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.

Project Prevent, My Reason to Write

How many years has the Arkansas Department of Health spent toiling away to find easy to swallow cessation and youth education campaigns?  Neither of which will have the impact that evidence based efforts to de-normalize tobacco use have.  And most recently the Tobacco Prevention and Cessation Program has announced the latest winners for their Project Prevent essay contest. Well, let loose the under inflated balloons. 

Of all the winners of all the age groups none mentioned the tobacco industry.  Only one made reference to the manufacturers of cigarettes boosting nicotine.  A short look at the web page clearly indicates that marketing strategies targeting youth were clearly emphasized.  Well, where was that emphasis rewarded by recognition and awards?

The kids that wrote these essays aren’t gonna be smokers.  They can spell and their syntax is fairly cogent. They pay attention in class.  The young people who are at risk are on the scholastic periphery and an essay contest is maybe one of the most ineffective means of affecting their behavior. The sorts of things that are evidence based to reduce youth initiation are policy changes that challenge the tobacco industry; policies that denormalize tobacco use, taxes, tobacco free space, marketing reform. And here’s the rub. Unless you recruit young people to advocate for these policies their involvement is wasted.  Every science class they’ve taken tells them that tobacco is gonna kill them. But until they are savvied to the fact that someone is playing them for a mark, efforts miss the mark. And unless they become politically involved in policy change they are also misled and disenfranchised in any effort at reducing tobacco prevalence. 

So what we have here with Project Prevent is an activity that not only does not prevent tobacco use it wastes the effort of those youth who might well be engaged in evidence based effective prevention. Local grantees get to say, Woo Hoo! We got the local kid in the paper.  ADH gets to say, Look, a kid in the paper!  But at no point does anyone get to say that this is making a difference in itself.  Good press is good press, but unless there is advocacy for underlying policy change you’re just spending the money. And for far too long TPCP and too many grantees have hoisted a Mission Accomplished banner when the money gets spent. 

Sincere tobacco free advocates need to demand that Settlement funds be spent efficiently to reduce prevalence.  Easy tripe like youth essays have limited value in this endeavor.

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.

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The Right Message

Here is the link to the previously mentioned presentation: The Right Message. Why not, Why, and How.  I was encouraged reading in the new 2014 Best Practices for Tobacco Control the emphasis on Mass Reach health Communication.  The tobacco industry is pretty clear in their goal of selling a profitable product.  Public health on the other hand has been divided in its efforts and less than honest about actually saying what it should be doing is making that product unprofitable.  This is one reason I tend to try and recognize tobacco free space as not merely the clean indoor air but also the parking lot free of signage or the counter top free of product.  It is not merely that tobacco is a health risk.  The tobacco industry is a health risk.

Anyway, here is the link to the video again.

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.

Tobacco Free Activists Recognized by National Group

Handsel Art

19 November 2013

FOR IMMEDIATE RELEASE

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Tobacco industry marketing tactics, like product placement, make nicotine addiction seem normal 

and harmless and are often subtle and deceptive. 

Two Arkansas photographers have been recognized in a national tobacco prevention photography contest hosted by Countertobacco.org.  Ashley Richter, a tobacco free advocate attending North Arkansas College, was a winner in the Youth Appeal category with a photo of  an electronic cigarette advertisement adjacent to candies at a convenience store counter.  An Honorable Mention in the same category was awarded to J.R. Few of rural Marion County for a photo showing product placement of flavored cigars next to bubble gum and hard candies. Photos like these, showing nicotine products and ads in proximities to candies or foodstuffs, display the unfortunate and false subliminal message that they are harmless and normal.

Countertobacco.org is the first comprehensive resource for groups working to challenge tobacco at point of sale. The tobacco industry has a history of sophisticated and successful marketing that, in addition to a federal conviction for fraud in 2006, addicts and kills over 400,000 Americans annually. Currently, the major focus of tobacco industry marketing is the retail environment where tobacco is sold. Not coincidentally, research shows that convenience stores selling tobacco are where youth most frequent.

Few, a volunteer with the Arkansas Cancer Coalition and the Coalition for a Tobacco Free Arkansas notes, “Ms. Richter’s photo is topical and important because the industry is taking advantage of a loophole in federal and state regulations for tobacco products to market the electronic cigarette. These devices are not a tool to help people overcome their nicotine addiction. They are a marketing strategy to prevent just that.”  Public health research has shown that rather than helping people quit smoking, electronic cigarettes prompt a dual use of nicotine delivery with no real net health benefit.  

The American Cancer Society holds the annual Great American SmokeOut on the third Thursday of November. The ‘SmokeOut’ is designated as a day nicotine addicts can take a day off and perhaps extend a tobacco free life.  If we pay attention to groups like Countertobacco.org it may also be an opportunity to understand how the tobacco industry continues to market a deadly addictive drug. 

The Arkansas Department of Health offers free counseling for nicotine addiction at 1-800-QUIT NOW.

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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.

Using grammar to challenge electronic cigarette marketing

Early electronic cigarette marketing.

Seeing the growth of the popularity of electronic cigarettes I wanted to note the importance of tobacco free advocates making a collective effort at getting our language together. ANR has a presentation ice breaker where the audience is asked to say, “smoking ban.”  The presenter then congratulates them for getting that out of the way so that they never have to utter that phrase again.  We work for tobacco free spaces, clean indoor air, and safe smoke free workplaces and public space. We try to avoid saying anything about “anti tobacco” and recognize that “environmental tobacco smoke” is a polite industry way of talking about secondhand smoke. We need to make sure that we do not address the industry challenges from electronic cigarettes with their language. 

It is with this spirit that I suggest that advocates drop, as is conversationally convenient, the use of terms like “vaping” and “E vapor.”  Even the term “E cig” has the short harmless aspect of a nickname.  We might do well to consider the discipline of always using a full description of “electronic cigarettes” as another “nicotine delivery device.”  We can refer to the effluent as just that, “effluent.”  And make note to point out the “fine particulate” included in the “aerosol contamination.” 

The stakes are too high to allow the tobacco industry to define our terms.

CTFA Holds Annual Conference

The Coalition for a Tobacco Free Arkansas (CTFA) held its 11th annual Striking Out Tobacco in Arkansas Conference at the Riverfront Wyndham in North Little Rock September 12th.  Attended by advocates from around the state, the conference featured such prominent speakers as Dr. Valerie Yerger from the University of California, San Francisco(UCSF) and the noted tobacco industry whistle blower, Dr Victor DeNoble.

Dr. Yerger, an Associate Professor of Health Policy at UCSF, is probably best known for her involvement w the Legacy Tobacco Documents Library. But for this presentation she donned her credentials as a licensed naturopathic doctor to talk about menthol in tobacco. The Family Smoking Prevention and Tobacco Control Act, that gave the FDA limited authority over tobacco, banned fruit and candy flavors in cigarettes but neglected menthol.  Yerger noted that menthol’s medicinal application was not merely a benign flavoring.  As a natural anesthetic it not only masks the harshness of tobacco smoke but also enhances drug delivery. This encourages addiction and makes cessation more difficult.  She pointed out the importance of seeing that 80% of African Americans, who smoke, smoke menthol. Challenging tobacco, challenging menthol in tobacco, is a matter of social justice.

  

Ritney Castine, representing the Campaign for Tobacco Free Kids, gave a lively overview of modern tobacco control and the value of youth involvement in policy change.  Noting that many only wanted young people to be cute, he emphasized,  “Cute isn’t effective.” Castine added that young people are essential to any great change but could only be that as fully vetted participants.

A knowledgable review and refutations of the myths surrounding of the Affordable Care Act was provided by consumer assistance specialist from the Arkansas Insurance Department, Sandra Cook.

Karin Rudolph, with the FDA’s Center for Tobacco Products, presented a well scripted party line account of the FDA’s  limited authority over cigarettes under the Family Smoking Prevention and Tobacco Control Act. This law, passed in 2009, was supported by many major public health groups, and tobacco giant Phillip Morris.

The day culminated with former Phillip Morris scientist, Dr. Victor DeNoble.  Dr. DeNoble recounted animal research proving that, contrary to industry claims, nicotine was a very addictive substance. He was kept silent for a decade by a confidentiality agreement with Phillip Morris. It was only his 1994 testimony before Congress that allowed him to speak out.  Echoing previous remarks and questions about the burgeoning E-cigarette market he noted that the device was not  a safe alternative to smoking but designed to enable continued addiction.

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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.

One Remedy from US v Phillip Morris

Handsel Art

FOR IMMEDIATE RELEASE

2 December 2012

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Tobacco Companies to Issue Corrective Statements

On November 27, 2012 Judge Gladys Kessler clarified remedies of her 2006 ruling  in U.S. v Phillip Morris that found the tobacco industry guilty of racketeering and fraud.  Tobacco companies must publish corrective statements that they lied about the dangers of smoking and manipulation of nicotine addiction,  the hazards of secondhand smoke, and the misconception of allegedly safer “light” and “low tar” cigarettes.   This remedy promises to be the most significant action the government has taken against the tobacco industry in nearly 45 years. 

In 1999 the Department of Justice (DOJ) filed suit under RICO statutes for a decades long conspiracy by the tobacco industry to deceive the American people.  In 2005 a D.C. appellate court denied the original remedies proposed to disgorge $280 billion from tobacco companies as illegal profit. This prompted the DOJ to  reassess remedies and highlight a 25 year $130 billion national tobacco cessation program.  This was a significant setback, though not the last in the DOJ’s case.  

Begun during the Clinton Administration, many involved were surprised when the Bush administration continued the suit.  Yet just days before going to the judge, a Bush political appointee, Robert McCallum, ordered lead counsel and DOJ career lawyer, Sharon Eubanks, to reduce requested remedies for the cessation program to just $10 billion.  McCallum was subsequently rewarded for his work in the DOJ with an ambassadorship to Australia.  (The litany of political interference in this case has been well documented by Ms. Eubanks in her book, Bad Acts.) Judge Kessler’s final order in favor of the DOJ involved 4 major remedies including: disjunctive remedies designed to prevent future RICO violations, eliminating deceptive “light” and “low tar” brand descriptors, disclosure of documents and marketing data, and corrective statements financed by the industry. 

The 2007 Best Practices for Tobacco Control, Health Communications Interventions notes that, “Aggressive state and national counter-marketing campaigns that have more directly confronted the tobacco industry’s marketing tactics have also demonstrated effectiveness but have often become targets for budget cuts.”  Requiring tobacco companies to admit criminal deceit, on their own dime, takes prevention to another and hopefully more effective level.  

The  tobacco industry has a history of manipulating public policy and serious oversight should be given.  But these statements have a timely potential.  An unfortunate aspect of tobacco prevention seeks a solution in making addicts quit and preventing youth initiation while ignoring the industry. The FDA’s recent introduction of 8 Tips for Talking with Youth about Tobacco and the DHHS’  new site BeTobaccoFree.gov  are packed with information about the health effects of tobacco use and nicotine addiction.  But both sites behave as if tobacco use were simply an accident of nature and completely omit the culpability of the tobacco industry in promoting a deadly product.  This promotion, not coincidentally, resulted in a criminal conviction for which these corrective statements hope to begin to remedy.  The terrible pandemic of tobacco related disease will not be resolved on the backs of the victims but on the rogue capitalists who profit from tobacco. This remedy from U.S. v Phillip Morris is a constructive step in that direction.

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A National Disgrace

I was coincidentally looking through the TTAC newsletter when Katherine Donald shared the link w her Coalition for a Tobacco Free Arkansas mailing list.  What I happened to fall upon in the table of contents was the link to the FDA Tobacco Products page and 8 Tips for talking to youth about tobacco. I get the FDA updates but don’t always follow up.  This is one reason why.

The CDC 2007 Best Practices for  Comprehensive Tobacco Control Health Communications Interventions makes the statement:

“Adolescents and young adults are very sensitive to perceived social norms and media presentations of smoking behavior. Nonsmoking adolescents exposed to tobacco advertising and promotional campaigns are significantly more likely to become young adult smokers. Because adolescents and young adults have been and continue to be so heavily exposed to images of smoking in the media, tobacco advertising, and promotional campaigns, public health counter-marketing campaigns are needed to focus on preventing initiation and promoting cessation.”

Nowhere in the FDA ‘tips’ for talking to youth is there any mention of tobacco advertising, tobacco promotion, marketing, or even the words “tobacco industry.” Instead, it focuses on how the young individual must decide, regardless if they are 11 years old or not, if they will become a nicotine addict.  This is just another example of how and why the Family Smoking Prevention and Tobacco Control Act is a national disgrace.

How is it that the Campaign for Tobacco Free Kids, the American Cancer Society, the American Heart Association, the American Lung Association, and a wealth of popular public health groups, not including the National African American Tobacco Control Network and Americans for Nonsmokers’ Rights, could support such a terribly flawed bill?

That is a huge question. How, or will, these groups rectify and apologize for their misspent support?  The greater issue is: how will the rest of us redeem a federal law that institutionalizes tobacco unlike never before?

SOS launches another youth activity, yawn.

A major aspect the tobacco industry uses to justify marketing and promotion of a deadly addictive drug is that consumers make a responsible adult choice.  In litigation, when victims have sued, almost invariably the argument industry takes is that you can’t be sure tobacco killed you and even if it did you knew better and chose to smoke.  I mean we’ve had this warning on the pack since 1965.  What were you thinking?

Phillip Morris funds ostensible tobacco prevention programs to keep kids from starting to smoke with the message that smoking is a choice only an adult should make.  Can you think of a better way to get kids to smoke?  It’s an adult choice.  So what if most smokers make that choice a few years early?  The tremendous capacity for nicotine to addict is fairly much a neglected aspect of the product.  It’s all about choosing.

And along comes the latest Stamp Out Smoking essay contest.  The theme this year is My Reason to Write.  Students are encouraged to write a letter thanking someone for their smoke free example or encouraging someone to quit.  Notice anything?  It’s all about choosing. In fact, the heading of the page says “We can all say NO to tobacco.” 

Undoubtedly we’ll see the same tired pleadings to addicted family members and blustering pledges to never start so they can make the team.  In fact one of the suggestions is to organize a pledge drive.  (I would welcome any legitimate research able to show that no smoking pledges are worth any more than the paper they are printed on.)  In the first case the focus is on a role model in their lives.  They may be an addict but they are still role models so something must be OK about nicotine.  In the second instance, the industry line about choice being the significant aspect of smoking is parroted.  Success with youth focused tobacco control programs are often frustratingly short term.  With efforts like this it is no wonder.

I am fond of saying that tobacco has not been a benign weed by the side of the road for 400 years.  But this is what is depicted when young people are told that the individual's choice to be tobacco free will make the difference.  In the tips for parents and teachers on how to talk to kids about tobacco nowhere is the tobacco industry mentioned.  Nowhere does it say that tobacco marketing, promotion, and public use are the result of multi-national corporations’ demand for profit. Instead these talking points would have us believe that being tobacco free was like choosing one cereal over the other for breakfast.  Characterizing the issue like this makes it seem that smoking is a normal part of their day, they shouldn’t do it, but it's normal.  When the very opposite should be our message.

In 1996 Dr. Stanton Glantz wrote in the American Journal of Public Health, 

“Finally, the public health community should realize that the best way to keep kids from smoking is to reduce tobacco consumption among every one.  The message should not be “we don’t want kids to smoke”; it should be “we want a smoke-free society.”  As the tobacco industry knows well kids want to be like adults, and reducing smoking sends a strong message to kids about social norms.”

That was 16 years ago.  Dr. Glantz spoke at the CTFA conference just last week.  Was anybody  responsible for this campaign there?  Have they ever been?  It is bad enough to have Burson Marsteller’s only U.S. based affiliate paid to run campaigns like this. The revolving door of personnel without actual tobacco control experience in the TPCP program makes ineffective messaging like this even more unfortunate.

CTFA Holds Successful 10th Anniversary Conference

Handsel Art

16 September 2012

FOR IMMEDIATE RELEASE

contact J.R. Few

handselart@gmail.com

or 870-427-1365

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

Handsel Art

19 August 2012

FOR IMMEDIATE RELEASE

contact J.R. Few

handselart@gmail.com

or 870-427-1365

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.

Cigars, Candy, Litigation, and Laws

Cigars, Candy, Litigation, and Laws

In 2009 Congress passed the Family Smoking Prevention and Tobacco Control Act with support from major public health groups, and tobacco giant Philip Morris. Lauded by supporters as a landmark, the bill gave the Food and Drug Administration limited authority over tobacco.  But three years after passage, the bulk of the FSPTCA has been delayed or repealed by tobacco industry litigation.  Requirements that tobacco advertisement near where children are present be limited to black on white has been struck down.  Large graphic package warnings, scheduled to go in effect in 2012, are still delayed.  And most recently authority preempting local control over point of sale warnings has been delivered a setback in a New York appellate court.

While many consider the omission of menthol in the list of restricted cigarette flavorings a serious flaw in the FSPTCA, banning fruit and candy flavors have not been thwarted in the courts.  Unfortunately, pro tobacco forces in Congress have introduced a serious challenge in the Traditional Cigar Manufacturing and Small Business Jobs Preservation Act of 2011.  Purportedly focused on high end cigar products, this bill would remove cigars from FDA regulatory authority.  However, that includes the smaller candy and fruit flavored cigars that are a significant feature of the tobacco cartel’s growth market.  These small cigars are more accessible to youth not only because they are sold in flavors but they are also sold individually and often the most inexpensive tobacco product available.  The 2012 Surgeon General’s Report on Youth and Young Adult Tobacco Use notes that 1 in 5 white male high school seniors is a current cigar smoker and that most typically consume more than one type of tobacco product. 

This proposed legislation should alarm local tobacco free advocates because 3 of Arkansas’ Representatives are co-sponsors.  Additionally, retailers in Arkansas are not yet required to place all tobacco products behind the counter. Product placement, like placing small cigars next to bubble gum, has long been a tactic in a sophisticated strategy making tobacco seem normal and desirable in stores where youth frequent.  

For all its flaws, the FSTPCA may show most promise in the potential for point of sale regulation. The new law allows state and local restrictions on the “time, place, and manner” but not “content”  of tobacco marketing. One locality, Haverstraw, NY, has become the first U.S. municipality to restrict tobacco displays, mimicking tactics public health advocates have employed in other countries.   

Protecting the marketing and promotion of inexpensive candy flavored tobacco with bill titles like “Small Business Jobs Preservation” would be silly if the cost to public health were not so tragic.  The Surgeon General’s Report  notes that 80% of high school smokers will go on to smoke into adulthood.  Half will die prematurely.  It is this compelling interest that should drive policy makers to recognize the tobacco cartel’s continued profit at the public’s expense, and end it.  

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