Tobacco Documents Online

4 0 BLUEPRINT FOR SUCCESS ~ Aw COUNTDOWN ~ 2 0 0 0 ... © . TEN YEARS TO A TOBACCO-FREE AMERICA 1- • ( AMERICAN T CANCER SOCIE7'Y' ~ AmeTican Heart m Association w 0 t AMERI CAN ~' LUNG ASSOCIATION as S,°al People E e Christm _ Th e

• COUNTDOWN 2000 BLUEPRINT FOR SUCCESS Contents Drafting Committee i Preface iii Introduction vi Targeted Populations: Youth, Minorities, Women and the Educationally Disadvantaged 1 Tobacco Excise Taxes: Raising the Cost of Tobacco 10 Restrictions on Smoking in Public Places 16 Sources of Additional Information 22 Conference Copy September 11, 1990 I I

• COUNTDOWN 2000 BLUEFRINT FOR SUCCESS Drafting Committee . ! Charles A. LeMaistre, M.D., Chair President, University of Texas M.D. Anderson Cancer Center, Houston, Texas TARGETED POPULATIONS: YOUTH, MINORITIES, WOMEN AND THE EDUCATIONALLY DISADVANTAGED Reed V. Tuckson, M.D., Subcommittee Chair Volunteer, American Lung Association Senior Vice President for Programs, March of Dimes, White Plains, New York Former Commissioner, District of Columbia Public Health Commission, Washington, DC Scott D. Bailin, J.D., Vice President, Public Affairs and Legislative Counsel American Heart Association, Washington, DC Richard Hamburg, National Affiliate Legislative Coordinator, American Heart Association, Washington, DC Steve Largent, Communications Director, American Heart Association, Utah Affiliate, Salt Lake City, Utah Joe Patterson, Director of Public Education, Division Services, Government Relations and Special Projects, American Cancer Society, Atlanta, Georgia TOBACCO EXCISE TAXES: RAISING THE COST OF TOBACCO Mary Sandberg, Subcommittee Chair Assistant Director of Public Issues, American Cancer Society, California Division, Los Angeles, California Carl Booberg, Executive Director, American Lung Association of Virginia, Richmond, Virginia Harry Holmes, Ph.D., Director of Governmental Relations, University of Texas, M.D. Anderson Cancer Center, Houston, Texas John H. Madigan, Jr., Assistant Vice President, Public Affairs, American Cancer Society, Washington, DC t

RESTRICTIONS ON SMOKING IN PUBLIC PLACES Hon. Alexander "Pete" Grannis, Subcommittee Chair New York State Assemblyman, New York, New York Fran Du Melle, Director, Office of Government Relations, American Lung Association, Washington, DC Russell Hinz, Manager, Health Care Policy, American Lung Association/American Thoracic Society, Office of Government Relations, Washington, DC John Pinney, Corporate Health Policies Group, Washington, DC Former Executive Director, lnstitute for the Study of Smoking Behavior and Policy, Harvard University, Cambridge, Massachusetts Dorothy Stake, Volunteer, Member, National Public Issues Committee, American Cancer Society, Lennox, South Dakota ADVOCACY Patricia M. Hudgins, Ph.D., Subcommittee Chair Volunteer, American Heart Association Kirksville College of Osteopathic Medicine, Kirksville, Missouri Angela T. Mickel, Director, Tobacco-Free America Legislative Clearinghouse, Washington, DC Michael Pertschuk, Co-Director, The Advocacy Institute, Washington, DC • • • ii

• • COUNTDOWN 2000 BLUEPRINT FOR SUCCESS Preface In recent decades, the U.S. tobacco manufacturers have spent untold billions of dollars to protect and expand the sales of their addictive and deadly products. These unconscionable peddlers of destruction pose an enormous and well-financed challenge to voluntary health agencies. And yet, In the face of nearly overwhelming odds, the tide of public opinion has been turned by scientific facts and by a strong coalition of tobacco-control forces who are as creative as the tobacco marketers, and even more energetic. Having led the way in this battle during the past decade at the national level as the Coalition on Smoking Or Health, the American Cancer Society, American Heart Association and American Lung Association united as Tobacco Free America (TFA), now bring important additional resources to a growing trend evidenced in states and localities across the nation. Our course of action for the 1990s will be set at Countdown 2000, a landmark conference in Washington, DC, on September 9-11, 1990. Countdown 2000, sponsored by Tobacco-Free America and its member organizations, will develop the strategy and enhance the skills needed by state and local voluntary leaders in their pursuit of a tobacco- free America by the year 2000. Essential to the achievement of this goal is the release of this Blueprint for Success. The document is an action plan for achieving consistent nationwide policy in states and localities. It provides guidelines to address the following three major tobacco issues: 1) marketing targeted at special populations, 2) tobacco excise taxes and 3) restrictions on smoking in public places. This draft will eventually form the basis for achieving the goals we share for the year 2000. Following are summaries of recommendations for the three primary issues. tn Targeted Populations o . a~ The tobacco industry has long targeted youth, women, minorities and the educationally disadvantaged ~ u0 • through massive advertising and publicity campaigns needed to replace the thousands of consumers ~ iii

lost each year as smokers die from smoking-related illnesses or decide to kick their habit. The report of this subcommittee clearly identifies the tactics used by tobacco companies to target population groups with sophisticated market research and advertising. The subcommittee makes a number of recommendations to curb these efforts. Included are severe limitations on sales and access of tobacco products, tobacco education for children in grades K-12, tobacco-counter promotion for youth and minorities and the creation of state offices on tobacco and health. The subcommittee also proposes a modification in the Public Health Cigarette Act of 1969 to allow states to take more effective action in curbing cigarette advertising. Existing constitutional authority allows a ban on most promotional activities. This subcommittee argues that states and local entities must 'regulate what the tobacco industry has failed to do on its own." Tobacco Excise Taxes The subcommittee on tobacco excise taxes reviews well-known studies and data analyzing taxes as deterrents to smoking, particularly for young Americans who never have used tobacco. Recognizing that most revenue generated by increased tobacco excise taxes is needed by the states for general purposes, the subcommittee recommends that a portion be devoted to health care goals such as prevention, education, media campaigns and smoking cessation. A primary focus of any excise tax increase should be to apply that increase to all tobacco products. The subcommittee also recommends that the Tobacco-Free America Legislative Clearinghouse serve as a key resource center too help states increase their tobacco excise taxes. Restrictions on Smoking In Public Places The subcommittee on smoking in public places has developed a strong set of recommendations for consolidating and strengthening state and local smoking-control efforts. To achieve the Countdown 2000 goals, the subcommittee specifies the following minimum standards: smoking should be prohibited in child day care centers, on school property, in all public and private work places, In retail stores, In health care facilities and on any form of public transportation. Most other indoor areas open to the public would be smoke-free under these proposals. Restaurants would provide smoke-free space based • S IV

~ on the ratio of nonsmokers to smokers. Any state-level preemption provision must be opposed because it would preclude potentially stronger action in localities. Finally, the subcommittee opposes statutes providing civil rights protection for smokers. The Challenge Ours is not an easy task. We have a great deal more to do to assure that our nation enters the next century free from the deadly scourge of tobacco. More than 50 million Americans continue to smoke. Many young people - seduced by the allure of tobacco advertising and promotion at vulnerable points In their lives - take up the addicting habit every day. To help people stop smoking - and keep countiess others from starting - state and iocaf advocacy efforts of the ACS, AHA and ALA must be strengthened. While we have reason to celebrate our numerous victories, we cannot rest. Our strength lies not only in our resolve to preserve and promote public health, but also in our'naturai resources,' the millions of dedicated volunteers who lend their time, talents and services to our effort. ~ Our objective in releasing this Blueprint for Success is to provide a focal point for public policy action over the next ten years and beyond. Our plan requires a full commitment to tobacco-control advocacy from each organization and at all levels. Material and human resources dedicated to this effort must be increased, and the commitment of both volunteers and professional staff further encouraged, supported and rewarded. Most importantly, the journey ahead will take commitment, resources and brainpower. This conference will be a catalyst for action in that quest. - Charles A LeMaistre, M.D. ~ 0 0

Introduction The American Cancer Society, American Heart Association and American Lung Association began working together in the early 1960s to educate Americans about the serious health hazards associated with tobacco use. In 1985, the three agencies created Tobacco-Free America (TFA), and Its programs, induding the Smoke-Free Class of 2000, Tobacco-Free Schools and the Legislative Clearinghouse, to meet the following three specific goals: • to form strong state and local coalitions of the three agencies to focus the attention of legislators, regulators and other public officials, as well as the general public, on the health hazards of tobacco use and the need for enactment of tobacco-control legislation; • to foster public perception that smoking is a socially unacceptable behavior and encourage smokers to quit and young persons not to start; and • to attain a smoke-free society by the year 2000, as called for by former U.S. Surgeon General C. Everett Koop. The TFA Legislative Clearinghouse was established to help achieve TFA's goals for tobacco- control advocacy, by serving as an information bank and advisory resource to the state and local offices of the three organizations, as well as to government agencies, private citizens and corporations and the media. The Clearinghouse monitors state and local tobacco-control legislation and regulations and analyzes trends and effects of the information collected. This information is used to - • advise and assist coalitions and agencies in formulating and implementing strategies for Involvement in tobacco-control advocacy; • develop and update model guidelines, legislation and testimony for use by state and local agencies and coalitions to facilitate tobacco-control advocacy; • compile public attitude surveys, cost-benefit analyses, fact sheets and scientific studies for use by coalitions and agencies; and • educate volunteers and staff of TFA's member organizations. The work of the Clearinghouse enables the three agencies to adopt a unified approach to tobacco-control advocacy and to learn from and respond to tobacco industry tactics used across the country. If the tobacco-control movement is to achieve its public policy goals ir1 the last decade of the 20th century, the advocacy efforts of the ACS, AHA and ALA must be strengthened and better coordinated. While the economic dominance held by the tobacco industry has proved to be a significant • • • vi

• barrier in our battle for public health, it is in no way impenetrable. The strength of our organizations lies not only in our commitment to the preservation and promotion of public health, but ~uso In the over 5 million persons who volunteer their services. Currently, one may question whether our grassroots are not merely Astroturf, an artificial roster of volunteers who may or may not respond to a call for action. We are most effective when we have a core group of dedicated advocates who will act on a moment's notice. In the wake of major tobacco- control victories, such as the passage of the New York State Clean Indoor Air Act and the overwhelming approval by California voters of Proposition 99, the ballot initiative that Increased the state cigarette excise tax by 25 cents, there have also been setbacks. For instance, Colorado, Kentucky, Oregon, Tennessee and Virginia enacted anti-discrimination protections for smokers by prohibiting employers from establishing as a condition of employment that employees and prospective employees must be nonsmokers; thus, putting smokers into a"protected" class. In addition, several states have adopted restrictions on smoking in public places that prevent localities from enacting further restrictions. These regressions, when viewed from a global perspective, signify a negative trend for the tobacco-control movement that began in the late 1980s, in spite of the great progress made during the bulk of that ~ decade. Our ability to organize, energize and mobilize our vast base of dedicated volunteers to affect public policy will determine our degree of success in the 1990s. Our objective in setting into motion this national 'plan of action' is for states and localities to use public policy to the fullest extent over the next ten years, and beyond, to achieve a tobacco-free society. This plan may be illusory without total commitment to tobacco-control advocacy from each organization, at all levels. To be successful in our campaign, the ACS, AHA and ALA must adopt tobacco-control advocacy as a major organizational priority and act accordingly. Public policy can have an enormous Impact on our efforts to eradicate the diseases upon which our organizations where founded. We must transcend turf battles, institutional rivalries, bureaucratic resistances and Intra- institutional inertia in the common pursuit of the overriding public goal. The movement needs both professional advocacy resources and dedicated, trained, empowered volunteers. To accomplish these goals, we need mutual commitment and support at the local, state and national levels; a coordinated strategic plan; Interactive communications networks; and advocacy training and skills building. Ln 0 To provide the necessary support and assistance to achieve the objectives in the Blueprint for ~ co Vii Y Q N

Success, two management goals must be adopted to reaffirm commitment to public policy advocacy for tobacco-control and to continuing and expanding the TFA Legislative Clearinghouse as a resource for the respective ACS, AHA and ALA field organizations. GOAL #1: Acceptance and affirmation that public policy advocacy Is absolutely essential to fulfill the mission of health promotion and disease prevention through tobacco- control regulation stated by the American Cancer Society, American Heart Association and American Lung Association. • National, state and local boards should adopt tobacco-control advocacy as a priority. This action requires the education of volunteer boards as to the efficacy of tobacco-control advocacy as a way to achieve the overall mission of our respective organizations. • Staff and resources of national, state and local agencies must be dedicated to the political education, recruitment, confidence-building and institutional recognition of their volunteer members who advocate tobacco-control policies at each level of government. . Tobacco-control advocacy committees must be organized, or strengthened, at all levels to reflect a clear priority within the organizations. • Staff positions of experienced government relations/public affairs professionals must be created at the state level. • State and local coalitions must be organized or strengthened with the following: added human and financial resources; aggressive outreach to new and potential alliances. We must reach out to and enlist in our quest other sectors that have a vested interest In tobacco reguiations,-such as: Consumer groups Environmental groups Minority groups Older Americans Women's groups Educational groups Civic and community organizations State and local governments Youth groups Non-tobacco related businesses Unions Health professionals' groups Smokers for tobacco-control Religious organizations Unlikely allies Other professional associations Political parties Sports organizations Celebrities Arts and cultural organizations Insurance companies Victims professional advocacy personnel; and strategic planning and communications capability. Y ~ (0 F- Q W viii

• • GOAL #2: The Tobacco-Free America Legislative Clearinghouse wiii continue to provide tts services to the field to assist in the achievement of the goals that are essential to attaining the objectives of the Countdown 2000 Blueprint for Success. • Develop a national, uniform, multi-tiered, interactive communications and distribution network in conjunction with the ACS, AHA, ALA national government relations/public affairs offices and other systems whose design is consistent with the goals articulated in the Blueprint for Success. • Provide strategic planning counseling support services that Includes a team of experts in tobacco-control strategies, similar to a SWAT team, who are available to travel to states and localities that require immediate strategic support to kill or pass a measure. • Provide training for staff and volunteers in tobacco-control advocacy skills, lobbying techniques, media relations and coalition management. • Develop resource materials, including policy research and guidebooks. Compile case studies that provide detailed accounts of major tobacco-control campaigns - successes and failures - and lessons learned from those campaigns that may be applied elsewhere; efficacy studies of existing laws. ix

• • Targeted Populations: Youth, Minorities, Women and the Educationally Disadvantaged GOAL: It is a primary goal of Tobacco-Free America to decrease or deter consumption of tobacco products by groups of individuals targeted by the tobacco industry. RATIONALE: Tobacco use by youth, minorities, women and the educatfonaify disadvantaged continues at higher rates than other segments of the population. The tobacco industry has long targeted youth, minorities, women and the educationally disadvantaged with advertising campaigns. The industry spends massive amounts of money to sponsor community and sporting events traditionally attended by these target groups. And, the industry places Its tobacco advertisements in locations that will maximize exposure to these specific groups. In fact, the media has featured many examples of such targeted 'philanthropy and promotion. In April 1990, the Washington Post reported that RJR Nabisco contributed $30 million for 'innovative education programs" to schools across the country, including $1.2 million to two schools In Washington, DC. At around the same time, Philip Morris contributed $1 million to District of Columbia public schools. An Arlington, Virginia woman wrote the following to the Post: The companies are desperate to develop new clients, since so many of their old ones have either quit or died young. This is only the latest in a series of calculated efforts to lure youngsters to smoke through careful public image building. Added a District of Columbia man, That's a great ethics lesson the District [of Columbia] has presented to the young men and women in the Nation's capital city: take the money and run, regardless of the source or the strings attached. [If] Philip Morris really wanted to promote good health for the kids of Washington, it should have removed every sign and symbol of smoking - and any mention of its name - from its contribution and the programs that that contribution would fund. Reed V. Tuckson, M.D., former Commissioner of Public Health for the District of Columbia asks, Where do the cigarette companies go to find these new recruits for the death march to the land of profit and greed? To get not only to the children, but also the other vulnerable and oppressed segments of our country. They go to the people of color, to women and to the poor.... The tobacco industry is subjugating people of color through disease. in the spring of 1890, a black minister, the Rev. Calvin 0. Butts, pastor of the Abyssinian Baptist • Church in New York City, became so upset with cigarette advertisements In nearby neighborhoods that he whitewashed billboards containing liquor and cigarette advertisements.targeted at blacks. Said Reverend Butts, 'fhe prevalence of alcohol and cigarette advertisements in...America's inner cities 1

manifests the elastic ruthlessness of these companies' greed and proclivity to exploit the poor and disenfranchised peopie.' Facts & Figures Much of the concern for Industry targeting is tied to the increased rate of tobacco-related mortality and morbidity in certain segments of the population. For example, black men experience a 20 percent higher mortality rate from heart disease and 58 percent higher incidence of lung cancer than white men. Black women have a 50 percent higher mortality rate from heart disease than white women. Overall, blacks are 1.32 times more likely to die from malignant neoplasms, including lung cancer. They are 1.34 times more likely to die from diseases of the heart. Inexorably tied to these statistics is tobacco prevalence data. Prevalence differs when factored for race, sex and level of education. According to the National Health Interview Surveys, 28.8 percent of whites as opposed to 34 percent of blacks continued to smoke in 1987. Other studies show that Hispanic men smoke at even higher rates, as high as 40 percent. Although smaller percentages of women than men smoke (26.8 percent vs. 31.7 percent), the overall decline has been four times greater for maies over a 20-year period. By educational level, tobacco use is almost double for those with no more than a high school education when compared with college graduates. For blue collar and white collar workers, the prevalence disparity is 39.7 percent to 27.5 percent, respectively. Further, according to the Final Report of the 1989 Tobacco Use in America Conference - There also appear to be specific cigarette brand purchasing patterns within minority populations. Of those who smoke, 47 percent of Mexican-American men smoke Marlboro and 20 percent Winston; 30 percent of Mexican-American women smoke Marlboro, 20 percent Winston and 16 percent Salem. Use of menthol cigarettes Is very common among blacks, with 76 percent reporting that they smoke that type of cigarette. Such purchasing patterns are a result, in large part, of continued tobacco industry targeting of these groups. Early in 1990, R.J. Reynoids introduced a new product, called Uptown, clearly targeted to blacks. Said Secretary of Health and Human Services Louis W. Sullivan, M.D.,''At a time when our people desperately need the message of health promotion, Uptown's message is more disease, more suffering and more death.' cn 0 j rn ~ 0) 2

0- The test marketing of Uptown in Philadelphia was stopped only after a public uproar was led by a coalition of more than 40 groups and given greater credence by Sullivan's comments. While addressing a press conference in February 1990, Sullivan said - It is frightening to realize that studies have found that the younger the age at which one begins to smoke, the more likely that a person will become a long-term smoker and develop smoking-related diseases. In fact, 90 percent of smokers begin a cigarette addiction as children or adolescents. Advertisers [must] shun the temptation of this tainted money, stained by addiction, disease and death. Finally I call upon smokers and potential smokers - Including young people, women, minorities and blue-collar workers - to exercise good judgement and personal responsibility. The life you save may not only be your own but also the life of someone you love or maybe don't even know, who might passively breathe the deadly tobacco fumes. Tobacco Promotion In February 1990, R.J. Reynolds caused an uproar when the public learned that a new brand, Dakota, would be test marketed to young, poorly educated white women described by the cigarette manufacturer as 'virile femaies.' The preferred Dakota smoker was described by R.J. Reynolds as 'a woman with no education beyond high school, whose favorite television roles are 'Roseanne' and ~ evening soap opera 'bitches' and whose chief aspiration is to get married in her early 20s and spend her free time 'with her boyfriend doing whatever he is doing.'" The Women VS. Smoking Network, a coalition of women's groups based in Washington, DC, noted the parallels between Dakota and Uptown. According to a director of the group, Anne Marie O'Keefe, 'When you target for marketing you target for death." Tobacco industry product manipulation has included promotional efforts such as the marketing of the ill-fated 'smokeless cigarette," Premier, in 1988. The cigarette was advertised as providing The Cleaner Smoke.' Under intense public pressure, led by the Coalition on Smoking OR Health and other pro-health groups, the product was pulled off the market in late 1988. The Coalition had previously petitioned the Food and Drug Administration to investigate low-tar cigarettes, including Premier, in an attempt to expose their use as a drug delivery system. The Coalition argued that the tobacco companies' advertising was tantamount to a health claim. Tobacco companies frequently sponsor sporting events, Including bowling, skiing, speedboat racing, truck and tractor pulls, fishing, tennis (Virginia Slims circuit), stock car racing (Winston Cup), i soccer (Marlboro Cup) and horse racing (Marlboro Stakes). Although tobacco advertising is prohibited 3

on television, the strategic placement of tobacco product ads in baseball stadiums, hockey rinks and other sporting venues is quite visible when American families (and their children) watch TV. in early 1990, USA Today reported that tobacco company sponsorship of sports and culturai events amounted to $150 million in 1989, with about 70 percent spent on sports. Dr. Alan Blum, of Doctors Ought to Care, an outspoken critic of the tobacco industry and its advertising and promotional strategies, states, "You watch an auto race and you see cars going around tracks with cigarette logos. You watch tennis and you see the logos in the background. Truth is good, but juxtaposition Is better.' ~ States Joe Chemer, president of Smoke-Free Educational Services in New York City, 't have found that the average sixth-grade giri actually thinks women tennis players smoke. Jennifer Capriati plays Virginia Slims [tournamentsJ at 13 [years of age]. That means she is not old enough to smoke but she is old enough to be a walking billboard for a cigarette company." A recent Winston advertisement included a'900" number to call for sports scores. The brand was advertised as 'Your ticket to the best in sports.' Tuckson says, "The tobacco industry seeks to gain 'innocence by associaiion' through sponsorship of events. They attempt to make cigarette brand names synonymous with community events like the Ebony Fashion Fair, the Kool Jazz Festivals and Salsa Festivals In the Latino communiry.' Helen Munoz, of the National Coalition of Hispanic Health and Human Services Organizations, sheds further light on the subject. "Perhaps most disturbing of all.' she says, 'a study of 4th and 5th graders in Los Angeles revealed that Hispanic boys and girls are more likely to say they used cigarettes (than their non-Hispanic counterparts) and that Hispanic boys were six times as likely as their non- Hispanic white counterparts to be smokers.' Using such practices, the tobacco industry regularly violates its own 'woiuntary advertising and sampling code.' The code prohibits advertisements and sampling practices aimed at persons under the age of 21. For example, the industry also has resorted to 'couponing,' whereby cigarette smokers can send in coupons to redeem 'prizes' ranging from additional packages of cigarettes to compact discs. A recent giveaway promised a free pack of Alpine cigarettes. The only protection against minors participating was a disclaimer on the advertisement that "by accepting this offer you certify that you are a cn 0 -s m Y • 4

. smoker 21 years of age or oider.' R.J. Reynolds sponsored a'Millionaire Cash Quiz Game' whereby contestants were urged to submit ten or more correctly answered game tickets in order to win $2. The more packs smoked, the more money you could win. The industry also targets the economically disadvantaged and the young through the marketing of generic products. This sector of the market has risen dramatically in recent years and now holds a substantial market share. The tobacco industry also targets these groups with promotional giveaways of items such as hats, T-shirts and sporting equipment. These items are often distributed at areas of high concentrations of youth, such as sporting events, rock concerts and public beaches. Access & Distribution Most cigarette vending machines remain unsupervised, inviting purchase by youth. Free samples are distributed on street comers and at athletic and music events well-attended by those under 18 years of age. + By mid-1990, 45 states had minimum-age laws for the purchase of cigarettes. Yet, enforcement ' of these laws Is a serious problem. Most current licensing laws do not address the Issue of enforcing the minimum age for purchasing tobacco products. Officer Bruce R. Talbot of the Woodridge (IL) Police Department, testifying before Congress lri April 1990, described a new law passed in his hometown. He said he had - received complaints from teachers, parents and even the students themselves that Woodridge merchants are selling cigarettes to minors. On one occasion, a gym teacher observed a 13-year-old female student purchase a pack of Mariboros from a Mobil gasoline station just two blocks from the school. Woodridge...has reduced tobacco sales to minors from 83 percent to zero. But without this legislation our local efforts may have been for naught because the merchants whose stores border Woodridge continue to sell cigarettes to 13-year-old children 94 percent of the time. Philanthropy In 1989, the tobacco industry contributed millions of dollars to the National Archives to help promote the 200th anniversary of the Bill of Rights. This action placed the Philip Morris name on millions of television sets for the first time since tobacco advertising was banned on television nearly 20 years ago. The ~ Coalition on Smoking OR Health called the campaign -- 5

a corporate image advertising blitz that was cleverly designed to wrap the tobacco company and, by implication, its marketing practices in the American flag and the first ten amendments to the United States Constitution.... The so-called bill of rights campaign is not about freedom or good corporate citizenship. It Is intended to further the cigarette company's goal of continuing to market its products to children, minorities, women and blue-collar workers.... Tuckson points out that Philip Morris gave $2.4 million to the local chapters of 180 black, hispanic and women's groups in 1987. Says Tuckson, 'fhe United Negro College Fund received $267,000 from R.J. Reynolds, $120,000 from Philip Morris and $32,000 from Brown and Williamson. So they are telling the 18-year-olds going to college, 'We gave you all the money for your education, so you owe us access to your markets." Countdown 2000 Legislative & Regulatory Objectives Access to and Distribution of Tobacco Products Although the tobacco industry has developed its own 'Code of Cigarette Sampling Practices,' which details certain standards to be observed to avoid distributing cigarette samples to under-age children, reports of random spot-checking of sampling and distribution points prove that such restrictions are not being observed. Trials observing minors attempting to purchase cigarettes In Boston, MA, Baltimore, MD, Allentown, PA, Decatur, IL, Brookline, MA, Worcester, MA, New Brunswick, NJ and many other cities found that minors were able to purchase tobacco products more than 70 percent of the time. Countdown 2000 Objective: Achieve a ban on cigarette and tobacco product vending machines. As interim objectives, the following measures are acceptable public policy: • a ban on unsupervised vending machines and/or • a ban on multi-use vending machines. Note: Any state law enacted to limit access to tobacco product vending machines must also clearly recognize that the mere posting of signs is ineffective in deterring access by minors to tobacco products sold via vending machines. Additional Countdown 2000 objectives Include the following: • establish, as the standard, a minimum purchase age for tobacco products of 18 years of age; • adequate and meaningful penalties should be set for both retailer and minors; • require the licensing of retailers comparable to the licenses issued for the sale of alcoholic beverages. The use of the licensing fee could be applied toward the costs of enforcement and public education activity; 0 • . 6

• • ban the distribution of free or discounted samples; and • prohibit, via the mail system, access to tobacco products. Critical to any law that adequately addresses the problems of access to and distribution of tobacco products to young people is the enforcement of such laws and regulations. Careful attention must be paid to - • provision of adequate resources to state and local agencies charged with enforcement responsibilities, • authority to conduct random monitoring of restrictions on access and distribution of tobacco products to minors, and . • establishment of mechanisms to faciitate the reporting of citizen or other complaints to a designated office or department concerning violation of laws that restrict or prohibit the sale and/or distribution of tobacco products to minors. inspection responsibilities should be clearly delegated to such designated offices. Advertisina To curb advertising abuses by the tobacco industry, TFA recommends as a Countdown 2000 objective, enactment of state and local bans on advertising to the fullest extent permitted by the U.S. Constitution and not In violation of federal preemption law (Public Health Cigarette Act of 1969). Countdown 2000 Objective: As allowed by the U.S. Constitution and federal law, ban the advertising of tobacco products within each state. Specific objectives could be - • a ban on all billboard advertising and advertising on other public visual displays (scoreboards, etc.); • a ban on all advertising within state supported mass transit systems; and • a ban on all advertising in intrastate media. Note: There Is considerable case law distinguishing the power of the federal government under the Commerce Clause of the U.S. Constitution from the powers of the states over intrastate commerce. There is even a Supreme Court decision upholding a state's right to regulate billboard advertising. However, the federal preemption clause applies to advertising that addresses the relationship between smoking and health. Therefore, bans on billboard advertising must be Inclusive of all advertising. Promotion There is growing dependence by the tobacco industry on promotional activity to secure new smokers. This is especially true for youth, minorities, women and the educationally disadvantaged. 7

Countdown 2000 Objective: Ban tobacco product promotion to the fullest extent permitted by the U.S. Constitution, Including but not limited to product manipulation, sponsorship, pricing, give- aways (i.e.: T shirts, hats, etc.), coupons and product placement. An added objective could be - • funds raised through tobacco product excise taxes should be earmarked to support alternative sponsorship of community-related activities. Other Policy Considerations Much can be done through grassroots efforts to decrease or deter the consumption of tobacco products by youth. In the area of education and empowerment, TFA recommends that grassroots advocates consider the following additional activity: • network with the non-health based institutions (religious groups, youth clubs, social organizations and community groups) to foster education, and to ensure promotion of self- esteem; • seek mandatory comprehensive school education programs (K-12) that Include tobacco education, emphasizing that tobacco is an addictive gateway drug and that the tobacco Industry deliberately advertises and promotes cigarettes in ways that lure youth Into becoming addicted to their products; and • promote and encourage funding for counter-advertising and counter-promotion aimed at youth. For minorities, TFA has the following additional goals: • Increase the cultural and language relevancy of educational messages, and . Increase state funding for minority health programs to support programs to prevent tobacco use and to address tobacco use cessation. As a final action, TFA recommends support of applicable sections of federal legislation that would - . provide grants to states for activities that will prevent the initial use of tobacco products by minors, • encourage the cessation of the use of tobacco products among youth through prohibitions on the sale of tobacco products to minors, . improve the enforcement of existing provisions, • prohibit the sale of tobacco products in vending machines unless the presence of minors is not allowed on the premises where the machine is located, • promote and enforce a minimum age of at least 18 for the purchase of tobacco products, • enhance the ability of state health departments to implement comprehensive planning and Intervention activities for anti-tobacco use, and • provide education and training to teachers and health care professionals. . • • 8

• Conclusion As stated in the Final Report of the Tobacco Use in America Conference, held in Houston in January 1989 - Studies have shown a relationship between media dependence on tobacco advertising revenue and coverage of smoking and health topics. Tobacco sponsorship of organizations and events appear to discourage those organizations from speaking out and educating their constituents about smoking and health. Cigarette advertising and promotion also seem to affect and/or promote an atmosphere in which tobacco use is legitimate, even wholesome, and certainly acceptable.' We are dealing with an industry whose voluntary code states that 'cigarette advertising shall not suggest that smoking is essential to social prominence, distinction, success or sexual attraction.' State and local public policy makers must work within their constitutional and federal legislative constraints to regulate what the tobacco industry has obviously failed to do on its own. cn 0 ~ ~ ~ • (0 ~ . ~ U3 9

Tobacco Excise Taxes: Raising the Cost of Tobacco GOAL: To Increase, at a substantial rate, the existing state and local excise taxes on all tobacco products to deter consumption, especially among young people. RATIONALE: Sixty percent of current smokers start by age 14, 90 percent by age 19. Research Indicates that teenagers are more price-responsive and use less tobacco when the price increases. Tobacco was one of the first goods taxed in North America, initially by the British and then by the newly independent Republic In the early 1790s. The early tax on snuff was eliminated in 1804 and revived briefly as a wartime measure in 1814. Various federal tobacco taxes were imposed In 1864, Including a tax on cigarettes, as part of a package of taxes to finance the Civii War. In one form or another, federal excise taxes on tobacco have remained a part of the tax system. The tax on tobacca was a particularly important source of revenue to the federal government prior to enactment of the Income tax in 1913. The federal tax on cigarettes over the 120-year period from 1864-1983 tended to fluctuate with the revenue requirements of the government, corresponding to alternating periods of war and peace. The federal tax on cigarettes, introduced during the Civil War, was raised briefly during the Spanish American war, and again during World Wars I and II. During the Korean War, the federal excise tax was Increased from seven to eight cents per pack. It remained at this level for more than three decades, and was then temporarily doubled to 16 cents a pack as part of the Tax Equity and Fiscal Responsibility Act of 1982. After several temporary extensions, Congress made the 16-cent rate permanent In 1986. A federal excise tax on smokeless tobacco was levied by the Omnibus Budget Reconciliation Act of 1985. In 1987, federal tobacco taxes grossed $4.8 billion, with more than 98 percent of revenues provided by the tax on cigarettes. But cigarette excise taxes have contributed a declining share of total federal revenue since World War 11. Moreover, the federal excise tax has declined In real terms since 1964, despite rising concern about the adverse health effects of smoking that followed release of the 1964 Surgeon General's Report and adoption of specific federal tobacco-control policies. One reason for the decline was the lack of legislated increases in the tax rate. Inflation also eroded the real excise tax because these taxes tend to be unit rather than ad valorem taxes. A unit tax is a constant nominal rate per unit of a well-defined product, whereas the ad valorem tax is a constant fraction of either wholesale or retail price. Current federal taxes on cigarettes, • • 10

S cigarette paper and tubes, smokeless and smoking tobacco, and small cigars, as well as most state and local taxes on cigarettes, are unit taxes. Federal taxes on large cigars and most state taxes on non- cigarette tobacco products are ad valorem taxes. Cigarette taxes fall relative to the price of cigarettes when cigarette taxes are not changed by at least as much as the rate of general inflation or the rate of Increase In cigarette prices. Price Elasticity & Demand for Tobacco Products One of the first principles learned in Economics 101 Is the law of downward sloping demand, that Is, the demand for a product declines as the price increases. Many studies have shown that this theory holds for tobacco products, especially cigarettes. Several studies have been conducted to measure the reliability of teenage elasticity. The General Accounting Office (GAO), in a June 1989 study, concluded that teenage smokers do respond substantially to changes in cigarette prices. The GAO report indicates that the range of estimates for teenage elasticity (ages 12-17) vary from -0.76 to -1.2. Thus, a 10 percent increase in cigarette prices will result in a decrease in teenage smoking from 7.6 percent to 12 percent. 0 In 1988 the National Institute on Drug Abuse indicated that 18 percent of high school seniors (aged 17 and 18) smoked. If you determine that you want to cut this rate in half, or 9 percent, a 10 percent tax increase should accomplish your goal since such an Increase will cut consumption anywhere from 7.6 percent to 12 percent. Should you determine that you want to eliminate smoking by high school seniors, according to the elasticity model, an increase of 20 percent or more would be necessary. Health Impact of Tobacco Excise Taxes: A Look at the Debate Kenneth Warner, Ph.D., contends in his article, "Heaith and Economic Implications of a Tobacco-Free Society,' that the arguments of both the tobacco industry and tobacco-control activists are fundamentally flawed, or miss the point. Warner believes that the economic tmpact of a tobacco-free society would be modest and of far less consequence than the principal implication: a significantly enriched 'quality and quantity of life.` The Warner article, which appeared in the Journal of the American Medical Association In « October 1987, clearly states that the use of cigarettes causes more premature deaths than AIDS, use of 11

heroin, cocaine and alcohol, fire, automobile accidents, homicides and suicides combined. Attainment of a tobacco-free society by the year 2000 would eliminate 350,000 premature deaths; those persons spared a tobacco-related death could add 15 years to their lives. Warner implies that altering the causes of death in the country will reduce the burdens on health care facilities and shift medical specialties to other disease areas. He is concerned that the tobacco industry cries that the demise of the tobacco Industry will ruin the U.S. economy, while tobacco-control activists falsely suggest a multi-biilion dollar fiscal dividend. Both are wrong, according to Warner. While some in the voluntary health agencies concerned with tobacco might argue with Wamer's characterization of the debate, we must not lose sight of our goal, which is to Increase the excise tax on tobacco products to deter consumption of these deadly products. How the additional revenues are spent by our political leaders is their decision. Although we may be asked to comment on the use of those funds, our interest is the public's health. Policy Considerations Public policy considerations entrenched in this debate include the following: • How much do you raise the tobacco excise tax at the state and local level? How does the federal tobacco excise tax effect state and local taxes? What are the benefits of switching from a specific unit tax to an ad valorem tax? • Do we support efforts to earmark or dedicate a portion of the increase In tobacco taxes for education programs or related health care costs? • How do you counter bootlegging/smuggling arguments? • How do you accomplish raising the tobacco excise tax - legislative process or through Initiative and referendum? Countdown 2000 Legislative & Regulatory Objectives Tobacco Excise Taxes Selecting the appropriate level for a state tobacco excise tax compliments the legislative activity suggested In the previous section, Targeted Populations: Youth, Minorities, Women and the Educationally Disadvantaged, by adding a further tool to the arsenal available to deter young people and other targeted populations from taking up the addictive habit of tobacco use. • 12

• State officials continue to be concerned that an increase in tobacco excise taxes at the federal level would adversely affect their own revenues. Studies show that this has not happened, primarily because some states increased their excise taxes at the same time as the federal government. Countdown 2000 Objective: Achieve an increase in the state and/or local tobacco excise tax sufficient to deter tobacco use by young people. There are a variety of strategy options available to determine the appropriate level of increase for a state or local tobacco excise tax, including: • Strategy Option 1: Level of Taxation With the exception of Hawaii, ail federal, state and local tobacco excise taxes are specific unit taxes, that is a specific set amount per pack of cigarettes. This formula Is used because of its administrative simplicity. Yet the negative effect Is that real revenue tends to decline with inflation. Unit excise taxes must be raised periodically if real revenues and the impact on consumption are to be maintained. An option for consideration Is replacing the unit excise tax with an equivalent yield ad va/orem tax, which is a constant fraction of either retail or wholesale price. Another option is to index the unit tax to changes in either the general price level or to a price index for cigarettes and other tobacco products. • A final option is to consider use of the teenage elasticity figures (-0.76 to -1.2) to compute the tax increase for your state or locality. Other Issues to consider when determining the level of taxation include the tax level in neighboring states or localities, date of last increase and tax level on other tobacco products if only a cigarette tax increase is under consideration. • Strategy Option 2: Earmarking An excise tax increase may be justified based on the fact that a higher cost for the product may be a deterrent to a practice--tobacco use-that has an undesirable health consequence. Thus, new revenues may be earmarked to various public need Including the costs of health care, public and/or school education, or counter- advertising and promotion measures. • Strategy Option 3: Bootlegging and Smuggling The possibilities of bootlegging and smuggling are often used as objections to raising tobacco excise taxes. Officials are concerned about losing revenues to neighboring states or localities. Such problems can be resolved by raising the level of taxation to meet or surpass the rate in surrounding areas. • • Strategy Option 4: The Legislative Process vs. An Initiative or Referendum State excise taxes can be legislated by governmental jurisdictions or by citizen petition. The lobbying efforts of tobacco companies frequently make it difficult to increase state 13

excise taxes on tobacco products by the state legislature. In these circumstances, the iniilative process has proven to be an effective vehicle for change In those states that allow initiatives or referendum. Undertaking the initiative/referendum process requires an abundance of resources, both human and financial. To be successful, proponents need a strategic polfticat/media plan to deal with this high stakes process and the well-financed tobacco industry. Only 25 states allow initiatives and referendum. The table on the following page provides Information on each state's requirements. • Strategy Option 5: Exemption Clauses In many states, tobacco products are exempt from state or local sales tax. Consider the removal of any exemption clauses, If your state has such language in its taxation code. Conciusion From a public health policy perspective, a primary focus of the excise tax increase on L11 tobacco products is the deterrence of smoking. Since the tax increase also will generate substantial income, each state will need to establish guidelines on how to use that revenue. Support for new tobacco excise taxes can be expected from various interest groups with sometimes differing perspectives on government funding priorities. Consequentiy, It Is Important to bring together early in the campaign process those whose perspectives should be reconciled to assure a successful outcome. As states begin to Implement the Countdown 2000 Blueprint for Success, the Tobacco-Free America Legislative Clearinghouse will play an extremely important role. It is essential that the Clearinghouse be considered the primary resource center in any coordinated effort to secure new excise taxes on tobacco products. 0 • 14

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Restrictions on Smoking in Public Places GOAL: To protect public health, exposure to environmental tobacco smoke should be eliminated. RATIONALE: Establishment of public indoor smoking control laws will protect public health by effectively reducing invoiuntary exposure to environmental tobacco smoke. According to the U.S. Surgeon General, as many as 5,000 nonsmokers die each year of diseases caused by inhaling smoke released Into the air by tobacco products. Environmental tobacco smoke (ETS) Is second only to asbestos in causing more deaths than all other known airborne pollutants combined. While much is known about the adverse health consequences of tobacco use by smokers, recent reports also show a clear health danger to nonsmokers. As a result, public policy debate by local, state and federal lawmakers has focused on protecting nonsmokers from ETS. According to the 1990 Tobacco Free America Legislative Clearinghouse report, State Legislated Actions on Tobacco Issues, '45 states and the District of Columbia restrict smoking In some manner in public places.' These laws, coupled with those at the local level, range from simple (banning smoking on school buses while they operate) to comprehensive (restricting smoking in most public places, including restaurants and all work places). While there has been a dramatic proliferation of smoking control laws over the past three years, the policy debates that have erupted in local and state legislative chambers hav6 proved that the tobacco industry has raised the stakes by abandoning the political strategy of opposing all smoking control laws to pushing for laws that preempt local action and classify smokers as a protected class. Across the country, the tobacco industry is working to consolidate its power in the statehouse. State legislatures provide a forum more conducive to working through political process, including campaign contributions, well-placed and well-respected highly paid lobbyists and legislative maneuvers controlled by Institutionalized power brokers. The tobacco industry is in a damage control mode on smoking control laws and would prefer to use the state political system where citizens have less access to lawmakers, as opposed to localities where public opinion generates policy change more rapidly. To effectively counter this strategy, public health advocates need to wQrk for public indoor smoking control laws that adhere to the highest public health standards - standards that meet the daunting health risk posed by tobacco use and exposure to others' tobacco use. To meet this challenge, it is vital that public health advocates establish firm public policy Cn 0 ~ t3~ Y (0 Y N 0 • • • 16

S positions that define basic goals and establish the parameters for negotiation strategies. While the political climate in a given legislative body may not be conducive to achieving all of the goals articulated in this Blueprint for Success, it is crucial for smoking-control advocates to secure restrictions on smoking in child care facilities, educational institutions and the work place. These are absolutes. Other provisions in public Indoor smoking-control laws may be used as points of negotiation, leverage to ensure inciusion of the priority affecting children and occupational protection. Countdown 2000 Legislative & Regulatory Objectives Restrictions on Smoking In Pubiic Piaces Restrictions on smoking in public places remain a keystone in the overall challenge to achieve a tobacco-free society. To accomplish the public health goals inherent in this arena, TFA recommends that a series of provisions be adopted to provide uniform protections for the nonsmoker. Priority emphasis should be placed on achieving restrictions that provide protection for children and the adult workforce. Protection of children is not only a public health imperative but Is essential to set a healthful ~ example that could prevent children from becoming addicted to tobacco later In life. The latter requires restrictions on the use of tobacco products by teachers and other school personnel while on school property. The work place is targeted for priority action because working adults spend a significant portion of their waking hours-eight or more hours per day, five days per week-at work. Daily exposure to tobacco smoke poses an unnecessary health risk and therefore; elimination of tobacco smoke exposure becomes another critical public health goal that should lead to increased productivity, decreased employee health problems and a safer work environment. Countdown 2000 Objective: Enact a comprehensive Clean Indoor Air statute to ensure elimination of exposure to environmental tobacco smoke. • Comprehensive statutes should inciude the following provisions: A prohibition on smoking in all child care facilities, including any portion of a facility ~ whose purpose is the care and/or pre-school education of children. r 0) N N 17

Note: Regulatory Initiatives may be appropriate to achieve this objective by accessing the jurisdiction of day care licensing agencies. • A prohibition on smoking on school property, inciuding any portion of a facility whose purpose is the education and/or care of students. In facilities of higher education, every effort should be made to prevent tobacco use on school property, except for private residences on such property. Educational facilities are public and private schools, elementary and secondary schools, colleges, universities and other educational and vocational institutions. Qgt : Regulatory initiatives may be appropriate to achieve this objective by accessing the jurisdiction of N school boards and other licensing agencies. Further, many educators and staff are employed under collective bargaining agreements, therefore, work place restrictions exceeding state or local restrictions should be negotiated through the collective bargaining process. • A prohibition on smoking in all private and public work places. Work places are any area In a place of employment where one or more employees are assigned and perforrm services for their employer. Work places include offices, factories, warehouses, food service establishments and other places of employment. Specified areas should include meeting and conference rooms, and other areas generally used by employees to carry out their work. • A prohibition on smoking In all health care facilities. Health care facilities inciude hospitals, health care clinics and laboratories, and community health care centers. Note: Regulatory initiatives may be appropriate to achieve this objective by accessing the jurisdiction of licensing agencies responsible for accrediting such facilities. • A prohibition on smoking on all forms.of public transportation including buses, trains, subways and taxis. • A prohibition on smoking in food service establishments except In designated areas. The food service establishment (restaurant) provision should be prevalence-based. Thus, a restaurant will be smoke-free, except in a designated area whose size Is determined by the national percentage of nonsmokers to smokers (i.e.:- In 1989, approximately 70 percent of the population was comprised of nonsmokers, thus, 70 percent of any food service establishment should be designated smoke-free). A food service establishment is any Indoor area open to the public or portion thereof in which the primary business is the sale of food for on-premises ut 0 ~4 03 ~ tfl ~ N N • S 18

• 0 consumption including, but not limited to, restaurants, cafeterias, coffee shops, diners, sandwich shops and short-order cafes. A bar is defined as any indoor area open to the public and devoted to the sale and service of alcohol beverages for on-premises consumption of such beverages. Service of food is considered incidental if the food service generates less than 40 percent of total gross sales. Any bar that generates 40 percent or more of total annual gross sales from the sale of food for on-premises consumption should be considered a food service establishment. • A prohibition on smoking in indoor areas open to the public Including auditoriums, elevators, gymnasiums, enclosed indoor areas containing a swimming pool, public buildings (any building owned or operated by the state or any county, city, town, village or other political subdivision, public Improvement, or special district, public authority, commission, agency or public benefit corporation; or any other separate corporate Instrumentality or unit of state or local government), theaters, museums, libraries, indoor common areas, waiting rooms, banks, rest rooms and waiting areas in public transportation terminals. • Any comprehensive Clean Indoor Air statute must not contain any preemptive clauses that are Intended to remove power and authority to regulate the Indoor environment from a unit of local government. Preemption clauses have been attached to laws restricting smoking in public places in six states. A new form of preemption was recently passed in Virginia (1990) that was disguised as a'tocal option.' Local option permits localities to enact ordinances that further restrict smoking in public places; however, the local legislation must conform to a'model' bill laid out In the state law. Because the state law dictates to localities what language they use, this local option clause serves as a disincentive for localities to take action. Preemption clauses may serve to weaken stronger pre-existing local laws, preclude stronger local laws from being passed in the future and run contrary to the usual legislative procedure of setting minimum standards that local governing bodies may exceed. I • Any comprehensive Clean Indoor Air statute must not contain provisions that provide civii rights protection for smokers against employment discrimination. 19

This type of legislation prohibits employers from requiring as a condition of employment that an individuai be a nonsmoker. All employers in the state would be prohibited from firing or refusing to hire a person who smokes when not on the job. While such legislation does not allow smokers to violate smoking restrictions in the work place, it would deter employers from voluntarily extending smoking restrictions out of fear of litigation. For those concerned about equal rights regardless of race, color, sex, religion or other Individual characteristics that we cannot control, anti-discrimination clauses are an offensive inserted by the tobacco Industry to muddy the public health debate over tobacco access and use. Some tobacco-industry initiated legislation purports to 'protect the civii rights of smokers' by elevating smokers to a protected class of individuals, putting them on a par with women, minorities, handicapped persons and the elderly. In fact, such legislation provides greater protection to smokers by allowing them to take their cases directly to the courts and, therefore, bypass the state body with jurisdiction over other discrimination cases. Other civil rights statutes that have been carefully and thoughtfully crafted by legislatures and Interpreted by the courts over the years provide protection for those who truly need it. Categorizing smokers as a protected class trivializes and skews the concept of civii rights. Cigarette smoking Is a dangerous health hazard. Anti-discrimination laws are designed to protect persons whose basic individual rights are under attack. Hundreds of smoking-control laws across the country stipulate that in cases of dispute between a smoker and nonsmoker, the nonsmokers's wishes prevail. Anti-discrimination laws would serve to negate such stipulations. In addition, an anti-discrimination law would give a smoker the power to bring suit against both the employer and the nonsmoker with whom there is a grievance. Conclusion Despite the tobacco Industry's predictions that smoking-control laws and policies will cause problems in the work place, hamper economic development, impose an undue regulatory and financial burden on business, to date the industry has yet to produce independent evidence that corroborates these claims. • 20

0 • • In fact, the overwhelming popularity of smoking-control policies has led government and business alike to provide ennanced protection for their workers and patrons. The provisions articulated in this Blueprint for Success are not designed to pit smokers against nonsmokers. They are not intended to force people to stop smoking. If laws are established based on the public heaith principles advanced in this document they will prevent the Involuntary exposure to an Indoor environmental toxin. Many state and local governments already have established sound smoking-control laws. Many others have taken tentative, although Inadequate, steps to address the health threat posed by involuntary exposure to environmental tobacco smoke. The Tobacco-Free America Legislative Clearinghouse serves as the primary national source for information on tobacco-control initiatives for the voluntary public health community, state and local government officials and the media. This is a valuable resource that tobacco-control advocates are urged to utilize. 21

Sources of Additional Information Targeted Poputations American Medical Association. Final Report: Tobacco Use in America Conference. 1989. American School Health Association, Association for the Advancement of Health Education, Society for Public Health Education, Inc. National Adolescent Student Health Survey, 1987. Munoz, Helen. 'Tobacco Advertising: Selling Disease to Hispanics.' Testimony before the Subcommittee on Transportation and Hazardous Materials, U.S. House of Representatives. Washington, DC. March 1, 1990. Rivo, Marc L, Kofie, Vincent, Schwartz, Eugene, Levy, Martin E., Tuckson, Reed V. 'Comparisons of Black and White Smoking: Attributable Mortality, Morbidity and Economic Costs in the District of Columbia,' Journal of the National Medical Association. Vol. 81, No. 11, 1990. Sullivan, Louis W. Remarks at news conference. Washington, DC. February 23, 1990. Talbot, Bruce R. Testimony before the Committee on Labor and Human Resources, U.S. Senate. Washington, DC. April 3, 1990. Tobacco-Free America. Tobacco Sampling: There is No Free Lunch. April 1990. Tye, Joe B. 'Tobacco and Youth Reporter.' All issues. Palo Alto, CA. U.S. Department of Health and Human Services. Smoking and Health: A National Status Report. 1990. Tobacco Excise Taxes American Medical Association. Final Report: Tobacco Use In America Conference. 1989. Council of States Governments. Book of the States: 1990-91. Manning, Willard G., et al. 'The Taxes of Sin,' Journal of the American Medical Association. March 17, 1989. Office of the U.S. Surgeon General. Reducing the Health Consequences of Smoking: 25 Years of Progress, a Report of the Surgeon General. U.S. Department of Health and Human Services. 1989. U.S. General Accounting Office. 'Teenage Smoking: Higher Excise Tax Should Significantiy Reduce the Number of Smokers.' June 1989. Warner, Kenneth. 'Health and Economic Implications of a Tobacco Free Society.' Journal of the American Medical Association. October 16, 1987. Ln 0 ~ oz ~ (D r N 0) I • • 22

• • • Restrictions on Smoking in Public Places Advocacy Institute and Public Citizen. The Advocates Guide to Preemption: Preserving State and Local Protection for Public Health and Safety. Washington, DC. 1990. Gamer, Donald. Fair Treatment for the New Minority. 1990. Sylvester, Kathleen. 'The Tobacco Industry Will Walk a Mile to Stop an Anti-Smoking Law.' Governing. May 1990. Tobacco-Free America Legislative Clearinghouse. Anti-discrimination Protection for Smokers. Washington, DC. 1990. Tobacco-Free America Legislative Clearinghouse. Washington, DC. 1990. Tobacco-Free America Legislative Clearinghouse. Washington, DC. 1990: Tobacco-Free America Legislative Clearinghouse. Washington, DC. 1989. Tobacco-Free America Legislative Clearinghouse. Washington, DC. 1990. Guidelines for State Legislative Procedures. Preemption: Restrictions on Smoking in Public Places. State Laws Restricting Smoking on School Property. State Legislated Actions on Tobacco Issues. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Smoking: A Report of the Surgeon General. Washington, DC. 1986. 23