Anti-smoking funds sparse Despite a $250 billion tobacco lawsuit windfall, only a few states are using the money to fight teen smoking. However, those that try are coming up big.
When Mississippi's governor signed House Bill 641 last May, making it illegal for anyone, including teachers, to use tobacco in public schools, it was a major victory for the state's newest anti-smoking warriors: a teen advocacy group called Frontline.
Funded by the state's settlement with tobacco companies in 1997, the teens had pressed lawmakers during a rally on the state Capitol steps earlier in the year.
''We didn't think it was right for a teacher to tell students, 'You shouldn't smoke,' and then run around to the teacher lounge in between classes and have a cigarette,'' says Seth Bassett, a high school senior from Jackson, Miss., and Frontline's state co-chairman.
The legislative victory -- as well as data showing smoking declines as steep as 21% among youth in Mississippi -- are among the payoffs that state officials attribute to the launch of a comprehensive anti-tobacco campaign using $62 million from its settlement with cigarette makers.
Mississippi's success, however, is overshadowed by a far gloomier picture nationwide. The states are to receive about $250 billion over 25 years from the landmark settlement with cigarette manufacturers about three years ago.
However, only about 8% of the initial payments is being used to fund anti-smoking efforts, according to Thomas Houston, director of the SmokeLess States National Program Office at the American Medical Association.
Moreover, only six states are spending -- either with settlement money or other funds -- what the Centers for Disease Control and Prevention considers the minimum for an effective anti-smoking program, according to a report released this month by the Campaign for Tobacco-Free Kids.
Across the USA, legislatures are battling over where to direct the windfall. So far, with no restrictions on how the money is spent, states have heard proposals ranging from cutting taxes to cleaning up strip mines. ''Most of the states have not put in the critical mass (of money) recommended by the CDC,'' says John Seffrin, CEO of the American Cancer Society. ''I worry that some of those states will give (anti-smoking programs) a lick and a promise and say it doesn't work.''
Messages for teens
The concern comes at a critical time for efforts to help teens stop lighting up -- or to stop them from ever starting. In 1999, about 35% of high school students were smokers, according to the CDC, up from 28% in 1991. Still, anti-smoking advocates see several glimmers of hope: a leveling off nationally between 1997 and 1999, and sharper drops in several states that suggest anti-tobacco forces have finally discovered how to craft a message that adolescents will heed.
Some states, such as Mississippi, Florida and Minnesota, are spending millions from their settlements on youth groups, education and, in perhaps the most visible aspect of the new war on teen smoking, edgy TV ads with a pointed message: Big tobacco wants to manipulate you, kid.
Drawing on adolescents' penchant for rebellion, campaigns such as Mississippi's ''Question It,'' Florida's ''truth'' and Minnesota's ''Target Market'' portray tobacco companies as sinister authority figures. ''Their brand is lies,'' Florida ads say. ''Our brand is truth.''
The messages apparently resonate. In Florida, smoking is down 40% among middle-school students and 18% among high-schoolers since the state began an anti-smoking campaign with tobacco settlement money in 1998, according to the Department of Health. ''The figures are impressive,'' says Debra Bodenstine, director of the Division of Health Awareness and Tobacco. ''They're not the norm.''
In Mississippi, which has used its tobacco settlement to promote a comprehensive anti-smoking effort since 1999, smoking dropped 21% for middle school and 10% for high school students between 1999 and 2000, according to the Mississippi Department of Health.
Other states with longer-running programs funded by cigarette taxes, such as California and Massachusetts, also report declines.
''Any time we can, from a social marketing standpoint, stop a trend, it's huge,'' says Jim Audette, director of Minnesota's ''Target Market'' program, which launched last year. ''What Florida did was reverse a trend in just two years. I've never seen that before.''
However, states making strides are in the minority, as are those devoting big money to the problem.
The settlement in November 1998 between tobacco companies and 46 states netted $206 billion, ostensibly to recover tobacco-related disease costs. Four other states -- Florida, Minnesota, Mississippi and Texas -- negotiated an earlier, separate settlement of $40 billion.
But according to the non-profit Campaign for Tobacco-Free Kids, only 15 states have made a ''substantial'' commitment to fund smoking prevention programs using their tobacco settlement money -- spending at least 50% of the minimum funding recommended by the CDC for an effective program. Only six states are spending the minimum.
An additional 12 states have committed ''modest'' funding -- less than half the amount recommended by the CDC. The rest of the states have set aside minimal funds or none at all.
Michigan, for example, has allocated none of its settlement money for anti-smoking programs. Instead, it plans to spend the bulk of its $8 billion share on college scholarships and for research in genetics and biotechnology.
''We figure that we've already paid for the costs associated with smoking through our general fund or other state budgets at the sacrifice of other programs,'' says John Truscott, a spokesman for Michigan Gov. John Engler. ''Now that this pot of money becomes available, we're putting it into programs (that were sacrificed).''
In South Dakota, where nearly 44% of teens smoke, Gov. Bill Janklow wants to use the state's share of the settlement -- about $25 million a year -- on a college scholarship program. The state placed its initial payments in a trust fund, allocating $700,000 in interest to a smoking cessation program.
''There's a disconnect,'' says Michael Moore, the Mississippi attorney general who brought the first state lawsuit against the tobacco companies and has lobbied lawmakers in 30 states. ''There are people making the decisions about the money who weren't involved in the litigation. They know very little about it, and they don't feel like they're part of the mission.''
Speaking the language
However, some states have made the connection. And, typically, they're the ones doing battle with a new weapon: MTV-style counter-marketing.
Rather than wag fingers at kids, they pit them against the perceived evil of big tobacco. ''You target us, we target you'' is a tag line on some ads in Minnesota. In one TV spot, kids hold up signs: ''Tobacco companies have a strategy. Start them early. Tell them it's cool. And keep them addicted. Why? They gotta replace the dead ones.''
No numbers have emerged yet to gauge the effectiveness of the program, which kicked off last spring. But few question its necessity. A Minnesota Department of Health survey in 1998 found that 42% of 12th graders smoked cigarettes in the past 30 days, up from 31% in 1992.
''It allows youth to legitimately lead the movement,'' says Audette, of Minnesota's Target Market. ''It takes out the piece that's killed tobacco prevention in the past, and that's preachiness.''
The in-your-face approach, most experts agree, was born in Florida. After settling its lawsuit against cigarette makers in 1997, the state launched a pilot tobacco prevention program. One of its first efforts: Talk to teens. It held a youth summit in March 1998, drawing 600 children from across the state.
''We basically fell on the strategy of, 'We don't have the answer, so let's ask kids,''' says Chuck Wolfe, a former director of the Florida Tobacco Pilot Program who went on to help launch the American Legacy Foundation, a national anti-tobacco group funded by the tobacco settlement. ''They said, 'We're tired of hearing health messages. Everybody knows tobacco is bad for you.' That was like a light going off for us.''
It was at the summit that the first television ads in Florida's ''truth'' campaign were filmed. One shows a girl wearing a ski mask, reading a list of demands to the tobacco industry as if she were a terrorist. ''The other,'' Wolfe says, ''is 600 kids in a field, waving at the tobacco industry. They all waved in one motion and said, 'Hi.'''
Both were designed to send a message on behalf of Florida teens: We're here, big tobacco, and we want you to listen to us.
''They speak to teens in teens' own voice,'' Wolfe says.
Others have followed Florida's template. In Mississippi, a ''Question It'' radio and TV campaign features a spot in which tobacco company executives laugh and pat each other on the back as a lab monkey goes through nicotine testing -- as though they take sinister pleasure in addicting the animal.
''They (teens) needed to understand that smoking was actually an expression of conformity,'' says Eric Hughes, creative director at Maris, West & Baker Advertising Communications, the Mississippi ad agency that crafted the spots. ''You're doing what a company wants you to do, for their benefit.''
Nationally, the American Legacy Foundation -- funded with about $1.5 billion of the settlement negotiated by the 46 states -- has run its own ''truth'' ads on radio and TV. They include the controversial body-bag ads shown during the Sydney Olympics. One ad, which parodies the cowboy image of the Marlboro Man, shows teens herding horses carrying black body bags. The tag line: ''What if cigarette ads told the truth?''
Education and enforcement
However, the programs rely on more than advertising. In August 1999, the CDC recommended that states establish comprehensive tobacco control efforts that include education in communities and schools, cessation programs and greater enforcement of laws.
Florida, for example, enacted a law in 1998 that allows courts to suspend the driver's license of anyone under 18 caught with tobacco. The state stepped up community efforts, including teen-led ''SWAT'' teams -- Students Working Against Tobacco -- in each of its 67 counties. The teams spread the anti-smoking gospel among youth, leading sessions at community centers, holding rallies and, in one county, having a beach cleanup at which kids picked up 50 pounds of cigarette butts and other refuse.
But if Florida is a pattern for success, it's also an example of these programs' tenuous existence. After the program received $93.2 million in its first two years, lawmakers tried to cut all funding for 2000 before agreeing to spend $44 million. The cutback led to the elimination of 10 staffers and a reduction in radio and billboard ads, says program director Debra Bodenstine.
''It's just going to be up in the air every year,'' says Christine Ortiz, 18, who lobbied lawmakers for funding in 1999 while she was a high-schooler in Longwood, Fla. She now studies at MIT in Boston and speaks on tobacco issues for the American Legacy Foundation's ''truth'' program.
Danny McGoldrick, research director at the Campaign for Tobacco-Free Kids, says programs in other states also remain in doubt. Montana, Virginia, Maryland and Maine, for example, all are facing legislative challenges to their anti-smoking spending, he says. Mississippi, conversely, not long ago guaranteed $20 million a year for The Partnership for a Healthy Mississippi, which runs Frontline and other efforts.
''With the states, the big concern I have is, 'What's going to happen next year?' '' says Gregory Connolly, who directs the program in Massachusetts. ''Three years ago, all we heard states say was, 'We're suing for the kids.' Then they turn around today and say, 'We sued for the money.' If that's what we did, we had no right being in the courtroom in the first place.