ORIGINAL ADDRESS BY C, EVERETT KOOP, MUD,, Sc,D, SURGEON GENERAL KS, PUBLIC HEALTH SERVICE AND DEPUTY ASSISTANT SECRETARY FOR HEALTH US, DEPARTMENT OF HEALTH AND HUMAN SERVICES PRESENTED AT THE SCHOOL OF MEDICINE PUBLIC FORUM UNIVERSITY OF SOUTH FLORIDA TAMPA, FLORIDA MARCH 18, 1987 1 (GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC,) I'M DELIGHED TO JOIN YOU THIS AFTERNOON,,,ESPECIALLY TO TALK ABOUT SMOKING, AS YOU PROBABLY KNOW, DURING MY TIME AS SURGEON GENERAL, I'VE BEEN GIVEN MANY COMPLEX ASSIGNMENTS: THE "BABY DOE" CASE, ,,ORGAN TRANSPLANTS-CARE FOR THE AGED-NOW AIDS, BUT ONE ISSUE WAS WAITING FOR ME IN MY NEW OFFICE, RIGHT AFTER MY CONFIRMATION BY THE US, SENATE BACK IN NOVEMBER 1981, AND IT HAS BEEN A PART OF MY DAILY AGENDA FOR THE PAST FIVE AND A HALF YEARS: AND THAT ISSUE IS SMOKING, YOU MIGHT SAY, "IT COMES WITH THE TERRITORY," AT FIRST, I HAD THE ASSIGNMENT BECAUSE IT BELONGED TO MY OFFICE, 2 BUT NOW, AFTER BEING IMMERSED IN THE DATA FOR A FEW YEARS -- AND AFTER CLOSELY OBSERVING JUST HOW THE CIGARETTE INDUSTRY 'VJORKS -- I'M KEEPING THE ASSIGNMENT BY CHOICE, AS YOU KNOW, SMOKING IS THE DIRECT OR INDIRECT CAUSE OF SOME 340,000 PREMATURES DEATHS EACH YEAR, PLUS MANY TIMES THAT NUMBER OF PERSONS WHO SUFFER FROM SMOKING-RELATED CANCER, HEART DISEASE, AND STROKEwBUT THEY JUST HAVEN'T DIED YET, THE ANNUAL BILL FOR THIS MORBIDITY AND MORTALITY IS AN ENORMOUS BURDEN FOR THE AMERICAN PEOPLE TO CARRY, EACH YEAR THE DOLLAR COST TO OUR SOCIETY IS NOW ESTIMATED TO BE $65 BILLION IN DIRECT HEALTH CARE COSTS AND LOST PRODUCTIVITY, IT WAS THIS KIND OF INFORMATION THAT CONVINCED ME, BACK IN 1982, TO ANNOUNCE THE GOAL OF MAKING THE UNITED STATES A SMOKE-FREE SOCIETY BY THE YEAR 2000, AND, INCIDENTALLY, I MADE THAT ANNOUNCEMENT RIGHT HERE IN FLORIDA, 3 THE RESPONSE TO MY CALL WAS IMMEDIATE AND STRONG -- AND IT'S GOTTEN CONSISTENTLY STRONGER EVER SINCE, TENS OF DOZENS OF VOLUNTARY AND PROFESSIONAL ORGANIZATIONS, INCLUDING ALL THE MAJOR ORGANIZATIONS IN MEDICINE, PLUS LITERALLY MILLIONS OF ORDINARY CITIZENS, HAVE TAKEN UP THE CHALLENGE OF MAKING AMERICA SMOKE-FREE BY THE YEAR 2000, AND IT'S ONLY RIGHT FOR ME TO ACKNOWLEDGE RIGHT HERE THE TREMENDOUS SUPPORT GIVEN ME THROUGHOUT THIS CAMPAIGN BY THE AMERICAN LUNG ASSOCIATION AND ITS AFFILIATES IN ALL 50 STATES, HERE IN FLORIDA, YOU'VE BEEN DOING AN OUTSTANDING JOB, I'M THINKING IN PARTICULAR OF THE,,, "FREEDOM FROM SMOKING" CLINICS,,, YOUR WORK WITH PHYSICIANS, ESPECIALLY THOSE TAKING CARE OF PREGNANT WOMEN,,, AND, OF COURSE, YOUR WORK AT THE STATE AND LOCAL LEVELS, BRINGING THE ANTI-SMOKING MESSAGE INTO THE SCHOOLS OF FLORIDA, 4 FRANKLY, I'M VERY IMPRESSED WITH THE EFFORTS IN THIS STATE, VIRTUALLY EVERYWHERE YOU TURN -- TAMPA, MIAMI, FORT MYER, JACKSON- VILLE, SARASOTA -- THERE'S A STRONG PROGRAM OF SOME KIND THAT IS HELPING SMOKERS QUIT AND HELPING NON-SMOKERS TO STAY THAT WAY, AS A RESULT OF THIS KIND OF RESPONSE ALL ACROSS THIS COUNTRY, I AM CONVINCED THAT MOST AMERICANS HAVE COME TO TRULY UNDERSTAND THE SIGNIFICANCE OF THE ANTI-SMOKING CAMPAIGN, AND JUST WHAT u THAT SIGNIFICANCE? IN ITS SIMPLEST TERMS, THE ACHIEVEMENT OF A SMOKE-FREE SOCIETY WILL INSURE THAT WE WILL HAVE RESCUED THE PEOPLE OF AMERICA FROM THE PREVENTABLE BURDEN OF SMOKING-RELATED ILLNESS AND DEATH, ,,A BURDEN THEY HAVE BEEN CARRYING FAR TOO LONG AT A FAR TOO HEAVY A PRICE, 5 AND I WANT TO EMPHASIZE THOSE KEY WORDS -- "PREVENTABLE BURDEN OF SMOKING-RELATED ILLNESS AND DEATH" -- FOR TWO VERY GOOD REASONS: FIRST, SMOKING IS A PERSONAL CHOICE, NO ONE IS REQUIRED TO SMOKE, IN FACT, ANYONE CAN -- AND SHOULD -- CHOOSE NOT TO SMOKE AS THE FIRST AND MOST IMPORTANT ACT OF PERSONAL, PREVENTIVE HEALTH CARE, SECONDLY, THE SCIENTIFIC RECORD IS CLEAR ON THE RELATIONSHIP BETWEEN CIGARETTE SMOKING AND ABOUT TWO DOZEN SERIOUS DISEASE CONDITIONS, MOST OF THEM WITH HIGH FATALITY RATES 6 OVER THE PAST 30 YEARS BIOMEDICAL RESEARCHERS, PHYSICIANS, AND PUBLIC HEALTH PERSONNEL FROM MORE THAN 80 COUNTRIES HAVE GENERATED MORE THAN 50,000 STUDIES ON SMOKING AND HEALTH, ABOUT 2,000 MORE ARE ADDED EACH YEAR, IT'S AN EMBARRASSMENT OF RICHES, MANY HAVE BEEN DONE RIGHT HERE IN FLORIDA, I COULD CITE, FOR EXAMPLE, em * THE WORK IN SMOKING AND STRESS AT U,S,F, HERE IN TAMPA,,, 9 THE 5-YEAR STUDY IN SMOKING CESSATION AND RELAPSE PREVENTION AT THE UNIVERSITY OF FLORIDA AT GAINSEVILLEw + ALSO AT GAINSEVILLE, THE 7-YEAR STUDY -- STILL GOING ON -- BY THE COLLEGE OF MEDICINE CONCERNING SMOKING AMONG THE ELDERLY,,, 7 + AND A NUMBER OF IMPORTANT STUDIES BY RESEARCHERS IN FLORIDA '/,A, HOSPITALS, A MAJORITY OF THE 50,000 STUDIES FROM AROUND THE WORLD CONCLUDE [HAT CIGARETTE SMOKING EITHER IS A CONTRIBUTING CAUSE OR IS THE 'RIMARY CAUSE OF ILLNESS AND DEATH, THANKS TO THE RESEARCH OF THE PAST 25 YEARS,,, WE KNOWvTHAT A PERSON WHO SMOKES HAS A RISK OF SUDDEN CARDIAC DEATH THAT IS 3 TIMES THE RISK OF THE PERSON WHO DOES NOT SMOKE, WE KNOW,, ,THAT ABOUT 85 PERCENT OF ALL LUNG CANCERS IN THE UNITED STATES ARE CAUSED BY CIGARETTE SMOKING. PEOPLE WHO SMOKE A COUPLE OF PACKS A DAY HAVE A LUNG CANCER DEATH RATE THAT IS AS MUCH AS 25 TIMES GREATER THAN THE RATE FOR PEOPLE WHO DON'T SMOKE AT ALL, 8 WE KNOWwTHAT CIGARETTE SMOKING IS THE MAJOR CAUSE OF CHRONIC OBSTRUCTIVE LUNG DISEASE, ESPECIALLY EMPHYSEMA AND CHRONIC BRONCHITIS, IN FACT, EMPHYSEMA IS QUITE COMMON AMONG OLDER PEOPLE WHO'VE SMOKED, BUT IT'S RARELY FOUND AMONG OLDER NON-SMOKERS, AND WE KNOW,,,THAT WOMEN WHO ARE PREGNANT HAVE AN INCREASED RISK OF DELIVERING THEIR BABIES PREMATURELY ,a ,OR OF ABORTING THE FETUS SPONTANEOUSLY ,,,OR OF DELIVERING A STILLBORN CHILD,, ,OR OF GIVING BIRTH TO A CHILD WHO IS UNABLE TO SURVIVE MORE THAN A FEW DAYS OUTSIDE THE WOMB, THOSE ARE THE FACTS THAT HAVE BEEN GENERATED SINCE 1964 BY FIVE SURGEONS GENERAL -- LUTHER TERRY, WILLIAM STE'VJART, JESSE STEINFELD, JULIUS RICHMOND, AND I -- AND PUBLISHED IN 18 OFFICIAL REPORTS, 9 I REGARD THE SCIENTIFIC CASE AGAINST CIGARETTES AS BEING AIR- TIGHT, AND I AM JOINED IN THAT OPINION BY THE VAST MAJORITY OF THE MEN AND WOMEN IN MEDICINE AND PUBLIC HEALTH TODAY, THROUGH THE YEARS, THOSE REPORTS BY THE SURGEONS GENERAL HAVE DOCUMENTED THE RELATIONSHIP BETWEEN, tm SMOKING AND CANCER, mm SMOKING AND CARDIOVASCULAR DISEASE,,, SMOKING AND LUNG DISEASE,,, SMOKING, CANCER, AND CHRONIC LUNG DISEASE AMONG WORKING PEOPLE, AND -- THE MOST RECENT ONE -- ON THE EFFECTS OF PASSIVE SMOKING, 10 THE CONCLUSION OF EACH REPORT HAS BEEN UNEQUIVOCAL: SMOKING IS A MAJOR CONTRIBUTOR TO THE INCIDENCE OF SIGNIFICANT FATAL DISEASES IN THE POPULATION, AND I MIGHT ADD THAT THIS PROCESS OF RESEARCH AND PUBLIC EDUCATION HAS CONTINUED,, , THROUGH 5 PRESIDENTS, TWO DEMOCRATS AND THREE REPUBLICANS,,, THROUGH 10 SESSIONS OF THE UNITED STATES CONGRESS,,, AND RIGHT THROUGH GRAMM-RUDMAN-HOLLINGS, AND NOW, FOLLOWING THE MOST RECENT LAW PASSED BY THE CONGRESS AND SIGNED BY PRESIDENT REAGAN, THE MANUFACTURERS OF CIGARETTES MUST PUT NEW AND STRONGER WARNINGS ON THEIR PACKAGES AND IN ALL THEIR ADVERTISING, 11 THERE ARE 4 VERSIONS AND YOU'VE PROBABLY SEEN ALL OF THEM BY NOW, SINCE THEY MUST BE ROTATED EVERY 3 MONTHS, THERE'S NOTHING FANCY ABOUT THESE WARNINGS, THEY'RE IN THE SAME PLAIN ENGLISH THAT ANY FAMILY PHYSICIAN WOULD USE -- AND SHOULD USE -- tiITH A PATIENT WHO SMOKES, AND THERE'S NOTHING VAGUE ABOUT THEM EITHER, it ONE CATEGORICALLY SAYS THAT ",,SMOKING CAUSES LUNG CANCER, HEART DISEASE, EMPHYSEMA, AND MAY COMPLICATE PREGNANCY," + ANOTHER WARNS THAT ",a, PREGNANT WOMEN WHO SMOKE RISK FETAL INJURY AND PREMATURE BIRTH/' + A THIRD SAYS THAT ",a, CIGARETTE SMOKE CONTAINS CARBON MONOXIDE," 12 + THE FOURTH WARNING SAYS THAT ",,,QUITTING SMOKING NOW GREATLY REDUCES SERIOUS HEALTH RISKS," THIS IS A TOUGH ONE, BECAUSE WE KNOW THAT NICOTINE IS PROBABLY THE MOST ADDICTIVE DRUG IN OUR SOCIETY, STILL, SMOKERS MUST TRY, BECAUSE, AS THIS LABEL IMPLIES, IT'S NEVER TOO LATE TO QUIT, THAT, BRIEFLY, IS THE CASE OF "THE PEOPLE VERSUS TOBACCO," IN MY OPINION, IT'S OPEN-AND-SHUT, BUT, AS YOU MAY HAVE GATHERED ALREADY, THE CASE THUS FAR HAS DEALT MAINLY 'dITH THE HEALTH RISKS OF PEOPLE WHO SMOKE, THE SO-CALLED MAINSTREAM SMOKERS WHO INHALE SMOKE DIRECTLY FROM THE CIGARETTE, HOWEVER, BEHIND THE CLOUD OF MAINSTREAM SMOKE IS NO SILVER LINING BUT ANOTHER CLOUD, ,,AND IT'S KNObiN AS SIDESTREAM SMOKE, THE CIGARETTE SMOKE THAT NON-SMOKERS INHALE INVOLUNTARILY FROM THE AMBIENT AIR, 13 RESEARCH IN SIDESTREAM SMOKE HAS EVOLVED SLOWLY BUT STEADILY OVER THE PAST 10 YEARS SO THAT, BY NOW, WE HAVE A PRETTY GOOD IDEA OF ITS EFFECTS, AND WE PUBLISHED THAT DATA AND OUR CONCLUSIONS IN THE 18Tti SURGEON GENERAL'S REPORT, WHICH WE RELEASED LAST DECEMBER THE 16Tt-i. THAT REPORT INDICATES, FOR EXAMPLE, THAT, ,. THE CHILDREN OF PARENTS WHO SMOKE HAVE A MUCH HIGHER U.RJn RATE, COMPARED TO CHILDREN WHOSE PARENTS DO NOT SMOKE, AND THE NONSMOKING WIFE OF A SMOKER RUNS A HIGHER RISK OF LUNG CANCER THAN DOES THE NONSMOKING WIFE OF A NONSMOKER, I BELIEVE WE'LL SOON FIND THE SAME THING ALSO TRUE FOR THE INCIDENCE OF HEART DISEASE, EMPHYSEMA, AND CONGESTIVE LUNG DISEASES AMONG NONSMOKING WIVES OF SMOKERS, 14 ALSO, "SIDESTREAM" SMOKERS EXPOSED TO OTHER PEOPLES' HEAVY SMOKING IN THE SAME OFFICE SPACE OR WORKROOM ABSORB AS MUCH SMOKE AS IF THEY THEMSELVES WERE "MAINSTREAM" SMOKING TWO OR THREE CIGARETTES PER DAY, AND SO ON, NOW, JUST WHAT Is IT IN CIGARETTE SMOKE THAT IS SO HARMFUL FOR EVERYONEamWHETHER YOU'RE A "SIDESTREAM" OR A "MAINSTREAM" SMOKER? FIRST OF ALL, YOU BOTH BREATHE IN THE SAME 4,000 OR SO CONSTITU- ENTS OF CIGARETTE SMOKE: YOU BOTH INHALE THE SAME TARS, THE SAME NAPTHALENE, AND THE SAME PYRENE AND BENZOPYRENE,, , 15 YOU ABSORB THE SAME CARBON MONOXIDE, METHANE, AMMONIA, AND ACETYLENE,, , AND YOU INHALE THE SAME HYDROGEN CYANIDE, ODDLY ENOUGH, SCIENTISTS HAVE DISCOVERED THAT SOME OF THESE TOXIC AGENTS ARE FOUND IN GREATER CONCENTRATIONS IN SIDESTREAM SMOKE THAN IN MAINSTREAM SMOKE, 0 TAR, FOR EXAMPLE, THE SUBSTANCE THAT IS THE MOST CARCINO- GENIC, IS 70 PERCENT MORE CONCENTRATED IN SIDESTREAM SMOKE THAN I'N MAINSTREAM SMOKE,,, 0 CONCENTRATIONS OF CARBON MONOXIDE ARE TWO AND A HALF TIMES GREATER IN SIDESTREAM SMOKE THAN IN MAINSTREAM SMOKE,,, 16 0 NICOTINE IS 2,7 TIMES GREATER IN SIDESTREAM SMOKE,,, 0 AMMONIA IS 73 TIMES GREATER IN SIDESTREAM SMOKE-AND SO ON, AND THE MOST RECENT RESEARCH IN THIS AREA INDICATES THAT NONSMOKERS RETAIN THESE POISONS IN THEIR BLOODSTREAMS TWICE AS LONG AS SMOKERS DO, I HOPE THAT MY LECTURE TODAY WILL CONVINCE AT LEAST THOSE PHYSICAL CHEMISTS IN THE AUDIENCE WHO NOW SMOKE THAT IT REALLY IS TIME FOR THEM TO QUIT, BUT THIS IS EXACTLY THE KIND OF INFORMATION THAT HAS SPURRED ON THE MOVEMENT BY NONSMOKERS TO BAN SMOKING IN VIRTUALLY EVERY PUBLIC SPACE AND IN ALL PUBLIC TRANSPORT, 17 I'M SURE IT WAS IN THE MINDS OF THE FLOPRIDA LEGISLATURE WHEN IT ENACTED ONE OF THE STRONGEST CLEAN INDOOR AIR ACTS IN THE COUNTRY, IT'S THE INFORMATION THAT QUITE NATURALLY LEADS THE STATE DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES TO BE SMOKE-FREE IN ITS OWN BUILDINGS, GOOD FOR THEM, IT'S THE KIND OF DATA THAT CONVINCED THE TOWN COUNCILS OF ASPEN, COLORADO, AND BEVERLY HILLS, CALIFORNIA, TO BAN SMOKING IN PUBLIC SPACES WITHIN THEIR RESPECTIVE JURISDICTIONS, BUT THIS IS MORE THAN JUST A FIGHT FOR CLEAN AIR IN RESTAURANTS, OF EVEN MORE SIGNIFICANCE IS THE GROUNDSWELL THAT'S DEVELOPING TO BAN SMOKING WHERE PEOPLE WORK, 18 WE ADDRESSED THIS ISSUE IN OUR DECEMBER 1985 REPORT OF THE SURGEON GENERAL, THAT REPORT DEALT SPECIFICALLY WITH THE 'VJAY SMOKING CONTRIBUTES TO THE INCIDENCE OF CANCER AND CHRONIC LUNG DISEASE AMONG THE MEN AND WOMEN OF THE AMERICAN WORKFORCE, CLOSE TO 110 MILLION MEN AND WOMEN GO TO A FULL-TIME JOB EVERY DAY SOMEWHERE IN THE UNITED STATES, UNHAPPILY, ABOUT 38 PERCENT OF THAT TOTAL -- OR SOME 41 MILLION WORKERS -- ARE CIGARETTE SMOKERS, THE WORKERS MOST AT RISK, OF COURSE, ARE THOSE IN INDUSTRIES THAT MINE AND PROCESS COAL, ASBESTOS, SILICA, AND RADIUM, FOR EXAMPLEwAND THOSE THAT MANUFACTURE OR HANDLE TEXTILES, PETROCHEMICALS, PESTICIDES, AND AROMATIC AMINES,,,OTHERWISE KNOWN AS THE "CLEANING AND DYING INDUSTRY," 19 WORKERS IN THESE INDUSTRIES -- WHO ARE ALREADY AT RISK ON THE JOB, WHETHER THEY SMOKE OR NQT -- MAKE MATTERS WORSE FOR THEMSELVES IF THEY SMOKE, AND OUR 1986 REPORT GIVES THE DATA TO PROVE IT, THAT'S WHY BOTH ACTIVITIES -- ELIMINATING CIGARETTE SMOKING AND REDUCING THE EXPOSURE TO HAZARDS IN THE WORKPLACE -- ARE SEPARATE BUT NEVERTHELESS COMPLEMENTARY ACTIVITIES, WE'VE GOT TO DO BOTH AND DO THEM WITH MAXIMUM EFFECT,,aAGAIN, WITH THE TOTAL HEALTH OF THE AMERICAN YORKER IN MIND, THERE IS, OF COURSE, AN IMMEDIATE NEED TO ELIMINATE SMOKING AMONG WORKERS IN THOSE INDUSTRIES AND OCCUPATIONS WHICH WE ALREADY KNOW PRESENT RISKS TO EMPLOYEE HEALTH AND WELL-BEING, BUT THEN, WE MUST MOVE AHEAD WITH SMOKING CESSATION PROGRAMS AMONG THOSE OTHER INDUSTRIES WHERE THE HEALTH DATA MAY BE LESS CLEAR, BUT WHERE THERE'S ENOUGH SUSPICION OF TROUBLE THAT THEY REQUIRE OUR ATTENTION, 20 AND HERE I'M TALKING ABOUT OCCUPATIONS THAT ARE RELATIVELY NEW, FOR EXAMPLE, o a 9 WORKERS IN THE COMPUTER INDUSTRY ARE POTENTIALLY EXPOSED TO OVER 400 DIFFERENT TOXIC AGENTS, INCLUDING ARSENIC, NITRIC ACID, AND FREON DE-GREASING AGENTS, + THE NEW SEMI-CONDUCTOR INDUSTRY HAS SOMETHING LIKE 300 POTENTIALLY HARMFUL AGENTS PRESENT IN ITS WORK ENVIRONMENT, THESE INCLUDE LEAD SOLDER, FLUXES, PHOTOCHEMICALS, AND HIGHLY TOXIC DOPING COMPOUNDS SUCH AS HEXA-METHYL-DISILAZANE, 9 AND THE RADIO AND TELEVISIaN EQUIPMENT INDUSTRY IS ANOTHER ONE, WITH NEARLY 400 AGENTS, INCLUDING EXOTIC METALS AND CHEMICALS, 21 AMONG THESE WORKERS, IT IS CONCEIVABLE THAT SMOKING IS THE MORE SERIOUS HAZARDmWE DON'T KNOW THAT FOR SURE, BUT, EVEN WITHOUT SUPPORTING DATA, WE KNOW THAT A WORKER WHO SMOKES ONLY MAKES MATTERS WORSE PERSONALLY AND FOR CO-WORKERS IN THE SAME ENVIRONMENT, THIS WAS THE CASE IN THE GOVERNMENT WORK-FORCE, AND I'M DELIGHTED TO REPORT TO YOU TODAY THAT THE US, GOVERNMENT IS NOW SEVERELY RESTRICTING SMOKING IN ALL ITS MEETING AND WORKSPACES, THE DEPARTMENT OF DEFENSE ACTUALLY TOOK THE LEAD IN THIS, BUT NOW ALL AGENCIES -A CIVILIAN AND DEFENSE ALIKE -- ARE ON THE WAY TO BECOMING SMOKE-FREE, AND MANY PRIVATE COMPANIES HAVE COME TO THE SAME CONCLUSIO RALSTON PURINA,,, SELLOWES MANUFACTURING,,, BOEING AIRCRAFT,, , CIGNA INSURANCE,, , FORD MOTOR COMPANY OF CANADA,, o PACIFIC NORTHWEST BELL,,, AND MANY, MANY OTHERS, 22 WHEN YOU ASK THEM WHY THEY WENT SMOKE-FREE, THE C,E,O,'s SAY THEY DID IT FOR THE WELL-BEING OF THEIR WORKFORCE, BUT ONCE THE POLICY IS IN PLACE, THESE SAME COMPANIES DISCOVER THAT A SMOKE-FREE WORKFORCE HAS LESS ABSENTEEISM, CAUSES FEWER FIRES, HAS HIGHER PRODUCTIVITY, AND IS GENERALLY HEALTHIER YEAR-ROUND, AS A RESULT, MANY INSURORS ARE INCLINED TO GIVE A SMOKE-FREE COMPANY A BREAK ON PREMIUMS: SOME FIRE AND CASUALTY COMPANIES WILL KNOCK 50 PERCENT OFF THEIR PREMIUMmNEW YORK LIFE REDUCES ITS ANNUAL PREMIUMS ON COMMERCIAL DISABILITY POLICIES BY $150 PER NON-SMOKING EMPLOYEE,, #AND BLUE CROSS/BLUE SHIELD OF MINNESOTA GIVES A 22 PERCENT DISCOUNT ON PREMIUMS FOR INSURED NON-SMOKERS, SO GOING SMOKE-FREE MAKES GOOD ECONOMIC SENSE AS WELL, 23 ALL THIS INFORMATION, THEN, ADDS UP TO A DOUBLE ASSIGNMENT HERE: FIRST, WE NEED TO ESTABLISH SMOKING CESSATION PROGRAMS RIGHT ACROSS THE SPECTRUM OF AMERICAN EMPLOYMENT, BETTER THAN 50 PERCENT OF WORKERS IN BLUE-COLLAR OCCUPATIONS NOW SMOKE,,,CONSTRUCTION WORKERS, TRUCK DRIVERS, MAINTENANCE MEN, AND SO ON, WE'VE GOT TO FIND A WAY TO REACH THEM WITH OUR ANTI-SMOKING MESSAGE, AND SECOND, WE NEED TO WORK WITH MANAGEMENT AND WITH STATE AND LOCAL GOVERNMENTS TO NEGOTIATE THE ORDINANCES AND AGREEMENTS NECESSARY BOTH TO ENCOURAGE SMOKERS TO QUIT AND TO PROTECT NONSMOKERS FROM THE EFFECTS OF SIDESTREAM SMOKE IN THE WORKPLACE, IN BOTH AREAS, THE COUNTRY NEEDS THE INVOLVEMENT OF ITS HEALTH PROFESSIONALSwOF BUSINESS, INDUSTRY, AND EMPLOYEE LEADERSHIPmOF STATE AND LOCAL GOVERNMENT, a ,AND OF AN INFORMED AND AROUSED PUBLIC, 24 TO BE HONEST ABOUT IT, THE ANTI-SMOKING CAMPAIGN NEEDS ALL THE INFORMED AND INVOLVED ASSSITANCE IT CAN GET BECAUSE IT'S A TOUGH FIGHT ALL THE WAY, WE'RE TAKING ON MORE THAN JUST DISEASEwWE'RE TAKING ON THE CIGARETTE INDUSTRYwAND YOU AND I KNOW THAT THE CIGARETTE INDUSTRY IS A VERY FORMIDABLE ADVERSARY, THAT INDUSTRY ACCOUNTS FOR ABOUT 2,s PERCENT OF THE NATION'S GROSS NATIONAL PRODUCT, OR ABOUT 860 BILLION, EACH YEAR, IT SPENDS ABOUT $2 BILLION A YEAR JUST ON ADVERTISING ALONE, THAT'S A LITTLE OVER 88 FOR EVERY PERSON IN THE UNITED STATES~MOKER AND NONSMOKER ALIKE, BUT SOME AMERICANS ARE GETTING MORE OF THIS ADVERTISING ATTENTION THAN ARE OTHERS, 25 WOMEN ARE ONE SUCH TARGET GROUP, AND IT SEEMS TO BE EFFECTIVE, WOMEN SMOKERS ARE ALSO GIVING UP CIGARETTES, BUT AT A MUCH SLOWER QUIT-RATE THAN THE ONE FOR MEN, FOR EXAMPLE, MEANWHILE, LUNG CANCER IS NOW THE LEADING CAUSE OF CANCER DEATHS AMONG WOMEN, SURPASSING BREAST CANCER, I FIND IT QUITE DEPRESSING THAT THE EDITORS AND PUBLISHERS OF THE MAJOR WOMEN'S MAGAZINES ARE HAPPY TO CARRY LAVISH, FULL-COLOR CIGAR- ETTE ADS, BUT DECLINE TO RUN THE LIFE-SAVING, ANTI-CIGARETTE ARTICLES THAT COULD HELP SAVE THE LIVES OF THEIR READERS, AND FRANKLY, IT'S BEYOND ME WHY ANY SELF-RESPECTING WOMAN TENNIS STAR WOULD PLAY IN THE "VIRGINIA SLIMS" TOURNAMENT, YOUNG PEOPLE ARE ANOTHER MAJOR TARGET GROUP, AND WHY NOT, SINCE 90 PERCENT OF ALL PEOPLE WHO SMOKE STARTED THEIR HABIT WHEN THEY WERE IN THEIR TEENS 26 I'M ALSO TRULY CONCERNED ABOUT THE CONCENTRATED BARRAGE OF CIGARETTE ADVERTISING AND PROMOTION THAT'S DIRECTED AT MINORITIES, AMONG BLACKS, FOR EXAMPLE, IT TAKES THE FORM OF FULL-COLOR, FULL-PAGE ADS IN ALL MAJOR MAGAZINES WITH A PREDOMINANTLY BLACK READERSHIP, THE INDUSTRY ALSO PUBLICIZES ITS DONATIONS TO BLACK AND HISPANIC COMMUNITY SERVICE ORGANIZATIONS AND ITS SPONSORSHIP OF LAVISH FESTIVALS, FASHION SHOWS, AND OTHER EVENTS FEATURING POPULAR MINORITY ENTERTAINERS AND SPORTS FIGURES, I WISH THOSE ORGANIZATIONS AND PERSONALITIES WEREN'T SO WILLING TO TAKE THE MONEY, I WISH THEY KNEW -- JUST AS CLEARLY AS WE KNOW AND AS THE TOBACCO INDUSTRY ITSELF KNOWS -- THAT THE RATE OF LUNG CANCER AMONG BLACKS IS 119 PER 100,000 POPULATION, ,,OR m GREATER THAN THE WHITE RATE OF 81 PER 100,000 POPULATION, 27 THE TOBACCO MONEY GIVEN TO THOSE COOPERATING BLACK ORGANIZATIONS AND PERSONALITIES IS PART OF THE HIGH PROFIT THAT THE INDUSTRY IS SQUEEZING OUT OF THE DISEASED LUNGS OF BLACK MEN AND WOMEN WHO SMOKE, IT'S A TERRIBLE SITUATION, FOR THE MEN AND WOMEN WHO DIRECT THE FORTUNES OF THE CIGARETTE INDUSTRY, I SAY IT IS ALSO AN UNFORGIVABLE SITUATION, BUT I EXPECT IT TO CHANGE, BECAUSE THE INDUSTRY'S DAYS ARE NUMBERED, DESPITE THE BILLIONS OF DOLLARS IT SPENDS AND DESPITE THE MERGERS AND BUY-OUTS OF FOOD COMPANIES AND REAL ESTATE AND BEER AND WINE, THE CIGARETTE INDUSTRY ITSELF IS NOT NOW -- AND i/ILL NEVER AGAIN BE -- A GROWTH INDUSTRY, 28 YES, IT IS A FORMIDABLE ADVERSARY TODAY, BUT IT BECOMES LESS AND LESS FORMIDABLE WITH EVERY TOMORROW, PER CAPITA CIGARETTE CONSUMPTION CONTINUES TO DECLINE AND THAT CURVE WILL NEVER AGAIN GO UP, WE KNOW THAT,, #AND THE INDUSTRY DOES, TOO, HERE IN FLORIDA, FOR EXAMPLE, ANNUAL SALES HAVE DECLINED FROM 139 PACKS OF CIGARETTES PER CAPITA IN 1980 TO 125 PACKS IN 1986, AND FOR THE FIRST TIME IN MANY YEARS, LESS THAN 30 PERCENT OF FLORIDA'S ADULTS NOW SMOKE, FOR THE WHOLE COUNTRY, THAT FIGURE IS NOW JUST UNDER 28 PERCENT, AND, DESPITE THE ADVERTISING PRESSURE, THE INCIDENCE OF DAILY SMOKING AMONG HIGH SCHOOL SENIORS IS NOW ALMOST HALF WHAT IT WAS LESS THAN 10 YEARS AGO, YOUNG PEOPLE IN GREATER AND GREATER NUMBERS REALIZE THAT, IN THEIR JARGON, THE COMPANIES ARE JUST "RIPPING THEM OFF," HENCE, CIGARETTE SMOKING IS NOW RIGHT UP THERE WITH SUCH OTHER TEEN-AGE DISASTERS AS BAD BREATH, PERSPIRATIONwAND PARENTS, 29 THAT'S WHY I PREDICT THAT THE AMERICAN CIGARETTE INDUSTRY, FOR ALL ITS ENORMOUS ECONOMIC POWER, WILL VIRTUALLY DISAPPEAR OVER THE NEXT 20 YEARS, I BELIEVE THAT HISTORY IS CLEARLY ON THE SIDE OF THE NONSMOKER, AND IT'S ON OUR SIDE, AS HEALTH PROFESSIONALS THEREFORE, I KNOW THAT WE'LL ACHIEVE OUR GOAL, WHICH IS TO MAKE OUR HOMES, SCHOOLS, AND WORK ENVIRONMENTS SMOKE-FREE BY THE YEAR 2000, IT'S NOT AN IMPOSSIBLE DREAM, IT CAN BE DONE, AND I WANT YOU TO BE ASSURED THAT THE US, PUBLIC HEALTH SERVICE AND ITS SURGEON GENERAL -- I AND WHOEVER ELSE COMES AFTER ME -- WILL DO WHATEVER WE CAN TO MAKE THAT DREAM OF A SMOKE-FREE SOCIETY COME TRUE, 30 I INTEND TO MAKE SURE THAT ON MY DESK, WAITING FOR MY SUCCESSOR, WILL BE NOT JUST THE 13 SMOKING-AND-HEALTH REPORTS THAT L FOUND BUT THE ADDITIONAL 8 THAT I HOPE WILL STAND AS MY CONTRIBUTION TO THIS COUNTRY'S LIFE-SAVING CAMPAIGN AGAINST CIGARETTES, THANK YOU, #I%###