Personal Ambition, Tobacco Prevention in Arkansas

A little knowledge is a dangerous thing.  I started trying to find out WTF was going on within Arkansas Department of Health TPCP issues.  Long time advocates were being edged out.  Given the revolving door for ADH employees and community grantees the institutional memory of tobacco prevention was being put at serious risk.

Snot the first time.  

Years ago functionaries within the Arkansas Cancer Society and the Arkansas Heart Association did their royal best to wrest ADH funding from the Coalition for a Tobacco Free Arkansas.  I recall former CTFA Chair, Dr.Caesar Compadre, laughingly talk about his first issue w CTFA was a motion to dissolve the coalition. Fortunately this bizarre coup was thwarted.

Unfortunately, the pettiness of some individuals involved, at w least tobacco, still seems the take away. Recently the bureaucracy within ADH has gone out of their way to alienate and de-fund the two statewide coalitions, the Coalition for a Tobacco Free Arkansas and the Youth Extinguishing Smoking Teams.  Both CTFA and the fiduciary for YES teams have declined to re-apply for restrictive and micro managed grant opportunities. Couple this w an ADH request for proposals for a statewide coalition that both CTFA and the YES people have been encouraged to ignore and one can see a very focused attack on the two most effective coalitions, and individuals, in the state.

A sincere tobacco free advocate has to ask, “Why?”

In 2003 the very first real lesson tobacco free advocates in Arkansas learned was that there must be a distinct separation between the tobacco free lobbyist and the tobacco free advocate.  At one level this is a matter of simple semantics. At another it is bureaucratic and ineffectual neurosis.

There is bullshit going on within the Arkansas Department of Health and those ostensibly working as public health advocates that truly stinks of pettiness, ambition, and personal gratification. Unfortunately, this comes at an inopportune time for  tobacco free advocates. We should not be fighting among ourselves now. We should be educating policy makers up and down a legislature dominated by right wing de-regulation anti public health zealots.

Funny how long time tobacco (free) lobbyists do so little of that.

I am always open for queries and conversation.

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.

A current thought on harm reduction

 Harm reduction was a term coined in response to diseases and maladies encountered by homosexual men and by intravenous drug users in the face of the tremendous onset of the AIDS epidemic in the late 80s.  Clean needles and condoms were seen as a way to offset the worst effects of a public health crisis until an actual cure or remedy for the diseases that were killing people was found. 

Since then the term ‘harm reduction’ has been bastardized by the tobacco industry as not a way to reduce harm until a remedy for tobacco related disease is found but a way to perpetuate tobacco industry profit under the guise of public health.  This is so very evident after we see that the same arguments for the ‘harm reduction’ of spit tobacco are the same used for the novelty of electronic nicotine delivery.  There is disease related to intravenous drug use and some sexual behaviors.  There is disease related to tobacco use.  One use of the term ‘harm reduction’ wants to find a remedy for disease.  The latter uses the term as a means of continuing tobacco industry profit.  The crux is that there may be a human inclination toward intoxication and certain sexual behaviors but that does not necessarily include nicotine.

Focusing public health efforts on safe sex and clean needles responds to modified and alternative behaviors as remedial. Focusing efforts on changing nicotine delivery responds to alternative nicotine delivery as the remedy.  The first is a public health strategy. The latter is a marketing strategy.  As the multinational tobacco corporations ease their way into electronic cigarettes we see more and more of the same arguments for ignoring actual data concerning dual use and disease.  Electronic nicotine provides no significant pubic health benefit.

One must look closely to see the tobacco industry’s subtle diversion of blame and rights with harm reduction. The original use of the term regarding drug use and sexual behavior wants to see individuals change their behavior.  The tobacco industry wants to see harm reduction confuse behavior with a choice of nicotine delivery. 

The tobacco industry is not concerned with rights, but profit.

CTFA Holds Successful 10th Anniversary Conference

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16 September 2012

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CTFA Holds Successful 10th Anniversary Conference

Dr. Stanton Glantz

Over 160 advocates from around the state celebrating public health successes from the past decade gathered for the Coalition for a Tobacco Free Arkansas’ 10th annual Striking Out Tobacco in Arkansas conference in North Little Rock September 13th, 2012.  Attendees were treated with presentations from some of the most distinguished tobacco control authorities in the nation.

Dr. Greg Connelly, from the Harvard School of Public Health, was influential in getting the Family Smoking Prevention and Tobacco Control Act passed in 2009. This law gave limited authority over cigarettes to the Food and Drug Administration. An original member of the FDA’s Tobacco Products Scientific Advisory Committee, Connolly has since resigned and had little to recommend about the law today. He encouraged the audience to put pressure on the FDA to act more quickly regarding a decision about menthol.  The original bill banned characterizing fruit and candy flavors in cigarettes but neglected to include menthol in these restrictions.  The Committee concluded that menthol in cigarettes made initiation of nicotine addiction easier and quitting more difficult. Their March 23rd 2011 report stated, “removal of menthol cigarettes from the marketplace would benefit public health in the United States”.  The FDA’s final decision was due 90 days after the submission of the report but has not acted.  80% of African American smokers consume menthol cigarettes.

Keynote speaker, Dr. Stanton Glantz, a founding member of the group Americans for Non Smokers’ Rights and Director of the Center for Tobacco Control and Research at the University of California at San Francisco, recounted how the tobacco free movement had evolved in California.  He called attention to the statewide media campaign emphasizing that nicotine was addictive, secondhand smoke will kill you, and the tobacco industry lies. He noted that focusing on a corrupt industry creates a ‘social un-acceptability‘ quotient  that could be as effective as tobacco taxes in decreasing use.

Glantz pointed out that he and Dr. Connolly had been on opposite sides of the law giving the FDA authority over cigarettes. Noting that the industry was now offering soluble nicotine products to sidestep smoke free laws and keep people addicted he added, “One thing I think we should be pressing for at the FDA,  if they should ever grow a back bone, which is unlikely, but if they should they should prohibit co-branding of these non cigarette products, so they can’t say Use Marlboro snus on the plane and smoke Marlboro cigarettes when you can.” 

He concluded that tobacco control efforts really do work.  Over 15 years the California  tobacco control program cost $1.4 billion.  But health care costs from an almost immediate reduction of heart disease deaths and asthma attacks, and 14% decreased incidence of lung cancers over a decade, saved the state $86 billion.  “So when politicians say we don’t have enough money for tobacco control, everything they cut from that, they are paying over and above that in health care costs and it’s not 20 years from now.”

Recognizing  Arkansas’ deeply flawed clean indoor air law, Glantz suggested that activists work locally to rectify exemptions.  He complimented advocates for a 30% drop over the last 3 years in cigarette sales in Arkansas.  “You’ve got to realize that every little success you have is dollars out of a multi national corporation’s pocket, and they don’t like that,  and are going to do everything in their power to stop that.”

Additional speakers included representatives from the National Latino Tobacco Control Network, the American Lung Association, and the University of Wisconsin. “CTFA always does a great job addressing disparities,” says Julie Andersen from Marion County.   “This year was no different with speakers focusing on Latinos, the LGBT community, and nicotine dependence among those living with a mental illness. Excellent conference!”

The Coalition for a Tobacco Free Arkansas is a statewide network of organizations with a shared mission to challenge the tobacco industry.  More information can be found at www.arfreshair.com 

Renowned Speakers to Address CTFA Conference

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19 August 2012

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Renowned Speakers to Address CTFA Conference

In 2003, when the Coalition for a Tobacco Free Arkansas (CTFA) held the first Striking Out Tobacco in Arkansas conference, it was for many of the statewide group of advocates their first opportunity for tobacco prevention education.  While the conference is only a facet of the advocacy CTFA offers, the 2012 event, September 13th at the Wyndham Riverfront in North Little Rock, will include a collection of some of the most respected tobacco control advocates ever gathered in Arkansas.  Featured speakers include two of the most influential tobacco free advocates in the world, Dr. Stanton Glantz and Dr. Gregory Connolly.

Glantz, Director of the Center for Tobacco Control and Research at the University  of California at San Francisco, has been involved in tobacco control since 1978.  A founding member for the advocacy group, Americans for Nonsmokers’ Rights, he has been a leader in helping establish the most effective means to challenge the industry at all levels of policy. His research covers a wide range of issues including the effects of secondhand smoke on the cardiovascular system and the public health benefits of smoke free legislation.  Additionally, Glantz has been instrumental in establishing the Legacy Tobacco Documents Library making 50 million pages of previously secret industry documents available to the public. 

Dr. Connolly is the Director of the Center for Global Tobacco Control at the Harvard School of Public Health.  Originally trained as a dentist, Connolly is an appointee to the World Health Organization’s panel on Smoking and Health and led the highly successful Massachusetts Tobacco Control Program for nearly 2 decades  His work in tobacco control is internationally recognized and has included research on tobacco product design, reduced risk products, tobacco interventions and prevention of tobacco related disease.

These speakers alone would be significant for any conference.  However, CTFA has also secured Dr. Bruce Christiansen from the University of Wisconsin, an authority on treating tobacco dependence,  National Director of the National Latino Tobacco Control Network,  Dr. Jeanette Noltenius,  and Linda Cullers, Senior Director of Health Promotions, American Lung Association for the Plains-Gulf Region. 

Katherine Donald, Executive Director for CTFA says, “Tobacco free advocates know that education is one of our greatest assets.  This promises to be a tremendous opportunity for public health advocates, activists, teachers, parents, policy makers, or anyone concerned with tobacco prevention in Arkansas.”

Tobacco continues to be the leading cause of death in Arkansas, and secondhand smoke, the third leading preventable cause, kills over 500 of our neighbors annually. Unfortunately, prevention funding is at a 10 year low while the tobacco industry spends $129.5 million marketing each year in Arkansas alone.

Registration is $50 per person. Forms and information are available at www.arfreshair.com .  As a special incentive, registration fees will be waved for any policy maker or candidate for public office.  This is one event you do not want to miss.

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Dr. Stanton Glantz, the American Legacy Foundation Distinguished Professor of Tobacco Control at the University of California, San Francisco will be one of several prestigious speakers at the Coalition for a Tobacco Free Arkansas’ Striking out Tobacco in Arkansas conference at the Wyndham Riverfront in North Little Rock September 13.

Disciplined Language

On May 6 the Arkansas Cancer Coalition posted a disturbing op ed online written by Billy Parish their Community Outreach person. The editorial is disturbing primarily because it frames the issue of tobacco prevention in language tobacco companies use and questions the limits to tobacco prevention. Ostensibly the piece asks how we will get more Arkansans to show support for tobacco control policies. That question seems to have been rhetorical because my response disappeared from both the comments section on their website and the ACC FaceBook profile page, where I first linked to the editorial. For your amusement, my response, and answer to his question, appears below.

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6 May 2011

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“How we frame the question usually leads to an answer.”

The fact that you question the pandemic of tobacco related disease as some sort of libertarian issue about smokers tells me you are still under the thrall of industry propaganda. We don’t ask these kinds of questions about sanitation or hand washing requirements. We don’t carefully weigh an individual’s right to drive drunk or faster than the speed limit. Why should we phrase the question about tobacco prevention as one of personal liberties? The fact is we shouldn’t. Tobacco prevention is a matter of public health. And the only place that rights come into play is a human right to every opportunity for health and safety.

The tobacco industry loves it when we phrase the issue as a matter of personal choices made by smokers because it distracts from the much more appropriate focus of allowing, even subsidizing with our permissive laws, a predatory rogue industry responsible for an obscene majority of the death and disease on this planet. A tobacco free advocate has very little interest in interfering with anyone’s decisions. Tobacco free advocacy challenges the perception that this kind of tolerance for tobacco related disease is not and does not have to be a normal part of our lives. It is not the tobacco free advocate that blankets our parking lots with advertising. It is not the advocate who makes sure that every time a child enters a convenience store they will pass eye level logos and at every check out look up at a colorful wall of tobacco. It is not the advocate who manipulates the nicotine in their product to enhance addiction to a product so flawed that it will eventually kill half of all users because they were unable to quit. It is not the advocate spending millions challenging public health legislation to reduce tobacco use. It is not the smoker doing this either. It is the multi-national corporations whose sole aim is to profit and profit at any cost. This is the focus of tobacco prevention.

The tobacco free advocate seeks to de-normalize tobacco use in our society to the point where no one ever wants to smoke enough to become addicted, to change the social norm to where no addiction can support the demand for profit the industry needs to survive. We create tobacco free spaces not merely because secondhand smoke is deadly but also because it helps smokers quit and is the example to young people that tobacco is not normal or appropriate. We place significant taxes on tobacco not merely to offset revenue losses from tobacco related disease but also because it makes tobacco more expensive and less accessible. We regulate marketing for the same reasons, to de-normalize tobacco use.

In 2006 the tobacco industry was convicted in Federal court of racketeering and fraud for 50 years of deceit and manipulation of our laws and public opinion. To confuse tobacco prevention with something we are doing to smokers and even suggest that there is a question about the limits tobacco free advocacy should accommodate demonstrates just how effective this fraud has been and continues to be.

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subsidy

Subsidizing the tobacco industry is not dissimilar to subsidizing any industry in a capitalist community. Industry is offered tax breaks, incentives, and opportunity for conducting business in a community as an opportunity for employment and improving commerce. We provide tax breaks in return for a positive economic impact. The unfortunate difference is that the tobacco business is an economic drain. The American Lung Association has estimated that a pack of cigarettes should cost $16.66 to simply break even for the cost to the public health.

While honest work, jobs dependent on selling cigarettes are a poor trade for $812 million in tobacco related health care costs annually in Arkansas, the litter. or the lives.

Arkansas Cancer Coalition Press Conference, Lung Cancer Awareness

Click title for link to video.

Governor Proclaims November Lung Cancer Awareness Month

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14 October 2010

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Governor Proclaims November Lung Cancer Awareness Month

ACC Executive Director Cornelya Dorbin displays Governor Mike Beebe’s proclamation that November is Lung Cancer Awareness Month in Arkansas.

Calling attention to the single greatest cause of lung cancer, tobacco smoke, is one motivation the Arkansas Cancer Coalition petitioned Governor Mike Beebe to join states across the country in proclaiming November 2010 Lung Cancer Awareness Month in Arkansas.

Dr. Joycelyn Elders, former U.S. Surgeon General, calls lung cancer a “manmade disease”. At the beginning of the 20th century lung cancer was almost unheard of but today more people die from lung cancer than any other cancer. “The increase and decrease in mortality from lung cancer follows the rise and fall of cigarette use,” says the Arkansas Department of Health Tobacco Prevention and Cessation Branch Chief Dr. Carolyn Dresler. “Historically and globally, we can follow a 20 year lag in a population when cigarette sales spike and lung cancer rates peak.”

“So much of the prevention for lung cancer can be achieved through policy change,” notes ACC Lung Cancer Workgroup Chair, Dr. Thaddeus Bartter. The CDC has established Best Practices for effective tobacco prevention that include increased tobacco taxes, smoke free air, and market reform. Exemptions to Arkansas’ 4 year old clean indoor air law makes it one of the weakest protections from secondhand smoke in the nation. Even after recent tobacco tax increases, Arkansas’ is still below the national average and 27th lowest in the country. The Arkansas legislature let a bill posting the quit line at tobacco retailers die in committee in 2009.

Lung cancer data enjoys an unfortunate distinction in Arkansas. Tobacco related disease is the leading cause of death in the nation and lung cancer accounts for about a third of this morbidity. Yet Arkansas’ 2,100 lives lost to lung cancer is 42% of annual tobacco related deaths in the state.

Another motive for calling attention to lung cancer is an effort at facilitating the most current quality care to all Arkansans. African Americans start smoking later in life, smoke less, but compared to whites, are more likely to die from smoking related disease. One of the major goals of the ACC Lung Cancer Work Group is to identify strategies for dealing w disparities and at risk populations.

The Arkansas Cancer Coalition will hold a press conference in the Capitol Rotunda on November 16 at 10:30am. Representatives of the medical community, advocates, and policy makers will join the Governor in highlighting the urgent need and potential for prevention and treatment for lung cancer. Please join us in demonstrating your support for intelligent effective tobacco prevention and providing all Arkansans with quality care.

Dr. Philip Gardiner Addresses CTFA Conference

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13 September 2010

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Authority Discusses Menthol in Tobacco

“Young Blacks have found their thing, it’s menthol in general and KOOL in particular.” Philip Morris Tobacco Company, 1974

Recently Arkansans were fortunate to have Dr. Philip Gardiner speak at the Coalition for a Tobacco Free Arkansas’ annual Striking Out Tobacco in Arkansas conference. Dr. Gardiner is a public health activist concerned with issues ranging from racial disparities in health care, AIDS and cancer, to the effect of menthol in tobacco and the African American community. The National African American Tobacco Prevention Network estimates that 82% of African Americans smoke menthols. The tobacco industry has a history of advertising, discounting, and promoting menthol cigarettes most heavily in African American communities.

In 2009 Congress passed the Family Smoking Prevention and Tobacco Control Act giving limited authority to the FDA over tobacco. The Act prohibited tobacco companies from using fruit and candy flavors in tobacco in an effort to curb youth smoking but failed to eliminate the most common flavoring, menthol.

Gardiner’s presentation noted the CDC estimates smoking rates in the African American community at 22.4%. A more detailed study shows smoking rates closer to 38%. African Americans start smoking later in life, generally smoke fewer cigarettes, smoke cigarettes with a higher nicotine content compared to other ethnic groups, and are more likely to smoke menthol cigarettes. They also suffer disproportionately from tobacco related disease and death.

The FDA Tobacco Products Scientific Advisory Panel is currently studying the effect of menthol in tobacco. Menthol is used in many different products and is generally considered harmless. Dr. Gardiner’s emphasis was to broaden the concept of harm in cigarettes because it makes smoking more palatable, harder to quit, and “makes the poison go down easier.” It is the “ultimate candy flavoring”, he said.

The Subtleties and Sophistication of Tobacco PR

This morning i opened up my daily Google Alert on Tobacco and happened to catch the headline, “Tobacco could help save lives, UC Davis team says”. Following up on this I read the press release concerning the UC Davis Big Bang business plan competition winners who had been awarded $15K for their proposal to use the tobacco plant as a source for vaccines. One of the members of the winning team is quoted, "I think this is an opportunity where tobacco can be used in a good sense."

Now this caught my eye for a couple of reasons. One is because I knew Davis, CA had a historical reputation for a tobacco free environment. In 1993 Davis had the only 100% smoke free policy in the nation and even today has extensive outdoor protections from secondhand smoke.

The second reason I was suspicious is because I knew that there was a bizarre use of Arkansas Master Settlement monies at the Arkansas Biosciences Institute. The MSA was the $246 billion settlement with the tobacco companies and the states for the harm caused by tobacco related disease. This has proven to have been a huge victory for the tobacco companies for the simple reason that nowhere in the agreement is it stipulated how this money is spent. Today states have only dedicated about 2.3% of MSA and tax revenue monies for tobacco control. Arkansans, however, stand alone with the Initiated Act 1 of 2000 dedicating their MSA payments toward primarily health related issues. Among these issues is the Arkansas Biosciences Institute created from 23% of the MSA to “focus on agriculture and basic and clinical scientific research that will lead to health improvement, especially in the area of tobacco-related diseases.” Now a state of the art research facility is a fantastic thing for a place like Arkansas. But early in 2004 Dr. Carole Cramer was hired as the Executive Director. Dr. Cramer’s expertise is the genetic engineering of the tobacco plant. This takes some mental agility to see that as an area of tobacco-related disease, but this is Arkansas.

So knowing of this tobacco industry coup and the smoke free distinction Davis enjoys I went to see just who could have influenced the Big Bang award. The major sponsor of the award is DLA Piper, a global law firm that represents anyone from the French gaming industry to, you guessed it, the tobacco industry. Arkansans may recall that DLA Piper senior Policy advisor Dick Armey recently came into the state to campaign against the proposed tobacco tax to fund our state's trauma system.

So now, is anyone else leery here?

The tobacco industry has a ready history of deceit and manipulation of public opinion toward tobacco and a degree of sophistication and cunning that almost baffles the imagination. This is just one more example.

Riverfest Smoke Free?

In July of last year, after much ado and the hard work of many of us, City Manager Bruce Moore signed the Little Rock Parks Commission recommended policy that Little Rock City Parks be tobacco free. The policy went into effect in October.

Now as Riverfest approaches it is questionable if the organizers of the event are going to respect this policy or continue their subsidy for the tobacco industry at the expense of the community. A quick glance at the Riverfest website cites only Arkansas clean indoor air laws with no recognition of the Parks Commission’s tobacco free policy at all.

Will we once again suffer the drifting smoke, pay for collecting the cigarette litter, and finance the corporate welfare for a rogue industry? The organizers of Riverfest may not care about the community and the entertainers but I bet their sponsors do. You can find them here. Contact the city manager’s office too. Demand not merely simple courtesy but evidence based public health policies.

It’s your air and your music, don’t share any more of it with the tobacco industry.

Effective, Evidence Based Messaging

The December edition of the journal Adolescent Health includes an important study regarding effective messaging for tobacco initiation. The paper, The Perception of Secondhand Smoke Risks Predict Future Adolescent Smoking Initiation , concludes that “perceptions of personal second-hand smoke risks and parental second-hand smoke risks significantly deterred adolescent smoking initiation”. This current research may not be novel but it is impressive in showing that perceptions about the dangers of secondhand smoke have triple the effect on smoking initiation among youth compared to peers’ smoking. And this conclusion is revealing because focusing on peer pressure is a mainstay of industry funded campaigns ostensibly aimed at reducing youth addiction to nicotine. The 2007 CDC Best Practices on Health Communication Interventions cites research showing that these campaigns not only are ineffective they actually can increase youth initiation (p 32). The Best Practices also notes that the most effective media campaigns created a negative reaction to the tobacco industry itself (p 34).

Those campaigns reliant on no evidence base will not be interested in this. But sincere efforts at reducing smoking prevalence in Arkansas can take advantage of this research to fashion campaigns that will not only be effective but also can be crafted to work toward rectifying seriously flawed clean indoor air laws.

Currently Arkansas’ Stamp Out Smoking tobacco prevention media is capitalizing on the recent state and federal tobacco tax increases to promote the 1-800 QUIT NOW cessation services. This may well be justified for a time but should not miss opportunities for long term effective tobacco prevention policies.

Cranford Johnson Robinson Woods, the firm that holds the SOS account, has in the past cited market research showing a high degree of brand recognition as evidence of a successful campaign. In 2008 CJRW announced it was becoming an affiliate of the PR monolith Burson Marsteller. With longtime ties to the tobacco industry, BM is responsible for creating the National Smokers’ Alliance and the Accommodation Program as front groups to oppose tobacco taxes and clean indoor air laws.

This tremendous conflict of interest becomes most suspicious when media campaigns do not take advantage of evidence based research for effective prevention. At some point attention should be given to the differences between effective branding and effectively reducing the influences of the tobacco industry on our communities.

Tobacco Free Spaces

I posted this on Globalink, so why not here, right?

I respectfully take issue with the perspective that tobacco free advocates are being “absolutist” about smoke free public space. Strict adherence to tobacco free space is simply consistent with what we know to be evidence based to effectively reduce tobacco use and nicotine adduction. Saying that outdoor tobacco policies need be “reasonable and fair” is little more than the accommodation argument the industry uses to delay clean indoor air in bars and restaurants. We are accommodating the tobacco industry not nicotine addicts. One reason that so many have quit using tobacco is because there have been regulations in place that make smoking less convenient; quitting easier. Enabling smokers is doing no one but those that profit from the sale and prevalence of nicotine a favor.

Are there limits to which we should regulate public nicotine addiction? Perhaps. But given the present almost unbelievable mortality and disease associated with the products the industry purveys that time is not yet here. We have evidence based incremental approaches to de-normalizing the tobacco pandemic: market reform, significant increases in the price, tobacco free space, and inclusive of the first three, support for cessation. Saying that regulating tobacco out of doors is unreasonable neglects the tragic subsidy we allow Big Tobacco when they foul our air, litter our public spaces, and prey on our youth.

Advocates should challenge the tobacco industry not collaborate. I see little reason to accommodate the tobacco industry. Communities have a justifiable and compelling interest in regulating rogue capitalists right out of town.

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.

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