Florida's Tobacco Pilot Program (TPP;-2003, with its edgy Truth media campaign, achieved unprecedented youth smoking reductions and became a model for tobacco control programming. In 2006, 3 years after the TPP was defunded, public health groups restored funding for tobacco control programming by convincing Florida voters to amend their constitution. Despite the new program's strong legal structure, Governor Charlie Crist's Department of Health implemented a low-impact program. Although they secured the program's strong structure and funding, Florida's nongovernmental public health organizations did not mobilize to demand a high-impact program. Implementation of Florida's Amendment 4 demonstrates that a strong programmatic structure and secure funding are insufficient to ensure a successful public health program, without external pressure from nongovernmental groups.Large-scale, well-executed state tobacco control programs reduce tobacco use, 1-4 tobaccoinduced disease, 5-7 and health costs. 3,4 Despite this proven effectiveness, many state governments have eliminated or restricted the scope of tobacco control programs, often under pressure from the tobacco industry, [8][9][10] which recognizes such programs' power. 11 In response, tobacco control advocates in some states have tried to create stronger tobacco control program structures to insulate these programs from political attacks. 8,[12][13][14] However, absent consistent pressure from public health groups, strong programmatic structures are not sufficient to protect these programs from attacks or to ensure successful implementation. 8,10,14,15 Following the 1997 settlement of Florida's Medicaid lawsuit against the tobacco industry, Governor Lawton Chiles (D, 1991-1998) immediately created and provided strong political support for Florida's large youth-focused Tobacco Pilot Program (TPP). 16 The TPP and its edgy Truth media campaign, focusing on tobacco industry behavior (a strategy known as industry denormalization 17 ), achieved unprecedented success [18][19][20][21][22] : smoking prevalence among middle school students dropped by 40% and among high school students by 18% during the program's first 2 years ( Figure 1). 24 Despite its success, and perhaps because of the threat the program posed to the tobacco industry, 11,25,26 the TPP was subject to almost Correspondence should be sent to Stanton A. Glantz, PhD, Professor of Medicine, Center for Tobacco Control Research and Education, Suite 366 Library, 530 Par-nassus, University of California, San Francisco, CA 94143-1390 (glantz@medicine.ucsf.edu).
Human Participant ProtectionThis research was approved by the University of California, San Francisco committee on human research. All interviewees gave informed consent.
ContributorsA. Kennedy, S. Sullivan, and Y. Hendlin collected the data. A. Kennedy and R. Barnes prepared the first draft of the article. S. Glantz defined and supervised the project and secured funding. All authors helped revise the article and respond to reviewers' comments.
NIH P...