THE WAR ON SMOKING: California blazed a trail to eradicate smoking Now, more states are following suit with similar plans of attack. John Frank reports.

Colleen Stevens doesn't talk like a typical public healthcare official. Rather, she sounds like a grizzled veteran of a long and arduous war - someone who knows that while she's won some skirmishes, the struggle is far from over.

Colleen Stevens doesn't talk like a typical public healthcare official. Rather, she sounds like a grizzled veteran of a long and arduous war - someone who knows that while she's won some skirmishes, the struggle is far from over.

Colleen Stevens doesn't talk like a typical public healthcare official. Rather, she sounds like a grizzled veteran of a long and arduous war - someone who knows that while she's won some skirmishes, the struggle is far from over.

Stevens is head of California's tobacco education media campaign. That state was the first to launch an anti-tobacco campaign, holding its initial press conference in April 1990. 'Taking on the tobacco industry is not a fun job,' says Stevens. 'It is a very formidable enemy.'

Robert Gould, a Porter Novelli partner who directs the company's national healthcare practice, is even more blunt. 'It's a battle for the hearts and minds of the entire community,' says Gould, who works on anti-tobacco issues with the American Legacy Foundation, a national nonprofit public health organization based in Washington, DC.

The tobacco industry spends billions of dollars each year - dollars 6.7 billion in 1998 - to sell cigarettes. Funds from the national tobacco settlement and state-imposed cigarette taxes have allowed states to begin spending millions on anti-tobacco messages.

However, states are clearly being outgunned. Massachusetts, for example, is spending dollars 13 million annually on anti-smoking advertising and PR, while the tobacco industry spends dollars 120 million a year in the state, says Gregory Connolly, director of the Tobacco Control Program at the Massachusetts Department of Public Health.



Combat on many fronts

Despite spending disparities, states such as California, Massachusetts and Florida say they are winning battles, and their efforts are paving the way for others just getting into the fight.

Indeed, public relations is an integral part of any successful anti-smoking campaign. But experts agree that PR has to be used in conjunction with advertising, community outreach and public affairs or it's doomed to fail.

'Programs that work are programs that are comprehensive,' says David Zucker, a Porter Novelli SVP and global key account leader who has worked extensively on anti-smoking efforts for Florida.

National advertising efforts such as the Legacy Foundation's Truth campaign provide air cover, Gould says, continuing the war analogy. But state-level PR plays the role of ground troops that fight for every inch of territory.

California has been a very aggressive trailblazer. The state approved a 25-cent-a-pack cigarette tax back in 1988, with 20% of the money raised going to health education, translating into around dollars 114 million in funding a year. About a tenth of that is devoted to advertising and PR.

'California's program targets the entire state and all populations,' says Matthew LeVeque, a VP with Rogers & Associates, which works with the state. While much of the money supports school-based tobacco education programs, California also funds local health departments and community-based organizations that can reach out to ethnic groups. Two ethnic PR firms work with the Asian and Hispanic populations. 'Our goal has been to change the whole social norm in California,' Stevens says.

That's meant painting the tobacco industry as an enemy that constantly needs to recruit new smokers to preserve itself. 'They're still sending positive messages that it's OK to smoke,' Stevens says of the industry.



A healthy PR strategy

In 1998, as part of a campaign to communicate the dangers of second-hand smoke, California banned smoking in bars, a longtime smoking bastion and target for the tobacco industry's promotional efforts.

Bar owners were sent direct mail about the ban to allay their concerns that it would cost them business - the ban went into effect on New Year's Eve. 'We weren't going to wait to allow the tobacco industry to frame that issue,' recalls LeVeque, who handles external communications and works with local community groups to formulate messages, train activists and ensure everyone stays on message.

Instead, satellite media tours were held in a smoke-free bar two days before the ban went into effect. In addition, media kits on the positive impact of the ban were sent to more than 500 California media outlets.

On the teen front, every California high school journalism adviser receives a bimonthly mailing with articles for their papers on the benefits of not smoking. LeVeque also furnishes story ideas and sources for high school journalists.

The year 2000 was called 'the year to quit smoking,' and LeVeque's team sent out PR kits to local groups that could be used to push the theme.

Radio promotions were planned around holidays such as the Fourth of July to kick off new anti-smoking efforts. Messages focused on the benefits of quitting. 'You can take any communication tool and say we've used it,' LeVeque says.

Results have been impressive. Cigarette consumption in California has dropped 38% - twice the rate for the country as a whole - since 1988.

The state's adult smoking rate has also fallen twice as fast as the country's in that time. Since 1995, youth smoking rates have declined in California, while national youth smoking rates steadily increased until 1999, when CDC statistics indicate a slight decline.

Roughly dollars 1.5 million of the dollars 13 million that Massachusetts spends on anti-tobacco marketing is devoted to PR, says Connolly. The state has used scientific studies to generate media attention for its programs.

For example, a study criticizing R.J. Reynolds' health claims about its new Eclipse cigarettes was used to garner national media coverage.

'The ad budget is there, but I think we also pride ourselves on getting attention with good science,' says Connolly. 'For every buck we spend in advertising, I want two dollars in print coverage generated by PR.'

Florida launched its teen-oriented anti-tobacco campaign in April 1998, working with Porter Novelli and ethnic PR agencies. It includes in-school activities, enforcement of tobacco sales policies, community group partnerships and youth advocacy efforts, says Zucker.

'Teenagers get a sense of control out of smoking,' he says. 'We tried to turn that around and show that they were giving into a manipulation by the industry. A real act of control is to not give in.'

An April 1998 summit brought together 600 Florida teens for a three-day discussion on how best to convey anti-tobacco messages. The result was the Truth campaign, and consulting teens helped ensure the brand was on target. 'Branding this was a very important part of the strategy,' Zucker says.

PN staffers on the account wanted to call the effort 'Rage,' but the teen advisers felt 'Truth' would better communicate the message of tobacco industry manipulation. 'Kids said, 'We just want the truth,'' Zucker recalls.

The Legacy Foundation also uses the Truth brand for its national advertising, and other states have picked it up.

The Florida summit evolved into a teen youth advocacy group called Students Working Against Tobacco (SWAT). That first summer, a Truth Train made 10 stops across the state, and events were held to create SWAT teams at the county level. Today, 15,000 Florida teens are members. SWAT is planning to call on Philip Morris to give the money for its new corporate image campaign to charity.

Florida spends about dollars 35 million annually on tobacco education, with dollars 15 million of that going to advertising and PR. 'We're trying to position this as a hip, rebellious teen brand,' Zucker says of Truth. After two years, it seems to be working. The rate of middle-school smoking is down 40% in Florida. The smoking rate among high school students is down 18%.

Zucker's only regret is that he doesn't have more money to go after adults.

'Ideally, we'd want to be doing more than we do against adults, but it is a question of resources,' he says.



'Kick Ash' marketing

Other states are benefitting from the pioneer efforts of California, Massachusetts and Florida. For example, Minnesota started its teen campaign in April 2000, using many of Florida's tactics. It started with 400 teens coming to its 'Kick Ash Bash' and creating the brand name 'Target Market.' Minnesota is devoting dollars 11 million over two years to advertising and public relations. Weber Shandwick is handling PR.

Weber group manager Ted Johnson says sending a tractor trailer around the state with tobacco company documents - garnered from legal actions against the industry - that detail marketing efforts has been effective in reaching teens with the theme of industry manipulation. A six-week tour brought documents to 30 middle schools and reached approximately one million kids, according to Johnson. High school students staff the rolling exhibition.

Mimicking a tobacco industry tactic, the campaign also created a 'Target Market' CD featuring Minnesota music talent and backed by a multi-city tour of the performers. 'Whenever in doubt about tactics, we ask 'What would Big Tobacco do?'' Johnson says.

Arizona has picked up on the music theme as well, creating 'Tobacco the Musical,' a show performed by kids and aimed at fourth, fifth and sixth graders, says Susan Heck, marketing manager for the Arizona department of health services tobacco education and prevention program.

That state has also used baseball players to combat the idea that smokeless tobacco is harmless. 'The false perception is that baseball players accept chewing tobacco, so it's very important they speak out,' says Heck. 'There's a lot of potential to link sports marketing to the healthcare community.'



Second-hand strategies

Oregon, which started its PR efforts in 1998, borrowed creative work from other campaigns, eliminating the need to generate its own ads, says Joe Weller, VP with Pac/West Communications in Lake Oswego, OR. The campaign has targeted adults by pushing for local ordinances to restrict smoking at work and require retailers to keep cigarettes behind counters. 'We're not telling kids not to smoke,' Weller explains. 'We're creating a culture in which smoking is less acceptable.'

States such as New York, Georgia, Maryland and Colorado are expected to make up the next wave of anti-tobacco PR, says Porter Novelli's Zucker.

When they do, they'll be able to look at the strategies that have worked in other states - but they should expect a long struggle. The tobacco industry has had generations to sell to Americans, and states are relative newcomers on the other side of the issue. As a result, 'States have to make a commitment to a comprehensive, ongoing effort,' says Stevens.

'We view the situation more as a glass-half-full situation,' says Dr. Terry Pechacek, associate director for science and public health at the Centers for Disease Control and Prevention (CDC). That's because programs are producing results even in places like California, where the industry is still outspending the state by almost ten to one, he says. CDC is hopeful that other states will spend more to achieve even better results. The war continues.



BATTLE GUIDELINES

The Centers for Disease Control and Prevention recommends the following



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