Tobacco Control Program

THIRTEEN YEARS IN THE MAKING

As a friend said to me recently, “Just think.  If you never do anything else in your life, you will be in the history books for your work in tobacco control.”  At the time, we were in the middle of another setback in trying to protect people from secondhand smoke, and I realized that no matter how difficult the work, it was true.  The hundreds of people who have worked on tobacco control over the past decade or more have all made history together in creating one of the most powerful public health movements in American history.  And in 1995 when I came to this work, I knew a time would come when people would not be exposed to secondhand smoke, but I wasn’t sure it would happen in my lifetime.  And suddenly, here it is.

Of course, you could date anti-tobacco programs well over eleven years ago. Thirty years ago, Margaret Kane, Executive Director of the American Lung Association of Rhode Island, was a lone voice crying that smoking was dangerous to smokers and to those exposed to secondhand smoke.  She was joined by Jerry Maldavir from the American Cancer Society in seeing the Smokefree Schools Act passed prohibiting smoking in all schools.  The Smokefree Workplace Act made companies responsible for accommodating the needs of non-smokers.  The Tobacco Sales to Minors legislation banned the sale of tobacco to children and youth, and made it illegal to distribute free samples or to sell loosies.  But it took until 2004 to pass a law that makes almost all public places and workplaces completely smokefree on March 1, 2005.  Rhode Island is the seventh state to do so.  More are on the way.

But we begin our story in 1991 when the Rhode Island Department of Health was awarded a Project ASSIST grant (the American Stop Smoking Intervention Study for Cancer Prevention).  Little did we know that we were about to become part of a movement that would change the landscape of public health.  It is the story of the lowly Davids of public health up against the tobacco industry Goliath, a story filled with suspense and intrigue, power and greed, and the spirit of little guys banding together to make the impossible happen.

That first year, the National Cancer Institute convened the 17 funded state programs at a conference.  There were a grand total of 35 people in attendance.  By 2000, when we looked out at the participants at the World Tobacco Control Conference in Chicago, there were thousands of people in the largest auditorium I have ever seen.   In 9 years the movement grew from 35 to tens of thousands.

One of the original 35 was Carol Hall-Walker.  Maybe that’s why her name appears in a tobacco company document as one of those Project ASSIST problem people the tobacco industry was complaining about.  She was joined by Lodie Lambright, an indomitable tobacco foe, and in 1995 by Betty Harvey.  The plan for ASSIST was to focus on policy change supported by media advocacy and programs.  The focus on policy change took the tobacco industry by surprise, and states began passing strong legislation to protect people from exposure to secondhand smoke and to limit the sale of tobacco products to underage youth. 

The tobacco industry responded, and at one time, we counted at least 10 tobacco company lobbyists covering the Rhode Island General Assembly in an effort to stop such legislation. 

Meanwhile, on the monthly conference calls of the Program Managers in the 17 ASSIST states, two states were being sued by the tobacco industry for illegal lobbying, charges that were unfounded, but tactics the industry used to turn staff from their important work in tobacco control to preparing documents and working on the lawsuits. 

Here in Rhode Island each year we were asked by an agency in Virginia for a list of the names of all agencies we funded and the amount of money we gave them.  We waited for something to happen, but decided we were probably considered too small a potato for a major tobacco industry dirty trick.

Periodically we were able to add another public place to the growing list of places smoking was prohibited—dormitories, the State House, laundromats.  But smoking prevailed in workplaces and in most public places. 

The Department of Health had $125,000 to spend on media advocacy to support new policies until 2001 when the RI General Assembly provided $1 million in an appropriation for media campaigns to show the public how important it was to protect people, especially children and youth, from tobacco use and from exposure to secondhand smoke.  A year later, another million provided for school and community projects to spread the word.  And a year after that, another million was provided to help smokers quit.

We began to see a change in public opinion as more and more people quit smoking, and more and more people wanted to be in smokefree environments.  They began to make their wishes known to the their legislators.  Representative Betsy Dennigan introduced smokefree legislation year after year.  Each time the bill was introduced more and more people heard about the increasing evidence about just how dangerous secondhand smoke really is. 

Rhode Island banded together with other New England states in 2002 to fight for and win a cigarette tax increase.

In 2003, Senator Susan Sosnowski introduced legislation in the Senate as Representative Dennigan introduced hers in the House.

It is impossible to underestimate the impact of the advocates from the Campaign for a Healthy Rhode Island.  The group included our state level partners, the American Lung Association of Rhode Island, the American Cancer Society, the American Heart Association, Ocean State Action, and community agencies, some funded by the Department of Health, some through a grant from the Robert Wood Johnson Foundation, and many individual volunteers. The tobacco control advocates had learned how to organize support from the majority of Rhode Islanders who want protections from secondhand smoke.  They also learned to work with key decision-makers to increase the chance of passage of the Act. 

The group blossomed and in 2003 worked with legislators to seek passage of the Worker Safety Act of 2003.  It went down to defeat, but it was clear that the movement for protection from secondhand smoke had become very powerful, with 72% of Rhode Islanders supporting smokefree workplaces and public places.  In the 2004 legislative session, Majority Leader Gordon Fox introduced the Public Health and Worker Safety Act of 2004, and was instrumental in working toward passage of the Act in the House, as Senators Sosnowski and Roberts shepherded it through the Senate. 

Every year Dr. Patricia A. Nolan, Director of Health, went before the legislature to deliver the increasingly damning statistics on the dangers of exposure to secondhand smoke.  Her ability to deliver the science without exaggeration made her a powerful voice for the science of the effects of this deadly product, and legislators told us that it was her persistence in delivering the facts that helped turn the tide.  At a time when some Health Department Directors in other states held back, Dr. Nolan went everywhere to advocate for tobacco free public places and workplaces and for providing tobacco treatment to anyone who wanted it. 

So today we celebrate the passage of the Worker Safety Act of 2004 into law.  Workers in record numbers are protected from dangerous exposure to secondhand smoke at last, and Rhode Islanders can go into restaurants and other public places without being exposed.  So when I am 93, telling my great grandchildren what I worked on at the Health Department in my younger years, I hope they will be amazed that anyone ever had to do such work.  I can hear it now, “You mean you were part of the tobacco control movement?  Wow.  I can’t even imagine people smoking cigarettes.”