"I smoked my first cigarette and kissed my first woman on the same day. I have never had time for tobacco since."

~Arturo Toscanini 1867 - 1957: Observer, 30 June 1946

Community Advocates in Action

North Carolina attorneys general Roy Cooper and 28 other state attorneys general banded together and threatened to file a joint lawsuit against Brown & Williamson Tobacco Company for their “Kool Mixx” marketing campaign and Kool cigarettes. Brown & Williamson used images from the popular hip-hop culture that depicted images of rappers and DJs and that targets African American youth. Kool cigarettes have been found in convenience and other retail stores in urban areas. The marketing campaign includes CD-ROM with music video, games, radio headset and advertisements that were placed in magazines with a high youth readership such as Vibe, Ebony, Jet, Entertainment Weekly and Rolling Stone.

In a recent development, Brown & Williamson agreed to scale back their “Kool Mixx” marketing campaign and Kool cigarettes because of a complaint letter from the Attorney General of Maine, Steven Rowe, who is responsible for enforcement of the Master Settlement Agreement (MSA). 

Attorney General Steven Rowe stated that ”Brown & Williamson’s actions in placing advertisements in stores and in magazines with high youth readerships, despite the advertising undeniable youth appeal, the well-known high youth exposure to advertising in retail stores, and the availability of alternative advertising venues that eliminate or greatly reduce youth exposure, constitutes youth targeting in violation of section V.A of the Consent Decree and section III (a) of the MSA."

Although Brown & Williamson has agreed to scale back their program, the National African American Tobacco Prevention Network (NAATPN) is still encouraging the African American community at the grass roots level to take action. NAATPN wants to ensure that Kool cigarettes are completely removed from shelves across the country, and the only way to do that is to get local community groups involved.

Question Why Central youth group out of Durham, North Carolina joined the fight by participating in Operation Storefront. Youth conducted surveillance of 65 local stores to determine which stores were selling Kool cigarettes. Question Why wants to educate and bring attention to Kool cigarettes and their appeal to youth. Their goal for Operation Storefront is to get management to voluntarily remove Kool cigarettes from the shelves to limit youth access to this product.  

Join the fight and get involved. Send your activities to fightkool@naatpn.org. For more information about the Kool Mixx campaign, go to www.naatpn.org.

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Spit Tobacco is Not a Safe Alternative to Smoking

By Paul M. Turner Jr.
Director, North Carolina Spit Tobacco Education Program

Today the manufacturers of spit tobacco products are touting dip and chew as a safe alternative to smoking and as a harm reduction tool. Some faculty members at institutions of higher learning are also making this assertion. It should be pointed out that many of these researchers are receiving funds either directly or indirectly from the manufacturers of spit tobacco products.

As more laws are passed restricting smoking in the workplace, bars, restaurants, airplanes, etc., smokers are looking at alternative ways to get their nicotine. This presents a real opportunity for manufacturers of spit tobacco products. According to the Federal Trade Commission, the advertising budget for these companies between 1985 and 2001 increased from $80 million to $237 million. During the same time period, revenues went from $730 million to $2.1 billion.

Spit tobacco products are just as addictive as smoking products, and in fact some snuff products appear to be more addictive. The rate of nicotine absorption through the oral mucosa from snuff is especially rapid, as the high PH of salvia provides a favorable environment. One pinch of moist snuff can contain the same amount of nicotine as smoking 2-5 cigarettes. A person who dips 8-10 times per day is receiving the same dose of nicotine as from smoking 30 to 40 cigarettes.

There are certainly many more deaths per year from smoking than from spit tobacco use. However, spit tobacco is not a safe alternative to smoking. Spit tobacco contains more than 2,500 different chemicals; 28 are known to cause cancer. Common oral health problems associated with spit tobacco use are dental caries, gingivitis, periodontal disease, and luekoplakia (which appear as white patches in the mouth). There is a 5% chance that leukoplakia will develop into oral cancer. In addition, users will have more frequency of hypertension, strokes, cardiovascular disease, acid reflux, stomach disorders and peptic ulcers. A spit tobacco user is 50 times more likely to have oral cancer than a non-user.

Therefore, health professionals must be aware that tobacco is tobacco; nicotine is nicotine; and health consequences are health consequences. It doesn’t make a difference whether you smoke it, dip it, chew it, or inhale it. An office protocol for tobacco users is needed to better manage patients. Spit tobacco is not a harm reduction tool, but a dangerous product. Patients need to be educated that they need to quit and about cessation methods that are available to help them.


Paul M. Turner, Jr. is Southeast U. S. Director of Oral Health America’s National Spit Tobacco Education Program (NSTEP) and Director of the North Carolina STEP. He is also working as a principal in establishing a spit tobacco education program in Alberta, Canada. He resides in Canton, N.C.

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Enthusiasm Runs High at Youth

Leadership Institute

An empowering statewide Youth Leadership Institute on Preventing Teen Tobacco Use was held March 12 –14, 2004 at the Sheraton Hotel in Research Triangle Park. The Institute was conducted through a partnership between the N.C. Health and Wellness Trust Fund Commission (HWTFC) and the Tobacco Prevention and Control Branch (TPCB). The event was the culmination of six months of strategic planning, with youth involvement, which began with a day-long planning retreat on Saturday, November 1. 

This very successful Institute involved 312 youth participants and 223 adult participants, for a total of 535 diverse participants representing youth/adult teams from 62 counties.

The event was designed to provide in-depth, interactive leadership training and skill-building courses for youth and adults to create youth-driven, adult-supported tobacco use prevention work plans designed to impact the HWTFC teen tobacco prevention and cessation objectives.

The agenda kicked off with an insightful Teen Town Meeting led by North Carolina student leaders and Bill Corr, Executive Director, Campaign for Tobacco-Free Kids, regarding solutions for prevention teen tobacco use.

On Day 2 of the Institute, Lt. Governor Beverly Perdue unveiled the new Tobacco Reality Unfiltered (TRU) television ad campaign and new website. A major highlight was having Anna Booth, a Charlotte teen who appears in one of the ads, to present on behalf of the TRU Campaign. Anna’s television ad captured her personal testimony about her grandmother who died of a tobacco-related disease. Her story touched the heart of everyone in attendance.  In addition, Anna presented Lt. Governor Perdue with a large card signed by everyone at the meeting and praised her for her strong support and leadership. This plenary session received tremendous positive feedback--receiving the highest overall evaluation from participants.

Day 3 focused on team action planning lead by Question Why (?Y) staff and TPCB Regional Field staff.  Participating youth/adult teams developed local action plans around the HWTFC teen tobacco prevention and cessation objectives. These plans are linked to a 6-month follow-up evaluation for the Institute.   

The closing rally was tremendous, with teams sharing their action plans and a great closing video produced and edited by Ruiz Agency, as well as ads produced by the two television production mini-courses.  Please visit the TRU website at www.realityunfiltered.com for photos and video from the Institute.      
 
All the participants – youth, adult leaders and staff – should be applauded for their dedication and commitment.  The participants left energized and reunited in the tobacco prevention movement.  The rally ended with everyone singing “AIN’T NO STOPPING US NOW… WE ARE ON THE MOVE!!”

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Tobacco-Free Schools Leadership Forums

Reach Out to School and Community Leaders

Since 2002, schools have become an increasingly popular rallying point for the tobacco prevention movement in North Carolina.  The logic is clear.  Eliminating access to tobacco products and creating opportunities for peers and adults to “role model” healthy behavior leads to a decrease in youth tobacco use. Diminishing exposure to secondhand smoke leads to healthier students; healthier students learn better.

Currently, 36 (31.3%) of North Carolina school districts have adopted a 100% tobacco-free school policy. This represents a 177% increase since 2002.

Since the last The Voice Box issue, two more school boards, Stanly and Catawba, have passed the policy on the first reading. They should join the list of 100% tobacco-free school districts in summer 2004.

Several more votes board presentations are coming up as North Carolina communities rally to develop tobacco-free school policies. It is indeed a grassroots phenomenon – driven by school, health, youth and community leaders – that continues to build momentum across the state.  Today nearly 600,000 (42.5%) students attend a 100% tobacco-free school district in our state.  

The Tobacco Free Schools Program recently held Leadership Forums in Weldon, Pinehurst and Elkin.  Conducted in collaboration with local Health and Wellness Trust Fund Commission (HWTFC) and its tobacco prevention grantees, the Leadership Forums provided an opportunity for key school and community leaders to learn how this policy can decrease student health risk behavior, support academic success, prevent tobacco use initiation, encourage cessation, and change the culture of the school district to promote healthy students, staff and environments.

The panel discussion included superintendents and principals from tobacco free-school districts sharing their experiences and encouragement.  Dr. Melva Fager Okun from Quit Now! NC also offered information on opportunities for school staff cessation. Nearly 160 superintendents, school board members, health directors, principals and others attended. Thanks to CapStrat, the forums generated excellent press coverage, including several articles and op-ed pieces, which meant the message about the benefits of a tobacco free school district reached thousands.  

Generous funding from the HWTFC has contributed to the success of these other activities:

•  $75,000 in minigrant funding has been awarded to school and community groups working to adopt or enforce a 100% tobacco free school policy.
• The program website – nctobaccofreeschools.dph.ncdhhs.gov – is being finalized and should be ready to launch very soon.
• The very successful pilot of the Tobacco Free School Signs Project, which provides free signage to school districts that adopt the “gold standard” policy, has been expanded.  A range of signs that communicate the 100% tobacco free school policy are now available to all 36 eligible school districts.

For more information on the Tobacco Free Schools Program, please contact Suzanne DePalma, Director, at (919) 715-4409 or email.  

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Bookshelf of a Tobacco Control Expert                                                     

(As a feature of The Voice Box, members of the Tobacco Prevention and Control Branch will recommend books on tobacco and related topics. Feel free to send in your own recommendations to Julie Helsabeck for inclusion in a future issue!)

The selection below is recommended by TPCB Epidemiologist Scott Proescholdbell:

Thank You for Smoking by Christopher Buckley.  A hilarious book of fiction about a PR executive that sounds a little too real.  A fast read for those in public health and a must read for those who need a little levity in their occupation. The life and times of  a tobacco industry public relations specialist is depicted in a humorous detail and should be read by tobacco control practitioners everywhere.

These selections are recommended by TPCB media and secondhand smoke consultant Ann Houston:

Trust Us, We’re Experts! (How Industry Manipulates Science and Gambles With Your Future) by Sheldon Rampton and John Stauber. This troubling, eye-opening book (by the authors of another good one,  Toxic Sludge is Good for You!) shares case studies of public relations and its use of “experts” to improve corporate profits at the risk of the public good, and often public health. Along with many mentions of the tobacco industry and its history of “junk science” is a chilling explanation of the industry’s response to the release of the 1993 EPA report declaring the health dangers of Secondhand Smoke. The whole book is fascinating, and makes you think twice about all the messages we receive from corporate America.

Civil Warriors: The Legal Siege on the Tobacco Industry by Dan Zegart. This is an insider’s view of the litigation that eventually led to the Master Settlement Agreement and an up-close look at the players involved. You will meet Ron Motley, the product liability lawyer who decided – for personal as well as financial reasons – to go after the tobacco companies. This is a fascinating page-turner that tells the stories of whistle-blowers who were terrified of retaliation from an industry fighting for its life. This book is a true story that reads like a novel. I couldn’t put it down.

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Urban Legends Exposed: Cigarette Butts

(As a regular feature in The Voice Box, we address Urban Legends about tobacco that we hear circulating in N.C. and give the real information to correct them. If you have any questions you’d like this column to address, email Julie Helsabeck)

Myth:          Cigarette butts are biodegradable, so throwing them out the car window is not a problem.

Reality:       First and foremost, lit cigarette butts are a fire hazard and every year numerous fires are started as a result of discarded cigarette

butts thrown from passing vehicles.  Second, aside from being unsightly, they can be a hazard to wildlife in aquatic environments, where toxins can leach into the water system.  Cigarette butts have been found inside the bodies of fish, birds and small animals, who mistake them for food.

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  Youth Talent

(Editor’s Note: Thadene Peace of Wake County won the talent show that was part of the Youth Leadership Institute held on March. She won by reading an original poem. Here is her untitled tobacco poem.)

He came into my home with no invitation
the tendency shown to me wasn't
much of an explanation
First he crept into my mothers room and polluted her heart
It didn't sit to well with me this unforgiving start
She opened up her heart for this constant friend indeed
An appetite greater than you know to fulfill her every need
My mom becomes stressed with no money to pay the bills
no water no heat do you have any idea how it feels
 living in the dark but money was found for a smoke
She smoked while i froze my love she revoked
The smallest thing made her upset/the promise he made was obviously not met
I realized she needed more of what I did not know
All I felt around my home was nothing like a glow
 Taking in information on this man made creation; plaguing the nation
death dealer family killer my mind in constant rotation
My sister came to me one day with water in her eyes
She began to tell me the truth
For once i wished for lies
Knowing for a fact that tobacco is a gateway drug
Who knew the gate would lead the path straight to the one I love
crack cocaine drove my mother insane
surprisingly enough I was the blame
As a family crumbled no need to look at me funny
Tobacco is a drug that gets high off your money
My story my rhyme
my words every line
last I heard it was said that killing is a crime
Tobacco started this and no doubt it will end
Do you have any idea how hard it is to get a shattered heart to mend
Words can't explain what being here means
with all my troubles I'll never let tobacco intervene
I refuse to let tobacco kill my mother
the prison bars have already taken my father as well as my brother
Tobacco can handle the death rate no need to kill each other
Words can't explain what being here means
I would love for my mom to be around to watch me conquer dreams
To bad T-o-b-a-c-c-o took my mother never to let her go
Handle your business is what they say to me
to get my point across I'll put my business all in the streets
If we don't do it now tobacco will control
a world we thought was made from steel now it begins to fold
our kids are pressured to smoke and tobacco company's say it's okay
As longs as we lay on the ground they continue to step on our backs
So we unite and build a strong force and ask them what they think about that
They say we are the future we decide our fate
now or never tomorrow may be too late
Think if your mother was mine with problems of the same kind
rise above this obstacle get ready it's time.


By Thadene Peace

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(Editor’s Note: If you have a web site you would like to recommend, send it to Julie Helsabeck,and we will consider it for a future issue.)


This issue’s website is www.QuitNet.com

Tobacco use cessation takes many forms. Counseling can take place in groups or individually, on the phone or face-to-face. Now cessation counseling can be as nearby as your computer.

Thanks to the Internet, tobacco users now have a new resource available to them to aid tobacco use cessation: the web-based cessation program.  One of these programs, QuitNet, uses cessation methods proven by the U.S. Public Health Service (PHS) to be effective. QuitNet focuses its counseling on the PHS Clinical Practice Guidelines for tobacco use cessation.

Launched in 1995, QuitNet operates in association with the Boston University School of Public Health and is located at www.quitnet.com.

Two types of programs are offered on the site: Basic and Premium.  The Basic service is free and provides a quitting guide, support forums and "Q-mail", a type of email support from other QuitNet members.  For $39.95 for the first 3 months and $9.95 per month thereafter, members can receive the Premium service.  This adds to the basic service by providing personal advice from a QuitNet counselor, personalized medication support, customized quitting tips and guides, a tailored quit plan and discounts on medication to help you quit. 

The support forums generate a thriving online community that is considered the heart and soul of the "Q", as the program is affectionately known.  Forums are separated by topic and cover issues such as weight gain, other addictions, spirituality and celebrating quitting milestones, among others.  Also free on the site is a link to other tobacco cessation resources and a "Community" section where members can find a quit buddy, celebrate an anniversary, give a testimonial or browse the user directory.

If you or someone you know wants to quit using tobacco, remember that effective counseling and support are as close as your computer.  Log on to www.quitnet.com and start quitting!

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If you have feedback or comments please let us know, OR you can contribute your own story about tobacco prevention and control in N.C. Please send to Julie Helsabeck.