Tobacco Control in Transition: Public Support and Governmental Disarray in Arizona 1997-2007

• Tobacco control in Arizona flourished from 1997-2007, thanks to public support at the ballot box and the hard work of Arizonan tobacco control activists. • Arizona's state-run Tobacco Education and Prevention Program (TEPP), created by Proposition 200 in 1994 from 23% of a 40 cent tobacco tax increase, provided a key component in Arizona tobacco control, spending between $15 and $36 million annually. • Tobacco control advocacy between 1997 and 2007 resulted in more than tripling tobacco excise taxes from 58 cents to $2.00, enacting comprehensive local clean indoor air ordinances, defeating tobacco industry counter-initiatives, and passing Smoke-Free Arizona, Arizona's statewide comprehensive clean indoor air law. • Arizona tobacco control advocates instituted 18 local clean indoor air ordinances between 1997 and 2007. The tobacco industry has never won at the ballot box in Arizona, locally or statewide. • On November 7, 2006, Arizona became the 16th state to pass a comprehensive clean indoor air act. The law went into effect on May 1, 2007. The Arizona Department of Health Services enforces the law with revenues from a 2 cent tobacco excise tax included in the Smoke-Free Arizona initiative. Any tax funds not used to enforce clean indoor air go to Arizona's tobacco control program TEPP. • Tobacco taxes were raised to 58 cents per pack by Arizona voters in 1994. In 2002, voters raised tobacco taxes 60 cents to $1.18 per pack, with the revenue going to the Arizona Health Care Cost Containment System (AHCCCS). Tobacco taxes were raised again by voters in 2006 to $2.00 per pack with 80 cents paying for early childhood care. • Deciding how to spend Master Settlement Agreement (MSA) money was contentious and politically difficult, as illustrated by an unwillingness to compromise among the Legislature, Governor, and County Health Departments. Ultimately voters decided in November 2000 to allocate all of the MSA funds to AHCCCS to expand Arizona's medicare program to 100% the federal poverty level. No MSA money goes to tobacco control. • The Tempe smokefree ordinance, passed by initiative in May 2002, became Arizona's first 100% clean indoor air act including bars. Dr. Leland Fairbanks led the Arizona tobacco control organization Arizonans Concerned About Smoking (ACAS) to spearhead the successful effort and defended Tempe's smokefree ordinance against the ensuing legal challenges and attempted referendum by pro-tobacco groups. • Local efforts to pass other clean indoor air ordinances in Arizona often led to compromises that routinely exempted bars. Also, elected officials in Phoenix resisted adopting a smokefree ordinance despite tobacco control leaders' concerted efforts. Tempe's successful comprehensive clean indoor air act in 2002, however, paved the way with Guadalupe (2002) for Prescott (2003), Coconino County (2003), Flagstaff (2005), and Sedona (2006), to successfully pass comprehensive clean indoor air acts of their own. • In FY2002 Governor Jane Hull and the Legislature, looking for available funds during a recession period, diverted $60 million from the Health Education and Research Accounts, which fund TEPP and research on tobacco-related disease. These funds were never recovered. • To prevent further seizures of TEPP funds, in November 2002 voters passed the referendum Proposition 303 which increased the tobacco tax 60 cents (two per cent of which went to tobacco control) and re-enacted the original 1994 Proposition 200 tobacco control measure bringing TEPP under voter protection, preventing it from further legislative tampering. Voluntary health organizations now turned their attention from protecting TEPP funds to translating their electoral success into a comprehensive statewide smokefree campaign. • While TEPP expenditures exceeded the Centers for Disease Control (CDC) minimum recommended levels for state tobacco control expenditures (at the time, $27.8 million) from FY1999 through FY2001, in October 2007 the CDC increased its Best Practices estimate for Arizona to $68.1 million annually, a figure Arizona has not yet approached in its tobacco control spending. • In 2004, prompted by citizens (but not the ALA, AHA, or ACS), Arizona Legislator Linda Lopez (D-Tucson) introduced a statewide clean indoor air bill including bars into the Republican-controlled House. The bill, however, was assigned to three committees, denied a hearing, and died in the Commerce Committee. • In Arizona, the tobacco industry spent a total of $16,201 in direct campaign contributions between 1997 and 2006 on legislators, constitutional officers, and political parties. Tobacco industry lobbyists spent $25,367 on legislators during this period. Republicans received more than 5 times the tobacco companies' contributions as Democrats. • In the 2006 election cycle RJ Reynolds mounted an $8.8 million counter-initiative (Proposition 206, the Non-Smoker Protection Act) in an attempt to confuse voters and preempt local tobacco control. The campaign concentrated much of its resources attacking Proposition 201, the health group-driven Smoke-Free Arizona initiative. Despite Reynolds' superior resources and negative campaigning, 57.3% of voters rejected Reynolds' initiative, while 54.8% of voters approved Smoke-Free Arizona. • TEPP's media campaigns with Riester-Robb from 1996-2001 enjoyed commendations nationally. The TEPP-contracted ad agency sold over 2 million units of merchandise with the media campaign's tagline Tobacco: Tumor causing, teeth staining, smelly puking habit. In July 2001 the Arizona Department of Health Services (ADHS), which manages TEPP, did not renew the media contract with Riester-Robb, instead favoring the E.B. Lane agency. This rough transition from one agency to the next occurred just as the Legislature appropriated TEPP's funds, throwing TEPP into disarray, resulting in a dead year (approximately Fall 2001-Fall 2002) under the E.B. Lane contract when tobacco control media came to a virtual halt. E.B. Lane provided TEPP's lower intensity media campaigns from 2002 through 2005. From 2005 to 2007, TEPP did not coordinate media through a contracted ad agency, instead working on a more fragmented ad hoc basis. In late 2007, TEPP contracted again with the Riester firm, though with a smaller budget. • TEPP suffered from a lack of leadership since the program's inception, with a revolving-door Office Chief position, inconsistent directives from the ADHS, and overcautiousness concerning crossing the lobbying-advocacy/advocacy-education line. Between 2005 and 2007 every TEPP employee left, leaving the agency without many employees having any prior experience in tobacco control. As a result, many tobacco control advocates perceived TEPP as an ineffective program, not making best use of its resources. While TEPP leadership in 2007 painted an optimistic vision of TEPP's future, concrete programmatic action that reflects current best practices remains to be demonstrated.