Shaping Tobacco Control in
Louisiana: Then and Now
Dr. Charles L. Brown, MD
LSU Health Sciences School of Public Health
March 27, 2007
Overview and Introduction
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Tobacco is the great public health story of our country
The cigarette has made more money and caused more
illness than any other consumer product
The science of the manipulation of this agricultural product
into a deadly drug delivery system needs retelling over
and over.
The control of tobacco use has evolved over many years
and has involved health promotion, legislation, litigation
and regulation and is still unsolved.
All interested in public health need to study the story of
tobacco control to devise new approaches to the control of
use and how this may be applied to other health related
problems.
Overview and Introduction
Impact of monthly tobacco sales on the
state of Louisiana
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High school students who smoke
25%
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Adults who smoke
22.6%
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Adults who die each year
6,400
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Second hand smoke deaths
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Direct health care costs
610-1090
$1.47 Billion
Overview and Introduction
Impact of monthly tobacco sales on the
state of Louisiana
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State Medicaid program
$663 million
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Productivity losses
$1.91 Billion
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Louisiana marketing
$285 million
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Per pack subsidy
$8.00
Louisianans’ Contribution on the
adverse effects of tobacco use
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Dr. Alton Ochsner, MD
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Dr. Jack Strong, MD
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Elizabeth T. H. Fontham, MPH, Dr PH.
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Dr. Sarah Moody-Thomas, PhD
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The Castano Group
National Milestones of
Tobacco Control
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January 1964- The Surgeon General’s Report
that points out the health hazard of cigarette
smoking
July 1965- The Federal Cigarette Labeling and
Advertising Act
April 1970- The Public Health Cigarettes Smoking
Act of 1969
1982- The Surgeon General identifies cigarette
smoking as the chief preventable cause of death.
October 1984- The Comprehensive Smoking
Education Act
National Milestones of
Tobacco Control
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October 1987- The CDC estimates 315,120
deaths per year result from cigarette smoking.
Subsequently raised to 430,000.
December 1987- Congress bans smoking on
domestic flights of two hours or less.
November 1989- Congress bans smoking on all
domestic commercial airline flights
July 1992- The Synar Amendment prohibits sale
of tobacco to 18 and under.
February 1994- Commissioner David A. Kessler
of the FDA announces intention to regulate
cigarettes because of the nicotine.
National Milestones of
Tobacco Control
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May 1994- Mike Moore sues to recover cost of
Medicaid expenditures caring for tobacco related
illnesses.
June 1997-1998- Attempt to get Congress to
approve the settlement between the tobacco
companies and the AG’s. This failed
June 1997- Mississippi, Florida, Texas and
Minnesota settled with the tobacco industry
August 1998-Fourth Circuit ruled that the FDA
lacked jurisdiction over tobacco.
November 1998- Master Settlements Agreement.
National Milestones of
Tobacco Control
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September 1999- Department of Defense
files a civil lawsuit against the tobacco
industry. A year later the case proceeded
under RICO. The final judgment was in
2006.
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March 2000- The Supreme Court ruled that
the FDA could not regulate tobacco.
State Milestones of
Tobacco Control
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1983- Louisiana Clean Indoor Air Act with a
pre-emption clause
1986- Allows for smoking in all areas of the
Superdome EXCEPT for the arena.
June 1997- Senator Ullo’s bill regulating the
sale of tobacco
June 1998- Attempt to raise the excise taxfailed
November 1998- Master Settlement
Agreement
State Milestones of
Tobacco Control
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June 1999- Attempt at Statewide Tobacco
Control Program- Failed
October 1999 Constitutional Amendment –
Millennium Trust Fund
June 2000- Increase excise tax by 4 cents
until 2002
June 2001- Attempt at pre-emption repealFAILED
2001- Securitization of 60% of MSA.
State Milestones of
Tobacco Control
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2002- Special session- Created the
Louisiana Cancer Control Consortium
June 2002- Increase of the excise tax by 12
cents and renewed 4 cents
June 2003- Prohibits smoking in all areas of
the Superdome; Change if the wording of
pre-emption but not repeal
State Milestones of
Tobacco Control
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July 2003- Creation of TFL and LPHI
contract
June 2005- Attempt to increase excise tax
and repeal of preemption failed
June 2006- Act 815- The New Clean Indoor
Air Act and the repeal of pre-emption.
A Long Time Ago-June 1964
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Prohibition of sale to minors
Taxation of the product
Labeling with health effects
Advertising prohibition
Counter Advertising
Education
Cessation efforts
Legislation versus Litigation
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Policymaking by legislation
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Policymaking by litigation
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Adversarial legalism
WHAT NEXT?
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Tobacco has lost its bloom
Look again at the pharmacology of
addiction and explore new drugs that
interrupt the changes in the
neurotransmitters of the brain
Revisit the whole problem of youth use.
What have we learned from the past that
we can change in the future?
WHAT NEXT?
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Is there any possibility to examine the MSA
and the dependence of the States on this
income stream?
Explore in detail the subsidization of the
tobacco industry in which we care for those
made ill rather than having them pay up
front for their eventual illness.
Look again at the cessation effort with
particular attention to those groups with
excess use to target the efforts.