vending machines encourages the between-meal consumption of sugarrich products.

As with most situations, prudent choices must be made and the advantages and disadvantages of alternate choices must be weighed in the balance. However, permitting vending machines that offer sugar-rich foods which injure oral health and offer no genuine nutritional advantage, seem to us to be self-defeating.

And just a brief quote from the "Oklahoma Public Health Association Bulletin" which raises two significant questions. One is "Do the higher costs of health and dental care resulting from a high intake of sweets out weigh the profits derived by schools from the sale of candy and soft drinks?" and two, "Is it consistent to encourage the Government to spend millions of dollars for school lunches and then permit the schools to sell candy and soft drinks, which often compete with the sale of nutritious lunches?"

The American Dental Association strongly urges the inclusion of statutory authority to regulate the sale of food items in competition. with programs authorized under the Child Nutrition Act. The association supports, therefore, Senate Bill 1309 introduced by Senator Case.

Mr. THORNTON. As I recall, after the law was changed to permit local school districts to offer competitive foods in schools and, more particularly, during the lunch hours, some States and districts immediately moved to continue the prohibition that previously existed under the Federal regulation.

Do you have any idea as to how many States and areas, in fact, have done that?

Dr. ALLEN. No, I do not. I think the Dallas School System just recently did.

Mr. CONWAY. The school system in New York has done it.

Mr. THORNTON. To what extent is your association conducting any kind of an education effort in this instance with State and local officials to point out to them the same things that you are pointing out to this committee with respect to the hazards and dangers you have mentioned in your testimony as well as the advisability of them placing certain restrictions on the offering of competitive foods?

Dr. ALLEN. Well, I think this is done mostly at the components of society levels. I think all our programs counsels on how they meet with school officials in our local school district. They have nothing but fruit and milk in vending machines in high schools in our school district. I think it is left up to the local components. There has been a great educational campaign though several other groups associated with the American Dental Association, the American Society of Preventive. Dentistry, and other outlets, and I think American Society of Dentistry for Children, and I think there is an ongoing effort at the local level to influence local school boards.

Mr. THORNTON. An earlier witness mentioned the possibility that the offering of certain competitive foods, especially prior to lunch hours, may also be contributing to increased plate-waste, that is by those students who grab a bottle of soda or a candy bar and then go through the line to get their lunch. It was suggested that this may curb their appetite sufficiently to increase their plate waste. Have you gone into

that area at all in terms of collecting any evidence regarding that matter?

Dr. ALLEN. I think there is a lot of evidence from a nutritional standpoint saying that these kinds of foods are appetite robbers and that they do fill the children up, particularly soft drinks, for example, fill the children up and, therefore, they are not as hungry when they sit down to a normal meal.

Mr. THORNTON. Thank you very much. We appreciate your patience and your coming here to testify.

[The prepared statement of Dr. Allen follows:]

STATEMENT OF DR. WILLIAM E. ALLEN, MEMBER, COUNCIL ON LEGISLATION, THE AMERICAN DENTAL ASSOCIATION, PASADEna, Calif.

Mr. Chairman and Members of the committee, I am Dr. William E. Allen from Pasadena, California. In addition to maintaining a dental practice limited to the care of children, I am also a member of the American Dental Association's Council on Legislation. The Association appreciates this opportunity to present its views on S. 1309, a bill to amend the National School Lunch Act, introduced by Senator Clifford P. Case of New Jersey.

The Association strongly supports section one of the bill which would repeal that section of the Child Nutrition Act that now denies the Secretary of Agriculture the discretion to limit the sale of snack foods through vending machines in direct competition with the regular food service programs provided in school lunchrooms. The Association is also pleased to support section two of the bill to establish school nutrition education programs. Nutrition education is a large and important part of the practice of preventive dentistry.

The Association concerns in this area are based on the experience of the over 100,000 active members who regularly witness the unnecessary decay of young, sound teeth by the misguided nutritional attitudes and habits of school age children.

The availability of confectionary and soft drink vending machines in schools is something that has concerned the Association since changes were made by Congress in the school lunch programs authorized under the Child Nutrition Act. The Association opposed those changes, which opened the door to placement in schools of vending machines, and we continue to do so. Our opposition is not directed toward vending machines as such. The source of our opposition is that, weighing the conflicting claims, we think the balance clearly tips in favor of reestablishing the authority to regulate the sale of food items in competition with the programs carried out under the act just cited. Briefly, these are the reasons that lead our Association to this position.

Dental disease is widely prevalent in the United States. Of the various manifestations of dental disease, tooth decay is by far the most common. It is also one of the most preventable. Reasonable adherence to a few simple rules of oral hygiene would prevent most tooth decay from occurring. One of those rules is to eat a balanced diet or, to put it more sharply in the negative, to avoid a diet heavy in sugar-rich foods. Such a rule is also of paramount importance with respect to a person's general health since most sugar-rich foods, advertising to the contrary, are of negligible nutritional value.

Children suffer particularly from tooth decay. By the time a child is 14 years of age, more than a third of his teeth have already become decayed. It is hard to imagine another childhood ailment that is so preventable and yet so prevalent. In this connection, the relationship between sugar-rich foods and dental decay was positively established and recorded in the Journal of the American Dental Association, in a well-documented study published by the Council on Dental Health and the Council on Dental Therapeutics of the American Dental Association.

Because of the Associations' responsibility for safegurading the dental health of the American public, the Councils were charged to document the known or potential hazards to dental health resulting from the frequent consumption of sweetened beverages and other sugar-containing substances. The Councils concluded: "From the health point of view, it is desirable especially to have restriction of such use of sugar as is represented by the consumption of sweetened carbonated beverages and forms of candy which are of low nutritional value.

The Council believes it would be in the interest of the public health for all practical means to be taken to limit the consumption of sugar in any form in which it fails to be combined with significant proportions of other foods of high nutritive value."

Since that report, several independent studies have added to and amplified the conclusions reached by the Association's Councils. A partial listing of the most recent studies is appended to this statement.

In our previous statements to Congress on this matter, we stated our twofold concern. We share, first of all, the desire of all Americans that children be afforded diets that are high in nutritional value. The present school lunch program plays a valuable role in helping to assure this. It would be imprudent and, we think, unfair to the child to tempt him to ignore the well-balanced lunch available to him in favor of purchasing foods from vending machines that would be far less valuable in terms of his overall growth and development.

Secondly, we are concerned about the deleterious effect on the oral health of children that is the consequence of undue consumption of super-rich foods, many of which are commonly sold in vending machines.

Conclusive evidence has long been available concerning the hazards to dental health resulting from the undue consumption of sugars. The hazards are especially great among school-age children. The sale of sugar-containing drinks and other confections in schools through vending machines encourages the betweenmeal consumption of sugar-rich products.

Dentists have been bringing this evidence to the attention of their patients and the general public for decades. Sound oral health care involves disincentives against indulgence in sugar-rich snacks between meals, much less in place of wellbalanced meals. Uncontrolled placement of food and drink vending machines purveying such products militates against the efforts being made by dentists, parents and schools to teach good oral hygiene habits to children.

Various forces are exerted upon a child during his formative years with respect to diet. Those that favor good dietary habits include, or should include, parental training by both precept and example, dental health education courses in school and regular visits to the dentist. A child that has all these benefits is fortunate indeed. A child who lacks one or more of them is, of course, even more vulnerable than he otherwise would be to the development of bad dietary habits. The school experience, I think it can be agreed, it not a refuge from life but a preparation for it. Schools ought to be teaching their students about our total society, both its virtues and its drawbacks. But we don't think it is at all rational to desire or permit schools to themselves become a source of temptation toward the less satisfactory aspects of our life. It is irrational to ask a child to take a course in health education at 11:00 in the morning and; at noon, send him to a cafeteria where vending machines offer him an array of precisely those kinds of foods against which we just warned him.

As a child develops and approaches full maturity, it is true that he can rightfully expect to exercise greater freedom of choice at 16 than at 6. Again, however, that does not seem to our Association to be a sufficiently weighty argument to justify transforming the school into a source of supply for whatever some may desire if it distorts the central purpose of an educational institution.

It is also sometimes pointed out that the proceeds from vending machines sales are, in some schools, used for highly laudable purposes. That clearly poses a difficult problem. Every parent or parent-teacher group wants its school to have the finest equipment, resources materials and so forth. Schools are often hard pressed to find the funds to purchase what they should have. All of us, as citizens, need to be sympathetically alert to that need and be responsive in meeting it. When all is said and done, however, it is hardly defensible educational policy to tempt a child to injure his oral health in order for his school to have more athletic equipment or better band uniforms.

As in most situations, prudent choices must be made, the advantages and disadvantages of alternate choices must be weighed in the balance. However judged, machines that offer sugar-laden foods that injure oral health and offer no genuine nutritional advantage, seem to us to conflict with the intent of the School Lunch Program.

Before closing. I would like to quote in part from an article that appeared in the October, 1974 issue of the Oklahoma Dental Association Journal:

“Research during the past several decades has shown that there is a positive association between the amount and frequency of sugar eaten by children and their amount of tooth decay. When we consider the fact that elementary school

children in Oklahoma need a mean average of $65 each in dental care, the monetary cost of eating sweets between meals becomes apparent.

"The Oklahoma Public Health Association recently passed a resolution calling the attention of school administrators and local government officials to the need for protecting the health of school children by eliminating the sale of sugarrich food products from the schools. A typical response from school personnel has been, 'If we don't sell candy, the children just go across the street to get it, and maybe get run over. Why shouldn't we prevent accidents, and make money for ourselves by selling it in school?'

"If the school is not adequately supported and revenue must be obtained by supplementary methods, the sale of milk and fruit is preferable to the candy machines. Many students would buy milk, fruit juices, and fresh fruit in preference to candy and soft drinks if they had a choice.

"Candy and soft drinks are major sources of increased and 'empty' calories that contribute to overweight. When obesity is not corrected in childhood, the chances are poor for successful weight loss in adulthood. Infant mortality also is higher for offspring of mothers who are in a poor nutritional state.

"Parents, teachers, school administrators, and dental personnel should consider these questions:

-Is our belief in the need to control dental caries, obesity, and infant mortality important enough to stimulate a concerted effort toward the removal of candy and soft drink machines from schools?

-Do the higher costs of health and dental care resulting from a high intake of sweets outweigh the profits derived by schools from the sale of candy and soft drinks?

-Is it consistent to encourage the government to spend millions of dollars for school lunches, and then permit the schools to sell candy and soft drinks, which often compete with the sale of nutritious lunches?"

The American Dental Association strongly urges the inclusion of statutory authority to regulate the sale of food items in competition with programs authorized under the Child Nutrition Act. The Association supports S. 1309 introduced by Senator Case and hopes that these views will be placed in the permanent hearing record.

APPENDIX

RECENT STUDIES RELATING TO NUTRITION AND DENTAL HEALTH

William David, D.D.S., Lincoln, Nebraska: The Physical Character of Food as a Dietary Factor in Dental Caries Control; The Chronicle of the Omaha District Dental Society, Volume 33: Feb., 1969, Pages 179–180.

Eleanor J. Edmonds: Diet and Dental Health; Texas Dental Journal, Volume 88: May, 1970, Pages 21–22.

T. H. Grenby, BSC, Ph. D.: Some Aspects of Food and Dental Carics; Chemistry and Industry, Volume 28: September, 1968, Pages 1266–1270.

R. L. Hartles, Ph. D., DSC: Dietary Modification as a Means of the Control of Dental Caries: Dental Health, Volume 10: Autumn, 1971, Pages 47-51.

P. B. V. Hunter, BDS: Sugar and Dental Decay; School Dental Service Gazette, Volume 80: October 1970, Pages 59–60.

William H. Keeler, MD, MPH and John E. Higgins, D.D.S., Roanoke, Virginia; The Indiscriminate Distribution of Sweets to Children as Favors or Captive Purchases; Journal of the American Dental Association, Volume 75: October, 1967, Pages 903-907.

Ernest Newbrun, DMD, Ph. D.: Sucrose, The Arch Criminal of Dental Caries; Journal of Dentistry for Children, Volume 36: July-August, 1969, Pages 239–248. Abraham E. Nizel, D.M.D., MSD: Dental Carics: Protein? Fats and Carbohydrates; A Literature Review, New York Dental Journal, Volume 35: February, 1969. Pages 71-81.

J. D. Palmer, BDS, LDS; Dietary Habits at Bedtime in Relation to Dental Caries in Children, British Dental Journal, Volume 13: April 6, 1971, Pages 288-293.

Solomon N. Rosenstein, D.D.S.: Systemic and Environmental Factors in Rampant Caries; New York State Dental Journal, Volume 32: November 1966, Pages 400-406.

Gordon Stevenson, MS: Present Status of Programs to Control Dental Caries by Combining Lactobacillus Counts and Dietary Restriction of Carbohydrates; Journal of Dental Education, Volume 35: June, 1971, Pages 41-42.

G. B. Winter, MB, BDS, FDS, DCH: Sucrose and Cariogenesis; British Dental Journal, Volume 124: May 7, 1968, Pages 407-411.

Mr. THURSTON. Col. Ellsworth Reiss.

STATEMENT OF COL. ELLSWORTH C. REISS (RET.), PRESIDENT, NATIONAL ASSOCIATION OF STATE AGENCIES FOR FOOD DISTRIBUTION, TRENTON, N.J.

Colonel REISS. It is my pleasure as the president of the National Association of State Agencies to appear before your committee in regard to Federal food commodities as portrayed in S. 850.

Recently, an amendment to H.R. 4222, which is similar to S. 850, eliminated so much as pertains to cereals, oils and shortening which, in value, would be over and above the ten cents per meal in commodity or cash allowance. Of course, the full committee in the House voted 35 ayes and 2 noes on the commodity part. However, when the bill reached the House floor the food commodities were married to an amendment with a 25 cent ceiling on lunches. This price ceiling on lunches went down in an overwhelming defeat which included the

food commodities.

On page 45 of the House of Representatives Report 94-68 the minority views are as follows:

The other provision is one mandating the purchase of specified commodities, cereals, oils and shortening, at the 1974 level of purchase in addition to the level of commodity purchases, or cash in lieu of commodities, which are now ten cents a meal with an escalator clause which could go to 11.1 cents next year. The cost of this addition is $79 million. Aside from cost, we believe that this provision is extremely unwise. Once the Congress starts mandating the purchase of certain commodities as opposed to others there may be no end to such requirements, and the Department of Agriculture may well be put in the position of not being able to take best advantage of market conditions. The reason cercals, oils and shortening as net purchased last year is that the Department of Agriculture concentrated very heavily on the purchase of high protein items such as beef, cheese and other meats; thus, from a nutrition standpoint, this was highly desirable. Thus supplied, they could make their own purchases of cereals and oils.

Gentlemen, this viewpoint is well taken, and it convinced many of the members of the House; however, other major important data was almost totally excluded.

Recently the President of the United States, through the Secretary of Agriculture, increased foreign aid under Public Law 480 from $1 billion to $1.6 billion involving food support. Public Law 480 pertains to donations of farm products to foreign governments, intergovernmental and voluntary agencies, and the World Food Program to relieve hunger, and for military and political reasons. I have a letter dated October 1, 1974 from the White House indicating that for the past 20 years, $25 billion of food commodities has been shipped to needy people in all parts of the world.

For your information, the U.S. Department of Agriculture during fiscal year 1974 purchased over $81 million in grains and over $25 million in oils and shortening for our domestic programs. Out of this total purchase, approximately $49 million in grains and $20 million in oils and shortening pertained to school lunch and other related programs. This amounts to approximately 4 percent of the total export

program.

Gentlemen, do you think that Congress and the President can justify a $600 million increase in export programs and then turn down a $69 million request for our domestic programs? Is this beneficial to our taxpayers and to our domestic programs?