Tobacco Road Block: The Impact of a Grant to Stop Kids From Smoking

In 1999, the Robert Wood Johnson Foundation gave $50-million to the National Center for Tobacco-Free Kids — one of the largest grants made by any foundation

that year — and to this day it is still the largest single grant that the foundation has bestowed on a single entity.

The grant, which was distributed over the past five years, followed a $20-million grant that the foundation provided in 1996 to start the organization, now known as the Campaign for Tobacco-Free Kids. The charity mounts an array of advocacy activities to reduce the number of youngsters who smoke — a continuing challenge, despite progress made in recent years in achieving its goals.

The foundation felt compelled to create its own organization to tackle smoking, says the grant maker’s spokesman, Joe Marx.

“Tobacco was, and is, the No. 1 preventable cause of death and disease in this country, and as a health and health-care foundation, our president at the time felt like we had a responsibility to do something about it,” says Mr. Marx.

The anti-tobacco movement lacked a well-financed central source for communications, advocacy, and public-policy research, says Mr. Marx. “On the other hand, there was a very powerful, well-funded tobacco industry that was spending billions to promote its products,” he says. “We were like Afghan rebels shooting darts at Russian tanks. Until we built a stronger, more sophisticated united front, we didn’t have a chance.”

Since the Johnson Foundation created its anti-smoking group, a 1998 legal settlement with the tobacco industry has poured billions of dollars earmarked for public-health efforts into state coffers and created the American Legacy Foundation, an operating foundation in Washington with a $160-million annual budget (compared to the Campaign’s $15-million) that works to educate the public about smoking’s dangers.

In subsequent years, smoking rates among teenagers have declined, and several states, cities, and counties have enacted tougher tobacco-control laws. Although Joel London, spokesman for the Office on Smoking and Health at the Centers for Disease Control and Prevention, says he can point to no proof that nonprofit efforts are directly responsible for those changes, he believes the Campaign deserves at least partial credit: “We know that the policy issues and interventions that the Campaign promotes — increasing excise taxes on cigarettes, for example — do work.”

Likewise, the tobacco manufacturer Philip Morris USA, in Richmond, Va., says that the Campaign has had an impact. “According to the CDC, youth smoking rates are at their lowest point in a generation,” says Jennifer Golisch, a company spokeswoman. “We think that’s great news, and it’s due in part to the efforts of the Campaign, the American Legacy Foundation, and other groups.”

Spreading the Word

Although the Campaign for Tobacco-Free Kids has had other benefactors — currently, it receives money from the American Cancer Society and the American Heart Association — the Robert Wood Johnson Foundation has covered most of the Campaign’s $15-million annual budget, contributing $10-million per year from the 1999 grant. (In October, it announced plans to give the Campaign an additional $14-million over the next three years.)

Most of the Robert Wood Johnson Foundation’s funds have been spent to promote the three major goals of the Campaign: to keep the issue of smoking in the public eye; to identify public-policy changes that would decrease smoking among young people, and to expand and strengthen the network of advocates who push for tobacco-control policies. The only major aspect of the Campaign’s work the foundation money does not support is its efforts to lobby policy makers, says William V. Corr, the organization’s executive director.

About a third of the group’s budget — the largest slice — is devoted to communications-related activities, which include traditional advertising, as well as publicizing research about public policies that deal with smoking, says Matthew Myers, president of the Campaign for Tobacco-Free Kids.

As an example of why such efforts are vital to his group’s mission, he points to a research study, financed by the Robert Wood Johnson Foundation, which was published in last month’s issue of the American Journal of Public Health. The study documented the number of Americans who would stop smoking and the number of lives that would be saved if every state spent the amount recommended by the Centers for Disease Control and Prevention on smoking-prevention programs.

Before the study’s results were released, the Campaign worked with researchers to figure out how many lives would be saved in each state; the day the study was published, he says, the Campaign distributed tailored news releases to local advocates, who then used them to bolster their cases to the news media.

“If Robert Wood Johnson had funded only the research that appeared in the American Journal of Public Health, four scientists would’ve seen it,” says Mr. Myers. “But because of the role we have an opportunity to play, we’re able to ensure the research gets the attention it deserves, gets translated into language that is easily understood, and gets put into the hands of advocates and decision makers who can make it part of the larger public-policy debate.”

Indeed, the press release received so much attention in New York that Mr. Myers was asked to personally present the research findings to a state legislative committee meeting.

Identifying Activists

The second largest chunk of the Campaign’s budget, approximately 25 percent, goes toward building a network of people who are concerned about reducing smoking. Thus far, Mr. Myers says, it has identified 350,000 such individuals online, who can be reached by state and local advocates for the cause. It also links the 150 most active among them nationwide via a virtual think tank, a password-protected Web site called Smart Talk.

Approximately 15 percent of the group’s budget pays for public-policy research activities. The Campaign’s Web site (http://www.tobaccofreekids.org) contains the fruit of these efforts, a comprehensive collection of tobacco-related statistics. The research department also provides customized data about an array of smoking-policy issues.

“If, for example, there is a debate in any state about what the impact would be of raising a tobacco tax by any amount of money, within an hour we can tell them how many fewer kids will start smoking, how much state revenue will be generated, and what the impact will be on Medicaid costs,” says Mr. Myers.

Changing Times

Since the Campaign for Tobacco-Free Kids was created, the percentage of teenagers who smoke has decreased sharply. In 1996, for example, 49 percent of eighth-grade students reported that they had tried cigarettes, compared with 28 percent who said they had done so in 2004, according to data released in December by the National Institute on Drug Abuse and the University of Michigan.

Additionally, over the past few years, seven states and a growing number of cities and counties have enacted laws that prohibit smoking in public buildings, and 38 states, as well as the District of Columbia and Puerto Rico, have increased excise taxes on tobacco products.

The Campaign’s efforts have led to a greater awareness of the hazards of youthful smoking, says Cheryl Healton, president of the American Legacy Foundation. “That has been their contribution: putting the problem on the map,” she says.

Although both groups work toward the same goal, their division of labor is clear, Ms. Healton says. “We have a strict no-lobbying provision. Much of what they do, we can’t do,” she says. In addition, she says, “to be blunt, there’s the matter of scale.” She notes that her group, whose budget is more than 10 times the Campaign’s, often buys expensive advertising on television and other mass-audience media, while the Campaign takes a more grass-roots approach.

Despite their successes, Mr. London, of the Centers for Disease Control, says the Campaign and other tobacco-control advocates should not rest on their laurels.

“Even though we’ve seen our youth numbers drop to the lowest levels since we’ve been tracking them, there is concern that we may soon start to see those numbers move back upwards,” says Mr. London, pointing to data showing that from 2000 to 2002 the percentage of middle-school students using tobacco products has remained unchanged.

The strength of the tobacco industry is a huge obstacle, he says. The industry spent $12.5-billion in 2002, the last year for which figures are available, on advertising and promotion, according to the Federal Trade Commission — up from $5.7-billion in 1997, the year before the industry’s legal settlement with the states.

Funds for the Future

Money is very much on the minds of the Campaign’s leaders — and also on those of the American Legacy Foundation’s executives. The foundation, which received its last payout from the tobacco-industry settlement in 2003, will have no more income from that source as of 2009, says Ms. Healton. In preparation, it has been cutting its budget by $10-million to $20-million each year, reducing the number of grants it awards, and preparing to conduct its first capital campaign.

The Campaign for Tobacco-Free Kids, meanwhile, is also looking to cast a wider net in its search for revenue, says Mr. Corr, its executive director. Although he says the organization has not set a fund-raising goal, it will involve intensified appeals via direct mail and to companies and foundations.

“Given the [Johnson] foundation’s contribution, we didn’t have a real active fund-raising department with which to go into the future,” he says. Now, “we’re using all potential sources to sustain ourselves.”

Although the Johnson Foundation has begun focusing increased attention in recent years on its efforts to reduce childhood obesity — planning to spend $14-million to investigate ways to improve nutrition in children and teenagers, for example — Mr. Corr says that his group’s efforts to do more fund raising have nothing to do with its benefactor’s shifting priorities.

Instead, he says, it is merely an effort to ensure his group’s continued financial health: “We don’t expect any foundation to support us into perpetuity.”

Groups like the Campaign will need to stay in the fight against tobacco use, says Mr. London. “Despite the successes of the last five years, there is still a lot of work to do,” he says. “The continued efforts of organizations like the Campaign for Tobacco-Free Kids and the Robert Wood Johnson Foundation are an important part of helping make sure that the progress we’ve made doesn’t start to slip backwards in the years to come.”

Heather Joslyn contributed to this article.