# Presentation: 082979

## Campaign for Tobacco Free Kids

***Key Opportunities for Tobacco Prevention and Cessation in the U.S.***
***William V. Corr, J.D.***
***Executive Director***
***February 6, 2007***

## Mission

**Reduce Tobacco Use and Its Toll on Health by:**
- Preventing youth from starting to smoke
- Helping smokers quit
- Protecting everyone from secondhand smoke

##       Tobacco Use in the United States       Remains Unacceptably High

**ADULTS**
- In 2005, about 45 million adults in the U.S. smoked cigarettes (20.9%)
**KIDS**
- In 2005, about 3.75 million high school students smoked (21.9%)
**Everyday in America:**
- 		- More than 4,000 kids try their first cigarette
- 		- Another 1,000 kids become new daily smokers
- 90% of all long term smokers start as teenagers or younger.

## Slide 4

## Slide 5

## Tobacco Excise Tax Increases
Smoke-free Laws
Funding for Comprehensive Tobacco Prevention & Cessation Programs

- Smoke-free Laws
- Funding for Comprehensive Tobacco Prevention & Cessation Programs

**Population-based Policies ****Reduce Smoking**

## Effects of a 10% Tobacco Tax Increase

- Nearly 7% decline in youth prevalence
- A 2% decline in adult prevalence
- A 4% decline in overall consumption

**Notes:**
Show tax ads from Pete -- transparencies

How can we influence price.  We do it by supporting public policies (i.e. excise tax increases) that effectively raise the price of cigarettes and other tobacco products.  Economic research shows that price influences consumption – particularly for kids.

We have supported tax increases at the federal and state level through:

Advertising in support of the tax increases
Direct lobbying
Grassroots organizing – letter writing, visits, etc.

In 1997, we saw state excise tax increases in 8 states.  In Alaska, the increase was from 29 cents to a full dollar, now the highest cigarette tax in the country.

We’ve also supported the Hatch - Kennedy proposal to increase the federal excise tax to fund health insurance for uninsured kids.

Our support for package 

## Slide 8

## Recent Cigarette Tax Increases

**CALIFORNIA**

**NEVADA**
**    ****80**

**OREGON**
**118**

**WASHINGTON**
**202.5**

**ARIZONA**
**   ****200**

**NEW MEXICO**
**91**

**TEXAS**
**141**

**OKLAHOMA**
**103**

**UTAH**
**69.5**

**COLORADO**
**84**

**KANSAS**
**79**

**NEBRASKA**
**64**

**IDAHO**
**57**

**MONTANA**
**170**

**NORTH DAKOTA**
**44**

**SOUTH DAKOTA**
**153**

**MINNESOTA**
**149.3**

**IOWA**
**36**

**MISSOURI**
**17**

**ARKANSAS**
**59**

**       ****36**
**LOUISIANA**

**MS**
**18**

**ALABAMA**
**42.5**

**GEORGIA**
**37**

**FLORIDA**
**33.9**

**SOUTH CAROLINA**
**7**

**NORTH CAROLINA**
**35**

**TENNESSEE**
**20**

**KENTUCKY**
**30**

**ILLINOIS**
**98**

**WISCONSIN**
**   ****77**

**MICHIGAN**
**200**

**IN**
**55.5**

**OHIO**
**125**

**WV**
**55**

**30**
**VIRGINIA**

**PENNSYLVANIA**
**135**

**NEW YORK**
**150**

**MAINE**
**200**

**VT**

**NH: ****80**

**MA**

**CT:****151**

**RI:****246**

**NJ:****258**

**DELAWARE:****55**

**MARYLAND:****100**

**DC:****100**

**HAWAII**
**160**

**ALASKA**
**180**

**States that have recently passed or implemented a cigarette tax increase ****(since 1/1/2002)**

**WYOMING**
**60**

***               ******December 2006***

**CT**

**MA:****151**

**87**

**VT:****179**

- TX’s & SD’s tax rates are effective 1/1/07.  AZ’s tax rate is effective 5/1/07.  The second phase of the VT tax increase (an additional 20-cents) will be effective 7/1/07, bringing the VT tax to 199 cents per pack.

## Effects of Smoke-free Laws

- Protection from secondhand smoke
- Prompt more smokers to try to quit
- Increase the number of successful quit attempts
- Reduce the number of cigarettes that continuing smokers consume
- Discourage kids from starting

## The U.S. Surgeon General concluded that smoke-free laws:

- “The debate is over. The science is clear: Secondhand smoke is not a mere annoyance but a serious health hazard that causes premature death and disease in children and nonsmoking adults.”
- 		*[Source - Richard Carmona, Surgeon General, June 27, 2006]*
- The ***U.S. Surgeon General*** concluded that smoke-free laws:
- “... have been shown to decrease daily tobacco consumption and to increase smoking cessation among smokers.”
*	**	**[**Source - U.S. Department of Health and Human Services **	**	**	**(HHS), **	**Reducing Tobacco Use: A Report of the Surgeon **	**	**	**General, 2000]*

**What do Government Health Authorities Say?**** **

## The National Cancer Institute concluded that: 

- The ***National Cancer Institute*** concluded that:
- “... workplace smoking restrictions are accompanied by an increase in cessation attempts and a reduction in number of cigarettes smoked per day by continuing smokers.”
*	**	**[Source - National Cancer Institute, Population Based **	**	**	**Smoking Cessation: Proceedings of a Conference on What **	**	**Works to Influence Cessation in the General Population, **	**	**Smoking and Tobacco Control Monograph No. 12, NIH **	**	**Pub. No. 00-4892, November 2000]*

**What do Government Health Authorities Say?**** **

## Impact of smoke-free workplace policies on cigarette 

**“****1. Total prohibition of smoking in **
**the workplace strongly affects **
**Industry volume.  Smokers facing **
**these restrictions consume 11%-**
**15% less than average and quit at a**
**Rate that is 84% higher than **
**average.”**

**“****2. Milder workplace restrictions**
** ****such as smoking only in designated **
**areas, have much less impact on**
**quitting rates and very little effect **
**on consumption.”**

***Philip Morris internal document***
***January 22, 1992 ***

**Impact of smoke-free workplace policies on**** ****cigarette **
**consumption and smoking prevalence**

## Smoke-Free Laws

**Smoke-Free Laws**

***November 2006***

*** The Montana and Utah laws extend to bars in 2009. **

*** Arizona law effective 5/1/07**

**Restaurants**

**Restaurants & Bars**

**Notes:**
Includes Columbus, OH, Lawrence, KS, Lincoln, NE, Roswell NM, copperas Cove, TX

Wilmette, IL
Madison WI
Burlington VT
Minneapolis
Bloomington
Powell OH
Worthington OH
Fargo ND
Wauseon OH
Winooski, VT

## Essential Elements

- Community-Based Programs
- Public Education  (Media)
- Helping Smokers Quit
- School-Based Programs
- Enforcement
- Evaluation

## Comprehensive Programs Work

***To Reduce Youth Smoking***

**Maine: Cut **
**high school **
**smoking by**
** ****59% in 8 years**

**Oregon: Cut **
**smoking by**
** ****51% among **
**eighth graders **
**between ‘96 **
**and 2002**

**Mississippi: Cut  **
**public middle school smoking**
** ****by 48% & high school smoking**
**by 32% between 1999 & 2004**

**Florida: Cut **
**middle school **
**smoking by **
**50% & high school **
**smoking by **
**35% in 4 years**

## Comprehensive Programs       Reduce Adult Smoking

**Massachusetts: **
**Cut adult **
**smoking by 21% **
**between **
**1993 and **
**2000**

**Arizona: Cut **
**adult smoking **
**by 21% between **
**‘****96 and ‘99**

**California: Cut **
**adult smoking by **
**32.5% between **
**1988 and 2004 **

**Maine: Cut adult smoking by 12.5% b/t 2001 and 2004**

**WA: Cut adult smoking by 13% between 1999 and 2004**

**New York: cut adult smoking by 14% between 2001 and 2004**

## FY 2007 Tobacco Money for Tobacco Prevention

**$1.6 Billion**

** ****$597.5 Million**

** ****$ 21.7 Billion**

**$14.7 Billion **
**Tobacco Tax Revenues**

- $**7.0 Billion**
**Tobacco Settlement Revenues**

- FY 2007 Tobacco Money for Tobacco Prevention

## FDA REGULATION OF CONSUMER PRODUCTS MEANS . . . 

- Ingredient review and disclosure
- Removal of harmful substances
- Manufacturing guidelines to ensure cleanliness and safety
- No defective or misbranded products
- Truthful packaging and advertising
*EXAMPLE:  A new ingredient in Macaroni & Cheese must be declared safe for consumption and listed on the box*

**FDA REGULATION OF CONSUMER PRODUCTS MEANS**** ****. . .**

***Regulating how products are manufactured, marketed and sold***

## TOBACCO PRODUCTS ARE EXEMPT FROM FDA PROTECTIONS 

- _NO_ product review
- _NO_ ingredient review
- _NO_ ingredient disclosure
- The ammonia, arsenic and other toxic chemicals found in cigarettes remain *unregulated *and *unreported *to consumers
*EXAMPLE:  A new ingredient in Marlboro cigarettes can simply be added to the product - no tests needed, no disclosure necessary, no questions asked*

## LOW TAR CIGARETTES

- A CASE EXAMPLE OF THE NEED FOR REGULATION

## Slide 22

## Slide 23

## NCI Smoking and Tobacco Control 

**Monograph 13 Reveals Low-Tar No Safer**

- 2001 study found “light” and “low-tar” cigarettes no less harmful than other brands
- Tobacco industry deliberately marketed low-tar cigarettes to prevent smokers from quitting
- Tobacco companies deliberately developed low-tar products which tested safer by machines but were just as dangerous when actually smoked

## WHY DIDN’T LOW TAR CIGARETTES REDUCE THE RISK OF DISEASE

- The Government underestimated the complexity of the product and the ability of the manufacturer to change the product in ways not reflected in the machine tests
- The Government underestimated the power of addiction and the ability of manufacturers to increase the addictive nature of its products in ways that were not easily discovered

## New so-called “reduced risk" products being marketed to smokers as a “healthier” alternative

## Is History Repeating Itself?

## Slide 28

## THE TRUTH ABOUT “REDUCED RISK” PRODUCTS

**Tobacco Industry Unleashes New ****Generation of Deceit**
- “[It] **will not kill them as quick or as much** as other brands,” Bennett LeBow, CEO, Vector, Manufacturer of new Omni cigarettes.

- January 11, 2002

##         Other Products That Contain Nicotine Are Subject To FDA Regulation

- Rigorous review for safety and efficacy
- Rigorous marketing standards

## Slide 31

- FDA Regulation is Key

- Prohibit marketing
- - that influences kids
- - that mislead adults
- Product regulation
- - eliminate or reduce harmful components
- - nicotine levels
- - “reduced risk” claims
- - disclosure of ingredients, including in smoke
- New health warnings – including graphic warnings
- Ban candy and other flavorings and misleading terms like “light” and “low tar
- Allow states to ban/restrict when/where/how tobacco products are advertised

## Federal Lawsuit - Background

- September 1999 – Department of Justice files suit against major cigarette companies
- Alleged 50 year conspiracy to defraud/deceive American public
- Millions of documents
- Over 1000 orders issued by Judge Gladys Kessler
- Nine month trial with 84 witnesses, ended June 2005

**Notes:**
Racketeering:  a complex legal definition.

For our purposes, “conspiring to do harm.”  

## After Trial Concludes, 6 Groups File Motion to Intervene

- Public health intervenors argued that “...interest of public health organizations and their members are no longer being adequately represented in the case...”
- Judge Kessler granted the request.
- “in a case of this magnitude... it will serve the public interest for major public health organizations, who have long experience with smoking and health issues to contribute their perspectives on what appropriate and legally permissible remedies may be imposed should liability be found.”
- Intervenors: American Cancer Society, American Heart Association, American Lung Association, Tobacco-Free Kids Action Fund, Americans for Nonsmokers’ Rights and National African American Tobacco Prevention Network.

**Notes:**
because...the government reduced the amount it is asking the tobacco companies to pay for a smoking cessation program from $130 billion over 25 years, as recommended by its expert cessation witness, to a $10 billion over five years.”

## Judge Kessler’s Decision

- 1,700 pages, issued August 2006
- Companies engaged in 50 year fraud – that is continuing.
- “Defendants have marketed and sold their lethal products with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy or social costs that success exacted.”

## 	“The evidence in this case clearly establishes that Defendants have not ceased engaging in unlawful activity... For example, most Defendants continue to fraudulently deny the adverse health effects of secondhand smoke which they recognized internally; all Defendants continue to market “low tar” cigarettes to consumers seeking to reduce their health risks or quit; all Defendants continue to fraudulently deny that they manipulate the nicotine delivery of their cigarettes in order to create and sustain addiction; some Defendants continue to deny that they market to youth in publications with significant youth readership and with imagery that targets youth....”

**Judge Kessler’s Decision**

## 	“...Their continuing conduct misleads consumers in order to maximize Defendants’ revenues by recruiting new smokers (the majority of whom are under the age of 18), preventing current smokers from quitting, and thereby sustaining the industry.”

**Judge Kessler’s Decision**

## Remedies Proposed by DOJ and/or Intervenors

- Require payment of $4.8 billion annually to fund a comprehensive smoking cessation program, available to all smokers who want to quit.
- Require the companies to pay $600 million annually to fund public education campaigns on youth prevention, light/low tar cigarettes and secondhand smoke.
- Prohibit practices the companies have used to market to children, deter smokers from quitting and mislead the public about harms of smoking.
- Set annual targets for reducing youth smoking rates, and provide for significant fines if targets aren’t met.

## Our Response?

- Is our response commensurate with the level of harm caused by tobacco use and that will continue to occur unless we intervene?
- We have proven strategies and critical regulation, but there is much more we need to know.  For example:
- NCI has funded vitally important research, but if FDA can regulate nicotine levels and other carcinogens in cigarettes and smokeless tobacco, is NCI prepared to advise FDA?
- NCI research on community based prevention paved the way for our current efforts, but we have growing disparities in tobacco use among population groups and we don’t know the most effective ways to reach them.
- States have billions of dollars in tobacco taxes and settlement funds, and the DOJ lawsuit could produce $5 billion a year for cessation treatment services.  But, state legislators know that, at best, 25-30% of smokers who follow current recommendations for quitting will succeed.  Research to improve cessation methods could encourage substantial new treatment resources to avert tragedy for 45 million adult smokers.