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Anti-smoking campaign is gone; teen smoking is up
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This wall hanging was created by teens involved in the Target Market campaign in St. Paul, before it was shut down. (MPR file photo)
The federal government recently published the results of a Minnesota study that shows teens are becoming more susceptible to smoking. The findings also suggest the Legislature's decision to cut anti-smoking money last year is to blame. The survey of 1,000 teenagers found that 53 percent consider themselves more likely to start smoking. That's up 10 percentage points from previous surveys. Anti-smoking groups say the findings reaffirm that lawmakers made a mistake in gutting a tobacco endowment to balance last year's budget.

St. Paul, Minn. — Flush with cash from the state's settlement with the tobacco industry, Minnesota spent a lot of money from 2000 to 2003, trying to convince teenager smokers to quit and others to never start. More than $10 million a year went into one edgy teen-oriented advertising campaign called Target Market.

"I just want to say thank you. Thanks. Thank you Big Tobacco, for convincing me to smoke," said one ad. "And this filter just makes me feel so safe. Thanks. It's like a seat belt or an air bag. Thank you Big Tobacco for singling me out as a main target. For underestimating our intelligence. Thanks a lot."

The Target Market campaign is credited with helping reduce teen smoking in Minnesota by 11 percent. But last year it met the budget axe. Lawmakers raided the $1.1 billion endowment that helped fund the ad campaign to plug the state's $4.6 billion dollar budget deficit.

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Image Rep. Fran Bradley

The impact of that decision might have gone unnoticed if it weren't for a contract signed by the Minnesota Department of Health. The Health Department had been tracking Target Market's effectiveness all along, and still had to pay for one more round of teen smoking surveys, even though the ad campaign was shut down.

David Sly, a researcher at the University of Miami medical school, conducted the surveys.

"In Minnesota, we have what we really call a natural experiment. ... We have everything in place and then we take one thing out, and what that thing was that was taken out of the equation was the Target Market program," says Sly. "And when that thing was taken out, what really changed was the measure of those intentions to smoke."

Sly found that in the six months after the Target Market ads went away, teen susceptibility to smoking increased from 43 percent to 53 percent. That doesn't mean more teens were smoking. But researchers say when kids admit they would consider smoking, they often do become smokers. Statistically, the results are very significant, said Sly.

"The change that occurred after the program was stopped was really large enough that the message it's giving should really be heeded -- not just by Minnesota, but by other states that are going through a similar decision-making process," says Sly.

Not so fast, according to Rep. Fran Bradley, R-Rochester. He disagrees with the conclusion that the budget cuts are the reason teens are more likely to smoke.

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Image Aggie Leitheiser

"I think it would be very hard to draw any conclusions about change. First of all, although we dissolved the endowment we didn't dissolve funding," Bradley says. "We're continuing to invest in anti-smoking efforts, and the Health Department continues to get federal and private grants also to fight smoking. So, pretty early to assume that whatever changes might have occurred, have actually caused an effect."

Bradley also questioned whether the Target Market campaign was as effective as anti-smoking advocates have claimed. Tobacco companies raised cigarette prices during that same time period, said Bradley, so it could be that some kids had to quit because they couldn't afford to smoke.

Bradley also claims the Target Market television and radio ads were needlessly expensive.

"There are many of us who have some debate about what works, what doesn't work, how much money you should spend, who benefits from all the money, those kinds of things. I think it's a fair public policy debate," says Bradley.

The Target Market Campaign was expensive. Even anti-smoking advocates agree on that point. But Aggie Leitheiser, assistant commissioner at the Minnesota Department of Health, said it's hard to dispute the campaign's effectiveness.

I'm pretty concerned that Minnesota is no longer anywhere close to the top tier of leadership states in what we are attempting to do with reducing tobacco use. That's puzzling to me, for a state that always prided itself on being very much on the leading edge of public health policy.
- Jan Malcolm, former state health commissioner

"I think what the Target Market evaluation proves -- and the Target Market campaign itself -- is that with a lot of effort and a lot of community investment and a lot of activities, you can change behavior," says Leitheiser. "Changing behavior is never easy, and it usually takes a lot of work and effort. What we were able to show is that we were able to be successful."

Why do effective anti-smoking campaigns need to cost so much? Anti-smoking advocates say it's to combat the barrage of ads by cigarette companies. In Minnesota, the tobacco industry spends roughly $39 per person on advertising. In the past year, the state of Minnesota spent a little more than $1 per person to counter those ads.

Stanton Glantz is a professor of medicine at the University of California at San Francisco, and author of the book "The Cigarette Papers." It's no surprise to him that teen susceptibility to smoking increased when Target Market went away. He says the Minnesota study proves that to fight smoking, states have to spend money.

"The tobacco companies are out there spending billions of dollars marketing to teens and everyone else. And when the state abrogates its responsibility, and stops working to counter the pro-tobacco influences, then you start to see smoking start to go up -- or susceptibility, which is the likelihood people will smoke to go up," says Glantz.

This is the second time Minnesota has proven that intense counter-marketing works, says Glantz. In 1985, the Health Department saw teen smoking rates go down when it launched it's first big anti-smoking campaign. That program met the same fate as Target Market, when lawmakers cut funding because of budget problems.

But Glantz doesn't blame lawmakers for Target Market's demise. He blames those who should have been protecting anti-smoking programs.

"I think that the public health community and the voluntary health agencies, the American Lung Association and others, are really the ones to blame for the program being shut down," Glantz says. "They simply refused to mobilize the kind of aggressive advocacy effort that it takes to defend these programs against the tobacco industry and its political allies."

California's anti-smoking programs were under the same attack in the mid-1990s during a severe recession. Glantz said lawmakers wanted to re-direct money from the state's cigarette tax to plug their budget gap. But the American Heart Association and another group launched a barrage of full-page newspaper ads attacking the plan. The politicians quickly backed off. Glantz thinks the same approach would have worked in Minnesota.

Stuart Hanson disagrees. He's the interim executive director of the Smoke-Free Coalition, and a pulminologist. Minnesota health groups put up a good fight, said Hanson, but the governor and most legislators were determined to use the tobacco endowment to protect a pledge not to raise taxes.

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Image "Its a travesty"

Hanson said lawmakers neglected the fact that they had a duty to do something about smoking, which is the No. 1 preventable cause of death in the state.

"The good that could come from this is to wake up our Legislature and governor, to say we have made a mistake here. It's just sad, from a practitioner's point of view like myself, to see that we have to go through this sort of as a cycle," says Hanson.

"It's what we predicted would happen, and it's happening right before our eyes, because of decisions the Legislature and the governor made last year. It's a public health travesty to see this happen, and not be able to redirect our public good towards a problem that shouldn't happen to us," Hanson says.

The Smoke-Free Coalition and other health groups are planning to push lawmakers next year to restore all of the anti-smoking money that was taken away. They also want lawmakers to increase Minnesota's 48 cent-per-pack cigarette tax. The state used to have the third highest cigarette tax in the nation, but has fallen to 35th in recent years.

Minnesota's standing concerns Jan Malcolm, former commissioner of Health under Gov. Jesse Ventura. She helped create the tobacco endowments four years ago. She says the shift in the state's priorities is tragic.

"I'm pretty concerned that Minnesota is no longer anywhere close to the top tier of leadership states in what we are attempting to do with reducing tobacco use," says Malcolm. "And that's puzzling to me, for a state that always prided itself on being very much on the leading edge of public health policy. I'm really kind of perplexed about why we seem to be going backwards faster in Minnesota than most of the other states that I'm tracking right now."

Even though the tobacco endowment probably will not be restored, the Minnesota Department of Health thinks it has come up with a way to effectively reduce smoking without spending large sums of money. The agency has turned its attention to tobacco-free environments.

The Health Deparment has given grants to two organizations that are now pushing for a smoking ban in Minneapolis and St. Paul bars and restaurants. That tactic is controversial. But Health Department officials said it's their most cost-effective option at this point for reducing Minnesota's teen smoking rate.

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