[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
SMOKELESS TOBACCO: IMPACT ON THE HEALTH OF OUR NATION'S YOUTH AND USE
IN MAJOR LEAGUE BASEBALL
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
__________
APRIL 14, 2010
__________
Serial No. 111-110
Printed for the use of the Committee on Energy and Commerce
energycommerce.house.gov
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COMMITTEE ON ENERGY AND COMMERCE
HENRY A. WAXMAN, California, Chairman
JOHN D. DINGELL, Michigan JOE BARTON, Texas
Chairman Emeritus Ranking Member
EDWARD J. MARKEY, Massachusetts RALPH M. HALL, Texas
RICK BOUCHER, Virginia FRED UPTON, Michigan
FRANK PALLONE, Jr., New Jersey CLIFF STEARNS, Florida
BART GORDON, Tennessee NATHAN DEAL, Georgia
BOBBY L. RUSH, Illinois ED WHITFIELD, Kentucky
ANNA G. ESHOO, California JOHN SHIMKUS, Illinois
BART STUPAK, Michigan JOHN B. SHADEGG, Arizona
ELIOT L. ENGEL, New York ROY BLUNT, Missouri
GENE GREEN, Texas STEVE BUYER, Indiana
DIANA DeGETTE, Colorado GEORGE RADANOVICH, California
Vice Chairman JOSEPH R. PITTS, Pennsylvania
LOIS CAPPS, California MARY BONO MACK, California
MICHAEL F. DOYLE, Pennsylvania GREG WALDEN, Oregon
JANE HARMAN, California LEE TERRY, Nebraska
TOM ALLEN, Maine MIKE ROGERS, Michigan
JANICE D. SCHAKOWSKY, Illinois SUE WILKINS MYRICK, North Carolina
CHARLES A. GONZALEZ, Texas JOHN SULLIVAN, Oklahoma
JAY INSLEE, Washington TIM MURPHY, Pennsylvania
TAMMY BALDWIN, Wisconsin MICHAEL C. BURGESS, Texas
MIKE ROSS, Arkansas MARSHA BLACKBURN, Tennessee
ANTHONY D. WEINER, New York PHIL GINGREY, Georgia
JIM MATHESON, Utah STEVE SCALISE, Louisiana
G.K. BUTTERFIELD, North Carolina
CHARLIE MELANCON, Louisiana
JOHN BARROW, Georgia
BARON P. HILL, Indiana
DORIS O. MATSUI, California
DONNA M. CHRISTENSEN, Virgin
Islands
KATHY CASTOR, Florida
JOHN P. SARBANES, Maryland
CHRISTOPHER S. MURPHY, Connecticut
ZACHARY T. SPACE, Ohio
JERRY McNERNEY, California
BETTY SUTTON, Ohio
BRUCE BRALEY, Iowa
PETER WELCH, Vermont
Subcommittee on Health
FRANK PALLONE, Jr., New Jersey, Chairman
JOHN D. DINGELL, Michigan NATHAN DEAL, Georgia,
BART GORDON, Tennessee Ranking Member
ANNA G. ESHOO, California RALPH M. HALL, Texas
ELIOT L. ENGEL, New York BARBARA CUBIN, Wyoming
GENE GREEN, Texas JOHN B. SHADEGG, Arizona
DIANA DeGETTE, Colorado STEVE BUYER, Indiana
LOIS CAPPS, California JOSEPH R. PITTS, Pennsylvania
JANICE D. SCHAKOWSKY, Illinois MARY BONO MACK, California
TAMMY BALDWIN, Wisconsin MIKE FERGUSON, New Jersey
MIKE ROSS, Arkansas MIKE ROGERS, Michigan
ANTHONY D. WEINER, New York SUE WILKINS MYRICK, North Carolina
JIM MATHESON, Utah JOHN SULLIVAN, Oklahoma
JANE HARMAN, California TIM MURPHY, Pennsylvania
CHARLES A. GONZALEZ, Texas MICHAEL C. BURGESS, Texas
JOHN BARROW, Georgia
DONNA M. CHRISTENSEN, Virgin
Islands
KATHY CASTOR, Florida
JOHN P. SARBANES, Maryland
CHRISTOPHER S. MURPHY, Connecticut
ZACHARY T. SPACE, Ohio
BETTY SUTTON, Ohio
BRUCE L. BRALEY, Iowa
C O N T E N T S
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Page
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 1
Prepared statement........................................... 3
Hon. John Shimkus, a Representative in Congress from the State of
Illinois, opening statement.................................... 8
Prepared statement........................................... 10
Hon. Henry A. Waxman, a Representative in Congress from the State
of California, opening statement............................... 17
Prepared statement........................................... 19
Hon. Ed Whitfield, a Representative in Congress from the
Commonwealth of Kentucky, opening statement.................... 25
Hon. Anna G. Eshoo, a Representative in Congress from the State
of California, opening statement............................... 26
Hon. Steve Buyer, a Representative in Congress from the State of
Indiana, opening statement..................................... 26
Hon. Eliot L. Engel, a Representative in Congress from the State
of New York, opening statement................................. 28
Hon. Phil Gingrey, a Representative in Congress from the State of
Georgia, opening statement..................................... 29
Hon. Diana DeGette, a Representative in Congress from the State
of Colorado, opening statement................................. 30
Hon. Marsha Blackburn, a Representative in Congress from the
State of Tennessee, opening statement.......................... 31
Hon. Lois Capps, a Representative in Congress from the State of
California, opening statement.................................. 32
Hon. Joe Barton, a Representative in Congress from the State of
Texas, opening statement....................................... 33
Prepared statement........................................... 35
Hon. Donna M. Christensen, a Representative in Congress from the
Virgin Islands, opening statement.............................. 41
Hon. Janice D. Schakowsky, a Representative in Congress from the
State of Illinois, opening statement........................... 41
Hon. Gene Green, a Representative in Congress from the State of
Texas, opening statement....................................... 42
Witnesses
Terry Pechacek, Ph.D., Associate Director for Science, Office on
Smoking and Health, Centers for Disease Control and Prevention. 44
Prepared statement........................................... 47
Answers to submitted questions............................... 196
Deborah Winn, Ph.D., Deputy Director of the Division of Cancer
Control and Population Sciences, National Cancer Institute..... 58
Prepared statement........................................... 61
Answers to submitted questions............................... 216
Gruen Von Behrens, Stewardson, Illinois.......................... 83
Prepared statement........................................... 86
Robert D. Manfred, Jr., Executive Vice President, Labor Relations
and Human Resources, Major League Baseball..................... 89
Prepared statement........................................... 91
David Prouty, J.D., Chief Labor Counsel, Major League Baseball
Players Association............................................ 97
Prepared statement........................................... 99
Joseph Henry ``Joe'' Garagiola, Sr., Major League Baseball
Announcer, Former Major League Baseball Player................. 106
Prepared statement........................................... 111
Gregory Connolly, M.P.H., D.M.D., Professor of the Practice of
Public Health, Harvard University.............................. 114
Prepared statement........................................... 116
Submitted material
Statement of Dr. Cheryl Healton, President of Legacy, submitted
by Ms. Capps................................................... 141
Statement of the American Association for Cancer Research,
submitted by Ms. Capps......................................... 143
Article entitled, ``Under the Floorboards,'' by the National
Association of Convenience Stores, submitted by Mr. Whitfield.. 148
Article entitled, ``Sex, drugs and BlackBerrys,'' in The
Washington Times,'' submitted by Mr. Whitfield................. 153
Report entitled, ``The Strategic Dialogue on Tobacco Harm
Reduction: A Vision and Blueprint for Action in the United
States,'' submitted by Mr. Buyer............................... 154
SMOKELESS TOBACCO: IMPACT ON THE HEALTH OF OUR NATION'S YOUTH AND USE
IN MAJOR LEAGUE BASEBALL
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WEDNESDAY, APRIL 14, 2010
House of Representatives,
Subcommittee on Health,
Committee on Energy and Commerce,
Washington, DC.
The Subcommittee met, pursuant to call, at 10:08 a.m., in
Room 2123 of the Rayburn House Office Building, Hon. Frank
Pallone, Jr. (Chairman of the Subcommittee) presiding.
Members present: Representatives Pallone, Eshoo, Engel,
Green, DeGette, Capps, Schakowsky, Matheson, Barrow,
Christensen, Sarbanes, Waxman (ex officio), Shimkus, Whitfield,
Buyer, Blackburn, Gingrey and Barton (ex officio).
Staff present: Brian Cohen, Counsel; Alvin Banks, Special
Assistant; Mitchell Smiley, Special Assistant; Brandon Clark,
Minority Professional Staff; Clay Alspach, Minority Counsel,
Health; Ryan Long, Minority Chief Counsel, Health, and Aarti
Shah, Minority Counsel, Health.
OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone. I call the meeting to order.
Today the subcommittee is having a hearing on the
prevalence--well, I should say the title of it is ``Smokeless
Tobacco: Impact on the Health of Our Nation's Youth and Use in
Major League Baseball,'' and I will recognize myself for an
opening statement.
The subcommittee is examining the prevalence of smokeless
tobacco products, diseases linked to the use of these products
and the correlation between smokeless tobacco use by youth and
Major League Baseball players. This is an important issue of
longstanding interest to this committee, and it is my hope we
can continue to raise awareness about the dangers of smokeless
tobacco and shape future discussions both in Congress and in
Major League Baseball.
There are various names for smokeless tobacco. I have to
say, I haven't even heard of all of them. It is called spit
tobacco, chewing tobacco, chew, chaw, dip, plug and probably
many other things unknown to us in this room. But in all forms,
the tobacco sits in the mouth while the user sucks on the
tobacco juices, spitting off when they get rid of the saliva
that builds up, allowing nicotine to be absorbed into the
bloodstream without even swallowing. But no matter what name
you call it, its use is clearly dangerous to your health.
In the United States, both smoking and smokeless tobacco
has long been associated with baseball. In the early days of
the 1900s, baseball players chewed it to keep their mouths
moist on dry and dusty fields or they would spit it into their
gloves to soften up the leather and even use it to prepare the
notorious spitball. Then during the 1950s, smoking tobacco
became the product of choice. In fact, when baseball games were
first broadcast on TV, cigarette ads became prominent features.
Smoking was such a part of Major League Baseball that fan
loyalty in New York could be identified merely by what
cigarette brand an individual smoked.
In the 1970s, things shifted again as the public became
aware of the dangers of smoking and chewing tobacco crept back
into baseball. During that time, the smokeless tobacco industry
used celebrity baseball players as models in their
advertisements, sent free samples to clubhouses in the major
leagues, minor leagues and colleges, and ramped up efforts to
reach a more youthful audience. As a result, sales rose by 55
percent between 1978 and 1985. Since then, smokeless tobacco
use by baseball players appears on TV screens across the United
States 7 months out of the year. It doesn't seem too much of a
stretch to consider that kids associate tobacco use as part of
the game, and perhaps even believe that it is part of the game
that enhances an athlete's performance. I could easily imagine
a child thinking well, last night Yankee Nick Swisher hit a
home run with a wad of chew in his cheek, maybe I can do that
too. And the hero phenomenon is a powerful mania that can have
profound effects on our children.
My own concern is that smokeless tobacco use in baseball
presents a public health risk that extends beyond the baseball
players themselves. Millions of teenagers and young adults in
the United States use smokeless tobacco. The most recent survey
results indicate that over 13 percent of high school boys and
over 2 percent of high school girls currently use smokeless
tobacco products. In fact, surveys by the Centers for Disease
Control and Prevention have found that among high school boys,
usage rates of smokeless tobacco increased by 22 percent
between 2003 and 2007.
Now, we all know that tobacco use causes cancer no matter
how it is absorbed by the body. Smokeless tobacco is not a safe
alternative to smoking, and I am worried that message is not
reaching the youth of our country. A 2008 study by the World
Health Organization's International Agency for Research on
Cancer concluded that smokeless tobacco users have an 80
percent higher risk of developing oral cancer and a 60 percent
higher risk of developing pancreatic and esophageal cancer, and
despite bans of smokeless tobacco in college and the minor
leagues, there is no ban on it in Major League Baseball.
So I look forward to exploring the reasons behind this
exception. I am also anxious to hear from our witnesses about
their recommendations on how Congress can better address this
public health issue, and I would like to thank all of our
witnesses for being here today.
[The prepared statement of Mr. Pallone follows:]
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Mr. Pallone. I will recognize the gentleman from Illinois,
Mr. Shimkus, for the purpose of making his opening statement.
Mr. Shimkus. Thank you, Mr. Chairman. I ask unanimous
consent that my full statement be submitted into the record.
Mr. Pallone. Without objection, so ordered.
OPENING STATEMENT OF HON. JOHN SHIMKUS, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF ILLINOIS
Mr. Shimkus. And then I will just briefly summarize. First
of all, I want to welcome Gruen Von Behrens, who is from my
district. He is a young man who will be testifying about the
damages of smokeless tobacco, and I appreciate his testimony
and his advocacy. Tobacco use is bad. I think we all know that
in America today. We need to continue to tell the message.
As a young kid who wanted to be a baseball player my whole
life, of course we get to do that still here in Washington with
the Congressional game, but athletes are role models to
somebody, and professional baseball has to understand that they
are a role model to the next generation of kids, and we want to
encourage that good leadership by example style.
I also want to mention and welcome Joe to the committee
room. I am a St. Louis area Member of Congress residing in
Collinsville, so as a St. Louis boy, we want to welcome you to
the committee. I still remember fondly throughout Major League
Baseball but especially in his hometown of St. Louis, Missouri.
We had a master settlement with the tobacco companies that
should have paid in $206 billion over 25 years. The Government
Accountability Office states that only 30 percent of the
settlement funds went to health care. Travesty number one. Only
3.5 percent of the funds went to tobacco control like smoking
cessation and other educational programs. So when money was
provided in a settlement to the States to do what we are
talking about today, government didn't do their job. Government
always overpromises and we always underdeliver, and the master
settlement is a perfect example of not delivering on a
settlement with the tobacco companies.
We have a lot of issues here to face in health care, the
recently passed health care bill, 3,000 pages. There are
already fixes that need to be done, whether it is preexisting
conditions for kids left out until 2014, whether it is the
doctor fix, which still hasn't been done which cuts physician
payments starting this month. It is going to be extended maybe
a month. Can you imagine running a business on calculations of
income on a month-to-month basis? That is what we should be
dealing with our time today, addressing the health care needs
of the country, applauding the work--I am not suggesting that
using the bully pulpit to continue to say that tobacco use is
not, I am not saying that is not a good use of time. I think
when we are in an economy that people are calling the Great
Recession and we are looking at ways to create and expand jobs,
government underfunding health care delivery in this country or
taking away Medicare Advantage from seniors or cutting $500
billion from Medicare, there is probably a more critical use of
our time.
With that, Mr. Chairman, I yield back my time.
[The prepared statement of Mr. Shimkus follows:]
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Mr. Pallone. Chairman Waxman.
OPENING STATEMENT OF HON. HENRY A. WAXMAN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CALIFORNIA
Mr. Waxman. Thank you very much, Mr. Chairman.
Last year, we passed a law out of this committee that
finally was signed by the President, the Family Smoking
Prevention and Tobacco Control Act, and it grants FDA authority
to regulate content, advertising and marketing of tobacco
products in order to protect the public health. This
legislation marked a critical step in a long history of efforts
to reduce tobacco use by teens, and we have seen progress. Teen
smoking rates are down, and while we still have a long way to
go, at least that trend is moving in the right direction.
But there is one exception to this improvement, that is
smokeless tobacco. With smokeless tobacco, the trends are
moving in the wrong direction, and the tobacco companies know
it.
Throughout the 1980s and 1990s, the use of smokeless
tobacco by teens declined at about the same rate as cigarette
smoking. But over the last few years, the decline in smokeless
tobacco use has stagnated, and use has increased. Last year,
smokeless tobacco use among 10th graders reached its highest
level since 2002. This is a serious health risk. The increased
use of smokeless tobacco will mean millions more teens getting
hooked on nicotine.
That is why I want to thank you, Chairman Pallone, for
holding today's hearing. We will hear from some of the Nation's
leading experts in smokeless tobacco use, learn about its
risks, and learn about how to stem the rising tide of use by
young people.
Two of our witnesses are not new to this Committee. In
1994, when I was chairman of the Subcommittee on Health and the
Environment, I chaired hearings on the health effects of
smokeless tobacco. At those hearings, we heard from Dr.
Connolly and from Joe Garagiola, both of whom will be
testifying today on the second panel. Mr. Garagiola's 1994
testimony discussed the same subject we will focus on today:
the impact of tobacco use by Major League Baseball players and
how it influences young people. We appreciate the work they
have done for decades now to reduce the use of smokeless
tobacco by kids and by Major League Baseball players.
Unfortunately, Major League Baseball, and the players' union,
have yet to take decisive steps to end this terrible scourge.
Some progress has been made. In 1993, Commissioner Selig banned
smokeless tobacco in minor league clubhouses and dugouts and
therefore baseball no longer allows tobacco companies to
provide free samples to players. And the league and the union
continue to educate players and fund efforts to reduce tobacco
use by youth. But at the Major League level, there continues to
be no restrictions on the use of smokeless tobacco by players.
This means that millions of young fans are exposed on a daily
basis to the use of smokeless tobacco by their heroes. The
camera shots are relentless. A recent study by Dr. Connolly's
colleagues at Harvard found that in just one game of the 2004
World Series, ballplayers provided $6.4 million worth of free
advertising for smokeless tobacco. If you are a Major League
Baseball player, and you are chewing tobacco, you can bet that
many thousands of young, impressionable ballplayers are
watching you chew. Too many of them will take up the habit to
be just like you. That is why Major League Baseball and the
players association need to take action to end the use of
smokeless tobacco by big league players. We are not saying they
should ban the players from using it but not to use it when
they are in public, when they are on the field. We don't let
baseball players in the leagues go stand out there in the field
and drink beer. Major League Baseball won't allow them to stand
on the field and smoke cigarettes. So why should they be out
there in the field in sight of all their fans on television and
at the ballpark using smokeless tobacco?
I think that baseball has the opportunity to protect
players' health and protect the health of millions of young
adults. This committee will continue its vigorous and ongoing
oversight of these issues. When Major League Baseball and the
union get together and negotiate the next contract, I hope this
will be on the table. I don't know why there would be an
objection from the players' union to the same rules for Major
League Baseball that apply to minor league baseball where they
don't allow the use of smokeless tobacco. The protection of
young Americans from the ravages of tobacco in all its forms
demands no less, and Major League Baseball and its players must
step up to the plate to do their part.
Thank you, Mr. Chairman.
[The prepared statement of Mr. Waxman follows:]
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Mr. Pallone. Thank you, Chairman Waxman. I neglected to
thank you in the beginning, but I want to now for all you have
done over the years to bring to light the problems with smoking
and the industry and championing and sponsoring the legislation
that has the FDA regulate tobacco use, so you are going back to
the 1990s and you have been doing this for so many years, so I
just wanted to mention that.
Next is the gentleman from Kentucky, Mr. Whitfield.
OPENING STATEMENT OF HON. ED WHITFIELD, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH OF KENTUCKY
Mr. Whitfield. Thank you, Mr. Chairman.
Today's hearing is titled ``Smokeless Tobacco: Impact on
the Health of Our Nation's Youth,'' and I don't think any of us
object to this type of hearing because it is imperative that we
explore this issue, but I think it is also important, and I
wish that we would be having a hearing on some mechanisms that
are already in place that could probably do more on addressing
this issue than this hearing would do. And what am I talking
about? Well, first of all, I do want to mention that on March
19, 2010, FDA reissued its 1996 rule and this rule becomes
effective on June 22, 2010, which will prevent the sale of
smokeless tobacco and cigarettes to those under 18 and prohibit
distribution of free samples of smokeless tobacco as well. But
what am I talking about? I think this hearing that we should be
focusing on, for example, the language that was in the stimulus
bill, and one of our complaints about some of that legislation
was the fact that none of us really knew what was in it, but
now are finding out, for example, that in the stimulus bill
there is $650 million appropriated, made available to carry out
evidence-based clinical and community-based prevention and
wellness strategies. So the federal government is already
giving out money to States if these States will use that money
to address certain things like sugar in drinks, tobacco
products and so forth. And yet none of us really knew anything
about that, and I think it would be beneficial to all of us we
could get into that in more detail.
The second thing is the House also when it approved the
health care bill approved--not only did we authorize but we
appropriated $5 billion between 2010 and 2015 and then $2
billion a year forever on programs that would allow States to
submit application for grants from the federal government. And
in those grants, they are doing things like saying that they
are going to increase taxes on certain products, that they are
going to be involved in zoning in where, for example, tobacco
products or other unhealthy products could be marketed. They
are also even talking about reducing the density of fast-food
establishments, and what does that actually mean? Are we going
to be determining where fast-food restaurants are located?
So while this hearing is worthwhile, I think our time would
be better spent on examining thoroughly what happened in the
stimulus bill and the health care bill and the money
appropriated for that relating directly to this issue. Thank
you.
Mr. Pallone. Thank you.
The gentlewoman from California, Ms. Eshoo.
OPENING STATEMENT OF HON. ANNA G. ESHOO, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CALIFORNIA
Ms. Eshoo. Good morning, Mr. Chairman. Thank you for
holding this hearing on the health impacts of smokeless
tobacco, especially its effect on the young people of our
country, which I really think goes to the heart of this issue.
This committee has spent a great amount of time examining the
health risks of smoking, and I am pleased that we are focusing
on this issue of smokeless tobacco today.
While cigarette smoking has declined substantially in our
country, which is very good news, especially in the last 10
years, smokeless tobacco use has decreased only slightly over
that period. This suggests that smokeless tobacco use is not a
substitute for smoking but instead is adding to the number of
tobacco users. Increased education and awareness about the
health risks of smoking along with tougher regulations have led
to a significant decrease in smokers in the United States. This
has been a Herculean effort and I think it really signifies
real progress.
As the tobacco industry sees sharp declines in sales, it is
obvious that they are looking toward alternative products to
hook young customers. Smokeless tobacco is inconspicuous. Kids
can use it at school or in class without causing much
attention. Smokeless tobacco is also a gateway substance
because kids who chew it are three and a half times more likely
to start smoking cigarettes. Both R.J. Reynolds and Phillip
Morris have introduced snus products, a less messy version of
what chewing tobacco used to look like. These small, contained
mesh packages are placed just under the upper lip, making it
more difficult to detect and eliminate the need for a spitting
cup. It really sounds pleasant, doesn't it?
While the research is not definitive, many claim that
smokeless tobacco is less harmful than smoking. A recent 60
Minutes investigation on the use of smokeless tobacco claims
that because tobacco manufacturers are not allowed to advertise
that it is any safer than cigarettes, their ads focus on
smokeless tobacco as a way to get around smoking bans, using
smokeless tobacco in the subway or at work.
I think that smokeless tobacco is a serious health hazard.
I think we have to do more to prevent young people from forming
these early addictions, and I look forward to hearing from our
witnesses today, most especially from former Major League
Baseball player Joe Garagiola, Sr.--it is really an honor to
have you here and to see you, I am a great fan of yours--and to
understand how our Nation's role models can set good, healthy
examples for the younger generation who look up to them.
Thank you, Mr. Chairman, and I look forward to the
testimony.
Mr. Pallone. Thank you.
Next is the gentleman from Indiana, Mr. Buyer.
OPENING STATEMENT OF HON. STEVE BUYER, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF INDIANA
Mr. Buyer. Thank you very much.
First of all, I would like to express my disappointment
that no one from the Center for Tobacco Products is here to
testify today, and now that the Center is up and running, we do
not have a single witness from what is to be the premier
tobacco regulator in our country, so I am very disappointed,
and I have a sense that the Center has been deliberately
disregarded in this hearing.
I continue to remain very interested in the issue of
smoking cessation in country. Chairman Waxman and I feverishly
debated this matter last year and I continue to follow the
science behind smoking cessation with hopes that we can share
valuable information with 45 million Americans who continue to
smoke today despite strong public health campaigns that have
been in operation for 40 years. We know that today over 70
percent of the tobacco users want to give up smoking, and
treatments for the diseases related to tobacco are costly for
our country. However, according to the Surgeon General's report
in 2008, of the 45 percent of smokers who reported trying to
quit in 2008, only 4 to 7 percent were successful and I believe
that that is failure, and what is really disappointing is, is
that the bill that was passed locks America into a system of
failure. Americans have no access to information about the
alternative methods of smoking cessation. For decades we have
left them with the understanding that they must either quit
smoking or die. However, this is not the only option for them,
and there is a vast schism in the public health community that
is crying out for the FDA and government officials to
acknowledge the scientific research which continues to show
that individuals throughout the world are finding tremendous
success through harm-reduction strategies yet we continue to
ignore harm-reduction strategies with regard to smoking. Oh, we
will apply them to everything else in life but not to smoking,
and I think that is pretty ridiculous. If we continue to employ
harm-reduction strategies and give Americans this information
showing the respective risks of tobacco products ranging from
cigars and cigarettes to smokeless products and eventually
pharmaceutical smoking products and complete cessation, we can
give Americans who cannot or will not quit smoking new options
to obtain the nicotine that they are dependent on or from
products that are up to 99 percent less hazardous than
cigarettes in terms of risk of tobacco-related illness. We must
acknowledge the growing public health community that is
acknowledging the differential risks between cigarettes and
non-burning tobacco products including almost 80 peer-reviewed
scientific and medical publications over the last 25 years of
which four of them, Mr. Chairman, I am going to ask be
submitted for the record.
The FDA stated on its Web site that it will perform its
duties by using the best available science to guide the
development and implementation of effective public health
strategies to reduce the burden of illness and death caused by
tobacco products. In carrying out its responsibilities to
implement the bill we passed last year, while neither the FDA
nor the Center for Tobacco Products are here to testify, I look
forward to asking the CDC and NCI about their initiatives to
incorporate the latest science into our Nation's tobacco
control programs so that we can most effectively reduce death
and disease attributed to tobacco. I yield back.
Mr. Pallone. Thank you, Mr. Buyer.
Next is the gentleman from New York, a big fan of Major
League Baseball, from what I remember, Mr. Engel.
OPENING STATEMENT OF HON. ELIOT L. ENGEL, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW YORK
Mr. Engel. Well, thank you very much, Mr. Chairman, for
having this important hearing today to examine the prevalence
in use of smokeless tobacco products, the health effects from
use of these products and the correlation between smokeless
tobacco use by youth and Major League Baseball players.
It is fitting, Mr. Chairman, that we hold this hearing in
April as our Nation has once again embraced the start of a
baseball season. I represent the Bronx. I am from the Bronx,
and I grew up less than half a mile from Yankee Stadium, and I
love the Mets as well, so know how much joy the game can bring
for so many families including my own three children. I can't
even count how many games I have brought them to, and thank
you, Mr. Chairman, for remembering that I am a big baseball
fan. And these players rightly or wrongly are someone kids are
fascinated with for their athleticism and accomplishments for
the best of the best in baseball. Kids are like sponges soaking
up everything around them, and whether or not it seems subtle,
they pick up on one of the more unfortunate aspects of
baseball, which is the prevalent use of smokeless tobacco.
Today we have reports that up to a third of Major League
players report using this highly addictive drug. Smokeless
tobacco puts people at risk for oral cancer, gum disease, heart
attacks, cardiovascular disease and cancer. It also causes
leukoplakia, a disease of the mouth characterized by white
patches and oral lesions.
I want to commend Major League Baseball for trying to
proactively help our players and in turn the kids that look up
to them through their efforts. The 1993 minor league tobacco
policy has banned the use and possession of all tobacco
products by club personnel and by players in minor league
ballparks and during team travel as well. Major League Baseball
established the National Spit Tobacco Education Program, called
NSTEP, to curb the use of smokeless tobacco products through
public service announcements featuring popular players and
education and treatment programs for players, but there is a
major gap in MLB. While personnel are barred from smoking with
a uniform in view of spectators, they can still chew tobacco.
MLB has said that this policy is one that the players
association has sought to protect in collective bargaining. I
am concerned that the players association continues to contend
in their written testimony today that baseball players should
not be prohibited from using substances that are legal and
available to the general public. Mr. Prouty has even said that
it is impossible for most fans to tell if players are using
smokeless tobacco while playing baseball or in the dugout. I
have to say I am disappointed in this response. There have been
well documented instances of players on TV being clearly shown
to be using smokeless tobacco. In fact, in one World Series
game in 2004, at least 9 minutes of such footage was shown, so
kids do see it. And secondly, while smokeless tobacco may be
legal, there is a difference between players who want to use it
in the privacy of their own homes and when they are on TV being
paid very generous salaries to provide entertainment to
millions of families each night. Every workplace has rules
about what their employees can and cannot do. Such is a matter
of respect for the institution of Congress. We have to wear
suits and ties or other appropriate attire when on the floor of
the house. So therefore, it seems quite fair and reasonable
that players abstain from using smokeless tobacco on the field,
and I urge the players association to continue to consider
these facts.
I want to welcome Joe Garagiola, who is one of my personal
heroes, and the other people testifying today, and I thank you,
Mr. Chairman.
Mr. Pallone. Thank you, Mr. Engel.
Next is the gentleman from Georgia, Mr. Gingrey.
OPENING STATEMENT OF HON. PHIL GINGREY, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF GEORGIA
Mr. Gingrey. Mr. Chairman, thank you.
According to a 2007 CDC study, 20 percent of high school
students smoke cigarettes and 8 percent of them use smokeless
tobacco. While smokeless tobacco may not be as prevalent among
teenagers as cigarettes, it can be no less damaging to their
health. All forms of oral tobacco have chemicals known to cause
cancer of the mouth, pancreas and esophagus. Oral and smokeless
tobacco also cause many other health problems such as gum
disease, destruction of bone sockets around the teeth and
eventually tooth loss.
All of us here today have experienced the pain and the loss
that comes with the onset of cancer. The mother of one of my
staff, her name is Mrs. Margaret Horn, was diagnosed with
leukemia a year and a half ago. There are many like Margaret in
communities and cities across this country that will face
cancer in their lifetime. It is a deadly disease and one for
which a cure is long, long overdue. It is with this thought in
mind that I want to thank Chairman Pallone for his interest in
this subject. Even one death from cancer is one too many.
Today we understand the impact that advertising and
pictures can have on our youth. Early movie stars of the 20th
century made smoking so fashionable. I even remember seeing ads
in magazines like Look and Life where there would be physicians
in their white coats and the stethoscope in their pocket. They
kept in the pocket back in those days. They didn't drape it
around their neck. But they would have a cigarette in their
hand. It was just amazing, and I am sure all of you have seen
those ads.
And of course, there are some baseball players who will
always in part be remembered for the amount of tobacco that
they could stuff into their cheek. Like anyone up on stage,
heroes can be memorable for the big things and for the little
things they do. With any impressionable child comes a chance
that they could emulate their heroes. To deny it is to deny the
importance that our heroes have to us as adults looking back.
The number of people on both sides of the dais of the committee
members paying tribute to Joe Garagiola, I do the same. I
remember when I was a kid growing up, and I loved catchers. I
never played catcher but I loved to follow the career of Joe
Garagiola and Clint Courtney and of course Yogi Berra. So, you
know, we all look back on our heroes and look up to them. If
smokeless tobacco was not something readily associated with
baseball players, I don't believe that bubble gum today would
be sold in packages that resemble these tobacco pouches. When I
was a kid, that is not how you got bubble gum. So in short,
there is an obvious correlation between the two.
I do want to make one point in light of all the testimony
that we are going to hear today. I do not doubt that children
may look up to baseball players or movie stars. However, I
think it is fair to say that parents can and should be their
greatest heroes. There will be many things in life, many
choices that are our children will face, many influences they
will have to weigh. It is the parents who have the greatest
opportunity and ability to educate our children about things
not only tobacco but alcohol and drugs and a lot of bad
behavior. With this thought in mind, Mr. Chairman, I would like
to encourage this committee not to forget the role that an
informed and engaged parent can have on the health of their
children.
I look forward to hearing from both panels of witnesses.
Thank you so much for being with us today. I yield back.
Mr. Pallone. Thank you.
The gentlewoman from Colorado, Ms. DeGette.
OPENING STATEMENT OF HON. DIANA DEGETTE, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF COLORADO
Ms. DeGette. Thank you very much, Mr. Chairman.
I have to say, I completely agree with the gentleman from
Georgia about the role of parents, and that also is my view,
that parents need to have a strong oversight over their kids.
But also in addition to that, I think the gentleman will agree
with me on this too. Study after study has shown that
advertising influences for tobacco and tobacco products are
particularly strong among minors, and in the past in the many
hearings that this committee has had, we have seen the effects
of advertising by tobacco companies on minors. In fact, in my
home State of Colorado, the tobacco industry is spending $171
million per year, and they will say that they are not targeting
that at minors, but as we have seen in many hearings, much of
that advertising is accepted by minors.
I will also say, being the parent of two young daughters,
teenage and young adults, I see that we have to revisit these
issues with every generation. My older daughter, who is in
college now, tells me that she is seeing many of her friends
who are highly educated, intelligent young people smoking and
using smokeless tobacco because they think it is cool, and so
we have to revisit these issues generation after generation and
we have to make sure that the people who these kids look up to
are not using tobacco products with the assumption that they
are OK for the kids.
I am especially concerned about the smokeless tobacco
because in places like Colorado, kids now are told from an
early age that smoking can kill them, but in many areas the
kids turn toward smokeless tobacco because they are not getting
that same message, and so I really look forward to working with
Major League Baseball and with all of my colleagues on this
committee to make sure those same messages are getting out to
kids and to make sure that our role models for these kids
including baseball players are also giving that consistent
message.
My younger daughter, who is 16, is the biggest Colorado
Rockies fan who exists. Her whole room is filled with posters
of these players, and it is pretty cute to me because she is a
girl, but she loves these players, she looks up to them as her
peers and her friends and she goes to every game, so I want to
make sure she gets the right messages from them, just like I
want to make sure she gets the right messages from anybody else
who is appealing to the teen market.
Mr. Pallone. Thank you.
The gentlewoman from Tennessee, Ms. Blackburn.
OPENING STATEMENT OF HON. MARSHA BLACKBURN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF TENNESSEE
Mrs. Blackburn. Thank you, Mr. Chairman.
Welcome to all of our witnesses today. We are pleased that
you are here and we appreciate the time that you have taken to
prepare your testimony and be with us.
Mr. Chairman, I will have to tell you, I do find it a bit
perplexing that we are here once again to discuss youth tobacco
usage when I have offered my bill, H.R. 1423, as an amendment
in this committee not only this Congress but also last Congress
to address this very issue, and unfortunately that request has
fallen on deaf ears but we have had it here in committee and in
subcommittee and looked at this during the markups in the 110th
and the 111th Congress. H.R. 1432 is a good government piece
which focuses on strengthening existing programs to prevent
illegal tobacco use. The bill strengthens the existing work
that States and localities are doing to reduce underage access
to and use of tobacco products through the evolution of SINAR,
a current successful and effective program to lower teen
smoking. The legislation takes the next step in the evolution
towards protecting youth and informing the public regarding
tobacco products. Mr. Shimkus mentioned the use of the MSA
funds, and it would have required States to use at least 10
percent of those MSA funds on smoking cession and prevention
programs. In addition, it would require the States to enforce
their laws prohibiting the sale of tobacco products to minors
or risk losing 40 percent of their federal subsidies. So when
you say, those of you on the other side of the aisle say you
are not sure about what to do, let me tell you, we have some
things that have been offered and we should be doing them, and
I do feel that if the Democrat leadership was serious about
reducing youth tobacco usage, surely there would have been
thoughtful debate given to that legislation.
But yet we are going to blame Major League Baseball for the
ills of youth smokeless tobacco usage so let us be clear. If
the MLB wants to change its policy on smokeless tobacco, an
agreement will be reached between the MLB and the MLB players
association. As the former president of the Middle, Tennessee,
Lung Association, and as a grandmother with a 23-month-old who
gets up every single morning and says go outside, play
baseball, it is his favorite thing to do, I am very fully
aware, I am fully aware of the risk of youth usage of tobacco.
I just find it a little bit of grandstanding that you would
pass not only in the 111th Congress but also in the 110th
Congress to take action and at a time when we should be dealing
with a budget that the Democrat leadership does not want to
deal with and when we should be looking at the problems that
have already been found with the health care that passed, we
are here once again addressing this issue when the solution is
clearly in front of you. I yield back.
Mr. Pallone. Next is the gentlewoman from California, our
vice chair, Ms. Capps.
Mrs. Capps. Thank you, Chairman Pallone, for holding this
extremely important hearing. I wish to introduce for the record
two important statements from our non-governmental
organizations, one being Legacy and the other, the American
Association for Cancer Research, in support of this hearing.
[The information appears at the conclusion of the hearing.]
Mr. Pallone. Without objection, so ordered.
OPENING STATEMENT OF HON. LOIS CAPPS, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CALIFORNIA
Mrs. Capps. It is common knowledge that tobacco is
unhealthy, dangerous and deadly. While we as a Nation have
taken great steps to reduce tobacco use, especially cigarette
smoking, we should all be alarmed by recent studies showing an
increase in smokeless tobacco use among young people. In my
field of public health, I am especially concerned that
smokeless tobacco products are somehow seen as a safe
alternative to cigarettes. We know conclusively that tobacco is
an addictive substance in any of its forms. It causes numerous
types of cancer, gum disease, oral lesions and increases one's
risk of cardiovascular disease. What is worse is that some of
these health repercussions can occur within just a few years of
use.
Tobacco companies have a history of targeting their
marketing campaigns to children and youth, encouraging them to
start using their products at an early age. One particularly
effective strategy was to get celebrity baseball players to
endorse and use their products both on and off the field. We
continue to deal with the negative repercussions of this today.
I commend the work that baseball has done to curb the use
of smokeless tobacco. I salute you for that. In particular, the
ban on its use in the minor leagues was a bold step to improve
the health of both their players and the public. Despite these
efforts, Major League Baseball continues to be a venue where
smokeless tobacco usage is glamorized. At best, it is free
advertising for the tobacco industry. At worse, it is putting
the lives of America's children at risk.
On a personal note, I have seen how my own grandchildren
look up to athletes with such admiration. Children and
adolescents watch these games to see their heroes compete. They
try to mimic their throws and their swings. What else will they
copy? While I sincerely hope that children who look up to
baseball players can learn to filter out the negative messages
they are receiving about smokeless tobacco use, you know, they
really shouldn't have to do that. So I look forward to hearing
from our witnesses today and appreciate the fact that you are
here, and I yield back my time.
Mr. Pallone. Thank you, Ms. Capps.
The gentleman from Texas, our ranking member, Mr. Barton.
OPENING STATEMENT OF HON. JOE BARTON, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF TEXAS
Mr. Barton. Thank you, Chairman Pallone.
There is a famous poem about Casey at the bat that starts
out, and I am trying to quote it from memory, so if I miss it,
I apologize to those who know it by heart. But it says,
``Somewhere birds are singing, somewhere people shout but there
is no joy in Mudville, mighty Casey has struck out.'' This is a
hearing that appears to have struck before we have even started
it, Mr. Chairman, not that I don't like baseball, I love
baseball. I remember when Joe Garagiola was actually a catcher
for the Pittsburgh Pirates. That shows how far back I go. We
are glad to have him here. I am not a big fan of tobacco. I
have never smoked a tobacco cigarette. I have never used
smokeless tobacco. I don't allow smoking in my office. That has
been a policy since I got elected in 1985. So I am not an
apologist for the tobacco industry. I don't accept and never
have political action contributions from tobacco companies. But
I don't see the need, Mr. Chairman, on this particular hearing
the way it is structured. We have passed a law regulating
tobacco products. I didn't support that law. Under that, the
FDA has issued rules prohibiting the marketing of tobacco
products to people under the age of 18. Their rule has been put
on their Web site. It appears to me to be pretty explicit and
fairly exhaustive in its attempt to prevent tobacco products
getting to our youth. There may be a few Major League Baseball
players that are under the age of 18. I am not aware of any but
I guess it is technically possible. If a Major Leaguer wants to
use a tobacco product, he still has that right under our
Constitution to do so. If that product happens to be smokeless
tobacco, he has the right to use it, and so far as I know,
there is not a prohibition against a Major League Baseball
player being a sponsor or somehow a spokesperson or being used
in an advertising campaign for that product. Again, I am not
defending the product, but even under the new law, it is a
legal product.
So we are going to have a hearing today, Mr. Chairman,
where we appear to be trying to intimidate Major League
Baseball into prohibiting or discouraging their players from
engaging in either the use of these products or serving as
spokespersons and in some sort of advertising situation for
those products. I think that is a misuse of the subcommittee's
time, Mr. Chairman. I think time would be better spent if we
began to investigate and oversee this recent mammoth 3,000-page
health bill that is now the law of the land. I was given
yesterday a draft, a 55-page draft of the mandates and the
timelines in that bill that are now law. There are many
mandates that become effective date of enactment, which is
March 23, 2010, that are already not being honored by the Obama
Administration. I think our time would be better spent, Mr.
Chairman, if we began immediately to see what the pluses and
minuses are of the new health care law and spent less time
appearing to do a grandstand hearing simply because Opening Day
was a couple weeks ago and people are beginning to focus on the
diamond and what activities are going on in Major League
Baseball.
I do thank the witnesses for appearing. I know you are here
sincerely to express your position and that there are issues to
be addressed. I don't think it should the subject of a
Congressional hearing at this point in time.
With that, Mr. Chairman, I yield back.
[The prepared statement of Mr. Barton follows:]
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Mr. Pallone. The gentlewoman from the Virgin Islands, Ms.
Christensen.
OPENING STATEMENT OF HON. DONNA M. CHRISTENSEN, A
REPRESENTATIVE IN CONGRESS FROM THE VIRGIN ISLANDS
Mrs. Christensen. Thank you, Mr. Chairman.
When we passed the Family Smoking Prevention and Tobacco
Act, we did so to control and hopefully reduce all tobacco use,
so I want to thank you, Chairman Pallone and Ranking Member
Shimkus, for holding this hearing because we are seeing
companies trying to redirect their marketing to the smokeless
tobacco market and it is important to remind everyone that
smokeless tobacco is also addicting and has harmful effects
such as oral and throat cancer and increased risk for
esophageal, stomach and pancreatic cancers as well as heart
disease and stroke. So smokeless tobacco is by no means a safe
substitute for cigarettes. Therefore, the increasing use of
smokeless tobacco among anyone but especially today's youth is
quite troubling to me as a physician, a mother and a
grandmother of a 3-year-old who is now in tee ball.
The history of smokeless tobacco use in Major League
Baseball only exacerbates the problem in today's youth because
of the influence that athletes, celebrities and entertainers
have on them. However cool, exciting or glamorous these
athletes or celebrities may seem, there is nothing cool,
exciting or glamorous about the harmful effects caused by using
smokeless tobacco that could impair or cut short the potential
of a young person before they even get the chance to experience
all that life has to offer.
The bill we passed and the President signed will restrict
marketing and advertising of tobacco products near schools and
playgrounds beginning this summer as well as implement other
limitations, but that is not enough. We do appreciate the
actions that the minor leagues have taken and look forward to
stronger action from Major League Baseball and to working
together around this Act and any additional legislation or
initiatives that will work to reduce and prevent the use of
smokeless tobacco and all tobacco in today's youth.
We appreciate our witnesses being here. We would like to
welcome also especially Joe Garagiola and we look forward to
the testimonies. Thank you. I yield back.
Mr. Pallone. Thank you.
The gentleman from Utah, Mr. Matheson.
Mr. Matheson. Thanks, Mr. Chairman. I will waive my opening
statement.
Mr. Pallone. The gentlewoman from Illinois, Ms. Schakowsky.
OPENING STATEMENT OF HON. JANICE D. SCHAKOWSKY, A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS
Ms. Schakowsky. First of all, Mr. Chairman, I want to thank
you for holding this hearing. It is never a waste of time for
us to focus on health risks that are posed to our children and
to have a thorough discussion over what may be done either
within this Congress or outside of in order to make sure that
our children are protected.
We know that on March 31st President Obama signed the PACT
Act into law, and this new law is a huge step forward in our
fight against the underage use of tobacco products and was
built on decades of advocacy and public outreach, and I applaud
this victory but I know that we have much work ahead. Big
Tobacco is still finding its way into the lives of our youth. I
think everyone in this room knows that chewing tobacco is just
as dangerous as lighting a cigarette, and we have heard over
and over what those risks are, but we have also started to see
a resurgence in the use of these products among young people,
particularly among young men, and prevention is an ongoing
process, as my colleague, Congresswoman DeGette, said. Every
generation we always have to keep repeating this.
As I was preparing for this hearing, one of my wonderful
interns, Michael Cottler, told me stories about his college
baseball team. Half of his team used tobacco products. Most of
them would chew but not smoke, and according to him, the
players chewed during games, not off the field. His experience
tells me we still have work to do and that a big chunk of the
responsibility to stop use of tobacco products by underage kids
comes from the role models that they look up to. And every time
I watch a baseball player spit before stepping up to the bat, I
know there are young ballplayers who dream of becoming pros who
see those images too.
According to the Harvard study of public health, just one
World Series game in 2004 had over 9 minutes of free
advertising for the tobacco industry because of shots of
players chomping on chew. I mean, you know, sometimes it
surprises me that this is looked at as attractive in any way
but apparently to young men, it does look very cool and
authentic.
Smokeless tobacco is not a healthier substitute for
cigarettes. It destroys lives and kills just as effectively as
its smoked counterpart. There has been an incredible grassroots
effort to educate the public about the dangers of smoking and
we have seen a significant reduction in underage smoking
because of it. Without that same commitment, I worry that young
people like my intern's baseball team will see chewing as an OK
substitute for cigarettes.
I applaud the minor league tobacco policy which has taken
smokeless tobacco out of the clubhouses and ball fields of the
minor leagues. We are going to need that same type of
aggressive action at the major league level if we are going to
get tobacco products out of the game, and I yield back.
Mr. Pallone. Thank you.
The gentleman from Texas, Mr. Green.
OPENING STATEMENT OF HON. GENE GREEN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF TEXAS
Mr. Green. Thank you, Mr. Chairman, for holding the hearing
on smokeless tobacco and the impact on our Nation's children
and use in Major League Baseball.
Each year millions of teenagers use smokeless tobacco.
According to the CDC, 13.4 percent of U.S. high school boys and
2.3 percent of high school girls currently use smokeless
tobacco products. Youth prevalence data from the Centers for
Disease Control also shows that while cigarette smoking has
declined substantially in the last 10 years, smokeless tobacco
use has decreased only slightly over that period. The CDC found
that among high school boys, usage rates of smokeless tobacco
increased by 22 percent between 2003 and 2007. There is a
perception that smokeless tobacco is a safe product and we
should be clear that studies have found that smokeless tobacco
can contain as many as 28 different carcinogens and smokeless
tobacco causes oral cancer, gum disease, increased risk of
heart attack, cardiovascular disease and nicotine addiction.
The World Health Organization's International Agency for
Research on Cancer concluded that smokeless tobacco users have
an 80 percent higher risk of developing oral cancer and 60
percent higher risk of developing pancreatic and esophageal
cancer. Smokeless tobacco can be an alternative to smoking
cigarettes and may be perceived as safer than smoking
cigarettes but there are still significant health risks
associated with smokeless tobacco.
Today we are discussing the use of smokeless tobacco in
Major League Baseball and how that impacts our youth. Like my
colleagues, there is nothing more American than baseball. I am
a fan of the Houston Astros. I actually worked there. I had the
ideal job for a 7th grader. I could sell soda water and earn
$10 a night and see all the baseball I wanted. In fact, I
skipped school to be able to go to Opening Day when we had the
Colt 45, so I remember it very well. But we still have to
provide the leadership from the players. Major League Baseball
has banned cigarette use by major league players in uniform and
in view of the public, has been banned for over 3 decades.
However, there are no restrictions on the use of smokeless
tobacco. Steps have been taken to restrict smokeless tobacco
use by players in uniform in minor league baseball but these
measures have not been in place in the major leagues. We do
know that in 2003 approximately 36 percent of the baseball
players in the league reported using smokeless tobacco. These
players are idolized by our children and seen using smokeless
tobacco which certainly we do not want to encourage our youth
to begin using a harmful product because they see a sports hero
using it.
I look forward to the testimony of our witnesses, Mr.
Chairman, and I yield back my time.
Mr. Pallone. Thank you, Mr. Green.
Next is the gentleman from Georgia, Mr. Barrow.
Mr. Barrow. I thank the chairman. I will waive an opening.
Mr. Pallone. Thank you.
I think that everyone has had an opportunity to----
Mr. Shimkus. Mr. Chairman?
Mr. Pallone. Yes?
Mr. Shimkus. I ask unanimous consent that my statement be
submitted into the record. Would that go for everyone?
Mr. Pallone. Yes. Without objection, it ordered that every
member's statement in full will be submitted for the record.
Mr. Shimkus. Thank you.
Mr. Pallone. We are now going to turn to our witnesses, our
first panel. I want to welcome them. Let me introduce the two
of you. First is Dr. Terry Pechacek, who is associate director
for science for the Office on Smoking and Health within the
Centers for Disease Control and Prevention. And on my right is
Dr. Deborah Winn, who is deputy director for the Division of
Cancer Control and Population Sciences with the National Cancer
Institute. Thank you both for being here. You know the drill.
You have 5-minute openings that become part of the record, and
of course, if you like, you may in the discretion of the
committee submit additional statements in writing for inclusion
in the record.
We will start with Dr. Pechacek.
STATEMENTS OF TERRY PECHACEK, PH.D., ASSOCIATE DIRECTOR FOR
SCIENCE, OFFICE ON SMOKING AND HEALTH, CENTERS FOR DISEASE
CONTROL AND PREVENTION; AND DEBORAH WINN, PH.D., DEPUTY
DIRECTOR OF THE DIVISION OF CANCER CONTROL AND POPULATION
SCIENCES, NATIONAL CANCER INSTITUTE
STATEMENT OF TERRY PECHACEK
Mr. Pechacek. Mr. Chairman, Ranking Member and
distinguished members of the subcommittee, thank you for the
opportunity to participate in this hearing. My name is Dr.
Terry Pechacek and I am the associate director for science in
the Office of Smoking and Health at the Centers for Disease
Control and Prevention. Today I will provide an overview of
smokeless tobacco including health effects, trends and product
use, and use of smokeless products and their marketing.
I want to begin by emphasizing a very important point.
There is no safe form of tobacco use. Use of any tobacco
product is hazardous to health. The only proven way to reduce
the staggering toll that tobacco use takes on our society is to
prevent people from ever starting to use tobacco and to help
those who already use these products to quit as early in life
as possible.
What is smokeless tobacco? Smokeless tobacco products come
in two forms: chewing tobacco and snuff, or ground tobacco. In
recent years, a new generation of smokeless tobacco products
has entered the U.S. market. They include snus, a form of moist
snuff, and dissolvable products such as lozenges, sticks and
strips. The questions in national surveys that I will cite in
this testimony generally ask respondents about the use of
smokeless tobacco products without disaggregating information
by specific product types.
The scientific evidence clearly shows that using smokeless
tobacco products is hazardous to health. They contain at least
28 carcinogens and are known to cause oral, pancreatic and
esophageal cancer. Some studies have also linked smokeless
tobacco use to fatal heart attacks and certain adverse
productive outcomes during pregnancy. Like cigarettes,
smokeless tobacco contains nicotine and is highly addictive. As
individuals use smokeless tobacco over time, they typically
change products they use to get more nicotine. In doing so,
they may be increasing their exposure to carcinogens and other
toxic agents.
The National Survey on Drug Use and Health, or NSDUH, which
is conducted by the Health and Human Services' Substance Abuse
and Mental Health Service Administration, indicates that about
3.5 percent of persons in this country age 12 and older, or
approximately 7.8 million persons, used smokeless tobacco in
the past month. Men are more likely than women to use smokeless
products. In fact, the highest prevalence of smokeless tobacco
use in recent years has been among young adult men. Therefore,
this testimony will focus on recent trends related to this
population. The NSDUH survey reported a significant increase in
smokeless tobacco use among persons 12 years and older from 3
percent in 2004 to 3.5 percent in 2008. During these years,
patterns of use among persons 26 and older have remained
relatively stable at about 3 percent. Patterns of use among
adolescent girls have also remained stable at a very low level.
The observed increase primary comes from an increase among men
18 to 25 years of age, especially in two demographic groups.
Among non-Hispanic white men, rates increased from 13.6 percent
in 2003 to 15.4 percent in 2008. Among Hispanic men age 18 to
25, rates of smokeless tobacco use increased from 1.9 percent
to 3.4 percent during that same time. Recent data from
Monitoring the Future also confirms an increase among young
males with the rate increasing from 15.8 percent in 12th-grade
boys in 2008 up from 11 percent in 2007. Data from CDC's 2009
youth risk behavior survey, which will be released this summer,
also is showing significant increase in smokeless tobacco use
since 2003 among both male high school students overall and
non-Hispanic white high school students.
As with smoking, most smokeless tobacco use begins during
adolescence and young adulthood. Data from NSDUH shows that in
2002, about 950,000 Americans 12 years and older used smokeless
tobacco for the first time. By 2008, that number had increased
to 1.4 million. Almost half of those first-time users were
under 18 and almost three-fourths were male. Traditionally,
cigarette smokers and smokeless tobacco users have been fairly
distinct groups. However, several national surveys show that a
large proportion of smokeless tobacco users are also smoking
cigarettes. This pattern is most common among adolescents and
young adults than among older Americans. In fact, the data
indicates that two-thirds of males between 18 and 25 who use
smokeless tobacco also smoke cigarettes. These trends need to
be placed in the changing context of tobacco use in the United
States including lower smoking rates, increased restrictions in
smoking in public and increased social acceptability of
smoking.
Mr. Chairman, am I over my limit?
Mr. Pallone. You are, but you can wrap up if you like.
Mr. Pechacek. So the marketplace has been changing with the
promotion of tobacco products increasing from 200 million in
2005 to 300 million in 2006, and particular concern is that
many of these smokeless products are being marketed in ways to
satisfy and sustain their nicotine addictions when they are
settings that do not allow smoking.
So what is the public health harm? This dual use raises
potential concerns. More than half of adolescents and young
adults who are using smokeless tobacco also are smoking
cigarettes. I have submitted my written testimony, which
provides greater details on these important issues, but it is
important to emphasize that recent increases in smokeless
tobacco use by adolescent boys and young men as well as
increasing dual use of cigarettes and smokeless tobacco are
reasons for serious concern. Together these may portend a
leveling off or even reversal in the decline of smoking and the
perpetuation of nicotine dependence including high levels of
tobacco-related disease and death in this country.
Thank you for the opportunity to participate in this
hearing and I would be happy to accept questions.
[The prepared statement of Mr. Pechacek follows:]
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Mr. Pallone. Thank you, and thank you for being mindful of
the time. I appreciate it.
Dr. Winn.
STATEMENT OF DEBORAH WINN
Ms. Winn. Thank you. Good morning. I am Deborah Winn,
deputy director of the Division of Cancer Control and
Population Sciences, National Cancer Institute, National
Institutes of Health. Thank you, Chairman Pallone and
distinguished members of the committee for the opportunity to
be here to discuss smokeless tobacco and its health
consequences.
It is well established that the use of smokeless tobacco
causes cancer of the mouth and throat, esophagus and pancreas.
As far back as 1985, the Advisory Committee to the U.S. Surgeon
General examined literature on health consequences associated
with use of snuff and concluded that the evidence is strong
that the use of snuff can cause cancer in humans. The evidence
for causality is strongest for cancer of the oral cavity. The
excess risk of cancer of the cheek and gums may reach nearly 50
fold in long-term snuff users. Global health authorities have
also reached similar conclusions. The World Health
Organization's International Agency for Research on Cancer,
which I will call IARC, convenes expert panels to evaluate the
world's scientific literature on environmental agents to
determine whether those agents cause cancer. Those reports are
considered to be highly authoritative and are used extensively
worldwide to provide the scientific basis for public health
action. This group has evaluated the carcinogenicity of
smokeless tobacco three times over the past 25 years and I
served as a member of all three panels. In 2009, IARC concluded
that the use of smokeless tobacco causes cancer of the mouth,
throat, esophagus and pancreas. These findings were based on
international data from North America, Scandinavia and Asia,
among other places. Using smokeless tobacco is associated with
at least a fourfold increased risk of oral cancer.
Scientists have a fairly clear understanding of how
smokeless tobacco causes cancer. It contains carcinogens, the
most common of them being the tobacco-specific nitrosamines.
Cancer may develop when metabolites of nitrosamines attach to
DNA causing a genetic mutation. This mutation leads to other
cellular disruptions and ultimately results in cancer.
Nitrosamines are found in all tobacco products and are not safe
at any level.
In addition to cancer, smokeless tobacco users are more
likely than non-users to develop leukoplakia, or white patches
in the mouth that can lead to cancer. Other changes in the
lining of the mouth related to smokeless tobacco include
wrinkling of the inner cheek and gums and color changes. In the
1980s, a national survey of teens found that more than 25
percent of children who used smokeless tobacco have these
changes compared to less than 1 percent of children who did not
use smokeless tobacco.
Cancer and leukoplakia are not the only adverse health
effects linked to smokeless tobacco. It is also associated with
gum disease, dental caries and reproductive effects such as
decreased fetal growth, increased risk of preterm delivery and
stillbirth. Other serious effects may include increase risk of
heart attack and stroke. A recent summary of data regarding
this subject showed that smokeless tobacco increased the risk
of fatal heart attack by 13 percent and death from stroke by 40
percent. Although more research is needed to firmly establish
whether smokeless tobacco is a risk factor for heart attack and
stroke, these studies suggest that smokeless tobacco may lead
to serious health consequences other than cancer.
Smokeless tobacco should not be substituted for cigarettes.
A large study done by the American Cancer Society examined the
health impact of quitting cigarette smoking versus substituting
smokeless tobacco for cigarette smoking. It compared more than
110,000 cigarette smokers who quit smoking and did not use any
other tobacco products with 4,400 smokers who switched from
smoking cigarettes to using smokeless tobacco. After 20 years
of follow-up, the risk of dying was 8 percent higher among
those who switched to smokeless tobacco than among those who
quit tobacco use entirely. Those who switched from smoking to
smokeless also had a 46 percent higher risk of dying from lung
cancer, a 13 percent higher risk of coronary heart disease and
a 24 percent higher risk of death from stroke compared to those
who quit tobacco entirely. In another study, using both
smokeless tobacco and cigarettes had a higher risk of heart
attack than the risks of using either one or the other.
It is important that people understand that there is no
scientific evidence that using smokeless tobacco can help a
person quit smoking. It does not provide a safer alternative to
cigarettes. All tobacco products are harmful and cause cancer
and there is no safe level of tobacco use.
I want to switch to media findings. Research findings show
that when adolescents associate a particular behavior with
people or personality characteristics they admire, they are
more willing to try that behavior because adolescents identify
with such people. Baseball players like many athletes serve as
role models and are probably considered the quintessential
users of smokeless tobacco. There are high rates of smokeless
tobacco advertising in magazines such as Sports Illustrated.
Considerable research has demonstrated that smoking in movies
or on TV increases positive attitudes towards smoking and
intentions to smoke in update of tobacco use among adolescents.
There is also evidence that positive role models can help
prevent smoking onset. Several studies show that celebrity
health behavior such as Magic Johnson's announcement of his HIV
status or Katie Couric's televised colonoscopy on the Today
show have immediate positive impacts, so actions taken by
baseball players to discourage the use of smokeless tobacco
could also have positive impact on youth behaviors.
We focus today on smokeless tobacco. However, the
scientific evidence continues to confirm that tobacco use in
any form causes cancer. All tobacco products contain harmful
chemicals, and no matter how they are presented in
advertisements, be warned that all tobacco products are
dangerous. The only way to reduce death and disease caused by
tobacco use is to prevent youth from starting to smoke and to
help current smokers to quit. These must remain our highest
priorities, and I appreciate the opportunity to talk to you
today.
[The prepared statement of Ms. Winn follows:]
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Mr. Pallone. Thank you, Doctor.
We are going to now take questions, 5 minutes from those
who gave opening statements, and we have a few members who
passed so they get 8 minutes for questions, and I will start
with myself.
Both of your testimony indicates strongly that smokeless
tobacco causes cancer, and we have talked a lot about smoking
tobacco and the different chemicals that make up a cigarette
that cause cancer. Now, you started how it works with chewing
tobacco when there is no smoking relation and how that causes
cancer, but just explain it to me again because it wasn't too
clear to me. What is it that causes the cancer? And then you
specifically mentioned pancreatic which, you know, I often
mention pancreatic at our hearings because my mom passed away
from pancreatic cancer, and most people don't know, you know,
when you ask what is the cause of pancreatic cancer, generally
speaking, the answer is, we don't know, so if you would just
reiterate some of that.
Ms. Winn. Sure. I will start with pancreas cancer first,
and important causes of pancreatic cancer are smoking and
smokeless tobacco. Heavier weight is also associated with
pancreatic cancer risk but there is certainly a great deal more
than we need to learn regarding pancreatic cancer risk because
we know that it is often identified at an advanced stage.
With regard to how smokeless tobacco causes cancer,
tobacco-specific nitrosamines are--nitrosamines are a category
of carcinogens, and tobacco-specific nitrosamines are found
only in tobacco products, and tobacco products contain these.
They have been found in experimental animals to cause cancer.
We also have done experiments that show the progression from
metabolites of these nitrosamines, which attach to DNA that
causes a replication error in the DNA when the DNA----
Mr. Pallone. But in other words, you don't inhale it, so
how does it get into your system?
Ms. Winn. Because you are ingesting.
Mr. Pallone. Just through your stomach, in other words,
through your digestive system?
Ms. Winn. Right.
Mr. Pallone. And then, you know, we get these muddled
messages about substituting smokeless for tobacco for just
smoking. I mean, you have made it quite clear that you think
that they are both dangerous, but what about this idea that
somehow you can substitute smokeless and that somehow weans you
off actually using cigarettes?
Ms. Winn. There certainly are differences in risks between
smokeless tobacco and smoking. However, what counts is the
potential effect on the population of giving advice to
recommend using smokeless tobacco. We have to consider that
that type of a message may delay or halt some people from
quitting smoking who might have quit smoking through some other
means. We also know that smokeless tobacco is a gateway to
smoking among young children. For example, in one study of
adolescent boys, the boys who used smokeless tobacco and no
other tobacco product were three times more likely 4 years
later to be using----
Mr. Pallone. Because there are studies that show that the
perception of risk from smokeless tobacco is declining among
youth, so bottom line, they may figure well, I better not smoke
a cigarette but I will chew instead, and then they get
addicted. We can't give the impression out that somehow that is
OK because what you are saying is, it often leads to smoking
cigarettes.
Ms. Winn. Absolutely, and there are no safe levels, and
smokeless tobacco causes a variety of diseases.
Mr. Pallone. Let me ask Dr. Pechacek, your testimony
explains how the scientific evidence clearly shows that
smokeless tobacco is hazardous, that 28 carcinogens have been
identified in smokeless tobacco. They cause specific physical
feelings and effects, cardiovascular effects, fatal heart
attacks. I mean, it seems to me that this is totally contrary
to what a baseball player or any athlete would want to do, so
how does tobacco use specifically affect the performance of an
athlete, in particular a baseball player? Because young
athletes, if they are paying attention, it would seem to me
that it would hurt their athletic performance, not enhance it
in any way. So what is the message there in terms of what it
means if you are young and you start using this stuff?
Mr. Pechacek. Well, first of all, our advice to both major
league or youth baseball players is that like any other person,
anyone who is using any form of tobacco, we would encourage
them to quit as early in life as possible. It is especially
important for the baseball players who are setting an example
because like parents, teachers and coaches, they serve as role
models to children and adolescents.
With respect to the specific aspects on performance, I can
provide you more detail on that from the previous work that has
been done in the Surgeon General reports but the key point is
that all users, particularly young adolescents and young adults
who are following those role models, need to be aware that all
forms of tobacco are addictive and cause cancer and serious
health effects and that quitting all forms of tobacco use as
early in life as possible will be very beneficial to their
long-term health.
Mr. Pallone. But I think they almost get the impression,
young people, that somehow it enhances athletic performance and
clearly it is the opposite in terms of performance.
Mr. Pechacek. Well, the aspects of this and how youth
perceive the product have been reviewed in past Surgeon General
reports, most in detail in the 1994 Surgeon General report on
the impact of tobacco on youth and young people. We are
currently updating that report, which will be out next year,
and are going into how these current patterns of smokeless
tobacco are being perceived by youth and are impacting their
overall decisions about what they are doing with using all
tobacco products.
Mr. Pallone. Thank you.
The gentleman from Illinois.
Mr. Shimkus. Thank you, Mr. Chairman.
Dr. Pechacek and Dr. Winn, I am getting conflicting
briefing things. You are listed as doctors but in here it says
Ph.D.'s. Are you medical doctors that have Ph.D.'s, or what is
the title here?
Mr. Pechacek. Ph.D., so I am an epidemiologist.
Ms. Winn. I have a Ph.D. in epidemiology.
Mr. Shimkus. Great. Thank you.
Dr. Winn, we have had hearings, and I am new in the ranking
member position, on the NCI and we appreciate the great work
that the cancer institute does and we really are starting to
focus on cost-benefit analysis, where the money goes, biggest
return on investment versus the politicizing of some research
dollars, and we will get more involved in that in the future,
but what is the deputy director of the Division of Cancer
Control and Population Sciences? For the layman, what does that
mean?
Ms. Winn. That means that we are the division that is
responsible for understanding environmental exposures and
genetic factors that may be linked to cancer in human
population studies. We are responsible for the cancer registry
system. We are responsible for understanding the effects of
cancer on people's outcomes in terms of quality of life,
physical functioning after cancer. We are responsible for
understanding the access to cancer care, quality of cancer care
in the United States.
Mr. Shimkus. Thanks. I think that helps. But in this
hearing, we are focusing on Major League Baseball but there are
other environmental issues that we could probably address. I
don't want to get raked over the coals but I represent deep
southern Illinois, and of course NASCAR is well known for its
advertising. Country and western music--I think most people
identifying chewing tobacco use with the West and cowboy use
and all those. Have you done similar focuses on or has our
committee or are we just focusing on one area, Major League
Baseball, and not looking at other environmental impacts?
Ms. Winn. Most of the research that I presented was not
done in tobacco in baseball players. Virtually all of the
research that I have presented has either been in national
surveys of schoolchildren or other populations.
Mr. Shimkus. Great, and let me follow up with this, and
then I will go to Dr. Pechacek. In your testimony, you said any
tobacco use--I mean, my colleague, Mr. Buyer, is really on this
risk avoidance and mitigation stuff but your testimony says
that patches or nicotine gum is not any help in reducing
nicotine and tobacco use for anyone.
Ms. Winn. No, there are effective ways of quitting use of
tobacco.
Mr. Shimkus. That is fine. That is really I wanted to get
record of. What you stated, I thought that you--and I think a
lot of us would say, no, we want to encourage people to
eliminate nicotine input over time, and most people can't do
cold turkey. Some can't. But I think there are some risk
avoidance and mitigation-type stuff and I know my colleague
will follow up on that.
Dr. Pechacek, according to a December 2009 report from the
Campaign for Tobacco Free Kids, only one State currently funds
a tobacco prevention program at the level recommended by the
CDC. Do you agree with that assessment?
Mr. Pechacek. We are continuing to work with our States,
and it depends on what year. The most recent put out by the
Campaign for Tobacco Free Kids, their criteria found that only
one State met our guidelines for recommended funding.
Mr. Shimkus. And so our focus probably should be, if we are
serious about this, is calling in the States and asking them
why aren't they fully funding the tobacco cessation plans as
recommended by the CDC. Don't you think that would be another
good approach?
Mr. Pechacek. The CDC is very clearly on this
recommendations to the States and about what works and what
levels of investment would be most effective. We are in regular
dialog with our States about comprehensive State programs and
local tobacco programs that use the evidence-based approaches
that have been shown to be effective and to be reducing rates
of both youth and adult tobacco use.
Mr. Shimkus. Thank you. That goes to my opening statement
where I talk about the master settlement agreement, which would
be about $206 billion over 25 years that the tobacco companies
would pay. Don't you think it is pretty egregious that only 30
percent of that money has gone to health care and only 3.5
percent of those funds go to tobacco control like smoking
cessation and education programs?
Mr. Pechacek. CDC has been very consistent in providing
evidence both to policymakers and individual States and to the
other groups.
Mr. Shimkus. You are being very political, and I appreciate
that. My point is, the State attorneys general have a master
settlement agreement which should have brought billions of
dollars into States. The States have used that money to do
other things other than health care and education. You have
also testified that you have recommended to States that they do
an educational program, believing that an exponential decrease
in tobacco use by kids would occur if they would at least fully
fund tobacco cessation and educational programs. I think if you
go to the conclusion here, we have States who received billions
of dollars who have not funded health care, who have not done
cessation programs, and now to a point of we see an uptick in
at least chew tobacco increase by kids, which is another
example of us failing to do the job that we are asked to do and
in essence took money for, thus showing how inept we are at
doing the jobs we are asked to do by the public, and I yield
back my time.
Mr. Pallone. Thank you.
Ms. Eshoo.
Ms. Eshoo. Thank you.
Dr. Winn and Dr. Pechacek, can you tell us what CDC and the
National Cancer Institute have observed with regard to use of
smokeless tobacco by teenagers?
Mr. Pechacek. In my testimony, I reviewed the latest
evidence that multiple surveys have shown an increase in
smokeless tobacco use overall in youth populations. The data
that we are going to be releasing this summer is the National
Objective Youth Use Tobacco Survey showing an increase in
smokeless tobacco use among adolescent males, high school males
overall and white students.
Ms. Eshoo. And in the minority community?
Mr. Pechacek. The NSDUH survey has found that when it is
looking at the recent increases nationwide in smokeless tobacco
use over the last 4 to 5 years, that the greatest increases
have been in non-Hispanic white and Hispanic males. So while
there have been traditionally higher rates of use in some other
demographic groups, non-Hispanic white males and Hispanic males
are the ones who appear to be showing the greatest increases in
recent years.
Ms. Eshoo. Do you have any thoughts on what accounts for
these increases in smokeless tobacco use? I mean, obviously we
have representatives from baseball here today. I think that
everything that adults do from being a parent to obviously
anyone in sports is a--you know, they are the gladiators of the
20th and the 21st century. So they heavily influence young
people. I think we do as well. Congress isn't always known for
putting forward all of its best but certainly when there is
something that goes wrong here, by example of an individual
member, that says something to the people of our country and
obviously young people. So do you have anything that you want
to tell us about what you think accounts for these increases in
smokeless tobacco use?
Mr. Pechacek. Yes. As the comments that in my written
testimony which we submitted is that these recent upticks need
to be placed in the changing context of tobacco use in this
country. Smoking rates are down and restrictions on smoking in
public places are increasing, particularly in your State of
California. And overall we have observed that there is an
increasing social acceptability of smoking.
However, while these things are occurring, there have been
significant changes in the smokeless tobacco industry and how
smokeless tobacco products are marketed. Until 2006, smokeless
tobacco was largely produced by companies that did not
manufacture cigarettes. Now major cigarette manufacturing
companies produce and sell most smokeless tobacco products in
the United States. In recent years, these companies have been
marketing smokeless tobacco and snus named after their leading
cigarette brands. The advertising and promotional spending on
these types of moist snuff products increased by 50 percent
between 2005 and 2006, the latest year in which these data have
been reported. This timing is significant because it was at
this point in time that this transfer from the smokeless
tobacco manufacturers being independent of cigarette makers
started. Of particular concern is that many of these new
smokeless products are being marketed in a way for smokers to
satisfy and sustain their nicotine addiction when they are in
settings that they cannot smoke.
Additionally, to your point, while we do not have any new
and more detailed studies with respect to sources of influence,
the two largest groups where we are seeing the increase are in
non-Hispanic young men and in Hispanic men. Additionally, we
know from other data that----
Ms. Eshoo. Let me just ask you about that. It is a little
confusing. Non-Hispanic young men and Hispanic older men?
Mr. Pechacek. No, 18- to 25-year-old white and Hispanic. We
call it non-Hispanic white to separate it from Hispanic that
self-identify Hispanic. So both Hispanic and non-Hispanic young
men who are----
Ms. Eshoo. You know what? It is got to be a little simpler.
It sounds--I don't understand what you are saying. Let me put
it that way. Name the groups. Name them.
Mr. Pechacek. White and Hispanic young men 18 to 25 years
old.
Ms. Eshoo. Increase?
Mr. Pechacek. Are increasing more than anybody else.
Ms. Eshoo. All right. Well, I think that these are really
disturbing trends. I just leaned over and I said to my staffer
a little while ago, when it comes to baseball players, why
don't they just chew gum, I mean, if they feel like they need
to chew something, and she responded because they are addicted.
So clearly I think there is a nexus here. I don't think it has
everything to do with those that play baseball but on the other
hand, they are individuals that are really looked up to and
young people always want to look in the mirror and see the
reflection of their heroes. So I think that we need to work
hard to find a way to reverse these trends and make sure that
smokeless tobacco really--when you come back in succeeding
years, that we can claim that there is a huge decline. This
isn't something that is healthy.
Anyway, thank you very, very much for your testimony. Dr.
Winn, I am over my time so I don't know if you wanted to add
something to it, but maybe you can when someone else questions
you. Thank you very much.
Thank you, Mr. Chairman.
Mr. Pallone. Thank you.
The gentleman from Kentucky, Mr. Whitfield.
Mr. Whitfield. Thank you all for being with us today. I
think that Congress has given the regulators a lot of
opportunities to make great progress in this area. It is true,
Mr. Pechacek, isn't it, that on June 22, 2010, it will be
illegal to sell a smokeless tobacco product to anyone under the
age of 18? Is that correct?
Mr. Pechacek. Yes, that is my understanding of the bill,
yes.
Mr. Whitfield. Now, many of us were not aware of it but in
the stimulus bill, which certainly was about creating jobs,
there was $650 million set aside in there to address clinical
and community-based prevention and wellness strategies, and it
is my understanding that that money was given to HHS and CDC to
get this money out there. So my question would be, number one,
of that money, how much went for tobacco strategies in the
States or the local communities?
Mr. Pechacek. I don't have those detailed numbers. We would
be happy to provide those to you and your staff in this
committee.
Mr. Whitfield. When this money became available, did you in
your regulations set out how much money should be spent on
nutrition and how much money on tobacco, how much money on
obesity or anything like that?
Mr. Pechacek. Well, yes, we can provide you the details on
the funding announcement. The priorities were smoking
prevention and obesity----
Mr. Whitfield. You said a certain amount of money for each
one of those in your regulations?
Mr. Pechacek. There were funding guidelines that were put
out to the States and the actual numbers we can get you in
terms of how the breakdown on that----
Mr. Whitfield. How much money remains to be spent of that
$650 million?
Mr. Pechacek. The application awards I believe are
completed now and are available that we can make available to
you. I think it all has gone through funding announcements and
awards.
Mr. Whitfield. Well, how much money has already been sent
out?
Mr. Pechacek. I would have to get our administrative people
to give you the details on that since the--applications have
been reviewed. However, the process of actually getting the
money into States budgets, you know, is an administrative
function.
Mr. Whitfield. So you don't know how much is going to be
going out in grants and you don't know how much money has
already been distributed to States and local government under
this program?
Mr. Pechacek. With respect to that $650 million, all of
that money was put into funding announcements, so yes, all of
that is going out.
Mr. Whitfield. Well, you know, one of the things that--I
mean, this is a big problem obviously, smokeless tobacco and
its impact on health, but to put this money in the stimulus
bill, and then I read an article that in Washington, D.C., they
received $977,000 and created one full-time job, and what did
they do with that money? They bought BlackBerrys for people so
that they could be in touch with their smoking counselors. Now,
do you consider that a good utilization of the money?
Mr. Pechacek. I don't have any details on that specific
case. However, there is very specific guidance that is provided
in the funding announcement from CDC with regard to the most
efficacious, comprehensive strategies that have been shown to
be effective and cost-effective in reducing tobacco use.
Mr. Whitfield. Although we were not aware of it, in the
health bill itself that passed, in the first 5 years there is
over $5 billion set aside for a grant program to go out
addressing the so-called maps intervention for communities
program. Where are you all in developing the regulations for
that?
Mr. Pechacek. Well, first of all, a point of clarification,
CDC is not a regulatory agency. We are a public health agency.
With respect to----
Mr. Whitfield. Well, HHS, you know, where they are on it.
Mr. Pechacek. The specific aspects of that overall
program----
Mr. Whitfield. Will you be involved in distributing that
grant money? Will CDC be involved?
Mr. Pechacek. CDC has a role in working with HHS and the
White House with respect to guiding the evidence-based
interventions that have been found to be most effective.
Mr. Whitfield. Well, I know in your position, you are
involved with smoking and health. I want to ask one other
question. One of the guidelines that they put in the area of
nutrition in spending this money is urging communities, local
communities to reduce density of fast-food establishments. How
do you propose that that be done? How do you hope that will be
accomplished?
Mr. Pechacek. That is outside of my division. With respect
to issues of tobacco, I can give you more specifics, but we can
provide you feedback on what we are doing on density of fast-
food restaurants if you would like.
Mr. Whitfield. Thank you. I see my time has expired. Mr.
Chairman, if there is not an objection, I would just like to
insert for the record a publication of the National Convenience
Store Association going into some detail about the health
portion of the stimulus bill as well as the Washington Times
article about the BlackBerry.
[The information appears at the conclusion of the hearing.]
Mr. Pallone. Without objection, so ordered.
Mr. Engel.
Mr. Engel. Thank you, Mr. Chairman.
Dr. Winn, your testimony describes baseball players, and I
am quoting you, ``as the prototypical user of chewing
tobacco.'' You also note that, and again, I quote from your
written testimony, that ``adolescents engage in more risky
behaviors including tobacco use to the extent they endorse
positive prototypes of individuals who engage in those
behaviors.'' I know that Mr. Manfred from Major League Baseball
and Mr. Prouty from the Major League Baseball players' union
are in the audience for this testimony and we will hear from
them later, but I want them to hear your views on this matter,
so let me ask you this very simple question. When teenagers and
young adults see Major League Baseball players using smokeless
tobacco, does it make it more likely that these young people
will themselves become users?
Ms. Winn. That is likely based on evidence that shows that
peers and parents and other role models for children influence
their use of smokeless tobacco.
Mr. Engel. So it was an obvious question. I know that would
be your answer. So let me also ask another obvious question. Do
you believe that if Major League Baseball and the players'
union were to agree to ban the use of smokeless tobacco on the
field and in the dugout, would that result in a reduction in
smokeless tobacco use among teenagers?
Ms. Winn. Well, certainly the evidence from Katie Couric's
colonoscopy and Magic Johnson's HIV status definitely had a
positive impact on the U.S. public in terms of taking
preventive measures, so it seems likely by analogy that that
would have a positive effect on youth in the United States.
Mr. Engel. Thank you.
Dr. Pechacek, do you have any thoughts of the impact of the
use of chewing tobacco by Major League Baseball players?
Mr. Pechacek. The evidence that we have reviewed in the
1994 Surgeon General report as well as other documents since
then shows that professional athletes in certain sports
including baseball have traditionally had high levels of
smokeless tobacco use. Athletes serve as role models for youth
and smokeless tobacco manufacturers have used these imageries
in advertising testimonials by featuring athletes in sports to
make smokeless tobacco products appear attractive to youth.
Teens to mimic the behaviors of those who they look up to and
identify with including baseball players and athletes. While
smokeless tobacco use was prohibited in minor leagues in the
early 1990s, this policy has not been extended to major
leagues.
Mr. Engel. Thank you.
Dr. Winn, I have heard reports that in Sweden, significant
numbers of people are quitting smoking and using smokeless
tobacco and that the country's rates of lung cancers have gone
down. This
might seem to support the argument that smokeless tobacco is a
form of harm reduction. This argument rests on the idea about
the use of smokeless tobacco is good because the risks of death
and disease from using smokeless tobacco are less severe than
the risks of death and disease from using cigarettes. So I want
to ask you about that. Does that idea match up with reality? Is
smokeless tobacco really a form of harm reduction, especially
when we are talking about children who are not using any form
of tobacco? I think that this notion of harm reduction becomes
even more untenable in the case of young athletes in general.
My understanding is that young athletes are less likely than
the general population to smoke cigarettes but they are more
likely to use smokeless tobacco. I want to hear your thoughts
on that.
Ms. Winn. Well, I have reviewed the report, the Swedish
statistics, and I want to note that the claim that because the
rates of smokeless tobacco have gone up that that has
influenced the rates of smoking going down. Well, I want to
emphasize three fundamental facts. One is that all tobacco
products are hazardous and there is no safe level, and what we
need to do is prevent its use and help them quit. But with
regard to the Swedish situation, the Swedish National Institute
of Public Health found in their survey that of Swedish women
who use snuff, that is a relatively small portion of women in
Sweden use snuff, but smoking rates have dramatically declined
in Swedish women, indicating that snuff is actually not
responsible for the decline in smoking. There is a continuum of
risk associated with both smokeless tobacco and smoking but we
are most concerned about issues related to dual use of smoking
and smokeless tobacco and on smokeless tobacco as a gateway for
children.
Mr. Engel. So in the case of young athletes who don't smoke
cigarettes but use smokeless tobacco because they see Major
League Baseball players using it, would it be fair to say that
smokeless tobacco use significantly increase their health
risks?
Ms. Winn. Yes. It increases their risk of oral lesions in
their mouth and many oral lesions have the potential to develop
oral cancer.
Mr. Engel. Thank you.
Thank you, Mr. Chairman.
Mr. Pallone. Thank you.
The gentleman from Indiana, Mr. Buyer.
Mr. Buyer. Thank you, Mr. Chairman.
Dr. Winn, I am trying to reconcile a couple of comments.
You acknowledge that there is a continuum of risk within
tobacco products, smoking to smokeless, pharmaceutical and
quitting, a continuum of risk. You acknowledge that, correct?
Ms. Winn. There is a continuum of risk associated with----
Mr. Buyer. From very high risk to very low risk. You
acknowledge that?
Ms. Winn. Quantitating it at the higher load, they all have
risks.
Mr. Buyer. You acknowledge that there is a continuum of
risk from very high risk to very minimal risk. Do you
acknowledge?
Ms. Winn. Very high risk to moderate risk.
Mr. Buyer. To moderate risk, so if I can say in proving
science that there is a product on the market that would remove
99 percent of the nitrosamines, you would define the 1 percent
as moderate?
Ms. Winn. All smokeless tobaccos have some risk of health
effects.
Mr. Buyer. That is correct. I concur with that. Now, let me
go back and acknowledge this, and let us not play games. Do you
acknowledge that there is a continuum of risk from very high
risk to very low risk?
Ms. Winn. Of specific----
Mr. Buyer. The health effects and the use of tobacco
products.
Ms. Winn. Some tobacco, for example, chronic obstructive
pulmonary disease is not caused by smoking tobacco.
Mr. Buyer. I am not going to quibble with you, because it
appears that if you won't even acknowledge that there is a
continuum of risk, then you are placing yourself in a camp of
complete abstinence. Now, I will concur with you that tobacco
products are not healthy. I concur with that. But to ignore
that there is a continuum of risk from very high risk, cigars,
to very low risk, which would be a product--let me ask you this
question. If you able to put a product on the market that
reduces the nitrosamines, does that improve the chances of
one's, or does that eliminate then health risks?
Ms. Winn. What causes us concern under those circumstances
is the population effect that might be influenced by people
smoking and adopting smokeless tobacco----
Mr. Buyer. Do you acknowledge that if I can reduce the
nitrosamines in a product that I can reduce the risk?
Ms. Winn. There is no epidemiologic evidence that shows
that that is the case. It is important that nitrosamine levels
be reduced.
Mr. Buyer. So are you saying to me then that an orb or a
stick that has reduced 99 percent of the nitrosamines is just
as harmful as smoking a cigar? That is what your statement is
saying.
Ms. Winn. Yes.
Mr. Buyer. And you concur with that?
Ms. Winn. Assessing nitrosamine levels or reduced
nitrosamine products is under the purview of FDA so I would----
Mr. Buyer. All right. Great. Your staff just gave you that
so you could read it. But just answer the specific question.
Ms. Winn. We don't know that there is any--there is no
level of nitrosamines that is known to be safe.
Mr. Buyer. Wow. So you are unwilling to recognize
differentials of risk within tobacco products? I guess that is
what I am hearing from you. You do not acknowledge that there
is a differential of risks among tobacco products?
Ms. Winn. There is a continuum of risk.
Mr. Buyer. Thank you. We got there, didn't we? We got
there. There is a continuum of risk. Now, why is that
important? It is important because as a country, those of whom
are the advocates of an abstinence approach are locking us in
to a system of failure. If we only have up to 7 or 8 percent of
whom want to quit, that is failure in my eyes. And so if we can
actually migrate a population from smoking to smokeless to
eventually quitting, that is important. Now, no one wants our
teens or adolescents or youth or you name it to gain access to
these products. So I concur with you on that point.
Mr. Chairman, I respect you because you are open to many
different distillations of thought and I believe in personal
cultivation, I believe in the scholarship maintenance of our
knowledge. It improves our self-worth and it is our quest for a
greater understanding and ration and reason and tolerance to
ameliorate. I am going to offer some differing views and I
would like to offer them for the record. So what I would like
to offer for unanimous consent to be placed into the record,
first is a report called a Broken Promise to Our Children. It
is an 11-year analysis of how the States are not spending the
MSA settlement on tobacco prevention. I ask unanimous consent
this be placed into the record.
Mr. Pallone. Can I just ask, are some of these things going
to be part of the printed record or can we just do them--how
does it work? It looks like it is pretty extensive. We can? OK.
Mr. Pallone. Without objection, so ordered.
Mr. Buyer. I would also ask unanimous consent that the
Strategic Dialog on Tobacco Harm Reduction: A Vision and
Blueprint for Action in the United States by Mitch Zeller and
Dorothy Hatsukami also be entered into the record.
Mr. Pallone. Can I look at that? Go ahead. Why don't you
continue?
Mr. Buyer. I would also ask unanimous consent that the
Smoke-Free Tobacco and Nicotine Products Reducing the Risk of
Tobacco-Related Diseases and by Scott Ballin be entered into
the record.
And last, I would unanimous consent--not last. I would ask
unanimous consent that the brief report on evidence against a
gateway from smokeless tobacco use to smoking by Dr. Brad Badu
also be entered into the record.
Mr. Pallone. I am just taking a minute here because I
noticed they are pretty extensive and I just want to make
sure--OK. Is that everything?
Mr. Buyer. Yes.
[The information appears at the conclusion of the hearing.]
Mr. Pallone. Without objection, so ordered.
Mr. Buyer. Thank you.
Mr. Pallone. Next is our vice chair, Ms. Capps.
Mrs. Capps. Thank you, Mr. Chairman.
I want to thank our witnesses for their excellent
testimony. I particularly want to thank the second panel for
your patience in waiting through this first one, which is our
process here in this subcommittee.
I have a question for each of you and I am going to start
with Dr. Pechacek. I was particularly alarmed by your statement
during your testimony that the perceived risk of harm from
smokeless tobacco has decreased, actually decreased among
teenagers. You know, we have taken such, I think, quite
significant steps through enactment of recent health reform
legislation to invest in greater wellness and prevention
strategies as a whole. We have this opportunity with some of
these new parts of the reform legislation. I would like you to
give us some advice of what strategies we could
take in our local communities through our health clinics
expansion and so forth to reverse this very alarming trend.
Mr. Pechacek. Comprehensive State and local tobacco control
programs that we have defined in our multiple CDC documents
give evidence-based approaches that have been shown to be
effective in reducing tobacco use overall as well as smokeless
tobacco. These approaches change environmental cues in ways
that make tobacco use in any form less acceptable and quitting
easier. These types of programs include educational strategies
as well as public policy changes that send a clear message to
youth that smokeless tobacco along with all product use are
dangerous to their health. On a concrete level, CDC has been
communicating a clear message that there is no safe form of
tobacco use and that any tobacco product is hazardous to
health. For example, the CDC has recommended since the mid-
1990s that schools implement 100 percent tobacco-free policies
that eliminate all tobacco products by faculty, staff and
students including smokeless tobacco on school grounds, at
school events including sporting events. CDC is closely
monitoring trends in the smokeless tobacco use and how
different marketing campaigns are impacting youth and providing
this information to our States so they can more effectively
provide informational campaigns that can turn around this
negative trend.
Yes, we are concerned about this downturn in perceived risk
which is in 8th, 10th and 12th graders with the largest drop in
10th graders. This indicator has been a very reliable leading
indicator of this type of question, not only for smokeless
tobacco but for cigarettes, alcohol, marijuana and other
behaviors. Therefore, this downturn does indicate reason for
concern.
Mrs. Capps. Thank you. I have a feeling our second panel is
going to elaborate on some of the specific ways that we can
really get this message across at such a key age group and
their habits of course will impact their health for a lifetime.
I appreciate that from the CDC.
Now, a question for you, Dr. Winn. During our committee's
debate on giving the FDA authority to regulate tobacco
products, some of our colleagues were advocating policies
promoting this so-called lower risk of tobacco products. I
think you heard some of that voiced today as well. In your
testimony, you clearly outline that transitioning from
cigarettes to smokeless tobacco actually contributes to more
negative health outcomes in many cases, and just for the
record, I would like to have you elaborate a bit more on this
strategy because this is a myth that keeps rearing its head,
and doesn't it make more sense to provide comprehensive
education about all tobacco kind of in line with what Dr.
Pechacek was saying to include information about why it is all
dangerous and how to be empowered to resist and reject it?
Ms. Winn. Right. Certainly the evidence to date, and it is
a growing literature, indicates that using both behaviors
increases risk of several chronic diseases, and that is a great
concern that we have with regard to some of the trends in youth
using both products together. This is a very concerning trend
that we have. Is there an additional specific question?
Mrs. Capps. No. Well, I think you are highlighting the
goals for having comprehensive education. In other words, if
you are talking about stopping smoking of cigarettes or never
starting with young people, you want to also make sure that
they don't see an alternative. It all has to be presented at
one time. Otherwise they are going to fall prey because the
targeting of advertising, and we have seen this with cigarettes
as well, is so insidious with young people, the targeting of
just the right images using athletes, which is understandable.
They are heroes. My grandkids look up to them. If they even see
them without even saying a word chewing, that will be in their
subconscious to be tempted to try, so I appreciate that very
much.
Thank you. I yield back.
Mr. Pallone. Thank you.
The gentlewoman from Tennessee, Ms. Blackburn.
Mrs. Blackburn. Thank you, Mr. Chairman. I appreciate that.
I have got just a couple of questions that I want to direct
to the two of you together, and again, thank you for your
patience for this morning. The CDC's youth risk behavior survey
measures smokeless tobacco among high school students. That is
correct, right?
Mr. Pechacek. Yes, 9th through 12th graders.
Mrs. Blackburn. OK, and it also publishes data for
individual States and a number of major cities, and as we were
getting ready for the hearing, I looked at the data that was
there for several Major League Baseball cities including
Baltimore, Boston, Chicago, Detroit, Houston, L.A., Miami,
Milwaukee, New York, Philadelphia, San Diego, San Francisco and
Washington, D.C. I wish that Nashville or Memphis was included
in that list but it is not, but we will talk about that another
day. So given the topic of this hearing and what we were going
to be discussing and looking at your survey, I found something
very interesting. Every single one of those major league
cities, every one of them, every single one of them, believe it
or not, had a teenage smokeless tobacco rate that was below the
national average, and I found that so interesting. The major
league cities have a smokeless tobacco rate that is below the
national average. And the same is true when you go back and you
look at the previous CDC surveys, which are published every 2
years. It was true in 2007, it was true in 2005, it was true in
2003, it was true in 2001. You know what? There is not one
single exception, not one. Every single Major League Baseball
city in every single year where the CDC survey measured, it was
lower than the national average. So if baseball players are
having such a dramatic impact on teenage smokeless tobacco use,
why would evidence of this impact only occur in places where
there is no Major League Baseball team? I want to know if there
was any finding in your work that would shed some light on
that, and I would love to hear from both of you on that.
Mr. Pechacek. Thank you for your question. Yes, there is
evidence that will help explain that.
Mrs. Blackburn. Wonderful. Elaborate.
Mr. Pechacek. First of all, rates of smokeless tobacco use
traditionally have been higher in more rural and other parts of
the country. We can provide you more detail on the geographic
breakdown. Additionally, the rates of smokeless tobacco use
among African American populations is much lower than overall
in other demographic groups. So those two factors alone just by
the demographics of the major cities that you have mentioned
result in a differential.
When we are looking at the influence of any factor, what we
are looking at is the exposure. One of the main things that we
have to be aware of in the exposure is the primary exposure is
not necessarily attending the baseball games but watching them
on the media so that the geographic distribution of the imagery
exposure is quite different than the location of the stadium.
Now, we do not have any published studies with respect to
number of minutes watching Major League Baseball and its impact
but the data that has been done will show that it is the youth
that are paying attention to baseball that may be at the
greatest risk.
Mrs. Blackburn. OK. So let me ask you this. Looking also at
your surveys, you see that the use went down from 11.5 in 1993
to 7.9 in 2007 and from 20.4 among teenage boys the smokeless
tobacco rate has dropped from 24.4 in 1993 to 13.4 in '07. So
what factors have been working so well in recent years? What is
it that is being done in recent years that is causing young
people to choose not to use smokeless tobacco? Is it education?
Is it parents? Is it outreach? Was it the tobacco settlement
agreement? What do you think has helped to spur that kind of
drop in usage?
Mr. Pechacek. First of all, the types of programs that work
for smokeless tobacco are very similar to those that work for
preventing all tobacco use, cigarettes and other forms. What we
have found is that the comprehensive types of programs that
focus on public policy change such as smoke-free environments
and other types of things that are sending a clear message that
all tobacco use is harmful is reaching youth. The programs in
the mass media are particularly effective that are providing
broad messages about the risk of tobacco use such as the legacy
media type of campaign as well as the State-specific campaigns.
All of those types of things are effective in preventing
cigarette use and smokeless tobacco use. One of the things that
is of concern is that while we have been seeing a decline in
both cigarettes and smokeless tobacco use through about 2005,
the data that will be published this summer from the youth risk
behavior shows a reversal of those trends that you were citing,
and then when you look at all the data points including the
2009 data point that will be released this summer, that the
rates of smokeless tobacco use among high school males has
reversed and is now increasing with the point of deflection or
the statistical point of change being 2003. So for a number of
years the pattern in multiple surveys is showing an increase of
smokeless tobacco use among youth in general, particularly
males, particularly white and Hispanic males.
Mrs. Blackburn. Thank you very much. I am over my time. I
will yield back. Thank you, Mr. Chairman.
Mr. Pallone. Thank you.
The gentleman from Maryland, Mr. Sarbanes.
Mr. Sarbanes. Thank you, Mr. Chairman. I have a couple of
sort of random questions here.
Just following up on the surveys, the cities that my
colleague mentioned where the rate of smokeless tobacco use is
lower than the national average, is it however the case that if
you looked at the use among the two populations you cited in
Hispanic youth and non-Hispanic white youth that in those
cities you would find evidence of this trend of an increase
even if it wasn't carrying a statistic above the national
average?
Mr. Pechacek. The individual data will be released this
summer with respect to all of the locations including the
national data. What we are seeing in the overall pattern is
yes, across the Nation in non-Hispanic white and Hispanic youth
we are seeing the uptick. This uptick has been going on for
several years now. With respect to patterns in specific
communities, we have not had those levels of analyses yet but
we certainly are willing to look into that.
Mr. Sarbanes. So it is at least possible that even though
the increase hasn't taken the statistic above the national
average in some of those places cited that the fact that there
is an increase could be connected to the use by role models
such as Major League Baseball players.
A lot of the discussion is focusing on Major League
Baseball, you know, responsibility to implement restrictions on
the use of smokeless tobacco because of the role model status
that the players have. This isn't really a question, it is just
kind of an observation, and I guess the second panel is in a
position to speak to this better. I would just think that the
owners and team management and the league itself would be
interested, given the kind of investments they make in their
players financially and otherwise to put these kinds of
limitations, regardless of the impact it is having on youth or
other members of the public, given the litany of effects that
you have been able to describe today in terms of how harmful it
can be and how quickly the conditions that it causes can
develop. That is the other thing that is striking when you look
at the testimony that you have presented, so I just want to
introduce that theme here that it is not simply about the
example that is being set that ought to cause us to call upon
Major League Baseball. I would just imagine that as a matter of
good practice and good business management on the part of the
league and the owners that they would want to institute this.
It has been done at the minor league level so somebody has
figured out that it is not a great thing because it is not the
role model aspect of the minor league baseball players that led
to that ban being put in place. It must have been some other
consideration like the health of the players. So I just don't
understand why that wouldn't apply to the major league players.
Let me ask you, is the restriction on advertising on
television and so forth that applies to smoking tobacco, does
that apply as well to smokeless tobacco?
Mr. Pechacek. The new FDA legislation signed last year
extends the restrictions more completely to smokeless tobacco.
Mr. Sarbanes. OK. So when you think about--I mean, I was
reading some of the testimony, one World Series game somebody
calculated there was 9 minutes of tobacco use that would have
been viewed by someone who watched the whole game on the part
of the players. That is like a giant loophole, isn't it, in
terms of being able to distribute this kind of imagery over the
airwaves? Is it fair to characterize it that way?
Mr. Pechacek. I believe our next panel is going to go into
that in more detail, but in general as we have reviewed in
recent Surgeon General reports from 1994 on, those types of
imageries do reach youth and do have an impact.
Mr. Sarbanes. And more sinister, arguably, because it is
more kind of just woven into the fabric of what they are seeing
than a full-force advertisement might be.
Thank you, and I yield back my time.
Mr. Pallone. Thank you, Mr. Sarbanes.
I guess that concludes our questions for the first panel,
but we do want to thank you, and you may get questions from us,
written questions, within the next 10 days that we will ask you
to get back to us as soon as you can, so thank you very much.
If I could ask the second panel to come forward and see
where your nametags are there. Take your seats and we will
proceed. Let me introduce each of you. First on my left is
Gruen Von Behrens, who is from Stewardson, Illinois. Thank you
for being here. And then we have Robert D. Manfred, Jr., who is
executive vice president of labor relations and human resources
for Major League Baseball. And then we have David Prouty, who
is chief labor counsel for Major League Baseball Players
Association. And then the famous, it says here Joseph Henry,
but Joe Garagiola, Jr., who is a Major League Baseball
announcer and a former Major League Baseball player. And then
finally is Gregory Connolly, who is a professor of the practice
of public health at Harvard University. I again thank all of
you for being here today. Try to keep the comments to 5
minutes. Your statement becomes part of the record. Of course,
you can submit additional written statements or comments if you
will after you leave here today.
So I will start with Mr. Von Behrens. I hope I am
pronouncing that correctly.
STATEMENTS OF GRUEN VON BEHRENS, STEWARDSON, ILLINOIS; ROBERT
D. MANFRED, JR., EXECUTIVE VICE PRESIDENT, LABOR RELATIONS AND
HUMAN RESOURCES, MAJOR LEAGUE BASEBALL; DAVID PROUTY, J.D.,
CHIEF LABOR COUNSEL, MAJOR LEAGUE BASEBALL PLAYERS ASSOCIATION;
JOSEPH HENRY ``JOE'' GARAGIOLA, SR., MAJOR LEAGUE BASEBALL
ANNOUNCER, FORMER MAJOR LEAGUE BASEBALL PLAYER; AND GREGORY
CONNOLLY, M.P.H., D.M.D., PROFESSOR OF THE PRACTICE OF PUBLIC
HEALTH, HARVARD UNIVERSITY
STATEMENT OF GRUEN VON BEHRENS
Mr. Von Behrens. That is correct, and thank you for
allowing me to be here today. I appreciate the opportunity and
I really hope that this message I bring to you will make you
all a lot smarter on about what tobacco can do to you.
My name is Gruen Von Behrens and I am a national
spokesperson here today on behalf of Oral Health America and
NSTEP and also myself. I travel throughout the United States as
a motivational speaker to youth about the dangers of tobacco
use. I have currently been in 46 of the 50 States of America,
every province of Canada and spoke to over 2 million kids
across North America about this topic. I work with different
collegiate and minor league athletic programs. I work with
different media across the United States. So I have a lot to
say when it comes to this topic.
Now, first things first. I always apologize to my viewers
because I understand I can be kind of hard to understand. I
have had 34 surgeries to my mouth and to my neck to get rid of
the cancer I had. And not everything I say always comes out the
way I want it to, so I apologize to the panel.
Nobody tells me that I have to do this. I didn't get in
trouble in my home State of Illinois and they are like, all
right, Gruen, for your punishment, you have to go out in
public, show people your face and tell them that tobacco did
that to you. That is not the reason I do this. I don't do this
as an authority figure as somebody who is going to preach to
anybody for using a tobacco product because me as an ex-tobacco
user realizes how powerful the addiction is on its victims. I
am not out there knocking cigarettes out of people's hands and
I am not knocking two hands out of their back pockets. I want
people to have a fair choice with their life. I want my viewers
to be able to look at my face and to my words and my story,
understand what I have been through so they can make an
educated and thoughtful choice for themselves about whether or
not they want to take up this position or not.
I come from a very small town in the Midwest, 750 people
in my hometown, and that is counting farm animals and small
dogs so it is a very rural area, and as a part of the culture
of our area, we use tobacco. My grandfather used tobacco. My
uncle used tobacco. Why do these two men who loved me dearly
and helped bring me up offer me a product that could hurt me
this bad? So I was very naive that this could happen to me. And
I hope that by traveling around the country and educating youth
about the dangers of tobacco, not only youth but parents,
certain forms of government, all different forms. You know, we
are sitting here with Major League Baseball and I think it is
great to be part of baseball. I think that as a baseball player
growing up, and I idolized the people I was watching on TV and
that led a small part to my tobacco use but not to the main
reason why I used tobacco. Across the United States there is a
culture out there where people pick up these habits at a very
young age because just being naive to what this product can do
to you. The amount of kids and people that I see victimized by
this drug is phenomenal. You know, I see 8-year-old kids using
spit tobacco. I see mothers wiping their babies' gums with spit
tobacco wrapped in a nylon stocking to cure a toothache. I see
10-, 11- and 12-year-old kids coming up to me after my
presentation and handing me their chew and saying I don't want
to use this no more because I didn't know that that could do
that to me.
As I said, I really appreciate the opportunity to be here
today. I hope that this message brought to America can educate
them about the dangers of tobacco. I see our government
sometimes almost telling us that spit tobacco is a safer
alternative to cigarettes, and numerous States, they raised the
taxation on cigarette sales but they will not raise the
taxation on tobacco sales. So as a whole, is that them telling
us that this is a safer alternative when I know it is not?
Every bit of spit tobacco that somebody puts in their lip, into
their oral cavity has the same cancer-causing ingredients in it
as three to five cigarettes smoked. So they are hurting their
oral cavity. This is as bad as whether they would be if they
ingested a cigarette. And then we talk about harm reduction.
Harm reduction. I laugh at the face of harm reduction, guys.
You get lung cancer, you get oral cancer. What is the
difference? You have still got cancer. You still have a very
deadly disease that you have to fight for your life to fix.
I stared using tobacco at the age of 13. At 17 I was
diagnosed with a full-blown oral cancer. So often people come
up to me and say oh, Gruen, spit tobacco only hurts the person
using it. I wish each and every one of you in here who are
interested, seriously interested in this cause, to have been
with me the day that my mom found out I was sick, the day my
mom sat in that doctor's office with me and bawled her eyes out
because her son had been diagnosed with this disease because of
trickery and misconception that this thing was a safe thing to
do, and the impact that had on my mother--I mean, I had people
come up and say to me that it only affects the person using it.
That is not right. It affects everybody in the community. It
affects each and every one of us. People are getting sick from
this. As the government, do what it takes to fix this problem.
I don't care if it baseball. I don't care if it with health
care. Mr. Barton says this isn't a very important thing, we
ought to worry about health care. I think we are worrying about
health care, guys. We are starting on this level. All right?
Let us make it this level.
Thank you for your time. I appreciate the opportunity to be
here.
[The prepared statement of Mr. Von Behrens follows:]
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Mr. Pallone. Thank you, and let me thank you also. I didn't
realize how often you go around and how many States and how
much you have become a spokesman for this, and we really
appreciate that. Thank you.
Mr. Manfred.
STATEMENT OF ROBERT D. MANFRED, JR.
Mr. Manfred. Chairman Pallone and members of the committee,
thank you for the opportunity to be here to address our shared
commitment to the reduction of the use of smokeless tobacco
products. I would like briefly to review Major League
Baseball's past and ongoing efforts to reduce or eliminate the
use of such products by players, as well as the legal framework
within which Major League Baseball's efforts have been
undertaken.
For almost 2 decades, Major League Baseball has worked on
multiple fronts to reduce the use of smokeless tobacco products
and educate members of the baseball community accordingly. The
centerpiece of our effort is the Minor League Tobacco Policy,
which was issued by Commissioner Selig in 1993. That policy
bans the use and possession of all tobacco products by club
personnel, including players, n minor league ballparks and
during team travel. We believe that our efforts at the minor
league level are crucial because players must learn at an early
age to avoid these product. The minor league policy is
displayed in all minor league clubhouses, and each minor league
player contract requires the player to represent that he is
aware of the policy and agrees to its provisions. To ensure
compliance with the policy, Major League Baseball's resident
security agents conduct roughly 100 random security inspections
of minor league ballparks annually. Players and field managers
who violate the policy are subject to game ejection and incur
substantial monetary penalties.
Major League Baseball has also administered a formal policy
regarding tobacco products at the major league level for well
over a decade. Pursuant to the major league policy, clubs may
not permit the distribution of tobacco products in major league
clubhouses. The major league policy likewise encourages clubs
not to permit club personnel, clubhouse attendants and the
like, to buy tobacco products on behalf of players.
I should also point out that club personnel are barred from
smoking when in uniform in view of spectators, and contrary to
a suggestion that was made in the earlier panel, our athletes
are not allowed to participate in tobacco advertising while in
uniform, and I am not aware of a single major league player who
endorses tobacco products publicly.
Our efforts to reduce the use of tobacco products extend
beyond formal disciplinary measures and into education and
treatment. To that end, the minor league policy encourages
field managers to hold tobacco education meetings with their
clubs and waives fines for first-time offenders who complete
cessation counseling programs that are provided by the club's
employee assistance professionals. Major League Baseball has
also collaborated extensively with its partners to raise public
awareness.
In 1994, Major League Baseball helped establish the
National Spit Tobacco Education Program to curb the use of
smokeless tobacco products. Major League Baseball has provided
NSTEP and its partners with over $100 million in cash
contributions, television exposures and other support to
conduct public service activities and announcements, which
featured players including stars like Hank Aaron and Derek
Jeter.
Within the baseball community, NSTEP has served major and
minor league players via numerous education and treatment
options. These options include oral examinations, brush
biopsies, educational seminars, cessation programs and training
for club employee assistance professionals. Through 2003, Major
League Baseball, at times on conjunction with the Major League
Baseball Players Association, sponsored NSTEP programs with the
assistance of grants from not-for-profit organizations
including the Robert Wood Johnson Foundation. Clubs continue to
administer oral examinations and smokeless tobacco education
programs as part of their annual spring training activities.
Highmark Blue Cross Blue Shield, the insurance provider for
minor league players, also conducts an annual spring training
presentation for players that addresses tobacco cessation
options.
Largely because of these efforts, the use of smokeless
tobacco products has declined substantially in baseball over
the last 2 decades. Commissioner Selig nevertheless remains
committed to exploring additional opportunities in conjunction
with the Safety and Health AdvisoryCommittee, a joint committee
of baseball and the MLBPA. Last November, at Commissioner
Selig's urging, the committee hosted a presentation on
smokeless tobacco use prevention by Dr. Ashok Shaha, a head and
neck surgery specialist from Memorial Sloan-Kettering Cancer
Center. During the 2010 season, the Commissioner's Office will
be surveying players to develop other educational and treatment
programs.
As we carry these initiatives forward, however, it is
important for the Committee to bear in mind the legal framework
that applies to smokeless tobacco. Like drug testing, the
regulation of player use of tobacco products is a mandatory
subject of collective bargaining. But unlike performance-
enhancing substances, smokeless tobacco products are legal in
all 50 States and for sale to and consumption by adults. And
even the most ardent critics of smokeless tobacco use as a
public health matter would argue that it compromises the
competitive integrity of our game in a manner analogous to
performance-enhancing substances. While an outright ban on the
use of smokeless tobacco in the major leagues is a laudable
goal, it will have to be pursued against the backdrop of these
legal realities.
I thank you for your time.
[The prepared statement of Mr. Manfred follows:]
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Mr. Pallone. Thank you, Mr. Manfred.
Mr. Prouty.
STATEMENT OF DAVID PROUTY
Mr. Prouty. Thank you. Chairman Pallone and members of the
committee, thank you for the opportunity to testify today. My
name is David Prouty. I am the chief labor counsel for the
Major League Baseball Players Association. I won't repeat
verbatim my written testimony but I just want to make a few
points based on the testimony and also what we have heard
today.
First, no one disputes the health risks of smokeless
tobacco. You have heard the medical evidence today. You will
hear more. And you have heard the compelling testimony of Mr.
Von Behrens. The players association completely agrees that
smokeless tobacco poses a huge health problem for this country.
Second, and it is for that reason that the players
association has long discouraged its members from using
smokeless tobacco. We have participated in educational programs
to alert the players and the public to its dangers. For
players, we have run educational seminars and offered medical
screenings in spring training. We have participated in the
NSTEP program that Mr. Manfred referred to, to offer cessation
workshops. We have worked with Mr. Garagiola, in fact brought
him to address a meeting of our executive board to talk about
this topic.
For the public, we have worked again through NSTEP on
various outreach programs including the taping of a series of
public service announcements involving prominent players
including Derek Jeter, Hank Aaron and also Jeff Bagwell and
Alex Rodriguez.
We have also embarked on a new program with the Partnership
for a Drug Free America called Healthy Competition, which is
focused on helping parents and children make smart decisions
regarding health and nutrition. The players want to help kids
choose what to do, not just tell them what not to do. Through
this program, we hope to educate young people, both athletes
and non-athletes, to make smart choices when it comes to
fitness, supplements, drugs, alcohol and tobacco, including
smokeless tobacco.
Third, the obvious question, why isn't smokeless tobacco
banned in baseball? Remember that smokeless tobacco is a legal
product available for all adults to purchase everywhere in the
United States but we can and we will educate players as to why
they should not use it. There is a tension here because many
players do not think they should be banned from using a product
which Congress has so far deemed to be legal. If Congress were
to ban smokeless tobacco, the players association would not
object and might even support such a measure. Would the players
association agree to ban smokeless tobacco in baseball as part
of our next round collective bargaining negotiations? Well, we
are a union. We pride ourselves on having a democratic
structure and a democratic process, much like this Congress. It
is up to the players, the members of this union, to decide what
issues they want to bring to the table. I can guarantee you
that I will bring back to the players the concerns that have
been raised here today, and I am sure more will be raised, back
to the membership of the union and that this issue will get a
full airing. That is how a union works and that is how
collective bargaining works.
Lastly, since this is the Health Subcommittee, I want to
raise with you another health hazard that affects our members
and the public at large, and that is the issue of dietary
supplements. Simply put, the existing regulatory scheme is not
working. There are many quality products on the market but
there are also many that contain dangerous ingredients that
aren't labeled as such. In fact, the Food and Drug
Administration just released a list of over 100 dietary
supplements that can be bought over the counter that contain
performance-enhancing substances which are banned under
baseball's drug-testing program. Our members have suffered the
consequences by testing positive and receiving suspensions as a
result of ingesting these products that contain such unlabeled
substances. We realize this may be a politically sensitive
issue for some on this committee, but without your help,
millions of Americans, young and old, athletes and non-
athletes, will continue to be at risk from taking supplements
that contain steroids, pharmaceuticals and other dangerous
substances. We hope that you will give this issue as well the
attention that it deserves.
Thank you for your time. I will be happy to answer any
questions at the conclusion.
[The prepared statement of Mr. Prouty follows:]
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Mr. Pallone. Thank you.
Mr. Garagiola.
STATEMENT OF JOSEPH HENRY ``JOE'' GARAGIOLA, SR.
Mr. Garagiola. Thank you, Chairman and the committee and--
--
Mr. Pallone. I think your mic, you have to bring it closer
and--there we go.
Mr. Garagiola. I have never been around a microphone
before. I don't know what to do. I just holler.
You are not going to hear a bunch of numbers from me, and
don't start the clock yet because I have got all kind of notes
here on my papers. These guys come with typewritten sheets and
all that, but I made some notes are listening to this. Six
hundred and fifty million dollars, when we started out with--
and I hate to hear that word ``smokeless.'' That belongs to the
tobacco companies. I could use a word that would get me kicked
out of a game when I hear that, but I will not. I watched 60
Minutes like you did and it was scary.
Let me just throw a few things out. In 1993--and I keep
hearing numbers and it is true. In 1993, 21 percent of the
players in the World Series used tobacco, spit tobacco. That is
what I call it, spit tobacco. That is what it is. In 2000, 7
years later, it was zero. Why was that? I was in the trenches
with a bunch of guys who went with me, and I called the
producers. I said why do you guys stay on that shot, get off
that shot. I called the guys who--the presidents of the
networks. Lenny Dykstra, who was the poster boy, just to give
you a story, I went up to him and I said Lenny, why do you use
that garbage, what did they give you? Did they give you any
money? He said no, I have to have it. Why do you have to it? I
just have to have it. And I said just tell me you won't use it
during the World Series. I will talk to my guys at CBS and we
will make an impact. No, I can't do that. Lenny Dykstra has
quit using it, guys, because he ran into a problem. So I don't
know about numbers and all that kind of stuff but I just want
you to know that that is where it got started.
Six hundred and fifty million dollars--when I was with
NSTEP, I made speeches across this country. I will never forget
going into Connecticut with the attorney general, and that is
when the tobacco company, they were going to use it as a safe
alternative to cigarettes. Oh, come on. Give me a break. I am
not going to go through all this. I am just going to tell you
some of the things that I have learned.
In my day, we called it chew. I chewed. Why did I chew?
Because the others players chewed. I thought it was part of
baseball, and that is what it is all about. I mean, the things
that you do because the other guys do it. They used to give us
salt tablets. Salt tablets, they used to give us. I think they
were trying to kill us is what I thought they were trying to
do. But it has improved so much, and now, I got so much I want
to say I am choking on myself.
Like many other players, I thought being a major league
player, you had to chew. You watch those guys, Lon Warnicke,
who I grew up with, that kind of--I chewed until my daughter
came home from school one day and said Daddy, are you going to
die? I said sweetheart, sure I am going to die, we are all
going to have to die. She said I mean are you going to die. I
said yes, but not now. I am not looking forward to it. And she
said no, and she had that look in her eyes. And I said
sweetheart, why are you asking me? And she said because we're
studying about tobacco and we are studying about lungs and they
said if you use tobacco you are going to die. I stopped. I
stopped. I wish you guys could walk with me on a field because
I have been called everything from a Nazi anti-tobacco chew
zealot. I mean, come on. This is what these ballplayers do. I
mean, forget the numbers and all that. Get in the trenches and
watch them. And with the minor leaguers, baseball has done a
great job, and baseball is taking a beating here. They really
have, and I am sitting next to the guy that I wanted to romance
here, put some Chapstick on and get him to do the job. But to
me, in my 20 years of working to spread the word about the
dangers of smokeless tobacco, many of my friends, Jack Crowl, a
coach, he lost half his tongue like my friend Gruen. I have a
tape here, and I am all over the place I know. I am going to
tell you about this tape. This is Gruen Von Behrens' tape, and
if any of the people on the committee would like to have a
copy, we will get it to you. I will get it to you. The
Diamondbacks paid for this. We didn't have any of that 650
million. There is a booklet that Bud Selig, the commissioner,
gave out to people, and I mean, it is nothing but little
cartoons that kids can see. Here is one. It is easy to quit
smoking cigarettes, you just take them out of your mouth. No,
Daddy, let us make him a nonsmoker--he is working on a
snowman--he will last longer. I mean, I was begging everybody
to help us, and they did. But I lost Jack Crowl, lost part of
his tongue, couldn't talk, and in a year he was dead. Bill
Tuttle--Bill Tuttle died one piece at a time. Bob Leslie, a
high school coach--and I never asked anybody to make a tape or
a DVD. Bob Leslie called and he said Amy and I, we want to make
a tape, and we went out there and made this tape, and I will
never forget when Bob Leslie died, I spoke at his funeral, and
here was Amy right where that chair is, the second chair,
holding a baby, and I said to myself, in her 20s, holding a
baby that can't even stand up by himself or walk, she should be
enjoying it, and instead of being a mother and a wife, she is a
widow. She hadn't even seen 30 years old. They all died too
soon.
That lit the fire, guys. I want to tell you, that lit the
fire, and that is why I agreed--in 1994, that is how long I
have been going out there--and I never got paid a nickel. Never
got paid a nickel. I didn't want to get paid. If they wanted to
hear my speech, they had to pay my flight there, and I am going
to tell you, sitting in the middle seat sucks. That is not in
the script, by the way. But anyhow, I agreed to chair the
National Spit Tobacco Education Program, and we had some money
from the Robert Wood Johnson Foundation. I worked with them and
now I haven't heard from anybody. It is almost like I got
leprosy.
Anyhow, I lobbied Major League Baseball to ban the
distribution of tobacco products in major league clubhouses, a
rule that is still in effect, and I am going to tell how that
started. Rob knows it. I went to the Diamondbacks and I said to
them, you guys hired the clubhouse guy, tell him he can't put
that tobacco there and don't let the tobacco companies give you
free tobacco, and kind of looked at me and he said what do you
mean. I mean clean it out, let them stop, make it inconvenient
to buy the tobacco, which they did, and that was good. But you
know what? When the kid comes up from the minor leagues, he
knows he shouldn't use it but I see it. The first thing they
know, they don't even pick the bat first, they throw a chew in
their mouth. We have to educate, educate, educate, and
Commissioner Selig is behind it 100 percent.
Hey, U.S. tobacco, if you look at it, they don't call
themselves a U.S. tobacco company anymore, they are a U.S.
smokeless tobacco company. Now, if that isn't a subtle
commercial, I don't know what is.
I have letters from Commissioner Selig and Donald Fehr both
who are backing what I am doing. Why can't baseball and the
players association right here get together and ban it? Take it
off the field. I think it was Mr. Waxman who said something
about we don't see a player going out there with a cigarette in
his hand. I know where he got that line, when I testified
before his committee. I mean, Arnold Palmer used to play golf,
walk on the green, flip a cigarette and putt, but we don't have
that in baseball. Tobacco is tobacco is tobacco. Get together.
The players association, baseball, get together, guys, ban
tobacco and anyone who uses it is penalized. I don't care if it
is a suspension. I don't care if it is fines or what. Get it
out of our game. It is a great game, greatest game going. I
have heard all kinds of things about it.
I almost forgot the most important thing. We have a club in
Arizona that I went to the Diamondbacks and I said you know,
why don't we let the kids in free. I wanted to call it Let's
Kick Their Cans, and this is what Bill Keane did for me. We
call it the No Chew Crew, and they get a red tee shirt with No
Crew Chew and they sign a pledge that they are not going to use
tobacco. Well, you don't know if they are going to use it or
not but they are going to be aware of it, but they get into the
game free if they come chaperoned.
This is Gruen Von Behrens' tape. We got this in every
school in Phoenix, Arizona. How I would love to see that in
every school in Arizona, the whole State.
Spit tobacco. I would like the players--and boy, do I get
it from them--who are role models, and I don't care what
anybody says, whether they agree, Charles Barkley
notwithstanding, they are role models. I want them to quit
carrying a can of dip in their uniform pockets and especially
where the youngsters see them. I just had an incident last
Saturday. I did a broadcast. I am just getting out of surgery.
I had three major surgeries. I didn't work at all last year and
I was in the hospital all of 2009, but when I got this
invitation, that is how important this is to me. I was in the
Diamondback clubhouse and one of the players, I don't want to
name him, he is sitting there with a laptop and he is dipping.
I go around the corner and they got a kitchen now. We never had
a kitchen. If you had a bologna sandwich, you were lucky. These
guys sit there and watch Days of Our Lives or whatever instead
of taking batting practice and then they wonder why they can't
hit and they are going to be broadcasters. I saw him using that
stuff. I said why are you using it now? Oh, it feels good.
Until they find something. I can name players. Curt Schilling,
we took him in for a brush biopsy that Rob was talking about.
He came out, he was as white as this towel because they found a
lesion and he had to have it biopsied. Curt Schilling, who
pitched in the World Series, I don't know if he's using again.
He may or may not. But it is a deadly, addictive habit, and it
is an uphill battle, this spit tobacco, and I am going to tell
you why. Nobody has mentioned it, but I will.
I have made speeches before the firefighters, police
officers, anyone who works with the public, they can't smoke.
They can't smoke. So what do they do? They use spit tobacco.
And when I told them about it and the reaction that I got was
tremendous, and they start early because the tobacco companies
advertise to them at a very early age. These companies mislead
you. You want to talk about advertising? Here is a catalog that
they put out, OK? I know you have got a bunch of books there,
Chairman. I will give you this if you want it. In fact, one of
them got me mad. Brad Roudeaux--Brad Roudeaux is from the
University of Alabama Birmingham. He is on the payroll of the
tobacco companies. So if you want to burn it, you can burn it.
You have my permission. Here is a catalog of gifts. Here is a
pool table. Do you know how many lids you need to get this pool
table? Ten thousand lids. You use 10,000 cans of tobacco, you
would have cancer of the feet. And, you know, they talk about
cowboys and westerns and all that. They do that.
We were at a NASCAR--one of the people here talked about
NASCAR. I went there and we put a sign up there, smokeless does
not mean harmless. They came and said that it was insulting to
them. I said insulting? I can't believe it. They made us take
it down.
It is not a safe alternative to cigarettes. Fewer people
die from it. That is the song of the tobacco companies. You
know what it is like? And this is what I said to the attorney
general in Connecticut. It is like saying don't jump out at the
50th floor, what are you nuts? Jump out of the 30th floor. You
got 20 floors on your side. The result is going to be the same.
It is a dangerous, deadly habit and baseball can't solve the
problem by itself. We need help. The players association--
Commissioner Selig encourages everything that I do. Donald
Fehr, he is gone now, right?
Mr. Prouty. Still around but he is retired.
Mr. Garagiola. But you are here.
Mr. Prouty. I am here.
Mr. Garagiola. OK. You go back with this message.
Let me just say this. We need truth in advertising. That is
important. I can't think of the Congressman's name, he was from
California. He called me and he said he is going to have a
press conference in California and could I get a ballplayer
because he wants to have stronger words on the can, and I
wasn't too smooth with him and I said is this a photo op or do
you really mean. He said no, I am really going to do it, and I
said what are you going to do. He said make a stronger message
black print, big print. I said OK. We came out there. A kid
named Mike Watson from Denver, he is a firefighter now, kid was
on a Friday, he quit. Monday he went back to using it. And, you
know, what can I tell you? Smokeless does not mean harmless.
I don't know what my time is but I am very emotional about
this----
Mr. Pallone. Your time is up but we appreciate the fact
that you----
Mr. Garagiola. Thank you very much.
[The prepared statement of Mr. Garagiola follows:]
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Mr. Pallone. No, I appreciate that you spent so many years
dealing with this and trying to make a difference, and I know
you are making a difference, so thanks a lot, really. I
appreciate it.
We will go to Dr. Connolly.
STATEMENT OF GREGORY CONNOLLY
Mr. Connolly. Thank you very much. It is really hard
playing cleanup witness to Joe Garagiola, believe me.
I did have the opportunity to testify 25 years ago before
Mr. Waxman on this very issue, and I think the only difference
I can see is that at the time Mr. Waxman had no hair and I did
have hair.
I am a dentist. I teach at Harvard. I had the opportunity
to work with Major League Baseball Players Association for
spring training and conducted surveys on why they used the
product, also did examinations of the oral cavities.
I just want to go through with what the players risk. If I
represented a union, I would be concerned with the health of my
union members. The Teamsters put efforts into protecting the
health of their union members and I think other unions in the
United States of America should worry about their union
members.
[Slide shown.]
But just turning over here, if you take the dip out you see
something called leukoplakia. This is a grade III, and I used
to have a game with the Blue Jays, I can guess how many dips
you use a week game. Just by looking at these lesions, you can
identify is it one can, two cans, three cans, four cans. And I
remember one player said I beat you, doc. I said one can. I
said look over here. It was two cans here and two cans here.
The University of San Francisco screened 52 players and found
two precancerous lesions in those white lesions, and those are
precursors to cancer. They are present in about 50 percent of
the players. The players tell me they want to stop, they can't
because they are addicted and they are doing it in spite of a
known health problem.
[Slide shown.]
This is another famous baseball player who spent literally
$10,000 to treat another condition. This is where the nicotine
and the ingredients get in and destroy the bone tissue. He had
to have grafting, and unfortunately midlevel of the season he
is back using again. Next slide, please.
[Slide shown.]
This is use rates. We monitor use rates over time, and we
see about one-third of the players use it, minor leaguers less,
maybe because of the ban with minor leaguers. I am really not
sure. But this really hasn't changed. So we are still seeing
players at risk of developing disease not during their careers
in baseball but most likely later in baseball. And I think you
have to protect the health of the players. That is the basic
element here. Next set of slides, please.
[Slide shown.]
So then we also look at reasons why the players use it, and
I asked them. We did a survey among 556 players and the
respondents who were heavier users primarily used reasons for
addiction. It was for, ``I was hooked,'' ``I was treating
relaxation, withdrawal.'' Not one player said I used it to
enhance my performance. Players are not proud of using this,
and that is the reality. They wish they didn't start as Little
Leaguers or as high school ballplayers or as minor league
ballplayers. Next slide, please.
[Slide shown.]
We estimated use over time, and it has been about 9 minutes
of game use from 1987, 1986 to 2004. It hasn't changed. What
has changed is the use now is being concentrated by a handful
of players. It is only one or two. The vast majority of
baseball players do not want to be bad role models, and the
only way one is going to deal with those one or two players,
and I can just look at--you know, we banned advertising through
the MSA. We banned it through the FDA Act. But all you have to
do is pick up the front of Sports Illustrated, and fortunately
this guy is wearing a Dodgers uniform and not a Red Sox
uniform, to see what type of advertising reaches kids across
America. I told the Jays, I said, you know, based on the use
you used just in the World Series, that equals the salary of
the entire club, and you guys are deemed to be greedy by
Americans. The one guy got up and said I am going to call my
agent. And it is spreading. This is Facebook. We are seeing
dozens and dozens of groups on Facebook with high schoolers
extolling the virtues of using smokeless tobacco products, and
it is all related to Major League Baseball players. We see two
groups on steroids, one opposed and one saying maybe it is OK,
but we are seeing widespread use of adding a drug, nicotine, to
users. Next slide, please.
[Slide shown.]
You know, when we take an oath as health professionals, we
take an oath to do no harm. That is called the Hippocratic
Oath. It is not an oath to do less harm. I want to make that
perfectly clear. We take an oath to do no harm. We have
medications called Nicorette that are outselling these newer
products 1,000 to one. They are being used effectively. They
are approved by the FDA. They increase quit rates. They double
quit rates and they don't have cancer-causing chemicals in
them. We have tens of thousands of baseball fields across this
Nation and it is banned on virtually every one except 30 yet
those 30 fields are the most important fields to the health of
American children, only those 30. You can't dip in high school.
We got NCAA to stop it. Major League Baseball stepped to the
plate and stopped it, and we have a problem right now in
America. We have a problem in America, and that is protecting
the health of the union and letting the members do what they
want to do and not be victimized by one or two players who
think somehow it is glamorous to throw it in your mouth and
look like who knows what.
I want to thank you very much for giving me the time to
testify, and the last time I was with Joe was at the Red Sox
game where he announced the whole gang to me and my son. It was
a wonderful experience. Thank you, Mr. Chairman.
Mr. Garagiola. No spit tobacco, either.
[The prepared statement of Mr. Connolly follows:]
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Mr. Pallone. Thank you, Dr. Connolly.
We are going to take questions from the members and I am
going to start with myself.
I am not trying to be difficult in any way, Mr. Prouty, but
you took a lot of time to explain that the smokeless tobacco
was essentially banned in minor leagues but you said in major
league it is not and you cited the fact that basically it is
legal and so why should we be pressured or whatever, I guess,
to ban it. But it is obvious that you ban a lot of other
things. I guess players aren't allowed to open a beer or mix
themselves an alcoholic drink in the dugout, and also you
banned the smoking of cigarettes, or Major League Baseball has
banned the smoking of cigarettes in uniform in view of the
public. I mean, cigarettes are legal, alcohol is legal. What is
the difference? Why is it so important to continue the use of
smokeless tobacco but not these other things? Why is it any
different?
Mr. Prouty. Well, Congressman, first of all, let me say
that there is a difference between cigarette smoking and
smokeless tobacco insofar as smoking affects the game. You
can't smoke while you are playing. Cigarette smoking also has
secondhand effects on other players. But I don't think we are
here today to defend smokeless tobacco. What we are saying is
that it is a legal product and it is legal in the United States
for use. If you want to go about banning it, Congress should go
about banning it.
Mr. Pallone. No, I understand that, but I guess what I am
saying is that is just seems strange to me. I guess when you
negotiate a collective bargaining agreement, why is there not
an effort to say pursuant to the collective bargaining
agreement that smokeless tobacco would be banned as well? I
guess I am asking from the point of view of the players as well
as from the point of view of the union. It doesn't make sense
to me that you would have a lot of--that you wouldn't press to
do the same thing. Is this coming from the players? Are they
demanding that it not be prohibited? What is the reason?
Mr. Prouty. Well, you know, in any organization, there are
varying views. We have people who are all for using smokeless
tobacco. We have people who are against it. We have a round of
collective bargaining negotiations coming up. We can only look
forward on this. We are just beginning to formulate our
proposals on all kinds of issue. I am not the union. We
represent the players. The players will get together and decide
what issues to bring to bargaining. Mr. Manfred's side will get
together and decide what issues they want to bring to
bargaining. As he said, smokeless tobacco is a mandatory issue
so if either side brings it up, we have got to talk about it.
We hear what you are saying. We will take the concerns of
everyone here back to the players. It is for the players to
make a decision about what to go ahead and bring to the
bargaining table, but rest assured, I will make sure based on
the hearing today that they hear what you are saying.
Mr. Pallone. I appreciate that. And then I wanted to ask
Mr. Von Behrens, and again, I appreciate your being here today.
When you said that you reached over 2 million kids in the
course of your speeches and presentations, that is really
amazing. But I wanted to go back. You mentioned when you first
started using tobacco. How much did your decision to start and
use correlate with your passion for baseball, which actually
you have, and do you think if you had known more about the
health effects when you were a young person you still would
have used it?
Mr. Von Behrens. You know, I tell kids every day that if
somebody like myself would have came and spoke to their school
or my school whenever I was a young man, there is no way I
would be sitting in front of you guys here today because I
would have made an educated choice and I would have stopped
using. This would have scared me enough into not using these
products. You know, baseball had, like I said, marginal effects
of why I used tobacco, guys. We are sitting here today and we
are talking about baseball and spit tobacco, baseball and spit
tobacco, and yes, I believe that they should not be able to use
it on the field. It is like smoking a cigarette on the field. I
am not going to get into that because that is not the type of
person that I am.
But there are so many other things that we are overlooking.
I am a competitive bass fisherman. I fish all over the Midwest.
There are boats out there selling ads. They are boats
advertising Longhorn tobacco. The guy who got second place in
the Bassmasters last year fished out of a boat sponsored by
Longhorn tobacco products. So there are so many other forms and
there is a lot more of these types of people out there than
there are potential baseball players. There is more hunters,
there is more fisherman, there is more farmers, kids, people
who aren't really that associated with baseball that are being
affected by the advertisements and the ploy that tobacco is a
safer alternative to cigarettes.
Mr. Pallone. But you are convinced that if we had more
education and awareness, a lot of these young people would not
start using it?
Mr. Von Behrens. Definitely. You know, it irritates me when
we talk about education because there is so many budgets cut
that are in effect across the United States. There is people
out there fighting to do their jobs to prevent you from using
these products. They can't even do their job anymore because
somebody wanted to build a road with the money donated to them
from the master settlement agreement. So we need to first make
sure that the master settlement agreement money goes into
education. That is what it is meant to be used for, not to fix
the roads, not to get somebody out of trouble, to educate
youth. And if we educate youth, I think in the long term we
will see our health and our financial well being get better. I
spent almost $3 million in medical expenses from what this
product did to me, 3 million bucks to have surgeries, to have
radiation treatment, to lay in the hospital for two months at a
time, $3 million. I don't know of one person who spent $3
million or how much taxation you will make off of one person in
their lifetime selling this product. It is a very harmful drug
and we just need to put guidelines in and make it better and
make kids understand what it can do to them.
Mr. Pallone. Thank you.
Mr. Shimkus.
Mr. Shimkus. Thank you, Mr. Chairman.
Mr. Von Behrens, you have made Illinois proud.
Mr. Von Behrens. Thank you.
Mr. Shimkus. I appreciate you coming, and Mr. Garagiola, of
course, you made St. Louis proud.
Mr. Garagiola. Before you start, I have this DVD. It is the
best piece of equipment I have to talk to people. It is all
about Gruen and nobody else, and he talks to high school kids,
and the Diamondbacks were good enough to make sure that it was
distributed and the schools got it. Gruen was great, and I wish
you could see the effect he had on the young people because
when he walked out there, there was a collective ``huh'' and
then he started, and boys, he knocked their socks off. I will
never forget that, Gruen.
Mr. Von Behrens. You know, I was----
Mr. Pallone. Would the gentleman yield? And I am not going
to take away your time. I will give you more time. What I was
going to suggest, Mr. Garagiola, is that you have or can get us
extra copies of that, we will circulate them to the members of
the committee.
Mr. Garagiola. You tell me how many you want.
Mr. Pallone. We will get back to you. And also I don't know
if there is a transcript of it. We could enter that in the
record. But we will look into that, all right?
Mr. Garagiola. I will tell you what. I am going to give you
that and the Bob Leslie tape when I ask Bob Leslie what is the
toughest part of the day.
Mr. Pallone. OK. Thanks.
Mr. Shimkus. And let me just follow up on that. You did
talk about the No Chew Crew program with Arizona. Has that been
accepted or replicated in any other ballpark organizations and
stuff?
Mr. Garagiola. I have been frustrated a lot. I am going to
answer that question as honestly as I can. Only one other club
called the Diamondbacks and said tell us more about it. That
was the Marlins. And nobody else. This booklet, I want to give
it to the little guys because I thought they could read it
because it is a tobacco message but they could also color it,
and Commissioner Selig, he gave me $50,000 to make the
distribution. One club, and I don't want to embarrass them, the
girl says I am going to throw them away because we don't have
any room to store them. I said no, you are not going to throw
them away. I called the president of the club and we got them
distributed. No, it was met with industrial-strength apathy.
Mr. Shimkus. Dr. Connolly, when you talk about the
addictions, I believe there are social kind of addictions, peer
pressure. Are you making a determination because social kind of
addictions and peer pressures or the physical addiction?
Mr. Connolly. Well, I think we have to understand that you
have two different dosing mechanisms for nicotine. The
cigarette, you get a rapid dose of nicotine and it falls off
and sets a spike effect. It is very, very attractive because it
is reinforcing and it has central nervous system effects. With
smokeless, it is a slow effusion across the oral cavity, about
20 cell layers, and you get a general background dose. And then
with a product like Copenhagen, you get a bolus of nicotine
into the central nervous system. So it is a chemical addiction.
The Surgeon General described it as such. And then we look at
quitting patterns. We find it is about the same. It is equally
hard for smokeless tobacco users and cigarette smokers to quit.
They are about the same because they are dealing with a
chemical addiction. Finally, what is disturbing is the increase
in dual use that we are seeing in the American public, people
using cigarettes and using smokeless, and what we may be
observing is the emergence of dual dependency, someone being
dependent upon cocaine and heroin at the same time. It is
extremely hard because of the difference in dosing to treat
dual dependency. This is a major concern that we have for the
Nation is that young people seem to be using both now in
particular parts of the country and it is going to be harder, I
believe, to treat those dependencies.
Let me point out too, the players association has to step
up to the plate here. I mean, we have to----
Mr. Shimkus. My time is----
Mr. Connolly. I am sorry.
Mr. Shimkus. I am going to address that, and we have been
here a long time already, but I do think my colleague from
Maryland, it does make sense if you have got an asset as the
players' union does and as Major League Baseball does to
protect the asset. I am a Republican. We believe in competitive
markets. We want to protect collective bargaining and we want
you all to work it out. I am not one to want government to
intervene with a national law to say--because if we ban tobacco
products, then we would have the underground economy, we would
have the products just like we have illegal drugs, et cetera,
et cetera. But it is always better, gang, if you do this and
work this out, and I think you hear collective agreement by the
panel that we would hope that in the next round you all would
step up and lead by example and then you wouldn't be called
back up here anymore for this issue.
Mr. Connolly.
Mr. Shimkus. Yes, sir.
Mr. Connolly. There is no silver bullet here. We need
education for the kids, education for the players. We need
treatment for those players. We need counseling. But we also
need policies. You can't say one is going to work without the
other. It is a combination of efforts.
Mr. Shimkus. Well, and Mr. Von Behrens mentioned the
family, and leadership is not just professional sports. It is
family. I caught in the hot summers of St. Louis and my parents
gave me salt tablets because of sweating, and that was what was
thought at the time.
We do appreciate your time and effort, and Mr. Chairman, I
will yield back.
Mr. Pallone. Thank you.
Chairman Waxman.
Mr. Waxman. Thank you very much, Mr. Chairman.
As I understand the situation, if Major League Baseball
wanted to ban the use of smokeless tobacco or cigarettes, they
can just go ahead and do it when it comes to the minor leagues,
but when it comes to the major leagues, they can't just go
ahead and do it because you have to have a collective
bargaining. The union represents the players in the major
leagues but not in the minor leagues. Is that right, Mr.
Prouty?
Mr. Prouty. Yes, that is correct.
Mr. Waxman. So the only way you would get to talk about the
major leagues would be through collective bargaining agreement?
Mr. Prouty. That is correct. It is a mandatory subject of
bargaining.
Mr. Waxman. So you have to bargain this question out and
have it as part of your contract.
Mr. Prouty or Mr. Manfred, do either of you disagree with
the harm that comes to the players after all the testimony you
have heard today from the use of smokeless tobacco?
Mr. Prouty. No, Congressman, we don't disagree at all.
Mr. Waxman. And Mr. Manfred, you don't disagree, do you?
Mr. Manfred. No. As a matter of fact, we put extensive
effort into trying to encourage our players at all levels,
minor and major league, to not use smokeless tobacco.
Mr. Waxman. Do either of you disagree with the idea that
children, young people are influenced by seeing behavior of
players on the field? Mr. Manfred?
Mr. Manfred. No, I don't.
Mr. Prouty. No, we don't disagree. Players are role models.
We don't dispute that.
Mr. Waxman. So then the question is, if there are health
risks to the users and there is a problem in the message that
is sent to the kids, you seem to both agree with that. Wouldn't
you both be in favor of agreeing to not allow players to be
using smokeless tobacco on the field?
Mr. Prouty. Congressman Waxman, it is not as simple as Mr.
Manfred and me just agreeing. We both represent constituencies.
The union is a democratic organization. We have to go back to
our members. We have to hear what----
Mr. Waxman. I understand that. What would be the argument
against it?
Mr. Prouty. The argument against it is that it is a legal
substance which can be used in this country.
Mr. Waxman. So are cigarettes.
Mr. Prouty. So are cigarettes.
Mr. Waxman. Your members don't want to reopen that issue,
do they?
Mr. Prouty. No, they don't.
Mr. Waxman. So you have two legal products. No one is
disputing that. How about drinking beer or other alcoholic
beverages? It is perfectly legal, may or may not be harmful,
depending on the circumstance. Do any of your players think
that they ought to be allowed to drink on the field?
Mr. Prouty. No, they don't. I don't believe so.
Mr. Waxman. So I am trying to understand an argument they
might make on smokeless tobacco. If it hurts the health of the
players and it influences adversely kids to use a product that
is going to harm their health, I would hope you would take back
to your members that they shouldn't stand in the way of what
Major League Baseball did when it came to the minor leagues and
put in the same policy for the major leagues.
Mr. Prouty. Absolutely, Congressman. You can be assured we
will take back the concerns that we have heard here today and
the players will continue that along with all the other issues
and we will bring it up in the next round of bargaining if that
is what they decide to do. It is a democratic organization. I
can't promise you here today it will be brought up. I can
promise you that I will bring back and make them understand as
we did with steroids and other issues you are aware of exactly
what Congress feels about this.
Mr. Waxman. What if your players said to you I don't want
to have a ban on steroid use because we think it helps us
improve our performance? Would the players advance the argument
in the collective bargaining agreement that there shouldn't be
any ban on performance-enhancing drugs?
Mr. Prouty. Congressman, that is not where we are. As you
know, we went through a series of----
Mr. Waxman. I remember. I remember it well. I am just
obviously pointing out the illogic.
Mr. Prouty. But, no, I understand that. But if you
remember, the process that we went through every time was, we
went back and held meetings with players and developed a
consensus about this is what has got to happen, these are the
risks, this is the testing program and frankly, if we don't
act, Congress is going to act but we would rather settle it by
collective bargaining. In the end, that is what we did was
settle it by collective bargaining, and you endorsed what came
out of that.
Mr. Waxman. Let me ask you if you will be willing to start
this process of consultation with your members now so you can
be ready with a consensus position to allow this to be part of
the collective bargaining when your contract is next up.
Mr. Prouty. Yes, we will, as I said before, bring this back
to the membership and start consulting.
Mr. Waxman. Good.
Thank you very much, Mr. Chairman. I appreciate everybody's
testimony today.
Mr. Pallone. Thank you, Chairman Waxman.
The gentleman from Indiana, Mr. Buyer.
Mr. Buyer. Thank you very much.
I want to agree with the comment, educate, educate,
educate. I think you are right. And in a free society, I
believe there are always going to be differences of opinions
based on differing values, beliefs, perceptions and also due to
the imperfections of reason. So in the effort to educate,
educate, educate, we also have to nourish the hope that how do
we achieve improvements to public health. Now, when you make
that effort, you cannot ignore science. Now, what was
challenging from the first panel was to have an individual who
would not acknowledge that there is a continuum of risk among
tobacco products. Now, I don't smoke. I don't advocate for
people to smoke. I also recognize that it is a lawful adult
product and that it is a product that we don't want in the
hands of children. So I also acknowledge as a worthy effort to
prevent role models from using such a product and what can we
do to make sure that children don't gain access.
Well, you know, we have done a lot of things. Not only have
we made it illegal for individuals under the age of 18 to gain
access to these products, but you know what? The master
settlement agreement. I am surprised by the advocates of this
panel that you haven't talked about the master settlement
agreement and the fact that the States out there are not
utilizing monies collected not only from the MSA but also from
cigarette taxes to be spent on education programs. So in fiscal
year 2010 alone, and this is according to the document that I
have now submitted to the record titled A Broken Promise to Our
Children. It states that in the current fiscal year 2010,
States will collect $25.1 billion from the tobacco settlement
and tobacco taxes and they will spent just 2.3 percent of it,
which is approximately $560 million, on tobacco prevention and
cessation programs. Now, when we passed Mr. Waxman's bill, I
had offered an amendment. I had offered an amendment for us as
a Nation to improve public health to acknowledge the continuum
of risk and is it possible to migrate people from smoking to
smokeless to finally quitting. Is that possible? When in fact
there is a crucible out there for which we can look at, which
is called the Swedish experiment. Incorporated in that
amendment was also the advocacy on behalf of Ms. Blackburn to
actually state that, you know, States, you should be required
to spend a portion on education, a portion of the MSA. That was
defeated. That effort was defeated here on the committee and it
should not have been. Because those of whom will acknowledge
and actually say that smoking a cigarette is just as bad as
utilizing a smokeless tobacco product ignores science. Because
there is truly a difference in the continuum of risk.
Now, I don't advocate the use of either of those products
but to say that a snus product that eliminates 99 percent of
the nitrosamines and you have got a 1 percent of health risk
versus the 100 percent from a cigar ignores science. And so it
is challenging for me because I look at this and say I agree
with the testimony of educate, educate, educate but why would
the advocates of abstinence then not be willing to educate
tobacco users that there truly is an opportunity to lessen the
risk, that if you can reduce the thousands of constituents and
toxins from smoking to move to smokeless, that that in fact can
make your healthier. But the complete goal here is actual
cessation of the tobacco product. To ignore that is also then
to ignore science and ignore the advocacy to educate, educate,
educate. A nation cannot be ignorant sustain freedom. So as a
government when you ask government for its help and assistance,
we as a government need to be honest with regard to is our
advocacy with regard to availability of tobacco products. Now,
for those of whom are advocating abstinence, if you want to
advocate the complete outlawing of tobacco products, go ahead
and say that if that is what the advocacy is. But that is not
what this committee has chosen to do. It is not as a country
what we have chosen to do.
So I just--I want to thank all of you for your efforts. It
is unfortunate with regard to Major League Baseball and the
players' union that my sensing is that you have been brought
here to testify and the committee is somehow strong-arming you
with regard to what should occur or not occur within collective
bargaining. I think that is wrong if we are going to actually
say that the marketplace is a sacred place. And so that is
unfortunate. You can choose to do what you believe is morally
right, and I believe that you have that sense and that can
happen at the table, but for us to strong-arm you and to
dictate as to what you should and shouldn't do and supplant our
moral understanding upon you, wow, if that is what we want to
do, then we should have made tobacco products illegal instead
of passing that bill.
With that, I yield back.
Mr. Connolly. Could I just comment?
Mr. Pallone. I think we should probably let them respond if
they want.
Mr. Buyer. I did not ask a question. I yielded back. I made
a statement.
Mr. Connolly. As a person----
Mr. Pallone. He has yielded back, Dr. Connolly.
Ms. Blackburn.
Mrs. Blackburn. Thank you, Mr. Chairman, and mine is more
of a statement than a question. I do appreciate that all of you
are here, and Mr. Buyer mentioned some of the frustration that
we have with this issue. As I said in my opening statement and
in my questions, in the 110th Congress, in the 111th Congress,
there was an opportunity to expand SINAR and to take care,
special care, extra care to address this issue of teens and
smoking.
Now, I was interested in the testimony of a couple of you,
Mr. Manfred, in your testimony, and Mr. Garagiola, in yours.
You talk about education and the importance of education, and
why this needs to be expanded, and I liked the example of the
No Chew Crew.
Mr. Garagiola. But you need money.
Mrs. Blackburn. OK. Then is this a program that would
function well with some of the master settlement dollars? Have
you looked at that? Are you seeking to move forward with
expanding that program through the--the money is there. I mean,
that is----
Mr. Garagiola. The money is there but I think it is--I have
a clipping that I have saved. This is from 2001. In North
Dakota, legislators have been criticized for considering using
a portion of the settlement money to built a state morgue. In
Alabama, legislators allocated a portion of the settlement to
fight gangs and satanic worship in public schools. In Montana,
officials funded a juvenile delinquent boot camp. Tobacco-
growing States like North Carolina, South Carolina, Virginia,
funds have been set aside to compensate tobacco farmers for
losing crop revenues as smoking declines. The problem comes
when you call these people. Mike Moore, the attorney general
from Mississippi, we thought we had the money, and when you
call the line is busy, they will get back to you. I am still
waiting for calls from some of these guys.
Mrs. Blackburn. Well, and the legislation I have brought
before this body that action was not taken on would have
addressed the usage of some of these master settlement funds
and would have required the States to meet certain expanded
criteria. There is a way to address this.
Mr. Manfred, I think you had a couple of thoughts, and I do
appreciate your testimony, and when you talked about the minor
league policy that is there on smoking and tobacco products and
the compliance rates on that, and I wanted to know if the
smoking cessation counseling programs that are provided by the
clubs' employee assistance personnel, to what extent that has
been successful and if you all are doing outreach specifically
geared toward children.
Mr. Manfred. Let me start with the employee assistance
programs. I think when you talk to our employee assistance
professionals as a group, the 30 of them, we get them together
twice a year, and I think that in all candor, they feel that
they have very good programs. They feel that they have a
moderate degree of success, and the single biggest frustration
that you hear from them is, people go through the programs,
they do well, they stop and then they return to use. You know,
if I had to summarize what our very long discussions with this
group, that is how I would summarize it.
In terms of outreach, Major League Baseball has been
committed to the NSTEP undertaking for years and years. I think
Mr. Garagiola referred to the fact that Commissioner Selig
allocated $50,000 recently for a specifically child-directed
program. He is holding up the pamphlets from that program.
Commissioner Selig himself sees this as a public health issue,
and I think that it is fair to say that our efforts in this
regard both internally and externally will continue.
Mrs. Blackburn. I appreciate that.
I will just close by saying from our perspective, there has
been an opportunity to address this. We have legislation. The
SINAR language has worked. We don't need to reinvent the wheel.
The goal is to make certain that children are educated and
realize the dangers of tobacco use. As a mom, as a former Lung
Associate volunteer, as the former president of that board, the
education programs have been vitally important and that is how
we are going to change this, and there does exist an avenue for
that and I think it is regretful that this committee did not
take up the opportunity to address that and I would have
preferred out time today be spent on some other components that
addressing some things in the health care bill that need to be
done or addressing getting a federal budget together which I am
understanding the Democrat leadership in this body does not
want to do.
With that, I yield back.
Mr. Pallone. Thank you.
There are only a few of us left so we are just going to
have a second round for whoever wants to ask questions, and I
am going to yield myself some time.
I asked Mr. Prouty before about a commitment to bring this
up, and I think Mr. Waxman did also, to bring up the issue of
smokeless tobacco in the context of collective bargaining
agreement, and I just wanted to ask Mr. Manfred the same thing,
if you would be willing to say that you would make the issue of
smokeless tobacco a priority when you negotiate with the
players over collective bargaining? Would you and the
commissioner fight to try to end the use of smokeless tobacco
by major league players? I mean, I know that you don't have--
you know, a lot of this depends on what happens but we are
still trying to at least get you and Major League Baseball to
say look, we will try to make this a priority, we will bring it
up, we are committed to putting an end to it in the same way
you have with the minor leagues.
Mr. Manfred. We have begun our preparations for 2011
already. I think that Commissioner Selig's directive that Dr.
Shaha make a presentation to the safety and health committee is
indicative of his commitment to the idea that this issue needs
to be addressed in 2011. I can also tell you that in our
conversations with individual teams, we have had a number of
teams raise this issue as something that we need to be putting
on the table in 2011.
Mr. Pallone. But can you just go beyond that and say that
it is a priority for that purpose?
Mr. Manfred. I can say--certainly I can say this, that for
Commissioner Selig it is a priority in terms of the issues that
we have discussed so far. I think that is an accurate
statement.
Mr. Pallone. I appreciate that.
I am going to yield back and ask Mr. Shimkus if he would
like to say anything or ask any more questions.
Mr. Shimkus. No, I just appreciate the panelists. I think
my colleague, Congresswoman Blackburn, makes a good point, and
I would request that maybe the full committee chairman bring in
the States and ask them to use their master settlement money on
the tobacco to print your brochures, to print the DVDs and get
them in all the schools across the country. That might be a
good use of that instead of some of the other things that Mr.
Garagiola highlighted in that old article. I mean, if we are
serious about educating, we ought to be about the business of
educating, and I appreciate those who are doing their part with
their own ability, but again, I think government has dropped
the ball on some of these aspects, and I yield back my time.
Mr. Pallone. Mr. Buyer, no additional questions? OK.
Let me thank all of you, really. I thought that his was
very worthwhile today. It is obviously an issue that Mr. Waxman
in particular but many members of the committee have cared
about for a long time, and I also appreciate the fact that some
of you are willing to take it back with the major leagues and
try to address it. I think it is very important to us, so thank
you very much.
The way we operate is that you may get additional written
questions within the next 10 days or so that we would also ask
you to respond to as quickly as possible.
Thank you. And with that, the subcommittee hearing is
adjourned.
[Whereupon, at 1:28 p.m., the Subcommittee was adjourned.]
[Material submitted for inclusion in the record follows:]
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