Tobacco Documents Online

I am heartened at the presence at today's meeting of the °lnterre- ligious Coalition on Smoking or EHealth" who can begin to bring our message to the homes of ald 'Artericans through the churches--the United Hethodistfhurch, the Church of Qtirist and others. We must work not only through the churches„but through all other, possible venues to get the word out--the word, not that smoking is bad for you, but the truth abouut;the industrv, its tactics and;the aftetmath. Cnfortunately;,the tobacco industry has not only influenced gov, emment officials, but has also financially contributed to other natural allies and avenues to the AmericanipubGc-yOW; NAACP, unions, progressive g;oups... the list goes on. Clearly, we're not going to solve,ttiis problem today, but in my opinion, there was neveraibetter day to start. We have recently enjoyed many successes,,public opinion„as evidenced by Drponesbury„ Ellen Goodnsan, Anna Quindlen and George Will has never been strongen There is a certain electt+icity in the air antici- pating the potential of a new administration, but also fearing,that the industry will be one step ahead: Our challenr is to make tobacco control not our issue, butAmerica's issue:. At this time, in this city, I feel it's appropriate to repeat one of the most famous quotes of our generation: "A'lllttiis will not be fiitished in the first 100 days, nor will it be finished in the fitst 1000 days, nor in the life of this administra- don, not even perhaps in our lifetime on this planet. Burletus begin." Thank you. 6

Opportunity Knocks; ~~ill' We Open the Door? As we look back over the four years sinee many of us met in Houston, how have we done?' Are we winning? Are we losing? Have weset our horizons high enough to challenge us to the utmost, but realistic enough to be achievable? Andhave we marshalled our will and our resources to achieve the achievable?' In some ways, it's hard to tell: If we look atCanada or Australia, or Thailand and Taiwan-even that lnst bastion of aggressive. Gauloise-blowing, France -we must look with admiration and not a little envy. But if we look at Germarty or Japan, and' most of the Third World-and if we acknowledge that we face the most concen- trated and politically potent tobacco industry opposition.-we're not doing so badly. As we take stock, it's hard not to be assailed by competing,im- ages; some of which herald great progress; others. just as com - pelling, auger stagnation. • Ttte :Wassachttsetts Division of ~the American Cancer Society and the coalition it led with great skill and!persistenee, with heart and soul, withstands an $8,000,000 onslaught by the tobacco industry to iemergg triumphant in its vanguard cigarette excise tax initiative. • In a small meeting,room in Springfield, at the annual STAT Conference, a group of tobacco control advocates bitterlyvent' their frustrations at, their felt exclusion from the I' state ASSIST coalitions, reflecting deep resentments thatthe activists who are the most dedicated tobacco control freedom fighters remain ,. unappreciated, uninvited to the table; unsupported while, as they see it, bureaucrats wallow in misdirected tobacco control dollars. • Yet in Raleigh, North Carolina, where tobacco control requires a quality of fortitude and courage which ~few of us are required to match, an ASSLST launched!conference, packed to standing;.,deaLk openly and'courageously with the challenges of 6ghting,tobacco in the very states for which tobacco is the perceived economic life blood. Keynote Address Michael Pertschuk Co-Director, Advocacy Institute • One thousand tobacco control workers gather in Los wtgeles too celebrate three boisterous years of Prop 99-an ethnic rainbow of newly minted, enthusiastic, resourceful tobacco control advo- cates who have radically altered the community environment for tobacco use in California--under the risk-talkrtg, politically unintimidated guidance of the California state heaith~department stafE.' Yet, look arottndIthis room. vationally;,we are no rainbow coali+ tion-and the very communities which are the prime marketing, and propaganda and organizing targets of the tobacco industry are largely missing from, the councils and inner coalition coreof' mosttobaeco control efforts,. We have come together here today with a shared~vision for the future: First, to achieve an authoritative, comprehensive, articulated National Tobacco CAntrol'PolicyAgenda, setting concrete national, state;and local objectives and'strategies for tobacco controL Simultaneously, to forge an organized core of unnversallv accepted, leaders and leadership groups, as in Canada, capable of tltwelop- ing and directing coordinated'national campaigns to achieve priority policy objectives. But before we can do that, we need to deal'openly and honestl4 with both our strengths and'our current limitations. Let me begin by; offering foryour consideration~over the next few days what strategic planners call a SWOT anahsis of our m rnve- mentas it'now stands: our internal strengths. our internal weak- nesses, the new external opportunities that beckon to us. and the ttireats that shadow our best efforts. Whst are our strengths? fI come up with no less than l 1-tltey are formidable -:uid we need!to take just pride in them: l. Among mainstream tobacco control advocates, there docs exist broad consensus on the four horsemen of tobacco control policy:lD excise tax increases; 2) extending smoke-free public places; 3) curbinq,advertising,and promotion; and 4) rt.strir- tions on youthaccess: 2. The movement has broughtforth a talented and diverse lraulur- ship pool: federal and state legislators, such as the itt-mvmlx-r Tobacco Use: An American Crisis 7

-and grrowing--Congressional (i.e., House of Representa- tives) ~ Task Force on Tobacco and Health; public health advo- cates both in and outside of government; deep6y coaunitted, energetic, and effective grass roots activists, including activists Rithin the healthrvolttntaries,,researcher/activists; lobbyists and' advocacy specialists. knd we are fortunate in being able to dtaw upon ttie successes and the battle-tested expertise of our skilled Canadian col- leagues, .Vnong;these leaders, there exists a potential~eore group ca- pable of providing coherent, respected„collective direction, a goodly number of whom are convened here today. 3. In, Wastiing4ott, the tri-ageny Coalition has developed the frame- work for a national legislative program. And it has just Ikunrhed a timely and ambitious federalexcise taAinitiativearound which all of us can now mobilize. tt coordinates its state affiliates, has built good'working rela- tions with key legislators and staff;,and is nowdeveloping a capaeity for influencing the new Administration's policies. It draws suppotrt,from as many as 150 national organir.ttions. Individual.membets of the Coalition have played'lead roles in tobacco controt'campaigns, most recently the campaign to achieve smoke-free international "skies, and the eHort to force the FDA to take responsibility for regulating tobacco products. And, in convening this meeting, the members of the Coalition and the AMA have signaled thein recognition of-die need and their commitment to strengthen the cohesion and capacity of our national tobacco control movement. 4. A(S, with new leadership at ttie,top, strong mid-level leadership on tobacco control, the sweet taste of success in the Massacltu- setts ezcise tax initiativve; and a long-term commitment;to the ASSIST coalitions;,is poised to cotnmit substantiaUnew funding and new national direction and energy to tobacco controL i. The !4MA House of'®eiegates:has been in the vanguard calling for strong action ~against tobacco advertising and promotion. Key AMA leaders and staff like Ron Davis and Tom Houston and the editors of JNMA have provided strongieadershi.p, andithe AMA has begun to mobilize actively, as with its sponsorship of: the Chicago protest march against the "Joe Camel" advertising campaign. 6. From ANR to IDOC to GASP to STAT to Sinoke-Free Pennsylva- ni.a, activists, the shock troops of'tobacco control, with daunt- less detemnination; almost no money and institutional support,, but awesome energy, have been the sparkplugs of change in city after city,; state after state, throughout America. ASH, and others have forged good and mostly successful state legisUdw battles to stop or disatm miscttievous and'divetsionaty Stnok- ers" Rights,lkws. 7: The 17'state ASSIST site coalitions are gaining rapidly,in capac- ity and cohesion. Through NCI, ASSISi is providing a planning, technical support and'staffing structure for sustained policy advocacy initiatives for the five }aeus beginning in September, 1993: And,,despite the perception,of some activists, NCI and ACS'are committed to bringing,the grass roots activists into the fold. 8: The Office on Smoking and Health (OSH), with strong CDCC support, has signaled!its;readiness-to commit its resources, its convening role, and its leadership voice to achieving a national infrastructure and strategic planLplkntting process. It has new, tresources, is li.kely,to gain more. and1as a[ready beenbuilding a support system for state health department tobacco control officers. 0SH is perceived as both committed and neutral, among the players, and has shown its readiness to reach out to, previously outlying constituencies. 9. Califotnia's massive resources, learning, and!techttical support infrastructure can be draavnuponto support; national~efforts: ll0: The emergence of such organimnons as the National As.cocia- tion of AfricatrAmericans for Positive Imagery (N14WPI) and the National Coalition of Hispanic Health, and Human Services Organizations (COSSMHO) hold great promise for new, con- centrated efforts to draw critical ethnic groups into full and equal partnership in~tobacco control. 11, (With all due modesty) , the Advocacy Institute provides a generally trntsted, respected, independent core of policry profes- sional5 committed to strategic planning and coordination of' tobacco control policy advocacy, andiSCAItGNet is close to achieving optimum reach as a universal communications and technical support pillar for media and!polit.yy advocacy initia- tives. These are our strengths--that's ahe easy part.lVow the internal weaknesses. Forgive me if'I tread on toes. But this week marks my 60th biithday, and d feel both obligated and entitled ito engage in unaccustomed,truth telling: And, in truth, while we have many ablo.and talented and commit, ted leaders, that ieadership is fragmettted. The limited finaneial resources committed by both,gavemmeat and non-gpvemment, funders are, too often, mis-iinected. We still lack the structures and!capaciryforoverafl priority setting; strategieplanning„tactieal coordination, and effective communications: sperfficallr. 1. Other than the modest..HeaWty People 2000" objectives, there exists no comprehensive, authoritative national tobacco eontrol policy: 2. Amo,ng,the~federal agencies,!VQI, which earliershamed'CsDC by the boldness of its ASSIST initiative has lately weasled and waffled on its commitment to full'funding af;ASSIST. EPR drops ETS!research. The FTC has been guilty of L3Lse andimisleading protnises by failing to match with action its rhetorical commit- ment;to challonging such,bligbts,as the Joe the Camel txm, paign. FDA reacts to calls that it assume jupsdiction over tobacco products as if it had!beentossed a red hot coal! HHN gingerly omits excise taxes ftrom the Healthy People 20t10:

objectives. And OSH has yet to purits new money where its mouth is. We are still awaiting,theWhite House executive order decreeing a government-wide non-smoking policy. The Office of Trade Representative has not quite finished pushing V'irginia~ Slims advertising campaigns dovm the throats of'countries who would spare their not yErsmoking women tharblight Perhaps the good riddance of~the Quayle-Sununnu White House will remove the hidden, encumbrances to actionby these agen- cies. Perhaps. 3. In DC, the Coalition on Smoking OR Health is essentially limited to the Cancer, Lung, and Heart voluntaries. While enlisting support from other organizations, the Coalition has had limited success in forging close alliances with the rest ofthe tobacco control movement. The leaderstiip of the three major voluntar- ies have provided'the coalitionmithithe barest of staff're- sources: It'operates with onlyasmalllstaff and1 no fullltime tobacco control lobbyists, and, while the Coalition has access to other staff and volunteers, tobacco control advocacy is onlyy one of manyissues engaging the voltmtarbes and their Washing- ton offires,. At the same time, it has been the three voluntaries alone who have committed staff time and resources to federal tobacco control lobbying-which is more than can be said of'other national groups nominally committed'to tobacco control, some of whom are quick to carp atthe Coalitioni 4;14te AM'rA' has never applied its formidable lobbying resources to tobacco conmol!with anything resembling its legendaryy mobilization on health care issues. 5. While ASH's voice is loud, it!shuns alliances and its legendary fund raising capacity dwarfs its tangible contribution to tobacco control mobilization. 6. The African-Amerioan,,Iatitto-Amenicatt, women's; and labor communities are wooed!by thetobacco industry; and neglected by the tobacco control entities (exceptithe California Health Department). The ASSIST coalitions are nominally committed to such outreach, but little true diversity has yet been achieved in the working eores of these coalitions.. VAAAPf„for example, lacks any futancial or staff underpinning. 7. The Carter Center has the potentiatlto help with both strategic planning and broadened outreach;,but it lacks both human andl financial'resources; 8. Too many activists are alienated, envious, obsessed with col- umninchesenvy;,intolerant of moderate or divergent views. Tfiey are offensively self-righteous. They are chronically underfunded in proportion to their undoubted'eontribution to tangible policy achievements and are chronically resentftil. 9. As a resource center, responsive to tobacco control advocacy groups (andlits futtdets),,rather than a"Crontline" advocacyy grooup; the Advocacy Institute is only able to make indirect contributions to the movementis strategic cohesfonj A number of activists have not'too gently suggested that the funds spent to support the communications and tectytical support activities of the Institute would be far, more effetxively investedldithey were divided among the activistswho actttallywork the front lines of tobacco controL And they; may be right. (Though we hope not). (If~I're thouOtlesslyoverlooked any of you, please let me know Dm confident I can find something at least equally offensive to say about everyone here. After all, none of us are perfect orclose:) These weaknesses are the more painful as we move into a new era of opportunity-opportunity which we tnay's'imply not be ready to seize: Among these external opportunities are the following:, 1. The new Administration offers hope and promise for the emer- gence of a broader, bolder national tobacco control policy. Though hardly single-mittdedicrntsaders, the Pt,esident-elect and' Hillary Clinton have tgken both personal and policy; standss against smoking.-a sharp contrast;,fbr example, with all I earlier presidential candidates. Donna Stialah was a strong. advocate of non-smoking policies both within the IDniversityof Wisconsin and the city of'Mladisott;,Bob Reich worked on tobacco control initiatives at the Ft1C. I would be surprised if the Clinton FTC transition team has not called for aggressive action by the FTC challenging youth-oriented cigarette advertis- ing sucha5 the ' Joe Camel" campaigns. Though it should be noted that; while issues ranging,fiom AIDS to health caree reform are receiving considerable attention, no dear A'dminis- tration leader on tobacco control has yet emerged. 2. The new Congress offers hope. Changes in the tnake-up of the House Energy and Commerce Cbmmittee, the House Appro- priations Committee, and the Senate Labor and Human Re- sources Committee, among others, may advance tobacco control initiatives --especialty, if these are supported rather than resisted by the Administration. The Congressional'tobacco task force is growing,l4te Women's Caucus appears ready to embrace tobacco control on its healthpromotion agenda. And tobacco control'leaders in the House and Senate are poised to pursue a broad and ambitious tobacco control agenda. And. Jesse Helms quit smoking. 3. As the Administration's health care reform proposals take shape, two opportunities emerge; I) sentiment approaching' consensus that cigarette and'alcohol excise taxes are a pre- ferred!sounce of revenues to fund an improved system. and 2), growing interest in developing a prevention component of tlte reform package, including tobacco and alcohol control poli- cies. 4. 4lomentum grows at federal, state and'local lecel.s for cigarette excise taxes, clean indoor air policies; and effective restraints on youth access. There is less momentum, butbroad!public suppoM for restraints onadvettising and promotion. 51 Analysis of'media content and tone reveals eoactartt progress (forwhicli we do claim some modest credit) in delegitimi7ing, the tobacco enterprise;,thereby undermining its politicaf power to resist and deflect appropriate tobacco control policies. For Tobacco G/se.• An American Crisis 9

example, the furor and focus on Yernon Jondan's RJR connec- tions highlighted the negative ethical implications of all such connections. Michael Eriksen is dead right Pursuing the public shaming of all those whoare prepared to profit, even remotely,, fnom the death and'~debilitation caused by smokirtg is a primary building; block for ourefforts. We know the'main source of our external threats, the transnational tobacco companies. We may nod, but the tobacco industrn never sleeps. While their moral resources erode, their finaneial!resources are inexhaustible. And they continue to be able to buy a vast army oflobbyists, propagandists, andlawyers- among them~,aLas„otherwise worthw'community leaders and vanguard community organizations. lfianks again to the uncanny'intelligence gathering efforts of Dt}C, we now have newi;r liberated' Philip Morris internal lobbying memos to remind ius that the industry's oampaign contributions and the tobacco ties of key transition figures and nominees will be a constant threat to uninhibited tobacco control policies. But the industtyis not the onlythreat, to tobacco control progress. Ignotance-sometiines willful-among both the public andd policy makers as to the enormity of tobacco's toll petsists.lttus, competing claims on the public agenda--suclt as AfDS, illicit substance abuse, and pollutioni--are still perceived as more seriotu and more pt7essing. A third threat is complacencv-complaceney in'the face of real gains in tobacco control. What does this snapshot--these strengths, weakrtesses,,opportu- nities; threats tell us about our tasks over, the next tiiree days? Let me suggest tbat, as we addeess the range'of specific and criti- cal issues which we have assigned ourselves, that we pay heed in each meeting-and in the invaluable informal networking which links us-to our meta-needs; • With a new Administration which gives promise of'more'open: ness ao tobacco control initiatives;,we need'to revisit both "ittside'' and ..outside"'s'ttategies: what'can we realisticallyexpect fi•om an enlightened Administration, and how'ean we help make sure that what might happen does happen? When, and how should we expect to join forces with and coalesce to support OSH, NCI, the state health departments?. • When and how best can we maintain outside pt essure on gov- errtment to make sure it remains upright? • Speci6rrally; how can we combine to develop a strategic plan to achieve a+lational!Policyon Tobacco Contnol'issued and em- braced by the Ptesident? • And how can we best maintain constant vigilance over the insinttating influence of tobacco industry money, and agentF on the nascent policies of'the new Adtninistration? • How can we broadeni and strengthen existing coalitions, both at federaland stateaevels, including:, finding the'will and'the ways to open up our coalitions to true partnership and cooperation with all significant tobacco con- trol entities, allowing ample rmom for independent,,but coordi- nated initiatives led by those with the energy'and skill to move'e beyond!eoalition consensus priorities: building'bridges of'financial support and'understartding to the gcass noots activists. meeting;the needsand'eoncerns of ethnic communities and leaders in shaping the tobacco control agenda and leadership structures. • How can we help provide financial and!technical support for emerging ethnic tobacco control leadership ~networ[cs? • How can we strengthen the technical support ittfrastructure, especially strategic communications and coordination including timely intelligence on tobacco industry'strategy and tactics, coun- seling pn counter•stategies, policy guidance based upon sound research andianalysis and readv.access to key data bases? • And finally, how do we find within ourselves the internal. spiritual resources to reach outto~eaehother as,friends.and~alliesd in a great cause, transcending the self-righteousness and means ness of spirit, the pettiness and vanity, the personal and institu- tional self-interesrthat too often corrode our efforts? Coming together is our start Leaving united!is our ehallenge: iin

Tobacco Control Battles: State Legislatures The tobacco control movement has no lack of information about the issues and4bout what needs to be done to help reduce to- bacco use in this countay. Advocates need to focus on how to accomplish their goals. Because this conference is being held in Washington, D:C., the focus appears to be on the federal govem- ment, but I1would urge you to focus on the other, end of the politi- cal system„local government. New York (city and state) has achieved many recent policy victo- ries; Cigarette advertising will be banned on mass trartsili Smok- ing is banned in New York City schools. The state has banned! vending machines that are available to kids. Free distribution of cigarettes is banned. Proposals have been made to stnengthente state clean indoor air act. Enforcement procedttres have been changed fromictimiital to civil in,the youth access legislation. Parents now have the right to initiate action against retailers who sell cigarettes to their children, along with licensing,requirements for cigarette vendors, requirements for lDs for cigarette purehas- ers: An increase in the state excise tax is in the works. Tobacco control legislation is no easier to pass in New York ttian any other state, but we have had success by starting first with local government.l4tis strategy divides and dilutes the ciganette cotttpa+ nies.' ability to use their resources. It is harder for the companies to work at the local level than at the state level. A number of counties had dean indoor air legislation before the state. Local governments have been enacting their own restrictions on smok- ing in public places: When state legislators saw those actions going ahead with popular support and no damage to.the local politicians who promoted them, they became interested We worked ion the state clean indoor air law for 13 years. As localI governments moved ahead, we were able to pass our billlalmost unanimously in both houses of'the legislature: And then came other successes, especially the adolescent tobacco youth prevention act. Among the groups that helped us to get this legislation passed were local public and private agencies„loeal'components of the American Cancer Society; American Heart Association, andlAttteri{ can Lung Association, and citizen advocates. They were very effective. People in the field were wrdtingletters, visiting legisla- tors, talldttg;to the media, and questioning legislators whose votes allied them with cigarette companies. Excerpts from the Remarks of New York State Assemblvman Alexander (Pete) Grannis In particular, we organized 13'0'groups throughout the state thatt brought school children to,Atbany: Teachers had class projects that uaed the adolescent tobacco youth prevention bill js a civicss lesson. Legislators who would not notrtttalljy have been supporters of tobacco control legisiationwere a ittle intimidated when facedd with ateacher and 30 third grade students. The students asked their legislators to pledge to support the bill! When one legislator who had pledged his support to the children voted against the bill. a press release was sent to his district pointing out that he went against his pledge: Thatonly had to happen once. The next time around, that legislator supported!the bill right away. In addition to the effective tactics of'the coalition, we were helped by the pressures of an election year and the uncertainties gener- ated among legislators by reapporrtionmenu We were in a good position to persuade legislators to do what was right in 1992. Looking ahead in New York, we expect the governor to propose a cigarette tax increase. His focus will be on the revenue that the taxx will provide, but it will also advance the health agenda: The em- phasis on revenue will help force an issue that otherwLse miGht not find support in the state legislature. Again, I urge you in to consider recommendations ttiatare aimed not just at Gongress: You should have recommendations that ~ are targeted with as muchdirectness as possible on loeal lgovern- ments: ThatiS where we will win the fighu We can make a real difference by getting the tail big enough so that the dog,cannot ignore that itis being wagged. In closing, I would like to add ttiatyou should try using a little humor in fighting the tobacco companies. One year. t'decided to have an AprillFool's IDaypress release describing a state wide effort by school children to have cigarettes declared the official New York state poison. The release was dated April 11 and said it was not for immediate release. National Public Radio. AP. and some local newspapers used'the story anyway, Wtteni the press discovered;the storywas a joke, they, were not pleased. So :dter all the fuss, lUdid turn the proposal into albill. This issue got tlre public's attention when we used'a frivolous approach to a serimus isaue: Humor ean-e a useful tool in trying to get :t mes:eagee across. While the issues are serious, humor can provide a way to focus attention on the tobacco industry. Tobacco Use: An Americaa Crisis I t

Tobacco's Targets: . . . Msnorxtles and Women Good Morning Iadies and Gentlemen. I appreciate the opportunity to speak to you!today, particulanly,; beeause I feel so passionately on the subject before us. I have: been asked to speak to:the special'eoncems of women and mi- norities as.targets of tobacco marketing and the effects oPthis exploitation. The market targeting,of minorities and women is syfnptomatic of the cortuptii^e int7uence of the tobacco industry: This influence penetrates and demeans our nation's journalism„science, politics and economics. The corruption is pervasixe, and symbolizes that ~ which is worst in our sociaVeconomic system: The pernicious influence of the tobacco:industry; based onobsceae and perfectly legal profits, tells us somethirtg;important atwutthe moral char- acter of this country. In this country we condone an industry that addicts children and murders the elderly: We knowing(y accept, in the name ofcommerce, a business that afflicts the most vulner- able and defenseless members of our society. The continued sale of this addictiti~e, destructiue drug i5 made possible only by an extended and complex perversion of our public institutions. I would like to explore wjth~youbriefiy; how we continue to accept a product that appeals exclusively to chiidrenl that ravages minorities and women, and'yet enjoys the sanction of lawand protection of government. This conditionis nowhere betoer dem, onstrated than in its impact on minorities andwomea. There is no doubt{ despite claims to the contrary by the industry; that tobacco companies target women and minorities. fiis is done through massive media buys in targeted market areas and throughrthe creation of special brands like "Dakota," °Slims;' or .,L'ptown." In f.alifornia's central ci6es and r1frican-Amerncart communities, itlis not uncommon to find four of every five bill- boards a&ertising alrohol or cigarettes. Tobacco advertising,is the pnncipal support of a great many minority publications; Tobacco is the primary sponsor of women's sports and maga- zines, Hundreds of'millions of~dollars are spent onmarketing for tninorities andiwomen, and it is obvious to anyone who cares to look I think we can all stipulate thartargeted'marketing is centrall to maintaining cigarette sales: Why, do tobacco companies target minordties and women? Simply because these populations are the most vulnerable. They will, for a vamery, of complex: reasons, buy; a product that most adults rejecrout of hand. Remarks of California State Senator Diane E. Watson It!is important to keep in mind that while this product i's sold'tn adults, iC is iititiaued exdusively among childten. Marketing or advertising aimed at minorities and'womenis in fact aimediav minority, children and adolescent women. Smoking is a symbolic acufor the young.. It is most often associated with blue-collkr, urban, disaffected lifestyles. Itlis a symbol ofdefiance, indepert- dence, rebellion,,sophistication and a rejectionof traditional values, It is all these things becanse a $4 billion ~annttal media effort creates this image. Can~you imagine anyone who would be more responsive to such a message than disaffected, adolescent, urban minorities longing for an, independenridentity-oryputtg women caught up in the emotional turbulence of puberty and initiation into the adulr woridP Who eM lacks the education; discipline and experience neces- sary too ignore the ealCulated appeal'of smolang? In~trutli only one other population is as vulnerable to smoking's appeal as minority and female children. This is third world minonty popula- tions: Economically vulnerable, medically unsophisticated, and consciously longing for symbols of westenn sophistication, these foreignpopulations: provide the consumer stock for future com- merce in tobacco. The tobacco industry is fully conscious of who it has to sell to. and obviously,; targets both domestic minority and!female children as well'as unsoptiistieatedipopulations in South America andl.asia. There is no great secret here. This is common knowledge. It is familiar to all of us and i most of the woriti. itte ac+erage age of ' smoking initiation in the United States today is ~ 12 and a half ye•ars, This state of affairs is accepted onlybecause ofsmokittg s long history and'the pervasive corruption of'public institutions. 7fie results of this targeted marketing are predictable. Smoking rates are higher among,Afrocan-Americans than whites, quitting rates are lower, and age adjusted!smoking death rates are 12' percent higher for African-Americans. The average lung,cancer death rate for Afincan-Americans during the 1980's was moree than double that of whites. unong those of my heritage, there is a well established and disproportionate predisposition to heart disease, hypertension, and cancers of the lungs, cervix, thrroat;, blkdder andilddney. These ane the primary afsictioru resulting ftomitobacco use, and Afncatt-Amedcatts suffer disproportion- ately from every single one of these diseases.

.#mong the most vulnerable and susceptible of our citizens, to- . bacco ~is the single largest preventable cause of death in this nation. In this simple fact'i5 demonstrated the cruelest, mostt mercenary exploitation of 'childt en in the world today. Tlus ezploitation is sustaitted1by a far more extended corruption than the legallsale ofan addictive drug to innoeent, ehildren. This corruption, fueled by obscene profits, seeps into itbe very core of'~ our society: This corruption afflicts our government, institutions„ our community leadership, our commerce, our science and our journalism. Tobacco profits finance the co•option, of leadership within minor- ity commtutities. Millions of dollars annually are spent, to support legitimate and committed minority setvice organizations. This money buys tobacco the silent approval of many in the minority community. My office has seen tobacco memos, for example, which compared minority recipients of tobacco dollars, and the relative valite these organizations provided in the fight against California's tobacco tax. The influence of toba,cco eontributions to public officialk is well- known and widely documented. In California„where we have seriously threatened tobacco interests, we enjoythe dubious disstitttctioniof ltavittg thesingle largest individttal recipient off tobacco political contributions. One hundred and'nine of 120 California legislators receive tobacco contributions. For 15'years, this pernicious influence prevented!any significant restriction on tobacco use: For 20 years, this influence prevented anysignibcanr federal interference in tobacco consumption. This influence perverts a critical purpose of democratic gpvernment Govern- ment, is intended to protect those unable to defend themselves--- yet our, government tia* twisted this responsibility to protect the weak into tax breaks and subsidies and legal shelter for this lethall industry. The pattern of perverting the purpose of public institutions is repeated in journalism, eotnmeree and science. Several long-term studies have found a direct, negative, correla- tion between a publication's tobacco advertising revenues and coverage of.tobacca stories. During Califorttia's aggressive and: tobaccamedia advertising campaign, numerous outdoor and television advertisers refused to sell us space or time. They feared! retaliation of tobacco eompany subsidiary, advertisers. Tobacco: advertising revenue is able, on occasion, to control journalLsticc editorial!policy. Tde indttstry makes a speciafeffort to silence minority publications. Tn'btisittess, the profits of selling death to children overcomes any hesitation an investor mayfeel in helping to killthousattds. Selling cancer to third world populations is °jusrbusiness." The single most widely held'stock among institutional investors in this coun+ try is Phillip Morris. Iast'year, TYmia magazine named R:J. -- -- Reynold.s the best managed company in the ttation, Busittess claims not to make moral judgments-only business decisions. But the investors, retailers, growers, shippers and advertisers who profit~from tobaceo give moral sanction~to the avoidable death ofi thousands. The corruptive inIluence of tobacco and tobacco profits on sci- ence has gone on for a long time:llThe tobacco industry subsidizes dozens of "scientists" to grind out sympathetic studies, confusing, intetpretations;,and misleading conclusions. WhDe such studies enjoy no credibility, the industry has been icapable of disputing or preventing legitimate research on the effects of tobacco usage. k single state, California, now produces more tobacco related' research than the National Institute of Health and all majorfoun- dations combined. This means that until California.s public acted, diseases which kill 400,000 people every year received hardly any attention. These circumstances represent a profound moral failure. The influence of the tobacco industry and its corruption of our public and community institutions is tragic. We condone the addiction of chlldren and death of the elderly. Government and community leaders surrender their: integrity out of avarice and our national character turns.a:tidy profit selling legal dope to the poorest andmostdefettseless people on earth. It is easy to condemn an industry which cripples our population. Itis convenientto don a holier-than-thou attitude and!as:sume a superior attitude. Butithe blame for this circumstance falls on all of'us. It falls on the minorirycommunity for not demanding change. It falls on mycolleagues in public office who turn a deaf ear to demands for change. It falls on a business community which makes tobacco available and on our media and scientific communities who allow themselves to be used!for the monetary gaini of others:. I realize this is a sweeping condemnation. But some shock is necessary. Tobacco is such a familiar, accepted a®iction~thac we tend to forget its fearsome toll. We cannorundo the insidious and sophisticated'frattdlof generations without bold strokes: Despite this depresssing assessment, I belleve tobaeco~ase will continue to diminish in this eountry and!worldivide. The EPA's reeenneonfirmation ofthe harmful effects of second-hand smoke should unleash ~a haii lof liability claims in workplaces and public places aeross this country. F'-trtally; tobacco users tnay have to take responsibility for at least the injury they do others. In California, we have tripled the quit rate of the general public t}irough counter advertisirtg: In this Nation's cities, tobacco ase among minoriry,children has been cut in lialf; due principally to new social attitudes. We need to recognize the culpability of our social and economic institutions. We need'to hinder the practice of smoking at every turn, and we must never stop. Tobacco 1Jse: An Ainerican CriSis 113, 1

Ch alenges in Tobacco' Control Good afternoon ladies and gentlemen„colleagues,,and distin- guished guests. It is an honor to jpiit you-our eountry's top leaders in the to- bacco control movement-at this important and compelling conference. So much has happened since we last carne together at,our 1989: meeting. Because of our hard'work, we are enjoying'tnany'suc- cesses-thanks in large part, to your leadership, your vision of a healthier society; and your success in fostering,an atmosphere of collaboration and cooperaflon. Tfiis conference couldn't bave eome at a better, more opptarttute time. Whatzw}tirlwind week we have jtt.st had-a week, I assure you, that the tobacco indusrrywill not easily~forget! All of us have ~gained''a,ttremendbus;, renewed sense of confidence and!vigor by EPA's long-a+waited'endotsement: an endorsement that showed that exposure to secondhand tobac co smoke does, indeedi causes lung cancer inimmn-smoking,adults and greatly inctease of risk of respiratory, illnesses in ctlildren. It's about;time the public knew the facts and risks,,and under- stood the severe conseqttences, But most impottantly;,it aPU also about time that our government shared its concern with its citizens. The CDC's public information campaign launchediThucsd7yto: inform Americans ofthe dangers of secottdliand tobacco smoke is also a majprstep in getvng the public to think, precisely, along, these !}nes. Ttieir campaign action guide;,,'It's time to Stop Being a~Passive Y,*Lctim;"'puts prevenGon in the hands of the indi~~- vidual--where it truly belongs. Your presence here, under one roof,' during this exciting time ofi opportunities just waiting to be tapped--is very, significant, in- deed. It sends apowerful message to the industryp loud and clear, that we have had enough of the smoke and mirrors, enough of the mombo jumbo, enough of the relentless distortion of facxs into Gction. We are here, we are prepared, we mean business, and we are noqoing to take.ivanymore. As Surgeon General, the issues that lie at the heart of tobacco control'are of great concern to me-those thatpertaia to tobacco ur,e by our yputh;,the increaseinusre by womenr-pardcularby Keynote Speech Antonia C. Yovello, MD, MPH Surgeon General (;S Public Health Service young women-and the targeting of women,,childrM and mi- noritygroups by ttie industry. I have ahvays devoted a latge portion of myagRnda to.opening,the eyes of those who tnay not yet see the real hazards and risks of tobacco use. Andii assure you, as long as I am Surgeon General,l urill not Jet up: not when so much more remains to be done. Because i~feelso strong(y about ~thia subject,itii5 especia!!yre- warding to see the soiidarityshown by the presence of so many cosponsors at this conference. What'a tremendotu line ot hardhitters we have here: • '11he:AmericanfMedicalAssociation; • The Centers for Disease Control (pSH);. • The City of Hope National Medical Genter, • The Qoalition on Smoking;OR'f9ealth--madee up of the American Cancer Society, American Heart Association, and ,Anerican f.ung,Association; • The Memorial Sloan-KetteringCancerCenter;;and • The University of Texas M.D. Anderson Cancer Center:. I know that in these few critical days, we will all have a chance to renew old ties; build new relationships, and develop an even stronger proactive stance to achieve a great deal more in~the coming years. Most importantly; I hope that we cut through our respective disciplines and experiences with a sharply boned; common goal: to come away from this conference with a struegic plan of action that is iilspiPed,~ yet I£3llstic.' We are in need of a plan of action that;can,diamatically save the lives of millions of Americans--especially our youtto--by helpmg them make informed'deeisions to avoid the risks and hazards of tobacco use. We ane in need of a plan of action tbat ean speak for our younger childrett-who have rrosay and no choice regarding'exposure to, secondhand smoke -wtiose resulting health problems, ranging fmm watery eyes and rttnny rtoses to asthma and pneumonia, are not for them to inhemt-~e of an aduk's pleasure:

Let me tell you what stands out most in mymind as we cut throu gh talk and' get down to aetioo-as we really spell out what we all can do to make our goals a reality. The Chalienges Ahead I call them the.Surgeon~General's ten challenges for tobacco control„because eolleagues, the time to act is nour,,there is a generation at risk. Challenge 1 The first challenge is to use ourvoice clearly, collectively, and assertively. Let's speak in one voice to broadcast our messages loud atid clear. Messages thavsav • Smoking is the single most ~ preventable cause of death in our society -and it is costing this Nation pienty-52 billion do lars ; per year, a billion dollars per week. •'fiat tobaeeo is the only prodtict tliatwhen used'as directed- results in death ~and disability. • That it is never too late to qtd • And that prevention does, indeed,,work! But we must all get involved and1work together to prevent this needless loss of'httman life. LeCs remind the public tharwe're talking about something quite devastating: tbe prema,ttrre deat,Bs of f nearly one iralf million people euery year in this country alone. 'Dltat! s tantamount to wiping out the population of! Boston in one year, Seattle the next; vashvilleADavidson the nexq and El Paso the year after that - Or,,put another way~ the annual number of premature deaths due to smoking is equal to three fttlly-loadedijEtmbo jets crashing andi killing everyoneon boaad every single day of the year! Think about itl Half a million needless deaths -and all of them preventable. Challenge 2 The second challenge is to expose the saeductionof our children by the tobacco industry-and to work proactively to counter their effective message and techniqpes. After all; the tobacco industrti must replenish the halfmillion smokers who.die each year from smoking-reiated disease and the one million wfio quit. What beuer replacement than those;with young, impressionable minds? The sobering facts eonceming tobacco and youth speak for them- selves:: • In the US every year, over one million children start to smoke: • What this means is that ttationally, each day, 3,UC10'young'people become regular smokets-roughly equivalent to the entire student bodies of about 4 average-size middle schools all stuntirtg to smoke, each and every day. We know thazi • Ten percent of these smokers begin smoking by the fourth grade, and by the 10th grade, nearly two-thibd+ have initiatedd smoking. •:1ttd. 90 percent of smokers begin smoking before the age of 21-7.5 percentdo so before 18; the legal age to purcha.se to- bacco in mostStates. And by the time they realize it, 90 percent are hooked on nicotine: • We estimate that if 20 million of the 70 million children now living in the U.S: wiIl smoke cigarettes as adults-at least 5 ~ mil- lion of them will die of smoking-related diseases. We know from years of research that the majority oflehildren who smoke are from homes where one or both parents smoke: And that the earlier they starrsmoking, the greater theit risk of lung cancer, heart disease; chronic lUttg disease, and a wide range of other smoking-related!health conditions. • We also know thatthree in four teenagers who smoke make at least one attempt to quit-but are unsuceessfu!-underscorittg, the powerful addiction of 'nicotine. • Nevertheless, the tobacco inditstry spends a staggering E4. billion each year onicigarette advertising and promotion. And each,year, the tobacco indtrstrygarners,b22'P million in profits from illegal sales of'tobacco to children. And each year, the inditstry tells us that they advertise only to promote brand lovaltv! We know better. We know that cigarette marketing takes on a wide variety of activities and distribution of goods that appeal to our kids. Youth-0riented events, displays ausporting eventt: and the distribution of~promotional items such as T-shirrts, posters, and caps--these are typicallof such marketing schemes alll around the country. I am deeply concerned that many young people are lured to these actrviues and start smoking and using tobacco as a result of the.tiee aggressive marketing ploys:. As a Nation; I believe we are not doing our part in tobacco control' by failing to insist that the tobacco indttstry become more soctallv responsible. I recognize the power of a free market and the importance (if advertising to make suchaimarket operate successfully. IloweverI when advertisements portray a dangerous habit like smoking :rs an exciting, youttiftti, and'healthy activiry, suchadverti_sementa do not honestly represent the real.life consequences of tobacco. ~ ~. ~ h d d l b l d uate t istri e, an a vertisement, We must then reeva e ution„sa of such products ifwe are indeed to protect the public, especially ~ the health of our children. CD The "seduction of'childrert" by advertising,will always remain a0) ~,~ hotly contt oversial issue-but we cannot let that intimidatc us or W halt our'pr~ogress in developing,effective preventionprogcunsn or~ l'V in speaking our minds. kfter all, the First Amendment w;is cre:uedAi ' for all Americarts.. Tobacco Use: AhAmerican Crisis 15