national tobacco control conference training session presented by ttac november 19, 2002

National Tobacco Control Conference Training Session

Presented by

TTAC

November 19, 2002

Today’s Objectives

• Describe TTAC training program for new employees and grantees

• Increase participants’ tobacco control knowledge to implement training programs in their state/ local organizations

• Identify areas for technical assistance

Introduction

Dearell Niemeyer Director, Tobacco Technical

Assistance Consortium

The Tobacco Technical Assistance Consortium

What is TTAC? What Does It Do?

What is TTAC?

• Unique not-for-profit organization

• National in scope

• Neutral in stance

• Flexible in approach

TTAC History

• Est. 2001 to provide state and local organizations with the necessary knowledge, abilities, tools and skills to succeed in reducing harm caused by tobacco

• Grant from the American Cancer Society, the American Legacy Foundation, and the Robert Wood Johnson Foundation

• Located in the Rollins School of Public Health at Emory University

TTAC Mission

Build capacity to achieve effective tobacco prevention and control programs and policies

TTAC Vision

Provide national leadership in technical assistance to strengthen community tobacco control programs

TTAC Services

• Provide training and technical assistance to state and local tobacco control programs and coalitions

• Maintain a cadre of skilled consultants available for on-site technical assistance

• Provide telephone consultation;• Improve coordination of technical

assistance among partner organizations

Guiding Principles

• Our environment reflects– Creativity– Inclusivity– Innovation– Continuous learning – Celebration of achievements

Guiding Principles (Cont’d)

• Our work is carried out openly, with a shared sense of :– Urgency– Spirit of respect, collaboration and trust– Enthusiasm– Commitment to public health principles and the

highest ethical standards

Philosophical Approach

• TTAC provides training and technical assistance to:– Increase knowledge and skills– Foster strong leadership– Increase organizational support– Strengthen partnerships

• The essence is capacity building

Partners

• CDC• SmokeLess States• Campaign for Tobacco-Free Kids• Latino Council on Alcohol and Tobacco• National African American Tobacco Prevention

Network• American Indian/Alaska Native support centers• Spaces available!!!

TTAC Assistance

• Technical assistance (eg, consultation, reviews)

• Information resources (especially web-based)

• Training support (planning, training activities, evaluation)

TTAC Provides Assistance On…

• Program development and implementation• Best practices and evidence-based

interventions• Program evaluation• Cultural competence, diversity and

inclusiveness• Strategic planning• Coalition building

TTAC Provides Assistance On…

• Long-term communication planning

• Advocacy development

• White Papers and legal research

• Resource identification

• Policy development and advocacy training

How Does Assistance Occur?

• Request is submitted via email, phone, or letter• TTAC staff responds and triages request• Technical assistance process begins, through

partners or through consultants• Work begins on activities• Project/activities end• TTAC receives report from consultant(s)• TTAC evaluates process and outcomes

Where You Come In

• Refer grantees or partners to us for assistance

• Refer possible consultants and experts to us to provide assistance

• Let us know what assistance you currently provide, and how we can complement your efforts

Contact TTAC

• Phone: 404-712-8474

• Email: [email protected]

• Via the web: www.ttac.org

Basics of Tobacco Control

What is BOTC? What Does It Do?

Basics of Tobacco Control

• What is it?– Tobacco control training program – Introduction to background issues

Web-Based Needs Assessment Response Rate 63.6%, N=35

Technology Is Available, Though Underutilized

3234 34

12 11

31

0

5

10

15

20

25

30

35

40

CD-ROM (n=32)

Internet (n=34)

Power Point(n=34)

Have

Use

21

30

21

4 4

14

0

5

10

15

20

25

30

35

CD-ROM (n=35)

Internet (n=35)

Power Point(n=35)

Have

Use

States Grantees

CD-ROM is the Biggest Opportunity

28

23

5

22

7 6

24

12

0

5

10

15

20

25

30

Hand outs(n=35)

Overheads(n=29)

CD-ROM(n=29)

Power Point(n=34)

Use

Desire to use

Purpose of BOTC

• Provide individualized training in a flexible format

• Address specific issues of tobacco control in priority populations

• Provide comprehensive resources in one location• Standardize tobacco control training for new

employees to tobacco control– Grantees– Community level– State level

BOTC Content

IntroductionTermsEvolutionMSAPartners

ScienceDocumentsHazards PrevalenceIndustry

Foundation Social changePopulation Based Advocacy Goals/objectives

ResourcesGlossaryDocumentsLinks

Evaluation Assessment Usability

Comprehensive and Accessible

• BOTC simplifies and integrates complex information

• BOTC is practically focused• BOTC is user friendly

– Multi-dimensional format – Minimum hardware requirements– Adjustable user features– Self assessment

Special Features

• User control of training experience

• Audio and video enhanced content

• Practical examples from experts in the field

• Pre-loaded with all necessary software

• Assessment feedback

Session Overview

Johanna M. Hinman, MPH, CHESProgram Coordinator

Session Overview

• Tobacco Control Milestones

• Translating the Science Into Practice

• Making a Difference

Milestones in Tobacco Control

Perry Stevens, MPA

Consultant

Tobacco Control Timeline

1945

1955

Relationship between cigarette smoking and diseases, including lung cancer established Industry CEOs formulate “an industry response” with a concerted “public relations campaign intended to preserve their profits” “A Frank Statement to Cigarette Smokers” refuted the findings of the scientific community and glorified the history of tobacco use in America Industry secretly engaged in the “Gentleman’s Agreement”

• Companies to share discoveries re: a “safe cigarette” • No in-house biomedical research on animals


1958

1963

Creation of the Tobacco Institute (a.k.a) “the open question” debate PM concluded that a “medically acceptable low-carcinogen cigarette may be possible” (but never releases the research) PM internally discussed methods for increasing the nicotine content of cigarettes B&W general counsel stated that “nicotine is addictive” and that “we are… in the business of selling nicotine, an addictive drug”


1963

1964

The Surgeon General prepared the first report on smoking and health; asks for cooperation of the Tobacco Companies, but it is withheld

The Liggett Company joined the Tobacco Industry Research Committee and the Tobacco Institute

Recommendation by PM R&D VP: “the industry should abandon its past reticence with respect to medical research. Indeed, failure to do such research could give rise to negligence charges.”


1965

1970

Limited performance of biological research begun, but the Gentleman’s Agreement otherwise remained intact

- Reynolds researched the mechanisms of emphysema using mice, nicknamed “The Mouse House”- Reynolds dismantles and destroys all records after PM complains

PM purchased a research facility in Cologne, Germany (INBIFO)

- Repository for information and files- To avoid discovery of adverse documents in times of litigation in the US


1970

1984

Study of smoke exposure on hamsters indicated that cigarettes were addictive and caused cancer; funding threatened by The Council for Tobacco Research (CTR) if published B&W memo discussed the addictiveness of nicotine, characterized nicotine as a poison, and noted consumer naivety PM internal memo re: the psychopharmacology of nicotine noted that company lawyers did not want the research to become public because it would support regulation by the FDA Philip Morris studied the effects of nicotine on the behavior of rats to research potential nicotine analogues; found “nicotine looked like heroin”


1988

1994

U.S. Surgeon General reports: “… tobacco addiction…similar to …heroin and cocaine” Dramatic rise in teenage smoking after Reynolds begins a massive dissemination of “Joe Camel”, which was designed to counter the “Marlboro Man” Reynolds instructed its advertising agency to destroy documents in their possession related to the “Joe Camel” campaign to avoid full disclosures of its practices Tobacco CEOs testified under oath before the Congressional Health Subcommittee that nicotine was not addictive


1995

2002

“The Tobacco Whistleblower” provides State of Mississippi Tobacco Litigation landmark testimony regarding the attempts of the tobacco industry to deceive, manipulate and evade the public

Tobacco companies entered into a “Master Settlement Agreement” with 46 State Attorney Generals in an effort to achieve a “significant reduction in youth tobacco use”

TTAC Est.

Science into Practice: Making the Most Out of the Work of Others

Kathleen R. Miner, Ph.D., MPH, CHES Associate Dean for Applied Public Health

Universities are full of knowledge; the incoming students bring in a little and the graduates take none away, thus knowledge accumulates.

Adapted from: Abbott Lawrence Lowell

Challenges to Decision Making in Public Health1. Lack of alternatives: funding/regulatory

restrictions2. Decision paralysis: analyzing minutiae3. International competition: organizational caps

(FTEs, % increases or decreases)4. Impatience: solving the wrong problem5. Involving the wrong people: we make the

decisions, they do the work6. Data doubting: questioning the credibility of data

to avoid making the decision

“A great many people think that they are thinking when they are merely rearranging

their prejudices.”

William James

Sources of Credible Evidence

Program surveillance data Information management Products Fiscal expenditures

Qualitative data Stakeholder impressions Social evidence

Quantitative dataPopulation health statusBehavior changeEconomic indicators

Defensible

instrumentation

Defensible

methodology

Plausible linkages

Theory

“If the world was a logical place, it would be men that

ride side saddle”

Rita Mae Brown

Role of Theory

Theory provides:1. provides context to evidence2. links one type of evidence to another type3. connects the dots among similar programs4. extrapolates short change to longer term change 5. encourages the feedback from practice to

theory.

Sources of Information

The Program’s Own Logic Peer Reviewed Literature

On Tobacco On Similar Populations On Same Theoretical Principles On Same Organizational Settings


Government PublicationsReducing Tobacco Use: A Report of the

Surgeon General Guide to Community Preventive Services:

Tobacco Use Prevention and ControlCDC’s Best Practices for Comprehensive

Tobacco Control Programs CDC’s Tobacco Control Program Goal AreasState Specific Documents


Professional Publications APHA AMA NACCHO and ASTHO

Panel of Experts National Databases Proprietary Data


Primary Data Collection– Medical, Hospital, and Personnel Records– Physician Visits and Charges– Program Records– Surveys (behavioral, opinion, market)– Case Studies (most similar, least similar,

typical, atypical) – Focus Groups

“If you are not a part of the solution, then you must a part of the precipitate.”

Steven Wright

Industry Tactics

Perry Stevens, MPA

Consultant

The Nine “D’s” of Tobacco Industry Survival

1. Deny the health consequences of smoking

2. Deceive consumers about the true nature of cigarettes through marketing and public relations

3. Damage the credibility of industry opponents

4. Direct advertising to women and youth, in addition to men, to maximize sales volume

5. Defeat attempts to regulate the industry or control smoking

Source: Cunningham, Rob. Smoke and Mirrors: The Canadian Tobacco War. 1996.

The Nine “D’s” of Tobacco Industry Survival (Cont’d)

6. Delay legislation if it can't be defeated

7. Destroy legislation once it passes

8. Defend lawsuits filed against the industry

9. Develop new markets around the world

Source: Cunningham, Rob. Smoke and Mirrors: The Canadian Tobacco War. 1996.

Industry Tactic #1

• Keep tobacco use from being discussed in terms of the public’s health – Try to frame tobacco use as anything but an

issue of public health– Turn the tobacco issue into an individual rights

issue to change the subject – Try to shift the focus from science-based

evidence to personal freedom

Industry Tactic #2

• Undermine public health messages about the dangers of tobacco use through deception, misdirection, and manipulation of the facts – “Industry experts” interpret and misuse science

to muddy the waters about the deadly effects of tobacco use

Industry Tactic #3

• Discount the facts and data on the harm caused by secondhand smoke – 3,000 non-smokers die in the U.S. each year

from lung cancer caused by other people’s smoking

– 64,000 non-smokers die every year in the United States from heart failure caused by other people’s smoke

Source: 2000 SGR, Reducing Tobacco Use, CDC

Industry Tactic #4

• Divert attention from tobacco profits by heavily publicizing its charitable giving and support of community services – In 1999, Philip Morris gave $60 million dollars

to charities then spent $100 million dollars on advertising to publicize its generosity

Source: Robert Dreyfuss, “Philip Morris Money.” The American Prospect v11 n10, March 27, 2000

Industry Tactic #5

• Perpetuate the myth of a “safer cigarette” – Light, ultralight, and low tar brands were

introduced and marketed to provide smokers an alternative to quitting

– Intended to prevent smokers from quitting– Ingenious and effective

Source: Smoker Perceptions of ‘Light’ and ‘Low Tar’ Cigarettes” published by Campaign for Tobacco Free Kids

Industry Tactic #6

• Highlight youth prevention efforts to offset the perception that tobacco companies are death merchants– For instance, Philip Morris has run a highly visible

campaign, including a TV ad during the Super Bowl, which urged parents to talk to their kids about not smoking

– However, one study indicates that while the industry is telling parents to talk to their kids…through their marketing, they’re telling the kids to rebel, assert their independence, and take some risks

Source:“New Study Shows Tobacco Marketing Undermines Good Parenting Practices” 07/16/02, by the Campaign for Tobacco Free Kids

Industry Tactic #7

• Introduce alternative nicotine delivery devices, or “smoke and mirror” products – Cleverly marketed to play on the public’s

health concerns; addict new users who believe they are making a healthier choice

– No government regulation of these products – No substantiation for claims they pose any less

risk than more familiar tobacco and nicotine products

Source: “New Tobacco Products—Lower Risk or More of the Same?” published by the Campaign for Tobacco Free Kids

Industry Tactic #8

• Advertising and Promotions– An all time high of $9.57 billion was spent on

cigarette advertising and promotion in 2000– Represents an increase of 16.2% from the $8.24

billion spent in 1999, and of 42.2% from the $6.73 billion spent in 1998

Source: Federal Trade Commission Cigarette Report for 2000

“Preserve the industry's freedom…”

Givel M. Tobacco lobby political influence on US state legislatures in the 1990s. Tob Control 2001;10:124-134

"Industry volume will be negatively affected by increasing smoking restrictions, the decreasing acceptability of smoking and increasing excise taxes. Corporate affairs will use direct lobbying, the media, and industry allies to minimize state and local tax increases, promote accommodation in public places and preserve the industry's freedom to advertise and promote cigarettes to adult smokers."

Industry Tactic #9

• Test market new products in various cities around the country – Be on the lookout to determine if a new product

is being promoted in your area– Indiana produced a print ad to counter test-

marketing of a new tobacco product in Indianapolis

Industry Tactic #10

• Target young adults– From 1993 to 2000, substantial reductions in

current smoking prevalence were reported for all age groups, except 18-24 years

– This group is particularly responsive to “Retail value added” products, "buy one, get one free," and other offers

Sources: MMWR 07/26/02, Vol. 51, No. 29; Federal Trade Commission Cigarette Report for 2000

Industry Tactic #11

• Lobby the U.S. Congress – Argue against state and local legislation to

restrict smoking and to support the passage of state laws that preempt stronger local ordinances

– Spent over $43 million in lobbying in the first six months of 1998 alone

Sources: 2000 SGR, CDC fact sheets; "Blowing Smoke: Big Tobacco's 1998 Congressional Lobbying Expenses Skyrocket" by Public Citizen

Industry Tactic #12

• Contribute “soft money” to the 2 political parties – From 1995 to 2001, tobacco companies

contributed more than $20 million to the parties, and nearly half that came from Philip Morris

• $3 million to Democrats

• More than $17 million to Republicans

Source: Common Cause's Soft Money Laundromat

Industry Tactic #13

• Support bans on clean indoor air laws – The industry waged a tremendous battle against

an Environmental Protection Agency report revealing the dangerous health effects of secondhand smoke

Source: “Tobacco’s Secondhand Science of Smoke-Filled Rooms” by Rampton and Stauber. Center for Media and Democracy. PR Watch v7n3, 2000

Industry Tactic #14

• Target minority newspapers and other publications; gain financial reliance– Many minority publishers rely on tobacco

companies for advertising revenue– This reliance reduces the likelihood that these

companies be held accountable

Industry Tactic #15

• Back so-called “independent” research organizations – For example, the Cato Institute:

• Published policy reports calling the MSA unconstitutional

• Challenged the validity of CDC research that determined more than 400,000 deaths in the U.S. each year are due to smoking-related illnesses

Sources: “Constitutional and Antitrust Violations of the Multi State Tobacco Settlement” by Thomas C. O’Brien, 05/18000; “Lies, Damned Lies, and 400,000 Smoking-Related Deaths” published in Regulation v21 n4)

Industry Tactic #16

Prevent Regulation of Tobacco • Tobacco ingredients remain protected as trade

secrets and are not regulated by the FDA• The labels 'light,' 'ultralight', and 'low tar' continue

to be used even though the terms are not based on the actual known properties of the cigarettes

• The FDA is still unable to regulate tobacco products although the nicotine in cessation products is regulated

Industry Tactic #16 (Cont’d)

• The industry continues to successfully oppose attempts to make information about its products available to the people who use them

• Anything we know about the constituents of secondhand smoke has been learned from analysis of the smoke by non-industry scientists

• Until these products are regulated, it will be impossible to prevent the industry from continuing to profit at the expense the public’s health

Industry Tactic #17

• Sponsor industry meetings– Invite reputable tobacco control scientists and other

professionals to take part in industry-sponsored meetings

– For instance, in August 2002: Philip Morris funded the Life Sciences Research Office to conduct a meeting on the “relative health risks of non-tobacco ingredients added to cigarettes”

– Tobacco control forces, including the Campaign for Tobacco Free Kids, mobilized to educate potential participants that they will be manipulated

Source: Campaign for Tobacco-Free Kids, memo to Tobacco Control Community, 7/22/02

Making a Difference

Dearell Niemeyer Director, TTAC

Kathy HartyTechnical Assistance Specialist Consultant

The first step is not action; the first step is understanding.

“Communities must change…”

Source: Centers for Disease Control and Prevention. Best practices for comprehensive tobacco control programs – August 1999. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, August 1999.

“To achieve the behavior change that supports the nonuse of tobacco, communities must change the way tobacco is promoted, sold, and used while also changing the knowledge, attitudes, and practices of young people, tobacco users, and nonusers.”

0

1,000

2,000

3,000

4,000

5,000

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990

Nu

mb

er

of

Cig

are

tte

s

Source: USDA; 1986-2000 Surgeon General's Reports

Great Depression

End of WW II

Nonsmokers’Rights Movement

Begins

1st SurgeonGeneral’s Report

Fairness DoctrineMessages on TV and Radio

Federal CigaretteTax Doubles

BroadcastAd Ban

Tobacco Control Policies WorkTobacco Control Policies WorkAdult Per Capita Cigarette Consumption and Major Smoking-and-Health Adult Per Capita Cigarette Consumption and Major Smoking-and-Health Events--United States, 1900-1999Events--United States, 1900-1999

MasterSettlementAgreement

NicotineMedications Available Over the Counter

1st Smoking-Cancer Concern

1st World Conference

on Smoking and Health

Surgeon General’sReport on EnvironmentalTobacco Smoke

1st Great American Smokeout

"The problem of today cannot be solved at the same level of thinking that created them."

- Albert Einstein

Federal programs, national partners,

litigation and other inputs

Inputs Activities Outputs Short-term Intermediate Long-term

Counter-marketing

Exposure to no-smoking and pro-health messages

Changes knowledge, attitudes and

behaviors

Smoking denormalized

Decreased smoking

Outcomes

State tobacco control

programs

Community and state

partners and organizations

Communitymobilization

Policy & regulatory

action

Effortstargeted todisparate

pops

Increase availability and use of cessation

and related services

Training andprofessionaldevelopment

Creation of smoking bans,

and no-smoking regulations and

policies

Community and state

partners and organizations

Reduce initiation among youth

Increase cessation among youth &

adults Reduce exposure to

ETS

Reduced tobacco-related

morbidity & mortality

Increased environments with

no smoking

Tobacco Prevention and Control Logic Model – OverviewGoal: Decrease Smoking

Decreased tobacco-related

disparity

Making a Difference

• Systems Change

• Legislation & Policy Making

• Your Information System

Guide to Community Preventive Services

• Provides scientific evidence for which tobacco control interventions do/don’t work

• Allows state and local programs to focus time and resources efficiently and effectively

• Lets state and local programs know which efforts to avoid

Primary Sources for Evidence- Based Strategies• Reducing Tobacco Use: A Report of the Surgeon

General• The Guide to Community Preventative Services:

Tobacco Use Prevention and Control• Treating Tobacco Use and Dependence: Clinical

Practice Guideline• Best Practices for Comprehensive Tobacco

Control Programs

Rationale for Evidence-Based Interventions• Policies are interventions

• Polices are effective interventions

• Evidence is available

• Evidence supports adoption

Policies are Interventions

Policy Intervention

Reduce Exposure to ETS

Increase Cessation

Reduce Initiation

Reduced Morbidity

&Mortality

Source: California State Board of Equalization (packs sold) and California Department of Finance (population). U.S. Department of Agriculture. Note that CA data is by fiscal year (July 1-June 30) and U.S. data is by calendar year. Prepared by: California Department of Health Services, Tobacco Control Section, June 2000.

Pac

ks/P

erso

n

Smokers Smoke LessCalifornia and US Cigarette Consumption Packs Per Fiscal Year, 80/81 - 00/01

US

0

50

100

150

200

CA 162.3 158.8 152.5 144.6 141.4 136.4 131.1 126.6 112.6 103.2 94.7 91.1 84 79.3 77.5 74.8 72.7 69.2 61.3 50.6

US 192 187.7 175.1 173.1 168.5 163.7 159.9 154.8 146.3 141.3 136 132.1 127.2 126.2 125.3 124.1 121.1 116 106.8 101.5

80/81 81/82 82/83 83/84 84/85 85/86 86/87 87/88 88/89 89/90 90/91 91/92 92/93 93/94 94/95 95/96 96/97 97/98 98/99 00/01

CA

Smoking Among Adults DeclinesAdult Smoking Prevalence

1977-2000 California and US

0

5

10

15

20

25

30

35

40

Perc

en

t

US CA

Sources: United States--NHIS, US Centers for Disease Control and Prevention; California--CTS, 1990, 1992-3, 1996, weighted to 1990 CA population; CATS/BRFS, 1994-2000, weighted to 1990 CA population. Prepared by: California Department of Health Services, Tobacco Control Section.

Tax Increase and Start of

the CA Tobacco Control Program

* Definition change in 1996 resulted in more “occasional smokers” being counted.

*

77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00

One Team’s Victory is Another’s Loss…

“In California our biggest challenge has not been the anti-smoking advertising created with cigarette excise tax dollars. Rather, it has been the creation of an anti-smoking infrastructure, right down to the local level. It is an infrastructure that for the first time has the resources to tap into the anti-smoking network at the national level.”

— Philip Morris, Overview of State ASSIST programs, undated

Source: PM document 2021253353/3357

Analysis of InterventionsIntervention

Designed To

Strongly

Supported

Tactics

Sufficiently

Supported

Tactics

Insufficiently

Supported

Tactics*

Reduce Youth Initiation

•Increasing the unit price for tobacco products

•Mass media campaigns**

•School-based education programs based on the social influence resistance model

•Community

•Youth access restrictions

•Peer-based interventions

•Penalties for possession and use by minor

•School policies to prohibit tobacco use on school grounds

*Does not mean the they have been found to be ineffective, rather there was insufficient evidence to conclude effectiveness**When combined with other interventions

Analysis of Interventions

Intervention

Designed To

Strongly

Supported

Tactics

Sufficiently

Supported

Tactics

Insufficiently

Supported

Tactics*

Reduce ETS

Exposure

•Laws and ordinances that ban smoking in public buildings, worksites etc.

•Community education on ETS exposure in the home

*Does not mean the they have been found to be ineffective, rather there was insufficient evidence to conclude effectiveness

Analysis of Interventions

Intervention Designed To

Strongly

Supported

Sufficiently

Supported

Insufficiently Supported*

Increase Cessation

•Provider counseling to patients, including brief advice

•Health Care system interventions to assess for tobacco use and counseling to patients

•Pharmacologic treatment of nicotine addiction•Increase the price (tax) •Mass media campaigns**•Telephone Quit lines**•Smoking bans

•Reminders to prompt providers to discuss cessation with patients

•Reduced out-of-pocket costs for effective cessation therapies

•Mass media cessation series

•Cessation contests using mass media for promotion

•Provider education on tobacco and cessation

•Smoking cessation programs for youth

*Does not mean the they have been found to be ineffective, rather there was insufficient evidence to conclude effectiveness**When combined with other interventions

Evidence-Based Lessons

• Focus the program where change must take place

• Provide sharply focused RFPs with clear indications of types of activities needed

• Link local programs to overall goals

• Provide assistance in proposal writing preparation

Evidence-Based Lessons

• Provide ongoing technical assistance and training

• Link local programs to statewide media campaigns and state media advocacy activities

• Maintain flexibility to allow local agencies to adjust to unforeseen developments

“Never doubt that a small group of thoughtful citizens can change the world. Indeed, it’s the only thing that ever has.”

- Margaret Mead

The Art of Tobacco Control

• Highlight advocacy, policy, and politics

• Promotes issues to influence policy-makers

• Encourages social change

• Educates the public

• Sways public opinion

• Influences policy makers

Tobacco control is not about changing an information gap; its about changing a power gap

Tobacco Industry Hates…

• Clean indoor air

• Aggressive media campaigns

• Community-based programs that undermine the social acceptability of tobacco

• Tax increases

Tobacco Industry Accepts…

• Youth access programs

• School programs

• Comprehensive health education

• Pregnant women should not smoke

Politicians Respond to 2 Things …

1. Money …

2. … and pain

…. And you don’t have any money

Politicians Must…

• Fear and respect you

• Worry about what crazy thing you will do next

• Know that you do not care what they do to your other programs

The Tobacco Industry Has Learned…

• It is getting better at hiding

• It owns the Republican Party and rents the Democrats

• It has totally infiltrated:– Hospitality industry– ASHRAE and ventilation– Grocers associations

Beating the Tobacco Industry

• Leverage the public (public health’s best asset)

• Keep the fight public and the public engaged

• Confront tobacco industry groups that work in the shadows and through intermediaries and force them away from the tobacco industry


• Early phases of tobacco control implementing legislation are very important

• Bad precedents, once set, are exceptionally hard to reverse

• Avoid compromises early in the process

• Do not be afraid of controversy; use it


• Press for and defend high-quality programs

• Beware of reasonable sounding compromises in the anti-tobacco program, even when these suggestions come from “friends” in the health department


• The battle does not end when a tobacco control initiative is passed

• The battle does not end when Legislature enacts implementing legislation, even if it is a good bill

• The battle does not end when the health department or schools implement a good program

• The battle never ends….


• Coalitions are a good thing

• But leadership is more important

Leadership is Not Tidy

Most of the time most things are out of hand. No leader enjoys that reality, but every leader know it.

Thank you!