What do you do when Big Tobacco gives you $246 billion? Naturally, you use it against the tobacco industry.

That's what started happening in 1998, when most of the states in the union won a $206 billion lawsuit against the tobacco industry on behalf of ill and dying smokers -- and the remaining four settled separately for a not-too-shabby $40 billion. The money was to help compensate states for the enormous cost of treating lung cancer, heart disease, emphysema and other smoking-related diseases.

But states also had the discretion to use the funds for campaigns to stamp out smoking and prevent more Americans from getting hooked. By all accounts, those efforts are paying off. California has seen per capita cigarette consumption plummet nearly 60 percent, nearly twice that of any other state. Cigarette consumption in Massachusetts is also steadily falling: the latest tally shows a 32 percent drop. Preliminary results in Minnesota show that smoking among 12- to 18-year-olds has been cut by one quarter.

How are they doing it? Here's a snapshot of some of the most successful anti-smoking campaigns in the nation.

Matt Novak's come a long way. A little over a year and a half ago, the 17-year-old was an innocent. He'd tried smoking briefly but never got addicted, and he'd never given the tobacco industry a second thought. To get out of school one day, he agreed to go to a meeting of 400 teens in St. Cloud, Minnesota where Target Market, the state's new anti-tobacco youth movement, was first dreamed up. There, he got his first lesson in how tobacco companies hook young smokers, and it astonished him. It also made him furious. "It angers me that men in suits sit in corporate towers trying to addict my little brothers and are making a ton of money off of it," he says.

Today he's using the tobacco industry's marketing tactics to beat them at their own game. Co-chair of Target Market's executive committee, Novak helps lead thousands of student activists in the state's largest and most visible anti-smoking campaign.

"You Target Us, We Target You" is Target Market's current slogan. Modeled after Florida's highly successful "Truth Campaign," which features antismoking ads designed by teens, Target Market gives young people the leverage and power to design their own tobacco counter-marketing. With an $8.5 million yearly budget, teen volunteers such as Novak produce concerts and sports events to publicize the cause. Their efforts include "Kick Ash Bash" gatherings, music CDs, underground films, and CD-Roms. They sponsor anti-industry presentations, including "tours" of the tobacco industry's most damning documents, and campaigns such as "Rip It Out," in which teens tear out tobacco magazine ads and mail them to Target Market in order to receive the organization's free promotional gear. They've met twice with tobacco industry executives, and even filmed an interview with Brown and Williamson's CEO that they turned into a provocative anti-smoking commercial.

Working as advisors to ad agencies, teenagers in Minnesota brainstorm ad concepts for a statewide media blitz that highlights tobacco industry manipulation of young people. One award-winning television ad showed an African American teen reading from tobacco industry documents, including the quote, "We target the young, the black, and the stupid."

Launched in April 2000, Target Market's ranks have already swelled to 33,000 members. What's more, 83 percent of teens are aware of the program, and teen smoking continues to fall, says Alana Petersen, the program's executive director. The turnaround is especially welcome: before Target Market, youth tobacco rates in the state had gone up 35 percent over the past six years, faster than the rest of the nation.

[The Target Market program was discontinued in 2003 due to cutbacks in state funding. In a subsequent study conducted at the University of Miami School of Medicine, the Centers for Disease Control reports that the demise of the program led to an increase of about 10 percent in adolescent susceptibility to cigarette smoking within six months. --Editors]

Minnesota was the first state to actually take tobacco companies to trial, using millions of previously secret tobacco industry documents that proved, among other things, that tobacco companies had targeted teenagers. Together with Blue Cross Blue Shield of Minnesota, the state won its lawsuit against the tobacco industry in 1998. By 2001, the state had distributed over $30 million in grants, says Randy Kirkendall, manager of Minnesota's tobacco control program.

Among its innovative programs is Minnesota's new quit line (1-877-270-STOP), sponsored by an independent public health foundation called the Minnesota Partnership for Action Against Tobacco (MPAAT). Callers with a health plan will get immediately connected to their plan's smoking cessation program. Those who are uninsured or whose health plans don't offer smoking cessation services will get free bilingual counseling through the partnership with the help of participating health plans. The goal is to make it as easy as possible for motivated smokers to quit, says the foundation's Julie Jensen.

"I see my friends who smoke wanting to quit and they can't," says Novak. "I don't think it's cool that people are making money off disease and death."

In contrast to Minnesota's new anti-smoking efforts, California's landmark anti-tobacco program is the oldest and most comprehensive of its kind. The nation's first sustained anti-smoking campaign, it's hailed as a model for other states and wins accolades for its sophisticated and aggressive media campaign. Californians voted to levy a hefty cigarette tax in 1988 -- even though the tobacco industry spent millions to defeat it -- and the state health department used the money to create a sweeping media and education campaign against smoking. The state also gets $22 million a year from the 1998 tobacco industry settlement.

California's media campaign set the trend for risky, hard-hitting ads that attack and expose the tobacco industry's deceptive marketing practices, says Colleen Stevens, chief of the state's anti-tobacco campaign. The multicultural ads also show the devastating health consequences of smoking on its victims.

In one television ad, 13-year-old Brian recalls how his father broke the news that he had terminal lung cancer from smoking cigarettes. "He took me into the back yard to tell me, and that was the first time I ever saw him cry," he says.

One of California's most famous series of ads features the Marlboro Man, the quintessential tobacco icon. "I miss my lung, Bob" he says in one ad. "Bob, I've got emphysema" he says in another. The message is simple: Tobacco hurts even the most healthy and macho among us. (For more on California's antismoking media campaign, see California's media war against tobacco.)

After 12 years fighting the tobacco industry, the state now has arguably the toughest anti-smoking laws in the world. The California Department of Health Services, which oversees the anti-smoking campaign, has helped ban smoking in most workplaces and even in bars and restaurants.

The David and Goliath-like effort has paid off: Not only are the ranks of smokers falling steadily throughout the state -- far surpassing the national averages -- but tobacco-related illnesses such as lung cancer and heart disease have dropped markedly as well.

Massachusetts voters passed their own cigarette tax in 1992 and designed a far-reaching anti-tobacco campaign that closely mirrors California's. The anti-tobacco media campaign is likewise designed to aggressively confront the tobacco industry's marketing tactics and make the health effects of smoking real -- and personal.

One series of ads featuring smoker Pam Laffin particularly caught the people's attention. The 29-year-old Laffin, who started smoking at age 10, had emphysema and endured a failed lung transplant. Her face is puffy from medications as she says from her hospital bed, "Sometimes the only thing that keeps me going is a belief that maybe I can do some good in this world. In the end, though, you're gonna decide if all this suffering has been for nothing. I just hope you can learn from my life before you have to pay with your own." She died two years later.

These unflinching messages, reinforced with strong local anti-smoking programs and quit helplines, hit their mark. Smoking levels have fallen throughout the state. Moreover, surveys show that young people who recall the ads are half as likely to start smoking as those who don't, says Michael Siegel, MD, MPH, associate professor at Boston University School of Public Health and a specialist in tobacco control policy. "If you can cut in half the rate of smoking initiation among adolescents that's a huge effect," he says. "That kind of magnitude in a public health program is an amazing success story."

All the money flowing into state coffers for anti-smoking campaigns hasn't gone without a protest from the tobacco industry, which has attacked several antismoking ads as unfair. It is no coincidence, say health advocates, that tobacco companies' yearly marketing and advertising expenses shot up to $15.2 billion in 2003 -- more than double what tobacco companies spent in 1998.

The influence of tobacco industry lobbying and the amount of money that Big Tobacco pours into political campaigns is still so overwhelming that state anti-tobacco programs have to fight governors or state legislatures each year to make sure their budgets aren't slashed. And while the settlement money was to compensate states for the costs of treating smoking-related illnesses, many states are using the windfall to finance a variety of unrelated programs (including, in seven states, assisting tobacco growers).

"There's simply no excuse not to fund anti-smoking programs. Its tobacco settlement money -- what better use is there?" says Danny McGoldrick, Vice President of Research for the nationwide Campaign for Tobacco-Free Kids. "Excuses -- such as there's no money or that the programs don't work -- won't wash any more."

In Massachusetts, the state's anti-tobacco campaign is changing fundamental beliefs about smoking and the tobacco industry, says Dr. Howard Koh, former Massachusetts Commissioner of Public Health and a professor at the Harvard School of Public Health. "We've changed the whole culture of how tobacco is perceived," he says. But he adds, "You can't take any public health efforts in tobacco for granted. They're always being undermined by the tobacco industry."

-- Loren Stein is a medical and legal writer based in Palo Alto, California.

(For more on California's anti-smoking media campaign and to see some of its most compelling ads, click here; for more on Florida's Truth Campaign , click here.)

Further Resources

Minnesota Partnership for Action Against Tobacco, www.mpaat.org

Target Market (Minnesota), www.tmvoice.com

Minnesota's tobacco control program online, www.mntobacco.net

California Tobacco Control Section, www.dhs.cahwnet.gov/tobacco

Massachusetts Tobacco Control Electronic Resource Library, http://tobacco.neu.edu/

References

First published December 13, 2001
Last updated January 25, 2007
Copyright © 2001 Consumer Health Interactive