UCSF Tobacco Control Policy Making: United States Title Tobacco Control in Florida 1999-2011: The Good, The Bad, and The Ugly Permalink https://escholarship.org/uc/item/9rq720x1 Authors Kennedy, Allison Sullivan, Sarah Hendlin, Yogi et al. Publication Date 2011-09-30 eScholarship.org Powered by the California Digital Library University of California Tobacco Control in Florida 1999-2011: The Good, The Bad, and The Ugly Allison Kennedy, BA Sarah Sullivan, BA Yogi Hendlin, MSc Richard L. Barnes, JD Stanton A. Glantz, PhD Center for Tobacco Control Research and Education School of Medicine University of California, San Francisco San Francisco, CA 94143-1390 September 2011 Tobacco Control in Florida 1999-2011: The Good, The Bad, and The Ugly Allison Kennedy, BA Sarah Sullivan, BA Yogi Hendlin, MSc Richard L. Barnes, JD Stanton A. Glantz, PhD Center for Tobacco Control Research and Education School of Medicine University of California, San Francisco San Francisco, CA 94143-1390 September 2011 Supported in part by National Cancer Institute Grant CA-61021 and endowment funds available to Dr. Glantz. Opinions expressed reflect the views of the authors and do not necessarily represent the sponsoring agency. This report is available on the World Wide Web at http://escholarship.org/uc/item/9rq720x1. Reports on other states and nations are available at http://escholarship.org/uc/ctcre_tcpmus. EXECUTIVE SUMMARY From the 1970s through 2011, tobacco control advocacy in Florida was led by the local divisions of the American Cancer Society, American Lung Association, and American Heart Association (tri-agencies), with the American Cancer Society as the dominant player. The tobacco industry used an extensive group of allies, campaign contributions and lobbying to try to block tobacco strong control policy in Florida through 2011. Between the 1987 and 2008 election cycles the tobacco industry spent $5.9 million in campaign contributions. From 2006 - 2010, the tobacco industry spent $6.3 - $11.7 million on legislative branch lobbying and $1.8 - $4.6 million on executive branch lobbying in Florida. In-state cigarette manufacturer Dosal was a significant political force, outspending its national counterparts. Florida was a tobacco control leader in the U.S. in the 1970s, with passage of local clean indoor air laws in 50 cities and 11 counties. The tobacco industry stifled local progress in 1985 through passage – with support of the tri-agencies – of a weak statewide clean indoor air law with preemption of stronger local laws, and subsequently blocked any attempts to repeal preemption. In 2002, the tri-agencies ran a successful ballot initiative campaign (Amendment 6) to strengthen the 1985 law, making workplaces and restaurants (not bars) smokefree, overcoming significant tobacco industry opposition and winning 71% of the vote. Tobacco control advocates used their voter mandate to fight legislative opposition to strong implementation of Amendment 6, emphasizing to legislative leadership that they would not accept any significant exemptions in the law. Despite preemption, during the 2000s, grassroots advocates demonstrated continued desire to create more smokefree space in Florida through clean outdoor air restrictions at beaches, parks, hospitals, colleges, and universities. Florida is home to the Engle Case (1994), the first smokers’ class action lawsuit to reach a jury verdict in the U.S. Findings of liability in the case have enabled Florida’s smokers to file individual (“Engle Progeny”) suits. Between February 2009 and April 2011, 38 Engle Progeny verdicts were reached, including 26 for plaintiffs, with damages of $359 million. The existence of over 9,500 Engle Progeny cases makes Florida a crucial state for the tobacco industry and an effective state tobacco control program which draws attention to the nefarious deeds of the industry especially threatening. In 1998, Florida launched its Tobacco Pilot Program (TPP), including the “truth” industry- denormalization media campaign. TPP reduced high school smoking 30 day prevalence from 27.4% to 17.8% and middle school smoking from 18.5% to 9.2% between 1998 and 2002, becoming a worldwide model for effective youth tobacco use prevention. Despite its success, funding for TPP was incrementally cut by a hostile Legislature under Governor Jeb Bush (R, 1999-2006) from $70.5 million in FY1999 to $1 million in FY2004, likely due to influence from the tobacco industry. Although the tri-agencies fought the cuts with direct lobbying and a well-organized “insider” grassroots lobbying campaign, their unwillingness to use “outsider” lobbying techniques to challenge TPP cuts, including holding responsible policymakers directly and publicly accountable, signaled to policymakers that they could eliminate the TPP’s funds without any significant repercussions. After 7 years of reduced TPP funding, Florida’s tri-agencies ran the constitutional Amendment 4 campaign to restore a state tobacco control program, to be designed according 1 to CDC Best Practices for Comprehensive Tobacco Control Programs and funded by 15% of the state’s 2005 tobacco settlement payments ($60 million annually). Amendment 4’s implementing legislation created a strong legal foundation for the program, but earmarked $10 million annually for Area Health Education Centers. The tri-agencies were unwilling to fight the earmark, because its champion, Senator Durell Peaden (R, Crestview), was the powerful chair of the Senate Health and Human Services Appropriations Committee. In 2007, the Bureau of Tobacco Prevention Program (BTPP) was created in Governor Charlie Crist’s (R, 2006-2010) Department of Health to administer Amendment 4. Despite the program’s strong legal structure, poor staffing and low-impact programming, including an ineffective media campaign and heavy emphasis on cessation, restricted its success. The tri-agencies did not use their strong voter mandate to demand a high quality, high impact tobacco control program in its first three years. As of 2010, the program had no measurable impact on youth smoking rates, in sharp contrast to the earlier TPP. The program appeared to be making improvements in 2010 and early 2011. In 2009, Florida’s tri-agencies capitalized on a budget deficit to raise Florida’s historically low cigarette tax by $1 to $1.339. Passing the tax through the Legislature represented a significant victory over Florida’s traditionally anti-tax ideology, and appears to have reduced per capita cigarette consumption by 20.6 packs per capita per year (29%) by 2010. Major U.S. tobacco companies made several attempts to pass a “non-participating manufacturers” fee in Florida in the 2000s, to be assessed on companies not party to the 1997 Medicaid fraud settlement, including Dosal. Dosal effectively fought the fee through highlighting differences between it and the large U.S. manufacturers. The Amendment 6 campaign was a model clean indoor air ballot initiative campaign. Grassroots interest in expanding smokefree space must be harnessed by advocates to secure a repeal of preemption and eliminate exemptions in the state clean indoor air law. Repealing preemption will provide the BTPP with increased local policy change opportunities. Advocates should continue to look for opportunities to raise the state’s cigarette tax, and should support a non-participating manufacturers’ fee. Emphasizing the 29.4% decrease in per capita cigarette tax consumption which appears to have resulted from Florida’s 2009 $1 cigarette tax increase, along with revenue generating power, will help them build support for the tax and fee. Aggressive advocacy, including public criticism of pro-tobacco politicians, is sometimes necessary to protect effective tobacco control programs, as evidenced by destruction of the TPP. Florida’s tri-agencies must aggressively fight against the $10 million BTPP earmark for AHECs, which have implemented low-impact cost-ineffective cessation programming. Inadequate implementation and the poor results of the BTPP demonstrate that strong structure is not sufficient to ensure that a tobacco control program is effective. Advocates must demand a high quality, effective tobacco control program from the Department of Health, including a strong media campaign and community-based policy change. Florida’s tobacco control advocates achieved remarkable tobacco control policy change between 1999 and 2011, but the full potential of their accomplishments was limited by an unwillingness to exert the political pressure necessary to strongly implement and protect the tobacco control policy that they secured. 2 TABLE OF CONTENTS EXECUTIVE SUMMARY ............................................................................................................ 1 TABLE OF CONTENTS ................................................................................................................ 3 LIST OF ABBREVIATIONS ....................................................................................................... 10 CHAPTER I: INTRODUCTION .................................................................................................. 15 Tobacco Use in Florida ............................................................................................................. 15 Adults..................................................................................................................................... 15 Consumption .........................................................................................................................