At its simplest level, advocacy involves writing or speaking in an effort to convince others to take some type of action. Tobacco control advocacy is aimed at reducing the harm caused by tobacco use by changing the underlying political, economic, and social conditions that encourage tobacco use. In this effort, groups of citizens, or advocates, band together to promote policies and practices that protect people from exposure to cigarette smoke, prevent young people from starting tobacco use, and create an environment supportive of quitting smoking. Typically, science, politics, and activism are combined to generate public support for these goals.
Leaders of the highly profitable tobacco industry view tobacco control advocacy as a threat to their business. Tobacco companies have spent billions of dollars lobbying federal, state, and local lawmakers to vote against policies promoted by tobacco control advocates. The industry also conducts expensive campaigns to convince smokers, business owners, and the general public to resist adoption of tobacco control policies.
Tobacco control advocates often work with far fewer resources than the tobacco industry. Tobacco control advocacy represents a substantial extension of earlier public health efforts that focused on educating smokers directly about quitting and on teaching school children about the dangers of smoking. Advocacy efforts now focus on change at the community level—on improving the environment in which people make decisions to use tobacco or not. This often requires public awareness, understanding, activation, and sometimes outrage. Ultimately, advocacy changes the behavior of individuals by targeting institutional policies and practices.
Advocates often organize their efforts by joining forces in local or state coalitions. They strategically use mass media to publicize the changes needed to protect people from tobacco's harmful effects and to expose the tobacco industry's aggressive marketing and lobbying efforts. Both tobacco control advocates and their opponents try to shape the debate by framing the issue or message to succinctly illustrate their views (e.g., describing tobacco use as a "pediatric disease" or as an "individual freedom").
Tobacco control advocates promote a variety of public and private policies at the federal, state, and local levels. States and communities vary greatly in the number and types of laws passed and in how well they are enforced. The following are examples of the major types of policies promoted by tobacco control advocates.
INCREASING PRICE THROUGH TAXATION
State and local governments have the authority to increase taxes paid by people who buy tobacco products, which increases the price an individual pays for these products. In theory at least, the more tobacco costs, the less tobacco people use. As of 2000, the federal tax on cigarettes was 24 cents per pack. All fifty states also impose cigarette taxes—ranging from 2.5 cents a pack in Virginia to one dollar per pack in Alaska and Hawaii. Several states increased tobacco taxes in the 1980s and 1990s. For example, California passed a law in 1988 increasing the state's cigarette tax by 25 cents per pack; and the tax proceeds were mostly used to finance tobacco-related education and research programs, media campaigns, and health services.
RESTRICTING TOBACCO MARKETING
Tobacco is one of the most heavily advertised products in the world. A federal law passed in 1969 prohibits tobacco advertising on television and radio, and state and local ordinances passed in the 1980s and 1990s restricted some forms of tobacco marketing. Additionally, in 1998, the tobacco industry agreed to end all outdoor advertising and promotional giveaways as a part of the Master Settlement Agreement with state attorneys general in forty-six states. However, cigarette advertising continues to be prominent in magazines, in stores that sell tobacco products, and through industry sponsorship of car races, concerts, art exhibits, and other events.
ESTABLISHING SMOKE-FREE WORKPLACES AND PUBLIC SPACES
Smoke-free environments protect nonsmokers from breathing toxic tobacco smoke and help smokers reduce or quit smoking. Since the 1970s, thousands of employers have restricted smoking in their work spaces and hundreds of local governments have passed ordinances banning tobacco use in schools, restaurants, theatres, libraries, shopping malls, and other public places.
RESTRICTING YOUTH ACCESS TO TOBACCO
Most tobacco users begin smoking as preteens or teenagers and become addicted during the first few years of tobacco use. All states have laws prohibiting tobacco sales to those under 18 years of age, but these laws are often unenforced, making it easy for underage people to get cigarettes. Policies to restrict youth access to tobacco include increasing enforcement of laws prohibiting underage tobacco sales, banning or limiting access to vending machines, posting warning signs where youths attempt to purchase tobacco products, and establishing a minimum age for clerks who sell tobacco. The Synar Amendment, a federal law adopted in 1994, encourages states to enforce youth access laws by threatening to reduce federal funding for mental health programs to any state that does not demonstrate effective enforcement.
Increasingly, lawsuits are being brought against tobacco companies to hold them accountable for their actions. This is an effective strategy that was bolstered in the 1990s by the increased availability of internal tobacco industry documents revealing a long standing practice of targeting underage users and potential users. Although tobacco control advocacy started with small groups at the community level, it has developed into a subdiscipline within public health, and many organizations made tobacco control a priority.
Altman, D.; Balcazar, F.; Fawcett, S.; Seekins, T.; and Young, J. (1994). Public Health Advocacy: Creating Community Change to Improve Health. Palo Alto, CA: Stanford Center for Research in Disease Prevention.
Chapman, S., and Lupton, D. (1994). The Fight for Public Health: Principles and Practice of Media Advocacy. London: BMJ Publishing Group.
Fishman, J.; Allison, H.; Knowles, S.; Fishburn, B.; Woollery, T.; Marx, W.; Shelton, D.; Husten, C.; and Eriksen, M. (1999). "State Laws on Tobacco Control—United States, 1998." Morbidity and Mortality Weekly Report 48(SS03):21–62.
Institute of Medicine (1994). Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and Youths. Washington, DC: National Academy of Sciences Press.
Jacobson, P., and Wasserman, J. (1997). Tobacco Control Laws: Implementation and Enforcement. Santa Monica, CA: RAND.
U.S. Department of Health and Human Services (1994). Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, GA: Author.
Wallack, L.; Dorfman, L.; Jernigan, D.; and Themba, M. (1993). Media Advocacy and Public Health: Power for Prevention. Thousand Oaks, CA: Sage Publications.
