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.

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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.

Addiction Incorporated

On August 7 at the North Little Rock Riverfront Wyndham, the Arkansas Department of Health Tobacco Prevention and Cessation Program, in partnership with the Coalition for a Tobacco Free Arkansas, presented a viewing of the documentary Addiction Incorporated. Using an overview biography of industry whistle blower and tobacco free advocate, Victor DeNoble, the film outlined the challenges and industry subterfuge around the scientific discoveries demonstrating the addictive nature of nicotine.

The film begins with a background of DeNoble as a naive working class lad finding himself as  a post doc fellow with a job offer from Phillip Morris. His work for PM involved research on alternatives to nicotine that might reduce cardiovascular risks.  Studies on lab rats led to the conclusion that nicotine was in fact a very addictive substance. Phillip Morris shut down the research and fired DeNoble. Bound by a nondisclosure clause, it was only a decade later that this research was revealed in testimony before a congressional panel investigating the tobacco industry. Using interviews with lawyers, industry executives, and public health advocates the film follows litigation, the first efforts at FDA regulation, the MSA, the Family Smoking and Tobacco Prevention Act, and the RICO conviction of the tobacco industry in U.S. v Phillip Morris et al.  At a certain point in this journey DeNoble decides to dedicate his advocacy to educating children about addiction and tobacco.

Previous to the viewing a couple sitting behind me identified themselves as novices to tobacco prevention asking what they could expect.  I told them I hoped that the film would help direct advocates to recognizing the necessity of challenging the tobacco industry.  Without understanding the vector of the industry tobacco control at best is masturbation. 

The film did a fine job of documenting the last 30 years of public health’s dealings with the tobacco industry.  Where it failed was in noting that what passed for public health victories were actually successful long term industry strategies.  The adult smoking rate may have fallen from around 60% in the late 50s to 20% today but morbidity from tobacco related disease still tops 400,000 Americans annually.  The litigation of the late 90’s spawned the Master Settlement Agreement with the states. But of those settled funds only about 2% are spent on tobacco prevention today.  The first efforts in the 90s at allowing the FDA regulatory control over tobacco were thwarted by the Supreme Court’s ruling that for the  FDA to retain it’s guarantee for health and safety it would have no choice but to ban tobacco.  Congress had not given the FDA that authority.  The 2009 Family Smoking and Tobacco Prevention Act was a law written by Phillip Morris allowing FDA limited regulation and compromising that guarantee and the integrity of the FDA.  And even the significant RICO conviction carried no meaningful punitive measures. To many of us the film was ancient history just scratching the surface of tobacco industry subterfuge and deceit.  But judging from the crowd reaction it was news to quite a few.

The documentary left the impression that the tobacco pandemic could be resolved if we could just keep young people from ever starting.  That, in itself, is  part of industry strategies to blame the victims for tobacco related disease while omitting their own culpability.  Nowhere was it mentioned the numerous youth tobacco prevention programs the industry funds that have been shown to be ineffective and can actually increase youth initiation by depicting smoking as a choice only an adult should make.  The film neglects the complicity that industry funding makes of otherwise well intentioned groups like the Boys and Girls Clubs and 4H Clubs.  We don’t see how Keep America Beautiful is hijacked into providing public ashtrays that not only distract the blame for litter from tobacco companies but actually encourage public smoking. We don’t learn in the film that the growth market for tobacco is in the lowest socio economic class in this country and in underdeveloped nations. Unmentioned are the millions the tobacco industry spends in a token effort to make themselves appear to be good corporate citizens while profiting from a product that is by far the leading cause of death and disease on the planet.  We don’t hear of the political funding opposing tobacco taxes and tobacco free spaces. Or of the friendly politicians bought by the pallet load. 

Addiction Incorporated is a film we all should see.  But it should be viewed with the awareness that the tobacco industry is actually much much more amoral. The documentary is good as long as we realize it is but a starting place in challenging tobacco.

Arkansas Clean Indoor Air, needs work yesterday

Most recently a glaring example of how poor the Arkansas Clean Indoor Air law is occured. Sportsfans will remember that this was then Governor Huckabee’s effort at leaving Arkansas to campaign for president as the health care candidate w a minimum of tobacco prevention. It wouldn’t do for his record of collaboration with the tobacco industry without some lip service of a clean air act to survive. That is what the ACIA is, lip service badly in need of repair.

Adding insult to this are serious questions about enforcement from the Arkansas Department of Health today.

One saturday in late July my friend Harry stops in the Goldpan Cafe in Lakeview AR for breakfast on his way to help his brother lay a foundation. Harry is retired, got time on his hands, and the Goldpan is open. He also is the parent of a middle schooler avid on tobacco prevention. So he knows that the half a dozen kids he sees shouldn’t be sitting in the smoking section. Smoking Section? Arkansas law protects them from secondhand smoke in all businesses. They shouldn’t be inside the building!

So he files a complaint w the Arkansas Department of Health at the Breatheasy site. Done. Until a few days later he gets a call, and a hang-up. Then immediately after a call and verbal abuse for making his report of noncompliance. When he notices his answering machine has 3 more ‘messages’ later in the week from apparently Goldpan patrons, all abusive. He starts to reconsider his decision to ignore the first call. The ACIA contains a ‘non retaliation’ clause ostensibly intended for employee protection, and according to the ADH lawyer, never tested in this kind of case.

To synopsize, the ADH lawyer says that there is no official procedure under Arkansas’ Freedom of Information Act to get Harry’s name and apparently the ADH investigator provided this information at the time of the visit. One can file a non-compliance report anonymously.

I drove by the Goldpan today and took this photo. Came home and filed a a report of noncompliance stating:

"In attempting to enter the business, which has been granted an exemption and is a smoking establshment, I noticed that the business had no signs conforming to Section VI of the Rules for Arkansas Clean Indoor Air law http://www.arcleanair.com/pdf/clean_indoor_air_act_rule_2006.pdf . The only signage visible at the entrance was a crude paper sign saying, "No one under 21 allowed in, 7,28,09." I fled."

Investigators from ADH had time to give out my friend’s name and contact info yet not enough to rectify simple signage requirements? It would be easy to fault the local ADH tobacco prevention coalition grantee, and probably should. But not all counties have a coalition and how many businesses remain noncompliant simply because no one informed enough about the law has entered the business? A complaint driven public health and safety law is ridiculous enough without lacking sincere efforts at enforcement.

Policy makers need to know how badly flawed this legislation is. There is no safe exposure to secondhand smoke and no room for second tier enforcement of a public hazard that kills 5,000 Arkansans annually.

Tobacco prevention funding coveted and threatened

It is no accident that the Arkansas Department of Health announced that smoking rates, since the 2002 inception of the state’s tobacco prevention program, have dropped by nearly 100,000 smokers.  There is little doubt that this is monumental and will save countless lives and dollars. The impetus for releasing these stats is more than likely the Arkansas legislature’s perennial targeting of the Master Settlement Agreement funding for these programs is a little louder than usual.  

It is almost baffling that some legislators cannot understand that tobacco use is the leading cause of death and disease, number one, most, more than the top five, combined.  Almost baffling because the limited lobbying ability of publicly funded or un-funded tobacco free advocates is dwarfed by the full time lobbying effort of an industry convicted of fraud and racketeering in Federal court.  The resilience of Arkansas legislators to the facts of challenging  tobacco unfortunately leads to serious concerns about the intellect of some of our solons.

Additionally, questions surround the recent SB922 that would have decimated tobacco prevention specifically.  This bill had sponsorship enough in both the house and senate to pass but mysteriously was pulled by the bill's main sponsor.

Justification for raiding Initiated Act 1 of 2000, that delegates Arkansas’ MSA funds for “health related issues” is far from clear.  This act has actually really distinguished Arkansas’ spending of these monies.  Nationally only about 3% of states’ MSA is spent challenging tobacco.  Only a little less than a third, $12-15 million annually, are spent on actual tobacco prevention and cessation programs in Arkansas.  Still, there are those that resent any opposition to the status quo subsidy the tobacco industry enjoys.

We should certainly demand results and oversight of these funds.  I will not defend all uses that have evolved with this voter mandated legislation. But 100,000 fewer smokers and going from 6th highest adult use to 10th is a dramatically significant social change.  Just as certainly should the funding for evaluation be the very last budget compromised.

Legislators should protect and enlarge tobacco prevention spending in Arkansas. None of Arkansas’ recently increased tobacco tax goes toward prevention.  The actual increased tax should continue to significantly impact reduced smoking prevalence but the most cost effective tobacco prevention is still comprehensive clean indoor air legislation.  

I said I wouldn’t defend all of the tobacco prevention funds and a particular emphasis on cessation over creating tobacco free space is a problem.  In fact, research published in the American Journal of Public Health says,  

“Smoke-free work-place policies are about 9 times more cost-effective per new nonsmoker than free NRT programs are. Smoke-free workplace policies should be a public health funding priority, even when the primary goal is to promote individual smoking cessation.”  AJPH 2005 Jun;95(6):969-75. (07-17-2009)

Cessation is almost a natural fit for a department of health program but it is not tobacco prevention. It is treatment, treatment for nicotine addiction. ( The efficacy of NRT and pharmacology is a huge discussion) And treatment for nicotine addiction is not the most cost effective use of funds. It is part of an effective comprehensive evidence based plan to reduce tobacco use but it is not the primary means to de-normalizing tobacco use. ( Remember: taxes, tobacco free space, marketing reform)

Regardless, if legislators are interested in affecting the $812 million in annual tobacco related health care cost or the $1.3 billion in lost productivity, tampering with Act 1 is not the way to go.   Even with the new taxes, tobacco will not begin to cover the cost to the community.  Permissive tobacco policies are de facto subsidies for the tobacco industry; an industry whose return to the state is limited and debatable indeed.  

 

100,000 fewer smokers is huge for Arkansas.  Before hampering these results the legislature has a clear need to rectify the exemptions and lack of enforcement for Arkansas Clean Indoor Air act and Act 13 protecting children from SHS in cars and take seriously challenging the subsidy for the rogue capitalists that profit from tobacco. 

El Dorado works for smoke free bars

Just a note from the southern end of the state tonight.

Handsel Art

12 July 2009

FOR IMMEDIATE RELEASE

contact J.R. Few

handselart@marioncounty.com

or 870-427-1365

Community Supports Smoke Free Bars.

Tobacco free activists marshaled nearly three dozen advocates to amend their city’s clean air ordinance to include bars at the El Dorado City Council meeting in Union County July 9th.  Led by Pride Youth Program’s executive director Deb Crawford, the Union County Tobacco Free Coalition’s presence dwarfed a minority of pro tobacco voices.  

Championing the amendment is Alderperson Vertis Mason. (pictured) 

El Dorado’s smoke free ordinance was enacted in 2006 before the Arkansas’ Clean Indoor Air act. This local ordinance includes much needed buffer zones around entrances and exits.   Arkansas’ Clean Indoor Air act specifically neglects protection from any smoke out of doors and adds exemptions for businesses that restrict anyone under 21.

Speaking in favor of the amendment,  north Arkansas activist J.R. Few praised the Council’s foresight in correcting a flaw in Arkansas’ law because, “We do not lose the right to breathe at 21.”

Executive director for the Coalition for a Tobacco Free Arkansas, Katherine Donald, noted that the whole state is watching El Dorado set the curve for smoke free air in Arkansas.    The El Dorado City Council is expected to take up a third and final reading of the amendment on July 23.

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Contact Deb Crawford at  Deb@prideyouthprograms.org for information on how to assist their efforts to extend their smoke free ordinance to bars.

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.