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Information Exchange Training

Tobacco Prevention:

CONNECTING

FOR THE FUTURE

October 17-18, 1995

Washington, DC

National Cancer Institute

American Cancer Society

American Stop Smoking Intervention Study for Cancer Prevention

"TOBACCO PREVENTION: CONNECTING FOR THE FUTURE"

ASSIST INFORMATION EXCHANGE TRAINING

OCTOBER 17 - 18, 1995

Hotel Washington

Washington, D.C.

AGENDA

Tuesday, October 17

9:00 a.m. - 9:10 a.m. Welcome Remarks

(Ballroom - Lower Lobby Level)

Peter Greenwald, M.D., Director, Division of Cancer

Prevention and Control, National Cancer Institute

9:10 a.m. - 9:30 a.m. Opening Address

(Ballroom - Lower Lobby Level)

Richard Clausner, M.D., Director, National Cancer Institute

9:30 a.m. - 10:00 a.m. Institutionalization Through Intervention

(Ballroom - Lower Lobby Level)

Donna Grande and Jerie Jordan

10:00 a.m. - 10:15 a.m. Morning Break

10:15 a.m. - 10:40 a.m. The Honorable Donna E. Shalala

Secretary, Department of Health and Human Services

(Ballroom - Lower Lobby Level)

10:40 a.m. - 12:30 p.m. Allegiances in Health: Women as Tobacco Prevention

Advocates

(Ballroom - Lower Lobby Level)

Moderator: Regina Penna

Presenters: National Organization for Women: Karen

Johnson

Maine: Sandy Hoover, Carol Goloff

New York: Elizabeth Hobkirk, Judy Avner

Wisconsin: Susan Latton, Millie Jones

12:30 p.m. - 12:45 p.m. Transition Time

12:45 p.m. - 2:15 p.m. Lunch and Keynote Speaker

(Washington Room - Roof Top Level)

Dr. Dorothy I. Height, National Council for Negro Women

2:15 p.m. - 2:30 p.m. Transition Time

ASSIST Information Exchange Conference October 17-18, 1995

7



INSTITUTIONALIZATION THROUGH INTERVENTION

Donna Grande and Jerie Jordan

Where Are We and Where Are We Going?

  • ASSIST Model imbedded with institutionalization.
  • Policy ensures that issues are institutionalized as law or private policy, which becomes the accepted norm.
  • Taxes ensures that the cost of tobacco is high. If earmarked, ensures a lasting program within the DOH and other organizations
  • Media cues and messageschanges the mindset of the general public and raises awareness to support changes for the future.

What Has Been Done To Create the Change?

  • States have passed excise tax increases and earmarked funds for tobacco prevention (MA, MI).
  • State laws have been passed to prevent preemption.
  • Organizations have changed policy (schools, worksites, health care settings).
  • Professions have been trained on ways to integrate messages into daily practice (health providers).
  • Networks have been created to streamline information flow.
  • Overall infrastructure has been builtlocal coalitions connected with state coalitions.


What Remains To Be Done?

  • Greater support and education of the issue to build the constituent base.
  • Expand the base of support to include organizations and professions that have not been a part of the movement (unions, blue/pink-collar workers, community-based organizations, and political groups).
  • Pass policies to raise taxes, strengthen clean indoor air restrictions, prohibit youth access to tobacco, and limit advertising and promotion.

ASSIST Information Exchange Conference October 17-18, 1995

25




EXCEPTS REGARDING YOUNG WOMEN AND SMOKING

1. Emphasize the positives of not smoking. Some tobacco prevention messages attempt to make non-smoking appear to be enjoyable, glamorous, sophisticated and attractive, as the tobacco industry currently portrays smoking. This seizes many of the attributes girls in the roundtables ascribed to smoking. This approach is favored by some because it emphasizes the positive aspects of health, rather than the negatives of smoking. A criticism is that it may validate sexists stereotypes of femininity. Many who favor a woman-centered approach to tobacco prevention are uncomfortable with this.

2. Emphasize the negatives of smoking. The opposite approach is to emphasize those things that girls told us that they dislike about smoking. Such messages point out that cigarettes do not deliver the image that the advertising promises. Girls in the roundtables said the thing they disliked most about smoking was that it makes the smoker's clothes and hair smell badly (sic). In this vein, the Minnesota Department of Health had developed TV spots with the message, "Smoking makes your clothes smell."

3. Exploit girls' need to be popular. Some girls in the roundtables cited boys' disapproval of smoking as a reason not to start. Many agreed with a teenage who said, "Some guys won't date smokers." Adolescents in the roundtables said that their boyfriends' opinions about smoking had a significant impact on their behavior. One teen said, "A girl would probably not smoke in front of her boyfriend if he doesn't smoke." In 1990, the American Cancer Society developed a TV spot showing peer disapproval of smoking, called "Smoking is Real Gross," in which three boys show visible disgust for a girl's smoking. This turns around the "smoking makes you popular" assurance of cigarette ads, but retains the deeper implicit message that girls are defined in terms of what boys think about them.

4. Play to girls' concern for their looks. It appeared from the roundtables that adolescents are much more concerned about how smoking affects their appearance (yellow teeth, bad breath, unpleasant smell on hair and clothing) than they are worried about the long-term risk of chronic illness. Recognizing that young girls are far more likely to be concerned with their physical appearance than their future health, the Vermont Department of Health produced a TV spot entitled "Beautiful Lady" showing in a very dramatic and disgusting way that smoking causes skin wrinkles. However, some women's advocates are uncomfortable with messages that tell girls they are going to be judged on the basis of their looks.

5. Stress their importance as role models. Several teens and many mothers in the roundtables expressed concern that their smoking sets a bad example for younger sisters or daughters. One girl said, "I stopped because I didn't want my younger brothers and sisters doing it." Research done for the Massachusetts smoking prevention campaign shows that older adolescents feel a responsibility to be positive role models for younger siblings.

6. Expose the tactics of the industry. Many girls in the roundtables expressed cynicism about tobacco company advertising. One said, "You know the models in those ads don't really smoke." A young girl declared, "Those ads are so fake!" A fairly new approach in antismoking messages is to take on the cigarette industry by exposing its tactics. For example, the Minnesota Department of Health developed a series of ads

ASSIST Information Exchange Conference October 17-18, 1995

75



PREEMPTION: RECOGNIZE AND STRATEGIZE

Robin Hobart and Michael Siegel

Preemption is a serious threat to the viability of the tobacco prevention movement.

  • Preemption destroys the possibility of community investment in tobacco prevention, which is essential for effective public health interventions.
  • Preemption destroys the possibility of community-level change, which is essential for changing the social norms regarding smoking.
  • Preemption destroys the durability of tobacco prevention efforts. It brings a quick but painful death to the practice of tobacco prevention.
  • Preemption destroys tobacco prevention coalitions and turns allies into enemies.

RECOGNIZING preemption requires:

  • Careful examination of ALL bills/amendments at ALL stages of the process.
  • An assumption that all legislation is preemptive, unless it contains specific antipreemption language.

STRATEGIZING to prevent preemption (in public health-sponsored bills) requires:

  • The insistence of coalitions that antipreemption language be included in any and all state tobacco prevention bills, with no exceptions.
  • The agreement of all coalition members, in advance, that exclusion of preemption language is not subject to compromise, with no exceptions.

STRATEGIZING to fight preemption legislation (in bills introduced by the tobacco industry) requires a media-based campaign that frames:

  • Tobacco industry sponsorship of the preemption bill as a deceptive strategy to undermine community public health efforts in order to protect industry profits.
  • Preemption as being inconsistent with public desire to get big state government off our backs, as it destroys local autonomy to protect community health.


ASSIST Information Exchange Conference October 17-18, 1995

105



CHARACTERISTICS OF LEGISLATION THAT WITHSTANDS INDUSTRY CHALLENGES

Richard A. Daynard

The success of state tobacco prevention programs turns primarily on the willingness of state agencies, local health department, and municipal legislative bodies to adopt effective state and local tobacco prevention measures. For state and local measures to be truly effective, they must be:

  • Enacted in a legally valid manner
  • Drafted so as to withstand probable tobacco industry legal challenges to them.

For both state and local measures, this requires an examination of the Federal law background to state and local tobacco prevention to avoid problems with:

  • Federal preemption
  • The commerce clause
  • The first amendment
  • Due process and privacy rights
  • Equal protection
  • Antitrust law.

Those who are considering the passage of local tobacco prevention measures must then examine the state law sources from which local governmental bodies derive the power to control the sale and use of tobacco under state law and the limits inherent in their powers to do so. State or municipal bodies contemplating state and/or local tobacco prevention measures should then investigate the Federal and state laws relevant to enacting each of the following tobacco prevention measures:

  • Bans on smoking in public areas such as restaurants
  • Vending machine bans
  • Bans of tobacco billboards and taxi roof ads
  • Bans of free-standing tobacco product displays
  • Bans of free distribution of cigarettes (sampling)
  • The use of compliance checks ("sting" operations).

ASSIST Information Exchange Conference October 17-18, 1995

112



EXCERPTS REGARDING ADVERTISING, MEDIA MANIPULATION AND USING CHILDREN

1. Amendment rights. Commercial speech is not subject to the same First Amendment rights as individual speech. Courts uphold this notion. The tobacco industry prefers to make deals and conduct business behind closed doors out of the public view, so it is ironic that they are suddenly so concerned about First Amendment rights.

2. The FDA regulations are really quite modest. The regulations could have imposed many more restrictions on tobacco advertising and on access.

3. While the FDA regulations are significant and deserve support, local control over tobacco access is still needed. The federal government is best able to regulate advertising of tobacco, but monitoring and enforcement of illegal sales to children are still best handled at the local level. The FDA regulations do not address retailer licensure, one of the most effective means of reducing youth access. Licensure is done most effectively by communities concerned about their children. In Michigan the local preemption prohibits local communities from acting to protect children. Repealing local preemption provides the cornerstone for a strong protective law in Michigan. Coupled with the FDA regulations, preemption repeal paves the way to a truly comprehensive program that will reduce children's access to tobacco.

Suggested Media Strategies

1. Letters-to-the-editor, op-eds, and editorials are needed over the next three months. Responses to any of these expressing an opposing viewpoint are also needed.

2. Newspaper articles and radio and TV talk shows are also good ways to educate people about the significance of the regulations and the link to preemption repeal.

3. Kids are goods spokespeople, except that they don't believe that advertising has any influence over their behavior. (Most adults will also say that advertising has no impact their (sic) behavior.) Using them to talk about access or the numbers of ads that they see daily or weekly is a good strategy. (One community in another state had kids do a "billboard" walk where the kids counted the number of tobacco billboards in a community.)

ASSIST Information Exchange Conference October 17-18, 1995

152



YOUTH AS EFFECTIVE LEADERS IN TOBACCO USE PREVENTION

Gail Joyce

There are many ways in which teens can play a more prominent leadership role in the tobacco prevention movement.

  • They are knowledgeable, articulate, and passionate about the issues
  • They offer a new and fresh perspective
  • All of the current major tobacco issues are directly related to youth.

To be effective leaders, youth must be:

  • Prepared

- Provided with the latest and most relevant information, statistics, and studies

- Trained in how to work with elected officials and community leaders

- Trained in how to work with the media

  • Involved Directly In:

- Developing goals and strategies

- Planning a course of action or special event

- Actual production/execution of plan or event

Teens can be effective as:

  • Advisors
  • Spokespersons
  • Teachers.

Examples:

  • State/community action plans
  • FDA petition drive
  • White House meeting and National Press Conference with President Clinton
  • Teach younger students.

ASSIST Information Exchange Conference October 17-18, 1995

167


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