKIN, E. Up to Snufl A Handbook on Smokeless Tobacco. Eugene. Oregon: Independent Video Services, 1987. SHAFFER, H., BECK, J.C., BOOTHROYD, P. The primary prevention of smoking onset: An inoculation approach. Journal of Psychoactii*e Drugs 15(3): 177-184, July-September 1983. SHIPLEY, R.H., ORLEANS, C.T., WILBUR, C.S., PISERCHIA, P.V., MCFADDEN, D.W. Effect of the Johnson and Johnson LIVE FOR LIFE Program on employee smoking. Preven- tive Medicine 17( 1):25-34, January 1988. SKINNER, W.F., MASSEY, J.L., KROHN, M.D., LAUER, R.M. Social influences and con- straints on the initiation and cessation of adolescent tobacco use. Journal of Behavioral Medicine 8(4):353-376, December 1985. SLADE, J.D. A disease model of cigarette use. New York StateJournalofMedicine 85(7):294- 297, July 1985. SMITH, J.W. Long term outcome of clients treated in a commercial stop smoking program. Journal of Substance Abuse Treatment 5:33-36, 1988. SMITH, L. The D-Day story. In: Steinfeld, J., Griffiths, W., Ball, K., Taylor, R.M. (eds.) Smok- ing and Health. II. Health Consequences, Education, Cessation Activities, and Governmen- tual Action. Proceedings of the 3rd World Conference on Smoking and Health. U.S. Depart- ment of Health, Education, and Welfare, Public Health Service, National Institutes of Health, National Cancer Institute. DHEW Publication No. (NIH) 77-1413, 1977, pp. 409-413. SNOW, W.H., GILCHRIST, L.D., SCHINKE, S.P. A critique of progress in adolescent smok- ing prevention. Children and Youth Services Review 7: I-19, 1985. SOFFER, A. Smoking, the new ACCP fellowship pledge, and preventive medicine. Chest 77(4):459-460, April 1980. SOFFER, A. Introduction. Chest 93(2, Supplement):33S. February 1988. SOLBERG, L.I. Implementing a tobacco cessation program in clinical practice. MedicalTimes 116(4):119-124, April 1988. SPIEGEL, H. A single-treatment method to stop smoking using ancillary self-hypnosis. Infer- national Journal of Clinical and Experimental Hypnosis 18(4):235-250, 1970. STONE, E.J. School-based health research funded by the National Heart, Lung, and Blood In- stitute. Journal ofSchool Health 55(5): 168-174, May 1985. SUSSMAN, S., BRANNON, B.R., FLAY, B.R., GLEASON, L., SENOR, S., SOBOL, D.F., HANSEN, W.B., JOHNSON, C.A. The television, school and family smoking preven- tion/cessation project. II. Formative evaluation of television segments by teenagers and parents-Implications for parental involvement in drug education. Health Education Re- search 1(3):185-194, 1986. 459 SUSSMAN, S., DENT, C.W., FLAY, B.R., HANSEN, W.B., JOHNSON, C.A. Psychosocial predictors of cigarette smoking onset by white, black, Hispanic, and Asian adolescents in southern California. Morhidi~ and Morrali@ Weekly Report 36(4S): 1 lS-16s. September 4, 1987. TAYLOR, P. The Smoke Ring. Tobacco, Money. and Multinational Politics. New York: Pan- theon Books, 1984. TELCH, M.J., KILLEN, J.D., MCALISTER, A.L., PERRY, C.L., MACCOBY, N. Long-term follow-up of a pilot project on smoking prevention with adolescents. Journal ofBehavioral Medicine 5( l):l-8, 1982. THOMPSON, E.L. Smoking education programs 1960-1976. American Journal of Public Health 68(3):2X)-257, March 1978. TONNESEN. P., HANSEN, M., HELSTED, J., GUNNERSEN, A.B., FORCHAMMER. H.. STOCKNER, M. Effect of nicotine chewing gum in combination with group counseling on the cessation of smoking. New En,g[and Journal of Medicine 3 18( 1): 15-l 8, 1988. TROYER, R.J., MARKEL, G.E. Cigarettes, the Bottle Over Smoking. New Brunswick, New Jersey: Rutgers University Press, 1983. U.S. DEPARTMENT OF DEFENSE. Report on Smoking and Health in the Militay. U.S. Department of Defense, Office of the Assistant Secretary of Defense (Health Affairs), Office of the Assistant Secretary of Defense (Force Management and Personnel), March 1986. U.S. DEPARTMENT OF DEFENSE. Updated Report on Smoking and Health in the Military. U.S. Department of Defense, Office of the Assistant Secretary of Defense (Health Affairs), Office of the Assistant Secretary of Defense (Force Management and Personnel), June 1987. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Smoking Programsfor Youth. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute. NIH Publication No. 80-2 156, June 1980a. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. The Health Consequences of Smoking for Women. A Report of the Surgeon General. U.S. Department of Health and Human Services, Public Health Service, Office of the Assistant Secretary for Health, Office on Smoking and Health, 1980b. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. The Health Consequences of Smoking. The Changing Cigarette: A Report oj" the Surgeon General. U.S. Department of Health and Human Services, Public Health Service, Office of the Assistant Secretary for Health, Office on Smoking and Health. DHHS Publication No. (PHS) 81-50156, 1981. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. The Health Consequences of Smoking: Cancer. A Report of the Surgeon General. U.S. Department of Health and Human Services, Public Health Service, Office on Smoking and Health. DHHS Publication No. (PHS) 82-50179, 1982. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. The Health Consequences of Smoking: Cardiovascular Disease. A Report of the Surgeon General. U.S. Department of Health and Human Services, Public Health Service, Office on Smoking and Health. DHHS Publication No. (PHS) 84-50204, 1983a. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. The Physician's Guide. Hon. to Help Your Hypertensive Patients Stop Smoking. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. DHHS Publication No. (NIH) 83-1271, April 1983b. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. The Health Consequences of Smoking: Chronic Obstructive Lung Disease. A Report of the Surgeon General. U.S. Depart- ment of Health and Human Services. Public Health Service, Office on Smoking and Health. DHHS Publication No. (PHS) 84-50205, 1984. 460 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. The Health Consequences of Smnking: Cancer and Chrnnic~ Lung Disease in the Workplace. A Report of the Surgeon General. U.S. Department of Health and Human Services, Public Health Service, Office on Smoking and Health. DHHS Publication No. (PHS) 85-50207, 1985a. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. A Decision Maker's Guide to Reducing Smokingatthe Worksite. U.S. Department of Health and Human Services, Public Health Service, Office on Smoking and Health, Office of Disease Prevention and Health Promotion, 1985b. US. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Smoking and Health. A Na- tionalStatus Report. A Report ta Congress. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Educa- tion, Office on Smoking and Health. DHHS Publication No. (CDC) 87-8396, 1986a. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. The Health Consequences of Inwluntary Smaking. A Repar-t of the Surgean General. U.S. Department of Health and Human Services. Public Health Service, Centers for Disease Control. DHHS Publication No. (CDC) 87-8398,1986b. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. The Health Consequences of Using Smokeless Tobacco. A Report of the Ad\?sory Cnmmittee to the Surgeon General. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. NIH Publication No. 86-2874, 1986~. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. State and Local Programs an Smoking and Hea/th. U.S. Department of Health and Human Services, Public Health Ser- vice, Office of the Assistant Secretary for Health, Office on Smoking and Health. DHHS Pub- lication No. (PHS) 86-50190, l986d. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Clinical Opportunities for Smoking Intervention. A Guide for the Busy Physician. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. NIH Publication No. 86-2178, August 1986e. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. National Survey of Worksite Health Promotion Ac,tivities: A Summary. U.S. Department of Health and Human Services, Public Health Service, Office of Disease Prevention and Health Promotion. Monograph series, Summer 1987. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. The Health Consequences of Smoking: Nicotine Addiction. A Report of the Surgeon General. 1988. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Education, Office on Smoking and Health. DHHS Publication No. (CDC) 88-8406, 1988. U.S.DEPARTMENTOFHEALTH ANDHUMAN SERVICES. The 1987NutionalAdoie~ cent Student Health Survey. U.S. Department of Health and Human Services, Public Health Service. Office of Disease Prevention and Health Promotion, in press. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE. The Health Conse- quences af Smoking. A Report of the Surgean General: f972. U.S. Department of Health, Education, and Welfare, Public Health Service, Health Services and Mental Health Ad- ministration. DHEW Publication No. (HSM) 72-7516, 1972. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE. San Diego Smoking Research Project. Fit'e Year Status. U.S. Department of Health, Education, and Welfare, Center for Disease Control. DHEW Project No. 200-75-0516:1-7, 1976. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE. The Health Conse- quences #Smoking. 1977-1978. U.S. Department of Health, Education, and Welfare, Public 461 Health Service, Officie of the Assistant Secretary for Health, Office on Smoking and Health, DHEW Publication No. (PHS) 79-50065, 1978. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE. Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention. U.S. Department of Health, Education, and Welfare, Public Health Service, Office of the Assistant Secretary for Health and Surgeon General. DHEW Publication No. (PHS) 79-55071, 1979a. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE. Smoking and Health, A Reportofthe Surgeon General. U.S. Department of Health, Education, and Welfare, Public Health Service, Office of the Assistant Secretary for Health, Office on Smoking and Health. DHEW Publication No. (PHS) 79-50066, 1979b. U.S. DEPARTMENTOF HEALTH, EDUCATION, AND WELFARE. Teenage Smoking. Im- mediate and Long-Term Patterns. U.S. Department of Health, Education, and Welfare, Na- tional Institute of Education, November 1979~. U.S. PREVENTIVE SERVICES TASK FORCE. Recommendations for smoking cessation counseling. Journal ofrhe American Medical Association 259(19):2882, May 20, 1988. U.S. PUBLIC HEALTH SERVICE. Smoking and Health. Report of the Advisory Committee to the Surgeon Genera/ ofthe Public Health Service. U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control. PHS Publication No. 1103, 1964. UNIVERSITY OF THE STATE OF NEW YORK. Annotated Resource Guide for Alcohol, Tobacco and Other Drug Abuse/Misuse Prevention Education Programs. Secondary Level. Albany, New York: University of the State of New York, State Education Department, Bureau of Drug Education, 1979. WALTER, H.J., VAUGHAN, R.D., WYNDER, E.L. Primary prevention of cancer among children: Changes in cigarette smoking and diet after six years of intervention. Journal of the National Cancer Institute, in press. WARNER, K.E. The effects of the anti-smoking campaign on cigarette consumption. American Journal of Public Health 67(7):645450, July 1977. WARNER, K.E. Possible increases in the underreporting of cigarette consumption. Journal of the American Srarisrical Association 73(362):31&3 18, June 1978. WARNER, K.E. Cigarette smoking in the 1970's: The impact of the antismoking campaign. Science 211(4483):729-731, February 13, 1981. WARNER, K.E. Selling Smoke: Cigarette Advertising and Public Health. Washington, D.C.: American Public Health Association, October 1986. WARNER, K.E., ERNSTER, V.L., HOLBROOK, J.H., LEWIT, E.M., PERTSCHUK, M., STEINFELD, J.L., WHELAN, E.M. Public policy on smoking and health: Toward a smoke- free generation by the year 2COO. A statement of a working group to the Subcommittee on Smoking of the American Heart Association. Circulation 73(2):38 IA-395A, February 1986. WARNER, K.E.. MURT. H.A. Impact of the antismoking campaign on smoking prevalence: A cohort analysis. Journal ofPublic Health Policy 3(4):374-390, December 1982. WEISSMAN, W., GLASGOW, R., BIGLAN, A., LICHTENSTEIN, E. Development and preliminary evaluation of a cessation program for adolescent smokers. Psychology ofAddic- fiveBehaviors 1(2):8&91, 1987. WHELAN, E.M. A Smoking Gun: How the Tobacco Industry Gets Away With Murder. Phila- delphia: George F. Stickley, 1984. WILBUR, C.S. The Johnson and Johnson Program. Preventive Medicine 12:672-68 I, 1983. WILSON, D.M.,TAYLOR, W.,GILBERT, J.R., BEST, J.A.,LINDSAY, E.A., WILLMS, D.G., SINGER, J. A randomized trial of a family physician intervention for smoking cessation. Journal of the American Medical Association 260( 11): 1570-l 574, September 16, 1988. 462 WONG, W. Smoke-free rooms really will decide this California vote. Tobacco firms pour in money to fight proposal to ban indoor public puffing. Wall Street Journal, October 25,1978, pp. I, 23. WORDEN, J.K., FLYNN, B.S., BRISSON. S.F., SECKER-WALKER, R.H., MCAULIFFE, T.L., JONES, R.P. An adult communication skills program to prevent adolescent smoking. Journal of Drug Education I 7( I ): 1-9, 1987. WORDEN. J.K., FLYNN, B.S., GELLER, B.A., CHEN, M., SHELTON, L.G., SECKER- WALKER, R.H., SOLOMON, D.S., SOLOMON, L.J.,COUCHEY, S., CONSTANZA, M.C. Development of a smoking prevention mass media program using diagnostic and formative research. Preventi\,e Medicine, in press. YOUNG, S.R., CHEN, T.T.L., CERNADA, G.P. An evaluation of a biofeedback smoking education program. International Quarterly of CnmmuniQ Health Education 2(4):329-337, 1981-1982. 463 CHAPTER 7 SMOKING CONTROL POLICIES 465 CONTENTS Introduction ..................................................... ..47 1 Part I. Policies Pertaining to Information and Education ................... 474 Warning Labels on Tobacco Products ................................ 474 History and Current Status .................................... 475 Effectiveness of Cigarette Warning Labels ....................... 482 Summary ................................................ ..48 5 Disclosure of Tobacco Product Constituents ........................... 488 History and Current Status .................................... 488 Effects of Disclosure of Tobacco Product Constituents ............. 490 Mandated Education About Health Risks .............................. 491 School Education ........................................... 491 CurrentStatus ........................................ ..49 1 Compliance and Effects .................................. 494 Broadcast Media .......................................... ..49 6 History .............................................. ..49 6 Effectiveness ........................................... 497 Restrictions on Tobacco Advertising and Promotion ..................... 500 Effects of Tobacco Advertising and Promotion .................... 500 Mechanisms by Which Advertising and Promotion May Affect Consumption ...................................... ..50 1 Evidence .............................................. 503 Formal Empirical Analysis ................................ 503 Regression Analyses ................................. 503 Survey Research and Experimental Studies of Reactions to Advertisements ................................. 505 Additional Empirical Observations and Logical Arguments ...... 506 Indirect Mechanisms: Media Coverage of Smoking ............ 508 Federal Advertising Restrictions ............................... 5 10 State and Local Advertising Restrictions ......................... 5 12 Effects of Government Actions to Restrict Tobacco Advertising ............................................ ..513 Policies Under Consideration .................................. 5 15 Summary ................................................ ..516 Reporting Requirements ........................................... 5 17 Surgeon General's Reports .................................... 5 17 Biennial Status Reports ...................................... 5 17 Federal Trade Commission Reports ............................. 5 18 Effectiveness ............................................. ..518 Government Expenditures and State Smoking Control Plans .............. 520 Federal Expenditures ........................................ 520 State Smoking and Health Plans ............................... 524 Part II. Economic Incentives ......................................... 526 447 Tobacco Excise Taxation ...................................... History and Current Status ................................ Federal Excise Taxes ................................. State and Local Excise Taxes .......................... Effects of Excise Taxes on Smoking and Health ............... Price Elasticity of Demand for Cigarettes ................ Effects of an Excise Tax Increase ....................... Health Consequences of Tax Changes ................... Policies Under Consideration .............................. Tobacco Excise Tax Increases ......................... Switch to an Ad Valorem Tax ......................... Earmarking of Revenues .............................. Insurance and the Treatment of Smokers .......................... LifeInsurance .......................................... History of Premium Differentials ....................... Current Status of Premium Differentials ................. HealthInsurance ........................................ Current Status of Premium Differentials ................. Factors Influencing Decisions About Premium Differentials . . Property and Casualty Insurance ........................... Effects of Insurance Premium Differentials on Smoking Behavior Health Insurance Coverage for Smoking Cessation Treatment ... Summary .............................................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Part III. Direct Restrictions on Smoking .............................. Government Actions to Restrict Smoking in Public Places and Workplaces Smoking Restrictions in Public Places ......................... Federal Actions ....................................... State Legislation ...................................... Local Legislation ...................................... Smoking Restrictions in Public Transportation Facilities .......... BusesandTrains ...................................... Commercial Airlines ................................... Smoking Restrictions in the Workplace ........................ Government Worksites . . . . . . . . . . . _ . . Private Worksites . . . . _ . . . . . . . . . Judicial Actions . . . . . . . . . . . . . . . . . . . Effects of Government Actions to Restrict Smoking Implementation, Compliance, and Enforcement Public Opinion . . . . . . . . . . . . . . . . . . . . . Smoking Behavior _ . . . . . . . . . . . . . . . . . . Summary . . . . . . . . . . , . . . . . . . , . . . . . . . . . . . . . . Smoking Restrictions in the Private Sector . . . . . . . . . . . . Workplace Smoking Restrictions . . . . . . . . . . . . . . . History and Prevalence . . . . . . . . . . . . . . Level of Restrictiveness . . . . . . _ . . . . . _ ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... . . 527 . . 527 . . 527 . . 529 . . 533 . . 533 . . 538 . . 540 . . 541 . 541 . . 542 . . 542 . 543 . . 544 . . 544 . 546 . . 547 . . 547 . . 548 . 550 . . 551 . . 552 . . 553 . 555 . . 556 . . 556 557 . . 557 . 570 . . 572 572 . . 573 . . 574 574 _ 576 . . 576 . . 576 . . 576 . . 577 . . 578 . . 579 . . 580 . . 580 . . 581 . 583 468 Reasons for Adopting Smoking Policies ..................... 583 Correlates of Worksite Smoking Policies ..................... 584 Health Care Facilities ........................................ 585 Schools ................................................. ..58 7 PublicTransportation ...................................... ..58 8 Effects of Smoking Restrictions ................................ 589 Implementation and Compliance ........................... 590 AttitudesandNorms ................................... ..59 0 Smoking Behavior ....................................... 59 1 Participation in Cessation Programs ......................... 593 AirQuality ........................................... ..59 4 OtherEffects ......................................... ..59 4 Summary .................................................. 594 Restrictions on Children's Access to Tobacco .......................... 596 How Do Children Obtain Tobacco Products? ..................... 597 History of Tobacco Access Laws ............................... 597 Current Tobacco Access Laws ................................. 598 Compliance With Tobacco Access Laws ......................... 604 Effects of Current Access Laws ................................ 607 Summary .................................................. 607 Federal Regulation of Tobacco Products .............................. 608 Regulation of Tobacco Products Prior to 1964 .................... 608 Regulation of Tobacco Products After 1964 ...................... 610 Environmental Tobacco Smoke Exposure ........................ 6 12 TobaccoProductAdditives ................................. ..613 Fire Safety of Cigarettes ..................................... .6 14 SmokelessTobaccoProducts ................................ ..615 Alternative Nicotine-Containing Products ........................ 615 Summary ................................................ ..617 Conclusions ..................................................... ..618 References ...................................................... ..62 1 469 INTRODUCTION This Chapter describes and evaluates policy measures that have affected, have been intended to affect, or might be expected to affect, smoking behavior. For current pur- poses, the term policy refers to a set of rules that guide the present and future behavior of individuals and organizations to achieve a specific goal. Smoking control policies encompass a diverse group of actions in both the public and private sectors. They share the common potential for reducing the burden of tobacco-induced illness by decreas- ing the prevalence and intensity of cigarette smoking in the United States. The smoking control policies discussed here interact with and often complement non- policy activities, such as smoking cessation and prevention programs, described in Chapter 6. The distinction made here is that policies primarily involve the setting of rules, whereas nonpolicy activities are usually offered on a voluntary basis to smokers or potential smokers and attempt to influence directly the decision to smoke. The no- tion of policymaking is often associated primarily with government, but private sector organizations, such as schools, businesses, and health care facilities, have also set policies that influence smoking. Conversely, nonpolicy actions, such as voluntary smoking cessation programs, may be undertaken by Government units like Federal agencies or the Armed Forces, although most such activities are conducted by private organizations. This Chapter covers tobacco control policies that have been adopted or seriously con- sidered by Federal, State, and local governments and by the private sector, focusing on developments since the release of the first Surgeon General's Report in 1964. Each section reviews the history and rationale for adopting a particular policy, analyzes what is known about its impact on smoking behavior, and discusses related policies under serious consideration. While it would be ideal to determine the independent effect of each policy on public knowledge and smoking behavior, in many cases this is difficult to assess. Smoking control policies occur in a context of multiple social influences on smoking; individual policies overlap in time with each other and with the nonpolicy in- fluences on smoking described in Chapter 6. Because relatively few studies adequate- ly control for potentially confounding influences on smoking, it is often difficult to identify the effect of an individual policy on smoking behavior or knowledge. Chapter 8 considers the aggregate impact of antismoking activities and changing social norms over the past 25 years, including both policy and nonpolicy actions, on smoking. The focus of the Chapter is necessarily on cigarettes; they are the predominant form of tobacco use, the cause of the overwhelming majority of tobacco-related diseases, and the subject of most policy efforts. Nonetheless, the Chapter also includes policies that target other forms of tobacco use. As with the rest of this Report, the Chapter's scope is limited to the United States; smoking control policies outside the United States have been reviewed by Roemer (1982,1986). Furthermore, the Chapter does not cover tobacco trade policy, because it has limited relevance to smoking prevalence in the United States. The targets of smoking-related policies are diverse; they include not only consumers (smokers) or potential consumers of tobacco products, but also suppliers, growers, 471 manufacturers, distributors, and vendors. To summarize the array of tobacco control policies that have been considered or adopted, this review follows a classification proposed by Walsh and Gordon (1986): (1) educational and persuasive efforts, (2) economic incentives, and (3) direct restraints on tobacco use, manufacture, or sales (Table 1). Policies in the first category aim to inform the public about the health risks of smoking and persuade individuals to stop, or not to start, smoking. The second group of policies involves market mechanisms that increase the costs of smoking to the manufacturer, the vendor, or the consumer of tobacco products. The third category in- cludes public policies that directly reduce opportunities to smoke by limiting the sale or use of tobacco products or that attempt to reduce the toxicity of tobacco products by regulating their contents. In many instances, policies that are educational for consumers have a regulatory nature for suppliers. An example is the Federal Government's re- quirement that all cigarette packages carry a Surgeon General's warning. In these cases, policies are categorized according to their influence on consumers or potential con- sumers. Although broad in its coverage, the Chapter is limited to policies that have been adopted or seriously considered for adoption in the near future. Considerations of space and emphasis have forced the exclusion of a few policies that have been discussed in both the news media and the academic literature. Perhaps most conspicuously, this Chapter includes no discussion of tobacco farm policy. In particular, the tobacco price support and allotment system (better known as the tobacco "subsidy") is not considered. The impact of this policy on smoking and health is indirect (Warner 1988). Similarly, no attempt is made in this Report to examine the issue of how governments might facilitate tobacco farmers' transition to other crops or careers (Warner et al. 1986b). Furthermore, this Chapter does not discuss other activities that might have a substan- tial impact on smoking but are not properly categorized as policies. A prominent ex- ample is tobacco product liability suits, which seek to establish the legal liability of tobacco manufacturers for the tobacco-related illnesses of smokers (Daynard 1988). The lawsuits themselves are private matters, not policy issues, and while there are policy issues relevant to the lawsuits, the lack of a significant body of literature on the issues of interest precludes coverage of them. Finally, the Chapter does not treat in detail the strongest potential policy: a total ban on tobacco sales and use. Given the addictive- ness of tobacco, the unique history of tobacco use (which was widespread and cultural- ly accepted long before the hazards were fully appreciated) and the Nation's experience with alcohol prohibition, a total ban on tobacco is at present neither widely discussed nor likely to be adopted. 472 TABLE L-Past, present, and proposed tobacco control policies Information and education I. Require health warnings A. Packages B. Advertising Economic incentives I. Increase tobacco taxation (e.g., excise tax) Direct restraints on tobacco use 1. Restrict smoking in certain places (e.g., public places, workplaces. schools. hospitals) 2. Require disclosure of constituents of tobacco products or smoke A. Tar, nicotine, carbon monoxide B. Tobacco product additives 3. Mandate educational programs A. Schools B. Mass media 2. Mandate insurance incentives A. Premium price differentials (smoker-nonsmoker) B. Cover smoking cessation treatment costs 3. Reduce or eliminate tobacco price supports' 2. Restrict distribution (sales) A. By age (mmors) B. Via certain outlets (e.g.. vending machines) 3. Regulate product composition 4. Issue Government reports 5. Fund smoking research and programs 6. Restrict or ban advertising and promotion 4. Establish legal liability of producersa 4. Ban manufacture, sale. or usea "Not dIscussed m this Report. SOURCE: Modified from Walsh and Gordon (1986). PART I. POLICIES PERTAINING TO INFORMATION AND EDUCATION The majority of Government activity on smoking and health has consisted of provid- ing information and education to the public (Walsh and Gordon 1986). This encom- passes a broad range of policies whose primary aim is to warn the public about the health risks of smoking. This information might discourage individuals from starting or continuing to smoke, or at minimum permit them to be informed smokers. The in- formational message on smoking and health has broadened considerably since 1964, when the first Surgeon General's Report stimulated efforts to educate the public about the health effects of cigarette smoking. As further scientific knowledge accumulated on related topics, the content of information conveyed to the public expanded to include the health effects of using other tobacco products (US DHHS 1986c), the health con- sequences of involuntary tobacco smoke exposure (US DHHS 1986b), the addictive nature of smoking behavior (US DHHS 1988), and methods for quitting smoking (US DHEW 1979; US DHHS 1988). Government efforts to warn the public about the dangers of tobacco use have included these activities: (1) requiring that some information about health risks be placed on packages of cigarettes and smokeless tobacco products and on advertisements; (2) re- quiring that schools teach curricula on smoking and health; (3) reducing the influence of prosmoking messages by regulating or restricting some types of cigarette advertis- ing and promotion; (4) mandating the broadcast of antismoking messages on the electronic media in the late 1960s under the Federal Communication Commission's Fairness Doctrine; and (5) requiring the preparation of reports that summarize informa- tion on smoking and health and review public and private tobacco control activities. In additionthe Federal Government has encouraged and monitored the tobacco industry's testing and disclosure of the levels of certain tobacco smoke constituents. In the private sector, information and education on smoking behavior and the health consequences of smoking have been provided by voluntary actions of health organiza- tions, schools, health professionals, the mass media, and other groups and individuals. These efforts are described in Chapter 6. This Section covers Federal, State, and local government actions whose goals are to inform and educate. It describes public policies of the past 25 years in the United States, summarizes available data on their effectiveness, and reviews the current status of policies under consideration. Finally, because funding levels have influenced the ex- tent of Government's educational efforts, this Section also reviews the magnitude of Government expenditures on smoking and health. Warning Labels on Tobacco Products For the purpose of this Report, the term labeling is used to refer to the provision of health-related information on packages and in advertising. Warning labels could in- clude either brief statements printed on tobacco packages or more detailed information placed on package inserts, similar to those required for pharmaceutical products. 474 History and Current Status One of the earliest and best known mechanisms that the Federal Government used to inform the public about the health hazards of smoking was requiring that a warning label be placed on cigarette packages. Warning labels developed largely as a conse- quence of policy initiatives originated by the Federal Trade Commission (FTC) and subsequently modified by congressional action. This effort began shortly after January 11, 1964, when the Surgeon General released the Report of the Advisory Committee on Smoking and Health (US PHS 1964). Eleven days after the release of the Report, the FTC proposed three rules that would have required health warnings on cigarette packages and advertisements and imposed certain restrictions on cigarette advertising (FTC 1964a). The proposals were notable both for their comprehensiveness and for the speed with which they were published following the release of the Advisory Committee's Report. The FTC's proposed Rule 1 would have required that every cigarette advertisement and every pack, box, carton, and other container in which cigarettes were sold to the public carry one of the following warnings: CAUTION: CIGARETTE SMOKING IS A HEALTH HAZARD: The Surgeon General's Advisory Committee on Smoking and Health has found that "cigarette smoking contributes substantially to mortality from certain specific diseases and to the overall death rate." CAUTION: Cigarette smoking is dangerous to health. It may cause death from cancer and other diseases. After a 6-month comment period and public hearings, the FTC issued its final rule on June 22, 1964; this was published in the Federal Register on July 2, 1964 (FTC 1964b). The final rule resembled Proposed Rule 1; it required that all cigarette adver- tising and every container in which cigarettes were sold to consumers disclose clearly and prominently that cigarette smoking is dangerous to health and may cause death from cancer and other diseases. However, the final rule did not specify the exact word- ing of the warning, which was left up to the tobacco companies to determine. January 1, 1965, was set as the effective date for the package warning, and July 1, 1965, for the warning on advertisements. The effective date for the package label was later delayed until July 1, 1965, in response to a congressional request (Fritschler 1969). The FTC regulation was preempted before it took effect by the Federal Cigarette Labeling and Advertising Act of 1965 (Public Law 89-92), which was approved by Congress on July 1, 1965, and signed into law on July 27. This Act was the outcome of lengthy congressional debate in 1964 and 1965 about cigarette labeling requirements and advertising restrictions (Emster 1988). The law, which became effective on January 1, 1966, was the first of a series of Federal statutes enacting labeling require- ments for tobacco products (Table 2). Overall, the provisions of the law were less shin- gent than the FTC regulations they replaced. The law required that all cigarette pack- ages contain the health warning "Caution: Cigarette Smoking May Be Hazardous to Your Health." However, it required no label on cigarette advertisements and temporari- ly (through June 1969) prohibited any government body, such as Federal regulatory agencies or States, from requiring a health warning in cigarette advertising. The Act also prohibited any health warning on cigarette packages other than the statement re-