Unfiltered Facts for Teenagers

Big fund takes frank approach to warn about tobacco’s dangers

Only a few blocks from the Washington Monument, and many of this city’s other memorials, a

two-story-high banner hanging from the side of a building bears a single word: truth. Under the banner, in an empty lot on a busy downtown corner, lies a pile of body bags — 1,200 of them to illustrate the number of Americans who die each day from illnesses caused by smoking.

The so-called Tobacco Memorial was created last month by the American Legacy Foundation, the largest and perhaps the most closely watched anti-smoking group in the nation.

The memorial is one of the latest in-your-face efforts sponsored by the foundation as part of its anti-smoking campaign aimed at teenagers.

The campaign, called “Truth” — which is costing Legacy $145-million this year-involves television ads, a Web site, and the so-called Truth tour, groups of teenagers driving giant, orange-colored vehicles across the country to tell other young people about the risks of smoking and the strategies tobacco companies use to market their products.

Nicole Voelkel, an 18-year-old Legacy volunteer from Tucson, who helped build the Tobacco Memorial, says she is impressed by the bluntness of the foundation’s approach.

“Everyone is like, Tobacco is bad. Smoking is bad. Blah, blah, blah, blah, blah. But no one is doing this,” she says, gesturing to the pile of body bags behind her. “This is hard to ignore.”

$1.5-Billion Pledge

The American Legacy Foundation is also hard to ignore.

Besides the money it is spending on the Truth campaign, the organization is distributing $50-million to support research on tobacco use, as well as other programs intended to discourage people from smoking or chewing tobacco, especially in public places.

The foundation was formed last year with a $1.5-billion pledge (to be paid over 10 years) as part of the $206-billion settlement negotiated in 1998 between five tobacco companies and 46 states. Most of the money from the settlement — which came after the states sought reimbursement for the cost of treating people with smoking-related diseases — is going to the states to use as they wish.

The money being poured into the foundation must be used largely to keep young people from smoking. But even though the organization has more resources than any other anti-smoking group has ever received, not all tobacco-control advocates are as sanguine as Ms. Voelkel about the foundation’s potential.

Some worry that the foundation will be hamstrung by a provision in the settlement that bars the organization from doing anything that could be construed as vilifying the tobacco companies that are footing the bill. And others fear that the foundation’s 11-member board, six of whom must be selected from the ranks of state governors, attorneys general, or legislators, may be somehow influenced by tobacco companies, which lobby heavily in state capitals.

“I’m not sure if the American Legacy Foundation will be a bedfellow — willing or unwilling — of the tobacco industry or set out the other way and make a difference,” says Scott Goold, director of TobaccoFreedom.org, an anti-smoking group in Albuquerque.

But even if the foundation is able to assert its independence — as Legacy officials insist the organization has — it faces other tough challenges, too. Among them is finding its role in the scrappy and decentralized arena of tobacco control.

“We are the 800-pound gorilla who is also the new kid on the block,” says Cheryl Healton, Legacy’s chief executive officer, who has worked in public health for more than 20 years, most recently at Columbia University, in New York.

“There are a lot of people who already have programs in place, federal programs, state programs, foundation programs, and we’re trying to find an appropriate niche.”

‘A Test of the Board’

The foundation introduced its first major effort in February when it started broadcasting television commercials on channels such as Comedy Central, which has high viewership among teenagers.

But 10 days later, Legacy pulled two of the ads off the air when some tobacco companies and state officials raised objections, saying the spots violated the settlement.

One of the controversial ads showed body bags being unloaded outside the New York headquarters of Philip Morris, the nation’s largest tobacco company and a participant in the settlement. The other showed a woman entering the company’s office building with a metal suitcase labeled “lie detector.”

According to the agreement, the foundation can not use the tobacco companies’ money for any “personal attack on, or vilification of,” any person, company, or government agency, whether individually or collectively. But yanking the ads prompted anti-smoking advocates and other observers to lambaste the foundation for buckling under the pressure from cigarette makers.

Two months later, Legacy put all the ads either back on the air or on its Web site.

Ms. Healton says the ads returned as soon as the foundation’s board had a chance to meet and discuss what to do about the criticism. According to the settlement, Legacy’s board not only has to include the six state officials, but five other people with expertise in public health, medicine, or child psychology.

“It was a test of the board, and they passed with flying colors,” Ms. Healton says of the decision to run the commercials. “It was also a test of the tobacco-control community because they put a great deal of pressure on the foundation, which, frankly, was helpful, because there was a lot of countervailing pressure . We are in a pressure cooker. That’s okay. We are up to it.”

Thomas Ryan, a spokesman for Philip Morris, says that the company supports the foundation’s goal — to reduce smoking among young people — but disagrees with some of Legacy’s tactics.

Declining to give details, Mr. Ryan says that the company finds some of the elements of Legacy’s public-education campaign “inconsistent with either the letter or spirit” of the settlement. So far, he says, Philip Morris has only stated its opposition, but the company continues to consider all its options — including withholding money — if it feels that the foundation violates the terms of the settlement.

Ms. Healton concedes that the foundation is keenly aware of the anti-vilification clause. But, she says, all the clause means is that lawyers must review Legacy’s materials so the organization can be prepared for any opposition. Ms. Healton insists the foundation won’t pull any punches when aggressive tactics are necessary.

Conflicted Loyalties

Some observers are not so sure.

Studies have shown that attacking the tobacco industry is an effective way to reach young people with an anti-smoking message. But, Legacy’s critics say, the elected state officials on the foundation’s board may be reluctant to attack cigarette makers or test the limits of the anti-vilification clause because crossing the line could mean jeopardizing the settlement.

Since the states are expecting billions of dollars from the tobacco companies over the coming years, they would have the most to lose if the settlement crumbled.

“What we have seen over the past year is that some Legacy board members are conflicted in their loyalties,” says a tobacco-control expert who asked not to be named. “Do they protect the flow of money to the states or stand up to the mission of the foundation?”

Christine O. Gregoire, chair of Legacy’s board and the attorney general of Washington state, was a lead negotiator of the settlement. She rejects the notion that she or her colleagues have competing loyalties.

“I’m not conflicted,” she says. “I got into this in the first place to stop teen smoking. That’s what the master settlement means to me and that’s what the foundation means to me. I fought tooth and nail for the foundation, and I will fight for its mission: to stop teen smoking.”

State Spending

Some tobacco-control advocates and public-health officials do not question such dedication at Legacy. They say that, if anything, they are concerned that the foundation may do its job too well. Those observers worry that if Legacy continues to make a splash with its advertising campaign, state lawmakers won’t see the need to spend other money from the settlement on efforts to discourage tobacco use.

That would be a mistake, anti-smoking advocates say. The Centers for Disease Control and Prevention recommends that the average-size state spend as much as $83-million each year on tobacco-control programs.

State officials who negotiated the agreement, including Ms. Gregoire, say they intended most of the money being split among the states to be used for such programs, especially those aimed at children.

Instead, many states plan to spend much of the settlement money on projects unrelated to tobacco use, such as highway construction and biomedical research. In some cases, lobbyists seeking money for other causes have pointed to the work of the Legacy Foundation as a reason that states don’t need to spend their own money on anti-smoking campaigns.

In Pennsylvania, for example, the Hospital & Healthsystem Association of Pennsylvania testified before a state Senate hearing last year about the value of spending settlement money on medical research. At the same time, the association’s president testified that the state should not allocate money to anti-smoking programs until it is demonstrated that the foundation’s efforts “are not successful in Pennsylvania.” The state has not yet decided what to do with the money.

For its part, the foundation has tried to make it clear that its programs are meant to supplement — not replace — anti-tobacco work at the state and local level. Last month, Legacy announced $35-million in new grants to support statewide anti-smoking campaigns aimed at young people. A requirement for state recipients: to provide at least a dollar-for-dollar match of the grant money from their share of the settlement.

The foundation is also collaborating with other charities and grant makers on programs that are already in place.

For example, Legacy has pledged $8-million over the next four years to run anti-smoking programs in conjunction with a program sponsored by the W.K. Kellogg Foundation, in Michigan, that provides health care and education to poor and uninsured people in 13 areas around the country.

Matthew Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group in Washington, says that one of the true tests for Legacy is how well the organization integrates its work with programs like the one at Kellogg and myriad tobacco-control efforts nationwide. He says that a mass-media campaign aimed at teenagers would be more effective, for example, if it were linked to local and school-based anti-smoking programs.

“In setting early priorities, Legacy focused on building staff, getting its public-education campaign off the ground, and taking steps toward building a youth movement,” Mr. Myers says. But, he says, “I’ve seen an increased emphasis on their part at integration in the last two to three months and an increased appreciation of integration.”

Ms. Healton notes that the foundation continues to consult with other non-profit groups that specialize in tobacco control and other health issues, and with public-health officials at the state and local levels. Plus, she says, Legacy is creating nine advisory panels of researchers, anti-smoking advocates, and other health experts that will meet for the first time by the end of the year.

By that time, too, Legacy expects to have a full-time staff of about 60 people, nearly four times the number it started out with at the beginning of the year.

Rapid Growth

The foundation’s assets are also growing fast. It has established a reserve fund — spending two out of every three incoming dollars — that officials say could balloon to $1-billion in the next eight years.

Legacy will almost certainly have to dip into those funds if it intends to keep spending at its present level.

The settlement guarantees the foundation a total of about $1.5-billion: $25-million a year through 2008 and five annual payments of about $250-million to $300-million each — the last one due in 2003.

After that year, the big payments will end unless the tobacco companies participating in the settlement account for roughly 99 percent of the total domestic cigarette market.

If their share of the market is that big, the companies will continue to make payments to the foundation based on a formula that takes into account inflation and the sale of cigarettes.

Foundation officials are not counting on that money, however. Besides establishing the reserve fund, they are working on ways to supplement Legacy’s income, such as by selling advertising space on the Truth campaign’s Web site.

Officials say it is unlikely that the foundation would do any fund raising, since the organization does not want to compete for gifts with other anti-smoking charities.

For now, Legacy is concentrating on the Truth campaign and getting its other programs off the ground. New this month will be proposal guidelines for small research projects, and a fresh batch of television commercials — one of which is set at the Tobacco Memorial, using the body bags as props. Still, some observers wonder whether the foundation has what it takes to fight the anti-smoking battle over the long term.

“Their ads are great and they have a good chance of working,” says William T. Godshall, president of SmokeFree Pennsylvania, about Legacy’s commercials. “But we could just as easily see them decide to water down the ads if they feel pressure to do that. We still need to wait and see if the Legacy Foundation has a real backbone.”

At a Glance: The American Legacy Foundation

History and purpose: Established in March 1999 as a result of the November 1998 deal — called the Master Settlement Agreement — between attorneys general of 46 states and five United States territories and five of the country´s biggest cigarette makers. Through advertising, educational, and research efforts, the group aims to reduce the number of young people who smoke; reduce exposure to secondhand smoke; and increase the number of smokers who successfully quit.

Finances: The group expects to spend about $200-million this year, including $145-million on an advertising campaign aimed at teenagers.

Source of funds: The Master Settlement Agreement calls for the tobacco companies to pay the foundation about $1.5-billion over 10 years. The payments will be made through three funds established by the settlement: a base fund, which will provide $25-million a year for 10 years, through 2008; an education fund, which will pay $250-million to $300-million a year for five years through 2003; and a smokeless-tobacco fund that will pay $85-million over 10 years. For each year after 2003 that the tobacco companies participating in the settlement account for at least 99 percent of the domestic cigarette market, the companies will pay the foundation additional money through the education fund. The payments, which could be around $300-million a year, will depend on a formula that measures inflation and the sale of cigarettes.

Key officials: Christine O. Gregoire, attorney general of Washington State, chairwoman of the Board of Trustees; Cheryl Healton, chief executive officer.

Address: 1001 G Street, N.W., Suite 800, Washington 20001; (202) 454-5555

Web sites: http://www.americanlegacy.org and http://www.thetruth.com