10

Part II Abstract The European Action Against Tobacco

Maurice TUBIANA Institute Gustave-Roussy Rue Camille Desmoolins, Villejuif F-94805 Paris

others there was no warning or warnings which were so small that they were not readable. The largest and most effective ones were those in use in Ireland. The committee advised to extend to the twelve countries warnings identical to the Irish ones. In 1991 this regulation was adopted by the European Parliament and the Council.

3) Ban of direct and indirect advertisement in favor of tobacco. This proposal met heavy objections by several groups and countries. Nevertheless, progress has been made. The European Commission voted in May 1991 to accept this proposal which has been sent to the European Parliament. Probably a few years will elapse before a final decision is reached. In the meantime several countries (France, Italy, Portugal) have adopt- ed laws which forbid advertisement. In other countries the projects are pending.

4) Price policy. The price of tobacco varies widely within the community, the highest being in Denmark and the lowest in Greece. In principle, an harmonization of the taxes on tobacco should be implemented but the process is slow andthe goal will not be reached before at least a decade. The exclusion of tobacco from the cost of living index has been recommended. This measure has been implemented in 3 countries (France, Portugal, Luxembourg). It is still under discussion in

031

EVALUATION OF SMOKING HABIT AMONG YOUNG POPULATION FOR TARGETING ANTI-

SMOKING CAMPAIGN. Rakhi Chaudhuri, Keith Crist. Div of Surg Oncol, Med Co11 of OH, Toledo OH 43699. Proper targeting of anti- smoking campaign is necessary for success- ful reduction of mortality from lung can- cer caused by cigarette smoking. To iden- tify such population a survey was conducted among 1681 high school (HS) students (783 females and 898 males) regarding their smoking ha.bit, age of jnitiation, number of cigarettes smoked, parental and peer group smoking influence, etc.

SParent BPeer Grade #Student %Smoker Smoker* Smoker*

9 348 5.7 40 95 10 291 8.9 50 100 11 553 34.2 63 98 12 489 39.5 56 98

*Among students who smoke Smoking was more common among females (29%) than males (23%). Influence of peer group smoking was stronger on smokers than paren- tal smoking habit. After 10th grade the incidence and number of cig smoked increa- sed sharply (50% smoked more than 11 cig/- day). Data shows significant incidence of smoking among HS students. Hence, success- ful anti-smoking campaign should be started before high school and should be included in grade school health program.

Part III Abstract The European Action Against Tobacco

Maurice TUBIANA Institute Gustave-Roussy Rue Camille Desmoolins, Villejuif F-94805 Paris

others. 5) Health education at school. A program has been launched with the help of the education ministers of the 12 countries. In conclusion the fight against tobacco during the past five years has obtained several successes. Experience has shown that recommendations at the

community level can trigger emulation between the countries and facilitate the adoption at a national level of measures which could not have been obtained without this stimulus. However, in most countries the governments are schizophrenic with regard to tobacco and a massive support of public opinion is required to overcome the formidable obstacles raised by the tobacco lobby.

The exclusion of tobacco from the cost of living index requires an international action and various associat- ions and individuals should pool their efforts and cooperate.

Europe has already become one of the leading forces in the fight against tobacco.

032

J Virtamo, PR Taylor and P Greenwald. :,,":,",",;;si.

$ubltc Health Institute, Helsinki, Finland and

DETECTING LYNG CANCER 19 A LARGE FOHORT. JK Huttunsn, BK Edwarqs, N Malila,,J Haapakos 11 A HaTtman, J Papgren, OP Heinon2n,,

Natlonal Cancer Institute, Bethesda, Maryland, USA. The efficacy of alpha-tocopherol (50 mg) and beta-

carotene (20 mg) in reducing lung cancer incidence among male smokers aged 50 to 69 years is being evaluated in a controlled trial (the ATBC Study). Over 29,000 men entered the study; up to spring 1991, 111,000 follow-up years have accumulated. The main end-point. is incident. lung cancer, detected from 4 sources: 1) the study participants, 2) Cancer Register, 3) Hospital Discharge Register and 4) Death Register. Validity is checked from hospital records and death certificates. Over 96 % of primary lung cancer notices are true lung cancers; in some 3 % the primary site turns out to be an other organ, or unknown. Only 0.5 % of primary lung cancer notices are in fact some other respiratory disease, e.g. tuberculosis. An additional 2 % of lung cancers are found among notices of non-lung or unknown primary site cancers.

A chest x-ray is taken every 2,5 years to ensure lung cancers are detected early. The first follow-up x-rays since randomization are completed. Lung cancer incidence in the 3rd follow-up year (when the chest x-ray was taken) increased about 50 X, from 4.3 per 1000 man years to 6.6, falling to 4.8 during the 4th follow-up year. About 56 % of lung cancers found in chest x-ray were squamous cell type compared to 41 % of such cases found in clinical practice.