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TOBACCO TALKINGPOINTS Documenting the Problem Youth smoking is on the rise. Each day about 3000 American children become regular smokers. Of these, 1,000 will die early from tobacco-related illnesses. In the past sic years, the smoking rate among eigthth graders has risen 50 percent. Today the average teenager begins to smoke at 14 1/2 years old and becomes a daily smoker before age 18. Youth have widespread access to tobacco products. Although selling cigarettes to minors is already against the law in all 50 states, studies show that young people easily obtain tobacco products. Most children and adolescents who smoke purchase their own cigarettes. National data from the 1995 Youth Risk Behavior Survey show that over three-quarters of high school students under age 18 who had purchased cigarettes in the previous month had not been asked by a clerk to show proof of age. Local studies have shown that enforcement of minors' access laws -- especially laws requiring the retailer to check for proof of age -- can significantly reduce the percentage of retailers who sell cigarettes to minors. Clinton Administration Actions to Combat Underage Smoking * On February 28, 1997, President Clinton announced new FDA rules that prohibit retailers from selling cigarettes and smokeless tobacco to anyone under age 18. This age restriction is now a Federally enforceable regulation, giving retailers a greater incentive to adhere to the requirement. * Additionally, the FDA now requires retailers to verify age by photo ID for anyone under the age of 27 who attempts to purchase these products. Most state attorneys general, and even tobacco retailers, have indicated the need for checking ID's of customers older than 18, ensuring that retailers don't sell to mature-looking adolescents. * Future provisions will reduce the appeal of smoking and further restrict access. On August 28, 1997, new FDA rules will become effective. They include: prohibiting billboards within 1,000 feet of schools and playgrounds and restricting other advertising to black-and-white text only except in locations only accessible to adults; permitting black- and-white text only advertising in publications with significant youth readership; prohibiting the sale or giveaways of products like caps or gym bags that carry cigarette or smokeless tobacco product brand names or logos; and prohibiting vending machines and self-service displays except in places where people under 18 are are never present. On August 28, 1998 the FDA's final rule will prohibit brand name sponsorship of sporting or entertainment events. (This rule permits sponsorship in the corporate name). These rules have recently been struck down by a North Carolina district court, but are being appealed and are currently under discussion in a settlement process. The bulk of these new FDA rules were challenged and upheld in the courts recently. With this ruling, we can regulate nicotine-containing tobacco products and take important steps to protect our children from a lifetime of addiction and the prospect of having their lives cut short by tobacco-related diseases. We have taken a monumental first step down : the long, hard road we knew we had to go to protect our children. Page 6 15TH STORY of Level 1 printed in FULL format. Copyright 1995 Bergen Record Corp. The Record November 1, 1995; WEDNESDAY; ALL EDITIONS SECTION: NEWS; Pg. A12 LENGTH: 378 words HEADLINE: STUDY: KIDS MAGAZINE RAN JOE CAMEL IMAGE COLUMN: SMOKING SOURCE: Wire services BYLINE: FROM NEWS SERVICE REPORTS DATELINE: SAN DIEGO BODY: The Weekly Reader spread tobacco industry views and Joe Camel's image to millions of elementary school children and was far less likely than a competing newsletter to include health warnings, a University of California study shows. At the time the articles appeared, from 1989 to 1994, the Weekly Reader's owner was the largest shareholder in RJR Nabisco, the creator of Joe Camel, the cartoon mascot for Camel cigarettes. It has since sold its interest. In October 1994, health advocates attacked the Weekly Reader over an article for youngsters that discussed smokers rights and the harm to the industry from smoking restrictions. The article said nothing about smoking as a cause of lung cancer and heart disease. Following that uproar, researchers at the University of California, San Francisco, analyzed 34 articles from the Weekly Reader dealing with smoking. For comparison, they analyzed 28 from another school newsletter, Scholastic News, which is published by a family-owned company. In the Weekly Reader, 68 percent of the articles included tobacco-industry views and only 38 percent carried a clear message against smoking. In Scholastic News, only 32 percent of articles included industry views and 79 percent carried anti-smoking warnings. "Weekly Reader's interest in presenting both sides of an argument can often lead to ambiguity, similar to the ambiguity promoted by the tobacco industry," said Stanton Glantz, one of the study's authors. "They're reinforcing the industry's message." Page 7 The Record, November 1, 1995 The principal researcher, Edith Balbach of the University of California, San Francisco, said: "Weekly Reader needs to change its editorial policy. They're certainly not helping kids not to smoke." The researchers presented their findings Monday at the annual meeting of the American Public Health Association. Sandra Maccarone, Weekly Reader's editor in chief, was traveling and could not be reached for comment, and no one else at the company could comment on the study, Maccarone's office said. The Weekly Reader is owned by K-III Communications, a unit of Kohlberg Kravis Roberts, which was the largest shareholder of RJR Nabisco until March, when it sold its interest in RJR. LANGUAGE: English LOAD-DATE: November 2, 1995 FIRST LADY HILLARY RODHAM CLINTON ANTI-DRUG/ANTI-TOBACCO DISCUSSION C.K. MCCLATCHY HIGH SCHOOL SACRAMENTO, CA MAY 30, 1996 TALKING POINTS [Acknowledgments: Kathleen Whalen, principal; parents, students, and teachers] First of all, I want to congratulate members of the Boys Baseball and Girls Basketball teams for their championship seasons. I'm delighted to be here at a school that is truly making a difference in the lives of its students. I understand that your "Students Reaching Out" program is training students to teach younger children about the hazards of alcohol, tobacco and drugs. Their participation is not only an opportunity for community service, it also offers them important life skills. The Friday Night Live Club is also making a difference -- planning weekend events that present fun alternatives to unsupervised, off-campus activities. Programs such as these are more important than ever. Every year, one million children take up smoking. Marijuana use among young people has doubled since 1991. And alarmingly, surveys show that more and more children think it's "cool" to do drugs or alcohol. We all have a role to play in turning these trends back -- government, the media, schools, communities and parents. The President and his Administration are doing their part. Last summer, the President announced the nation's first comprehensive campaign to reduce children's use of tobacco products. Under the President's initiative, only adults will have access to tobacco products. And the Administration has proposed ways to limit the reach of advertisements and promotions that encourage children to begin using tobacco products. The President is also working aggressively to reduce drug use, particularly among young people. In March, the White House Leadership Conference on Youth, Drug Use and Violence launched a national media literacy and drug deglamorization campaign aimed at children. A Federal marijuana prevention initiative is resulting in the distribution of information to help educate young people and their parents about its dangers. And the President has also encouraged states to adopt a "zero tolerance" standard for drivers under age 21 who use drugs or alcohol and drive. At his State of the Union address this past January, the President made a remark we should all try to keep in mind. He said, "It is hard to be a parent today; but it is even harder to be a kid. All of us -- our businesses, our parents, our media, our schools, our teachers, our communities, and government -- have a responsibility to help children make it. " That is why what you are doing here in Sacramento is so important. Your efforts on behalf of your children and students are helping to keep many of them healthy and safe. Thank you. ### Contents EXECUTIVE PRESIDENT OFFICE or THE DEC & 6 1995 NEW EXECUTIVE OFFICE BUILDING American Journal December 1995. Vol. 85, No. 12 ISSN: 0090-0036 Established 1911 of Public Health Public Health Briefs The Journal's one-page author guide, "What AJPH Authors VARIOUS TOPICS Should Know," is printed in each 1690 The Availability of Low-Fat Milk in an Inner-City Latino Community: issue and is available from the Implications for Nutrition Education H. Wechsler, C.E. Basch, P. Zybert, Editorial Office. R. Lantigua. and S. Shea 1693 Inhaled and Oral Corticosteroids: Their Effects on Bone Mineral Density in Older Adults J.F. Marystone, E. L. Barrett-Connor. and D. J. Morton 1695 Changes in Perinatal Cocaine Use in an Inner-City Hospital, 1988 to 1992 S. McCalla. J. Feldman, H. Webbeh, R. Ahmadi, and H. L. Minkoff CHILDREN'S HEALTH 1698 Correlates of High-Density Lipoprotein Cholesterol in Black Girls and White Girls: The NHLBI Growth and Health Study J.A. Simon, J. A. Morrison, S.L. Similo. R. P. McMahon, and G. B. Schreiber 1702 Aerobic Fitness, Blood Lipids. and Body Fat in Children R. L. Hager, L.A. Tucker. and G. T. Seljaas 1706 The Reporting Sensitivities of Two Passive Surveillance Systems for Vaccine Adverse Events S. Rosenthal and R. Chen Other Journal Departments 1602 APHA Masthead 1604 What AJPH Authors Should Know 1605 Advertisers Index 1609 Journal Masthead 1710 Letters to the Editor 1714 Book Corner 1718 Membership Application APHA 1719 Association News: Obituaries and 40-Year Members 1727 Annual Meeting Cassette Order Forms American Public Health Association 1731 1994 APHA Auditor's Report 1734 Job Opportunities 1742 Volume 85 Index Tobacco Information in Two Grade School Newsweeklies: A Content Analysis ABSTRACT Edith D. Balbach, PhD, and Stanton A. Glantz, PhD Objectives. This study compared Introduction that the fact that smoking is dangerous tobacco-related articles from two is not in dispute. We further believe that elementary school publications, The October 14, 1994, fifth-grade our editorial voice on these dangers must be clear and consistent. Weekly Reader and Scholastic News, edition of Weekly Reader, a weekly newspa- published in 1989 through 1994. per distributed through schools, ran a Weekly Reader's philosophy is to handle Methods. Articles for grades 4 cover story titled "Do Cigarettes Have a health issues as news stories. with mul- through 6 were evaluated, and the Future?" that promoted smokers' rights,¹ tiple viewpoints: the philosophy of Scholas- publications were compared with a position advocated by. the tobacco tic News is that students need clear and each other. Also, issues of Weekly industry. The ensuing controversy²⁻⁵ fo- consistent messages on issues involving Reader published after acquisition by cused both on the specific content of the health and safety. The health messages K-III. which is owned by the firm that article and on the ownership of Weekly carried by both publications should con- formerly owned RJR Tobacco. were Reader. In 1991, Weekly Reader was pur- cern those who work in public health. compared with the earlier ones. chased by K-III Holdings.⁶ Kohlberg, Both publications are delivered weekly Results. Weekly Reader was less into elementary school classrooms that Kravis, and Roberts is the majority owner likely than Scholastic News to men- subscribe. Weekh Reader reaches 1 202 982 of K-III and, at the time, was the majority tion short-term consequences of students in fourth grade, 840 904 students owner of RJR Nabisco, America's second- smoking (32% vs 64%) or to give a in fifth grade. and 478 771 students in largest cigarette manufacturer. clear "no-use" message (35% vs sixth grade.⁸ Scholastic News reaches Sandra F. Maccarone (written com- 79%). Weekly Reader was more likely approximately a million students per munication. October 19, 1994). the editor- to give the tobacco industry position grade level (specific figures were not (68% vs 32%). Post-K-III issues of in-chief of Weekly Reader, asserted that released by Scholastic; this estimate was Weekly Reader were less likely to Weekly Reader's connection to the tobacco provided by Dolly Chugh at Scholastic in provide a clear no-use message than industry had not influenced the article's New York [oral communication. January earlier ones (62% VS 24%). content: 10. 1995]). The health messages they send Conclusions. Health profession- Weekly Reader's mission has always are thus widely distributed and are rarely als need to monitor the health infor- been to present news to kids that is reviewed on-site by school health profes- mation carried in these publications, "colorful but uncolored." We take this sionals. What effect do these differing which reach between 1 and 2 million mission very seriously. Our commit- editorial philosophies have on the nature ment to "presenting it straight" has kept students per grade level each week. of tobacco coverage in the two publica- us in business for 66 years. We also have Although neither publication had a responsibility to our readership not to tions? Has Weekly Reader's tobacco cover- perfect tobacco coverage, Scholastic press particular issues on them. Our age changed since its acquisition by News was significantly better than responsibility is to present facts that Kohlberg. Kravis. and Roberts? Weekly Reader. (Am J Public Health. help kids think about important issues and draw their own conclusions. 1995;85:1650-1653) Methods In contrast, on November 18, 1994, Ernest B. Fleishman, senior vice president and We identified articles related to director of education at Scholastic- tobacco published in Weekly Reader and publisher of Scholastic News, a competitor to Weekly Reader-emphasized that Scho- lastic was family owned and unrelated to The authors are with the Institute for Health K-III or Kohlberg, Kravis, and Roberts: Policy Studies, Department of Medicine, Uni- versity of California, San Francisco. At Scholastic News we believe that in Requests for reprints should be sent to most cases, various sides of an issue Stanton A. Glantz, PhD, Department of should be presented to young people. Medicine. Box 0124, University of California, However, we draw the line when it San Francisco, CA 94143-0124. comes to health and safety. We believe This paper was accepted July 17, 1995. 1 obacco Information Scholastic News (grades 4 through 6 editions) from January 1989 through December 1994. The study was limited to TABLE 1-Tobacco Messages in Two Magazines for Schoolchildren: Weekly Reader and Scholastic News, January 1989 to December 1994 these two publications because no other publication approaches them in terms of Weekly Reader Scholastic Newsᵇ circulation size and national distribution No. % All Articles (Donald Adcock. American Association No. % All Articles Articles on Tobacco Articles on Tobacco P of School Librarians, American Library Association, personal communication, Short-term conse- 11 32 18 64 021 June 1995). Copies of all but 7 of 486 quences covered published issues of Weekly Reader and all Inclusion of industry 23 68 9 32 .010 viewpoint but 1 of 468 published issues of Scholastic Inclusion of clear 13 38 22 79 .002 News were located; 28 tobacco-related no-use message articles were found in Scholastic News Use of product trade 11 32 4 14 139 (6.0% of the issues), and 34 were found in names Weekly Reader (7.1% of the issues). Only materials distributed directly to students Note. The Fisher exact test (two-tailed) was used in comparing data. n = 34 articles. were reviewed: thus, teacher's editions on = 28 articles. were not included. K-III Communications (i.e., Kohl- berg, Kravis, and Roberts) acquired Weekly Reader in April 1991, so all issues of them, a no-use message was provided; (2) posed to the actual advertisements, is that Weekly Reader published in the 1990/91 whether advertising figures. such as Joe the surgeon general's warning is not school year were included in the analysis Camel or the Marlboro Man, were pic- required to be visible on them. and it was of "pre-K-III" articles. Of the Weekly tured without editorial marking (e.g., the sometimes cropped out of the picture. In Reader articles found, 13 were in the international "no" symbol); and (3) one of the four ads (25%) shown without pre-K-III category and 21 were in the whether smoking was presented as a negative symbols in Scholastic News. the "post-K-III" category. "right." Third. it was determined whether warning was not visible: in 8 of the 11 The criteria for evaluating the ar- trade names or advertising figures ap- (73%) Weekly Readers including brand ticles were derived from the US surgeon peared in photos and how they were names. the warning was not visible on at general's 1994 report titled Preventing handled (i.e., was there some effort to least one photograph. Tobacco Use among Young People.9 This include a "no smoking" message in or on RJR Nabisco's Joe Camel appeared report recommended that tobacco educa- the photo?). Finally. it was determined eight times in Weekly Reader. Joe Camel tion for youth (1) emphasize the short- whether the tobacco industry's position may have appeared more often than other term consequences of tobacco use. such as (presented directly or indirectly, as opin- brand images because of the controversy smelling bad or having yellow teeth. as ions of smokers) was included and whether surrounding the use of this cartoon opposed to long-term consequences such or not it was countered by other sources. character. He is readily recognizable by as lung cancer or heart disease; (2) An opinion was considered countered children, and there have been calls for establish the true social norms of tobacco unless it was the last comment included in ending such use of cartoon characters. 10-12 use for young people (i.e., how many the article. Statistical analysis was con- There were no negative markings on the young people actually use tobacco and the ducted with a two-tailed Fisher exact test. photos. so they were little different from acceptability of tobacco use): and (3) actual ads. In one case (6th-grade edition, counter positive messages to use tobacco. Results February 12. 1992), Joe Camel was in full such as those contained in ertising and color on the cover, and the Joe Camel other media. Weekly Reader is Scholastic News billboard featuring Joe and a group of Each article was evaluated through In terms of information on short- musicians was in full color on the center- the use of the several specific criteria. term consequences. clarity of the no-use fold. Next to the billboard photo was a First, it was determined whether or not message. and presentation of the industry photo of Camel gear solicitations and a the article mentioned short-term conse- viewpoint. Weekly Reader was weaker than copy of a poster from "Right Decisions, quences of tobacco use, including the fact Scholastic News (Table 1). In addition, Right Now," RJ Reynolds Tobacco Com- that smoking is not "cool." Second, it was Scholastic News never gave the industry pany's program for youth. The caption on determined whether there was a clear the last word in an article; Weekly Reader the poster reads as follows: "A new ad "no-use" message, especially from peers. did so 9 of the 23 times (39%) in which the campaign from the maker of Camel Articles were screened to ascertain industry viewpoint was provided. Al- cigarettes encourages kids to make the whether youth were shown. in photos or though tobacco brand names and market- 'Right Decisions, Right Now' about smok- drawings, smoking, possessing. or buying ing imagery without negative editorial ing." No particular decision (in particular, cigarettes and whether accurate data markings. such as the international "no" remaining a nonsmoker) is suggested as were provided (was the source of the data symbol, ran more often in Weekly Reader correct. The poster itself shows two boys given, and were the data accurately (11 times vs 4 in Scholastic News), the with "buzz" haircuts and leather jackets presented?). Also, we examined (1) difference was not statistically significant. smoking in a men's room and has the whether, when young people were inter- One of the problems with the use of caption "And you think this looks cool?" viewed or stories were written about photographs of advertisements, as op- They arguably look very cool.¹³ Balbach and Glantz In contrast. while Joe Camel ap- physical problems has not generally de- K-III. For example, in 1990, prior to the peared seven times in Scholastic News, terred young people from smoking. Short- K-III acquisition, Weekly Reader (5th- students were demonstrating against Joe term problems. such as yellow fingers and grade edition, September 7. 1990) ran a Camel in three of these appearances, and teeth, bad breath, and smelly hair and his picture had an international "no" cover story, "Children and Cigarettes," clothes. need to be emphasized with that concluded: symbol over it. In two cases, a small youth. as do the methods the tobacco photograph of a Joe Camel advertisement industry uses in its advertising to promote However. the Tobacco Institute. an illustrated a story on how the industry organization that represents tobacco a positive or cool image for smoking.9 uses advertising "to hide the dangers of growers and makers of tobacco prod- The different approaches of these ucts, says there is no direct proof that smoking in their ads." In the final two two student news publications to the tobacco causes cancer or any other appearances by Joe Camel in Scholastic coverage of health issues led to differ- deadly diseases. And. says the institute, News, a Camel ad was in the background ences in their coverage of tobacco. From a controlling tobacco products is not fair of a photograph. to the 50 million Americans who want public health perspective, the clear and to smoke. Despite the disagreement. consistent antitobacco messages of Scho- smoking has been banned in many Weekly Reader before and after lastic News are more appropriate in regard schools. hospitals. and public places. In Acquisition by K-III to issues related to youth and tobacco. By recent years, no-smoking rules have spread to many offices. factories. and The acquisition of Weekly Reader by contrast. Weekh Reader's interest in pre- other workplaces. In February. the K-III was associated with one statistically senting both sides of an argument can often Government banned smoking on nearly significant result and several trends. The lead to ambiguity. similar to the ambiguity all U.S. airline flights less than six hours percentage of tobacco articles in which a promoted by the tobacco industry. long. clear and consistent no-use message was The problems with Weekly Reader's These are the last sentences in the story, provided dropped from 62% to 24% coverage of tobacco are well illustrated by arguably leaving fifth graders with the (P = .038). the controversial October 14, 1994. issue impression that there is some legitimate Discussion of the short-term health that prompted this study. The cover controversy regarding the health effects of consequences of smoking tended to im- photograph featured a picture of one man smoking. The effort to create controversy prove after K-III acquired II Teekly Reader. holding aloft a large cigarette on which and doubt about smoking is a well- Before K-III. Weekly Reader mentioned "No More Taxes" was written and an- established tobacco industry strategy. 14.15 short-term health effects only 15% of the other man wearing a sign that read Weekly Reader's editorial approach clearly time, in comparison with 43% post-K-III "Freedom of Choice." The caption was as puts it in a position of supporting this (P = .140). On the other two dimensions— follows: "In Washington. D.C.. tobacco strategy. trade names and industry coverage- workers protest high cigarette taxes and Although problems with Weekly Read- coverage tended to deteriorate. There smoking bans. Taxes and bans have er's tobacco coverage predate acquisition were no trade names visible 77% of the caused many tobacco growers and work- by K-III, the lessening of the clarity of the time pre-K-III, in comparison with 62% ers to lose their jobs." The story itself no-use message since the acquisition is a of the time post-K-III (P = .465). The contained many of the smokers' rights rate of presentation of the tobacco indus- cause for concern. as is the tendency to arguments. such as "Many say it's wrong try's viewpoint remained about the same give smokers or the tobacco industry the for a government to place such a high tax (69% of the time before acquisition VS final word in stories: In one story (6th- on cigarettes just because some studies 66% of the time after acquisition), but the grade edition, October 10. 1994), Thomas have shown them to be a health hazard. Lauria is identified as "a member of a industry or a smoker was given the final 'There's a lot of things [that are] worse,' word in the story more often after the smokers' rights group" instead of as the said Ken Boyd. a tobacco grower in acquisition by K-III (33% after VS 15% spokesperson for the Tobacco Institute. Kentucky." In the same issue, a photo- before acquisition. P = .486). (The avail- Lauria. in his comments. equates smoking able data had only a .10 power to detect a graph appeared of a Camel cigarette sign, to drinking alcohol and engaging in 15% change in the prevalence of pro- with the surgeon general's warning high-risk sports activities and states that tobacco images at a significance level of cropped off. A young man was leaning adults should be allowed to decide what .05, so the small sample size may have against a sign lighting a cigarette. model- they should and should not do. The ing smoking behavior. A sidebar outlined contributed to the failure of these changes equation of smoking to other adult plea- the pros and cons of a smoke-free nation. to reach statistical significance. Achieving sures and the emphasis on choice and a power of .8 would have required about No specific health consequences of smok- decision making follow known tobacco 300 articles.) ing, long or short term, were discussed. industry strategies to encourage young The benefits were vague and abstract: people to smoke. 14-16 nonsmokers would probably live longer, At approximately the same time as Discussion some studies suggested billions of dollars the controversial Weekly Reader piece, in health care savings, and there would be Scholastic News (4th-grade edition. No- Both Scholastic News and Weekly fewer fires. The costs were specific: 47 000 vember 18, 1994) ran a cover story about Reader rely too heavily on discussion of jobs lost. $3 billion in lost crop revenue, two Houston children who convinced the long-term health effects of tobacco and $12 billion less in taxes for govern- Marvel Comics to eliminate smoking on use to provide optimal tobacco education ments, leaving them with less money for its comic trading cards. A detailed dia- to children. While tobacco-induced lung health care and schools. gram. labeled "Smoking is Bad for the cancer, other cancers, heart disease, and It should be noted that the ambiguity Body." discussed both the long- and other respiratory problems are vital public in Weekly Reader's coverage does not date short-term consequences of smoking. In a health concerns, the threat of long-term solely from the time it was acquired by sidebar called "States Get Tough on 1652 Tobacco Information Smoking," clean indoor all laws were Conclusions 4 Reilly P Classroom rule: a KKR vehicle discussed. The article commented that finds prohi and education a rich but uneasy "Many smokers do not like the new laws. While expert opinions from health mix: flap over Weekly Reader spotlights They say they have a right 10 smoke in educators are typically solicited for mate- K-111's role in molding young minds. Wall rials used in schools that arc explicitly Sirrel Journal, October 12. 1994:A1.` public places." However. this was mmedi- 5. Schevitz T. Smokers' rights story in kids' atcly followed by a countering statement: labeled as "health" materials. general use paper attacked San Francisco Examiner. "But the rules are supposed to protect materials, including student news publica- October 12. 1994:A4. people's health. Even if you don't smoke, tions, are less likely to be subjected to 6. Two educational publishing businesses are breathing smoke from somebody else's review by health professionals. The poor purchased. Wall Street Journal. April 3, quality of the tobacco information pre- 1991:B6 cigarettes can hurt your health. For that 7. Fleishman EB. An important message. reason, smoking ibles has gcl tougher sented in Weekh Reader, in comparison Scholasiic Vews November 18. 1994. Edi- and tougher in the future." An earlier set with that provided in Scholastic News, tion 56. of stories on secondhand smoke that should concern those interested in to- 8. Ulnch's International Penodicals Directory, appeared in the fourth-, fifth- and sixth- bacco use prevention among youth. More 1994-1995 33rd ed. New York, NY: RR generally. health professionals concerned Bowker: 1995. grade editions (March 19. 1993) did not give the industry viewpoint at all and used about a variety of youth health issues 9. Preventing Tobacco Use among Young People: .4 Report of the Surgeon General. Washing- the following sidebar headline in the should bc aware that health information ton. DC US Dept of Health and Human fifth-grade edition: "SMOKE + HU- enters the classroom through a variety of Services. 1994. MAN BODY = TROUBLE sources. Weekh Reader and Scholastic 10. Fisher PM. Schwartz MP Richards JW. On November 18, 1994 coinciding News are distributed to a combined 1 to 2 Goldstein AO. Rojas TH Brand logo with the Great American Smokeout. the million students per grade level every recognition hy children aged 3 to 6 years: week. -Each student has a copy to take Mickey Mouse and Old Joe Camel. JAMA. grade 5/6 edition of Scholastic News 1991:266:31-5-3148. emphasized the millions of smokers who home and read. No conventional health 11. DiFranza JR. Richards JW. Paulman PM, are trying to quit. The article titled "Up in materials involve this kind of penetration. el al. RJR Nabisco's cartoon camel pro- Smoke: Why Are More Kids Trying It is important 10 know what materials motes camel cigarettes to children. JAMA. reach students at individual schools, to be 1991:266:31-9-3153. Cigarettes?" countered the argument that smoking is cool and glamorous. It also attentive to the information provided in 12. Pierce JP. Gilpin E. Burns DM. et al. Does discussed the fact that young people do those materials. and to ensure that the tobacco advertising target young people to start smoking? Evidence from California. not worry about lung cancer because they materials provide health messages consis- JAMA 1991:266:3154-3158. believe they can quit any time but that tent with good public health practices. 13. Lipman J. Why activists fume at anti- quitting is hard. A roundtable discussion smoking ads. Wull Street Journal. February of public school children established a References 20. 1992:B9. 1. Levy D. Weekly Reader's smoking story 14. Myers ML. Iscoe C. Jennings C. Lenox W, no-use peer norm. The fact that smoking lights debate. USA Todav. October 11, Minsky E. Sacks A. Staff Report on the is the leading cause of death in the United 1994:A1 Cigarette Advertising Investigation. Washing- States was labeled a "fact." There was no 2. Applebome P A rarity. an uproar at ton. DC: US Federal Trade Commission; tobacco industry viewpoint in the cover Weekly Reader New York Times. October 1981. story or sidebar. The coverage was not 12. 1994:B8 15. Glantz SA Tobacco: Biology and Polincs. perfect. however: three photos showing 3. Joe Camel goes to grade school: article on Waco. Tex. HEALTH EDCO: 1992. cigarettes in newspaper for fifth-graders 16. DiFranza J. McAfee T. The Tobacco people with cigarettes modeled smoking sets off a controversy. Los Angeles Times Institute: helping youth say "yes" to to- behavior. October 14. 1994:BI. Editorial. bacco J Fam Pract 1992:6:694-696. December 1995. Vol 85, No. 12 American fournal of Public 1653 TALKING IT OVER BY HILLARY RODHAM CLINTON FOR IMMEDIATE RELEASE My late mother-in-law was a chain smoker for most of her life. Whenever she came to visit us at the Governor's Mansion in Little Rock, she always had to go outside to smoke. After lighting up one day, she asked Chelsea, who was almost 8, what she wanted for her birthday. "I want you to quit smoking," Chelsea said. That simple plea from a granddaughter helped end a 48-year addiction to cigarettes. My mother-in-law stopped smoking for good on Chelsea's birthday in 1988. Children have always been the most persuasive voices in convincing adults to give up cigarettes. 1 don't think I've ever met a child who hasn't been blunt about his or her aversion to smoke. Consider the fifth-grader who wrote in a letter to my daughter: "I hate smoking. I can't even be around smoke. I cough and choke." Yet somehow between childhood and adolescence, too many young people forget their better instincts and begin smoking. Adolescents account for the purchase of some 500 million packs of cigarettes a year. On any given day, 3,000 young people become regular smokers. And nearly 1,000 of them will die as a result of their addiction. Recently, there has been renewed debate over whether tobacco is addictive. I think most of us agree that it is, and we appreciate those loud warnings that Dr. C. Everett Koop, the Surgeon General from 1981 to 1989, gave us when he talked about the dangers of smoking. Yet while many adults elementary-school teachers and parents, especially -- are working to combat the lure of smoking, still others are getting children hooked for life. Consider this: The Weekly Reader, a popular children's magazine, published articles on smoking between 1989 and 1994 that spread tobacco-industry views and offered limited information about the health effects of smoking, according to a study by a medical professor at the University of California at San Francisco. It turns out that The Weekly Reader is owned by the same company that at the time owned RJR Nabisco, the country's second-largest maker of cigarettes. Another study has shown that Joe Camel, the cartoon mascot of Camel cigarettes, is now as recognizable to 6-year-olds as Mickey Mouse. Joe is LISSA MUSCATINE 003 TALKING IT OVER 7/16/96 Page 2 everywhere on jackets, baseball caps, gym bags, tank tops. No wonder Camel is the most familiar cigarette brand among 12- to 17-year-olds. Our children can't even watch their favorite sporting events without seeing the logo of a cigarette brand on a stadium wall or in the background of the television screen. Movies today are filled with characters reaching for a cigarette -- or worse, marijuana, the next step for some kids who get hooked on tobacco. Last fall, for example, I was shocked when my mother and I watched two "family" movies in which the heroines casually smoked marijuana. What is clear is that commercial interests -- and corporate greed -- are working against our children. If children can get through their adolescent years without smoking, chances are, they won't light up as adults. And they are less likely to fall down the slippery slope that begins with cigarettes and leads to illegal drugs and other destructive addictions and behaviors. To help reduce smoking among young people, the Clinton administration has proposed regulations that, if put into effect, would allow cigarettes to be sold only in face-to-face transactions with adults. Tobacco billboards would be prohibited within 1,000 feet of schools and playgrounds. Other billboards and magazines with significant youth readerships could only display black and white, text-only advertising. Companies would not be allowed to sell or give away products such as hats bearing a cigarette logo or name. Brand names such as Virginia Slims or Winston could not sponsor sporting events (although those events could be sponsored in the corporate name). And the tobacco industry would fund a public education campaign about the dangers children face from smoking. Whether or not these regulations go into effect, we need to be more vigilant as a society about the social costs of business decisions and how they influence our children. While we all want to encourage competition and innovation -- hallmarks of American capitalism - we must strike the right balance between the freedom businesses need to make profits, and the preservation of family and community values. We can't afford to sacrifice either one. COPYRIGHT 1996 CREATORS SYNDICATE, INC. ALL RIGHTS RESERVED July 16, 1996 SENT BY:ALA ; 7-17-97 :10:10AM AMERICAN LUNG ASSOC. - :# 2/10 MESSAGE POINTS FOR SMOKING STORY While smoking rates for adults are declining, teen smoking is on the rise. Peer pressure, easy access to cigarettes and culural norms are only part of the reason why. Unfortunately, the tobacco industry has mastered the fine art of linking cigarettes to fame, fortune and fast times through its extensive marketing and advertising campaigns. By featuring attractive, young models smoking, the tobacco industry has effectively linked cigarettes to beauty, fashion and eternal slimness. In actual fact, smoking causes a host of illnesses including lung cancer. emphysema and chronic bronchitis. In addition, research has consistently shown that smoking causes skin wrinkling and may make women appear less attractive and prematurely old. Cigarette use in movies is perhaps the most insidious form of tobacco advertising. Nothing on the screen says its a tobacco ad. There is no warning about tobacco use. The only thing a young person sees is a famous, often attractive movie star lighting up and looking sexy. With a single movie, the tobacco industry can reach millions of young people in every country in the world. Each year, the tobacco industry spends more than $4 billion dollars on cigarette advertising. Who knows how much the tobacco industry spends to have their products prominently featured in the movies. Regardless of whether the tobacco industry pays for cigarette use in the movies or not, every time an actor or actress lights up, millions of young people get the message that smoking is desirable, sexy and glamorous. Some actors and actresses who found out how deadly smoking can be are: John Wayne, Humphrcy Bogart, Gary Cooper, Betty Grable, Lee Remick, Lucille Ball and Tallulah Bankhead (silent screen actress). All of these very glamorous actors died on not-so- glamorous smoking-related diseases such as lung cancer and emphysema. The American Lung Associaiton docs not promote censorship of smoking in movies. Instead it encourages self-censorship by asking that the film industry be aware of the images it portrays and that young people be aware of what they're watching. Michael A. O'Mary 07/17/97 10:27:24 AM Record Type: Record To: Alison Muscatine/WHO/EOP CC: Subject: Re: Some info from the NewsWeek article if you haven't read it already: At least one of the leads in every Oscar nominated film last year lit up on screen. Smoking is portrayed as sexy. Witness Leonardo DiCaprio in Romeo and Juliet last year. Young peope believe they are invicible and are convinced that they can quit smoking if they want. Furthermore, they believe their young bodies are able to handle the harmful effects of smoking easily. Cigarette companies will have to aim at a slightly different demographic thanks to the tobacco deal. They have already started targeting 20 somethings by producing speciality cigarettes. (Along the same lines as specialty beer and coffee) The article appeared in NEWSWEEK on July 21, 1997. I'm going to check with the American lung association to see if they have any furthur studies on this. SENT BY ALA ; 7-17-97 :11:01AM ;AMERICAN LUNG ASSOC. ;# 1/6 AMERICAN LUNG ASSOCIATION® FAX FAX NUMBER: 202-456-6244 TO: Michael Ombry FROM: Elimphese Hlinko, 212-315-6473 DATE: TOTAL PAGES INCLUDING COVER SHEET: 6 SUBJECT: MESSAGE: you need any other information please call! IF YOU DO NOT RECEIVE ALL THE FAX SHEETS. PLEASE CALL AS SOON AS POSSIBLE When You Can't Breathe, Nothing Else Matters OPERATOR 1740 Broadway New York. NY 10019-4374 ALAFAX NO. (212) 315-8872 Fax: (212) 265-5642 Phone: (212) 315-8700 7-17-97 :11:03AM AMERICAN LLING ASSOC. 1 SENT BY ALA American Lung Association Fact Sheet TEENAGE CIGARETTE SMOKING Cigarette smoking during childhood and adolescence produces significant health problems among young people, including cough and phlegm production, an increased number and severity of respiratory illness, decreased physical fimess. an untavorable lipid profile, and potential relardation in the rate of lung growth and the level of Insximum lung function. An estimated 419,000 Americans die cach year from diseases caused by smoking. Smoking is responsible for an estimated one in five U.S. deaths and costs the U.S. at least $97.2 billion each year in health care COSTS and lost productivity. Each day, 3,000 children smoke their first cigarette. That's more than one million annually. Approximately one-third of these children who become smokers will eventually die of smoking-related diseases. At least 3.1 million adolescents are current smokers. People who begin smoking at an early age are more likely to develop severe levels of nicotine addiction than those who start at a later age. Cigarene advertisements tend to emphasize youthful vigor, sexual attraction and independence themes, which appcal to teenagers and young adults struggling with these issues. A survey reveals that in 1994, 30.7 percent of boys between the ages of 12 and 17 had tried some form of smokeless tobacco. Although previously little use of smokeless tobacco was seen among adolescents, the prevalence of its use among older teens increased between 1970 and 1985. coincident with strengthened marketing by the smokeless tobacco industry during that time. Approximately 90 percent of all initiation of tobacco use occurs among persons under the age of 18. According to a 1995 national survey of high school students, the overall prevalence of current cigarette use and frequent cigarette use were 34.8 percent and 16.1 percent, respectively. Peers, siblings, and friends are powerful influences. The most common situation for first trying a cigarette is with a friend who already smokes. A recent survcy indicated that among students 17 years and under who were current smokers. 77.5 percent reported never being asked for proof of age when buying cigarettes in a store. Tobacco use primarily begins in early adolescence, typically by age 16; almost all first use occurs before the time of high school graduation. # 3/ 6 : 7-17-97 04AM ; AMER ICAN LUNG ASSOC.- SENT BY : ALA Teenage Cigarette Smoking/2 Tobacco use is associated with alcohol and illicit drug use. and acts as a "gateway drug." It is generally the first drug used by young people who enter a sequence of drug use that can include tobacco. alcohol, marijuana. and harder drugs. According to the 1994 Surgeon General's report, 12-17 year olds who reported having smoked in the past 30 days were three times more likely to use alcohol, eight times more likely to smoke marijuana, and 22 times more likely to use cocaine, within those past 30 days than those 12-17 year olds who had not smoked during that time. The initiation and development of tobacco use among children and adolescents progresses in four stages: forming attitudes and beliefs about tobacco trying to experiment with it regularly using tobacco being addicted Sociodemographic factors associated with the viset of tobacco use include being an adolescent from a family with low socioeconomic status. Behavioral risk factors for tobacco use by adolescents include: low levels of academic achievement and school involvement lack of skills required to resist influences to use tobacco and experimentation with tobacco products. Personal risk factors for tobacco use by adolescents include: a lower self-image and lower self-esteem than peers the belief that tobacco use is functional lack of the ability to refuse offers to use tobacco Environmental factors for tobacco usc by adolescents include: accessibility and availability of tobacco products perceptions by adolescents that tobacco use is normal peers and siblings use and approval of tobacco use lack of parental support and involvement as adolescents face the challenge growing up In August 1996. the Food and Drug Administration issued regulations to limh the accessibility and appeal of tobacco products to young people. The regulations include the following. billboards and signs: Billboards and signs limited to black-and-white text only: except in adult-only facilities: tobacco billboards banned within 1,000 feot of schools and playgrounds; :# 1/6 7-17-97 :11:06AM AMERICAN LUNG ASSOC. 1 SENT BY : ALA Teenage Cigarette Smoking/3 print ads: black-and-white text only ads in publications whose youth readership is more than 2 million, or 15 percent, of total readership: vending machines: cigarette vending machines limited to facilities where children are prohibited; giveaways: ПО product giveaways with brand names or logos; sponsorship: enteriainment or sporting events sponsored only in the corporate name, not the brand name: photo IDS: buyers under age 27 must produce photo identification; education: industry-run educational campaign, including TV ads, about health risks; singles: no free samples. single cigarette sales or packages of fewer than 20 cigarettes. Tobacco use in adolescence is associated with a range of health-comprounising behaviors, including being involved in fights, carrying weapons, engaging in high risk sexual behavior. and using alcohol and other drugs. The following materials are available from the American Lung Association, 1-800- LUNG-USA: Facts About Cigarette Smoking (Order #0171C) Don't Lei Your Dreams Go Up in Smoke (Order #1032C) The Coach's Final Lesson Video (Order #6315) Smokeless Tobacco (Order #0606) Is There A Safe Tobacco? (Order #1092) # # # ap/amkteen apd 196 # 5/ 6 : 7-17-97 :11:07AM :AMERICAN LUNG ASSOC.- SENT BY ALA American Lung Association Fact Sheet CIGARETTE ADVERTISING AND PROMOTION Cigarettes are one of the most heavily marketed consumer products in America. Tobacco companies currently spend almost $6 billion a year to promote and advertise their products and have increased their spending by more than 12 times since 1971, when advertising on radio and television was banned. An estimated 419,000 Americans die each year from diseases caused by smoking. Smoking is responsible for an estimated one in five U.S. deaths and costs the U.S. at least $97.2 billion each year in health care costs and lost productivity. While tobacco products have been mass produced and marketed for decades, it has taken many years for their deadly effccts to be scientifically documented. Tobacco is the only legal product that causes death and disability when used as intended. Advertising and promotion for tobacco products often are misleading and deceptive. Tobacco advertising and promotion project images of smoking as fun, sexy, glamorous, macho, and, most insidiously, healthful. The tobacco industry is the second largest advertiser in the print media, including magazines and newspapers, and the largest advertiser on billboards. Persuasive advertising and promotion add to the difficulties of those trying to stop smoking by projecting the impression that smoking is a normal activity indulged by almost everyone. Another strategy of tobacco advertisers is to mount aggressive campaigns aimed at specific segments of the population, such as women, African Americans, Hispanics, and blue collar workers.* Through advertising and promotion, the tobacco industry targets 1.75 million new smokers a year to compensate for those who quit or die. Brand names used in sponsoring sports, musical and cultural events convey an image of corporate "good citizenship" and generosity, and connect tobacco products. which are toxic and addictive. with exciting and healthy events and activities. Tobacco companies are allowed to deduct the cost of advertising and promotion from their taxes as a business expense. which saves them in excess of $1 billion a year in taxes. In a 1987 survey of public attitudes, a majority of Americans indicated their support for a ban on cigarene advertising. More than 30 national magazines no longer accept cigarette advertisements. A 1992 Gallup poll reported that a majority of the American public (74 percent) believe that some tobacco product advertising and promotions are meant to cncourage children to smoke. and 68 percent of the public believe that tobacco product advertising and promotions should not be allowed at entertainment and sporting events. Racial and ethnic minority terminology reflects that used by the Centers For Disease Control. :# 6/6 SENT BY: ALA : 7-17-97 :11:10AM AMERICAN LUNG ASSOC. - - Cigarette Advertising/2 Many states and localities have taken action by barring tobacco advertising on public property, in public transit vehicles, and in publicly owned stadiums and other facilities. On the other hand, because of the influence of the tobacco companies, a provision of the 1969 federal law providing for health warning labels on cigarettes also prohibits states and cities from restricting tobacco advertising and promotion in privately owned sites such as theaters, on taxi cabs, etc. This legislation also affects anything where interstate commerce rules apply, such as advertisements in magazines. Powerful lobbying forces representing the tobacco industry, as well as advertising agencies and some in the print media, continue to oppose any restriction on tobacco advertising and promotion. For more information. including the following materials and Freedom From Smoking (FFS) group clinics, call the American Lung Association at 1-800-LUNG-USA: Facis About Cigarette Smoking (Order #0171C) FFS Self-Help Guides (Order #0063/0055) "In Control"/ FFS Video Program (VHS) (Order #6300) Also available: State Legislated Actions on Tobacco Issues (Contact: Coalition on Smoking OR Health. 1150 Connecticut Avenue, N.W., Suite 802, Washington, DC 20036; phone 202/452-1184) ### sp/emhedv apd 8/96 SENT BY:ALA : 7-17-97 :10:54AM ;AMERICAN LUNG ASSOC. -> 7/10 Thumbs Up! Thumbs Down! AMERICAN LUNG ASSOCIATION. of Sacramento-Emigrant Trails Teens Take a Look at Tobacco Use In The Movies In conjunction with The American Lung Association of Los Angeles County The Los Angeles Linkage Project The Gold Country Tobacco Prevention Coalition This project is made possible by a grant received from the Health Protection Act of 1988. Propositon 99. SENT BY ALA ; 7-17-97 10:56AM :AMERICAN LUNG ASSOC.- - :# 8/10 A Special Thanks to the Youth Reviewers Aguila, Rowena Ewert, Josh Love, Melissa Richardson, Mary Albictz, John Ferreira, Tim Luong. Chinh Rolfe, Carrisa Albritton, Tevin Garcia, Alberto Matulis, Niki Rowna, Daniel Alston. Danielle Gluckman, Eric McElroy, Phron Roy, Bobby Andrade, Rebecca Harper, Harmony Merz, Jeremy Sahar, Andisha Melissa, Basquez Harper, Joshua Munro, Melissa Sartor. Alexander Bell, Maya Henderson, Joel Nagano, Aaron Scott, Jennifer Belnas, Jenny Howard, Maria Ngyuen, Fong Singh, Avtar Breslin, Carly Janssens, Jeff Ngyuen, Karen Stubbs. Charnell Brown, Courtney Kabigting, Filamer Ngyuen, Tiffany West, Rodney Cavillo, Sabrina Kaulupali, Irma O'Bryan. Gary Widby, Mairead Chinn, Kristin Kaulupali. Kath Padilla, Angelina Wright, Cristina Daniel, Evan Kharia, Gurbir Phan, Kim Young, Melissa Dupree, Tanedda King, Shalanda Pheatt, Lica Yu, Jie Eichhorn, Jasmine Lac, Helen Prophet, Nicole Zapata, Jenny Epps, Briana Lac, Elizabeth Reinhard, Robert Escalante, Evelyn Lopez, Raquel Rico, Albert New Directions for Youth of Los Angeles And to Members of the Oversight Committee Joe Baltake Cassandra Jennings Meredith Rolfe Sacramento Bee ALA of Sacramento- Sacramento City Emigrant Trails School District Ruth Blank Carolyn Martin Andrew Weisser Sacramento Cable ALA of Sacramento- ALA of Los Angeles Emigrant Trails County Debbie Dunn Pat McConahay Mairead Widby ALA of Sacramento- ALA of Sacramento- Youth Representative Emigrant Trails Emigrant Trails Pat Etem April Roeseler Jeanne Wilcox Los Angeles California Department Sacramento Educational Linkage Project of Health Services Cable Consortium STAFF Jane Hagedorn, Executive Director Curtis Mekemson, Project Consultant ALA of Sacramento-Emigrant Trails Penny Manson, Project Consultant Sue Smith, Project Director Marie Boman, Project Assitant Trisha Gibson. Project Coordinator