Tobacco Funds: Kids Get Stale Butt

Patrick Boyle
July 1, 1999

North Dakota needs a new morgue. West Virginia wants to fix some roads. Idaho wants to create a “rainy day fund,” in case something worse than cancer happens.

And in Florida, where programs funded by the state’s tobacco settlement helped to slash smoking among middle schoolers by 18 percent last year, the state just slashed the program. Among the casualties: several teens who made $6 an hour to produce anti-smoking ads.

Is this any way to handle the $246 billion that tobacco companies are coughing up to state governments?

When the nation’s major tobacco companies agreed to those payments last year as part of a deal to make dozens of liability suits disappear, the attorneys general who negotiated the settlements said they intended the money to be used for health and anti-smoking initiatives — with particular emphasis on attacking youth tobacco use.

“The reason we got into this fight was to protect public health and prevent underage smoking,” Ohio Attorney General Betty Montgomery (R) publicly declared when 46 states settled with Big Tobacco in November.

Today, however, it appears that only a fraction of that money will go to anti-tobacco efforts. “If current trends continue, the vast majority of the states will spend little or none of the tobacco settlement money on programs intended to prevent children from starting to smoke or on helping current tobacco users to quit,” says a recent study by the Campaign for Tobacco-Free Kids.

“There’s a huge degree of frustration and definite disappointment” among attorneys general, says Washington state AG Christine Gregoire (D), who led the settlement negotiations for her colleagues. “A number of the states are not spending the money on children, on child care, on tobacco prevention.”

While some of the money is being used to fight tobacco, state lawmakers are also claiming the dollars for scholarships in Michigan, tax cuts in New York, school repair in Colorado and budget balancing in Rhode Island. “A lot of people are looking at this as a money grab,” says Kitty Kinsman, a South Dakota consultant for groups trying to get the money dedicated to anti-tobacco programs there.

On one hand, the feeding frenzy is typical of legislative politics; no pot of cash is safe in a state capitol. But the struggle also reflects the overall failure of anti-tobacco, health, and youth-serving and advocacy groups to jointly organize and mobilize themselves quickly enough to build significant public and political support for their cause.

“There were states where the advocates didn’t do the preparation they needed to do,” says Carter Headrick, Midwest regional advocacy representative for the D.C.-based Campaign for Tobacco-Free Kids. “There are a lot of people who just didn’t believe the settlement was going to happen.”

Also striking is how frontline youth-serving agencies and their statewide leaders have been largely absent from the effort. While a few groups, such as the YMCA of Metropolitan Chicago, have been active, most have let health and anti-tobacco forces carry on the fight. This despite the fact that some of the settlement dollars are supposed to trickle down to community-based organizations (CBOs) to carry out antismoking initiatives aimed at youth. With just a fraction of the settlement pot being dedicated for anti-tobacco, the question is how much will actually find its way to frontline agencies that already work with kids every day, and are in strong positions to discourage youth tobacco use?

“If you’re not at the table, you’re not going to get anything,” says Margaret Schmid, child health project director at the D.C.-based National Association of Child Advocates. “Only those who are active are in a position to have the funds directed toward the programs they’re advocating.” She’s telling NACA members “to go for it.”

The Promise

Last November was a giddy time for people who’ve been trying to reduce youth tobacco use. That’s when the attorneys general from 46 states, four territories and Washington, D.C., announced a groundbreaking settlement with the nation’s major tobacco companies, representing 99 percent of the U.S. tobacco market. In exchange for dropping more than 40 lawsuits seeking billions of dollars in damages for health care costs caused by tobacco products, the companies would pay the states an estimated $206 billion over the next 25 years. The companies would also kick in $1.5 billion for research and advertising against youth smoking, and abide by a plethora of new restrictions — such as the elimination of tobacco billboard ads — aimed at cutting youth tobacco use. (See page 19).

Four other states — Florida, Texas, Minnesota and Louisiana — had already settled with tobacco companies for a total of about $40 million. Battles continue over how the money will be used in those states as well.

The settlements could not have come at a better time for tobacco foes. The American Cancer Society estimates that 3,000 kids begin smoking every day, accounting for 90 percent of new smokers. The U.S. Centers for Disease Control and Prevention (CDC) reported in October that from 1988 through 1996, the number of teens taking up smoking as a daily habit grew 73 percent, to 1.2 million a year. The 1998 “Monitoring the Future” survey from the National Institute on Drug Abuse found that 22 percent of 12th graders reported smoking every day.

At the same time, anti-smoking initiatives in states such as California and Florida have been showing results. The most dramatic were in Florida, where a recent CDC study showed that after one year of initiatives funded by the state’s tobacco settlement, smoking had dropped 19 percent among middle schoolers and 11 percent among high schoolers.

The Reality

But despite the AG’s insistence that they won the money to help their states pay for tobacco-related health costs and to attack youth smoking, their pledges have crashed into the hard reality of state politics.

First, the settlement did not specify how the states must spend the money. Sen. Arlen Specter (R-Pa.) introduced a bill requiring the states to spend half the money on smoking reduction programs and assistance for tobacco farmers. The states objected, and the bill was voted down in March.

Without such a requirement, the funds remain under the control of governors and legislators. “It’s not the AGs’ money, it’s the states’,” says Joy Johnson Wilson, health lobbyist for the D.C.-based National Association of State Legislatures (NCSL). “It has to go through the process that all state appropriations go through.” Johnson is perturbed that “a bunch of lawyers” who negotiated a legal settlement that did not require how the money be spent are now complaining about how the money might be spent.

“It’s the process that frustrates people,” she says. “The advocates for kids, lung, cancer, are all frustrated because they have to line up with everyone else and go through the process.”

“If you say to any given legislators, ‘Here’s a pot of money, do what you want,’ they’re going to listen to whoever has the loudest voice,” says Cyndi Lewis, western regional advocacy representative for Tobacco-Free Kids.

There’s been a lot of yelling. State legislators this year have submitted more than 450 bills on how to spend portions of the money, according to NCSL. Most states have not decided how to allocate their first installments, which are expected next June. (The payments are based on a formula that includes population.)

Coalitions wanting the money for youth anti-tobacco programs find themselves competing primarily with proposals for health and education programs and for tax cuts, says Peter Fisher, manager of state issues for Tobacco-Free Kids. In several places, such as New York and Arizona, counties and cities have sued their states for a bigger slice. A group of Indian tribes filed suit in San Francisco last month seeking a share of the national settlement money.

“There are lot of pigs at the trough,” says John Schlitt, executive director of the D.C.-based National Assembly on School-Based Health Care, which has stayed out of the fray. One tough aspect of that fray, says Fisher, is that many of the competing proposals are worthwhile. The biggest single category is health care, including funding for the Children’s Health Insurance Program (Montana), elderly care (Florida), and the vaguely defined “Delaware Health Fund.” South Dakota lawmakers have talked about putting the money toward education. The creation of trust funds has become popular, although many of them — such as the “Children’s Trust Fund” in Kansas — leave room for a lot of interpretation over how the money could be spent.

There are other less visible hurdles. Although the settlements preclude tobacco companies from lobbying against the money being used for anti-tobacco programs, no one believes the companies’ influence with lawmakers has disappeared. “The residual effect of the tobacco industry’s involvement in politics will be felt for years,” says Nancy Golosman, executive director of a Seattle-based nonprofit anti-tobacco group, Washington DOC (Doctors Ought to Care). “The incredible amount of donations to both parties over time has an impact.”

The tobacco companies’ official position is that they want portions of the money used to curtail youth tobacco use. Philip Morris spokesman Brendan McCormick could cite no state where the companies have aggressively lobbied for that cause. “All of our government affairs people have copies of our statements,” he says. “They have been encouraged to communicate with elected officials.”

Added to that, most lawmakers have trouble grasping what tobacco prevention programs actually do, why they cost so much and whether they’re effective. “Legislators don’t know what we’re talking about,” says Fisher.

Politics appears to have played a big role in Florida. Even with its dramatic reduction in youth tobacco use, this spring lawmakers cut the anti-tobacco education fund by about half, to $32 million. The staff of the Tobacco Pilot Program was chopped to 20 from 31. Among the biggest concerns of lawmakers: the program’s aggressive anti-tobacco ads, such as the one that depicted tobacco executives getting awards for being society’s biggest killers.

So anti-tobacco forces have set relatively modest goals; they’re often seeking less than 10 percent of the settlement funds, although Illinois’ Half for Tobacco Prevention Coalition wants 50 percent. The successful coalitions have started early, allied themselves with health organizations, and drawn a broad array of community-based groups (including youth-serving and advocacy agencies) into their fold. The successes and failures in several states illustrate why that’s so critical.

Get Ready

Gregoire of Washington may be the most ardent tobacco foe of any AG in the country. Last summer her office was preparing for a liability trial against tobacco companies while she led negotiations on the national tobacco settlement. Anti-tobacco advocates kept in close contact with Gregoire, who asked them to develop a plan for spending money from a settlement or jury award.

“Money was going to come down the pike at some point,” says Golosman of Washington DOC, funded in part with $600,000 over the past three years from the Robert Wood Johnson Foundation’s SmokeLess States initiative, which is run by the American Medical Association. “It became apparent we were going to need another coalition to advocate for funding for a plan.”

They formed the Washington Alliance for Tobacco Control and Children’s Health, which Golosman chairs. It was comprised of health-related agencies such as the state heart, lung, cancer, hospital and medical associations. (Youth-serving and youth advocacy organizations were typically missing.) They soon discovered that another group had the same idea: Friends of the Basic Plan wanted more money for the state health plan that makes insurance more affordable for low income families.

Rather than compete, they joined forces. “What could have been a contentious problem became an opportunity,” Golosman says.

“Their agendas were similar,” says Lewis of Tobacco-Free Kids. “Everyone cared about kids, everyone cared about health for kids.”

The two groups developed a plan to provide sufficient funds for anti-tobacco initiatives and the health insurance plan. Soon after the group had its plan printed, the nation’s AGs announced the tobacco settlement in Washington, D.C. An hour after that press conference, the anti-tobacco and health plan coalitions held a press conference in Seattle to unveil their detailed proposal on how the money should be spent.

“Together we raised money from Tobacco-Free Kids, local organizations and member organizations to hire a full time lobbyist, a public affairs firm and a grass roots organizing team,” Golosman says.

The result: the state Senate dedicated $100 million from Washington’s first $323 million in settlement dollars to tobacco prevention. Republicans in the state House slashed that to $5 million, but restored the full funding under pressure from Gov. Gary Locke (D), Gregoire, and the anti-tobacco/health coalition. “We succeeded only because of that coalition,” Gregoire says.

Minnesota offers a similar lesson. With a state tobacco trial slated for last year, a coalition “started over a year ahead of time, knowing there’s going to be money and we’d better be prepared,” says Judy Knapp, executive director of the Minnesota Smoke Free Coalition. “The day the settlement happened” in May, 1998, she says, “we started trying to secure that funding for tobacco prevention.”

The coalition set out to garner 11 percent of the $6.1 billion settlement. It got written support from 250 organizations, including not only health-related groups but a Boy Scout troop and Cub Scout pack in Crookston, the Family YMCA of Albert Lea, six Boys & Girls Clubs, a youth soccer league, the Children’s Defense Fund Minnesota, several other youth-serving agencies and numerous schools.

The group didn’t quite get its 11 percent: the state created a $590 million Tobacco Prevention and Local Public Health Endowment to distribute grants to statewide and community based organizations. More than two-thirds of the fund is for tobacco prevention, including youth; the remaining one-third of the public health endowment is set aside for youth initiatives. When fully funded, Knapp says, the endowment will distribute $25 million a year for tobacco prevention.

Surprise!

In states like Michigan where there was no impending tobacco trial, the AGs tobacco settlement came too suddenly.

“We were caught flat-footed,” says Jim Moore, director of programs at the American Lung Association of Michigan, which helps to run the Michigan Coalition on Smoking OR Health. Coalition members had just started talking about preparing for a tobacco settlement when the deal was announced last November. It was January before the coalition had a working plan on how the money should be spent. The coalition was in no hurry, Moore says, because of “the sense that we had a lot of time. We kept asking our governor, ‘What about the money?’ He said, ‘I’m not going to talk about spending the money until we get a check.’ Then I’m watching his state of the state address in January, and he’s talking about how he’s going to use the tobacco settlement dollars. I’m watching this on TV. We didn’t even get a heads up that this was coming.”

Gov. John Engler (R) has proposed spending 75 percent of the settlement money on merit-based college scholarships and 25 percent on tax cuts. Analysts in Michigan say the scholarships would go largely to kids from stable, well-off families — i.e., “kids who don’t need it,” says Sharon Clayton Peters, president of Michigan’s Children, the statewide children’s advocate. Legislators have recently talked of using a small portion of the money on health programs.

Also caught off-guard were both Dakotas. Health groups formed a South Dakota Tobacco Free-Kids Network last year, but “they realized early on they were in no position to fight for the money,” says Headrick of Tobacco-Free Kids. They got the legislature to put off making a decision until next year while they develop a tobacco control plan. As of last month, the plan had “some general outlines,” says Susan Randall, executive director of the statewide Coalition for Children. They’ll work out details at a fall summit.

Advocates for kids weren’t so lucky in North Dakota. “The coalition’s a mess,” Headrick says. “They were not ready to fight this fight.” This is where the governor proposed using some of the money to renovate the morgue. Eventually the legislature allocated 45 percent of the first installment for water projects, 45 percent for schools, and 10 percent for health, which could include anti-tobacco efforts.

Left Out

If some anti-tobacco and health agencies were caught flatfooted by the national settlement, most youth-serving and youth advocacy organizations hadn’t even bothered to buy running shoes. The membership lists of coalitions that have been fighting for settlement funds reveal few youth-related agencies, especially those that are not specifically dedicated to health or tobacco issues. Typical is the South Dakota Tobacco-Free Kids Network, whose 20 members are mostly from the fields of health (American Lung Association, South Dakota Dental Association, South Dakota Academy of Pediatrics) and education (School Administrators of South Dakota). Its latest membership list appears to include no direct youth-serving agencies and one advocate, the Coalition for Children. “It’s a little lonely,” says Randall.

In Michigan, “Michigan’s Children has not been a real visible part” of the anti-tobacco coalition, says Peters. “It’s more a question of resources than philosophy.” In Illinois, the 38-member Half for Tobacco Prevention coalition includes at least 25 health organizations and four apparent youth-serving organizations: two YMCAs, a Boys & Girls Club, and Alternatives Inc., a nonprofit that provides counseling and after-school programs. At the Illinois Collaboration for Youth, an umbrella for youth-serving agencies, “We haven’t even talked about” lobbying for how the settlement funds are used, says collaboration lobbyist Arvid Hammers. “Maybe we should get involved.”
The YMCA of Metropolitan Chicago has been particularly involved. “Thirty-five percent of the high school students in Illinois smoke,” says Kevin Limbeck, vice president of planning. “It only makes sense that with our mission of offering healthy alternatives and life choices, that we be involved in this strategy.”

Usually, however, the few youth-serving organizations that sign on to such coalitions are playing a “me too” role, lending their names to support the work of anti-tobacco and health groups. Anti-smoking and youth organizations have not made a habit of working together. For example, the National Cancer Institute spends $21 million a year to fund anti-tobacco coalitions in 17 states under Project ASSIST (American Stop Smoking Intervention Study). Looking at the coalition members, “you would find a lot of organizations that are specifically tobacco, substance abuse or health types: the Heart Association, the Lung Association, the American Cancer Society,” says Bob Vollinger, the NCI public health advisor who oversees ASSIST. Youth-serving organizations “have not been as involved as we’d like them to be.”

“One of the big gaps in the [anti-tobacco] advocacy community is groups like the YMCA,” says Chuck Wolfe, who ran Florida’s youth anti-tobacco effort before coming to Washington, D.C. this year to be deputy director of a national foundation to combat youth smoking, funded by settlement dollars to study programs to reduce teen smoking.
The groups have not had trouble clashing. In 1997 a proposal by a Delaware church coalition (the Wilmington Interfaith Network) to create a tobacco tax to fund youth development programs drew opposition from anti-tobacco forces — including Tobacco Free Delaware (a teen anti-smoking effort under the RWJ Foundation’s SmokeLess States program) and the American Cancer Society. Thanks in part to in-fighting, the proposal went nowhere. (SmokeLess States does require its programs to have a youth development component.) This year Campaign for Tobacco-Free Kids President Bill Novelli publicly lambasted the National 4-H Council for accepting $4.3 million from Philip Morris to run a youth anti-smoking program.

‘Blame Me’

Why that gap? Each group blames itself.

“It’s not that they [anti-tobacco groups] are shutting us out,” says Dale Blythe, director of the Center for 4-H Youth Development at the University of Minnesota. It’s that youth-serving agencies “have not been as attuned as we could be” to the settlement negotiations. So when Minnesota settled with tobacco companies, “I didn’t know enough about what was going on to step in and say we want part of the money. ... The anti-tobacco groups are enormously successful and enormously focused. It makes it hard to jump in late.”

Youth-serving and youth advocacy organizations did not see the tobacco litigation as their fight. Rosemary Frazel, public policy director at Children’s Defense Fund Minnesota, sums up the common feeling when she explains that with health and anti-tobacco forces already working hard on the issue, there was little need for her agency to devote a lot of its precious money or time. “We did rely quite a bit on the smoke free coalition here to do most of the advocacy,” she says.

“It’s partly who led the fight,” says Jerry Stermer, president of Voices for Illinois Children, a statewide advocacy group. “We didn’t take a leadership role [in the tobacco settlement negotiations] because it seemed to be going very well. We have had too many [other] fights to be involved with that.”

For their part, Vollinger says anti-tobacco and health groups have typically worked with each other without consistently reaching out to youth-serving organizations. “There’s room for the whole tobacco-control movement to do a better job” on that, he says. Many youth-serving and advocacy agencies have not traditionally considered discouraging youth tobacco to be a core objective, even though they may weave anti-tobacco messages into some of their programs. But even those who provide health care at schools for whom youth tobacco use is clearly a prime concern “by and large aren’t at the table” in the settlement debate, says Schlitt, head of the school-based health care association. “Part of that is that the political process for many of them is just overwhelming.” School health providers are so out of the lobbying loop, he says, “they don’t know where the loop is.”

A Critical Role

Yet youth advocates and youth-serving agencies can play vital roles in shaping the youth anti-tobacco initiatives. When they’re involved in the coalitions, they can bring perspectives and ideas that might otherwise be ignored. When Randall of South Dakota’s Coalition for Children attended the Tobacco-Free Kids Network’s May meeting on the settlement funds, the plans being discussed by other members did not include any role for youth in shaping or carrying out programs. “We observed that there needs to more youth involvement,” Randall said. “There was a receptive response, but it wasn’t as if that was being thought about.”

In Illinois, Stermer of Voices for Illinois Children attended an anti-tobacco coalition meeting last month where he stressed “that we articulate early childhood and after-school” programs. Although his group will lobby legislators on the settlement dollars, he’s not sure it will join the coalition. “We want to have a broad coalition that articulate early childhood development, youth development, after-school programs,” he says. “We need to have more conversations before we’re completely comfortable that the coalition is aggressively able to say that.”

When it comes to carrying out anti-tobacco programs funded by the settlement, both camps agree that community-based youth-serving agencies must be involved. Those agencies, after all, know how to work with kids, have youth activities already in place, and have ingrained healthy decision-making skills into their programs.

“That [work] has to be done by those workers who are on the frontline everyday,” says AG Gregoire of Washington. “It’s going to be those youth groups that are gong to get funding or play a role” in program operation.

“You’ve got to get the range of other voices that really care about the quality of life of kids,” says Jack Levine, president of the Center for Florida’s Children, a statewide advocacy group. “The Boys & Girls Clubs have to be involved, the recreation providers, the range of civic and service groups. That’s ‘a must do.’”

That’s why the Florida Health Department, which distributes the state’s settlement funds, collaborates with community-based youth-serving agencies such as recreation departments, arts councils, Boy Scout troops and summer camps. Experienced youth workers have credibility in delivering the anti-tobacco message. “A lot of the kids are used to these counselors and trust them,” says Jennifer Craven, tobacco prevention coordinator for Charlotte County. One recreation department holds an anti-tobacco softball tournament. An arts council enlists kids to paint anti-tobacco murals. (See box, page 17.)

Anti-tobacco advocates also recognize that they can’t spend $246 billion lecturing kids not to smoke. “It’s absolutely gotta be fun for the kids,” says Jim Phillips, tobacco prevention coordinator for Putnam County, Fla. While much of the money will go to anti-tobacco advertising and programs aimed at getting current smokers to quit, Washington’s Gregoire envisions tobacco prevention programs woven into broader youth development activities. “We want it integrated,” she says. “I’m talking about the whole child. Our best success lies in [dealing with] the total kids, not just cigarettes.”

Youth development advocates contend that having kids involved in well-done, supervised activities during non-school hours reduces unhealthy behavior, even if the activity is not “anti” anything. “Being supervised after school cuts in half the risk that middle school kids will smoke, drink or abuse drugs,” according to a compendium of studies recently released by the D.C.-based Fight Crime: Invest in Kids.

But while people such as Lewis of Tobacco-Free Kids insist that “the funding is going to go out to groups that are not necessarily tobacco prevention,” they also insist that the money be used for specific tobacco prevention components. “You don’t have to be preaching at them,” says Kathy Harty, executive director of the Minnesota Partnership for Action Against Tobacco. But just doing positive youth activities won’t be enough. “It would be hard to say you’re doing an anti-tobacco program without mentioning anti-tobacco,” she says.

Advocates expect that in most states the funds will be funneled through the health department, as in Florida, which would review grant applications.

“Youth service groups would be smart to get actively involved” in helping states develop plans for spending the money, says Peter Berliner, executive director of the Children’s Alliance in Washington state. Hammers of the Illinois Collaboration on Youth points out that most states have not yet determined how they’ll divvy up the settlement. In those that have, such as Washington, details are still being worked out over what kind of in many states the settlement dollar fight will resume every legislative session. The debates so far have been primarily about spending the first installments. Florida’s battle illustrates that the dollars are never safe. Even in Minnesota, where the trust fund was established, Knapp of the smoke free coalition warns, “When times get tough, they [lawmakers] are going to try to raid this money.”

Resources

Peter Fisher

Campaign for Tobacco-Free Kids

1707 L St. NW, Ste. 800

Washington, DC 20036

(202) 296-5469

www.tobaccofreekids.org

Christine Gregoire

Office of the Attorney General

P.O. Box 40100

1125 Washington St., SE

Olympia, WA 98505-0100

(360) 753-6200

Joyce Johnson

National Conference of State Legislatures

444 N. Capitol St. NW, Ste. 515

Washington, DC 20001

(202) 624-5400

www.ncsl.org

Judy Knapp

Minnesota Smoke-Free Coalition

1619 Dayton Ave., Ste. 204b

St. Paul, MN 55104

(651) 641-1223

www.smokefreefuture.com

Chuck Wolfe

MSA National Foundation

750 1st St. NE, Ste. 940

Washington, DC 20002

(202) 842-3388

Sidebar:

Tobacco Funds: Kids Get Stale Butt: Smoke Trail

Tobacco Funds: Kids Get Stale Butt: Settlement Funds Reach Youth Development Agencies

Tobacco Funds: Kids Get Stale Butt: Tobacco Settlement Details


Boyle, Patrick. "Tobacco Funds: Kids Get Stale Butt." Youth Today, July/August 1999, p. 1.

©2000 Youth Today. Reprinted with permission from Youth Today. All rights reserved.

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