1. Shaping Tobacco Control in Louisiana: Then and Now Dr. Charles L. Brown, MD LSU Health Sciences School of Public Health March 27, 2007

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Legislation versus Litigation Policymaking by legislation Policymaking by litigation Adversarial legalism

16. 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?

17. 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?