Tobacco Control in Maine, 1979-2009: The Power of Strategic Collaboration

Maine has a small population, with a relatively high proportion of people living in the state’s major population centers, making Maine politics function more like a large city than a state, fostering bipartisan efforts to pass progressive tobacco control legislation despite the presence of tobacco industry lobbyist from the late 1970s throughout the 1980s. Credit for Maine’s successes in tobacco prevention and control can be attributed to two major factors: A cohesive and collaborative partnerships among tobacco control advocates with effective lobbying strategies (individually tailored campaigns rather than a one-size-fits-all approach) and diversified funding strategies. Since 1983, the Maine Coalition on Smoking or Health partnered with more than 100 state and municipal agencies, including the American Cancer Society, New England Division, the Maine Lung Association, Anthem Blue Cross Blue Shield, the American Heart Association, and the Maine Center for Public Health. Strong and consistent individual commitment to tobacco control, including support from the Maine Department of Health and numerous legislators, gave an advantage to tobacco control bills and laws. Early tobacco control legislation focused on the protection of indoor air, and struggled against powerful tobacco industry lobbyists. Throughout the 1980s and 1990s, the Maine legislature passed significant and progressive smoke-free air laws , including but not limited to smoke-free restaurants (1999), bars (2003), and cars (2008), as well as tobacco excise tax increases (the latest, in 2005, raised the excise tax from $1 to $2 per pack) and the establishment of a state tobacco control program. Tobacco control advocates in Maine were successful because they were able to sell a collective vision to health organizations in the state, and convinced these organizations to give up a little for the greater good of Maine’s residents. Tobacco prevention and control efforts did not begin in earnest until the mid 1990s, when Maine was faced with highest youth smoking rates in the country. In 1997, Maine’s network of health advocates worked with Governor Angus King (I), to promote a tobacco excise tax increase to fund a tobacco prevention and control program. This success was followed in 1999 with the statewide smoke-free restaurant bill, and smoke-free bars in 2003. By 2008, cars and outdoor dining areas were also smoke-free, passing easily without significant opposition from tobacco industry lobbyists. After the tobacco excise tax was doubled in 1997, Maine experienced with a dramatic reduction in youth smoking rates from 35% in 1997 to 20% in 2003. Adult smoking rates also declined steadily in Maine from 25% in 1996 to 18% in 2008. This was accomplished mainly through the state quit line along with the Partnership for a Tobacco-Free Maine’s (PTM) media campaigns targeting parents and adults. Despite the successes of the state tobacco control program, PTM at reducing youth smoking, the program’s narrow focus was at the expense of other vulnerable demographics, most significantly, young adults age 18-25. In 2007, 35% of young adults in Maine smoked at rates similar to 1992 levels (35%). Maine’s tobacco control advocates have worked tirelessly to protect the Fund for a Healthy Maine (FHM), Maine’s funding mechanism for the Master Settlement Agreement (MSA), the result of the 1998 lawsuit filed against the major US tobacco companies, which secured more than $40 million annually for the state. The statewide support of the FHM has been a result of the careful orchestration of the FHM’s diverse funding structure that has enlarged the circle of recipient beneficiaries. In 2001, PTM began receiving funds from the Master Settlement Agreement. Because of these funds, despite severe budget shortfalls since 1998, the PTM reported that tobacco control in Maine was funded at or just short of the CDC Best Practices for Comprehensive Tobacco Control Recommended Guidelines each year. In 2008, the Maine Center for Disease control acknowledged that their tobacco control funding, dedicated by the Legislature from the FHM, had been allocated to fund a variety of chronic disease programs in addition tobacco control, and that their reported spending had not been accurate. A portion of tobacco control funds were either unaccounted for or had been allocated to chronic disease programs. Beginning in 2009, PTMs accounting reflected the actual reduced funding level for tobacco control. The Partnership for a Tobacco-Free Maine’s misrepresentation of spending resulted in the diversion millions of dollars from tobacco control to other healthcare programs since 1999. Despite the state’s successes in reducing youth and adult smoking rates, there is a significant amount of work to be accomplished. To continue to reduce the burden of tobacco-induced disease, PTM must increase spending for tobacco prevention and control, and fund programs at levels recommended by the US CDC Best Practices for Comprehensive Tobacco Control Recommended Guidelines.