IYD: Congressional Testimony - Health & Tobacco

Congressional Testimony

Testimony: House Subcommittee on Health & Environment "Public Health Views on Tobacco"

Shepherd Smith, March 5, 1998

"Good morning, Mr. Chairman and members of this committee. We thank you for the opportunity to share our views on this important issue, and to hear what others on this distinguished panel have to say as well. All of us have the same interest and goal: to stop youth smoking. Congressman Waxman is to be congratulated for initially raising this issue, and Congressman Bliley for hopefully bringing it to a successful conclusion. We all wish to accomplish our goal as quickly as possible in the interest of America's youth and their future.

Many of you here know us from our work in AIDS. For over a decade we sought to have HIV and AIDS addressed primarily as a medical/public health issue, implementing fundamental tenets of medicine and public health to limit suffering caused by the HIV epidemic. To that end we established a Children's Assistance Fund, now known as the Children's AIDS Fund, which has served tens of thousands of children and families over the years.

While working in the AIDS issue it became apparent that a multitude of behaviors put people at risk for acquiring HIV. These interrelated behaviors were viewed by many as inevitable, and messages were often developed to reduce risk rather than avoid risk. Our view has been that risk can, and should, be avoided. We saw the need for a comprehensive risk-avoidance message to include alcohol, drugs, sex, tobacco, and violence. Consequently, we formed the Institute for Youth Development to bring this comprehensive risk-avoidance message to young people regarding these five major areas of risk behavior.

My own experience with tobacco goes back to 1957 when I was 12 years old. My father--who was a doctor with a public health degree--offered me a financial incentive to not smoke until I was 21. He understood then, as many understand now, the dangers of smoking. He instilled in me at a very early age the need to prevent young people from taking up this destructive habit. And like the early example he set in the 1950s in having a smoke-free work place, every office I have run in my life has been smoke-free as well.

Because of our involvement in the AIDS issue, we came to know many people in the public health community concerned with risk behaviors. We, like many in the arts and other charitable causes, came to know major funders, some of whom produce tobacco products. And over a longer period of time we came to know many members of Congress. That mix led us early on, when we were forming the Institute for Youth Development, to go directly to the companies and share what we felt was their responsibility to do something about youth smoking.

At that time many were publicly voicing opposition to the industry, but few, if any, were engaging them in dialogue and challenging them to do what was right. Our position on corporate responsibility is straightforward: any company that produces products that kids use or kids can abuse has an added obligation to help America's youth. We went beyond talking to companies about their obligation. We went to the public health community and the Congress and asked them to do something about preventing youth smoking.

In that context, and long before the settlement talks began, we helped facilitate discussions between people on the Hill and those in the public health community to see if there was a way to resolve this issue legislatively. These discussions did not involve the industry, but rather those interested in bringing forward the FDA rule (to see if that might be codified by Congress). Unfortunately, these discussions did not end with a legislative agreement but, in all likelihood, they helped facilitate discussions concerning an ultimate settlement.

My purpose of testifying today centers on the complexity of dealing with youth smoking. In looking at studies on youth behavior we see that it is very difficult to separate tobacco from other behaviors in which youth participate. This is best illustrated by a recent article in The Journal of Adolescent Health. A number of scientists reviewed 1991 and 1993 school-based Youth Risk Behavior Surveys (YRBS) data of over 28,000 student participants.

What they found was interesting as they looked for patterns of behavior involving alcohol, marijuana, sex and tobacco: "First young people began drinking alcohol followed 17 or 18 months later by cigarette smoking followed 10 or 11 months later by initiation of sexual intercourse." Many of us have heard it said that tobacco is the most important "gateway drug," and, in fact, in many instances that is true. And it is also true it often influences other risk-taking behavior. But ironically it may not be the substance that we should first target, especially in light of this new data.

In looking at data and developing messages, if patterns such as this do exist, we need to first focus on the behavior that young people might initiate, which would then delay or perhaps prevent the onset of tobacco use. In this case it appears that alcohol use is that behavior. Marijuana use did not fall into any specific pattern but we need to be alert to it in light of the dramatic increases of marijuana use over the last 5 or 6 years. It is possible it may precede smoking in the future, and perhaps even drinking alcohol. The message here is that we have to be cognizant of recent research, and allow science to help direct us toward what are the best messages.
Other relationships of behavior patterns are shown by the interconnectedness regarding those who are sexually active versus those who aren't, and their use of alcohol, tobacco, marijuana, and other substances. As you see from the Measuring the Risk book we have given you, those who are sexually abstinent are far less inclined to participate in any other risk behavior. Consequently, any tobacco campaign to reduce smoking should contain a strong sexual abstinence message, as well.

A stand-alone anti-tobacco message or a stand-alone anti-drug message or a stand-alone anti-alcohol message will have some impact, but it will not win the war. In California, for example, where a tobacco tax was levied for youth anti-smoking campaigns, some of the tobacco tax revenues are being used to reduce other related risk behaviors. These behaviors are proven to be interrelated. We have to get at the root of the decision making process regarding risk taking that youth generally experience.

To do that we must help young people develop decision-making skills in the earliest years so when they are faced with the opportunity to participate in these behaviors they are able to say no. Character education in grades K-6 is critically important in this process. To wait until young people are in middle school or high school to saturate them with anti-smoking messages alone, we believe, substantially misses the mark.

It is appropriate to inject a word of caution. The optimism expressed by some in substantially reducing youth smoking rates in the near-term through price hikes and ad campaigns may be ill founded. When we look at the California and Massachusetts experience with large price hikes and directed ad campaigns, the best we can say is they have reduced the rates of increase in teen smoking-not decreased youth smoking. Consequently, when I read in the latest edition of The American Public Health Association's newspaper, Nation's Health, that Delaware public health officials anticipate a 9% decrease in youth smoking with a $0.25 a pack excise tax, I worry. Their belief is based on extremely optimistic calculations. The article states, "research indicates that a 10% increase in the cost of cigarettes will likely result in 9% fewer young people becoming smokers."

This committee has heard from other experts who say each 10% increase will result in a 7% decrease. This is theory, not reality. Who's Who Among American High School Students released a survey in November 1997 which said only 12% of students surveyed were influenced by price. We need to look more closely at actual experience rather than base projections on this or that scientist's best guess.
We need to carefully examine the impact of the Synar Amendment state-by-state to see what works best...and what doesn't. We are dealing with a habit and way of life that has been with us for hundreds of years. In fact, the last states to set minimum ages for tobacco use did this as recently as 1993. Until more Americans-young and old-view tobacco use as more harmful than they do now, we should not expect dramatic change.

We also need to re-examine the FDA rule. Are their projections realistic? The settlement offers much more to reduce youth smoking, both in advertising restrictions and money. Does this mean much more can be accomplished? Or were those original projections overly optimistic?

Finally, any legislation developed must not reflect the belief that government is the sole answer to resolve the problem of underage tobacco use. The biggest influence on youth is their parent(s). The Journal of the American Medical Association September 10, 1997, issue reported on the largest study ever done of youth risk-behavior. It made just that point: parent-child connectedness is the biggest protective factor for young people. The best role model for children are their parents, but we must remember we are all role models. And government's role should be to support parents, not supplant them.

It is our hope legislation aimed at youth tobacco use will include parental involvement, instill personal responsibility and accountability, and highlight the interconnections of all unhealthy risk-behaviors. Once more, you are to be congratulated for your efforts to resolve this issue either through codifying the settlement in some form or separately addressing underage tobacco use legislatively. We wish you well in your endeavors in the interest of America's youth and their future.