state tobacco lobbyists and organizations in the united states

Public Health Briefs

State Tobacco Lobbyists andOrganizations in the United States:Crossed LinesAdam 0. Goldstein, MD, and Nathan S. Bearman

IntroductionOver the last 10 years, communities

across the United States have passedtobacco control measures that regulateenvironmental tobacco smoke exposure.'However, broad public support for to-bacco control initiatives has not translatedinto sustained increases in comprehensivestate or federal tobacco control legisla-tion.2.3

On the other hand, the tobaccoitO' . '?',,'industryremains exceptionally competent

in defeating most state tobacco controllegislation.4 Legislators from tobacco-producing states block most federal to-bacco legislation. Research has shownassociations between federal and statelegislators who accept campaign contribu-tions from the tobacco industry and theirvotes on tobacco legislation.56 Whilewell-organized antismoking coalitions as-sist the passage of tobacco control legisla-tion, no states have coalitions with thebudget, experience, and resources tomatch the tobacco industry.4'7

Tobacco lobbyists are frequentlymentioned as important agents influenc-ing the outcome of tobacco-related legisla-tion.8-11 When tobacco measures areconsidered in state legislatures, tobacco

.. ..

control coalitions may have one part-timelobbyist, whereas tobacco organizations

.i...........may have full-time lobbyists. There is littleresearch, however, to document the ex-

... tent of tobacco lobbying activity occurringat the state level.

The primary goal of this study was todetermine the total number and character-istics of tobacco lobbyists employed nation-ally at the state level by tobacco organiza-tions. We also determined the number ofhealth lobbyists employed by health orga-nizations, and, because most tobaccolobbyists represent more than one organi-zation, we examined how many tobacco

industry lobbyists lobby simultaneouslyfor tobacco and health organizations.

MethodsIn 1994, we obtained publicly avail-

able lobbyist data from all 50 US states.Lists were sent free of charge or werepurchased from the appropriate agency(e.g., state ethics bureaus, election boards).Lists categorized lobbyists with their re-spective organizations and/or alphabeti-cally by organization.

Two principal types of informationwere obtained from these lists: informa-tion on lobbyists (individuals who lobbyon behalf of a private or public organiza-tion) and information on the private- orpublic-interest organizations representedby lobbyists (e.g., Philip Morris, statemedical society).

From these lists, we created severalvariables. The first was total number oflobbyists in a state. If a lobbying firm waslisted without specifying the individuallobbyist, the lobbying firm was counted asonly one lobbyist, producing an underesti-mate of the total number of lobbyists. Thesecond variable was total number oforganizations (e.g., corporations, associa-tions) that employed lobbyists. We werenot able, through the sources used in thisstudy, to distinguish whether lobbyistsworked part or full time. The third

The authors are with the Department ofFamily Medicine and the Cecil Sheps Centerfor Health Services Research, University ofNorth Carolina, Chapel Hill.

Requests for reprints should be sent toAdam 0. Goldstein, MD, CB#7595, Depart-ment of Family Medicine, University of NorthCarolina School of Medicine, Chapel Hill, NC27599-7595.

This paper was accepted April 9, 1996.Editor's Note. See related editorial by

Fielding (p 1073) in this issue.

American Journal of Public Health 1137

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TABLE 1 Total Number of State Health and Tobacco Lobbyists In theUnlted States, 1994

Mean No.Organizations

Total No. (%) Total No. (%) EmployingTotal No. Tobacco Health Each Tobacco

State Population Lobbyists Lobbyists Lobbyists Lobbyist

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

TotalMean/stateRange

4 062 608 321551 947 255

3 677 985 1 3002 362 239 27329 839 250 1 284

3 307 912 3693 295 669 632668 696 250

13 003 362 2 2926508419 9161 115 274 2551 011 986 280

11 455 682 4 2225 564 228 5002 787 424 6022 485 600 6163 698 969 6414 238 216 5651 233 223 2504 798 622 4906 029 051 5579 328 784 8004 387 029 1 3542 586 443 2555137804 2024803 655 824

1 584 617 3761 206 152 5951 113915 1907 748 634 2701 521 779 1 09718 044 505 1 8546 657 630 512641 364 451

10 887 325 1 2233 157 604 4892 853 733 50011 924 710 6721 005 984 3283 505 707 331699 999 339

4 896 641 46517 059 805 1 9371 727 784 559564 964 317

6216568 13044 887 941 1 4541 801 625 5004 906 745 614455 975 664

49 022 783 39 4684 980 456 789

. . . 190-4 222

6 (2)3 (1)10 (1)2 (1)

21 (2)13 (4)11 (2)5 (2)17 (1)6 (1)7 (3)4 (1)10 (<1)10 (2)6 (1)7 (1)7 (1)7 (1)9 (4)8 (2)7 (1)

11 (1)25 (2)4 (2)13 (1)10 (1)6 (2)7 (1)4 (2)6 (1)3 (<1)9 (1)13 (3)11 (2)11 (1)5 (1)6 (1)16 (2)8 (2)9 (3)4 (1)

11 (2)7 (<1)

16 (3)14 (4)12 (1)9 (1)5 (1)

12 (2)7 (1)

450 (1)9 (1)2-25

25 (8)11 (4)87 (7)13 (5)89 (7)41 (11)106 (17)19 (8)

183 (8)45 (5)11 (4)33 (12)280 (7)26 (5)59 (10)42 (7)35 (6)16 (3)14 (6)52 (11)56 (10)

235 (29)63 (5)18 (7)

201 (10)44 (5)39 (10)31 (5)19 (10)66 (1)32 (3)75 (4)46 (9)27 (6)108 (9)36 (7)24 (5)186 (28)13 (4)32 (10)23 (7)69 (15)94 (5)27 (5)32 (10)57 (4)45 (3)43 (9)62 (10)9 (1)

2 999 (8)60 (8)9-280

174172

29261920147

5561216

85131626

633151128413156

42

588891310187107161871067485

62313

2-42

Note. Population data were derived from the 1990 US Census.

variable, tobacco-related organizations,pertained to the name of an organizationwhose principal function was related to

tobacco interests. Each tobacco organiza-tion in a state was counted once. Whenthe same organization existed in two or

more states, that organization was countedseparately (e.g., Philip Morris has lobby-ists in most states). The fourth variablewas total number of tobacco lobbyistsemployed by the corresponding tobacco-related organizations. From this variable,we computed the total number of lobby-ists in each state and the United States asa whole. The mean number of tobaccolobbyists per tobacco organization withinand across all states was derived bydividing the total number of tobaccolobbyists by the total number of tobaccoorganizations. The fifth variable, numberof lobbying organizations per lobbyist,represented the total number of organiza-tions in a state represented by an indi-vidual tobacco lobbyist. From this vari-able, we computed the mean number oflobbying organizations that tobacco lobby-ists worked for within a state.

We also examined the number ofhealth lobbyists representing health-related organizations in states. We de-fined health lobbyists broadly to includeorganizations lobbying for physicians, den-tists, nurses, hospitals and voluntary healthassociations, pharmaceutical companies,allied health organizations, and otherhealth care corporations. Finally, werecorded the number of health organiza-tions that employed a lobbyist who alsolobbied for the tobacco industry.

Microsoft Excel (version 4.0) descrip-tive and comparison statistics were usedin recording and analyzing data.

ResultsLobbying lists revealed that, in 1994,

a total of 36 468 lobbyists were active at astate level for one or more organizations.Of these lobbyists, 450 (1%) representedtobacco-related organizations (Table 1).All states had tobacco lobbyists (mean perstate = 9, range = 2 to 25). Each tobaccolobbyist worked, on average, for 13 lobby-ing organizations (range = 2 to 42). Incomparison with the 450 lobbyists work-ing for tobacco organizations, there were2999 lobbyists (8%) working for health-related organizations. States had an aver-age of 60 health lobbyists (range = 9 to280).

The distribution of health lobbyistsby their primary affiliated health organiza-tion showed that hospitals, hospital asso-ciations, and health care associationsrepresented 52% of all health lobbyingorganizations, with 1546 employed lobby-ists. Professional medical associations,academic medical centers, and medicalassociations employed 806 health lobby-

1138 American Journal of Public Health

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ists, or 27% of all such lobbyists. Publichealth societies, nursing associations, andother health groups employed 631 healthlobbyists (21%). In only nine states,representing a total of 16 lobbyists, was

there a health lobbyist who was lobbyingfor an organization whose primary mis-sion was the reduction of tobacco con-

sumption.Three hundred three health organiza-

tions employed lobbyists who also repre-

sented tobacco organizations (Table 2).Five major categories of health organiza-tions stand out as employing such lobby-ists: physician professional associationsand societies; hospitals, hospital associa-tions, and health care associations; phar-maceutical organizations; optometry andchiropractic associations; and medical/health care corporations. States had, on

average, 6 health-related organizationsthat employed tobacco lobbyists. Tenstates (Michigan, New Jersey, Tennessee,Missouri, Ohio, Louisiana, Florida, Ari-zona, Alabama, and Maryland) had 10 or

more health organizations that employedsuch lobbyists. Of all tobacco lobbyists,220 (49%) also worked as a lobbyist for atleast one health-related organization.

Figure 1 displays the total number ofstate tobacco lobbyists by tobacco organi-zation. Four tobacco organizations-Philip Morris, the Tobacco Institute, RJReynolds, and the Smokeless TobaccoCouncil-employed 87% of the 450 to-bacco lobbyists. Philip Morris and theTobacco Institute had lobbyists in all butfour states.

Discussion

Our research shows that the tobaccoindustry had at least 450 state-levellobbyists working on tobacco-related legis-lation in 1994. These lobbyists had a

presence in all US states, and 20 stateshad 10 or more tobacco lobbyists. In andof itself, this number is perhaps not toosurprising, particularly since tobacco com-panies have strong financial interests intobacco legislation. For instance, PhilipMorris and RJR Nabisco had combinedprofits in 1994 of more than $5 billion onrevenues of more than $80 billion.'2"13

Tobacco industry lobbyists also lobbyfor an average of 13 organizations, includ-ing tobacco, advertising, insurance, vend-ing machine, alcohol beverage, restau-

rant, convenience store, bank, and other

agencies. These alliances offer the indus-

try a chance to attach its interests more

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broadly to groups that otherwise may ormay not have an interest in the outcomesof tobacco control legislation.

However, despite the seemingly largenumber of tobacco lobbyists at a statelevel in the United States, there are seventimes as many health lobbyists as tobaccolobbyists. Some of these health organiza-tions have taken active roles in lobbyingfor stronger tobacco control legislation,but most have many interests other thanthe prevention of tobacco-related dis-eases.4.8 Since such organizations have anability to join in lobbying efforts that willallow for more effective tobacco controlcoalitions, and since tobacco control coali-tions that are well organized have greaterpotential to counter activities of tobaccoindustry lobbyists, public health advocatesshould encourage all health organizationsto devote a portion of their lobbyingefforts to supporting broad-based tobaccocontrol efforts.4'7

Given that there are a very largenumber of health lobbyists and thattobacco lobbyists represent many differ-ent organizations, it is also perhaps notsurprising that many tobacco lobbyistsalso represent health organizations. How-ever, important ethical questions areraised by the fact that almost one of everytwo tobacco lobbyists also lobbies for ahealth organization, along with the factthat more than 300 health organizationsin the United States employ on theirbehalf a lobbyist who also works for thetobacco industry. Moreover, our estimateof the number of health-related organiza-tions with such a conflict is conservativebecause we excluded from considerationorganizations such as insurance compa-nies that have health-related and non-health-related missions.

Health organizations that employtobacco industry lobbyists are faced withpotential or real institutional conflicts ofinterest. Therefore, it is incumbent onhealth organizations and their constitu-ents to know the details of all lobbyingand financial arrangements. Other re-searchers have pointed out the ethicalinconsistencies for health organizationsthat invest in tobacco industry stocks.'4Our research shows that such inconsisten-cies extend across the United States andthroughout many health care organiza-tions.

Lobbyists who work for both healthand tobacco organizations also have poten-tial and real individual conflicts of inter-est. Such lobbyists are not likely to lobby

Philip MorrisTobacco Institute

R.J. ReynoldsSmokeless Tobacco Council

Candy & Tobacco DistributorsCigar Association

Pipe Tobacco AssociationTobacco Wholesalers

U.S.Tobacco CompanyBrown & Williamson

American TobaccoLorrilard Tobacco Company

Othero 3) O 0 U0 D

FIGURE 1-Total number of state tobacco

on behalf of health organizations for any

tobacco use reduction measure for fear ofoffending their tobacco employer. Whileofficials of the American League ofLobbyists do not think that this representsa conflict of interest, they do think that itis inconsistent for a lobbyist to lobby forboth tobacco and health organizations.'5Lobbyists have a minimum duty to informnew and existing clients of potentialconflicts to allow for more honest delibera-tions.

The potential adverse effects on

public health of such conflicts of interestwere demonstrated recently in Florida,where lawmakers had passed legislationin 1994 making it easier for the state to

pursue its $1.4 billion lawsuit on recover-

ing Medicaid expenses for smoking-related illnesses. A bill to repeal thelegislation passed the Florida state senatein April of 1995, supported by a 53-member lobbying team assembled by thetobacco industry.'6 Two thirds of thetobacco industry lobbyists also repre-

sented hospitals and health insurancecompanies. The lead lobbyist for PhilipMorris at the time reported that "wewanted to have the first team, the bestpeople we could possibly find.... Wedidn't care about their other clients."'6 Byhiring health lobbyists to work for thetobacco industry, the industry assureditself of detailed information about impor-tant health care bills, thus allowing it to

"try to pass [bills] in every conceivableform at every conceivable opportunity."'6

Limitations to our analysis primarilystem from the source of the data. Some

lobbyists, by organization.

states have different procedures and for-mats for recording lobbying information,thus making it less accurate to use

lobbying lists for comparisons betweendifferent states. It is also impossible to

determine from the lobbying lists whetheror not lobbyists work part time or fulltime, how much they are paid for lobby-ing, or the extent or effectiveness of theirlobbying activities. Such information, whilevery important to an understanding of thefull extent of lobbying efforts, is not

completely obtainable under most circum-stances.

Our analysis showing 450 state to-bacco lobbyists in the United Statesprobably underestimates the extent oftobacco-related lobbying occurring at thestate level for several reasons. As demon-strated with the earlier example in Florida,tobacco organizations frequently will hiremore lobbyists to work on a campaign as

an important bill advances in a state

legislature. In addition, tobacco organiza-tions may hire lobbying or public relationsfirms to lobby on their behalf withoutdisclosing the source of the lobbyingeffort.

In conclusion, our analysis showsthat the number of lobbyists working forthe tobacco industry at the state level isnot nebulous, but can be counted, tracked,and used by concerned participants. Pub-lic health leaders should understand the

strategic importance that the tobaccoindustry places on state-level lobbying.Understanding the rationales, trends, andmeanings behind these numbers will

ultimately lead to an improved under-


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standing of ways to affect legislative issuesthat decrease tobacco consumption. O

AcknowledgmentThis research was supported in part by grant02293 from the Robert Wood Johnson Founda-tion.

References1. Major Local Tobacco Control Ordinances in

the United States. Washington, DC: USDept of Health and Human Services; 1993.

2. Preventing Tobacco Useamong YoungPeople:A Report of the Surgeon General. Washing-ton, DC: US Dept of Health and HumanServices; 1994.

3. Strategies to Control Tobacco Use in theUnited States: A Blueprint for Public Health

Action in the 1990's. Washington, DC: USDept of Health and Human Services; 1991.

4. Jacobson PD, Wasserman J, Raube K. Thepolitics of anti-smoking legislation.JHealthPolit Policy Law. 1993;18:787-819.

5. Moore S, Wolfe SM, Lindes D, DouglasCE. Epidemiology of failed tobacco controllegislation. JAMA. 1994;272:1171-1175.

6. Glantz SA, Begay ME. Tobacco industrycampaign contributions are affecting to-bacco control policymaking in California.JAMA. 1994;272:1176-1182.

7. Samuels B, Glantz SA. The politics of localtobacco control. JAMA. 1991;266:2110-2117.

8. Bearman NS, Goldstein AO, Bryan DC.Legislating clean air: politics, preemption,and the health of the public. NC Med J.1995;56:14-19.

9. Wright JR. Contributions, lobbying andcommittee voting in the U.S. House of

Representatives. Am Political Sci Rev.1990;84:417-438.

10. Ferraro T. The tobacco lords: the tobaccolobby. Multinational Monitor. January-February 1992:18-20.

11. Gray C. The tobacco industry provides alesson in effective lobbying. Can MedAssocJ. 1989;141:321-322.

12. Annual Report. New York, NY: PhilipMorris; 1994.

13. Annual Report. Winston Salem, NC: RJRNabisco; 1994.

14. Boyd JW, Himmelstein DU, WoolhandlerS. The tobacco-health insurance connec-tion. Lancet. 1995;346:64.

15. Pallarito K. Can lobbyists represent to-bacco and health? Modem Healthcare.March 1993:20.

16. Tobacco, health lobbies merge to fightFlorida suit. Durham Herald Sun. April 18,1995:C1, C7.

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A New Route of Transmission forEschenichia coli: Infection fromDry Fermented SalamiJohn Tilden, Jr., DVM, MPH, Wallace Young, Ann-Marie McNamara, PhD,Carl Custer, MS, Barbra Boesel, MS, MaryAnn Lambert-Fair, Jesse Majkowski,MPH, Duc Vugia, MD, MPH, S. B. Wemer, MD, MPH, Jill Hollingsworth, DVM,and J. Glenn Morris, Jr., MD, MPHTM

Introduction

Dry fermented salami is representa-tive of a class of traditional products inwhich raw, ground meat is preserved by aprocess of fermentation and drying.' Thelowered pH caused by fermentation andthe decreased available moisture caused bydrying, when combined with the inhibitoryeffects of salt, curing agents, and otherspices, create a hostile environment formost pathogenic bacteria.Z3 These prod-ucts are considered ready to eat and aregenerally not cooked before consumption.

In November 1994, an outbreak of 17cases of Escherichia coli 0157:H7 infec-tion in Washington State and Californiawas linked epidemiologically to consump-tion of presliced dry fermented salami(brand A).4 E. coli 0157:H7 had beenisolated from two intact packages ofbrand A salami collected at the retaillevel, with isolates from patients and theimplicated salami having identical pat-terns by restriction fragment-length poly-morphism analysis. Salami implicated inthese outbreaks had been produced by asingle facility (plant S) on August 25,1994. Hypotheses for the presence of E.coli 0157:H7 in this ready-to-eat product

included the following: (1) Organismspresent on raw meat ingredients surviveda substandard fermentation and drying

John Tilden, Jr., Jesse Majkowski, Jill Hollings-worth, and J. Glenn Morris, Jr., are with theEpidemiology and Emergency Response Pro-gram, Food Safety and Inspection Service, USDepartment of Agriculture, Washington, DC.John Tilden, Jr., is also with the EpidemiologyProgram Office, Centers for Disease Controland Prevention, Atlanta, Ga. J. Glenn Morris,Jr., is also with the University of MarylandSchool of Medicine and the Veterans AffairsMedical Center, Baltimore, Md. Wallace Youngand Barbra Boesel are with Inspection Opera-tions, Food Safety and Inspection Service,Alameda, Calif. Ann-Marie McNamara andCarl Custer are with the Science and Technol-ogy Program, Food Safety and InspectionService, Washington, DC. Mary Ann Lambert-Fair is with the National Center for InfectiousDiseases, Centers for Disease Control andPrevention, Atlanta. Duc Vugia and S. B.Werner are with the Division of Communi-cable Disease Control, California Departmentof Health Services, Berkeley.

Requests for reprints should be sent to J.Glenn Morris, Jr., MD, MPHTM, Epidemiol-ogy and Emergency Response Program, FoodSafety and Inspection Service, US Departmentof Agriculture, Washington, DC 20250.

This paper was accepted October 31, 1995.Editor's Note. See related annotation by

Hedberg and Hirschhom (p 1076) in thisissue.


state tobacco lobbyists and organizations in the united states

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