The tobacco industry's code of advertising in the United States: myth and reality.

The major American tobacco companies developed and agreed to abide by the Cigarette Advertising Code in 1964. The stated aims of the code were to prohibit advertising directed at young people, to prohibit advertising that used fraudulent health claims, and to assure compliance with the code's provisions through the establishment of an administrative arm and enforcement mechanism to prescreen and monitor all cigarette advertising. In the 32 years since the Cigarette Advertising Code's adoption, the tobacco industry has used the existence of this code and its revisions and promises of self-regulation in accordance with this code as evidence that it promotes tobacco use only in a responsible manner. The code has served as the basis of the industry's efforts to avoid further local, state, and federal regulatory oversight of its marketing activities. A historical review of cigarette advertising since 1964 indicates that the voluntary code's major provisions have been regularly violated in the spirit and the letter. The administrative and enforcement provisions of the original Cigarette Advertising Code were quietly dismantled soon after the voluntary code's adoption and were completely omitted from the revised code in 1990. The historical evidence indicates that self-regulation of cigarette advertising and promotion by the tobacco industry has been repeatedly given trials and has not worked.

Sustained effects of an educational program to reduce sales of cigarettes to minors.

We report 1-year follow-up data from a sample of stores participating in a 6-month community-wide educational effort to reduce cigarette sales to minors in Santa Clara County, California. The proportion of over-the-counter sales to minors at the 1-year follow-up illustrated that although statistically significant reductions were maintained 6 months after the intervention ended, recidivism occurred. Suggestions for achieving long-term reductions in sales to minors are offered.

Who profits from tobacco sales to children?

It is estimated that more than 3 million American children under 18 years of age consume 947 million packs of cigarettes and 26 million containers of smokeless tobacco yearly. These tobacco products account for annual sales of $1.26 billion. Approximately 3% of tobacco industry profits ($221 million in 1988) derive directly from the sale of cigarettes to children, an activity that is illegal in 43 states. Approximately half of the tobacco industry's profits, or $3.35 billion annually, derives from sales to people who became addicted to nicotine as children. Tax revenues to the federal ($152 million) and state ($173 million) governments from cigarette sales to children dwarf governmental expenditures on smoking and health. We describe how dozens of communities have effectively enforced laws that prohibit the distribution of tobacco to children and offer some suggestions for increasing efforts to prevent nicotine addiction.

Duty calls: hospitals' responsibility for controlling the tobacco epidemic.

Growing public awareness of the health hazards associated with smoking and the growing social unacceptability of the smoking habit constitute one of the major public health revolutions of our time. In recent years, almost all of the country's major medical and health professional organizations have become actively involved in the tobacco control movement. Unfortunately, hospitals and their professional associations have been conspicuously absent from the ranks of those leading this effort. The authors argue that the American Hospital Association and individual hospitals have an opportunity and a duty to become leaders in the effort to reduce tobacco addiction in this country and around the world. Specific suggestions are provided for individual hospitals and for their professional associations to work toward protecting the health of nonsmokers by eliminating cigarette smoking in hospitals, to work for political solutions to eliminate efforts by tobacco companies to promote smoking, and to reduce the incidence of smoking initiation among young people.

Reducing the illegal sale of cigarettes to minors.

This study reports on an effort to stop the illegal sale of cigarettes to minors. In Santa Clara County, Calif, 412 stores and 30 vending machines were visited by 18 minors aged 14 through 16 years with the intent to purchase cigarettes; they were successful at 74% of the stores and 100% of the vending machines. After an aggressive six-month campaign using communitywide media, direct merchant education, contact with the chief executive officers of chain stores and franchise operations owned by major companies, and grassroots work with community organizations, the percentage of stores with illegal over-the-counter sale of cigarettes to minors was reduced to 39%. Sales from vending machines were not reduced. While much remains to be accomplished in stopping the illegal sale of tobacco to minors, data from this study illustrate that a well-designed community and merchant education campaign can significantly reduce such sales.

Legislative efforts to protect children from tobacco.

Public health laws intended to prevent children from smoking have been enacted in many states. We surveyed the relevant laws in all states and the District of Columbia. The efficacy of one such law prohibiting the sale of tobacco to individuals under the age of 18 years was assessed with the cooperation of an 11-year-old girl. She was successful in 75 of 100 attempts to purchase cigarettes. On the basis of this experience and a review of existing laws, we have made recommendations for a model law. These include a prohibition of the possession of tobacco by minors, a prohibition of the sale of tobacco to minors, a requirement for a warning sign at the point of sale, a ban on cigarette vending machines, and a reward for individuals reporting violators of vending laws.

KIE: The authors surveyed state and District of Columbia public health laws aimed at keeping tobacco products out of children's hands. They then tested the efficacy of the Massachusetts ban on selling tobacco to minors with the help of an 11-year-old assistant, who was able to purchase cigarettes from 75 of the 100 businesses that she visited. In view of the serious health consequences of nicotine addiction, which often begins in childhood, the authors make recommendations for a model law that would outlaw tobacco possession by children and the sale of tobacco products to individuals under 21, promote health education about tobacco, and regulate more strictly the sale and distribution of tobacco products in general.

Promotion of tobacco products: issues and policy options.

During the past year, several prominent voluntary health organizations and professional medical associations have called for a ban on all forms of promotion of tobacco products. The proposal raises complex issues, ranging from determination of the effects of tobacco promotion to assessment of the constitutionality of banning advertising of a legal product. We identify the issues that underlie the concern of health professionals, review evidence addressing these issues, and describe and discuss frequently mentioned policy options, especially the ban proposal.

Survey of continuing education needs for nonemergency physicians in emergency medicine.

A questionnaire was mailed to every physician in Iowa (2,551) to determine their need for continued education in emergency medicine. There 884 usable responses (34.7%). Results revealed a low incidence of formal education in emergency medicine, particularly at the undergraduate and graduate levels, with a great incidence of continued education in the field. Approximately half of the responding physicians felt they treat an emergency patient at least once a week. The primary conclusion of the study is that continued education in basic emergency medical care is perceived as being necessary by physicians who are not specialists in emergency medicine, but, nevertheless, treat patients with medical emergencies. Physicians were most interested in education in basic life saving procedures, such as airway maintenance and cardiopulmonary resuscitation.