Interference in Program Management
In 1990 the tobacco industry had considered lobbying the Deukmejian
administration to weaken the tobacco control program, particularly the media campaign, but
it recognized that this strategy was unlikely to succeed. The
industry quickly recognized that Governor George Deukmejian had a hands-off approach to
day-to-day program management and that Ken Kizer, director of the Department of Health
Services (DHS), was committed to the anti-smoking program. Thus it was more productive to
concentrate on working with the Legislature and others such as the conservative California
Medical Association (CMA) and the liberal Western Center for Law and Poverty to divert
anti-tobacco education and research funds into medical services. This situation changed as
soon as Pete Wilson was inaugurated governor in 1991. According to Kizer, who stayed on at
DHS until a successor was named, things changed immediately: There were some
comments from ¦[Wilson's] office that they were unhappy and would like to see any
subsequent ads toned down, and wanted to review any of them.  As
the administration slowly strangled the program, it lost its effectiveness.
The battle over program content intensified over time, particularly
after June 1996, when the Legislature stopped diverting money from the Health Education
and Research Accounts into medical services. The health groups, which had become
reasonably used to and proficient at fighting the tobacco industry directly and in the
Legislature, had a much
more difficult time engaging in administrative battles to insure that the Health
Education money was spent effectively and not wasted on activities that the tobacco
industry considered acceptable. 
Squashing the Media Campaign
The media campaign had been a focal point for controversy ever since
the tobacco industry tried to kill it off in 1989 in AB 75, Proposition 99's first
implementing legislation (see chapter 5). In 1990 the industry recognized the power of
paid counter-advertising and had conducted its own focus group testing of the California
advertisements.[6-8] As the implementation of Proposition 99
continued, the media campaign continued to be controversial, with California tobacco
control advocates working to maintain a no-holds-barred tone and the tobacco industry and
its allies seeking to soften the tone and limit the scope of the campaign to targeting
children and pregnant women or else to presenting health messages. Assembly Speaker Curt
Pringle (R-Garden Grove) had even attempted to write these restrictions into law in 1996
(see chapter 14).
In 1990 the media campaign got off to a strong start. The first wave of
advertisements, launched in April of that year under AB 75, included thirteen television
spots and twelve radio spots, supplemented with three more television spots in February
1991. The campaign also included supporting billboards and print advertising. In addition
to its aggressive tone, the DHS Tobacco Control Section (TCS) tied the advertising to the
needs of the local programs. TCS convened a large Media Advisory Committee, consisting of
various stakeholders and representatives of local and ethnic programs, to review emerging
advertising concepts and provide feedback.
In January 1992 Governor Wilson tried to eliminate the media campaign by
refusing to sign the new contract with the advertising agency, Livingston and Keye
(previously keye/donna/perlstein; see chapter 10). The broadcasting of anti-smoking
advertisements ended immediately, as did the development of new advertisements. Although
the American Lung Association (ALA) successfully sued to force the administration to sign
the contract in May 1992, the governor's action significantly disrupted the campaign.
Although DHS began running the old advertisements again, no new media was available until
February 1993. This delay meant that two years elapsed between waves of new material. Once
the campaign restarted, Livingston and Keye released eleven television spots in February,
supplemented with four more in November, and a total of seven radio spots. Despite the
delay, the new advertisements maintained the tone of the earlier campaign, which focused
on discrediting the tobacco industry and highlighting the dangers of secondhand smoke.
In the fiscal years 1994-1995 and 1995-1996, the Legislature continued
to allocate money ”nearly $12 million annually ”to the media campaign. The
allocation, however, did not insure that a quality program would result or even that the
money would necessarily be spent. Instead of continuing the Deukmejian administration's
policy of treating the development and approval of the advertising spots as a matter to be
dealt with by public health professionals inside DHS and its advertising agency, the
Wilson administration required the advertisements to be approved by the secretary of
health and welfare, Sandra Smoley, and the Governor's Office. As a member of the
Sacramento County Board of Supervisors in 1990, Smoley was one of only two votes against
the Sacramento Clean Indoor Air Ordinance. The rate of production of new material fell
dramatically. Only five television spots were released in September 1994 and four in
September 1995. These television spots were supplemented by eleven radio spots. The
administration then stopped all production. There were no new advertisements between
September 1995 and March 20, 1997. In 1995-1996 the Wilson administration spent only $6.5
million of the $12.2 million appropriated by the Legislature for the media campaign. This
$5 million in unspent funds was the $5 million that Speaker Pringle succeeded in
allocating to smoking cessation efforts in 1996, effectively cutting the media campaign in
Figure 20. Effect of the media campaign on cigarette consumption.
After 1994, when Governor Wilson toned down the media campaign and focused on youth, the
Tobacco Control Program lost its effectiveness. Even so, from passage in 1988 through
1998, the program prevented about 2 billion packs of cigarettes from being smoked
(compared to the historical trend), worth $3 billion to the tobacco industry.
The efforts to squash the media campaign paid off for the
tobacco industry. The weakening of the media campaign, in both content and intensity, was
associated with an end to the drop in tobacco consumption in California (figure 20). The
California Tobacco Survey, conducted in 1998 by John Pierce of the University of
California, San Diego, under contract to DHS, demonstrated that smoking stopped falling in
California in 1994, at the same time that the funding diversions accelerated and the media
campaign and other programs were scaled back and toned down.
The loss of program effectiveness after 1994 meant that Californians smoked 840 million
packs of cigarettes (worth about $1.2 billion to the tobacco industry) between 1994 and
1998 that would not have been smoked had the program remained as effective as it was
between 1989 and 1994 (figure 21).
Figure 21. Effect of restrictions on media campaign on cigarette
consumption. Wilson Administration policies that scaled back and toned down the
anti-tobacco education campaign slowed the decline in cigarette consumption. As a result,
840 million packs of cigarettes, worth $1.2 billion to the tobacco industry, were smoked
that would not have been if the early trend had been maintained.
The funding cuts and slowdowns in producing new media materials were
only some of the problems faced by the media campaign. The controls placed on the content
of the media campaign were even more harmful. In 1994 TCS, working with its new
advertising agency, Asher/Gould, produced a thirty-second television advertisement,
Nicotine Soundbites (figure 22), that used actual footage from the landmark
April 14, 1994, congressional hearing conducted by Representative Henry Waxman
(D-California) at which the chief executives of the major cigarette companies denied that
nicotine was addictive. The advertisement began with an image of the executives standing
with their right hands raised swearing to tell the truth. Four of the executives, William
Campbell of Philip Morris, James Johnston of RJ Reynolds, Thomas Sandefur of Brown and
Williamson, and Donald Johnston of American Tobacco, all deny, each in turn, that nicotine
is addictive as their names and companies flash on the screen. The advertisement ends with
the question Do they think we're stupid? Public health advocates loved
the advertisement and the tobacco industry went berserk.
The advertisement was first aired on September 29, 1994. On October 6,
lawyers for RJ Reynolds wrote DHS on behalf of the company's chief executive officer,
James W. Johnston, claiming he was defamed and demanding an apology.
They also wrote to television station KABC in Hollywood, alleging that the advertisement
was false and defamatory and demanding that the broadcasts end immediately. They told Asher/Gould, Your creation of an
intentionally altered videotape is clearly outside the limits of legal or ethical
behavior, and my client shall hold your agency, and everyone in this project, personally
responsible.  The lawyers demanded that Asher/Gould
set aside and preserve every document ¦in your possession or custody and control
relating to the development, production, and distribution of the offending commercial.  Finally, they demanded that DHS director S. Kimberly BelshÃ©
undertake an immediate withdrawal of a television advertisement sponsored by
your Department which contains a false and defamatory attack upon our client. 
By October 17, 1994, KABC and two other television stations had pulled
the advertisement off the air. Bruce Silverman, the president of Asher/Gould, had offered
to indemnify several stations, including the Los Angeles NBC affiliate, to keep the
advertisements on the air. According
to Silverman, We don't see this as a horrible risk because we don't believe
that KNBC or anyone, for that matter, including us, will really be sued by Johnston.  The threat to sue and the knuckling under by three stations to the
threat, however, attracted broad media coverage.[15-19] The Minneapolis
Star Tribune had this to say in an editorial of October 17: Under the
circumstances, a tobacco executive threatening to sue for libel should be funny ”if
his threat hadn't worked. Incredibly, the TV stations ”in San Francisco, Oakland and
Los Angeles ”caved in to the pressure and took the commercial off the air. ¦Given
all the jibes aimed at the tobacco industry, it's amazing its leaders would choose to
fight this one. These ads simply underscored the oft-repeated fact that tobacco industry
executives are expert prevaricators. Why should they be sensitive about that? After all,
if you already make a profit from causing death, the charge of lying about it shouldn't be
too hard to live with. 
BelshÃ© publicly defended Nicotine Soundbites in a
letter replying to Johnston's attorneys. She wrote,
This is to inform you that the Department of Health Services will not
withdraw or alter the advertisement in question. Further, we adamantly deny any allegation
of defamation resulting from this advertisement. ¦The point made by the ad, we believe,
is that while individual industry executives may be able to make certain statements which
are literally true in a narrow legal context, these statements do nothing to give
credibility to the overall industry position that tobacco is not a harmful product.
Furthermore, I would like to take this opportunity to express my grave
concerns regarding recent attempts which have been made to intervene in the airing of
these ads by local television stations.
Nicotine Soundbites remained on the air. But after
DHS's public display of support, the administration quietly shelved it in early 1995.
Beginning in 1995, the Wilson administration refused to air the spot,
despite repeated requests to do so by public health advocates, including a formal request
by the Tobacco Education and Research Oversight Committee (TEROC).
The administration's repeated excuse was a desire to avoid litigation (something it had no
aversion to if the plaintiffs were the public health groups).
TEROC countered with a specific recommendation that it would endorse use of Health
Education Account money to defend the advertisement in court, if necessary. Since
Nicotine Soundbites was made up entirely of footage of the Waxman hearing,
edited down to fit a thirty-second spot, and since truth is a defense, such litigation was
extremely unlikely. Other states later aired the advertisement with no legal
The content controls were not restricted to Nicotine
Soundbites. In September 1994 Sandra Smoley personally intervened to remove 190
billboards bearing the message Secondhand Smoke Kills: Are You Choking on
Tobacco Industry Lies? (figure 23). Smoley ordered that the billboards be papered
over at a cost exceeding $10,000, even though BelshÃ© had approved them. When her role
became public because of materials that Americans for Nonsmokers' Rights (ANR) had
obtained from DHS under the California Public Records Act, Smoley defended her position to
the American Cancer Society (ACS), ANR, and the American Heart Association (AHA), saying
that she ordered the billboard pulled because it was found to be offensive
for government to use taxpayer funds to call a private industry a liar (emphasis
added). Smoley, a registered nurse, did not approve of accusing
the tobacco industry of lying, despite the fact that accelerating litigation against the
tobacco industry was revealing,
almost daily, new disclosures of the tobacco industry's lies to the public about
nicotine addiction, cancer, and marketing to kids over the last half century.
do the tobacco guys know that they're not telling us? She objected
to an image of tobacco executives shredding documents. When the advertising agency offered
to remove the few seconds of video showing the shredding, she still refused to allow the
advertisement to be aired. In response to complaints by the public health groups about the
administration's action, Smoley blamed them for raising the issue: Your
organizations have given unwarranted emphasis to the decision not to air an ad known as
`Insurance.' ¦While the ad had much potential, and could have been aired with
further work, DHS dropped the ad immediately after your press conference (emphasis
in original). The state spent over $250,000 producing
Insurance, only to leave the finished ad gathering dust on the shelf because
the public health groups had asked where it was.
Implementing Pringle's Pro-Tobacco Policies
In June 1996 Speaker Pringle had tried to insert language into the
budget that would have eliminated the media campaign's attacks on the tobacco industry,
meeting a long-standing objective of the tobacco industry. While Pringle lost in the
Legislature, the Wilson administration quietly used administrative procedures to
accomplish the same thing.
DHS used contracting procedures in an effort to slow down the media
campaign. At the time the 1996-1997 budget was signed, the contract to administer the
media account was held by the advertising agency Asher/Gould, which had won it in May
1994. This contract contained an option for DHS to renew it for two years, beginning July
1, 1996. As early as June 1996, Asher/Gould had delivered storyboards (pen and ink
versions of the proposed advertisements) to TCS for a new media campaign scheduled to
begin that fall. Based on the past successes of the campaign, several of these proposed
advertisements featured attacks on the tobacco industry.
Rather than simply exercising its option to extend Asher/Gould's
contract for two years so that the agency could move ahead with the work, DHS issued a new
Request for Proposals for the media campaign on August 2, 1996 (for the period from
January 1, 1997, through December 31, 1999). This action set in motion a protracted
process of submitting bids, judging proposals, and handling appeals for the agencies that
were not selected. Some people in TCS, as well as in the public health community, were
concerned that the entire process was designed as an attempt to replace Asher/Gould, since
the administration distrusted the agency's president, Bruce Silverman, for consistently
pressing for strong anti-industry advertisements. In the end, Asher/Gould won the new
contract, but the process delayed the development of the planned advertisements. In a
great show of circular logic, the time required for this process became one of the
administration's excuses as it came under increasingly strong criticism from TEROC and
public health organizations for delays in releasing new advertising.
One of these new advertisements was Cattle, which
showed cowboys ”portrayed as Marlboro Man types ”rounding up children as a
metaphor for the tobacco industry's efforts to hook kids on cigarettes (figure 24).
Cattle began with the words This is how the Tobacco Industry wants
you to see them and was originally to feature one of the cowboys lassoing a kid and
dragging him to where another cowboy was waiting with a branding iron labeled
Tobacco Industry. The final line was, The Tobacco Industry. If you
knew what they thought of you, you'd think twice. Another advertisement,
Thank You, a television advertisement that eventually became a radio spot, was
a sarcastic thank you letter from the tobacco industry to kids in
appreciation for their loyalty in spite of overwhelming evidence that tobacco kills. It
began with the words The Tobacco Industry would like to thank ¦ and
ended with Sincerely, the Tobacco Industry. These anti-tobacco industry
advertisements soon hit a brick wall.
During the summer of 1996, it was reported that Mike Genest, the
assistant deputy director for prevention services at DHS and someone who was widely viewed
as the governor's political watchdog in the department, and Dr. James Stratton, the state
health officer and DHS deputy director for prevention services, summoned Silverman to a
closed-door meeting in Sacramento to discuss what would be acceptable and what would not
be acceptable in the advertisements that were under development. When Silverman walked
into the room, he found four terms written on a blackboard: tobacco industry,
profit, nicotine addiction, and
lies. The DHS managers reportedly stood up and drew a line through each of
these terms; they were not to appear in any of the advertisements.
In July 1996 Genest said that everything that Asher/Gould had presented
for youth was controversial and would need to be approved several layers up the chain of
command. He questioned the efficacy of attacking the tobacco
industry, prompting Silverman to write Dileep Bal, head of the Cancer Control Branch
(which includes TCS), that the only effective method I know of to achieve that
[a reduction in tobacco use] via advertising is with the `Manipulation' strategy that we
just tested.  In addition to expressing general concerns about
attacking the industry, Genest wanted the phrase Tobacco Industry
changed to Big Tobacco.  Nothing was approved to go
In addition to slowing the approval process, the Wilson administration
made other changes designed to tone down and slow up the media campaign. Under previous
policy, once an anti-tobacco advertisement was approved, TCS and the media contractor used
their professional judgment in deciding when to run it. In August 1996, when Asher/Gould
suggested again running Industry Spokesmen, the very first Proposition
99 anti-tobacco advertisement (which had not been aired for several years), Genest
announced a new policy: every advertisement was to be cleared for each use, even if
it had been approved in the past. The approval process included
not only DHS management but also the
personal stamp of approval of Secretary Smoley. This new policy
effectively shelved forty existing television and thirty radio advertisements that had
been produced at a cost of millions of dollars to the taxpayers. It also ensured that
advertisements such as Industry Spokesmen, Nicotine
Soundbites, and others that the industry found so objectionable
would not be put into the advertising rotation by TCS or the media contractor. Bal
protested this new policy as a fundamental change that I for one was unaware
of until now.  Between the delay over the new spots and the
need for reapproval of the old, there was clearly no intention of getting the media
campaign up and running in a hurry.
The administration continued to impose tighter political controls on the
media campaign. On September 16, 1996, Joe Munso, chief deputy director of the DHS Office
of Public Affairs (OPA), the agency's public relations office, distributed a memo
announcing that he would review advertising concepts before they are
focus group tested or shared with stakeholders/interested parties (emphasis in
original). Thus, an official charged with protecting the
administration's political and public relations positions would review proposed
advertisements for political acceptability before any formal evaluation of the
advertisements for quality or effectiveness as public health messages could take place. As
these delays gradually ground the media campaign to a halt, with nothing but the old,
acceptable advertisements being run, departmental staff began informing
the administration that the advertisements were so overexposed that they had likely lost
Finally, BelshÃ© wanted TCS to justify not only the attacks on the
tobacco industry but also the entire strategy of countering pro-tobacco
influences in the community. This strategy, along with reducing exposure
to environmental tobacco smoke and reducing youth access to tobacco,
was one of the three main themes in all of DHS's programming, including media,
local programs, and the competitive grants. Robin Shimizu, a staff member at TCS who was
helping with the media campaign, warned Dileep Bal that these priorities were
developed and renewed with the assistance of the tobacco control communities throughout
California and do not simply belong to DHS/TCS. To back away from, or to have to justify
the use of, any one of them, or to eliminate one of the priorities would be viewed harshly
by everyone involved in tobacco control in the state as well as other states, unless there
were a very strong rationale for doing so.  Bal forwarded
Shimizu's comments to his boss, Don Lyman, head of the Chronic Injury and Disease Control
Division, with a comment of his own: `Countering pro-tobacco influences in the
community' is the very signature piece of our efforts to date, as any of the cognoscenti
within or without the state will attest to. To have that questioned in an issue memo you
or I have not seen is beyond anything. Any fundamental shift of these proportions without
input will produce quite a mushroom-cloud, besides being ill-conceived. Caveat emptor.  Bal further offered to host a full-scale consensus
conference of the national cognoscenti to discuss the issue, implying that those who
were requesting the justification did not really want this level of public discussion of
the issue. He also suggested that the countering strategy was being held
to a higher standard of proof of its efficacy than other DHS interventions. The strategy remained intact.
Shutting Out the Public Health Community
During the first years of the California anti-tobacco media campaign,
both DHS and the advertising agency had actively involved members of the public health
community, including TEROC, in the development of the advertising campaign with the aim of
coordinating the media campaign with the community-based tobacco control activities and
receiving expert advice on the content of the campaign.
Recognizing that efforts to slow down and weaken the media campaign would spark
controversy within the public health community, the administration shut this group out of
the review process.
As the legislatively constituted oversight committee for the Proposition
99 program, TEROC had a particular interest in the development and implementation of the
advertising campaign. TCS had routinely, if informally, involved TEROC in the development
of the advertising campaign by asking its members to review storyboards for advertisements
that were under development. The administration quit involving TEROC in the review of the
storyboards. The administration argued that TEROC was a security risk
and that sharing the advertisements with TEROC would increase the likelihood that the
tobacco industry would gain access to them. To this, Cook responded, The TEROC
is not an outside party; it is to be part of the process; and it is being deprived of the
tools necessary to function.  One of the other TEROC members
wryly observed that DHS apparently considered twelve-year-olds in a focus group less of a
security risk than the TEROC members.
At the December 10, 1996, meeting of TEROC, the committee discussed the
delays in the media campaign and the new closed review process used for approving new
media. Stratton announced that decision making about the media campaign had been removed
from TCS. He also claimed that he had the final say over the content of the
advertisements. No one believed him, but he was the first of a long line of officials
who claimed to have the final say (in order to provide political cover for Smoley and
the governor). TEROC formally requested to be allowed back into the process, specifically
asking for the opportunity to see and comment on the storyboards for planned
advertisements; Stratton refused.
The veil of secrecy extended to the advertising firm as well. The new
Asher/Gould contract issued on December 1, 1996, contained a new clause, nicknamed the
Silverman Clause, barring the advertising agency from discussing the
media campaign with anyone without prior written approval from DHS management.
The administration had a good reason for wanting to keep TEROC and the
other members of the public health community out of the process. They had secretly
weakened the June advertisements, just as public health advocates had feared.
By the December 1996 TEROC meeting, all the storyboards submitted by
Asher/Gould in June had been modified to remove the prohibited words the
tobacco industry and addiction. Cattle now began
with This is how the guys who make cigarettes ¦, and the final line was
simply If you knew what they thought of you, you'd think twice (figure
25). The text of the advertisement Thank You had also been changed, from
The Tobacco Industry would like to thank ¦ to Those of us
who make cigarettes would like to thank you. The final line, Sincerely,
the Tobacco Industry, was still included in the December 5 presentation attended by
TCS staff, Lynda Frost (deputy director of the Office of Public Affairs), Genest, and
Stratton, but it was later deleted.
Another new advertisement, Rain, which featured
cigarettes raining down on a playground, was based on the theme of hooking kids, but it
never mentioned the tobacco industry by name. The opening line was We have to
sell cigarettes to your kids, and the final line was How low will they
go to make a profit? Viewers were left with the impression that the advertisement
was about retailers.
Another proposed new advertisement, Voicebox (later
known as Debi ), was to attack the industry for lying about nicotine
addiction. It featured a woman smoking through a tracheostomy opening, stating that the
tobacco industry had lied to her about the addictive nature of its products. At the
December meeting, the industry attack approach was deleted, and the advertisement instead
promoted the state's 800 quit line. In the revised December version
neither of the prohibited terms addiction or the tobacco
industry was used. The advertisement instead featured a smoker who could not quit in
spite of undergoing a tracheotomy, urging others to give quitting a try. An anti-industry
advertisement had been converted into a cessation spot, one that implied quitting was
impossible ”a strange message from a public health department.
The effort to tone down the attacks on the tobacco industry flew in the
face of the research on message effectiveness that Asher/Gould had conducted for TCS. In
response to requests from administration officials for more and more justification for the
anti-industry strategy, Asher/Gould hired an outside evaluator to study the question. In a
November 1996 summary of its focus group research on different advertising messages and in
a December 1996 memo to Colleen Stevens, head of the media campaign at TCS, Christine
Steele, the Asher/Gould senior vice president responsible for the campaign, reported the
results. Five advertising strategies were tested on youths
between the ages of twelve and eighteen in focus groups in Sacramento and Los Angeles. The
messages tested were: (1) manipulation of kids by the tobacco industry, (2) the dangers of
secondhand smoke, (3) the short-term health effects of smoking, (4) the risk of romantic
rejection, and (5) the elimination of risks to the environment caused by smoking, with
results including cleaner beaches, fewer trees destroyed to produce cigarettes, and fewer
animals harmed by eating butts. Of the five, manipulation by the industry was the
strongest message in the groups. According to Steele, The body language of
kids clearly revealed that this [anti-industry] strategy provided kids with an emotional
wake up call. They sat up straight, they grimaced, they shook their heads, they became
riled up and vocal ”they at least became concerned about this formerly `low interest'
topic.  The administration was unmoved.
The ACS, which had been passive through the battles with the
administration, started to take more proactive positions in 1996. One reason may have been
that the administration was ignoring TEROC chair Cook, a longtime and high-level volunteer
in ACS. Another reason may have been to recover from an embarrassment that occurred when
the ACS's San Francisco unit awarded tobacco industry ally Willie Brown its
Humanitarian of the Year award.[45-48]
On February 4, 1997, the presidents of the ACS, AHA, and ANR wrote
Smoley to express their frustration with the administration's ostensible
defense of an industry responsible for the deaths of more than 42,000 Californians each
year ”the tobacco industry.  The three organizations
protested the long delay in the production of new media
output and urged Smoley to release a campaign that featured the original
campaign themes: the tobacco industry lies, nicotine is
addictive, and secondhand smoke kills. 
Meanwhile, John Miller, chief of staff to Senator Diane Watson (D-Los Angeles), chair of
the Senate Health
Committee, was threatening to hold hearings on the way the media
campaign was being conducted. It would take Smoley until March 7, over a month, to respond
that nothing would change. In response, AHA, ACS, and ANR took
out a full-page advertisement in the West Coast edition of the New York Times
featuring the infamous Philip Morris memo about Wilson and accusing the Wilson
administration of refusing to release hard-hitting television spots and removing
billboards to protect the tobacco industry.
On April 15, 1997, the ACS, AHA, and ANR presidents wrote the governor
requesting a meeting to discuss their concerns about the performance of his secretary of
health and welfare. The letter went unanswered for a month. On
May 16, the governor's deputy chief of staff and cabinet secretary wrote saying,
I am aware of your previous communications with the Health and Welfare Agency and
the Department of Health Services. Both Secretary Smoley and Director BelshÃ© have
forthrightly represented the Governor's position to you. 
Smoley, with Governor Wilson's explicit approval, was implementing Pringle's policy of
refusing to attack the tobacco industry, even though the Legislature had rejected his
language. The health groups accepted this rebuff quietly.
The TEROC Purge
Cook called an emergency meeting of TEROC for Monday, February 10,
1997, to follow up on Stratton's refusal to share information about the media campaign
with TEROC and to decide what action TEROC should take in response. For Cook, as an ACS
volunteer, it was hard to have to engage in political fights over the program. ACS had
stayed out of the 1992 lawsuit over the media campaign filed by ALA, preferring to try to
work things out with the governor. In the 1996 reauthorization fight, ACS had distanced
itself from the aggressive strategies used by ANR and AHA. But Cook, as chair of TEROC,
realized that the assault on the media campaign had to end. When asked about the changing
ACS role, she explained,
It's very hard, very hard. Within the Cancer Society, we have a lot of
divisions that are doing tobacco programs and are fighting their legislators and fighting
their governors to make sure the money is spent. But we have some that won't do it still.
They will not get into the fray that way. They don't understand that. To them, it's just
getting into the legal system and they don't think we should be in the legal system. And I
think we have become better advocates for the patient and for the prospective patients
because we are in the legal system now. We are willing to speak up and say these things
just cannot occur.
Cook's strong action in calling the emergency meeting could pose
trouble for the administration by attracting public attention and energizing the ACS and
other health groups, even though eight of TEROC's thirteen members are appointed by the
governor (two are appointed by the speaker of the Assembly, two by the Senate Rules
Committee, and one by the superintendent of public instruction).
On the Friday before the TEROC meeting, Stratton announced a major
shakeup of TEROC. Three physicians on TEROC who had been strong advocates for the
anti-tobacco education campaign were replaced with individuals closely allied with the
Wilson administration. Breslow and Dr. Reed Tuckson, president of Drew University of
Medicine and Science in Los Angeles, were told that they had been replaced in an action
allegedly taken three months earlier by Speaker Pringle, a Republican, the day before the
Democrats took over the Assembly. Neither Pringle nor DHS had given any previous
indication of these changes, even though TEROC had met in December, after the date on
which Pringle supposedly made the appointments; and the associated paperwork had
ostensibly been lost.  In addition, the governor
removed Paul Torrens, a professor of public health at UCLA who had been another outspoken
advocate for a strong program.
In the physicians' places, Pringle had allegedly appointed Hal Massey, a
retired Rockwell Executive who had been active in ACS, and Doug Cavanaugh, the president
of Ruby's Restaurants, an opponent of smoke-free restaurants and bars who was, according
to Pringle, familiar with the tobacco debate, balancing regulations with
people's right to smoke.  Wilson replaced Torrens with Dr.
George Rutherford, who had been the state health officer in the Wilson administration and
responsible for the Proposition 99 program until he left to join the faculty at the
University of California. Wilson also appointed Stratton to TEROC, making him a member of
his own oversight committee.
The TEROC purge, combined with a dismantled media campaign, made news.[53-59] Well over a hundred people came to the TEROC meeting on the
afternoon of February 10, compared with the ten to fifteen nonmembers who usually
attended. Audience members included the heads of a number of county tobacco use prevention
programs who emphasized the key role the media campaign played in their efforts. Without
the air cover created by the media, the impact of their local programs
was more limited. Steve Hansen, a member of the board of the California Medical
Association, suggested Stratton was guilty of public health malpractice. 
TEROC eventually agreed that Cook should write to BelshÃ©, informing
her of the committee's unanimous vote (even including Stratton's) to request a meeting to
review the storyboards for the current and future media spots; BelshÃ© rebuffed the
The Strengthened Advertisements
In February 1997 the administration responded to pressure about the
advertisements by again revising the televised advertisements, although this fact was not
made public at the time. On February 28, 1997, Lynda
351 Frost okayed the
restoration of the phrase the tobacco industry in the Cattle
advertisement, changing the revised version, If you knew what they
thought of you, you'd think twice, back to The Tobacco Industry. If you
knew what they thought of you, ¦ (figure 26). In Rain, the
voiceover comment at the end was changed to The tobacco industry. How low will
they go to make a profit? In addition, Thank You, which had become
a radio spot, now had the words Tobacco Industry both in the opening
sentence and in the last line.
By the time Asher/Gould prepared the final storyboards on March 3, 1997,
two versions of Voicebox were planned. In addition to the cessation
advertisement, a version was recreated that emphasized addiction and the behavior of the
tobacco industry. In it, the actor says, They say nicotine is not addictive.
How can they say that? ; the tag line at the end was The tobacco industry
denies that nicotine is addictive.
At the TEROC meeting on March 25, John Pierce, director of the
California Tobacco Survey, presented the latest California smoking prevalence data, which
showed that smoking rates for both youth and adults appeared to be going up. Overall,
youth smoking, which had been as low as 8.7 percent in 1992, rose to 11.9 percent in 1995
and remained flat in 1996 at 11.6 percent. The annual Behavioral Risk Factors Survey
conducted in house at DHS showed that adult smoking prevalence had increased from 16.7
percent to 18.6 percent between 1995 and 1996, reversing a
downward trend that had existed for nearly a decade. The
increase in smoking rates received wide media coverage.[62-64]
Public health groups blamed the increase on the fact that the administration had not fully
funded Proposition 99's anti-tobacco education programs and on its reluctance to attack
the tobacco industry. Sean Walsh, the governor's press secretary, commented that he was
frustrated because Wilson was being blamed for everything ” including [the
comet] Hale-Bopp.  He referred to the public health groups'
criticisms as Chicken Little-like comments made by zealots in the anti-smoking
TEROC finally saw the new advertisements at its March 25 meeting, after
they were released to the public, and Cook indicated that the members' reactions were
mixed. The advertisements as released, nine months after
Asher/Gould originally proposed them, were similar to those originally conceived by the
While the health groups did manage to get the 1997 advertisements
strengthened, the administration's reluctance to go after the tobacco industry remained.
On February 10, 1998, Christine Steele of Asher & Partners (the new name for
Asher/Gould) was once again having to justify to Genest the strategy of countering tobacco
industry influence, commenting that this approach is important, relevant and,
without question, necessary. 
The 1998 Hearings
By 1998, the Legislature had become sufficiently concerned about the
conduct of the media campaign that it held several oversight hearings to investigate the
matter. Senator Mike Thompson (D-Santa Rosa) held three hearings of the Budget and Fiscal
Review Committee. After two unsatisfactory appearances by DHS officials, Thompson demanded
that the advertising agency appear before the committee. In preparation for the hearing,
Stratton called Hal Asher of Asher & Partners to coach him about what they were to say
at the hearing. According to a memo Asher wrote to his coworkers, They
[Stratton, on behalf of the administration] want us to say ¦with all clients we present a
lot of ideas ¦some stay ¦some go. They want us to say ¦the state is not stalling.
(He initiated this ”not his exact words.) They rejected some ideas. Had input ¦and
then accepted many of the new commercials. In other words ¦they help in the process ¦and
this is like any client! ¦That the state added value to the campaign
(emphasis in original). Stratton emphasized the need not to air
dirty laundry in public and for everyone to be on the same page.
According to Asher, Stratton wanted them to say, We are extremely excited
about the new commercials that we are in the process of producing ¦and we think they will
be the most effective yet.  By May, DHS had, in fact, killed
virtually every idea that Asher & Partners had presented for countering tobacco
Responding to the administration'
- Tobacco Control Section. They get the job done quicker than the multiple approval levels
s stated concern that they would have to release materials
to the tobacco industry if they showed them to TEROC, the Senate Budget and Fiscal Review
Committee approved, in a bipartisan 5-0 vote, language to protect DHS in this regard. The
language was designed to ensure that the materials shared with the statutorily
created group [TEROC] not constitute putting this into the public domain. The
governor vetoed the language in the budget, although the new language corrected the
nominal security problem that the administration was citing to lock TEROC out of the
process. Senator Watson's September 16 hearing of the Senate
Health Committee featured extensive questioning of Stratton, who finally admitted publicly
that Smoley forbade the use of certain words in the anti-tobacco advertisements, such as
lies and profits.
The full truth about the administration's efforts to weaken the media
campaign finally came out at an October 16, 1998, Senate Judiciary Committee hearing
because Senator Adam Schiff (D-Pasadena) subpoenaed Asher & Partners to allow them to
testify fully, despite the gag clause in their contract with DHS. In
response to written questions, Asher & Partners wrote,
Campaigns which exposed the tobacco industry's marketing tactics have
been approved. Campaigns which take on the tobacco industry in a more universal manner
have generally been disapproved for being anti-business and because they
did not focus narrowly on the tobacco industry's marketing tactics. All
commercials which personified the tobacco industry were disapproved for
showing executives in a negative light. ¦
In our best professional judgment, California ¦is not getting the most
effective advertising campaign we can produce in the area of counter
advertising for all of the reasons previously discussed.
Bottom line: effectiveness could be improved if:
- Creative decisions were based on which messages would be most impactful against
consumers as opposed to politics.
- All creative decisions were left to the
in the administration. They also tend to focus more on a given message's effectiveness
rather than its political implications. [emphasis in original]
Asher & Partners also confirmed that, in 1997, after
intense pressure from tobacco control activists, the Administration finally allowed us to
use the phrase `the tobacco industry' and asked us to quickly redo all of our creative
materials to reflect the reneging of this restriction.
Trying to Control TEROC
As TEROC became an advocate for the media campaign, the political
appointees at DHS started to investigate how they could increase their control over this
nominally independent oversight committee. In addition to replacing outspoken members, DHS
also tried to exercise control over the meeting minutes, the Master Plan that TEROC was
required to prepare for the Legislature, and the meeting agendas.
In 1997 Jennie Cook, chair of TEROC, became aware that the DHS
administration had issued instructions for it to edit the TEROC minutes. Cook explained,
I mean, when they got to the point where they were reviewing the minutes
before I ever saw them and taking stuff out, I really blew my stack. Those are our
minutes, they're not the department's minutes, those are our minutes. I want everything in
it.  The review process affected more than just the minutes. On
March 4, 1997, Genest
sent an e-mail to TCS specifying, In no event, should TCS
TEROC staff simply distribute an agenda or other materials to TEROC without first
consulting with TCS management.  Bill Ruppert, the TCS member
who staffed TEROC, wrote to Bal to inquire about the procedure for approving minutes:
In the past, we FAXed the draft minutes to the chairperson of TEROC,
made any corrections requested by the chair, and then mailed the final out to the members.
For the December 10  and February 10  TEROC meetings, there
was [a] great deal of confusion and delay over approval of the minutes. There were
requests from the Deputy Director level and Division level for review of drafts even
before these drafts went to the Chairperson. It is unclear what the role of these
levels was at the time, whether it was approval or not. The chairperson told me that she
did not want anyone changing the minutes. [emphasis added]
Bal forwarded the note on to Lyman, who responded, The
rule is, `no surprises.' If the minutes are acerbic the front office wants to know before
they appear in front of them from some other source. He claimed that otherwise the
review was just for quality control purposes.
The agenda for the June 17, 1997, meeting also caused controversy when
Stratton demanded that Pierce be removed from the agenda, probably anticipating that
Pierce would present results from the California Tobacco Survey showing that the program
was being compromised by the funding diversions and the hindrances to the media campaign.
According to Lyman, Stratton does not want to see his face! ¦Tell them Pierce
is in San Diego busilly [sic] working away to get data for September.  Lyman also said that Stratton wanted the report from the University
of California to be longer and for the university to be put on the hot seat.
He also wanted the report from CDE to talk longer and invite more
questions on their productivity.  Cook was furious when Ruppert
conveyed these suggested changes, especially the order that she un-invite
The political leadership at DHS was particularly worried that a
presentation by Pierce at TEROC could put embarrassing results on the program's loss of
effectiveness before the public. Stratton responded on May 30 that with
respect to Dr. Pierce, it has always been our policy to share data when it is ready for
release. In the case of his contract, that means after he had conducted the analysis, put
it in writing, and shared with the contract management and technical staff in TCS for
approval and release. At the last TEROC meeting, this process was not followed.
356 I expect our usual
procedures to be followed this time.  Pierce could come to the
meeting, but only after DHS reviewed his presentation. Michael Johnson, the head of
evaluation at TCS, wrote to Bal to assure him that he would get advance data from Pierce:
I will forward to you and up through the appropriate channels.  Lyman also noted, We will `read him the riot act' and
place a `heavy' on each side of him at TEROC to assure he does not open a new bag of
unexpected tricks for them. 
The administration had succeeded in purging TEROC before the February 10
meeting, leaving no strong voices on the committee beyond Cook's. She was joined on May
19, however, by Professor Stanton Glantz of the University of California, San Francisco,
when Senator Bill Lockyer (D-Hayward) appointed Glantz to TEROC. Given Glantz's strong
opposition to the tobacco industry and politicians who supported industry interests, many
observers were surprised to see Lockyer ”author of the 1987 Napkin Deal, which gave
the tobacco industry immunity from product liability in California ”appoint Glantz to
TEROC. Lockyer's decision seemed to reflect the continuing
shift in overall Democratic policy away from its staunch pro-tobacco position during
Willie Brown's tenure as speaker. Glantz provided Cook with an important ally on the
At the time Glantz joined TEROC, he found it in the process of
finalizing its Master Plan for the next two years of the California Tobacco Control
Program. He considered the recommendations diffuse and not clearly focused on program
implementation, and he worked with Cook to strengthen and focus them. In July TEROC issued
its new Master Plan, with the following recommendations for future program direction:
- Vigorously expose tobacco industry tactics.
- Press for smoke-free workplaces and homes.
- Accelerate cessation of smoking in persons between the ages of 20 and 39.
- Strengthen school-based tobacco use prevention education programs consistent with
- Implement more effective control of tobacco sales to minors.
- Generate and adopt additional smoking prevention and cessation strategies that are
relevant to the many racial and ethnic populations in California.
- Link Proposition 99-financed research and evaluation efforts closely with Tobacco
Control Program activities.
- Increase the surtax on tobacco products by at least $1.00 per pack.
- Oppose any settlement of tobacco litigation that benefits the tobacco industry.
- Coordinate Proposition 99-financed programs with other State and Federal tobacco control
Lyman described Stratton's reaction to the final draft:
The good Dr. Stratton is unhappy. ¦Stratton sees stuff in the recommendations that
he still has trouble with and other TEROC members had trouble with too. He also remembers
that this was to be referred to the writers to come back next time with another try at
language. So, how come the rush-rush?  TEROC had actually
agreed to let Cook make corrections in accordance with feedback from members and then send
the final version to the printer. DHS took its time printing the report and quietly
released it during the doldrums of late August when most people were more interested in
finishing up their summer vacation than debating tobacco control policy. While the
University of California and CDE took steps to implement the TEROC Master Plan, DHS
Delayed Implementation of the Smoke-free Workplace Law
When Governor Wilson signed California's smoke-free workplace law, AB
13, on July 21, 1994, it was scheduled to go into effect on January 1, 1995. Experience
with similar laws passed at the local level had demonstrated the need for a period of
several months of public education to achieve effective compliance. Despite several
recommendations from TCS and other public health advocates, Smoley prohibited use of the
advertising campaign to publicize California's then-new smoke-free workplace law. At the time, Philip Morris was mounting its initiative campaign for
Proposition 188 to overturn California's workplace smoking restrictions, and the tobacco
industry was worried that the state would use the advertising campaign to educate people
about AB 13 (see chapter 11). Even after the health groups
defeated Proposition 188, however, there was still no advertising to educate the public
that virtually all workers had a right to a smoke-free workplace.
While the tobacco industry was unhappy about the smoke-free workplace
law, it was apoplectic about the smoke-free bar provisions scheduled to go into effect on
January 1, 1998. The industry made several unsuccessful attempts to get the law overturned
in the Legislature, and by mid-1997 there was evidence that it would mount a major
358 encourage people
to ignore the law. This situation made an adequate period of public education, using the
media campaign, particularly important. Indeed, TEROC specifically called for such a
campaign in its 1997 Master Plan.
In fact, TCS had started preparing for the January 1 implementation of
the smoke-free bar law during the previous summer when it surveyed the local lead agencies
to find out what information, materials, and approaches would be the best way to educate
bar workers about the new law. Philip Morris, through its
public relations firm, Burson Marsteller, and its National Smokers Alliance, had been
sending mailings to bar owners warning of severe economic ramifications if the smoke-free
bar provisions of AB 13 were implemented. Using Proposition 99
funds, TCS funded the ALA Contra Costa-Solano to manage a statewide program known as
BREATH (which originally stood for Bar and Restaurant Employees Against Tobacco Hazards)
to educate bar owners and employees about the law. BREATH created posters, handbooks,
mailings, and a compendium of ideas that the LLAs could use to educate bar owners and
dispel tobacco industry myths about the economic chaos that the law would allegedly
A 1996 DHS-commissioned Gallup poll found that more than three times as
many bar patrons preferred a smoke-free bar as were happy with the current unregulated
situation. A 1997 poll by the nonpartisan Field Institute
showed that 86 percent of bar patrons in California would stay in a bar the same amount of
time or longer if it were smoke free, and 76 percent of California bar patrons were
bothered by secondhand smoke in bars, restaurants, and other public places. Even so, based on the experience of implementing the early
smoke-free workplace laws, TCS wanted to educate both bar owners and employees, as well as
patrons, about the new law well in advance of the effective date of January 1.
TCS asked its advertising agency, Asher & Partners, to present ideas
and a time line for using the media campaign to fill this need in the spring of 1997 and
expected to have radio spots and television ads running by June 1997. Despite the strong
evidence that such an educational effort would help the law go into effect more smoothly,
the administration put the media campaign on hold. DHS postponed the educational
advertisements so as not to appear to lobby the Legislature to vote against the exemption. ANR's Cynthia Hallett, who was working on implementing AB 13,
rejected this argument: Let's say they are trying to repeal the law that says
you have to stop at a stop sign. Does that mean while this law
359 is in debate, you
don't have to stop at the stop sign? That the law will not be enforced because there is
debate surrounding it?  But the Wilson administration refused
to prepare the public for the new law as long as the tobacco industry was trying to get it
repealed. Smoley ignored the Master Plan and TCS and delayed approval of advertisements
about the existing law, first proposed in May 1997, until October, a month after the
legislative session ended. (Part of the delay was due to waiting for Smoley's return from
a two-week vacation in China so that she could personally approve the advertisements.) It
was not until late November of 1997 that DHS began running two advertisements promoting
smoke-free bars ”one on the radio and one on television.
Pulling the Advertisements for Smoke-Free Bars
The controversy over advertisements about smoke-free bars extended
beyond the state level. In the summer of 1997, in anticipation of the implementation of
smoke-free bars, the Gold Country Coalition, based at ALA of Sacramento-Emigrant Trails
(ALA-SET), created its own smoke-free bar radio advertisements as part of its approved
work plan with TCS. The group knew that a public education campaign was going to be
necessary for effective implementation of the law. No official enforcement mechanism is as
effective as voluntary compliance and public demand.
Gold Country was also contractually obligated to do a Save a
Waitress campaign, as project director Sue Smith explained: In the
contract it says clearly ¦if AB 13 bar phase-in seems to be in jeopardy, the region will
create a campaign called Save a Waitress. We created the campaign. ¦We
sent scripts back and forth to TCS for approval, had one teleconference in which myself
and two of my staff sat in with some TCS staff and people from Rogers [TCS's public
relations firm], and they had a concern about a certain line that they thought might be
potentially lobbying, so we dropped that line and went a different direction.  It was common knowledge that the tobacco industry was trying to get
the law repealed and that DHS had long-standing regulations against lobbying
with Proposition 99 money:
Lobbying is communicating with a member or staff of a legislative
body, a government official or employee who may participate in the formulation of the
legislation, or the general public with the specific intention of promoting a yes or no
vote on a particular piece of legislation. Such communication is considered lobbying only
if its principal purpose is to influence legislation.
Educating legislators, their staff, government employees, or the
general public about your program or about tobacco-related issues in NOT lobbying.
The planned text of the advertisement was reviewed on a teleconference
with TCS on August 18. Some revisions were made, even though the advertisement did not
appear to violate the lobbying rules. It did not include a call to action, address a
particular piece of legislation, or express an opinion on a vote.
Gold Country's radio advertisement began airing on August 25, using the
Hi, I've been a bartender for a long time. When I worked in a smoky
bar, it was like smoking a pack of cigarettes a day. Did you know that bar workers are the
only employees not protected from secondhand smoke in the workplace?
Hi. I'm David Mendenhall. Sometimes my throat is so sore from the
poison in secondhand smoke that it hurts to sing with my band, Thicker Than Water. When
all other workplaces went smoke free, I thought bars were next. Now it may not happen in
I'm Laura Bass and I've been a cocktail waitress for years. When I
feel sick and complain about cigarette and cigar smoke, some say to work someplace else.
Where I work is not the issue. Staying healthy is.
We've listened to your stories and sympathized with your problems.
It's our job to serve you. Breathing secondhand smoke, though, should not be a condition
of employment ¦even for those of us who work in bars.
Smoke-free bars for California.
Sponsored by the Gold Country Tobacco Prevention Coalition through
Proposition 99 funds.
At the time, there was no pending legislation to modify AB 13. On August
28, 1997, the Assembly adopted language delaying smoke-free bars, which was sent to
committee for a September 2 hearing. If no legislation passed by September 12, the
deadline for the Legislature to act would pass. Gold Country
believed that the advertisement met the terms of the contract and the rules about
lobbying; TCS did not.
On September 5, April Roeseler, chief of the Local Programs Unit at TCS,
wrote Smith informing her that she had violated the contract rule prohibiting the use of
TCS funds to support lobbying activities. Roeseler also informed Smith that
TCS is not to be billed for any costs related to producing or placing this radio ad.
 Smith called Crocker Communications, Gold Country's media
subcontractor, with instructions to
pull the advertisement, but she was not happy with the decision.
According to Smith, I'm not a legal expert. But there's not a piece of the ad
that meets any definition of lobbying. 
Because the company had already purchased the air time, Crocker asked
Smith if she wanted to substitute an existing advertisement that had already cleared DHS
review. She told them to do so, then went on a weekend bicycle trip. Crocker picked what
was called the Mahannah advertisement, after the LLA director in Mono
County. The text of the Mahannah advertisement consisted of the following:
Violent coughing, heavy breathing and hacking becoming softer.
We're doing so much to keep California's indoor public areas
smoke-free. Now you can breathe easy in buildings, offices, restaurants and more. You
should be proud of yourselves for taking such good care of each other. Now we need to work
on the bars and nightclubs. Wouldn't you think?
(One single cough, male voice)
I thought so.
Smith came back to work on Monday to find a crisis. As she later
I'm off on a three-day bike trek and I come back and Jane [Hagedorn,
executive director of the Sacramento ALA] comes running over and says she just got a call
from DHS and that we were to report there in thirty minutes and to show how we had pulled
this from the airwaves or we pull your contract. Somebody apparently
heard that ad on Monday, made a number of phone calls. That's why we got pulled in there.
We were thinking we were getting pulled in for the Save a Waitress. So
we go to Save a Waitress and show the documentation from Crocker that
says, We pulled these advertisements. ¦However, these other
advertisements are still running and that's when things got really worse. After that
meeting a DHS representative (not from TCS) told me, You're history. 
Both advertisements were pulled, but ALA-SET continued to be concerned
about two aspects of the TCS letter. One was its broad definition of lobbying and the
dangerous precedent it would set. The other was the request to revise the contract to
remove the Save a Waitress piece. According to Smith, That
was considered by our local management team to be a cover-up by DHS and the Governor's
Office. Compromises were made on both sides, but the one thing that the ALA-SET management
refused to do would be to take it out of the contract. We were willing to concede the cost
of the ad initially, but were not willing to `make it go away.' 
On November 25, 1997, ALA-SET decided to go with the status quo
and accept a financial loss on the waitress ad, which meant that any
expenses incurred after August 18 could not be billed. Smith
had this observation: TCS was probably looking at the bigger picture. They
were fearful that if we spoke out about this issue, the state would look at every piece of
media that was ever distributed through Prop 99. I understood that fear. But I also think
that politically, that we could have played some more trump cards that I didn't get to
play. If I wasn't planning on staying around in this, I would have made a really big deal
about this. 
On December 16, 1997, Smith received a final follow-up letter from
Shimizu concerning an inappropriate use of Proposition 99 funds in the
production and placement of the radio ad, `Save a Waitress.' 
Shimizu warned Smith about her action: As you are aware, on August 18, 1997
staff at TCS advised you not to run the radio ad as you had drafted. However, you chose to
produce and run a version of the radio ad without any further contact with TCS staff which
resulted in the production of an ad deemed inappropriate for funding by Proposition 99.
For the record, this is to notify you that if inappropriate advertisements are produced
and placed in the future, your contract would be subject to termination. 
Whether TCS was merely echoing orders from above and making the best of a bad situation or
was independently asserting control over the field mattered little in terms of effect on
the program. According to Smith, I think it hurt all the regional efforts in
terms of media. ¦I think what bothered me the most was the lack of support by a system
that you've counted on being part of the solution with you. 
Far from being insulated from the politics of the program, the field was heavily buffeted,
and this buffeting extended to more than just local media programs. In Smith's view, this
buffeting came as a surprise: And I've heard different stories of who made the
phone calls ¦about whether they were tobacco lobbyists or particular legislators, but
there were two phone calls that were made. ¦That somebody can reach their fingers down
into a localized media campaign that's created via contract by local people, and could
make that go away. ¦And the intimidation was there at all times. 
The California Tobacco Survey: TCS Fires John Pierce
From the inception of the Proposition 99 programs, the Legislature had
funded a statewide prevalence survey, the California Tobacco Survey, to monitor the
program's impact on smoking and to identify which elements
363 of the program
seemed to be most effective. The survey was conducted for DHS by the University of
California, San Diego, and directed by Professor John Pierce. Pierce and his colleagues
had a record of finding politically unacceptable results beginning in 1991, when they
reported that the media campaign contributed to a 17 percent drop in smoking when Governor
Wilson was trying to eliminate the campaign on the grounds that it did not work.
Nevertheless, on December 8, 1997, TCS wrote Pierce and his co-investigator, Elizabeth
Gilpin, to inform them that TCS was amending their contract in order to extend
the time period through June 30, 2000 and to augment the contract by $3,052,332.
¦Essentially, the contract extension is for: the conduct of, analyses of, and reporting
on the 1999 California Tobacco Survey; the conduct of, analyses of, and reporting on the
longitudinal assessment of adolescent smoking initiation study; and the completion of
reports and additional analysis of the 1996 California Tobacco Survey. 
Six months later, TCS reversed itself. On June 15, 1998, TCS wrote the
UCSD investigators to tell them that TCS will not be renewing your contract to
conduct the 1999 California Tobacco Control Survey nor do we plan to fund your proposed
longitudinal study of adolescent smoking initiation. 
In the intervening months, Pierce and his coworkers had submitted a
draft report on the California Tobacco Survey concluding that, after 1994, the California
Tobacco Control Program had lost its effectiveness. TCS pressured the research group to
make changes to the report. Over time, the working relationship between Pierce's group and
TCS deteriorated. After TCS abruptly notified Pierce that the contract would not be
renewed, Pierce observed:
As I reflect on our experience with the State over the past year, I
can only conclude that the decision to terminate our contract was politically motivated.
Our difficulties with the Department of Health Services staff began when we did two
- a) Identified the coincidence between the halting of the decline in smoking behavior and
the diversion of money from the specific health education accounts mandated by the Tobacco
- b) Based on probabilities obtained from previous national and California research, we
projected that smoking rates in 15-17 year old adolescents in California were likely to
increase by 14% between 1996 and 1999.
Pierce's report concluded that the initial success of the program,
between 1989 and 1993, did not persist into the late period, 1994-1996. The
report suggested that a combination of reduced program funding,
increased industry advertising and promotion expenditures, decreases in tobacco prices,
and increased political activity contributed to the shift.
DHS asserted that Pierce's contract was not canceled because of the
work's quality but because Pierce was too difficult to work with.  Members of DHS's own Evaluation Advisory Committee, who supported
the quality of Pierce's work, also questioned the decision to terminate the contract but
received no better explanation. Mike Cummings, a cancer
researcher from New York and chair of the Evaluation Advisory Committee, wrote Bal and
Johnson on June 22, 1998:
Finally, as co-chair of the Evaluation Advisory Task Force, I would
like to express my deep dissatisfaction with the way the situation with Dr. Pierce was
handled. First, it became apparent at the June Evaluation Advisory Task Force meeting that
not all Task Force members were briefed on this situation and the concerns raised about
Dr. Pierce's report. This situation was unfair both to Dr. Pierce and to our task force.
Second, it is apparent that the decision to terminate Dr. Pierce's contract was made
before the task force meeting for reasons unrelated to the scientific issues that were
brought before the task force for discussion. It is an embarrassment that task force
members first learned about the contract termination from Dr. Pierce and not from CDHS.
The task force should have been notified of this decision before the meeting so that our
time could have been used more productively to advise CDHS about future plans for the
California Tobacco Survey. Third, it appears that you were attempting to use our task
force to raise concerns about the UCSD report in an effort to strengthen your case to
terminate Dr. Pierce's contract. Our task force members, who volunteer their time to
your program, should never have been put in this position.
An editorial in the San Diego Union-Tribune captured the
general outrage that greeted Pierce's firing:
Earlier this month, a report by UCSD researchers came to light which
concludes that California's anti-smoking campaign is coughing and wheezing for want of
state support. This prompted the state agency that commissioned the report to start taking
potshots at the messenger. Welcome to the world of power politics, where special interests
generally prevail against the public interest ¦ .
What we have here is not a failure to communicate, but a refusal to
capitulate. This report is scientifically sound while politically embarrassing to the
folks in Sacramento looking to undermine the anti-smoking campaign. They and their tobacco
buddies are doing whatever it takes, including attacking the integrity of respected
scientists, to gut a program approved by the voters. And that is despicable.
Cook, the chair of TEROC, however, refused to put the issue on the
TEROC agenda when Glantz requested that she do so. She responded, I have
considered the various facts and assertions that have been made and have studied the
responsibilities of TEROC, and have concluded that it is an internal administrative matter
which the Committee should not get involved in.  Cook's
decision to ignore Pierce's termination was all the more remarkable in light of an article
by Pierce and his colleagues that appeared in the Journal of the American Medical
Association the day before TEROC met; the article confirmed that the California
Tobacco Control Program had declined in its effectiveness beginning in 1994. These findings were widely publicized in the press on the morning of
the TEROC meeting, but no one at the meeting mentioned the news coverage or Pierce's
termination.[101-104] The courage to challenge the politicization
of the media campaign did not extend to the evaluation process, even though TEROC's
central purpose was to evaluate the campaign and report back to the Legislature on how to
At a project directors' meeting held in Palm Springs in June 1998, TCS
staffer April Roeseler, in a speech to the directors, commented that TCS's unspoken motto
was we hire people who believe you can never have too much stress. That
probably described the jobs of most project directors as well. For tobacco control
advocates, Proposition 99 was to be their opportunity to put in place a model program,
with its own funding source, that assured tobacco control advocates would be in the field
as continuously as the tobacco industry. That the political process would not give them
the freedom to produce that program was frustrating. One LLA director summed it up this
way: We had a pretty clear idea of what we need to do. ¦I think if the
campaign had been allowed to work the way it was designed to work, I think we would be in
pretty good shape. If we had a strong media campaign continuously and we had the counties
and schools funded continuously, if everybody had been able to work the way it was
supposed to, I think it would have been a lot more successful. 
The successes in California were instead achieved only in the face of a hostile tobacco
industry, an equally hostile political system, and a body of advocates at the state level
who were often slow to act.
The long periods with no advertisements or no new advertisements in the
media and the shift away from a hard-hitting campaign to softer,
messages reduced the effectiveness of the California Tobacco Control Program. The failure to implement a timely educational campaign about
California's smoke-free workplace law, particularly the bar provisions, has made it more
difficult to implement the law and, indirectly, supported tobacco industry efforts to
neutralize the law.
For the campaign to succeed in the long run, it is necessary for the
nongovernmental organizations, especially the voluntary health agencies, to be willing to
hold those charged with implementing the program accountable. This is often difficult for
them to do, since it requires acting against established political powers, not just the
tobacco industry. What is clear from the California experience, however, is that there are
as many opportunities for political interference with the anti-tobacco education program
through administrative actions as there are through the legislative process. Strong action
by outside groups is capable of influencing legislation and program content for the
better. Lacking such intervention, it is likely that in the long run the tobacco industry
will counter the program just as effectively through administrative controls as by
stealing the money.
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