A

A Strategic Analysis of

Movement
U.S. Tobacco Control Advocacy

Rising
March 1999

Prepared by the
A DV O C A C Y INS TITUTE
About the Advocacy Institute Table of Contents

The Advocacy Institute is dedicated to strengthening the capacity of social and economic justice advocates, both Introduction 2
within the U.S. and internationally, to influence and change public policy.
A behind-the-front lines organization, the Advocacy Institute brings together seasoned advocates and community- Executive Summary 4
based leaders to help build their capacity to advocate for just and civil societies. Skills are enhanced, ideas are nur-
tured into cohesive strategies, and advocates gain greater maturity and skill as movement leaders. AdvantagesInternal Movement Strengths 8
The mission of the Advocacy Institute is realized primarily through its two programs: the Capacity Building
Program and the Tobacco Control Project.
ChallengesInternal Movement Weaknesses 12

The Capacity Building Program provides capacity strengthening opportunities to advocates globallythrough ThreatsExternal Threats to the Movement 19
training, strategic counseling, and the highly regarded Fellows Programs.
Founded in 1987, the Tobacco Control Project is dedicated to building an effective tobacco control movement OpportunitiesExternal Opportunities for the Movement 27
by developing and supporting the capacity of community-based tobacco control leaders to advocate effectively for
strong, comprehensive tobacco control policies. The Tobacco Control Project offers technical support to the Next Steps 33
movement such as strategic guidance and counseling, dissemination of critical information and analysis, and the
electronic networks SCARCNet and SMARTalk. Conclusion 37
The U.S. tobacco control movement has achieved monumental progress over the past decade. The Tobacco Control
Projects consistent focus on media and policy advocacy, and strategic analysis and planning, has helped define the Appendix 1 38
terms of this historic public health debate.
The Advocacy Institute is a non-profit, tax-exempt organization under Section 501(c)(3) of the Internal Revenue Appendix 2 39
Service Code. Donations are tax-deductible to the fullest extent allowed by law. For more information about
A Movement Rising, the Tobacco Control Project, or the Advocacy Institute, please contact us at: Appendix 3 40

Advocacy Institute
1707 L St., NW Suite 400
Washington, DC 20036
phone (202) 659-8475
fax (202) 659-8484
email tobacco@advocacy.org

Visit our website at www.advocacy.org.

 2. This is a view from inside the tobacco control movement. Weve reached out as best we could to the far corners
of that movement, so that we could reflect the breadth of vision and insight among advocates. But we did not reach
Introduction outside, to those close observers of the movement, such as the thoughtful journalistsand there are manywho
covert tobacco control and whose view of us might help us see the movement more objectively.
3. While the Advocacy Institute staff sought to fairly reflect the wide diversity of insights and wisdom that
generously flowed to us in the course of this process, it would not be accurate to call this a consensus document.
In the final analysis, it represents the informed judgment of Advocacy Institutes Tobacco Control Project staff.

I
n late 1998, with support from The Robert Wood Johnson Foundation and the American Cancer Society, Errors of fact, we take full responsibility for. Perceived errors of judgment, we also take responsibility for
the Advocacy Institute undertook a comprehensive strategic analysis of the current United States tobacco although we are prepared to defend them.
control movement. This analysis was grounded upon an extensive series of consultations with veteran tobacco
control advocates. They were asked to view the movement in light of the proposed June 20, 1997 settlement, the We hope you find this analysis useful and thought-provoking.
failure of subsequent Congressional legislative efforts, the challenges and opportunities presented by the November
1998 multi-state settlement, and the successes and setbacks advocates have experienced at the state and local level.
The information gathering process for the analysis included: Mike Pertschuk Karla Sneegas Kay Arndorfer
Co-Director Consultant Director
One-on-one interviews (on the record, but anonymous) with more than 30 veteran state tobacco control coalition Advocacy Institute Advocacy Institute Tobacco Control Project
leaders, program managers, and advocates (see Appendix 1); Advocacy Institute
A series of confidential, transcribed interviews with 15 national tobacco control leaders and advocates (see
Appendix 2);
Insights and strategic observations drawn from Advocacy Institutes SMARTalk, a closed facilitated email list-serve Stephen Bobb Theresa Gardella Joel Papo
designed to help advocates secure funding for comprehensive state tobacco control programs; Program Associate Project Manager Research Associate
Tobacco Control Project Tobacco Control Project Tobacco Control Project
A one-day meeting of 12 veteran national and state advocates convened by Advocacy Institute on December 11,
Advocacy Institute Advocacy Institute Advocacy Institute
1998 (see Appendix 3); and
Extensive reviews of the strategic analysis drafts by more than two dozen national and state tobacco control
advocates and leaders.
The strategic analysis utilized the ACT-ON format (Advantages, Challenges, Threats, Opportunities and Next
Steps) to identify salient issues, and the steps that should be taken to build a stronger tobacco control movement.
The Advantages and Challenges sections address the internal strengths and weaknesses of the tobacco control
movement, while the Threats and Opportunities sections analyze the external influences that will have a direct
impact on our strategies over the next few years. In the Next Steps section, concrete actions are identified for
leaders of the tobacco control movement to consider in strengthening the national tobacco control movement
and advancing our policy objectives.
A Movement Rising: A Strategic Analysis of U.S. Tobacco Control Advocacy, March 1999 would not have been possible
without the help of our colleagues, many of whom thought we were nuts to undertake an analysis of the entire
tobacco control movement. Perhaps we are, but we did; and we are pleased to share the results with all of our
colleagues. It is our hope that this document will prove to be a stimulus and resource for the tobacco control
community as it now looks to the futureand that the utility of this analysis will be at least some measure
of reward for those who have been so generous in their counsel. We thank you all.
Before we begin, we offer three caveats:
1. By movement, we mean those people and efforts dedicated to changing public and private policies controlling
tobacco. This, of course, leaves out important activities contributing to a comprehensive tobacco control agenda,
such as perfecting and promoting effective cessation/treatment services, improving the effectiveness of school-based
education, care-provider intervention, and strengthening the quality of surveillance/evaluationexcept where such
objectives are themselves encompassed in policy or funding advocacy.

2 / Advocacy Institute Advocacy Institute / 3


Executive Summary
AdvantagesInternal Movement Strengths
While there have been disappointments and conflicts within the tobacco control movement, as well as
unimagined advances, this movement continues to enjoy potent strengths, as well as the benefit of valuable
lessons learned in the upheavals of the past several years. These strengthsor advantagesinclude:
Moral authority grounded on a strong scientific base;
A deep reservoir of dedicated human resources, among them a growing army of veteran advocates throughout
the country;
A solid movement infrastructure of technical support and funding;
A growing diversity of advocates, both culturally and politically;
Many mature, experienced state and local coalitions;
New partnerships forged with public health and education organizations, trial lawyers, the faith community,
elected policy makers, pharmaceutical companies, and even tobacco growers; and
Hundreds of advocates adept at media advocacy and a veteran press corps with whom they have developed
working relationships of trust and confidence.
ChallengesInternal Movement Weaknesses
Many of our challenges are the mirror image of our advantages. Perhaps the most formidable challenges deal
with our relationships with each other. As one veteran state advocate told us, There is a challenge to improve
collaboration and cooperation within the movement. A need to find ways to throw bombs at the industry,
not at each other.
Among the challenges we face are:
The growth and bureaucratization of the movement, which has leeched some of the inspiration and energy that
sprung from being citizen Davids challenging the industry Goliath;
Dependence upon public and philanthropic funding, which constrains advocacy, coupled with an aversion to
political engagement among too many tobacco control professionals, even in their role as private citizens;
The persistent narrowness of the tobacco control movements base, despite new outreach efforts to minority
communities, parents and educators, labor, faith communities, business and tobacco farmers;
Flawed intra-movement strategic communications that leave many state and local advocates feeling out of the
loop in strategic decision making, and sometimes lead to inflammatory misinformation;
A lack of sufficient resources for state and local coalitions to effectively address all tobacco control policy
objectives, coupled with a reluctance to set priorities;
The persistent gap between tobacco control funding and tobacco industry war chests;
Serious internal divisions among tobacco control advocates over core values and goals, strategies, leadership roles,
and issues of open communication and information exchange; and
4 / Advocacy Institute
A residue of lingering resentments, valid or not, including perceived inequities in funding, perceived self-
promotion, perceived patronizing arrogance of some newcomers towards tobacco control veterans, perceived
patronizing by some national leaders of state and local leaders, and perceived conflicts of interest.
ThreatsExternal Threats to the Movement
The tobacco control movements success has itself engendered a new set of external threats. Among them:
High profile media coverage of the state attorneys general lawsuits and the multi-state settlement has left many
Americans believing that the tobacco problem has now been dealt with;
Years of exposing tobacco industry wrongdoing has left the public numbed to additional revelations, and there is
even evidence of nascent sympathy for an industry that appears to have been punished enough;
There are signs of disenchantment with tobacco control programs that do not result in immediate and dramatic
declines in youth and adult tobacco consumption;
There is increasingly harsh commentary by journalists and othersnot industry flackswho raise concerns
about the effectiveness, the fairness, the overreaching, and the political expediency of tobacco taxes and other
tobacco control objectives;
Some citizens suspect that advocates for new, large tobacco control programs are more motivated by
self-interest in potential new jobs than in the public health.
While tobacco control advocates initially heralded the state attorneys general lawsuits as opening a powerful new
front against the tobacco industry, the multi-state settlement opened the door to several threats including:
Preemptive language and other tobacco industry subversion of the state settlement enabling legislation and
appropriations;
Straitjackets on tobacco control funding, such as limiting media initiatives to ineffective just say no campaigns;
Tobacco industry payments under the settlement, even when not applied to tobacco control programs, providing
politicians an excuse for opposing any new tobacco excise tax increases.
There is no new tobacco industry, but there are efforts underway to cultivate the appearance of a contrite and
reformed industry that is now a responsible corporate citizen. This new tobacco industry is armed with an arsenal
of more subtle strategies designed to deflect public outrage and prevent implementation of programs that
aggressively attack the tobacco industry and that promise effective tobacco use reduction.
Both the Congress and the state legislatures remain treacherous forums for tobacco control, as tobacco industry-
backed legislators work hand in hand with tobaccos bipartisan army of lobbyists to undermine in the shadows
what they would not dare to do in the spotlight of media attention.
Meanwhile, that critical spotlight dims as broadcasters and publishers lose interest in the old news of tobacco
fights, which are crowded out by new events and new public issue agendas.
OpportunitiesExternal Opportunities for the Movement
Despite the struggles and pitfalls delineated earlier, no set of opportunities holds greater potential than those
presented by the November 1998 $206 billion multi-state tobacco settlement. Throughout the country, state
coalitions this year are seeking nearly $2 billion, or roughly 30% of the first settlement payments. These funds
not only can underwrite an effective tobacco control program in every state, they have already spurred renewed
collaboration, organizing, and alliance building as tobacco control advocates join together to fight against their
diversion to politicians competing pet causes.
Advocacy Institute / 5
In Washington, DC, there may be a convergence of forces promoting the adoption by Congress of broad, strong State media advocacy campaigns, supporting tobacco control funding initiatives, tailored to the political culture
FDA authority over tobacco productsalthough not without struggle and risk. There is also untapped opportunity and environment of each state.
for riding the continuing momentum towards strong local clean indoor air ordinances and private workplace
policies. Long-term movement building initiatives:

In addition, there are: This strategic analysis strongly indicates the need for additional long-term movement-building initiatives including:

Opportunities for exploiting the treasure chest of tobacco industry documents for media advocacy, renewing
public outrage at the tobacco industrys corrupt practices;
Accelerating litigation opportunities to unearth more damaging industry documents, to force settlements that
result in public health advances and to cause financial harm to the industry, precipitating tobacco price increases
which discourage use; and
Opportunities for forming new partnerships and alliances with interest groups seeking a portion of the
settlement funds.
Perhaps the most encouraging developments in 1998 occurred not in the United States but internationally.
These international opportunities include the ascension of the dynamic Dr. Gro Harlem Brundtland to
Director General of the World Health Organization (WHO). She has already set tobacco control as a top
priority and recruited an exemplary tobacco control team. WHOs priority initiativethe adoption of a
worldwide International Framework Convention for Tobacco Control that includes an international model for
national tobacco control lawscan give impetus to U.S. domestic legislative efforts, as well as those in lesser
developed countries.
Next Steps
This analysis points the way to both short-term and long-term public policy initiatives and movement-
building needs.
Short-term common ground policy initiatives:
As of January, 1999 and at least through the current legislative sessions, several priority campaigns command broad
consensus:
Unity-building strategies that encompass long-term strategic planning, priority setting and consensus building
through participatory and collaborative decision-making;
Broadening movement leadership by nurturing and developing leadership capacity;
Rewarding political supporters and punishing political foes;
Broadening policy objectives beyond a youth focus;
Strengthening intra-movement communications;
Developing the capacity to engage in watch dog advocacy as states and the federal government implement new
tobacco control programs; and
The integration of international and national tobacco control advocacy.
Conclusion
There may never be a better opportunity than now to practice the lessons we have learned these past two years;
never a better time to repair the breaches; and never a better moment for looking ahead with deliberation. Right
now, there is agreement among advocates on the primacy of establishing strong state tobacco control programs and
an unprecedented, collaborative effort from all corners of the movement towards that end.
Further on the horizon lies the possibility of federal tobacco legislation. No serious Congressional initiative has yet
surfaced, but that is all the more reason why now is the time for a deliberative and inclusive process to work
through the salient priorities for tobacco control, to identify those non-negotiable core principles, and to distill and
talk through principled differences. As we have seen, total consensus has not been and will never be possible, but
reasoned debate, broad consensus on core issues, and civil agreement to disagree on other issues will be critical if the
tobacco control movement hopes to grow and fulfill its mission. It is our hope that this analysis will help lead in
such direction.

State-by-state campaigns to secure the appropriation of settlement-generated funding for comprehensive,

politically unshackled tobacco control programs;
Pursuit of federal legislation securing unfettered FDA authority to regulate the marketing and manufacture of
tobacco products and steadfast resistance to any Trojan Horse federal legislation which masks a weakening of
FDA authority or unjustified concessions to the tobacco industry;
Reinvigorated local clean indoor air initiatives, supported and sustained by the national organizations and
efforts to roll back preemption of strong local ordinances in those states where state preemption laws still prevail;
Advocacy for greater and better-targeted investment in tobacco use prevention and control research by NCI,
CDC, and the soon to be established national foundation, funded by the multi-state settlement; and
Advocacy for the funding of cessation/treatment programs.

Short-term funding and technical support needs:

Comprehensive technical assistance and unrestricted funding to support state-wide campaigns, especially to hire
lobbyists specializing in state appropriations processes;
National strategic media advocacy campaigns designed to rekindle and sustain appropriate outrage at tobacco
industry corrupt practices; and

6 / Advocacy Institute Advocacy Institute / 7


AdvantagesInternal Movement Strengths
1. Moral Authority
2. A Deep Reservoir of Dedicated Human
Resources
3. A Solid Infrastructure on which to Build
4. Growing Diversity
5. Mature, Experienced State and Local
Coalitions
6. New Alliances and Resources
7. Media-Savvy Advocates and a Veteran Corps
of Tobacco Reporters
W hile there have been disappointments and
conflicts within the tobacco control movement,
as well as unimagined advances, this movement
continues to enjoy potent strengths, as well as the
benefit of valuable, if painful, lessons learned in the
upheavals of the past several years.
It is therefore fitting, and wise, that we begin this
strategic analysis by reviewing the impressive
advantagesthe internal strengths of the tobacco
control movementwith which we face the future.
1. Moral Authority
As one environmental advocate not involved in tobacco
control once remarked, You have science, truth,
health, and justice on your side. All you need to do is
keep from blowing it! Of course its not that simple,
but it is worthwhile to affirm that the strength of the
scientific verdict against tobacco use and tobaccos mas-
sive toll of disease and death remain uniquely powerful
weapons in the arsenal of tobacco control advocates.
2. A Deep Reservoir of Dedicated
Human Resources
Veteran advocates contend that the primary strength
of the movement resides in its people and skills,
8 / Advocacy Institute
particularly in advocates bruised, hardened, and
politically tested in the crucible of battle. These
advocates, to the benefit of the movement, possess
an array of leadership qualities, including:
Thinkers and Strategists: long-term planners and
challengers of conventional thinking;
Statespersons: voices of authority, visionaries;
Outside Spark Plugs: the activists that politicians
fear meeting on the street;
Inside Negotiators: who help translate goals
into reality;
Communicators: who translate science into
sound bites; and
Bridge-Builders: who nurture consensus
and collaboration.
Few citizens movements can boast such a full
complement of essential leadership roles and skills.
3. A Solid Infrastructure on which to Build
The past decade has seen explosive growth in the
funding of the national and state tobacco control
movement infrastructure. The source of these funds
includes earmarked state tobacco control excise taxes,
federal and private philanthropic funding, and state
litigation settlement funds.
At the federal level, both the National Cancer Institute
(NCI), with its pioneering ASSIST program of 17 state
coalitions focused on public policy advocacy, and the
Center for Disease Controls (CDC) IMPACT
program, have greatly strengthened the tobacco
control capacity of state health departments. These
programs have been strongly complemented by the
relatively less constrained funding of an additional 30
sites through The Robert Wood Johnson Foundations
SmokeLess States Program administered by the
American Medical Association (AMA).
At least equally important has been the new commit-
ment of the national voluntary health associations to
the primacy of policy advocacy, backed by the funding
and staff resources to make that commitment a reality.
The American Cancer Society (ACS) has ratcheted up
its annual investment in national and state advocacy
from less than $1 million five years ago to its current
national advocacy budget of $8.5 million. The
American Heart Association and the American
Lung Association, though with less overall resources,
have made similar financial and policy commitments
to advocacy.
In 1995, The Robert Wood Johnson Foundation and
the American Cancer Society also created and funded
the National Center for Tobacco-Free Kids, a major
new resource which brought together expertise in
strategic communications and advocacy in both direct
federal policy advocacy campaigns and support
funding and technicalfor state and local initiatives.
Other effective advocacy and intermediary organiza-
tions have evolved to provide strategic intelligence and
expert guidance to state and local advocates, including
Americans for Nonsmokers Rights, the ASSIST
Coordinating Center at Prospect Associates, the
AMAs National SmokeLess States Program Office,
the Tobacco Control Resource Center at Northeastern
University, the Office on Smoking and Health at
CDC, and the Advocacy Institute.
Together, this new infrastructure is deployed in a wide
range of complementary roles which support policy
advocacy, including:
Direct, professional lobbying;
Established relationships of trust and confidence
with key policy makers;
State-of-the-art paid and unpaid media advocacy;
state coalitions.
Grassroots organizing and mobilizing;
Movement outreach and alliance building;
Targeted funding of state advocacy initiatives;
State and local coalition development and technical
support;
Advocacy training and leadership capacity building;
Intra-movement intelligence dissemination and
strategic communications; and
Strategic analysis and planning.
the way, with the building of multi-cultural networks
State tobacco control leaders also report that:
Greater availability of advocacy support funding
from diverse sources increases the opportunities for
pooling funds to respond to specific threats or
opportunities;
Such funding has greatly enriched the quality and
availability of technical assistance;
Multiple funding sources mean that state advocates
need not be dependent upon the whims or priorities
of any single funding source;
Funders now tend to trust the judgment of state
advocates to use the funds strategically. They also
tend not to micro-manage once the initial, tough-
minded review and approval of proposals has
been made;
This support also facilitates stronger national, state,
and local connectedness. Advocates in the field feel
less isolated, and welcome the fact that national
resources are being brought to bear at the state and
local levels, not just at the national level;
In many smaller cities or counties, the funding of
just one paid public health worker dedicated to
tobacco control has been the catalyst for unleashing
broad community participation and support, and
concrete policy change.
The benefits of this strengthened infrastructure can
perhaps best be glimpsed in the current, pro-active,
collaborative effort involving the National Center for
Tobacco-Free Kids, the American Cancer Society,
the American Heart Association, and virtually all
concerned national non-governmental and government
tobacco control organizations to provide targeted
funding and broad technical support to frontline
4. Growing Diversity
As recently as the early 1990s, the tobacco control
movement and its leadership could rightly be described
as narrow, exclusive, white, mostly male, and middle
class. While tobacco control is still not a movement
that mirrors the face of America, the last five years
have seen welcome diversification. California has led
Advocacy Institute / 9
and leadership. The investment in tobacco control
of organizations such as the National Association of
African Americans for Positive Imagery, the Asian
Pacific Partners for Empowerment and Leadership,
the American Womens Medical Association, and the
National Coalition of Hispanic Health and Human
Services Organizations has had a positive impact on
diversity as well. National tobacco control support
programs such as ASSIST, SmokeLess States, and
the CDCs Office on Smoking and Health have
made multi-cultural outreach and involvement
a priority.
Growing racial and ethnic diversity is complemented
by other types of diversity. For instance, despite the
largely partisan political divisions in Congress over
tobacco control legislation in 1998, tobacco control
continues to appeal to a broad cross-section of the
American public, bringing together people whose
political philosophies and positions on other public
policy issues may well be polar opposites. There are
also encouraging signs of greater geographic diversity
representing the full spectrum of urban, suburban,
and rural populations.
5. Mature, Experienced State and
Local Coalitions
There now exists a level of experience and maturity in
at least half of the state coalitions and in many local
coalitions that was unknown less than 10 years ago.
Indeed, it is now common to find state and local
tobacco control coalitions ably led by both staff and
volunteers with more than 7, 8, or even 10 years
of experience. These state coalitions have, in turn,
nurtured and supported local coalitions which
have proven most effective in thwarting tobacco
lobby efforts to defeat strong local tobacco
control ordinances.
Many of these coalitions, which have evolved over a
number of years and numerous campaigns, have devel-
oped strong internal working relationships based upon
mutual trust. They overcame or successfully set aside
conflicts that erupted at the national level with the June
20, 1997 proposed settlement and its legislative after-
math. These coalitions are now open to and welcoming
of assistance and support from all national tobacco
10 / Advocacy Institute
control organizationsand fully capable of utilizing
such support effectively.
6. New Alliances and Resources
The outreach and recruiting initiatives of the last
several years have brought new allies and new resources
to tobacco control, including:
The CDC-supported effort to reach out to impor--
tant new constituencies through such organizations
as the National Organization for Women;
The National Center for Tobacco-Free Kids outreach
to such newly engaged allies as the National
Education Association and the religious community;
The leveraging of litigation strategies and funding
support from trial lawyers;
Elected policy makers, predominantly Democrats,
but including a number of key Republicans; and
The pharmaceutical companies marketing nicotine
replacement products.
At the state and local level especially, coalition leaders
report great success in recruiting the impassioned
support of such groups as teachers, students, religious
leaders and their congregations, ethnic and womens
groups, and, at least in some communities, business
and local civic associations. Illustrative of the power of
such alliances was the story told by a local coalition
organizer about a religious leader outraged at the
stonewalling of a city council member on a billboard
ordinance. Erupting in anger, the minister warned the
council member that the 20,000 members of his
religious community would do all they could in the
coming election to oust that member from office.
One of the most remarkable successes over the past year
was the forging of an alliance between public health
advocates and tobacco farmers. Symbolic of this success
was the release of a Core Principles Statement by 40
tobacco grower and public health organizations,
including the Burley Tobacco Growers Cooperative,
Concerned Friends for Tobacco, the National Black
Farmers Association, the American Cancer Society, the
National Center for Tobacco-Free Kids, and the
American Heart Association. These core principles
included support for full FDA authority to protect con- In the process of covering tobacco, many journalists
sumers, that tobacco products not be marketed or sold developed working relationships of trust and
to kids, and that if there is a tax increase, a portion of confidence with tobacco control leaders and advocates.
the revenue would be used to assist farmers and their Their interest, understanding, and connections remain
communities. ready to be activated as new industry disclosures and
new tobacco control issues take center stage.
7. Media-Savvy Advocates and A Veteran Corps Added to this ability to approach the news media
of Responsive Tobacco Reporters or unpaid media strategically has been the advent
of targeted paid media or focused issue advertising.
News coverage has been the lifeblood of the tobacco
Developed and funded especially by ACS and The
control movement. Media researchers confirm that the
National Center for Tobacco-Free Kids, paid media
more coverage there is of an issue, the more importance has shone a harsh spotlight on the tobacco lobby
viewers and readers assign to that issue. Additionally, and unresponsive public officials.
media coverage frames the issue, shaping viewer
attitudes about who caused the problem and who is
responsible for fixing it. For example, in 1994, ABCs
Day One aired a landmark expos of nicotine
manipulation by cigarette makers. The program framed
the tobacco issue as one of governmental responsibility
to regulate and curb cigarette makers deception,
exploitation of children, and unchecked greed. Without
such framing, the public would likely have clung to the
more reflexive, individualist frameholding smokers
or parents responsible for the tobacco problem.
Sustained media coverage also appears to have a direct
impact on tobacco use prevalence. For example, some
analysts attribute the recent decline in tobacco use
among teenagersthe first of this decadeto the
massive coverage of tobacco in the media while the
proposed settlement and the ensuing legislative battles
were high on the national agenda.
While national coverage of tobacco issues has waned
some since legislation sponsored by Senator John
McCain (R-AZ) failed in July 1998, the disclosures
of industry abuses, and the high profile of settlement
and legislative issues engaged, motivated, and educated
hundreds of journalists, both broadcast and print,
to tobacco issues.
Much of this coverageand the framing of the stories
in ways that build support for tobacco control policy
initiativeswas directly attributable to the skill and
sophistication of hundreds of tobacco control
advocates. These advocatesskilled in the fine art of
media advocacywere either self-taught or received
training in programs such as ASSIST.
Advocacy Institute / 11

ChallengesInternal Movement Weaknesses
1. The Negative Consequences of Success
2. A Movement that Talks Loudly but
Carries a Small Stick
3. The Continued Narrowness of the
Movements Base
4. Flawed Intra-Movement Communications
5. Resources Still Spread Too Thin
6. A House Divided
1. The Negative Consequences of Success
Many of the internal weaknesses and challenges which
now face the tobacco control movement are mirror
images of its accomplishments and strengths, including:
a) A movement that no longer sees itself as David
vs. Goliath. The tobacco control movement has
always played the role of David in its fight against
the tobacco industry. Until recently, all David had
going for him was passion, a spirit of adventure, and
quickness of movement. In the 1990s, the tobacco
control movement became better-funded, coalition-
based, and bigger. In other words, David grew a
couple inches and got some muscles. Many veteran
tobacco control advocates feel that this new David
has lost some of his passion, spirit of adventure, and
flexibilityattributes that have always been essential
to countering the incomparably powerful Goliath
called Big Tobacco.
b) Competition over settlement-generated funding.
With the multi-state settlement concluded, effort
and energy will necessarily be directed toward
securing funding for comprehensive state tobacco
control programs. This may well lead to newly
divisive conflicts within tobacco control coalitions
over funding priorities, as well as with other
claimants to the funds.
12 / Advocacy Institute
c) The bureaucratizing of the movement. A tobacco
control movement made up of thousands of public
health workers, crimped by the constraints of
government and foundation funding, is a far cry
from the closely knit, passionate and adventurous
permissible activism. But the contrast with the tobacco
community that tobacco control veterans like to
remember. With numbers comes complexity, and a
loss of collegiality, flexibility, and consensus
building. More people are now drawn to this work
as a jobnot necessarily as a calling.
2. A Movement that Talks Loudly but Carries a
Small Stick
a) Constraints on advocacy. Almost all of the funding
for tobacco control comes with constraintssome
nearly paralyzing.
Federal and state government funding cannot be
used for lobbying or electioneering. Worse, what
constitutes lobbying and electioneering is
vaguely defined and those who control such
fundsat every levelinvariably impose even
tighter definitions and restrictions than the law
allows. Tobacco industry-inspired legal challenges,
red tape in clarifying the rules, burdensome
Freedom of Information Act (FOIA) demands,
investigative media probing, and intimidation by
tobaccos friends in the legislatures all foster fear
and result in less aggressive action. For example,
the recent extension of FASA restrictions that
prohibit the use of ASSIST funds for lobbying on
the local level may choke off what has been
vigorous advocacy efforts by local ASSIST
coalitions.
Foundation funding, too, cannot directly
support lobbying or electioneering, though
some philanthropic institutions have been less
disposed to imposing constraints which reach
beyond the requirements of the law.
Some organizations that enjoy charitable status
under the Internal Revenue Service Code are
unwilling to engage in lobbying activities even
though the law expressly permits the use of their
funds for lobbying up to prescribed limitsfor
fear of IRS investigation or political harassment.
Of course, the tobacco industry has exploited these
constraints to harass and intimidate advocates operating
well within legal parameters. But there are encouraging
signs that some advocacy organizationsand some
fundersare willing to push the legal envelope of
companies and their corporate allies remains stark; they
not only lobby with unrestrained abandon, but deduct
all their lobbying and political propaganda as tax-free
business expenses.
b) Aversion to political action. Tobacco control
advocates are very good at what one observer calls
belligerent conversation, belaboring politicians in
private and vowing to cause them great pain. But
very few tobacco control advocates actually engage
in the electoral process in ways that make their
threatsor vows of supportreal.
One state coalition director complained that getting
paid staff engaged in politics in their free, unpaid
time was his biggest challenge. He cited fear, not
knowing how to do it, and a low level of comfort
with the conflict and untidiness of electoral politics.
Others hold back simply because they do not believe
their efforts can make a difference. To be sure,
advocates have used advocacy strategies, including
paid advertising, to spotlight the failures of elected
officials, but few have taken the next stepselectoral
activityto hold those officials accountable.
There have been exceptions. An example is the
brilliant Maryland Childrens Initiative to enact a
$1.00 per-pack excise tax increase. The Initiative
coordinated a two-year electoral campaign that
utilized voter polls, candidate pledges, independent-
expenditure issue-advertising, and direct voter
education. As a result, Maryland entered 1999 with
its governor and nearly a majority of Assembly and
Senate members pledged to support the Childrens
Initiative as the Washington Post sternly reminded
them all in a February 1999 editorial holding them
to their word.
Most advocates in most states have shied away from
elections and working to punish those who have
taken tobacco industry campaign money and
slavishly voted tobaccos line; nor have they worked
to elect, or re-elect, candidates who have promoted a
smoke-free society. Because so many tobacco control
professionals are paid with government or founda
tion funds, they are keenly aware that those funds
cannot legally be used for electioneering. But in the
process, they have forgotten that they are only
bound by these rules eight hours a day, and there
are plenty of remaining hours to become active
advocates and citizens.
By contrast, the major voluntary gun control organi-
zations, such as Handgun Control Inc., have been
extremely active in electoral politicsraising hard
money to fund electioneering and working to
encourage grassroots political activity. Indeed, the
Maryland Childrens Initiative was modeled on a
successful campaign run four years earlier by
Marylanders Against Handgun Abuse.
3. The Continued Narrowness of the
Movements Base
There is concern about the general failure of the
tobacco control movement to broaden its base of
support beyond its traditional members: public health
voluntaries, a small band of volunteer tobacco control
activists, and public health workers. There is also
concern that tobacco control advocates primarily reach
out to Democrats and others left of center, neglecting
the importance of bi-partisanship and the potential for
recruiting moderates and religious conservatives. Some
advocates believe more can and must be done to reach
out to potential allies such as:
Minority communities (though progress has been
made, especially in California, minority voices are
commonly not heard when priorities are set, and
funding decisions tend to overlook the special
concerns and needs of minority communities);
Parents and educators;
Labor organizers;
Faith communities, both liberal and conservative;
Social change and corporate accountability advocates;
Hospitals and health care insurance companies;
Advocacy Institute / 13
 Business organizations, such as local chambers of
commerce and business trade associations; and
Tobacco farmers, retailers, and restaurant owners
who do not wish to march in lock step with the
tobacco lobby (after all, look at the case of Liggett
and Myera tobacco company that became a force
for tobacco control, albeit under very special
circumstances).
4. Flawed Intra-Movement Communications
One consistent complaint of advocates working in
states and local communities, especially acute at the
time of settlement negotiations in the spring of 1997,
was the lack of access to critical strategic information,
the lack of open channels of feedback (feedback loops)
to national decision makers, and a lack of input into
strategic planning. To be sure, there are a number of
formal and informal communications networks that
provide important and timely information (and,
sometimes, misinformation), but many advocates
still feel isolated, uninformed, and out of the loop.
In particular, the failure of national leadership to
communicate fully with field staff, grassroots
activists, and rank and file volunteers in 1997 and
1998 has fueled resentment at what is viewed as
authoritarian leadership.
5. Resources Still Spread Too Thin
It is true, as we noted under the Advantages section,
that the human and material resources available to
tobacco control advocacy are far more substantial than
ever before. But they remain limited, and often become
strained when coalitions fail to set priorities among
their numerous objectives. Because different groups
within coalitions have differing priorities, the common
resolution is to embrace them all indiscriminately. The
unwillingness to engage in priority-setting condemns
too many coalitions to spreading their resources and
energies too thin to be effective. In the current state
legislative sessions, this lack of resources might require
concentration on securing funds for a comprehensive
tobacco control program, while holding back on
other initiatives for the time being.
14 / Advocacy Institute
While many organizations and coalitions have been
greatly strengthened by full-time paid staff, they still
depend on the dedication and know-how of volunteers.
Unfortunately, the pool of long-time activists remains
small, and many experienced leaders and campaigners
have burned out, or moved on to other callings.
Only a few now serving have experienced more than
two or three years of campaigning, while our tobacco
industry and National Smokers Alliance adversaries
are commonly careerists with decades of experience.
6. A House Divided
Serious divisions among tobacco control advocates
concerning goals, policy priorities, strategies and tactics,
and decision making processes have always existed. For
the most part, these divisions remained submerged
until the past two years, when they erupted in the wake
of the global settlement of June 20, 1997, and its
legislative aftermath. This strategic analysis seeks to
avoid judging these divisions, but to give voice to com-
peting views. Most are principled disagreements that
merit mutual respect. Indeed, Advocacy Institute staff
found themselves on opposite sides of many of these
issues at different times.
We do believe an important step towards the restora-
tion of collaboration and unity lies in holding these
divisions up to the sunlighthowever painful
otherwise they will continue to lurk just beneath the
surface, causing distrust and threatening to erupt again,
undermining essential movement unity in future
legislative struggles.
a) Differing priorities among competing core values
and goals. Tobacco control advocates almost univer-
sally share certain core values which undergird their
advocacy. Among them are public health, corporate
accountability, and democratic decision making. The
June 20, 1997 proposed settlement between the
attorneys general and the tobacco companies, and the
subsequent legislative battle, however, brought to the
surface important differences in the relative priority
which advocates place on these values, differences
which they had not been forced to confront before.
Whether advocates liked it or not, they were
confronted with a situation that necessitated giving
certain values more value than others.
For example, some opposed the proposed settlement
and resulting legislative language because they placed
a higher value on promoting a democratic decision
making process that encouraged public input and
did not include closed door negotiating and a
Congressional environment filled with corporate
money and lobbyists. A true democratic process, they
believed, would ultimately produce a comprehensive
tobacco control bill free of unjustified concessions to
the tobacco industryand that process was worth
waiting and fighting for.
Many believed passionately that any form of
immunity for the tobacco industry, even an $8
or $9 billion cap on annual industry liability pay
ments, was fundamentally wrongboth morally
and strategically.
Others believed that the concrete and achievable
public health gains, especially the broad FDA
provisions, contained in the McCain bill as it was
reported out of the Senate Commerce Committee,
outweighed the limitations on corporate accounta-
bility represented by the McCain bills annual caps
on tobacco industry liability payments.
b) Differing policy priorities.
Federal vs. local focus. Policy prioritiesand
preferred venues for policy changetend to reflect
the policy arenas in which advocates operate. Not
surprisingly, those who operate nationally, with a
strong Washington, D.C. presence, see federal
legislation as the highest priority. They view
comprehensive federal policy and regulation as
holding the greatest potential for reducing tobacco
use, illness, and death.
Local advocates, by contrast, tend to be focused on
changing the community environment in which
tobacco use is an acceptable social norm, a strategy
based on social-cultural change. They believe that
such changes should come from the bottom up
since strong policies imposed from the top down
lack the community support that comes from local
policy making. They point to research demonstrat-
ing that most of the progress in reducing tobacco
use has thus far been made at the local level and
through vanguard state programs, such as those in
California and Massachusetts.
These differences between federal and local
priorities are sharpened by the belief of most local
advocates that Congress remains in the grip of the
tobacco lobby and that no legislation can possibly
become law without tacit approval by tobacco
lobbyists. They fear hidden loopholes in long,
complex federal legislation that will restrict their
local activities.
National advocates, while also wary of the tobacco
lobbys power and influence, nevertheless believe
that the power of state and local authority to
deal with tobacco is necessarily limited, and that
a confluence of sound strategies and other political
forces can occur to make strong federal law
possible.
The relative importance of FDA authority.
Virtually all tobacco control advocates support
full FDA authority over tobacco and nicotine
delivery products. But there are profound
differences as to the overall significance of such
authority.
There are many, especially among national
advocates, who see such authority as a unique
and fundamental instrument for ending death and
disease from tobacco use. They see even the most
effective state and local programs bottoming out
with no less than 20% of the public still smoking.
They also see the tobacco companies and the drug
companies transforming the marketplace for
nicotine delivery devices. One senior tobacco
policy analyst warned us:
There is a race developing between the drug and
cigarette companies to come up with a new
nicotine delivery device that has the nicotine
delivery capability (efficiency and flexibility) of
the cigarette with a minimal amount of health
risks. Within five years, I believe there will be 3
classes of nicotine delivery devices available for
nicotine users: 1) nicotine replacement devices
with minimal health risks (i.e. patches, gum,
etc,); 2) the Accord type device (only much
better) that heats tobacco, thereby freeing nicotine
for absorption by the smoker with limited health
consequences; and 3) cigarettes, which will
remain deadly.
Advocacy Institute / 15
 Within 10 years, the majority of nicotine users
will use items in the second category. How will
the tobacco control community respond to this
new device? It will be much safer and with little
or no ETS effect. In the end, the person who
controls nicotine and has the best delivery
device wins.
Some advocates believe only an FDA with broad
scientific resources and plenary regulatory powers
can harness these market forces toward the
effective reduction of the risk of nicotine delivery
products.
In stark contrast, others are convinced that,
even with regulatory power, no future FDA
Commissioneror U.S. President, for that
matterwould have the political courage, for
example, to gradually lower the nicotine levels of
cigarettes to eliminate the addictive power of
tobacco. Still others are philosophically offended
by such regulatory approaches as social engineering
that is entirely out of keeping with the dominant
American value of freedom of choice. They see
FDAs likely and appropriate role as only
marginally significant, perhaps limited to restrict-
ing advertising and promotion, and youth
access. And, they see the redoubling of state and
local effortsefforts which might be undermined
by a federal solution that robs local advocacy of
its energyas the only proven key to reducing
tobacco use.
This difference explains, at least in part, why some
national advocates are willing to accept limits on
tobacco industry civil liability if that is the price
for gaining full FDA authority, while others,
mostly local advocates but including national
advocates, see any such limitations as too steep a
price to pay.
If the Justice Department brings action to recover
Medicare funds spent on tobaccos victims, such
action may again lead to negotiations between the
Administration and the tobacco companies.
Potential trade-offs could again be on the table
arousing much, if not all, of the divisiveness and
rancor generated by the June 20, 1997 proposed
settlementunless the tobacco control com-
16 / Advocacy Institute
munity finds a way to work through these
differences.
c) Differences over youth-focused advocacy. There
are strong differences among advocates over policy
advocacy that focuses primarily on reducing tobacco
industry access to youth. Some who place high value
on adults freedom of choice tend to believe that
governments proper roleand the limits of public
policyshould be to prevent tobacco industry
access to youth, while preserving wide freedom of
choice for adults.
By contrast, those who oppose a single-minded
youth focus believe that government has an equal
responsibility to adopt policies which protect adults
from the undue risks of environmental tobacco
smoke and the deceptive and manipulative marketing
strategies of the tobacco companiesand that the
most effective prevention strategies for youth are
programs that reduce tobacco use by parents and
other adult role models.
Still others who object to a youth focus argue that
such advocacy plays into the hands of industry
rhetoric and leads merely to symbolic, ineffective
actions to discourage youth tobacco use, while
diverting attention and resources from more broadly
effective policies such as clean indoor air ordinances
and cessation programs. They note that the tobacco
lobby has exploited this youth frame by persuading
some state lawmakers to confine state programs to
ineffective youth oriented strategies.
The gap may be narrower than it appears. At least
part of this conflict arises from differences in what is
meant by youth-focused advocacy. There is proba-
bly consensus that programs and policies which only
target youth smoking are bound to be ineffective.
But some advocates believe that framing the tobacco
issue primarily in terms of sparing the next genera-
tion of smokers is not only essential to building
broad public support for youth oriented policies, but
actually contributes to the support for policiessuch
as increased excise taxes and clean indoor air ordi-
nanceswhich help control tobacco use at all ages.
d)Differing attitudes towards negotiation react differently, and take opposing positions and
and compromise. All contemporary tobacco actions. Conflict between leaders is unavoidable and
control advocates have fought the tobacco leadership styles in and of themselves cause conflict,
companies and their allies, such as tobacco farm as illustrated below.
organizations, restaurant associations, and retail
Hedgehogs and Foxes. The Greek poet Archilochus
associations. Some tobacco control advocates believe
wrote, The fox knows many things, but the hedge-
strongly that the time to stop fighting and begin
hog knows one big thing. The scholar Isaiah Berlin
talking to the tobacco industry will never come. A
divides leaders between hedgehogs and foxes, and
variant of this belief is that negotiations with the
the leadership of the tobacco control movement can
tobacco industry are inevitably a zero-sum game;
similarly be divided.
that is, any outcome which benefits the tobacco
industryas reflected in gains for tobacco company The hedgehogs include those whose single focus is
share pricesmust necessarily mean a loss for public the evil of the tobacco industry, for whom all
health. actions must be measured by the extent to which
the industry is set back, defeated, and forced closer
Others believe that circumstances, such as the state
to impotence. For other hedgehogs, the big idea
attorneys general cases, can persuade tobacco
is comprehensive federal legislation, and for still
companies to make fundamental public health
others, the dominant idea is that tobacco control
concessions, such as the acceptance of broad FDA
can only be achieved at the local level, from the
authority, that are not politically attainable in the
ground up.
foreseeable future without tobacco industry
acquiescence. The foxes, by contrast, have no fixed vision of
tobacco control. Their strategies are flexible, oppor-
Divisions over negotiating and compromising plague
tunistic, and changeable. They look to all levels of
the local level as well. In some tobacco growing
government for a mix of policy solutions. This
regions, for example, advocates remain divided over
years priority objective may be taking advantage of
the ethical implications of negotiating with tobacco
lawsuits against the tobacco industry, next years
farmers and their organizations. Likewise, advocates
objective the allocation of settlement funds to
who seek to find some common ground with retailer
comprehensive state tobacco control programs,
or restaurant associations are challenged by others
and the year after that full authority for the FDA
who view these entities as fully manipulated satellites
and local clean air ordinances.
of the tobacco lobby.
Foxes and hedgehogs drive each other crazy.
There does seem to be a consensus that coalitions at
all levels need to talk through, in advance, any
Tensions between inside and outside
potential compromise on the horizon, so that they
leadership roles. In highlighting the strengths of
are prepared to hold the line on non-negotiable
tobacco control movement leadership, this Strategic
principles when they are faced with demands, even
Analysis earlier pointed to the complementary roles
from their legislative friends, for concessions.
of both skilled inside leadersthose who have
access to, and the trust of, policy makersand out
e) Tensions arising from diverse concepts
side leadersexperts in utilizing the mass media
of leadership. There are as many leadership styles
and mobilizing activists to put pressure on policy
as there are leaders. Some leaders are self-appointed
makers. Both inside and outside leaders were instru-
and others are drafted. Some leaders inspire followers
mental in persuading Senator McCain and the
with the lure of a grandiose idea, others with a
Senate Commerce Committee to improve upon the
myriad of attainable goals. Some leaders will map out
original terms of the June 1997 proposed settlement.
their exact course, others will be less forthcoming
with their followers. The tobacco control movement At that point, however, those who played an inside
has a healthy supply of leaders, and when confronted role strongly believed McCain and the Commerce
with the same threat or opportunity, they may well Committee had met their major demands and the
Advocacy Institute / 17
 public health community had both the obligation
and the strategic need to strongly endorse the bill as
written. The outside advocates, while acknowledging
that the McCain bill was a substantial advance over
the June 20, 1997 settlement, continued to fight the
bill, concentrating their energies on Senate floor
amendments to strengthen the bill, especially the
Gregg amendment to eliminate the $6.5 billion
annual cap on tobacco company liability.
Such inside-outside tension is likely to erupt again,
for example, in the upcoming battles over state fund
knowing decisions arising from the November
multi- state settlement. State appropriations struggles
are uniquely inside battles, often hidden from view,
even from reporters who cover state legislative
activities. Most state coalitions recognize that they
will need to hire lobbyists with knowledge of the
arcane appropriations process and access to appropri-
ations staff and key legislators. Negotiations will
take place and consensus building will be sketchy at
best, leaving many outside advocates outraged.
Compromises will be reached and fragile tobacco
control coalitions will be challenged to remain
unified in their positions.
f) A residue of other resentments. In addition to
long-standing divisions within the tobacco control
movement and lingering resentments fueled by the
settlement, there are several perceptions which con
tinue to drive the movement apart. These include:
Perceived inequities of funding (especially for
communities of color). For years, many grassroots
activists have resented the fact that those who
volunteer the most time and passion to tobacco
control are consistently short-changed when
tobacco control funds are disbursed to those
whom they view as bureaucrats and careerists, or
representing already privileged communities.
Perceived self-promotion. What many advocates
view as the strategic need to give their organiza--
tions and leaders a strong media presence to pro-
mote the image of a powerful movement is viewed
by others as self-serving, egotistical self-promotion.
18 / Advocacy Institute
Perceived patronizing arrogance of newcomers
towards veterans, and of national leaders towards
state and local leaders. Some advocates, who have
toiled for decades in state and local organizations,
resent the emergence of new organizations in what
they view as positions of unearned national
leadership. The conflict this perception opens up is
widened by what is perceived as disdain for the
veterans experience and learning.
Perceived conflicts of interest. In the heat of last
years battles, opponents were quick to attribute
differences in goals, priorities and strategies, not to
genuine disagreement, but to hidden financial
conflicts of interest. Steadfast denials and
refutations of such charges never seem to catch up
with the rumors and accusations which race
through the Internet.
While serious and unavoidable differences among
dedicated advocates will continue to exist, their
pernicious impact could be substantially diminished
if intra-movement communications were significantly
improved, and if advocates were more ready, willing,
and better trained to confront and treat conflicts as
good faith differences.
As one veteran state advocate told us, there is a
challenge to improve collaboration and cooperation
within the movement. A need to find ways to throw
bombs at the industry, not at each other. Another
said, we dont know how to disagree constructively.
Many expressed the need for more sophisticated
training on principled negotiation and conflict
resolution.
ThreatsExternal Threats to the Movement
1. The External Consequences of Success
2. The New Tobacco Industry
3. The Same Old Tobacco Industry
4. The Continued Threat of a Hostile Congress
5. A Weakened or Weak-WilledPresident
6. State Legislatures: The Tobacco Lobbys
Reliable Sanctuary
7. The Medias Low Threshold of Boredom
8. Competition for the Public Agenda
1. The External Consequences of Success
In many ways, tobacco control advocacy has led a
charmed life during the 1990s. It has:
Been supported by great majorities of the public;
Been paid attention to and treated with respect by
the mediawhich have focused a consistent and
harsh spotlight on tobacco industry wrongdoing;
Benefited greatly from the litigation initiatives,
been done! Twenty-five years ago, tobacco use
energy, and financial resources of the trial lawyers
and the state attorneys general;
Gained the political leadership of a popular president
and vice-president; and
Been perceived as an issue which elected officials
could thwart or ignore only at some political risk
(this became especially clear after Bob Dole, on the
presidential campaign trail, suggested that cigarettes
are not necessarily addictive and downplayed the
health dangers of tobacco by comparing them to the
risks of milk to some)
For many tobacco control advocates, these favorable
conditions are seen as permanent and only growing
stronger. But there are clouds on the horizon:
a) Perceptions that the tobacco control movement
has already won. Congratulations, your job is
done! How many have had friends and colleagues
not working on tobacco control greet them with
such words in the last year or so? Theyve seen action
in their city council on a strong clean indoor air
ordinance or youth access bill. Theyve voted for state
excise tax initiatives. Theyve read about the defeat of
industry-inspired preemption bills. Theyve heard
about last years global settlement and think it went
into effect, or, theyve heard about the McCain bill
and think it passed. Maybe, theyve heard about the
state attorneys general settlement and think it solved
the tobacco problem. But we know better. Unless
state legislatures dedicate settlement funds to strong
state tobacco control programs, these events will have
been a lot of sound and fury signifying nothing.
Its a fair assumption that much of the public retains
the impression that something significant has actually
happened to strengthen tobacco regulations and end
tobacco industry abuses in the U.S. And for some
people, in some communities, much of the job has
prevailed across all class and social lines. Today, the
movements success in sharply reducing tobacco use
among the more educated and the more affluent,
restricting tobacco advertising, and enforcing smoke-
free environments, has made tobacco use far less
visible to middle class Americans.
So it is to be expected that tobacco control advocates
seeking to push the boundaries of existing regulations
and programs will meet increasing resistance, based
upon the perception that we have already dealt with
the tobacco problem. Their efforts will be viewed
as contrasting unfavorably with other unmet needs,
such as access to health care for the uninsured, the
control of illicit drugs, and strengthening public
education.
Advocacy Institute / 19
b) A movement thats no longer viewed by the
public as David vs. Goliath. Before the growth in
tobacco control funding; before the multi-state
settlement; before the adoption of tobacco control
advocacy by centrist political leaders like President
Clinton and Senator McCain, tobacco control
held great populist appeal, based on its David vs.
Goliath image; no longer.
Although the tobacco industry remains incomparably
powerful, both economically and politically, focus
groups convened in December 1998 by a coalition of
public health advocates in Wisconsin suggest that
many consumers seem almost as wary of non-profit
organizations as of big business. In 1992, William
Aramony stepped down as president of the United
Way of America after allegations that he misused the
charitys funds. The United Way incident looms
large for many who fear that even well-known
nonprofits might use money for unnecessary
administrative costs such as $80,000 desks or
fancy cars. Especially now with the infusion of funds
into states from the settlement, the public and
legislative eyes will be watching for any appearance
of misuse of funds.
c) Waning public outrage. Dr. Koop expressed the
frustrations of many advocates, when he lamented at
the National Press Club in September 1998: If out
siders were to visit this land their conclusion would
have to be that the enormity of the burden of
tobacco... and the failure of Congress to respond to
it, all constitute a scandal that should have pushed
Monica Lewinsky to page 7 of the second section.
Instead, this is now mostly a silent scandal, press and
public alike sort of saying, politics as usual, and the
politicians saw their duty and did not do it, so what
else is new? I, however, want you to consider anew
the disgraces of the tobacco wars and ask you, where
is the outrage?
Tobacco control advocacy flourishes best in an
environment of fresh public outrage at the tobacco
industrys wrongful behavior. But tobacco control
advocates have stoked the fires of public outrage so
long and so relentlessly that at least some of the
public may have become anaesthetized to new revela-
tions, no matter how horrendous. As the Wisconsin
coalitions focus groups suggest, The actions of the
20 / Advocacy Institute
tobacco companies, documented in the media as a
result of the lawsuit, are no longer shocking.
In trying to recruit business leaders to tobacco
control campaigns, organizers are beginning to hear
words of solidarity and even sympathy for the
tobacco industry, e.g., Havent you done enough to
them? And advocates in Florida report that state
politicians who had finally begun to shun tobacco
industry campaign contributions are now welcoming
them again. Why? Because the industry, in settling
the state attorneys general case, has been reformed.
d) Backlash. For many years, much of the criticism of
tobacco control initiatives was correctly seen as the
product of tobacco industry-funded fronts or
radical libertarians far out of the mainstream.
Therefore, tobacco control advocates have tended to
dismiss all such critiques as propaganda. But, as
tobacco control has became a generally accepted
good, it was to be expected that it would be
subjected to the skeptical eye of mainstream analysts
and journalists who generally delight in challenging
conventional wisdom.
Perhaps a harbinger of such critiques can be seen in
the comments of tobacco industry historian Richard
Kluger. In a Washington Post op-ed article, Kluger,
author of Ashes to Ashes, the Pulitzer Prize winning
book about the tobacco industry, wrote: Who
deserves blame for the Senates decision to jettison
the anti-smoking bill, at least for this year? President
Clinton pointed at the tobacco companies and their
advertising blitz. But at least part of the fault lies
with the anti-smoking lobby, which overreached in
its punitive demands.
And from Steven Brills new independent media
watchdog magazine, Brills Content, a critique of the
medias alleged sloppiness and gullibility in accepting
tobacco control advocates allegedly exaggerated
scientific claims of the case against environmental
tobacco smoke (ETS): [T]he mediawith ample
reason to be skeptical of any tobacco industry
claimshave downplayed any doubts about the
dangers of secondhand smoke, while parroting the
scariest available statistics about its effects. The fact is,
while proving a link between passive smoke and
cancer has been a tricky business for scientists,
reporting on the issue has been even harder for the
media, which have tended to take the grays that
often characterize the scientific process and portray
them in strong blacks and whites.
Some tobacco control advocates quickly dismissed
Contents article as tobacco industry propaganda,
citing tobacco advertising in the magazines pages.
But it would be a mistake for advocates to ignore
the indicators that, as tobacco control becomes an
establishment issue, it is naturally beginning to draw
skeptical scrutiny from independent journalists and
critics.
Even Los Angeles Times reporter Myron Levin, one
of the staunchest tobacco industry critics, wrote in
his McCain bill post-mortem: [T]obacco foes,
steeped in a combat psychology, lost a chance to
reach many of their long-cherished goals. But, secure
in the comfort of their trenches, they also avoided
having to face a future with fewer battles to fight.
These critics, and others, have raised concerns about
aspects of tobacco control policies which cause even
committed tobacco control advocates discomfort.
They emphasize:
The regressivity of excise taxes (and the political
convenience of taxing low income smokers who
often dont vote, in favor of middle class tax
benefits for those who do vote);
The persecution of smokers for their own
good, which cuts against the strong American
ethos of individual choice;
The seeming over-zealousness of advocates; and
new assaults to divert those funds (these threats have
The funding of prevention programs just to keep
advocates in business (even some tobacco control
advocates have made this charge).
In raising these issues, the critics tend to minimize
and divert attention away from the crisis in youth
smoking, the need to restrain industry corruption
and the real public health benefits of comprehensive
tobacco control programs and policies. But their
criticisms may also be seen as a warning that tobacco
control advocates may be in danger of losing touch
with the views of ordinary Americans.
e) Dangers lurking in the state settlements. For
most tobacco control advocates, the November
1998 multi-state settlement containsat best
limited public health benefits. In addition, it requires
advocates to wage fierce campaigns to secure state
appropriations of settlement funds for tobacco
control programs. These battles pose a series of
new, discrete threats:
The announcement by the tobacco companies
that they were raising cigarette prices by 45-60
cents a pack to pay for the settlement is now being
used by tobacco supporters to block any new
federal or state tobacco excise tax increases (though
recent market data reveals that these price increases
were largely vitiated by widespread discounting
and promotional pricing).
As state legislators allocate funds for state tobacco
control programs, tobacco lobbyists may be able
to slip in the industrys long-sought preemption
language on the grounds that tobacco control
is now being fully handled at the state level.
Preemption continues to be one of the industrys
main strategies to thwart health advocates.
Industry lobbyists will be afoot, seeking
debilitating provisions such as: limiting funding
to just say no campaigns targeted at children;
excluding private agencies like the health volun
taries from receiving tobacco control funds; and
placing programs in agencies open to industry
influence.
Once there is state funding of tobacco control pro-
grams, advocates will need to be on the lookout for
already surfaced in states such as Minnesota and
California). Finally, there is the threat that if these
new, relatively well-funded tobacco programs do not
produce strong, dramatic short-term results, the cry
will go up that these tobacco control programs are a
waste of money or worse, a fraud! Pressure could
build to end the programs and divert the funding.
Again, the Wisconsin focus groups cautioned,
Despite numerous anti-smoking campaigns,
smoking is still very prevalent among adolescents
and teens, therefore the effectiveness of these
programs is questioned.
Advocacy Institute / 21
2. The New Tobacco Industry
In December of 1997, a memo from the public
relations firm Bozell Sawyer Miller Group suggested
some messages the tobacco industry could use to
garner support for the June 20, 1997 proposed settle-
ment. The suggested messages were designed to create
the illusion that the industry was embarking on a new
era of ethical behavior. Any dishonest or unethical
behavior, we were to believe, was conducted in the
past by former industry executives. The new tobacco
industry, they argued, is headed by responsible and
honest executives.
Well, there is no new tobacco industry. There is,
however, a new arsenal of tobacco industry postures
and strategies which threaten to derail every significant
new tobacco control policy initiative. Ironically, these
new industry strategies neatly track the old
industries strategiesbut with far greater subtlety.
a) Public relations propaganda, or the gentler,
kinder tobacco industry. No tobacco control advo-
cate needs to spell out the unconscionable industry
practice of target marketing to kids when everyone in
America has seen Joe Camel leering down from bill
boards all across the country. Now, Joe Camel is
gone, and soon all of the industrys billboards will be
gone. According to recent news articles, the industry
appears to be shifting its marketing focus to college
age smokers, rather than the mid-teen and younger
target audience. Of course, the industry will continue
to find ways of appealing to childrenbut they seem
determined to do so in less obvious ways.
Following are some examples of Big Tobaccos public
relations propaganda:
The tobacco companies have appointed executives
whose express mandate is to assure against any
advertising targeted to under-age smokers. They
will serve as the poster children for tobacco
industry responsibility.
Philip Morris recently launched a $100 million
advertising campaign allegedly designed to
discourage youth smoking. The company claims it
conducted research and focus groups to determine
the most effective approach to dissuade youth from
smoking. While tobacco control advocates remain
22 / Advocacy Institute
deeply skeptical about both the motives and effec-
tiveness of this campaign, measuring the effects of
such advertising is extremely difficult. In addition,
proving the negativethat the ads dont work
will not be an easy task. Meanwhile, the industry
will reap the propaganda benefit of its highly
visible good works.
The industry has gained innocence by associa-
tion with the state attorneys general and governors
as co-sponsors of the severely restricted counter-
advertising programs mandated by the multi-state
settlement.
The companies will aggressively promote the
message that they have paid the price for past
sins by paying billions of dollars to the states in
the November 1998 settlement.
b) Demonizing tobacco control advocates. Focus
groups conducted by the industry in late 1997,
which laid the foundation for the industrys $40
million media assault on the McCain bill, revealed
that the public was prepared to believe messages
coming directly from the tobacco industry. This
proved especially true when those messages resonated
with the tax and spend, reverse Robin Hood
themes that the independent critics articulated.
So tobacco control advocates, who had long enjoyed
the trust of the public as public interest advocates,
began to be recast in the public mind as the hand-
maidens of tax and spend liberal politicians and
the willing tools of greedy trial lawyers. And, to
boot, the industry seized upon the complaints of
some independent critics that the advocates were
overzealous prohibitionists.
All of these negative images will predictably be
trotted out by the industrys propaganda machine
this year to tarnish the image and undermine the
credibility of tobacco control leaders and activists.
c) Using philanthropy to buy legitimacy, friends,
and the silence of potential critics. The tobacco
industry has always bought friendsnewly disclosed
documents show how such industry allies as restau-
rant and grocery associations have been artificially
propped up by heavy tobacco funding. But now it
has begun to aggressively reach out to various
childrens and social service organizations, which
earlier would have shunned them, such as the
National 4-H Council, to partner in its new
programs.
Doubtless, these invitations to partner will be accom-
panied by generous grants and contracts to support
the partner organizations, and implicitly quiet their
doubts and silence their voices. Meanwhile, the
industry has succeeded, through its paid ads on
television, in once again becoming a source of
significant revenues for the broadcasterrevenues
which may well mute aggressive broadcast news
coverage of industry abuses.
d) Making cynical alliances with just causes that
compete with tobacco control for funding. The
tobacco industrys alliances are not only formed with
natural economic allies, but with those who, for the
best of reasons, want to see settlement or excise tax
funds allocated to pressing needs, such as access of
the underserved to health care, support for educa-
tion, public housing, or tax relief. Yet allocating
limited funds to such needs directly or indirectly
undermines support for the funding of tobacco
control programs, and continues to buy silence in the
face of industry exploitation of these same vulnerable
populations.
e) Giving new life and legitimacy to the smokers
rights movement. Not only did the industrys $40
million advertising campaign to kill the McCain bill
succeed, but its liberal tax and spend schemes to
persecute smokers message tapped into resentment
and distrust of government among many smokers
and some non-smokers. Both in recruiting new
members and in framing the issue of tobacco
control regulation for the larger public, the
companies succeeded, more than ever before, in
raising the legitimacy of smokers rights advocacy.
Though unchanged as an almost totally industry-
funded front group, the National Smokers Alliance
(NSA) and allied groups have not only become more
aggressive in their litigation and political advocacy
strategies, but are beginning to be treated by the
media as a legitimate civic movement, much like the
National Rifle Association (NRA).
f)Propping up otherwise unmotivated or weak
allies. In this brave new world of the new
tobacco industry, even the industry fronts have
fronts: state and local advocates report that the
National Smokers Alliance has been quietly
supplying funds and technical support to
sometimes lukewarm allies such as restaurant
owners and retailers.
g) Wooing back the tobacco farmers. Tobacco
farmers have always been the human face of the
tobacco industry and the tobacco companies most
potent front. Now, having seen erosion in the once
lock-step support of tobacco farmers for cigarette
industry lobbying, the companies are moving aggres-
sively with new crop-support and other tobacco crop
purchasing schemes designed to secure farmer loyalty
and support.
h) Accessing and influencing politicians through its
formidable network of paid lobbyists. The tobacco
industry has always been able to field an army of
paid lobbyists who arent squeamish about taking
tainted money. But with the industrys reformed
image, it has been able to woo a new cadre of lobby
ists who rationalize that they are helping the industry
reform itselflobbyists such as former Senate
Majority Leader George Mitchell and former Texas
Governor Ann Richards.
i) Keeping politicians silent and compliant through
massive campaign contributions. Although
advocacy campaigns have made headway in
persuading many politicians to forswear tobacco
industry contributions, the industrys new image is
making it easier for some politicians who once
renounced Big Tobaccos money to solicit the
industry once again.
j) Highlighting the doubts of supportive scientists
and other authoritative experts. The industry has
always been able to cloud the issues related to the
health effects of tobacco by paying for scientists or
experts willing to promote the industrys agenda.
But now, the industry can take the doubts raised by
the new skeptics, described above and magnify these
fringe voices as if they were a large chorus of dissent.
Advocacy Institute / 23
k) Harassing and intimidating through litigation
and other legal processes. While tobacco industry
apologists have taken to decrying the greed of the
trial lawyers who made the attorneys general lawsuits
possible, the industry, mostly through front groups,
has stepped up its use of a wide palate of legal tools
to harass, intimidate, preoccupy and exhaust tobacco
control activists. From burdensome FOIA requests
to legally challenging state health departments to
delaying implementation of local ordinances, the
industry continues to use its financial and legal
might to overwhelm and undermine tobacco
control activities.
The NSA Exposed, published by Americans for
Nonsmokers Rights (ANR) in 1998, contains
dozens of case studies of industry-engineered
interference in local policy making. The report
systematically details how NSA operatives have
shown up in cities and towns from Mesa,
Arizona to Portland, Maine to fight local smokefree
ordinances. Financial support, bogus research, and
nuisance lawsuits are just a few of the intimidation
tactics they have used to try (usually unsuccessfully!)
to defeat local clean indoor air laws.
3. The Same Old Tobacco Industry
The tobacco industrys overt target marketing may be
restrained by its strategic maturity. For example, RJRs
abandonment of Joe Camelwhich tobacco control
advocates soughtalso deprived advocates of a
powerful symbol of the industrys assault on childrens
minds. But there is no reason to believe the industry
will hold back any of the political and economic
warfare it has developed to fight tobacco control efforts.
As analyzed in the Advocacy Institutes 1998 Smoke
and Mirrors report, the industry buys what it cannot
claim. The industry buys:
Surreptitious access to the public mind through its
public relations propaganda and paid political
advertising;
Legitimacy, friends, and the silence of potential critics
through its strategic philanthropy;
A civic movementthe smokers rights movement
which otherwise would not exist;
24 / Advocacy Institute
Astroturf stealth lobbying services which create the
illusion of grassroots and grasstops rebellion against
tobacco control policies;
Political allies and front groups propping up other
wise unmotivated or unconnected supporters such as
restaurant owners and retailers;
Access to and influence with politicians through its
formidable network of paid lobbyists, some of whom
have held legislative leadership positions such as
House Speaker or Senate Majority Leader;
Politicians, through its campaign financing;
Science and authoritative experts for hire; and
Harassing and intimidating litigation.
4. The Continued Threat of a Hostile Congress
While the Republican party, whose leadership
torpedoed the McCain bill, did not gain seats in the
1998 elections as anticipated, there was no discernible
voter retribution against those members who cast
pro-tobacco votes and continued to welcome lavish
tobacco campaign contributions. Thus, congressional
leadership and many Republican members of Congress,
politically indebted to the tobacco lobby as well as
philosophically opposed to aggressive regulation of any
business enterprise, remain hostile to effective tobacco
control legislation. In addition, new House Speaker
Dennis Hastert (R-IL) had been one of the tobacco
lobbys most reliable voices as a member of the Energy
and Commerce Subcommittee on Health and the
Environment.
Tobacco control coalitions that receive federal funds
and other tax exempt non-profit organizations can
expect renewed efforts from Representative Ernest
Istook (R-OK) and his allies to threaten and intimidate
those who advocate policy change, even though they
confine their activities well within the bounds of law.
5. A Weakenedor Weak-WilledPresident
Tobacco control advocates have never had such
outspoken champions of tobacco control in the White
House as President Clinton and Vice President Gore.
However, the President has shown a readiness to
compromise with the Republican leadership when such
compromises meet his larger political needs. While
Clintons popular support now runs strong, it could
erode and lead him to embrace compromises that
undermine tobacco control objectives. For example,
the White House is now in a strong position to insist
that the necessary waiver of federal claims to half or
more of the state settlement funds be conditioned on
enactment of adequately funded state tobacco control
programs. But such conditions might be weakened as a
part of broader negotiations and compromise between
the White House and Congressional leadership on a
wide range of issues. A far worse fate awaits federal
tobacco control efforts, of course, if the year 2000
brings us a Congress and a new president far less
dedicated to tobacco control than Bill Clinton or
Al Goreas every previous president of both parties
has been.
6. State Legislatures: The Tobacco Lobbys
Reliable Sanctuary
If there is one thing virtually all tobacco control advo-
cates agree upon, it is that the most significant battles
in 1999 will be fought in the state legislaturesthe
battles to insure adequate allocation of settlement funds
for comprehensive state tobacco control programs. But
state legislatures uniformly send shivers down the spines
of tobacco control advocates for many good reasons,
among them:
Most state legislatures are subject to the dimmest
spotlight. Many veteran tobacco control advocates
believe they are the least responsive to citizen over
sight, and are often less visible to citizens than local
governments and city councils. State legislative
activities are not as well-covered by the media as
Congress and more distant from voters than city
council matters.
The appropriations process in state legislatures, in
particular, is often carried out in the dark corners of
state capitolssubject to back-room deal making
and less amenable to the arsenal of citizen advocacy
tools, such as citizen rallies and letter-writing
campaigns.
The action of some state legislatures to enact
authorizing legislation to support the appropriations
process may provide tobacco lobbyists with multiple
Trojan Horse possibilities, such as the insertion of
local preemption provisions barring stronger local
action on the grounds that the state legislature is now
taking care of the tobacco problem.
Ironically, most states now face short-term surpluses.
These surpluses, in addition to pressure for tax cuts,
will deprive tobacco control advocates of one of their
strongest arguments for state tobacco excise tax
increases: the usually desperate need of the states for
new revenues to meet pressing state needs.
Governors and even state health departments will
also need watching. Governors and their political
appointees may establish window-dressing tobacco
control programs instead of programs that would
actually incense tobacco lobbyists and threaten
continued tobacco campaign contributions.
One veteran state tobacco control leader warns:
I see two serious threats as states begin to fund
programs: one, that programs will be innocently off
track; they will simply be poorly designed and
implemented. There may be different reasons for this,
but some would include the influence of a well-
intentioned political figure who simply wont listen
to the experts, perhaps for his own political reasons;
incompetence of the health department; or reluctance
to implement programs that some people (smokers,
retailers, manufacturers) find offensive. When these
programs fail they will discredit more effective
tobacco control elsewhere. How do advocates get such
programs on the right track? A problem is that it
means being critical of people we regard as friends.
A more insidious threat is that programs will be used
as window dressing by pro-tobacco politicians to pre-
vent the establishment of meaningful tobacco control
policies and programs. This is what we are seeing in
some states already, where the health department
treats tobacco not as a public health problem, but as
a public relations problem for the governor. Tobacco
control advocates are treated as the enemy, and
tobacco control resources in the department are
directed to projects that make the governor look good
while he blocks implementation of effective tobacco
control policies. They use the funding they give to
localities to discourage local coalitions from effective
policy action or cooperation with those advocating
for statewide policy change. How do advocates
challenge public health authorities that go over to
the dark side?
Advocacy Institute / 25
7. The Medias Low Threshold of Boredom
Tobacco stories have enjoyed a remarkable run in the
news from the late 1980s through the 1990s, especially
given the medias notoriously short attention span.
As tobacco control legislation moved to the top of the
Congressional agenda, the level of coverage escalated.
But once the McCain bill was shelved, national tobacco
coverage shrank overnight, except for a brief flurry of
news on the multi-state settlement in the fall of 1998.
Although there will be efforts at federal legislation in
1999, they are likely to be far less ambitious and far less
attention getting than the settlement-spurred, high-
visibility struggle over comprehensive tobacco control
legislation. Without new, dramatic health research
results (not likely), public attention on the hazards of
tobacco use will fade. Additionally, without dramatic
new revelations from the industry documents, it is
unlikely that we will see headline-grabbing investigative
stories (especially as the industry monitors its own
behavior to avoid the kind of attention that undermined
its standing in the past). Finally, the medias notoriously
low threshold of boredom with any continuing story
will become an increasing challenge for tobacco control
media advocates. Already, some journalists, like ABCs
Cokie Roberts, have decried the excessive attention paid
to tobacco stories.
8. Competition for the Public Agenda
Tobacco control rose on the public agenda at a time
when no overarching public issuessuch as war or
economic depression, or scandal and impeachment
occupied the public mind. Political analyst David
Gergen attributed the loss of the McCain bill to the
preoccupation of President Clintonand the country
with the Lewinsky affair. If new, riveting national or
international issues take center stage in the coming year,
tobacco control issues are likely to tumble from the
national agenda.
26 / Advocacy Institute
OpportunitiesExternal Opportunities for the Movement
1. New Legislative Opportunities
2. The Settlement Funds as Organizing and
Alliance Building Opportunities
3. The Treasure Trove of Industry Documents
4. Litigation Opportunities
5. Election Opportunities
6. International Opportunities
1. New Legislative Opportunities
a) State legislation.
The multi-state settlement bonanza. Despite the
struggles and pitfalls depicted earlier, tobacco
control strategists agree that the most potent short-
term opportunities for this year arise from the
multi-state settlement, and the fighting chance
though not the legal commitmentthat a
substantial portion of each states settlement will
be allocated to comprehensive state tobacco
control programs.
These are opportunities which must be seized.
They will not come again, and there will be fierce
competition in each states labyrinthine legislative
appropriations process for these funds. And, while
many of the state attorneys general and governors
have pledged to support allocation of at least some
of the funds to tobacco control, the breadth and
depth of each states program will be determined
by state legislatures in 1999.
One of the factors that makes this opportunity real
is the uniform commitment of all the national
organizations to support state coalitions and
advocates with a wide range of technical and
financial support. While the national organizations
also have a federal agenda, as discussed below, they
all have set support for the state campaigns as one
of their highestif not the highestpriority for
deploying their human and material resources
during the coming year.
Ironically, one of the most potent federal opportu-
nities relates directly to the state settlements: in the
last days of the 105th Congress, the White House
resisted a provision inserted in the final budget bill
by Congressional leaders to waive the federal gov-
ernments right to as much as 50% of some states
settlement funds, since those funds were paid to
reimburse the states for excess Medicaid costs
and 50% of state Medicaid funds come from the
federal government! The White House and
Congressional tobacco control supporters from
both parties have indicated their support for
legislation which would waive the federal right to
repayment only upon condition that adequate
funds be allocated to tobacco control programs
designed to follow the CDCs guidelines for
effective programs.
There may also be a sleeper opportunity in the
multi-state settlement itselfa provision which
prohibits the tobacco companies from lobbying
directly or indirectly to divert settlement funds to
non-health programs. Of course, this leaves the
tobacco lobby free to advocate for health programs
other than tobacco control funding, but it also
leaves tobacco lobbyists open to investigative
reporting, and even contempt of court penalties,
for workingas they did in states like Oregon
to have funds allocated to education, tax relief, and
other non-health uses.
Excise tax campaigns. In some states, cigarette
excise tax campaigns remain viable, despite the
price increases necessitated by the multi-state
settlement. This is certainly true, for example, in
Maryland, where support for a $1.50 cigarette
excise tax increase was made into a very successful
election campaign issue by tobacco control
advocates, childrens advocates, and religious
leaders. The re-elected governor and nearly a
Advocacy Institute / 27
 majority of both state Senate and Assembly
members signed a campaign pledge to support the
Maryland Childrens Initiatives effort to raise the
cigarette excise tax by $1.00. Advocates in other
states can also take heart from the victory of
Proposition 10 in California last November, which
raised the state cigarette excise tax by another 50
centsdespite a $30 million negative advertising
campaign by the tobacco companies to defeat the
initiative.
New state initiatives. Some advocates also see
state opportunities arising from the ashes of the
failed federal bill. For example, some advocates
believe that the so-called look-back provisions of
the settlement, penalties on tobacco marketers
based upon their failure to meet targets for the
reduction of sales to minors, could be tailored to
state sales and find broad appeal in some state
legislatures.
b) Local legislation.
Clean indoor air laws. Local tobacco control
advocates believe that the preoccupation of
advocates with the June 20, 1997 proposed
settlement, the ensuing internal conflicts, and
the tobacco control bill introduced by Senator
McCain (R-AZ) diverted advocacy focus and
resources from the movements most successful
policy gainthe widespread adoption of strong
local clean indoor air ordinances. Consider the
following: in 1984, there were no local ordinances
completely eliminating smoking in restaurants or
workplaces. In contrast, by the end of 1998, 227
ordinances completely eliminated smoking in
restaurants and 209 in workplaces.
The successful effort in the November 1998
elections to defeat initiatives that would have
overturned ordinances in Corvallis, Oregon and
Portland, Maine demonstrate the continued
popular support for such measures.
Other local ordinances Local legislative efforts,
in addition to clean indoor air, continue to be
effective tools for local advocates. For example,
since 1996, 10 counties in New York have enacted
local laws banning self-service sales of tobacco.
At least 45% of Minnesota counties have passed
28 / Advocacy Institute
strong youth access laws as a result of a state law
that took effect in August, 1997. In addition, at
least 300 Minnesota cities have or plan to adopt
their own youth access laws. The Minnesota state
youth access law, which was not preemptive,
encouraged local governments to use the state
law as a minimum set of standards for local
communities. And local governments in several
states have pursued and passed ordinances
restricting outdoor tobacco advertising.
c) Federal legislation. One broad residual benefit of
Senate consideration of the McCain bill in 1998 is
that the bar has been raised for acceptable federal
legislation. Its hard to recall now, but in the summer
of 1995, FDA Commissioner David Kessler and
President Clinton both asked Congress to enact
legislation enshrining the proposed FDA youth
access rulesbut not giving FDA broad regulatory
authority. But by the spring of 1998, the McCain
bill went much further and contained provisions,
such as the Frist FDA provisions and look-back
penalties that werent even on the horizon of most
tobacco control advocates earlier. Now those provi-
sions set the benchmark by which any new legisla-
tion must be judged.
Broad support for FDA authority. Federal
legislation confirming broad FDA authority to
regulate the manufacture and marketing of
tobacco products could be an opportunity in the
next Congress. Such a measure has already
received support from the Clinton Administration,
the Democratic minorities in both houses of
Congress, and some leading Senate Republicans
(including McCain and Senator Bill Frist, R-TN).
While the tobacco industry succeeded to some
extent in its efforts to undermine support for the
McCain bill by labeling it a regressive tax and
spend bill, they abandoned efforts to discredit
FDA authority as bureaucratic. FDA remains one
of the most respected and appreciated federal
agencies. Support for FDA authority over tobacco
products presents an opportunity to promote
collaborative action. Should the Supreme Court,
however, refuse to overturn the 4th Circuit Court
of Appeals ruling holding that FDA has no
existing authority over tobacco products, the
Republican leadership could attempt to press for 2. The Settlement Funds as Organizing and
weak legislation such as: Alliance Building Opportunities
A bill which would enact the FDAs State advocates report that the prospect of substantial
proposed youth access rules into law, but new funding for tobacco control has begun to attract
prohibit FDA from any broader or stronger new partners to the movement. In some states, African
regulation; American legislators and key community leaders, who
had not previously played an active role in tobacco
A bill to evade FDA authority by granting
control, have now taken a strong interest in developing
some regulatory authority over tobacco
a plan for tobacco control that meets the special needs
products to the Federal Trade Commission
and concerns of the African American community.
and the Centers for Disease Controlneither
Others report similar new interest among leaders of
of which have the broad powers or scientific
Latino communities, and other interest groups which
capacity of the FDA; or
had previously been difficult to draw in to tobacco
A bill with weak FDA powers, such as those control coalitions.
proposed in the last Congress by Senator Jim
One state tobacco control leader welcomed the
Jeffords (R-VT), Senator Orrin Hatch (R-UT)
possibility of a new linkage of different grassroots
and Senator Dianne Feinstein (D-CA).
coalitions. He talked about the opportunity to work
more cooperatively with Native Americans on issues
Federal excise tax increases. There may also be
of cigarette sales on Indian reservations; alliances with
opportunities in the 106th Congress for a federal
progressive convenience store owners so that tobacco
tobacco excise tax increase, although the tobacco
control advocates are not viewed as a threat but as
industry was successful last year in attacking such
a source of assistance in meeting demands placed
taxes in ways which resonated with many voters.
on them; alliances with neighboring states to form
Still, President Clinton announced in his State of
common bonds based on demographics and
the Union address that he will support a number
geography; and alliances between border states and
of popular domestic programs, such as improving
neighboring counties in order to work collaboratively
schools and expanding access to quality health-
on tax and smuggling issues.
care. His budget calls for a 55 cent tobacco tax
increase to help fund these initiatives. Despite the
anti-tax rhetoric of the industry and Republican 3. The Treasure Trove of Industry Documents
leadership, a majority of the Senate voted for the
Most analysts who continue to search and analyze
McCain bill, which contained a de facto excise tax
the millions of pages of once secret internal tobacco
increase of $1.10. Even conservative Republican
industry documents are convinced that these
Congressional leaders like House Ways and Means
documents will reveal new explosive evidence of
Committee Chair Bill Archer (R-TX) were
industry wrongdoing at local, state, national, and
prepared to consider more modest, but significant,
international levels.
increases (although to fund tax relief, not domestic
programs). These documents are viewed as an important
opportunity for tobacco control advocates to regain
It is true that the price increases forced by the
the initiative in the mass media through constantly
multi-state settlement, and the success of the
unfolding investigative stories which reframe the
tobacco industry in discrediting the McCain bill as
a tax and spend bill, makes any future excise tax tobacco issue from tax and spend politics to the
increase an uphill battle. But excise tax campaigns need to control the tobacco industrys corrupt practices.
have shown remarkable resilience in the face of While national reporters covering the tobacco beat may
attacks and cannot be dismissed. be hard to convince that any newly revealed documents
are different in nature from earlier, well-publicized
Advocacy Institute / 29
revelations, investigators believe there are state-specific
storiessuch as those widely publicized by California,
New York, and Minnesota researchersthat give a
fresh, state or local hook to stories of undisclosed
industry stealth lobbying and underhanded political
deal making.
Government and non-government organizations
have been working together to develop and support
systematic review, analysis, and publication of the
stories embedded in these documentsstories which
have the potential for supporting new tobacco control
policy initiatives at all levels of government.
Beyond the documents, there is also a strategic
opportunity in tracking the price increases and sales
data to show how much of the industrys legal
expenses and settlement costs are being dumped by the
companies on the backs of their loyal customers
instead of taking these costs out of their vast profits.
4. Litigation Opportunities
a) Private litigation. One virtue of the November
1998 multi-state attorneys general settlement is that
it left intact all private litigation initiativeswhile
the June 20, 1997 proposed settlement would have
extinguished all class action lawsuits. Another
important by-product of that settlement and the
earlier individual state settlements is that the massive
attorneys fees earned as part of the settlements pro-
vide a pool of funds for trial lawyers to sustain large
cases against the costly resistance of the tobacco
companies.
This becomes more significant in the wake of the
recent California jury verdict of $51 million in an
individual action against Philip Morris, the type of
case that was long considered least threatening to
the industry.
The major cigarette manufacturers themselves have
acknowledged in recent filings with the Securities
Exchange Commission that they expect that an
increased number of tobacco cases, involving claims
for billions of dollars, will come to trial over the next
year compared to prior years when trials in these
cases were infrequent.
30 / Advocacy Institute
The recent trend underscores the industrys fears.
Between July and September 1998, more than 80
new actions were brought against U.S. tobacco
interests. Similarly, a number of new cases were filed
immediately following the settlement reached by the
attorneys general and the tobacco industry in the
November 1998 settlement. While the current phase
of litigation against the tobacco industry had its
inception in 1994, recently there has been a marked
increase in the filing of such cases. As of October
1998, approximately 700 cases were pending against
U.S. tobacco interests, roughly 200 more than only
one year before. In addition to the hundreds of cases
brought by tobaccos victims in the United States,
several more were filed by private and government
plaintiffs in Canada, Puerto Rico, the Marshall
Islands, Nigeria, Panama and Guatemala. At least 54
private class action cases, representing millions of
addicted and otherwise injured smokers across the
country, continue to move forward. The pioneering
Engle case, seeking an estimated $200 billion on
behalf of hundreds of thousands of tobaccos victims
in Florida, is now in trial.
About 100 cases modeled on the state attorneys
general lawsuits have been brought by private
attorneys and/or local officials on behalf of the
citizens of a number of states, counties and/or cities,
union health and welfare funds, insurance companies
and Native American tribes, among others. Of these
cases, more than 60 have been brought by health
and welfare trust funds and similar entities in courts
across the country. While some have been dismissed,
others have received favorable preliminary rulings
and are expected to go to trial starting in 1999.
Some pending cases are based upon intriguing new
legal theories, such as the civil rights action brought
by the National Association of African Americans for
Positive Imagery on behalf of all living Black
Americans who have purchased or consumed men-
thol tobacco products since 1954. The plaintiffs in
that case claim that cigarette manufacturers targeted
the plaintiffs with menthol cigarettes while with-
holding from the public their knowledge of the
particular hazards posed by menthol, a pharmaco-
logically active substance which is now known to
promote addiction in the smoker.
Also not to be overlooked are the more than two
dozen cases now pending brought by non-smokers
who were injured by exposure to environmental
tobacco smoke.
Yet another group of cases has been brought
against the major cigarette manufacturers by entities
administering asbestos liability. In those cases, the
plaintiffs seek to compel tobacco companies to con
tribute to the costs of settlements and judgments
against asbestos manufacturers who have been held
responsible for their role in causing fatal lung
diseases in thousands of individuals, many of whom
also smoked cigarettes.
As the disappointing multi-state settlement cautions,
however, tobacco control advocates have had only
limited success thus far in leveraging tobacco
industry exposure to litigation in ways which
promote strong public health measures.
b) Federal litigation. There are two intriguing
possibilities for new legal initiatives from the federal
government:
Federal Medical Care Recovery Civil Suits.
President Clinton announced in his 1999 State of
the Union address that the Department of Justice
is formulating a litigation plan to take tobacco
companies to court to recover Medicare and other
health care program costs incurred by the federal
government for treating tobacco victims.
Criminal Indictments of Tobacco Companies,
Executives and Scientists. After more than four
years of rumors and leaked stories, the convening
of as many as five separate grand juries and
ongoing Justice Department investigations of
criminal wrongdoing, tobacco control advocates
were keenly disappointed that no indictments were
forthcoming in 1998. The one notable exception
was a guilty plea obtained by the Justice
Department in connection with its probe of
Brown & Williamsons use of the super-charged,
high-nicotine tobacco plant code-named Y-1.
DNA Plant Technology Corp., the California
biotechnology company which secretly helped
B&W develop Y-1, agreed to cooperate with the
governments investigation in exchange for
pleading guilty to a misdemeanor charge of
violating a law that prohibited the export
of tobacco seeds.
The latest informed intelligence on these investiga-
tions suggests that the Justice Department will
eventually prosecute major tobacco manufacturers
and tobacco industry officials on charges of criminal
conspiracy and lying to federal government agencies.
Cliff Douglas, who prepared the prosecution
memo submitted to Attorney General Janet Reno
by Congressman Marty Meehan (D-MA) that
triggered the criminal probes, and who has been a
strong advocate for criminal sanctions and a close
monitor of the investigations, believes that
indictments are still forthcoming. He points out,
moreover, that once federal prosecutors are ready
to indict high-ranking members of the tobacco
industry, they will be in a position to bring
significant creativity to the plea-bargaining
process. At the most dramatic level, that process
could lead to settlements far more stringent in their
tobacco control provisionsincluding agreement to
accept FDA authoritythan either the June 20,
1997 proposed settlement or the November 1998
multi-state settlement.
There are also potential litigation opportunities for
stretching existing laws to protect both non-smokers
and tobacco users, such as the Americans with
Disabilities Act and state Occupational Safety and
Health Administration laws.
5. Election Opportunities
There are candidate and issue initiative campaigns in
this country every year. When well organized and
adequately funded, tobacco control advocates have
been capable of significant advances in state excise
tax initiatives and in beating back industry-inspired
initiatives to weaken clean indoor air laws.
In closely contested legislative races in which one
candidate has taken tobacco campaign dollars and
voted against tobacco control measures, and a
strong opponent has renounced tobacco industry
contributions and focused on his or her opponents
ties to tobacco, the tobacco issue has shown
significant potency.
Advocacy Institute / 31
6. International Opportunities
Perhaps the most encouraging developments in tobacco
control in 1998 occurred not in the U.S., but interna-
tionally, where little had stirred for many years. These
developments include:
The ascension of Dr. Gro Harlem Brundtland
to Director General of the World Health
Organization (WHO). Dr. Brundtland is a
deeply committed public health physician and,
as former Prime Minister of Norway, a skilled
political leader. She has set tobacco control as a top
priority, and has recruited a tobacco control team
from among the ranks of the most effective inter-
national tobacco control advocates, including
Judith Mackay and Derek Yach.
The election triumph of the British Labor party,
which tipped the balance in the European
Community in favor of the long-pending ban on
tobacco advertising and promotion, which has
now been adopted (though the Blair government
has just chilled Medicaid-type government
litigation by the national health service)
The evolution of U.S. international tobacco
control policy, as evidenced by the Doggett
amendment (the only significant tobacco
legislation to pass the 105th Congress) which
prohibits U.S. government agencies from
promoting tobacco abroad. Furthermore, under
President Clinton, the U.S. has supportedrather
than suppressedWHO tobacco control efforts.
The International Policy Conference on Tobacco
& Children, the first international conference on
tobacco control issues designed specifically for
legislators, will be held in Washington, DC in
March 1999. The conference, initiated by Senator
Richard Durbin (D-IL) and sponsored by The
Robert Wood Johnson Foundation and the Center
for Tobacco-Free Kids, will bring together health
ministers, legislators, and international advocates
to focus on policy solutions to the tobacco epidemic.
The lawsuits by states against the tobacco industry
have prompted the governments of other countries
to sue tobacco companies to recoup medical costs
from tobacco-related illness. Whatever the fate of
these cases, they have stimulated uncommon
32 / Advocacy Institute
negative publicity for tobacco companies, raising
questions about good citizenship and underscoring
the health effects of smoking in countries where
knowledge of industry tactics and the disease that
they bring cannot be taken for granted.
In the past two years, most airlines have finally
gone smokefree, establishing clean indoor air as an
international norm.
In August 2000, the American Medical
Association and The Robert Wood Johnson
Foundation, among others, will host the 11th
World Conference on Tobacco and Health, in
Chicago. These conferences have been effectively
utilized in the past to force the host nation to turn
the spotlight on its own progressor lack
thereofand have helped to spur action.
There is promise of a greater focus by U.S.-based
health voluntaries, especially ACS; government
agencies, including the Centers for Disease Control
and the National Cancer Institute; and non-profit
organizations on supporting international tobacco
control activities. In addition to these groups,
INFACT will continue its energetic efforts to high-
light overseas marketing abuses by U.S.-based
transnational tobacco companies.
Perhaps most promising of all is WHOs priority
initiative: adoption of the groundbreaking
Framework Convention on Tobacco Control
(FCTC), which includes an international model
for national tobacco control laws. The campaign to
support the FCTC can give impetus to U.S.
domestic policymaking efforts and similar efforts
around the world.
Next Steps
1. Short-term Common Ground Policy
Initiatives
2. Short-term Technical Support Needs
3. Long-term Movement Building Needs
4. Preparing for the Shift from Policy Advocacy
to Watch Dog Advocacy
5. Integrating U.S. and International Tobacco
Control Advocacy
T he first four parts of this strategic analysis point
the way for the strategic planning that must take
place at all levels of the tobacco control movement.
Among the questions to be addressed in the strategic
planning process are the following:
How best to seize the opportunities identified?
How to take advantage of our strengths?
How to meet and overcome the internal challenges
facing the tobacco control movement?
How to confront the threats that loom on the
horizon?
This part of the analysis, Next Steps, is not a
comprehensive strategic plan. Rather, it is a framework
for both short-term and long-term planninga
starting place for the hard work of strategic planning
that must occur as the movement approaches the
next millennium.
1. Short-term Common Ground Policy
Initiatives
Ideally, the short-term campaigns which emerge from
the strategic planning process will serve multiple objec-
tives, including:
Pursuing those public policies which promise the
most effective means for reducing death and disease
from tobacco use; and
Providing goals and objectives around which the
tobacco control movement can unify, and which can
thus serve as means to restore collaborative relation
ships and mutual trust.
As of January 1999, and at least through the current
legislative sessions, several priority campaigns meet
those criteria:
The allocation of adequate funds for comprehen
sive and effective state tobacco control programs.
Federal legislation securing unfettered FDA authority
to regulate the marketing and manufacture of
tobacco productsand preventing any Trojan
Horse federal legislation which masks a weakening
of FDA authority.
State and local clean indoor air initiatives and efforts
to roll back preemptionand parallel campaigns for
the adoption of voluntary non-smoking policies by
businesses.
Investment in behavioral research, especially policy
research by the National Cancer Institute, the
Centers for Disease Control, and private philan-
thropy. Such research is essential both to guide policy
development and to inform policy makers about
effective policies.
Providing effective access to cessation and treatment
programs.
These are by no means the only tobacco control
initiatives worthy of pursuingespecially where special
opportunities arise, as in the state of Marylands power-
ful $1.00 a pack excise tax campaign. But national
organizations and state coalitions will need to think
hard about putting aside, temporarily, less promising
policy objectives which, however valid, threaten to
divert human and fiscal resources from the intense
effort which the state funding battles will require.
Advocacy Institute / 33
2. Short-term Technical Support Needs
If state coalitions are to effectively pursue strong, settle-
ment-funded state tobacco control programs, they will
continue to need unprecedented support from both
governmental and non-governmental national
organizations. Such support includes:
a) Technical assistance such as:
Strategic guidance and user-tailored materials
designed to communicate and persuade key state
decision makers on the need for comprehensive
state tobacco control programs, including hard
evidence of the success of vanguard programs;
Lobbying strategies and hands-on assistance
for state appropriations battles;
Guidance in resolving intra-movement
competition for settlement funds, and the
development of mutually supportive alliances
with non-tobacco claimants to settlement funds;
Timely insight into new tobacco industry strategies
and effective counter-measures to avert stealth
efforts to insert preemptive or other undermining
provisions in either enabling legislation or
appropriations bills;
User-friendly access to key data, such as research-
based ammunition supporting each element of
model state programs;
Litigation assistance, both offensive and defensive;
and
Guidance and training in effective policy advocacy
strategies which push the boundaries but do not
violate legal strictures governing the use of federal,
state, or local foundation funding.
b) Unrestricted funds to support state-wide
campaigns, especially for the hiring of lobbyists
specializing in the appropriations process.
c) Strategic media advocacy campaigns tailored to
the specific political environment and sensibilities of
each state, backed by national public relations and
advertising initiatives. These should lay the ground
work and promote the need for well-designed, fully
funded programs, and be targeted to resonate with
34 / Advocacy Institute
conservative, as well as liberal and moderate decision
makers. These efforts will need to:
Counteract public perceptions that tobacco control
has been done, that tobacco use is their prob
lem, not our problem, and that the proposed
new programs are excessive or no longer needed;
Prove that tobacco control works, dramatizing the
effectiveness of such comprehensive state programs
as those in California and Massachusetts in ways
that persuade voters and legislators that tobacco
control funds are an effective human and
economic investment;
Counteract unreasonable expectations or measures
of success;
Counteract tobacco industry propaganda that
frames tobacco use as an issue of individual choice
and of bad kidsnot of addicted kids;
Unmask the myth of The New Tobacco
Industry and revive earlier, successful strategies for
de-normalizing or de-legitimizing the tobacco
industry, especially through concentrated and sus-
tained exploitation of the industry documents,
both nationally and in state media, in ways which
reinforce public perceptions of the tobacco
industry as rogue predators who need to be
forcibly restrained by legistion and regulation; and
Dramatize the needand reasonablenessof
broad FDA authority over tobacco products and
their marketing.
3. Long-term Movement Building Needs
In addition to the launching of common ground policy
campaigns, the strategic analysis strongly suggests the
need for additional long-term, movement-building
initiatives including:
a) Building unity through strategic planning, priority
setting, and consensus-building. To be a truly
participatory and collaborative decision-making
process, these activities would include:
Systematic inclusion of field staff and volunteers
in both short and long-term policy and strategy
development within the national organizations;
On-going information sharing and consultative
processes, including national, regional, and local
face to face forums in which national, state, and
local advocates treat each other with mutual
respect and actively help to shape goals and
strategies before strategic initiatives are launched
or gain unstoppable momentum;
Long-term strategic think tank policy and
developmentagain taking full advantage of the
expertise that exists among state and local tobacco
control leadership, and providing continuous,
broad consultation and feedback; and
Development of on-going, informal coordination
among inside and outside advocates,
acknowledging the discrete roles for each, but
providing for continuous communications,
mutual critiques, and focus on common
objectiveseven where public positions areor
appear to bein conflict.
One veteran state advocate cautions:
as well as moderates and liberals. The movement
We must avoid the errors that were made after the
June 1997 settlement. The major groups need to be
held accountable for facilitating creation of a
strategic plan that almost everyone buys into.
The major governmental, voluntary and
foundation players and the National Center
must make a commitment to working together to
develop a strategy and to doing it in a way that
regards inclusiveness as central to the process. For
the next year, they all must make the creation and
widespread adoption (within the tobacco control
community) of this plan their top priority. Strategic
planning and communications about the planning
process and the evolving strategy must be included
in all meetings and conferences these players have
with their various constituencies. The groups
should coordinate their meetings and provide each
other with forums for presenting plans,
recommendations, etc.
b) Rewarding supporters and punishing foes in the
media and at the ballot box. There is a strong need
to recognize and reward those policy makers who
support and vote for tobacco control initiatives.
Awards and citations by health voluntaries are
importantand low costmodes of such
recognition.
More difficult, but still essential, is the mobilization
of citizen activistsapart from their roles as public
servants or employees of tax-exempt, non-partisan
health voluntaries, in electoral activities which seek
to hold accountable those politicians who continue
to take tobacco campaign contributions and vote at
the tobacco industrys call. Of course, not all tobacco
control advocates will feel comfortable in such roles,
but others should be reminded that they have rights
and responsibilities as citizens apart from their work
as public health professionals.
Thus, the tobacco control movement needs to be
non-partisan, but more political. For instance, it
should recognize supportive Republicans, such
as Senator McCain and New Jersey Governor
Christine Todd Whitman who support tobacco
control, and frame its messages in ways which
appeal to political conservatives and Republicans,
leaders need to be more political in mobilizing
broad, intense, grassroots activism, and more
political in acknowledging the need to cause pain
at the polls for those who do the tobacco industrys
political bidding while rewarding at the polls those
who work forand pledge to work forstrong
tobacco control policies.
c) Broadening outreach to interest groups, organiza-
tions, and individuals who could be valuable
partners in tobacco control efforts. These include
ethnic and minority groups, business leaders and
organizations, and non-health-directed civic associa-
tions. While minorities and women have been active
and effective in tobacco control efforts, they are not
yet appropriately represented in leadership roles.
d) Broadening the focus beyond youth. There needs
to be a new dialogue among those who view the
youth frame for tobacco control advocacy as the
most effective wedge for all tobacco control policy
and those who view a youth emphasis as too narrow
and playing into tobacco industry public relations
strategies. Such dialogue might at least lead to guide
lines on when and under what circumstances a
youth focus is most and least effective.
Advocacy Institute / 35
e) Developing capacity and nurturing leadership
among advocates. There are a wide range of training
needs for tobacco control advocates, from basic
training in tobacco control issues and strategies to
graduate training in movement leadership
techniques. Such advanced training might well
include strategic exchanges between veteran U.S.
advocates and our colleagues in other countries.
f) Strengthening intra-movement electronic
communications to provide more civil, inclusive,
bottom-up, reliable, and user-friendly access to
electronic advocacy-related data and ammunition.
One technique is the development and facilitation
of limited time, limited participant, collaborative
networks connecting experts and advocacy leaders
on focused, strategic exchanges. The Advocacy
Institutes SMARTalk, an electronic exchange
focused on the state legislative battles over the
disposition of settlement funds, is an example of
such a collaborative network.
g) Encouraging funding of prevention research
needs including community intervention trials to
test policy interventions in community settings and
comparative evaluations of the effectiveness of
differing state tobacco control programs.
4. Preparing for the Shift from Policy Advocacy
to Watch Dog Advocacy
As states and the federal government implement new
tobacco control programs, much of the focus of
tobacco control advocacy will shift from policy change
to overseeing and evaluating the effective implementa-
tion of those programs. That will necessarily involve
different forms of leadership, mobilization efforts,
and technical support. Planning for such a shift
should begin now. Advocates in the vanguard states
of California, Massachusetts, Oregon, and Arizona,
forced to contend with persistent industry efforts to
undermine strong programs, can point the way.
36 / Advocacy Institute
5. Integrating U.S. and International Tobacco
Control Advocacy
For most U.S.-based tobacco control advocates, inter-
national tobacco control has taken a back seat to battles
on the home front. Today, however, with the advent of
strong leadership at the World Health Organization
and the development of the international Framework
Convention on Tobacco Control (FCTC), designed to
guide national policiesincluding those of the U.S
that divide among advocates no longer makes sense.
Thus, participation by U.S. advocates in such efforts as
developing and launching a world wide campaign to
mobilize support for the FCTC at the 11th World
Conference in Chicago in August 2000, provides an
opportunity to advance both international and
domestic tobacco control efforts.
Conclusion
T
here may never be a better opportunity than now to practice the lessons we have learned these past two
years, painful as that learning process may have been, never a better time to repair the breaches, and never a
better moment for looking ahead with deliberation. Right now, there is agreement among advocates on the
primacy of establishing strong state tobacco control programsand an unprecedented, collaborative effort from all
corners of the movement towards that end. This collaboration is in itself a healing balm for past disagreements
and regrets.
Further on the horizon lies the possibility of federal tobacco legislation. No serious Congressional initiative has yet
surfaced but some of the same factors that gave rise to tobacco legislation in 1998 persist, including a mounting
burden of private litigation, a federal lawsuit to recover billions in Medicare expenses, and the President's
commitment to comprehensive tobacco control legislation.
The White House, Congressional leadership, governors, trial lawyers, and tobacco industry all have incentives
to begin again the process of negotiation and possible compromise. That is all the more reason why now is the
time for a deliberative and inclusive process to work through the salient priorities for tobacco control; to identify
those non-negotiable core principles; and to distill and talk through principled differences. As we have seen,
total consensus has not been and will never be possible. But reasoned debate, broad consensus on core issues,
and civil agreement to disagree on other issues will be critical. It is our hope that this analysis will help lead in
suchdirection.
"Hope. Realistic hope," wrote Erich Fromm, one of this century's greatest counselors, is a "decisive element in
any attempt to bring about social change." It is like "the crouched tiger" which is always ready to jump "when
the moment for jumping has come."
Have we gained enough wisdom so that when we leap, we win?
Advocacy Institute / 37
Appendix 1 Appendix 2
List of Interviewees for Strategic Analysis Transcribed interviews conducted by Mike Pertschuk between September
1997December 1998 as part of research on the book entitled Lead Us Not

Melissa Albuquerque Larry Downs Judy Knapp Andre Stanley Anne Ford Matt Myers
CDC Office on Smoking New Jersey Breathes Minnesota Smoke Free SmokeLess States Manager of Federal Relations Executive Vice President and General Counsel
and Health Lawrenceville, NJ Coalition Program Office National Center for Tobacco-Free Kids National Center for Tobacco-Free Kids
Atlanta, GA St. Paul, MN Chicago, IL Washington, DC Washington, DC
Pam Eidson
Amy Barkley Georgia Division of Lodie Lambright Carter Steger Cliff Douglas Jeff Nesbit
Coalition for Health Public Health ASSIST / Rhode Island American Cancer President Consultant
and Agricultural Atlanta, GA DOH Society Tobacco Control Law & Policy Consulting Washington, DC
Development Providence, RI Glen Allen, VA Ann Arbor, MI
Versailles, KY Monica Eischen Bill Novelli
CDC Office on Smoking Sally Herndon Malek Charyn Sutton David Kessler, MD President
Lynn Carol Birgmann and Health ASSIST / North Carolina Onyx Group Dean, Yale Medical School National Center for Tobacco-Free Kids
Kentucky ACTION / Atlanta, GA DOH Philadelphia, PA New Haven, CT Washington, DC
ALA Raleigh, NC
Louisville, KY Eric Gally Jeanne Weigum Witold Zatonsky John Seffrin
Consultant Marcia Nenno Association for Head, The Maria Sklodowska-Curie CEO
Michele Bloch Washington, DC American Cancer Society Nonsmokers Memorial Cancer Center and Institute American Cancer Society
American Medical Tampa, FL Minnesota of Oncology Atlanta, GA
Womens Association Donna Grande St. Paul, MN Warsaw, Poland
Rockville, MD Full Court Press Jane Pritzl Judy Wilkenfeld
Tucson, AZ ASSIST / Colorado DOH Phil Wilbur Russ Sciandra Special Advisor for Advertising Initiatives
Deborah Borberly Denver, CO Pacific Institute for Director Food and Drug Administration
ASSIST / New Mexico Kathy Harty Research & Evaluation Center for Tobacco Free New York Washington, DC
DOH SmokeLess States Jeanne Prom Bethesda, MD Albany, NY
Albuquerque, NM Program Office North Dakota Dept. Mitch Zeller
Chicago, IL of Health Seth Winick Julia Carol Associate Commissioner
Serena Chen Bismarck, ND American Cancer Society Co-Director Food and Drug Administration
ALA / Alameda County Ann Marie Holen Washington, DC Americans for Nonsmokers Rights Washington, DC
Oakland, CA Alaska Native Health Susan Schoenmarklin Berkeley, CA
Board American Cancer Society
Ralph DeVitto Anchorage, AK Milwaukee, WI Linda Crawford
American Cancer Society National Vice President
Tampa, FL Bob Jaffe Donna Scrutchins Federal and State Government Relations
Washington DOC AHA / Tobacco-Free American Cancer Society
Donna Dinkin Seattle, WA Illinois Project Washington, DC
Public Health Leadership Chicago, IL
Institute Jerie Jordan
Greensboro, NC American Cancer Society
Atlanta, GA

38 / Advocacy Institute Advocacy Institute / 39

Appendix 3
List of Participants in the Strategic Advisory Meeting, Advocacy Institute, December 11, 1998

Kay Arndorfer Sally Herndon Malek

Director, Tobacco Control Project ASSIST DOH Project Manager
Advocacy Institute North Carolina Dept. of Health
Washington, DC Raleigh, NC

Michele Bloch Mark Pertschuk

Chair, Tobacco Control and President
Prevention Subcommittee ANR Board of Directors
American Medical Womens Association Berkeley, CA
Rockville, MD
Mike Pertschuk
Anne Ford Co-Director
Manager, Federal Relations Advocacy Institute
Center for Tobacco-Free Kids Washington, DC
Washington, DC
Jane Pritzl
John Garcia ASSIST Field Director
Vice President, Community & Colorado Dept. of Public Health
Public Health Promotion Denver, CO
Prospect Associates
Silver Spring, MD Glenn Schneider
Community Organizer
Theresa Gardella Smoke Free Maryland Coalition
Project Manager Baltimore, MD
Advocacy Institute
Washington, DC Karla Sneegas
Trainer/Consultant
Cynthia Hallett Indianapolis, IN
Associate Director
Americans for Nonsmokers Rights Seth Winick
Berkeley, CA Director, State Government Relations
American Cancer Society
Rich Hamburg Washington, DC
Director, Legislative & Regulatory Affairs
American Heart Association
Washington, DC

40 / Advocacy Institute