A decade of pitched
battles over anti-smoking advertising campaigns in
California has shown that to succeed these ad campaigns must aggressively
expose hypocritical tobacco industry strategies rather than focus strictly
on smoking's health effects, two UC San Francisco researchers conclude.
Such anti-industry campaigns must have strong support from health advocacy
groups in order to withstand industry attempts to dilute or eliminate them
through political pressure on the state government, the UCSF team also
The assessment stems from an analysis of the past decade's fight over the
content of anti-smoking advertising in California. The 1988 passage of
State Proposition 99 mandated anti-tobacco education, to be funded by a
portion of an increased tobacco tax.
The new report, in the current quarterly issue of Tobacco Control,
published this week, reviews measures and counter-measures taken by the
California Department of Health Services (DHS), the office of former
Governor Pete Wilson and health advocacy groups to define and influence the
content of anti-smoking ads in California.
Use of aggressive billboard, television and radio ads - such as one showing
tobacco executives denying nicotine's addictiveness; another asking, "Are
you choking on tobacco industry lies?" - led to rapid drops in cigarette
smoking in the state, the UCSF researchers note, drawing on their own
analysis as well as studies carried out on contract for the state DHS.
The Wilson administration shelved these and other anti-industry ads under
pressure from the tobacco industry, the researchers report. After the ads
were stopped or toned down, the prevalence of smoking increased.
"The data shows that when the tobacco industry succeeded in shifting the
focus from the anti-industry ads to educational ads aimed at youth groups,
the campaign stopped working and smoking increased," said Stanton Glantz,
PhD, co-author of the report, professor of medicine at UCSF and a member of
UCSF's Institute for Health Policy Studies.
As a result, Californians smoked an extra 840 million packs of cigarettes,
worth more than a billion dollars, between 1994 and 1998, Glantz estimates.
The only thing that got the campaign stiffened up a bit was the fact that
health groups like the American Heart Association, the American Cancer
Society and Americans for Nonsmokers' Rights were willing to go to the
mat, putting a tremendous amount of pressure on the Wilson administration,"
First author on the new report is Edith D. Balbach, former assistant policy
analyst at the UCSF Institute for Health Policy Studies, now director of
the Tufts University community health program.
Some of the most potent ads never aired, the researchers said. One ad
points out that tobacco industry-owned insurance companies charged
non-smokers less for life insurance. Other ads were pulled or even papered
over on billboards, despite objections from public health advocates
including the Tobacco Education and Research Oversight Committee (TEROC),
with statutory oversight over the program, according to the UCSF researchers.
"We are going to see battles all across the country like the one that has
taken place in California," Glantz predicted. The state of Maine, for
example, recently began airing the ad showing tobacco executives denying
nicotine's addictive effect. "They are getting pressured to stop it," he
"In many states, the public health people are trying to put together strong
campaigns that work, and the tobacco industry is trying to divert the
funds to support more educational campaigns which look good, but -- as the
California data show - result in an increase in the prevalence of smoking,"
Glantz said. The experience in California demonstrates the need for
continuing aggressive intervention by health advocacy groups to maintain
the most effective anti-tobacco media campaigns, he and Balbach stress.
Their paper offers a behind-the-scenes look at the strategies and actions
taken by advertising agencies and state health agencies to develop biting
new ads, and counter-measures by the Wilson administration to dampen the
effect of the most provocative ads. In some cases, they report, efforts
were made to introduce legislative restrictions to the law created by the
1988 proposition. In addition, contracts with ad agencies were held up or
killed, and new policies put in place to add layers of review to allow
censorship of ads already approved by the program's oversight agency. The
paper also includes previously secret tobacco industry documents revealing
the tobacco industry's efforts to derail the campaign.
Eventually, by mounting outside pressure on the administration, public
health groups were able to push the media campaign back towards its
original posture," Balbach and Glantz write of the California experience.
The lesson:"Public health groups can help campaigns if they are allowed to
be involved; if they are not, however, they can still protect the quality
of the program through outsider, advocacy strategies designed to hold
public agencies accountable for mounting high-quality campaigns," they
The article by Balbach and Glantz is entitled "Tobacco Control
Advocates Must Demand High-Quality Media Campaigns: the California
Source: Wallace Ravven
News Services, University of California