Strong Tobacco Control Program Requirements and Secure Funding Are Not Enough: Lessons From Florida

Abstract

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...

Strong Smoke-Free Law Coverage in the United States by Race/Ethnicity: 2000–2009

“…Disparities in smoke-free law coverage may be decreasing because of progress in passing smoke-free laws in regions with large non-Hispanic Black populations: Florida implemented 100% smoke-free laws (workplaces, restaurants, and gaming establishments) in 2003, Louisiana (workplaces and restaurants) and Illinois (workplaces, restaurants, bars, and gaming establishments) in 2007, and North Carolina (restaurants and bars) and Michigan (workplaces, restaurants, and bars) in 2010. 33,41,42 …”

The Effect of Tobacco Control Measures during a Period of Rising Cardiovascular Disease Risk in India: A Mathematical Model of Myocardial Infarction and Stroke

“…We assumed that India's populace would react similarly to these interventions as other international populations; we chose meta-analyses that incorporated international settings to estimate intervention effects, as displayed in Table 1. We also developed a baseline simulation using rates of introduction of interventions based on real-world experiences [18]–[20], then performed several sensitivity analyses in which we varied the degrees of coverage to examine the impact of a range of possible implementation effects and timescales (Table 1). In our baseline simulation, we assumed that legislative interventions would be immediately introduced with full coverage throughout the country, but subsequent effects on smoking would occur linearly over a decade and further cardiovascular effects would also occur gradually over time, as detailed further below [21],[22].…”

“…In the case of smoke-free laws, mass media campaigns, and a tobacco advertising ban, our sensitivity analysis included some low ranges of potential effectiveness or enforcement (Table 1) to simulate the potential outcomes when these measures are poorly enforced [18]–[20]. We also estimated that the CVD risk reduction benefits of quitting tobacco smoking would decline at an exponential rate over 10 y, with a time constant of 19.1 mo, yielding a 15% decline in risk in the first year, 36% by the end of 3 y, and the remaining benefits over the subsequent 8 y [21],[22].…”

Young people and alcohol – where’s the risk? Changing the focus of school-based prevention initiatives

“…The Alcohol Truth Project was inspired by the Florida Tobacco Pilot Programme, which engaged in tobacco industry 'denormalization' via the Tobacco Truth media campaign (Kennedy, Sullivan, Hendlin, Barnes, & Glantz, 2012). The Alcohol Truth Project is informed by an approach that uses media literacy as a means of engaging young people in a critical social perspective.…”

“…Made me aware of how the alcohol industry targets people. (Craig 1 ) This approach could be understood to address young people's risk of and resilience to dangerous alcohol consumption supported by data from the Florida Tobacco Pilot, which saw a significant reduction in tobacco consumption following its social media Truth campaign highlighting the tactics of the Tobacco Industry (Kennedy et al, 2012). Critical media literacy is also highlighted by other studies as influencing health-related decision-making (Austin et al, 2012;Piran, 2010).…”