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State and Local Government's Role to Reach Tobacco Use Reduction Goals

November 6, 2003: Public and Private Sector Roles in Tobacco Use Reduction

Howard Koh, M.D., M.P.H., F.A.C.P., Commissioner of Public Health, Commonwealth of Massachusetts, Boston, Massachusetts

Dr. Koh began by showing slides of tobacco industry advertisements as well as some examples of counter-advertisements that have been produced in an attempt to denormalize the use of tobacco products. Dr. Koh described the 20th century as the "tobacco and cancer century."

Dr. Koh reviewed the ten year history of the Massachusetts tobacco control program. The initial goal of the program was to change the social norm around tobacco use, and the slogan that was used to successfully increase the tobacco tax in 1992 was "Tax Tobacco. Protect Kids." Components of the comprehensive program include: youth-focused efforts (mass media, school-based education, restricting sales to minors, and litigation to restrict advertising near school grounds); adult-focused efforts (media, tobacco dependence treatment and education including a Web site—*—and a toll-free telephone number—800-TRYTOSTOP—, and partnerships with health plans); and secondhand smoke efforts (media, promoting local regulations to restrict smoking, and a website—*). Dr. Koh then showed seven advertisements that had been produced for the tobacco control program.

Next, Dr. Koh shared data demonstrating the effectiveness of the Massachusetts tobacco control program. Adult prevalence is currently at 19.4 percent, which places the state at the fourth lowest in the country and cigarette sales have dropped by approximately 40 percent during the past 10 years. The prevalence rate among women, which is currently 10.8 percent, has seen the steepest decline in the country (with California not reporting data).

In terms of evidence that mass media has an effect on youth prevalence, a longitudinal study was conducted indicating that 12 and 13 year olds who had been exposed to the Massachusetts youth advertising were 50 percent less likely to progress to smoking as those who had not been exposed.

Dr. Koh went on to mention some of the litigation that has occurred in the state related to the tobacco control program. In 1996, a State Senator helped pass a tobacco product disclosure law which required tobacco companies to report their cigarette nicotine yields and all additives in all their brands by descending order of weight. The tobacco industry filed suit and it continues to be held up in court. Another lawsuit, led by Attorney General Tom Riley was filed to prohibit tobacco ads from within 1,000 feet of school grounds and playgrounds. The suit went all the way to the Supreme Court but unfortunately the court ruled against Massachusetts.

Dr. Koh concluded his remarks by describing the dire budget crisis that the state is currently facing and how as a result, the tobacco control program has lost all but $6 million of its funding (at the time of this meeting). He stated his commitment to rebuild the program and work with others around the table to continue to sustain funding for programs that we know are effective.

To close, Dr. Koh showed a brief video clip.

Dr. Carmona thanked Dr. Koh and introduced the next speaker.

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