shaping tobacco control in louisiana: then and now dr. charles l. brown, md lsu health sciences...
TRANSCRIPT
Shaping Tobacco Control in Louisiana: Then and Now
Dr. Charles L. Brown, MDLSU Health Sciences School of Public Health
March 27, 2007
Overview and Introduction
Tobacco is the great public health story of our country The cigarette has made more money and caused more
illness than any other consumer product The science of the manipulation of this agricultural product
into a deadly drug delivery system needs retelling over and over.
The control of tobacco use has evolved over many years and has involved health promotion, legislation, litigation and regulation and is still unsolved.
All interested in public health need to study the story of tobacco control to devise new approaches to the control of use and how this may be applied to other health related problems.
Overview and Introduction
High school students who smoke 25%
Adults who smoke 22.6%
Adults who die each year 6,400
Second hand smoke deaths 610-1090
Direct health care costs $1.47 Billion
Impact of monthly tobacco sales on the state of Louisiana
State Medicaid program $663 million
Productivity losses $1.91 Billion
Louisiana marketing $285 million
Per pack subsidy $8.00
Overview and Introduction Impact of monthly tobacco sales on the
state of Louisiana
Louisianans’ Contribution on the adverse effects of tobacco use
Dr. Alton Ochsner, MD
Dr. Jack Strong, MD
Elizabeth T. H. Fontham, MPH, Dr PH.
Dr. Sarah Moody-Thomas, PhD
The Castano Group
National Milestones of Tobacco Control January 1964- The Surgeon General’s Report
that points out the health hazard of cigarette smoking
July 1965- The Federal Cigarette Labeling and Advertising Act
April 1970- The Public Health Cigarettes Smoking Act of 1969
1982- The Surgeon General identifies cigarette smoking as the chief preventable cause of death.
October 1984- The Comprehensive Smoking Education Act
October 1987- The CDC estimates 315,120 deaths per year result from cigarette smoking. Subsequently raised to 430,000.
December 1987- Congress bans smoking on domestic flights of two hours or less.
November 1989- Congress bans smoking on all domestic commercial airline flights
July 1992- The Synar Amendment prohibits sale of tobacco to 18 and under.
February 1994- Commissioner David A. Kessler of the FDA announces intention to regulate cigarettes because of the nicotine.
National Milestones of Tobacco Control
May 1994- Mike Moore sues to recover cost of Medicaid expenditures caring for tobacco related illnesses.
June 1997-1998- Attempt to get Congress to approve the settlement between the tobacco companies and the AG’s. This failed
June 1997- Mississippi, Florida, Texas and Minnesota settled with the tobacco industry
August 1998-Fourth Circuit ruled that the FDA lacked jurisdiction over tobacco.
November 1998- Master Settlements Agreement.
National Milestones of Tobacco Control
September 1999- Department of Defense files a civil lawsuit against the tobacco industry. A year later the case proceeded under RICO. The final judgment was in 2006.
March 2000- The Supreme Court ruled that the FDA could not regulate tobacco.
National Milestones of Tobacco Control
1983- Louisiana Clean Indoor Air Act with a pre-emption clause
1986- Allows for smoking in all areas of the Superdome EXCEPT for the arena.
June 1997- Senator Ullo’s bill regulating the sale of tobacco
June 1998- Attempt to raise the excise tax- failed
November 1998- Master Settlement Agreement
State Milestones of Tobacco Control
June 1999- Attempt at Statewide Tobacco Control Program- Failed
October 1999 Constitutional Amendment – Millennium Trust Fund
June 2000- Increase excise tax by 4 cents until 2002
June 2001- Attempt at pre-emption repeal- FAILED
2001- Securitization of 60% of MSA.
State Milestones of Tobacco Control
2002- Special session- Created the Louisiana Cancer Control Consortium
June 2002- Increase of the excise tax by 12 cents and renewed 4 cents
June 2003- Prohibits smoking in all areas of the Superdome; Change if the wording of pre-emption but not repeal
State Milestones of Tobacco Control
July 2003- Creation of TFL and LPHI contract
June 2005- Attempt to increase excise tax and repeal of preemption failed
June 2006- Act 815- The New Clean Indoor Air Act and the repeal of pre-emption.
State Milestones of Tobacco Control
A Long Time Ago-June 1964
Prohibition of sale to minors Taxation of the product Labeling with health effects Advertising prohibition Counter Advertising Education Cessation efforts
Legislation versus Litigation
Policymaking by legislation
Policymaking by litigation
Adversarial legalism
WHAT NEXT?
Tobacco has lost its bloom Look again at the pharmacology of
addiction and explore new drugs that interrupt the changes in the neurotransmitters of the brain
Revisit the whole problem of youth use. What have we learned from the past that we can change in the future?
Is there any possibility to examine the MSA and the dependence of the States on this income stream?
Explore in detail the subsidization of the tobacco industry in which we care for those made ill rather than having them pay up front for their eventual illness.
Look again at the cessation effort with particular attention to those groups with excess use to target the efforts.
WHAT NEXT?