As the Worm Turns...

Life was so simple when the only thing tobacco free advocates had to deal with were the petty interpersonal politics of unqualified bureaucrats and ill educated political sycophants accidentally undermining challenges to the tobacco industry. This was infuriating when we imagined we were all on the same side.  Over a decade of advocacy makes me a novice compared to many.  But what sincere tobacco free advocates are dealing with today in Arkansas is completely new.  We were alarmed that tea bagger conservatives had taken over the ledge in the last session.  But, and I count myself among the naive, we had no idea what having a pro tobacco executive could do to evidence based tobacco prevention. 

We see what little regard this legislative and executive body has for human rights re education, race, women's rights, and LGBT issues.  Why did we imagine that tobacco control might actually fly under the radar?  Hell, I was just hoping.

Thus far the damage has been minimal but what I hear from the periphery of tobacco free advocacy near the Arkansas Department of Health is that actual tobacco free policy change is strictly verboten within the bureaucratic and financial arms of this administration’s Arkansas Department of Health. If you smell something rotten in Denmark, he said being sophomoric and cute, it is tobacco smoke.

I had great hopes that Mr. Hutchinson’s pro tobacco tenure would be tempered by his defeat in the Senate race years ago.  As if the accusations of being big tobacco’s pawn would humble or at least slow down pro tobacco advocacy as Governor today.  Apparently that was just wrong as shit.  I say this watching the obviously tobacco industry bill (SB978) dealing with Electronic Nicotine Delivery Systems sailing through the bowels of the legislature.  Egregious as the language is in the bill, the most offensive note is an amendment by Central Arkansas’ Douglas House that preempts any local control for stronger pubic health efforts.  Challenging preemption is Tobacco Free 101.

And if that wasn’t bad enough, the Arkansas Department of Health’s Tobacco Prevention Cessation Program is cricket silent about a bill that can detract from decades of tobacco free efforts and hinder decades more. The few people  that will actually talk to me tell me that ADH not only does not oppose the bill they ask that TPCP grantees essentially shut the fuck up. Just pretend we are all back in Kansas. Of course, that’s a bad analogy too.

I do not know many more people in tobacco prevention that I respect more than TPCP’s medical authority, Dr. Gary Wheeler. And I know this gentleman must be grappling with his conscience now. The potential bargains pressed upon sincere public health advocates to surrender tobacco free challenges scare the hell out of me for things to come. 

The visigoths are upon the gates. Save your sword for one last self inflicted wound.

SB978 was written by the nicotine industry. If I’m not around,  please someone document these crimes. Thanks.

Maybe there's a reason ADH has tobacco prevention in the basement.

I really don’t keep up w too much of ADH politics for a couple of reasons.  One is because I no longer volunteer for a local community tobacco prevention coalition.  The other is because it fairly typically makes me ill.

Such is the case learning that the 2015 RFPs for tobacco prevention have tweaked themselves to not only demand ownership of all work product and materials, (That really grates on an unpaid media volunteer) but also has dismissed the Coalition for a Tobacco Free Arkansas and the youth YES teams to find some party they can control as one entity. 

First, for as long as I have had any understanding of the MSA funding for which pittance is still left for actual tobacco prevention there has been a need for a distinct legal separation between lobbying and advocacy. It has always been the tactic, in Arkansas since ethics complaints in Fayetteville in 2004, for pro- tobacco forces to claim state funds were used to lobby for policy change.  Since then tobacco free challenges have made great effort to distance advocacy from lobbying.  I was there in Fayetteville when Dr. David Bourne suggested that advocates abridge their freedom to speak when Huckabee was threatening to pull ADH funding for tobacco prevention. This is the point of having a statewide coalition keeping accounting that distinguish lobbying efforts from any ADH funding. That degree of separation is integral to making policy change efforts immune to industry, and significantly legislative complaints, that public money was used to lobby. Policy change is essential to actual population based measured tobacco free change.

Like I said, I dunno what is going on within TPCP but it does not portend much tobacco free success and has the potential of discarding years of sincere educated and sophisticated advocacy protecting Arkansas’ dedication of MSA dollars. Micro managing organizations that have worked hand in glove with previous TPCP bureacrats neglects a tremendous learning curve that the tobacco industry depends on.

We expect more from the Arkansas Department of Health than petty politics but unfortunately, at least when it concerns tobacco, that has not been the case.

ADH Insults Tobacco Prevention Advocacy

I’ve had issues w the Arkansas Department of Health for about as long as I’ve known anyone associated. I’ve met some of the most insincere and self serving bureaucrats known to humanity working, ostensibly, toward tobacco prevention. That said, I’ve also known some of the most dedicated and committed individuals you could imagine.  The Tobacco Prevention and Cessation Program, with a few notable exceptions, has enjoyed talent and sincere advocacy.  Somehow they seem to move right along to other issues with too much frequency. 

Tobacco use is the leading cause of preventable death in the U.S. and in Arkansas.  The tobacco industry is responsible for the leading risk factors for heart disease, stroke, and lung disease. 90% of lung cancer is due to cigarette smoking killing more than the next top three cancer killers combined.  Tobacco kills.  Got that?

This week, I had the unfortunate opportunity to visit the Tobacco Prevention and Cessation Program’s offices. I had proposed to the Arkansas Cancer Coalition and was funded for a small grant to do air quality monitoring for a couple of the significant exemptions to Arkansas’ Clean Indoor Air Act of 2006. This was dependent on collaboration w the use of TPCP’s SidePak pm2.5 air monitors and damned if the device, that was actually purchased new for this venture, failed to work properly. Much to my disappointment I had to touch base w Debbie Rushing and lay the repair or replacement of this device on her table.  I have to say that she and Dr. Gary Wheeler have been more than supportive for my proposed activity.  Advocates need this kind of data to rectify our lame assed clean indoor air law.  And Gary and Debbie are both savvy and honest enough to admit it.

Enough about my complaining.  I had to return the SidePak.  This was my heuristic experience.  The last time I’d been to the TPCP offices was to meet Michael Johnson with the Rand Institute upstairs to discuss grantee evaluation about 2004.  The office was bustling with folks upstairs a in corner office space filled with windows.  Brochures and educational materials, were stacked in the hallways. 

On Monday I limped to the top of the exterior stairs to the main ADH security desk to return the SidePak.  The guard had to look up on his computer to discover where the TPCP offices were. “They are in the basement,” he said.  I took the elevator down into a short corridor with janitorial offices.  I could see stacks of paper towels in door windows.  I went back upstairs and a new police guy said I had to go through the double doors marked “No Admittance.”  I went back down and fortunately caught some gentleman to ask how to find the Tobacco Prevention offices and let me through.  He told me to follow him through the double door onto a loading dock and out through another.  He said the Tobacco Prevention office was down the hall and to the left.  I thanked him.  Stumbling down the hallway I found the TPCP sign on a door.  Inside, was a relatively empty roomful of cubicles, no reception.  Making my way to Ms. Rushing’s office I heard what makes her my hero for today speaking to the TSI SidePak people on the phone.  “And so, as a good customer service representative, what are you going to do for me?”  This after the failure of an unused, expensive, device.

Debbie, I apologize for adding to your workload.

My issue is that the Arkansas Department of Health literally has buried the people burdened with challenging the leading cause of death and disease in the basement. 

But wait there’s more!  I left Debbie on the phone with whatever cretin at TSI who may or may not make things right.  They sure won’t make the three days right I sat in smoke filled space at a horse track to get data. The notable thing here is that the Arkansas Department of Health does not really give a shit about the leading cause of death in Arkansas.

I left the TPCP offices and went through the double doors at the loading dock.  A young lady actually held the door for me.  Unfortunately, the doors on the other side, and that side too, were locked.  The door buzzer for assistance on my return went unheeded leaving me locked outside. I was starting to hike around the building when I saw a pair of women pushing a mail cart. She asked me if I was trying to get into the building and told me I was not supposed to be there.  I thanked her and took the elevator to give the young police guy my visitor’s sticker. (He was probably the most sympathetic and helpful individual I met with the exception of Ms. Rushing.)

The whole point of this missive despite my whining was to note that the Arkansas Department of Health and in consort with the Department of Human Services has done their very level best to hide the individuals charged with challenging the leading cause of preventable death in offices behind the janitors, a loading dock, and the mail room, w two doors that lock behind you.  This sucks.

If the state of Arkansas had any sincere ambition to protect the public health the political figureheads would do more than pay lip service to tobacco prevention.  And the actual individuals charged with the actual work would get better treatment than they do now.  I knew that the powers that be had abused and driven away a celebrated thoracic surgeon and one of the leading tobacco prevention advocates on the planet in Dr. Carolyn Dresler.  I did not know how far they had gone to discourage anyone of merit to make any habit of challenging the tobacco industry.  

Just in case anyone in Arkansas had any optimism about the political courage our policy makers have for tobacco prevention you should make more of an effort to thank the TPCP people who continue to work in Little Rock. The folks that run the Department of Health would rather we don't find the tobacco prevention branch.

###

TPCP, Using Media, and Lobbying

I’m bad about keeping a blog. Since no one reads it anyway it becomes little more than a journal.  But I need to follow up on an opportunity I was given presenting a short bit to the current Arkansas Department of Health Tobacco Prevention and Cessation Program (TPCP) Grantees at their Quarterly meeting at Pulaski Tech recently. The bulk of the day was an Americans for Nonsmokers’ Rights training by their Southern States Regional Consultant, Onjewel Smith.  

My presentation was little more than a combination of a perspective of how public health has always been short sighted, when it came to dealing with the tobacco industry from as far back as the Frank Statement, and a synopsis of a paper I delivered at the 2009 ASH Wales Conference in Cardiff, Wales.  The Cardiff presentation was an overview of successes Tobacco Free Marion County had in reducing BRFSS adult smoking rate numbers making use of a coordinated and comprehensive public relations campaign.  CTFA’s Katherine Donald suggested that since my gig came while everyone was eating their boxed lunches I was the Keynote Speaker.  I told her that if I ever got around to writing a C.V. it would be.

Dr. Gary Wheeler, acting medical head of TPCP and an inaugural graduate of the Clinton School of Public Service, I cannot brag on Gary enough, helped clarify my language about a Fayetteville bar owner’s complaint to the state Ethics Board.  Gary shared that calling attention to using public funds to lobby was a tobacco industry ploy  used against federal tobacco free efforts in the 90s.  Regardless, it was Huckabee in 2003 who said he wanted tobacco grantees to comply with the “letter as well as the spirit of the law” regarding tobacco prevention.  I quote this because he used the same language not 3 weeks later complaining about the legislature recessing rather than adjourning. Huckabee’s actions easily checked progress in tobacco prevention in Arkansas to this day, not excluding his 2006 exemption riddled Arkansas Clean Indoor Air Law. It really is an embarrassment that Huckabee has any kind of national stage in the media today much less a political voice.

But it does explain the murmured response among grant administrators and grantees when I assured them that they could lobby within semantics.  Hell, I encouraged them to lobby.  CDC Best Practices are all about policy change.  And my emphasis on semantics was exactly the same advice Lynda Lehing gave grantees in 2003.  There has to be some government employee/ bureaucrat mantra about safety in ignorance. At any rate it was Huckabee’s 2003 call to inaction that was the major prompt for me to speak out and use what I knew about public relations and the media as a voice once removed from Tobacco Free Marion County.  And like Ms. Smith inferred, tobacco prevention advocates often find themselves alone in the wilderness.  TFMC was no exception.  Using the media was a way of making the coalition seem much larger than it actually was.  And it can be for any tobacco prevention advocacy today as well. 

At some point in the near future I’ll put audio to my presentation and put it on line.

Fed's Latest Effort

Handsel Art

17 November 2010

FOR IMMEDIATE RELEASE

contact J.R. Few

handselart@marioncounty.com

or 870-427-1365

HHS Announces Tobacco Strategy

Earlier this month the Director of the U.S. Department of Health and Human Services, Kathleen Sebelius, announced the federal government’s latest strategy to control the leading cause of preventable death, tobacco. Headlining the announcement were the new graphic pack and ad warnings required by the Family Smoking Prevention and Tobacco Control Act giving limited authority over tobacco to the Food and Drug Administration. These 9 graphic warnings will cover 50% of any pack and 20% of advertising. In 1965 the tobacco lobby was successful in minimizing Surgeon General Luther Terry’s report that smoking caused cancer to the ubiquitous: “Smoking may be hazardous to your health.” Arguably, tobacco lobbyists still manipulate public policy.

Today 38 nations require similar or stronger warnings. Australia has required that all cigarettes be sold in plain packaging by 2012. Other nations‘ graphic pack warnings are a facet of the World Health Organizations Framework Convention on Tobacco Control. Ironically, the U.S. law requiring graphic warnings also inhibits this country’s compliance with the global treaty by including the tobacco industry on an FDA scientific advisory panel.

Requirements in the new legislation to quit using deceptive “light” and “low tar” packaging had been anticipated by the industry changing the actual language to suggestive lighter colored packaging. Actually, the elimination of the words “light” and “low tar” had been ordered by Judge Gladys Kessler in 2006 as part of her finding against the tobacco industry as racketeers. Restricting advertisements to black on white messaging were almost immediately struck down by the courts.

While the bill was supported by major public health groups, and global tobacco giant Philip Morris, not all advocates consider giving the FDA limited authority over tobacco a good idea. Dr. Heinz Ginzel, Emeritus Professor of Pharmacology and Toxicology at the University of Arkansas for Medical Sciences says, “ Any regulatory actions concerning tobacco taken under the auspices of the FDA are jeopardizing, contaminating, degrading and corrupting the declared original mission of the FDA.”

Other advocates like the National African American Tobacco Prevention Network object to a failure to include menthol flavoring while banning fruit and candy flavors. A recent press release from NAATPN states, “Our organizational stance is and has always been steeped in the historic exploitation and targeting of Black communities by the tobacco industry which began in the 1950’s when only 5% of our community smoked mentholated tobacco, and continues today because now nearly 83% of all tobacco consumed by Blacks is mentholated.” The FDA scientific advisory panel has until 2011 to determine how to regulate, if at all, menthol flavoring in tobacco.

One positive aspect of the new law is the removal of federal preemption for state and local governments to regulate point of purchase marketing. Currently the only signage or advertising mandates are legal age requirements. These are most often produced by the tobacco industry. Arkansans could now require the Quit Line be placed at point of purchase, regulate signage, or enhance any federal health warnings.

###

Bookstore Sells Toy Cigarettes

Handsel Art

22 October 2009

FOR IMMEDIATE RELEASE

contact J.R. Few

handselart@marioncounty.com

or 870-427-1365

Advocates Object to Toy Cigarettes

The tobacco industry spends $12.8 billion marketing annually in the U.S. but sometimes the least expensive marketing opportunities come from unlikely sources. Hollie Pierce, Coordinator for Tobacco Free Boone County in north central Arkansas, never imagined that her local book store would be glamorizing tobacco with toy cigarettes (pictured). But that is exactly what she found in the novelty pen section at the Books A Million store in Branson, MO recently.

“Marketing novelty cigarette pens just feet from the children’s book section sends a truly irresponsible message. The greatest part of our public health challenge is to de-normalize tobacco use,” says Pierce. 90% of the over 440,000 Americans who die from tobacco use started as children.

Knowing that children want to emulate adult behavior and making tobacco less appealing to youth are major steps in preventing addiction to nicotine.

Pierce is encouraging her colleagues in tobacco prevention and anyone to express their dismay for such thoughtless marketing by contacting Books A Million at feedback@booksamillion.com. She notes that retailers often just never realize the potential harm but, “What we may think of as a simple ink pen, may actually encourage youth and adults to smoke.”

Books A Million is the country’s third largest book retailer and operates over 200 stores in the Midwest and Southeast.

###

Harm redux/ FDA's limited authority

It is unfortunate to see ostensible tobacco prevention advocates carrying water for the tobacco companies under the banner of harm reduction. The term harm reduction was coined as a means of dealing in a compassionate manner with drug use and sexual behaviors that put one at risk of harm or disease. Needle exchanges and free condoms are tactics to protect individuals, and therefore the community, from the worst results of risk taking behaviors. Using the term in this manner there is no tacit approval, or disapproval, of the addiction but a means that an individual's behavior can reduce harm. The perversion of the concept toward tobacco is not behavior modification but product modification and hence implicit approval of nicotine addiction. Simply calling oneself smoke free does not address the real need to challenge the rogue capitalism behind the tobacco pandemic.

The linked article from Glantz, Barnes, and Eubanks is just about a must read for sincere tobacco free advocates. The question remains why so many public health advocates could support such poor, even detrimental, legislation. My first assumption is that while public health groups out of necessity must deal with tobacco related disease they are not primarily focused on what it takes to challenge tobacco.

My experience in tobacco prevention is minimal but an overwhelming awareness has been that not everyone who claims to be a tobacco free advocate is. This unfortunately includes everyone from ADH grantees, employees, and even major public health group lobbyists.

This sounds like an old saw to me now but I once heard Dr. Tom Houston remark that 100 years ago, when infectious disease was the leading cause of death, there were no transnational corporations challenging the public health. In 2006 Dr. Houston's words curiously came to fruition with a federal conviction for fraud and racketeering in U.S. versus Philip Morris. Philip Morris was the lone supporter among tobacco companies of the FDA's limited authority over tobacco. Be sure that it will not be alone in the inevitable litigation the tobacco industry will throw into the gears of curiously suspect legislation. Enjoy the article!

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000118

An open letter to the new Miss Arkansas, Sarah Slocum

Congratulations, Ms. Slocum! 

Soon you will be approached by all manner of sponsors wanting to get a piece of the crown and publicity.  One of these sponsors will be RJ Reynolds maker of Camel #9s, in the sleek pink and black packaging and promotion targeting young women.  

RJR will offer you large dollars to promote in schools a program they fund that is ostensibly a tobacco prevention program directed toward youth.  If you find it odd that a tobacco company would support effective tobacco prevention you would be right.  The Centers for Disease Control cites research showing that tobacco company funded programs to reduce youth use not only are ineffective but may increase youth initiation to tobacco.  

This particular program, 'Right Decisions, Right Now', by focusing on telling young people to resist peer pressure, infers that tobacco use is somehow more popular than they realized. Research has shown young people are twice as likely to smoke because of tobacco advertising than peer pressure.   Additionally,  this program portrays smoking as an activity only adults should choose.  Can you think of a better way to get kids to want to smoke? 

Miss Slocum, Miss Arkansas, I encourage you to take the high road and refuse to be the pawn of an industry that calls kids, “replacement smokers.”  Your status and role model are so important to so many people.  Please use it intelligently.

Thank you and good luck.  

p.s. you can learn more about tobacco industry tactics here:  http://no-smoke.org/document.php?id=276

Arkansas Clean Indoor Air, needs work now

This morning KUAR, the public radio station in Little Rock, ran this story on the 3rd anniversary of Arkansas Clean Indoor Air act.  http://tinyurl.com/lxwlqt  

The statement is made that the law went into effect 3 years ago but fails to mention that the state only began enforcement  2 years ago.  The inside scoop here is that when the environmental branch of ADH was planning to enforce the law the tobacco prevention branch was not invited to these meetings.  As recently as September of 2007 ADH was telling businesses that secondhand smoke could not drift back inside a building when, in fact, the law specifically does not regulate any outside smoking.

Dr. Gary Wheeler is quoted in saying that Arkansas has not seen an expected reduction in heart attacks yet and there may be due to other variables unique to Arkansas.  He goes on to suggest that confusion about the law could be rectified by removing the exemptions.  Dr. Wheeler is right on both counts.

The Arkansas variable that may be most important is the fact that the ACIA is not comprehensive protection from tobacco smoke.

Celebrated advocate, UCSF’s Dr. Stanton Glantz, during a presentation at Pulaski Tech in NLR last year, specified that heart attack rates only go down when clean indoor air laws have no exemptions, like bars.  http://tinyurl.com/ktd39n

Arkansas clean air law may have numerically increased the number of smoke free businesses in what seems a dramatic fashion. But the large exemptions, like the over 21 loophole, probably did not decrease anywhere near as dramatically the amount of secondhand smoke to which people were exposed.  And to stretch the argument further those individuals still enduring heavy exposure to SHS, bar patrons and employees, may well also be those at the greatest risk for heart disease; poor health habits, little health care, etc.  

Arkansas Clean Indoor Air act needs a tremendous overhaul.  This is made most urgent given that we are now discovering the new lottery legislation opens the door for potential gambling parlors.  These parlors as well as the racinos will no doubt include restrictions for minors and a carte blanch ‘adults only’ cachet for the tobacco industry.

Post One

By way of welcome, this is an experiment; another autodidactic adventure in posting art, angina, and activism.  I'm not sure I can tell them apart at all.