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September 10, 1997, Vol 278, No. 10 >
ARTICLE | September 10, 1997

Preemption in Tobacco Control: Title and subTitle BreakReview of an Emerging Public Health Problem FREE

Michael Siegel, MD, MPH; Julia Carol; Jerie Jordan; Robin Hobart, MPP, MPH; Susan Schoenmarklin, JD; Fran DuMelle; Peter Fisher
[+] Author Affiliations

Reprints: Michael Siegel, MD, MPH, Social and Behavioral Sciences Department, Boston University School of Public Health, 85 E Newton St, Room 840, Boston, MA 02118 (e-mail: mbsiegel@bu.edu).

Health Law and Ethics section editors: Lawrence O. Gostin, JD, the Georgetown/Johns Hopkins University Program on Law and Public Health, Washington, DC, and Baltimore, Md; Helene M. Cole, MD, Contributing Editor, JAMA.


JAMA. 1997;278(10):858-863. doi:10.1001/jama.1997.03550100084044
Text Size: A A A
Published online
Article
References

Objective.  —To describe the nature, extent, and public health significance of state legislation that preempts the local regulation of tobacco.

Data Sources.  —computerized database of local tobacco control ordinances, state tobacco control laws, preemption bills introduced during the 1996 state legislative session, articles obtained through a MEDLINE search (1984-1996) using the key word "preemption" or identified from bidliographies of these articles, public opinion surveys, and newspaper articles.

Study Selection.  —All identified data sources were used.

Data Extraction.  —analyses of preemption bills and state laws were conducted independently by multiple observers.

Data Synthesis.  —There has been a striking increase in the adoption of local tobacco control ordinances during the past decade; by the end of 1995, approximately 1006 communities had enacted a local tobacco control ordinance. In response, the tobacco industry has advanced legislation in 29 states that preempts local authority to regulate tobacco. During the 1996 state legislative session alone, 26 bills containing preemption were introduced, and 2 were enacted. Emerging trends in the tobacco industry's strategy to advance preemption laws include (1) amending legitimate tobacco control bills to preempt local tobacco regulation, (2) using the Synar amendment as a vehicle to advance preemption, and (3) promoting "superpreemption" bills that eliminate all local control of tobacco policy.

Conclusions.  —Preemption of local tobacco regulation is an important tobacco industry strategy that undermines the public's health. Preventing the enactment of new preemption laws and repealing existing ones should become a public health priority.

REFERENCES

1 +
US Dept of Health and Human Services. State Tobacco Control Highlights—1996 . Atlanta, Ga: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1996;. CDC publication No. 099-4895.
2 +
US Dept of Health and Human Services. Major Local Tobacco Control Ordinances in the United States (Smoking and Tobacco Control Monograph 3) . Bethesda, Md: National Institutes of Health; 1993;. NIH publication No. 93-3532.
3 +
Jacobson PD, Wasserman J, Raube K.  The politics of antismoking legislation . J Health Polit Policy Law . 1993;;18:787-819.
4 +
Conlisk E, Siegel M, Lengerich E, MacKenzie W, Malek S, Eriksen M.  The status of local smoking regulations in North Carolina following a state preemption bill . JAMA . 1995;;273:805-807.
5 +
Ellis GA, Hobart RL, Reed DF.  Overcoming a powerful tobacco lobby in enacting local smoking ordinances: the Contra Costa County experience . J Public Health Policy . 1996;;17:28-46.
6 +
Davis RM.  The ledger of tobacco control: is the cup half empty or half full? JAMA . 1996;;275:1281-1284.
7 +
Arno PS, Brandt AM, Gostin LO, Morgan J.  Tobacco industry strategies to oppose federal regulation . JAMA . 1996;;275:1258-1262.
8 +
Skolnick AA.  Cancer converts tobacco lobbyist: Victor L. Crawford goes on the record . JAMA . 1995;;274:199-202.
9 +
Fielding JE.  Revealing and reversing tobacco industry strategies . Am J Public Health . 1996;;86:1073-1075.
10 +
Bearman NS, Goldstein AO, Bryan DC.  Legislating clean air: politics, preemption, and the health of the public . N C Med J . 1995;;56:14-19.
11 +
Sylvester K.  The tobacco industry will walk a mile to stop an anti-smoking law . Governing . (May) 1989;;3:34-40.
12 +
Freyman R.  Butting in: the tobacco lobby shows no sign of flickering in its push to move smoking regulation out of city halls and into statehouses . Governing . (November) 1995;;9:55-57.
13 +
Jordan J, Pertschuk M, Carol J. Preemption in Tobacco Control: History, Current Issues, and Future Concerns . Berkeley, Calif: Western Consortium for Public Health; 1994;.
14 +
Actions Speak Louder Than Words: The Tobacco Industry's Stealth Strategy in State Legislatures. Chicago, Ill: American Cancer Society, American Heart Association, American Lung Association, Americans for Nonsmokers' Rights, National Center for Tobacco-Free Kids; 1996.
15 +
Massachusetts Dept of Public Health. Massachusetts Tobacco Control Program: Tobacco Control Provisions—A Survey . Boston: Massachusetts Tobacco Control Program; 1996;.
16 +
Pierce JP, Shanks TG, Pertschuk M, et al.  Do smoking ordinances protect non-smokers from environmental tobacco smoke at work? Tobacco Control . 1994;;3:15-20.
17 +
Wasserman J, Manning WG, Newhouse JP, Winkler JD.  The effects of excise taxes and regulations on cigarette smoking . J Health Econ . 1991;;10:43-64.
18 +
Chaloupka FJ.  Rational addictive behavior and cigarette smoking . J Polit Econ . 1991;;99:722-742.
19 +
Chaloupka FJ.  Clean indoor air laws, addiction, and cigarette smoking . Appl Econ . 1992;;24:193-205.
20 +
Chaloupka FJ, Grossman M. Price, Tobacco Control Policies and Youth Smoking . Cambridge, Mass: National Bureau of Economic Research; 1996;. National Bureau of Economic Research working paper.
21 +
Marcus BH, Emmons KM, Abrams DB, et al.  Restrictive workplace smoking policies: impact on nonsmokers' tobacco exposure . J Public Health Policy . 1992;;13:42-51.
22 +
Stillman FA, Becker DM, Swank RT, Hantula D, Moses H, Glantz SA.  Ending smoking at the Johns Hopkins Medical Institutions: an evaluation of smoking prevalence and indoor air pollution . JAMA . 1990;;264:1565-1569.
23 +
Borland R, Chapman S, Owen N, Hill D.  Effects of workplace smoking bans on cigarette consumption . Am J Public Health . 1990;;80:178-180.
24 +
Biener L, Abrams DB, Follick MJ, Dean L.  A comparative evaluation of a restrictive smoking policy in a general hospital . Am J Public Health . 1989;;79:192-195.
25 +
Woodruff TJ, Rosbrook B, Pierce J, Glantz SA.  Lower levels of cigarette consumption found in smoke-free workplaces in California . Arch Intern Med . 1993;;153:1485-1493.
26 +
Sorensen G, Rigotti N, Rosen A, Pinney J, Prible R.  Effects of a worksite nonsmoking policy: evidence for increased cessation . Am J Public Health . 1991;;81:202-204.
27 +
Longo DR, Brownson RC, Johnson JC, et al.  Hospital smoking bans and employee smoking behavior: results of a national survey . JAMA . 1996;;275:1252-1257.
28 +
Begay ME, Traynor M, Glantz SA.  The tobacco industry, state politics, and tobacco education in California . Am J Public Health . 1993;;83:1214-1221.
29 +
Aguinaga S, Macdonald H, Traynor M, Begay ME, Glantz SA. Undermining Popular Government: Tobacco Industry Political Expenditures in California, 1993-1994 . San Francisco: University of California School of Medicine, Institute for Health Policy Studies; 1995;.
30 +
Macdonald H, Glantz SA. California's Proposition 188: An Analysis of the Tobacco Industry's Political Advertising Campaign . San Francisco: University of California School of Medicine, Institute for Health Policy Studies; 1994;.
31 +
Macdonald H, Glantz SA. Analysis of the Smoking and Tobacco Products State-wide Regulation Initiative Statute . San Francisco: University of California School of Medicine, Institute for Health Policy Studies; 1994;.
32 +
Macdonald H, Aguinaga S, Glantz SA. The defeat of Philip Morris' 'California Uniform Tobacco Control Act.' Am J Public Health. In press.
33 +
Moore S, Wolfe SM, Lindes D, Douglas CE.  Epidemiology of failed tobacco control legislation . JAMA . 1994;;272:1171-1175.
34 +
Califano JA Jr.  Revealing the link between campaign financing and deaths caused by tobacco . JAMA . 1994;;272:1217-1218.
35 +
Wright JR.  Contributions, lobbying and committee voting in the US House of Representatives . Am Polit Sci Rev . 1990;;84:417-438.
36 +
Babcock CR.  Top 1995-96 'soft money' contributors to the national party committees . Washington Post . (February 17) , 1997;:A23.
37 +
Goldstein AO, Bearman NS.  State tobacco lobbyists and organizations in the United States: crossed lines . Am J Public Health . 1996;;86:p-1142.
38 +
Glantz SA, Begay ME.  Tobacco industry campaign contributions are affecting tobacco control policymaking in California . JAMA . 1994;;272:1176-1182.
39 +
Monardi FM, Glantz SA. Tobacco Industry Political Activity and Tobacco Control Policy Making in Washington: 1983-1996 . San Francisco: University of California School of Medicine, Institute for Health Policy Studies; 1996;.
40 +
Monardi FM, O'Neill A, Glantz SA. Tobacco Industry Political Activity in Colorado: 1979-1995 . San Francisco: University of California School of Medicine, Institute for Health Policy Studies; 1996;.
41 +
Lee G.  Tobacco lobby lights a preemptive strike: effort targets local anti-smoking laws . Washington Post . (September 9) , 1991;:A7.
42 +
American Cancer Society. A Survey of American Voter Attitudes Toward Cigarette Smoking . Boston, Mass: Marttila & Kiley; 1993;.
43 +
Opinion Research Corporation. Public Support for Local Control Over Tobacco-Related Issues . Princeton, NJ: Opinion Research Corp; 1996;.
44 +
Hart MA.  Bill will limit access to cigarettes . Philadelphia Inquirer . (May 20) ,1996;: A10.
45 +
Feder BJ.  Federal rule intensifies smoking fight in states . New York Times . (March 15) ,1996;:A1, A9.
46 +
Pub L No. 102-321,106 Stat 394. (State law regarding sale of tobacco products to individuals under the age of 18 years, July 10, 1992.)
47 +
US Dept of Health and Human Services. Substance abuse prevention and treatment block grants: sale or distribution of tobacco products to individuals under 18 years of age; final rule (61 CFR pt 1492-1509 et seq). Federal Register. January 19, 1996;61.
48 +
Food Marketing Institute.  Tobacco industry advocating model legislation to govern retail cigarette sales . In: Tanis J, ed. State to State: Analysis of a Current State Legislative Trend . Washington, DC: Food Marketing Institute State Issues Office; January 31, 1994;.
49 +
Gellene D.  Industry, retailers unveil effort to fight youth smoking . Los Angeles Times . (December 20) , 1995;:D7.
50 +
Minnesota Coalition of Responsible Retailers. Minnesota Coalition of Responsible Retailers Status Report . Minneapolis: Minnesota Coalition of Responsible Retailers; February 15, 1996;.
51 +
Brokaw J.  The war in the states: a win? Hiding behind retail groups and misleading laws: a loss? getting caught doing it . Mother Jones . (May-June) 1996;;21:56-57.
52 +
Coalition for Responsible Tobacco Retailing. Correction Notice to Retailers and Wholesalers . Washington, DC: Coalition for Responsible Tobacco Retailing; 1996;.
53 +
Traynor MP, Begay ME, Glantz SA.  New tobacco industry strategy to prevent local tobacco control . JAMA . 1993;;270:479-486.
54 +
Bibb v Navajo Freight Lines, 359 US 520,526-530 (1959).
55 +
Teret SP, DeFrancesco S, Bailey LA.  Gun deaths and home rule: a case for local regulation of a local public health problem . Am J Prev Med . 1993;;9( (suppl 1) ):44-46.
56 +
Kalodimos et al v Village of Morton Grove, 103 Ill 2d 483,470 NE2d 266,274 (1984).
57 +
Rosen G. A History of Public Health . New York, NY: MD Publications; 1958;.
58 +
Christoffel T. Health and the Law . New York, NY: Free Press; 1982;.
59 +
BF McMahon et al v City of Virginia Beach, 267 SE2d 130,134 (1980).
60 +
Samuels B, Glantz SA.  The politics of local tobacco control . JAMA . 1991;;266:2110-2117.
61 +
Macdonald H, Glantz SA.  The political realities of state tobacco control legislation: California's AB13 . Tobacco Control . 1997;;6:41-54.
62 +
Todd JS, Rennie D, McAfee RE, et al.  The Brown and Williamson documents: where do we go from here? JAMA . 1995;;274:256-258.
63 +
New York Consolidated Laws Service. Regulation of Smoking in Certain Public Areas (Clean Indoor Air Act) . Rochester, NY: Lawyers Cooperative Publishing; February 1996; (cumulative supplement); 25 (Public Health Law), Article 13E §1399-r3.
64 +
US Dept of Health and Human Services. Healthy People 2000: Midcourse Review and 1995 Revisions . Hyattsville, Md: Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics; 1996;.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
US Dept of Health and Human Services. State Tobacco Control Highlights—1996 . Atlanta, Ga: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1996;. CDC publication No. 099-4895.
2 +
US Dept of Health and Human Services. Major Local Tobacco Control Ordinances in the United States (Smoking and Tobacco Control Monograph 3) . Bethesda, Md: National Institutes of Health; 1993;. NIH publication No. 93-3532.
3 +
Jacobson PD, Wasserman J, Raube K.  The politics of antismoking legislation . J Health Polit Policy Law . 1993;;18:787-819.
4 +
Conlisk E, Siegel M, Lengerich E, MacKenzie W, Malek S, Eriksen M.  The status of local smoking regulations in North Carolina following a state preemption bill . JAMA . 1995;;273:805-807.
5 +
Ellis GA, Hobart RL, Reed DF.  Overcoming a powerful tobacco lobby in enacting local smoking ordinances: the Contra Costa County experience . J Public Health Policy . 1996;;17:28-46.
6 +
Davis RM.  The ledger of tobacco control: is the cup half empty or half full? JAMA . 1996;;275:1281-1284.
7 +
Arno PS, Brandt AM, Gostin LO, Morgan J.  Tobacco industry strategies to oppose federal regulation . JAMA . 1996;;275:1258-1262.
8 +
Skolnick AA.  Cancer converts tobacco lobbyist: Victor L. Crawford goes on the record . JAMA . 1995;;274:199-202.
9 +
Fielding JE.  Revealing and reversing tobacco industry strategies . Am J Public Health . 1996;;86:1073-1075.
10 +
Bearman NS, Goldstein AO, Bryan DC.  Legislating clean air: politics, preemption, and the health of the public . N C Med J . 1995;;56:14-19.
11 +
Sylvester K.  The tobacco industry will walk a mile to stop an anti-smoking law . Governing . (May) 1989;;3:34-40.
12 +
Freyman R.  Butting in: the tobacco lobby shows no sign of flickering in its push to move smoking regulation out of city halls and into statehouses . Governing . (November) 1995;;9:55-57.
13 +
Jordan J, Pertschuk M, Carol J. Preemption in Tobacco Control: History, Current Issues, and Future Concerns . Berkeley, Calif: Western Consortium for Public Health; 1994;.
14 +
Actions Speak Louder Than Words: The Tobacco Industry's Stealth Strategy in State Legislatures. Chicago, Ill: American Cancer Society, American Heart Association, American Lung Association, Americans for Nonsmokers' Rights, National Center for Tobacco-Free Kids; 1996.
15 +
Massachusetts Dept of Public Health. Massachusetts Tobacco Control Program: Tobacco Control Provisions—A Survey . Boston: Massachusetts Tobacco Control Program; 1996;.
16 +
Pierce JP, Shanks TG, Pertschuk M, et al.  Do smoking ordinances protect non-smokers from environmental tobacco smoke at work? Tobacco Control . 1994;;3:15-20.
17 +
Wasserman J, Manning WG, Newhouse JP, Winkler JD.  The effects of excise taxes and regulations on cigarette smoking . J Health Econ . 1991;;10:43-64.
18 +
Chaloupka FJ.  Rational addictive behavior and cigarette smoking . J Polit Econ . 1991;;99:722-742.
19 +
Chaloupka FJ.  Clean indoor air laws, addiction, and cigarette smoking . Appl Econ . 1992;;24:193-205.
20 +
Chaloupka FJ, Grossman M. Price, Tobacco Control Policies and Youth Smoking . Cambridge, Mass: National Bureau of Economic Research; 1996;. National Bureau of Economic Research working paper.
21 +
Marcus BH, Emmons KM, Abrams DB, et al.  Restrictive workplace smoking policies: impact on nonsmokers' tobacco exposure . J Public Health Policy . 1992;;13:42-51.
22 +
Stillman FA, Becker DM, Swank RT, Hantula D, Moses H, Glantz SA.  Ending smoking at the Johns Hopkins Medical Institutions: an evaluation of smoking prevalence and indoor air pollution . JAMA . 1990;;264:1565-1569.
23 +
Borland R, Chapman S, Owen N, Hill D.  Effects of workplace smoking bans on cigarette consumption . Am J Public Health . 1990;;80:178-180.
24 +
Biener L, Abrams DB, Follick MJ, Dean L.  A comparative evaluation of a restrictive smoking policy in a general hospital . Am J Public Health . 1989;;79:192-195.
25 +
Woodruff TJ, Rosbrook B, Pierce J, Glantz SA.  Lower levels of cigarette consumption found in smoke-free workplaces in California . Arch Intern Med . 1993;;153:1485-1493.
26 +
Sorensen G, Rigotti N, Rosen A, Pinney J, Prible R.  Effects of a worksite nonsmoking policy: evidence for increased cessation . Am J Public Health . 1991;;81:202-204.
27 +
Longo DR, Brownson RC, Johnson JC, et al.  Hospital smoking bans and employee smoking behavior: results of a national survey . JAMA . 1996;;275:1252-1257.
28 +
Begay ME, Traynor M, Glantz SA.  The tobacco industry, state politics, and tobacco education in California . Am J Public Health . 1993;;83:1214-1221.
29 +
Aguinaga S, Macdonald H, Traynor M, Begay ME, Glantz SA. Undermining Popular Government: Tobacco Industry Political Expenditures in California, 1993-1994 . San Francisco: University of California School of Medicine, Institute for Health Policy Studies; 1995;.
30 +
Macdonald H, Glantz SA. California's Proposition 188: An Analysis of the Tobacco Industry's Political Advertising Campaign . San Francisco: University of California School of Medicine, Institute for Health Policy Studies; 1994;.
31 +
Macdonald H, Glantz SA. Analysis of the Smoking and Tobacco Products State-wide Regulation Initiative Statute . San Francisco: University of California School of Medicine, Institute for Health Policy Studies; 1994;.
32 +
Macdonald H, Aguinaga S, Glantz SA. The defeat of Philip Morris' 'California Uniform Tobacco Control Act.' Am J Public Health. In press.
33 +
Moore S, Wolfe SM, Lindes D, Douglas CE.  Epidemiology of failed tobacco control legislation . JAMA . 1994;;272:1171-1175.
34 +
Califano JA Jr.  Revealing the link between campaign financing and deaths caused by tobacco . JAMA . 1994;;272:1217-1218.
35 +
Wright JR.  Contributions, lobbying and committee voting in the US House of Representatives . Am Polit Sci Rev . 1990;;84:417-438.
36 +
Babcock CR.  Top 1995-96 'soft money' contributors to the national party committees . Washington Post . (February 17) , 1997;:A23.
37 +
Goldstein AO, Bearman NS.  State tobacco lobbyists and organizations in the United States: crossed lines . Am J Public Health . 1996;;86:p-1142.
38 +
Glantz SA, Begay ME.  Tobacco industry campaign contributions are affecting tobacco control policymaking in California . JAMA . 1994;;272:1176-1182.
39 +
Monardi FM, Glantz SA. Tobacco Industry Political Activity and Tobacco Control Policy Making in Washington: 1983-1996 . San Francisco: University of California School of Medicine, Institute for Health Policy Studies; 1996;.
40 +
Monardi FM, O'Neill A, Glantz SA. Tobacco Industry Political Activity in Colorado: 1979-1995 . San Francisco: University of California School of Medicine, Institute for Health Policy Studies; 1996;.
41 +
Lee G.  Tobacco lobby lights a preemptive strike: effort targets local anti-smoking laws . Washington Post . (September 9) , 1991;:A7.
42 +
American Cancer Society. A Survey of American Voter Attitudes Toward Cigarette Smoking . Boston, Mass: Marttila & Kiley; 1993;.
43 +
Opinion Research Corporation. Public Support for Local Control Over Tobacco-Related Issues . Princeton, NJ: Opinion Research Corp; 1996;.
44 +
Hart MA.  Bill will limit access to cigarettes . Philadelphia Inquirer . (May 20) ,1996;: A10.
45 +
Feder BJ.  Federal rule intensifies smoking fight in states . New York Times . (March 15) ,1996;:A1, A9.
46 +
Pub L No. 102-321,106 Stat 394. (State law regarding sale of tobacco products to individuals under the age of 18 years, July 10, 1992.)
47 +
US Dept of Health and Human Services. Substance abuse prevention and treatment block grants: sale or distribution of tobacco products to individuals under 18 years of age; final rule (61 CFR pt 1492-1509 et seq). Federal Register. January 19, 1996;61.
48 +
Food Marketing Institute.  Tobacco industry advocating model legislation to govern retail cigarette sales . In: Tanis J, ed. State to State: Analysis of a Current State Legislative Trend . Washington, DC: Food Marketing Institute State Issues Office; January 31, 1994;.
49 +
Gellene D.  Industry, retailers unveil effort to fight youth smoking . Los Angeles Times . (December 20) , 1995;:D7.
50 +
Minnesota Coalition of Responsible Retailers. Minnesota Coalition of Responsible Retailers Status Report . Minneapolis: Minnesota Coalition of Responsible Retailers; February 15, 1996;.
51 +
Brokaw J.  The war in the states: a win? Hiding behind retail groups and misleading laws: a loss? getting caught doing it . Mother Jones . (May-June) 1996;;21:56-57.
52 +
Coalition for Responsible Tobacco Retailing. Correction Notice to Retailers and Wholesalers . Washington, DC: Coalition for Responsible Tobacco Retailing; 1996;.
53 +
Traynor MP, Begay ME, Glantz SA.  New tobacco industry strategy to prevent local tobacco control . JAMA . 1993;;270:479-486.
54 +
Bibb v Navajo Freight Lines, 359 US 520,526-530 (1959).
55 +
Teret SP, DeFrancesco S, Bailey LA.  Gun deaths and home rule: a case for local regulation of a local public health problem . Am J Prev Med . 1993;;9( (suppl 1) ):44-46.
56 +
Kalodimos et al v Village of Morton Grove, 103 Ill 2d 483,470 NE2d 266,274 (1984).
57 +
Rosen G. A History of Public Health . New York, NY: MD Publications; 1958;.
58 +
Christoffel T. Health and the Law . New York, NY: Free Press; 1982;.
59 +
BF McMahon et al v City of Virginia Beach, 267 SE2d 130,134 (1980).
60 +
Samuels B, Glantz SA.  The politics of local tobacco control . JAMA . 1991;;266:2110-2117.
61 +
Macdonald H, Glantz SA.  The political realities of state tobacco control legislation: California's AB13 . Tobacco Control . 1997;;6:41-54.
62 +
Todd JS, Rennie D, McAfee RE, et al.  The Brown and Williamson documents: where do we go from here? JAMA . 1995;;274:256-258.
63 +
New York Consolidated Laws Service. Regulation of Smoking in Certain Public Areas (Clean Indoor Air Act) . Rochester, NY: Lawyers Cooperative Publishing; February 1996; (cumulative supplement); 25 (Public Health Law), Article 13E §1399-r3.
64 +
US Dept of Health and Human Services. Healthy People 2000: Midcourse Review and 1995 Revisions . Hyattsville, Md: Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics; 1996;.

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