drink per day did not decrease their alcohol consumption (Hankin, 1994). This study suggests that universal prevention efforts may have some modest success in decreasing the consumption of alcohol, but that more targeted efforts are probably necessary for individuals who are regular users or who are addicted.

An IOM panel on fetal alcohol syndrome found that there are little data on the effectiveness of universal prevention efforts such as warning labels. The panel recommended, however, that these efforts should be continued to raise awareness of the dangers of alcohol, particularly fetal alcohol syndrome and alcohol-related birth defects and neurological defects (IOM, 1996b).

Warning Labels on Tobacco Products

In 1965, Congress passed the first law requiring warning labels on cigarettes (Public Law 89-92). The labels read, "CAUTION: Cigarette Smoking May Be Hazardous to Your Health." This language was strengthened in 1969 to read, "WARNING: The Surgeon General Has Determined that Cigarette Smoking Is Dangerous to Your Health" (Public Law 91-222). In an effort to further strengthen this warning, Congress passed the Comprehensive Smoking Education Act in 1984, which required four different warning labels. One specified the diseases caused by smoking, one urged quitting to improve health; one warned of birth defects and other dangers of smoking while pregnant; and one warned that cigarette smoke contains carbon monoxide (Public Law 98–474).

Labeling changes occurred during a period of increased public information about the dangers of smoking and increasing restrictions on smoking in public places, making it difficult to determine the exact impact of these labeling changes. However, research conducted in Australia before the introduction of cigarette warning labels indicated the importance of varying warning labels so that they would attract attention and ensuring that they are easily understood and easy to see and read (CBRC, 1992).

Advertising Bans

Legal bans or voluntary bans on advertising of alcohol and tobacco also represent a prevention effort; they curb exposure to messages that encourage alcohol and nicotine use. Cigarette advertising has been banned from radio and television since 1969, and advertisements for little cigars were similarly banned in 1973 (Public Laws 91-222 and 93-109). As of 1996, 48 states had some type of restriction, from minimal to comprehensive, on smoking in public places (CHS, 1996). In 1996, the liquor industry ended a self-imposed ban on television advertising. This action spurred debate about whether there should be comprehensive



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