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Implementing the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) relies heavily on enforcement. Little is known of the way enforcement agencies operate, prioritise or network. A questionnaire was sent to representatives of the International Federation of Environmental Health (IFEH) in 36 countries. Tobacco control was given low priority. Almost two thirds did not have any tobacco control policy. A third reported their organisation had worked with other agencies on tobacco control. Obstacles to addressing tobacco control included a lack of resources (61%) and absence of a coherent strategy (39%).

The tobacco industry is a major political force in Nevada. The industry dominated state politics through a combination of strategic alliances with the hospitality and gaming industries and campaign contributions. From 1990-2006 the tobacco industry contributed $552,111 to the state political parties and individuals running for state office. In 1975, health groups in Nevada attempted to pass a legislative proposal, AB 17, that would have required smoking and non-smoking sections in all indoor public places. Although weak by today's standards, the proposed law was progressive for its time. The health group's proposal was opposed by the Tobacco Institute, which organized the hospitality and gaming industries and law enforcement agencies into an alliance to oppose the law. The Tobacco Institute successfully weakened AB 17, which, as passed, only required smoking sections in state government workplaces and a limited number of indoor public places. In 1991, preemption was introduced in the state when Nevadans for Non-smokers' Rights, a group seeking smoking and non-smoking sections in restaurants made a curious compromise with the tobacco industry in the form of SB 313. SB 313 required restaurants with a seating capacity of 50 or more to have non-smoking sections but the law also explicitly preempted local government from passing stricter laws then the state related to clean indoor air. In 1995, super preemption (preemption of all aspects of tobacco regulation) was introduced in legislation backed by the tobacco industry that was intended to comply with requirements of the Synar Amendment (federal requirement to pass laws restricting the sale of tobacco to minor and report compliance). The tobacco industry convinced the legislature that super preemption was necessary to comply with the Synar Amendment. Preemption was not necessary to comply with Synar but health groups in Nevada were not able to convince the legislature of this fact or garner the legislature's support for an alternative legislative proposal to comply with Synar that did not include preemption. In 1994 the US Occupational Safety and Health Administration (OSHA) proposed Indoor Air Quality (IAQ) rules that would have mandated smokefree workplaces nationally. As part of its successful effort to block OSHA, the tobacco industry promoted ventilation as the "solution" to IAQ concerns. As part of this effort, the tobacco industry built partnerships with the gaming industry which representing pro-tobacco interests vigorously on the issue and remained allies in subsequent years. In November 1998, the Attorneys General of 46 states, including the Attorney General of Nevada, signed the Master Settlement Agreement (MSA) with the five largest tobacco companies. The MSA ended litigation brought by the state Attorney Generals, including Frankie Sue Del Pappa (D) of Nevada, to recover monies spent by the states to treat tobacco related disease as well as obtain some modest restrictions on cigarette marketing. The MSA put Nevada in a situation where the state expected to receive approximately $374 million through 2008, with continuing money into the indefinite future. In 1999, Governor Kenny Guinn and Assembly Democrats agreed on a compromise proposals for the how Nevada would spend its MSA money, with 40% of the money to college scholarships (Millennium scholarship program), 10% for tobacco control, and the remaining for a mix of health related issues. As a result, Nevada spent $4 million a year on tobacco control programming between 2001 and 2008 (30% of the Centers for Disease Control recommended minimum). To oversee MSA money spent on various health issues, including tobacco control, the Task Force for the Fund for a Health Nevada was formed, with members appointed by the Governor and legislative leadership, and included legislators and health experts. The Task Force distributed tobacco control funds through competitive grants. The formation of the Task Force increased Nevada's spending on tobacco control significantly, and coincided with a dramatic decrease in adult smoking prevalence in the state from 31% in 1999 to 21% in 2008. In the 1990's and 2000's tobacco control advocates made numerous unsuccessful attempts to repeal state preemption. The tobacco industry was successful and increasing its political influence and power in the state through campaign contributions and through aligning itself politically with the hospitality and gaming industry. Legislative proposals introduced by health advocates in an effort to advance tobacco control rarely made it out of committee. In 2003, health advocates were successful at increasing Nevada's cigarette tax by 45 cents to a total of 80 cents per pack. The proposal to increase the cigarette tax came at a time when the state was struggling with a significant budget shortfall. Health advocates did not to push for any of the tax revenue to be devoted to tobacco control programs. In November 2006, Nevada became the 17th state to pass a strong statewide clean indoor air law through a voter initiative sponsored primarily by the American Cancer Society. The initiative was opposed by a competing voter initiative sponsored by a segment of the gaming industry called the slot route operators. While the law included exemptions for bars and the gaming floors of casinos, it represented a significant step forward for tobacco control because it made all other public places including restaurants smokefree and repealed preemption. Challenges with the implementation of Nevada's new statewide clean indoor air law highlighted the fact that campaigns to introduce smokefree laws via ballot initiative need to coordinate with the state agencies responsible for implementation of the law. The health group initiative campaign did not coordinate with the state health divisions and as a result there were some avoidable implementation challenges. In addition, there were significant legal challenges that escalated to the state supreme court that as of July 2008 were not resolved. Despite the challenges, as of July 2008, Nevada's clean indoor air law was generally experiencing good compliance and increasing public support.

EXECUTIVE SUMMARY Argentina accounts for 15% of total tobacco consumption in Latin America and has made the epidemiological transition to an advanced stage in the tobacco epidemic. The Southern Cone region of the Americas leads the hemisphere in tobacco attributable mortality. Argentina is a developing country with economic interests in tobacco growing and rapidly increasing tobacco use in urban areas. In 2000, smoking prevalence was 40.4% among adults- 46.8% of men and 34% of women- and Buenos Aires urban youth (13 to 15 years old) had a 30.2% 30-day smoking prevalence (27.8% male; 31.8% female) compared to 17.7% (17.8% male; 17.7% female) in the United States. Argentina also has a high smoking prevalence among health professionals (30.3% of physicians, and 36.3% of nurses currently smoke). Given the limited smoking restrictions in indoor environments the general population is highly exposed to secondhand smoke both in public and private places. In 2000, the percentage of young people aged 13 to 15 years exposed to secondhand smoke in Buenos Aires was 69.6% at home, 87.6%, in public places, and 27.6% from their friends. A multi-country study carried out in seven Latin American cities in 2004 showed that the city of Buenos Aires had the highest airborne nicotine levels inside hospitals, schools, government buildings, airports, and restaurants observed. According to the National Program on Tobacco Control of the Ministry of Health and Environment of Argentina, tobacco use causes 40,000 deaths per year, including 6,000 due to secondhand smoke. The cost of the treatment of tobacco-related diseases is more than 4,330 million pesos per year, which represents 15.5 % of the total public expenditure on health care. Meanwhile, the tobacco excise taxes collected by the government are only 3,500 million pesos per year. The transnational tobacco companies working through their local affiliates dominate production and marketing of cigarettes in Argentina. Philip Morris International and British American Tobacco, as well as other transnational tobacco companies such as Liggett, Reemtsma, Lorillard, and RJ Reynolds International- through their local subsidiaries Massalín-Particulares and Nobleza-Piccardo- have been actively influencing public health policy-making in Argentina since the early 1970s. These transnational tobacco companies have used the same strategies in Argentina as in the United States to block meaningful tobacco control. Methods This report uses three main sources to describe the interference of the tobacco industry in tobacco control efforts in Argentina. First, we examined the tobacco industry documents in the University of California San Francisco Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu) and British American Tobacco Documents Archive (http://bat.library.ucsf.edu) and in Tobacco Documents Online (www.tobaccodocuments.org). We also used internet resources, major Argentinean newspapers (Clarín, La Nación, Página 12, La Prensa), local magazines (Muy Interesante, Revista 23, Somos, Humor, VEA), and the Argentinean National Congress Library for complete texts of the laws, bills and other tobacco control measures. Finally, we conducted face-to-face interviews with congressmen, public health officials, and tobacco control advocates in Buenos Aires during December 2003. Results • In 1966, the first bill on tobacco regulation was introduced in the Argentinean Congress to adopt a mandatory warning label on cigarette packs, but did not pass. In 1970 the government promulgated Law 18.604 that ended cigarette advertising on radio, television, and in movie theaters, and established fines for violators. This law was in effect only for one year. • In 1973 and 1974, two bills were introduced that would have placed a health warning label on tobacco products and advertisements, but these bills were not approved due to the intervention of the Cámara de la Industria del Tabaco (Chamber of Tobacco Industry), the tobacco industry's national manufacturers' association. • In 1977, as in the USA and other countries, the Chamber of Tobacco Industry created a weak and ineffective voluntary self-regulating code to avoid strong legislated restrictions on cigarette advertising. • In 1976 and 1979, the Ministry of Social Welfare drafted two bills to regulate the content of tobacco and alcohol advertisements and to require a warning label on cigarette packages. Tobacco Industry representatives lobbied government officials claiming that the established voluntary industry code was adequate and both bills died. • In the early 1980s, the Chamber of Tobacco Industry created the "Smoking Controversy Department" to counteract and undermine potential legislation. This department organized "Information Seminars" intended for selective community groups to promote the industry's position that the causal links between smoking and disease had not been proven. Seminars were aimed at the managers of tobacco production associations, agricultural technicians, physicians, scientists, journalists, tobacco advertising agencies, tobacco products distributors, elected officials, and Ministers of Health. The Smoking Controversy Department also produced and promoted literature arguing the industry's position. • During the 1980s, efforts to pass comprehensive tobacco control legislation intensified. These attempts were neutralized by a much better-organized tobacco industry that implemented a public campaign to lobby health authorities and convince journalists and the public that there was a "controversy" about the links between smoking and disease. • In 1986, the National Congress passed Law 23.344 that essentially codified the tobacco industry's ineffective voluntary advertising code and placed the weak health warning label "Fumar es perjudicial para la Salud" (Smoking is harmful to health) print on cigarette packs. Industry representatives had meetings with selected influential federal and provincial ministers, governors, and federal senators to water down the original proposal introduced by Representative Lorenzo Pepe in 1984. • In 1992, the 8th World Conference on Tobacco or Health was held in Buenos Aires. Local tobacco control advocates tried to push for the approval of a new comprehensive tobacco control bill in the Congress introduced by Representative Aldo Neri in 1990. At the same time, Philip Morris International and British American Tobacco worked together to divert the attention of the conference by organizing briefings with friendly journalists to create controversy about secondhand smoke. • In September 1992, the Neri Bill was approved in the Congress. The tobacco industry rapidly organized and orchestrated a major lobbying and public relations campaign to defeat it with the help of front groups (e.g., the International Advertising Association, the Inter-American Press Association, the Inter-American Society for Freedom of Commercial Speech, and the Argentine Association of Advertising Agencies), "scientific" consultants secretly hired and managed by industry lawyers based in the US, and Congressmen from the tobacco growing provinces. Ten days later, on October 10, President Carlos Menem vetoed the law. • Between 1992 and 2000, the tobacco industry supported alternative legislation to write the industry's ineffective voluntary marketing code into law. Even though they were not approved, these bills distracted political and public attention so that all efforts at meaningful tobacco control legislation were neutralized. • Since the mid-1990s, the tobacco industry has been promoting its "accommodation" program "La Cortesía de Elegir" (The Courtesy of Choice), to avoid legislation to end secondhand smoke exposure in restaurants and bars and to maintain the social acceptability of smoking. • Since 1997, the tobacco industry has been promoting ineffective "youth smoking prevention" programs (such as "Yo Tengo P.O.D.E.R." [I Have Power] and "Yo NO Vendo Cigarrillos a Menores de 18 Años" [I DO NOT Sell Cigarettes to Minors under 18]) to preempt meaningful anti-tobacco education by the government and to shift the focus away from the industry's responsibility for increasing youth smoking through its advertising and marketing. • In 2003, the Lower House Public Health Committee drafted a version that consolidated 18 tobacco control bills (including one from Representative Neri) but again, the tobacco industry succeeded in burying the bills. • In September 2003, President Néstor Kirchner signed the Framework Convention on Tobacco Control, the first international public health treaty negotiated by the 192 countries under the auspices of the World Health Organization. The ratification process in the Argentinean Senate remained bogged down as of September 2005, with limited efforts to ratify it. It appears that the industry is effectively lobbying Argentinean legislators not to ratify the treaty. • In August 2005, the Ministry of Health and Environment introduced in the Senate a new comprehensive tobacco control bill that follows the minimum standards required by the Framework Convention on Tobacco Control, including the creation of smokefree public places (including bars and restaurants) and workplaces, the end of all types of tobacco advertising (except point-of-sale) and sponsorship, and the placement of rotating health warning labels and images in cigarette packages. It also bans misleading descriptors (such as "light") and requires the placement of maximum levels of nicotine and tar print on packages. Recommendations 1. The journalists from print and electronic media, public health advocates, politicians and institutional leaders need to become more aware of how the transnational tobacco industry has manipulated and influenced policy making in Argentina, which affects the health of the public, and report this information to the public. 2. The national government, through the Ministry of Health and Environment, should implement a comprehensive educational campaign to enhance awareness about the health dangers of secondhand smoke and to promote the enactment of city-wide, provincial and national ordinances that prohibit indoor exposure to secondhand smoke. 3. Argentina should implement the principal provisions of the Framework Convention such as increased taxes, a complete advertising ban, and graphic pictorial warning labels on cigarette packages. 4. The federal government and health care industry need to support effective smoking cessation services, such as quit-lines, at minimal cost to all smokers. RESUMEN Argentina representa el 15% del consumo total de tabaco en América Latina y se encuentra en una fase avanzada de la transición epidemiológica en la epidemia del tabaquismo. La región del Cono Sur de las Américas lidera el hemisferio en mortalidad atribuible por tabaco. Argentina es un país en desarrollo con intereses económicos en el cultivo de tabaco y un alto consumo de tabaco en áreas urbanas. En 2000, la prevalencia del consumo de tabaco en adultos fue del 40.4% (46.8% en varones; 34% en mujeres). El mismo año, la prevalencia del consumo de tabaco en los últimos 30 días, en jóvenes de 13 a 15 años de la ciudad de Buenos Aires, fue del 30.2% (27.8 % en varones; 31.8% en mujeres) comparada con 17.7% (17.8% en varones; 17.7% en mujeres) en los Estados Unidos. Argentina posee también una alta prevalencia de consumo de tabaco entre los profesionales de la salud (30% de los médicos y 36.6% de los enfermeros actualmente fuman). Debido a las escasas restricciones al consumo de tabaco en ambientes cerrados, la población general está altamente expuesta al huno de tabaco ajeno, tanto en lugares públicos como en privados. En 2000, el porcentaje de jóvenes de 13 a 15 años expuestos al humo de tabaco ajeno en Buenos Aires, fue del 69,6% en sus casas, 87,6% en lugares públicos y 27,6% de sus amigos. Un estudio multicéntrico llevado a cabo en siete ciudades latinoamericanas en 2004, mostró que la ciudad de Buenos Aires tenía la mayor concentración de nicotina ambiental en hospitales, escuelas, edificios gubernamentales, aeropuertos y restaurantes observados. De acuerdo al Programa Nacional de Control del Tabaco del Ministerio de Salud y Ambiente de la Argentina, el uso de tabaco causa 40.000 muertes anuales, incluyendo 6.000 debido a la exposición al humo de tabaco ajeno. El costo del tratamiento de la enfermedades relacionadas al tabaco es de más de 4.330 millones de pesos por año, el cual representa el 15,5% del gasto público total en salud. Mientras tanto, los impuestos al tabaco recaudados por el gobierno son sólo 3.500 millones de pesos al año. Las compañías transnacionales de tabaco, trabajando a través de sus filiales locales, dominan la producción y la comercialización de los cigarrillos en la Argentina. Philip Morris International y British American Tobacco, así como otras compañías transnacionales de tabaco tales como Liggett, Reemtsma, Lorillard y RJ Reynolds International, a través de sus subsidiarias locales Massalín-Particulares y Nobleza-Piccardo, han influenciando activamente las políticas de salud pública en Argentina desde comienzo de los años 1970s. Estas compañías transnacionales de tabaco han utilizado las mismas estrategias en Argentina que en Estados Unidos para bloquear políticas de control del tabaco significativas. Métodos El siguiente reporte utiliza tres fuentes principales para describir la interferencia de la industria del tabaco en los esfuerzos por controlar el tabaco en Argentina. Primero, examinamos los documentos de la industria del tabaco que se encuentran disponibles en la internet en las bibliotecas Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu) y British American Tobacco Documents Archive (http://bat.library.ucsf.edu) de la Universidad de California en San Francisco, y en Tobacco Documents Online (www.tobaccodocuments.org). También utilizamos otras fuentes de información de la internet, los principales periódicos argentinos (Clarín, La Nación, Página 12, La Prensa), revistas locales (Muy Interesante, Revista 23, Somos, Humor, VEA), y la Biblioteca del Congreso de la Nación de la Argentina para ubicar y analizar los textos completos de leyes, proyectos de ley, y otras medidas de control del tabaco. Finalmente, en diciembre de 2003, realizamos entrevistas cara a cara en la ciudad de Buenos Aires, con legisladores, funcionarios de salud pública y activistas para el control del tabaco. Resultados • En 1966 fue introducido en el Congreso Nacional argentino el primer proyecto de ley para la regulación del tabaco. El proyecto, que no fue aprobado, requería la colocación obligatoria de una etiqueta de advertencia sanitaria en todos los paquetes de cigarrillos. En 1970, el gobierno promulgó la Ley 18.604 que ponía fin a la publicidad de los cigarrillos en la radio, la televisión y los cines, y establecía multas para los infractores. Sin embargo, esta ley estuvo en vigencia sólo durante un año. • En 1973 y 1974 dos proyectos de ley ingresados en el Congreso Nacional requerían la colocación de una etiqueta de advertencia sanitaria en los envases de los productos de tabaco y en su publicidad. Sin embargo, estos proyectos no fueron aprobados debido a la intervención de la Cámara de la Industria del Tabaco, la asociación nacional de productores de la industria del tabaco. • En 1977, de la misma manera que en los Estados Unidos y otros países del mundo, la Cámara de la Industria del Tabaco creó voluntariamente un Código de Autorregulación Publicitaria débil e inefectivo para evitar la aprobación de legislación que contemplara fuertes restricciones a la publicidad del tabaco. • En 1976 y 1979 el Ministerio de Bienestar Social de la Nación preparó dos proyectos de ley para regular el contenido de la publicidad del tabaco y el alcohol y para requerir una etiqueta de advertencia sanitaria en los paquetes de cigarrillos. Representantes de la industria del tabaco ejercieron presión política sobre funcionarios del gobierno reclamando que el ya voluntariamente establecido Código de Autorregulación Publicitaria de la industria era suficiente. Finalmente, ambos proyectos fueron archivados. • A principios de los años 1980s la Cámara de la Industria del Tabaco creó el "Departamento sobre la Controversia del Tabaco" como una herramienta para contrarrestar y menoscabar una posible futura legislación anti-tabaco. Este departmento organizó "Seminarios de Información" dirigidos a grupos específicos de la comunidad para promocionar la posición de la industria por la cual la relación causal entre tabaco y enfermedad no estaba comprobada. Los seminarios estuvieron dirigidos a gerentes de asociaciones de productores de tabaco, técnicos agricultures, médicos, científicos, periodistas, agencias de publicidad del tabaco, distribuidores de productos del tabaco, Ministros de Salud y otros funcionarios gubernamentales. El "Departamento sobre la Controversia del Tabaco" también editó y promocionó publicaciones exponiendo la posición de la industria del tabaco. • Durante los años 1980s se intensificaron los esfuerzos para aprobar una legislación amplia para el control del tabaco. Estos intentos fueron neutralizados por una industria del tabaco mucho mejor organizada que orquestó una campaña pública para ejercer presión sobre las autoridades de salud, y convencer a periodistas y al público en general sobre lo que la industria llamó la "controversia" sobre tabaco y salud. • En 1986 el Congreso Nacional aprobó la Ley 23.344 que esencialmente codificó el inefectivo y voluntario Código de Autorregulación Publicitaria de la industria del tabaco y requirió la colocación de la débil etiqueta de advertencia sanitaria "Fumar es perjudicial para la Salud" en los paquetes de cigarrillos. Representantes de la industria del tabaco tuvieron reuniones con influyentes ministros nacionales y provinciales, gobernadores y senadores nacionales para "suavizar" el proyecto de ley original introducido en 1984 por el Diputado Nacional Lorenzo Pepe. • En 1992 la 8va Conferencia Mundial sobre Tabaco o Salud se llevó a cabo en la ciudad de Buenos Aires. Activistas locales para el control del tabaco intentaron presionar para la aprobación en el Congreso de una ley amplia la cual había sido introducida en 1990 por el Diputado Nacional Aldo Neri. Al mismo tiempo, Philip Morris International y British American Tobacco trabajaron juntas para desviar la atención de la conferencia, organizando sesiones informativas con periodistas "amigos" para crear controversia sobre los efectos de la exposición pasiva al humo de tabaco. • El 30 de septiembre de 1992, la Ley Neri fue aprobada en el Congreso Nacional. Sin embargo, la industria del tabaco rápidamente organizó y orquestó un exitoso plan para derrotarla con la ayuda de grupos de fachada (por ej. la Asociación Internacional de Publicidad, la Asociación de Prensa InterAmericana, la Sociedad InterAmericana para la Libertad de Expresión Comercial, y la Asociación Argentina de Agencias de Publicidad), consultores "científicos" contratados y orientados por la industria y legisladores de las provincias tabacaleras, y montó una gran campaña de relaciones públicas y de presión política. Diez días más tarde, el 10 de octubre, la ley fue vetada por el Presidente Carlos Menem. • Entre 1992 y 2000, la industria del tabaco apoyó proyectos de ley "alternativos" que estaban en consonancia con su Código de Autorregulación Publicitaria. A pesar de no haber sido aprobados, estos proyectos sirvieron para distraer la atención política y pública y de esa manera, todos los esfuerzos para el control del tabaco fueron neutralizados. • Desde mediados de los años 1990s la industria del tabaco ha estado promoviendo su programa de "acomodación" conocido como "La Cortesía de Elegir" o "Convivencia en Armonía", para evitar legislación que ponga fin a la exposición pasiva al humo de tabaco ajeno en restaurantes y bares, y para mantener la aceptación social del consumo de tabaco. • Desde 1997 la industria del tabaco ha estado promoviendo programas de "prevención del uso de tabaco en jóvenes" inefectivos (tales como "Yo Tengo P.O.D.E.R." y "Yo NO Vendo Cigarrillos a Menores de 18 Años") para evitar campañas educativas anti-tabaco por parte del gobierno y para desplazar el foco de atanción por la responsabilidad que la industria tiene, a través de la publicidad y comercialización de sus productos, en el incremento del uso de tabaco entre los jóvenes. • En 2003, la Comisión de Acción Social y Salud Pública de la Cámara de Diputados de la Nación escribió un Dictamen Final que consolidaba 18 proyectos de ley para el control del tabaco (uno de ellos del Diputado Aldo Neri) pero una vez más, la industria del tabaco tuvo éxito en cajonear los mismos. • En septiembre de 2003, el Presidente Néstor Kirchner firmó el Convenio Marco para el Control del Tabaco, el primer tratado internacional sobre salud pública negociado por 192 países bajo los auspicios de la Organización Mundial de la Salud. Al mes de septiembre de 2005, el proceso de ratificación en el Senado argentino permanece estancado con pocos esfuerzos para ratificarlo. En vista de los acontecimientos pasados parecería que la industria ha estado ejerciendo presión exitosamente sobre los lesgisladores argentinos para que no ratifiquen el convenio. • En agosto de 2005, el Ministerio de Salud y Medio Ambiente introdujo en el Senado de la Nación un nuevo proyecto de ley amplio para el control del tabaco que está en sintonía con los estándares mínimos requeridos por el Convenio Marco para el Control del Tabaco. El proyecto contempla la creación de ambientes públicos y lugares de trabajo libres de humo de tabaco (incluyendo bares y restaurantes), la prohibición de la publicidad (excepto en los lugares de venta) y el patrocinio y la colocación de etiquetas de advertencias sanitarias rotatorias con imágenes, en los paquetes de cigarrillos. También prohibe la colocación de descriptores engañosos (tales como "suaves") y requiere los niveles máximos de nicotina y alquitrán impresos en los en los envases de tabaco. Recomendaciones 1. Periodistas tanto de los medios gráficos como electrónicos, activistas de la salud pública y líderes institucionales, deberían tomar conocimiento sobre como las compañías transnacionales del tabaco han manipulado e influenciado las políticas de control del tabaco en la Argentina lo cual afecta la salud de la población, y comunicar esta infomación a la población general. 2. El gobierno nacional, a través del Ministerio de Salud y Ambiente, debería implementar una amplia campaña educativa para aumentar la conciencia sobre los daños a la salud provocados por la exposicion pasiva al humo de tabaco ajeno, y promover la aprobación de legislación local, provincial y nacional que impida la exposicion pasiva al humo de tabaco ajeno en lugares cerrados. 3. Argentina debería implementar los estándares principales del Convenio Marco para el Control del Tabaco, tales como el aumento de los impuestos al tabaco, la prohibición total de la publicidad, y la colocación de etiquetas de advertencia sanitarias con imágenes en los paquetes de cigarrillos. 4. El gobierno nacional y el sector privado de la atención de la salud deben apoyar servicios de cesación tabáquica efectivos, tales como las líneas telefónicas de ayuda para dejar de fumar, a un bajo costo para todos los fumadores.

Oregon is one of four states in the country (California, Massachusetts, and Arizona are the others) which has increased the tobacco tax via an initiative and used a portion of the funds for a tobacco prevention and education program. The initiative (Measure 44, enacted in 1996) raised cigarette prices in Oregon by 30 cents, from 38 cents per pack to 68 cents per pack, (and raised the tax on non-cigarette tobacco products from 35% to 65% of wholesale price) making Oregon the third highest tobacco taxing state in the country when the tax began on February 1, 1997. Ten percent of this money (approximately $17 million over two years) is dedicated to the tobacco use reduction program. During the Measure 44 campaign, the tobacco industry used many of the same tactics it had used in other states to try to defeat the initiative. The industry outspent supporters 7 to 1; sponsored a competing initiative to dilute support for Measure 44; challenged the initiative's language and ballot argument; ran negative advertisements accusing the initiative's supporters of trying to line their own pockets and create more big government; and hired a well-known, respected public figure to oppose the initiative. Despite the industry's efforts, Measure 44 won with 56% of the vote. Measure 44's tobacco use reduction program has four components: local activities, education, statewide communications, and special populations. The Oregon Health Division has given grants to local communities for tobacco prevention and education activities for the first program year and has hired a firm to conduct its media campaign. Only four cities and one county in Oregon have passed local anti-tobacco ordinances: Eugene, Silverton, Beaverton, Corvallis, and Benton County. Because the local activities component of the tobacco use reduction program includes information on passing local ordinances, local ordinance activity should increase in the next few years. The tobacco industry has been a significant source of campaign contributions in Oregon. The industry first began contributing to legislative candidates in Oregon during the 1985-1986 electoral cycle. From the 1985-1986 electoral cycle until the 1993-1994 electoral cycle, the industry gave $149,900 to candidates for the state House and Senate. In 1994, Oregon voters adopted Measure 9, which limited political action committee contributions to legislative candidates to $100 each electoral cycle. Consequently, the tobacco industry did not contribute to legislative candidates during the 1995-1996 electoral cycle. Measure 9 was ruled unconstitutional in 1997, and the tobacco industry is again free to contribute more than $100 to candidates. As of September 1997, however, the industry had not contributed to any legislative candidates during the 1997-1998 electoral cycle. The industry has also given money to political parties. Since 1989-1990, when the industry first began contributing to political parties, it has given $16,200 to the Democrats and $24,450 to the Republicans, for a total of $40,650. Republicans controlled the House of Representatives during all three electoral cycles, and they controlled the Senate during the 1993-1994 electoral cycle. The tobacco industry has also spent money on lobbying activities. Since 1990, the industry has spent $1.1 million lobbying legislators. Oregon is one of 40 states to sue the tobacco industry to recover Medicaid and other costs associated with tobacco related illnesses.

Tobacco use is the leading preventable cause of death in South Carolina. Smoking-related medical costs amount to $1.1 billion each year, including $393 million for Medicaid. Tobacco growing in South Carolina declined by over 50 percent from 1997 to 2008. Tobacco accounted for less than 10% of the state's cash receipts from all crops in 2007. Despite the low levels of actual tobacco growing and the small role tobacco played in the state's economy in 2008, the cultural construct of being a "tobacco growing state" continued to have a disproportionately large impact on tobacco control policy making. Between 1997 and 2008, the tobacco industry lost its alliances with the Farm Bureau Federation and Commissioners of Agriculture, former staunch industry allies, because of negotiations over the Master Settlement Agreement, the buyout of the Tobacco Price Support system, and increasing purchase of foreign tobacco. Tobacco control Policy Score rankings of 2007/2008 legislators by knowledgeable tobacco control advocates revealed that legislators from the Pee Dee region, historically the stronghold of tobacco agriculture, were similar to the rest of the state's legislators in their attitudes towards tobacco control. Tobacco area legislators were formerly strong allies of the tobacco industry and historically worked with industry lobbyists to ensure defeat or manipulation of tobacco control bills. The 2007/2008 Policy Scores indicated that this was no longer the case. Tobacco control advocates should take advantage of the growing distance between tobacco companies and its former tobacco-growing allies and the decline in the actual importance of tobacco agriculture to challenge the rhetoric and resistance to tobacco control policies in the state. The tobacco industry built significant political influence in South Carolina through lobbyists, alliances with prominent trade associations, campaign contributions and other political expenditures. From 1996 to 2006, tobacco companies, trade associations and producers contributed a total of $680,541 to candidates for state office and to political parties. There is a measurable relationship between tobacco industry contributions and legislative behavior. As rated on a Policy Score scale from 0 to 10, with 10 being extremely receptive to tobacco control and 0 being extremely pro-tobacco industry, for every $1,000 received from the tobacco industry during the 2006 election cycle, a legislator's Policy Score decreased by 1.5 points. Democrats were on average 3.6 points more favorable towards tobacco control than Republicans, after controlling for campaign contributions. South Carolina was selected by the NCI in 1990 to participate in the 17-state ASSIST program. ASSIST funded tobacco control programming within the Department of Health and Environmental Control and established the state's first formal tobacco control coalition, the Alliance for a Smoke-Free South Carolina. The Alliance disbanded in 1997, leaving tobacco control advocacy disorganized and ineffective through 2003. ASSIST ended in 1999 and was replaced by a minimally-funded DHEC Tobacco Division supported primarily by about $1 million annually from the US Centers for Disease Control and Prevention. In 1998, the state signed the Master Settlement Agreement, securing approximately $70 million per year from the major cigarette companies. In 2000, the state securitized its settlement revenue, receiving a lump sum of $900 million up front in lieu of its annual payments through 2019. Refinancing in 2008 moved this date back to 2012. The 2000 General Appropriations bill set up 4 trust funds from the securitized MSA funds, with 73% ($574 million for healthcare), including tobacco control. Only $3.34 million of the MSA revenue was spent on tobacco control between 2000 and 2008. The state allocated an additional $6 million from the General Fund to the DHEC Tobacco Division between 2002 and 2008, with no state funding for the program between 2003 and 2006 and again in 2008. The Tobacco Division developed small-scale but innovative tobacco control programming, particularly community programs to promote policy change and the Rage Against the Haze youth movement. The DHEC leadership did not prioritize tobacco control between 2000 and 2008, although its support increased gradually due to efforts by the Tobacco Division, DHEC regional staff and the voluntary health groups. Funding requests remained at $2 million, significantly below the CDC recommended $62.2 million per year. Limitations by DHEC leadership on the role that DHEC staff play in local community-wide policy change efforts changed in 2007 to allow direct participation, but remained limited in scope. The voluntary health groups failed to prioritize increased funding for the DHEC Tobacco Division relative to their other lobbying focuses and continued in 2008 to act hesitantly in their lobbying of DHEC leadership to support tobacco control funding and policy change. In 2001, tobacco control advocates formed the South Carolina Tobacco Collaborative. It received 83% of its funding from the state health department, limiting its advocacy capacity. Increased funding from voluntary health groups and national partners between 2005 and 2008 allowed the Collaborative and the other prominent tobacco control advocacy groups, the South Carolina African-American Tobacco Control Network and the Smoke-Free Action Network, to increase advocacy between 2005 and 2008. These developments led to notable successes in clean indoor air policies and attempts to increase the state's tobacco tax. The cigarette tax in South Carolina remained the lowest in the nation in 2008, at 7 cents per pack. The last cigarette tax increase was in 1977, with nearly annual attempts to increase the tax defeated by coordinated efforts from the tobacco industry. Tobacco control advocates began to push for a cigarette tax increase in 2000, without success. Between 2006 and 2008, the Collaborative developed a well-funded and well-coordinated public education and lobbying campaign to support a cigarette tax increase. In 2008, the General Assembly passed a 50-cent increase, with $5 million of the annual revenue directed to the DHEC Tobacco Division, over active opposition from the tobacco industry and its allies. Governor Mark Sanford vetoed the bill for its lack of revenue neutrality, and Speaker of the House Bobby Harrell successfully prevented a veto override in the House. The 2006-2008 cigarette tax increase campaign showed that well-funded tobacco control advocacy could be successful over tobacco industry opposition in the legislature. The defeat of the increase bill demonstrated the need for stronger grasstops lobbying and relationship building with legislative leadership. Between 1977 and 1989, local policymakers passed 19 limited clean indoor air ordinances, building momentum for consideration of a state-level clean indoor air bill. In 1990, tobacco control advocates compromised with tobacco industry lobbyists to allow the passage of a weak statewide Clean Indoor Air Act, halting significant progress on clean indoor air through 2005. In 1996, the tobacco industry succeeded in using the Synar Amendment to integrate preemption into a youth access to tobacco amendment. The tobacco industry and tobacco control advocates assumed the provision also preempted local clean indoor air activity. Beginning in 1999, local policymakers in Charleston began to support local clean indoor air ordinance attempts despite assumed preemption. While Charleston did not pass an ordinance until 2006, news coverage of the city's efforts began a wave of consideration of local ordinances, eventually supported by state and local tobacco control advocates and the Municipal Association. Between May 2006 and December 2008, 21 local clean indoor air ordinances passed, 12 of which passed before the state Supreme Court rejected the argument that preemption applied to clean indoor air ordinances. Two localities were sued over their ordinances on preemption grounds, but won both cases in the Supreme Court. During the 2007/2008 legislative session, tobacco control advocates joined together to successfully defeat multiple attempts to institute express preemption through weak clean indoor air legislation supported by the tobacco industry. Given the success of local clean indoor air efforts, the strategy of tobacco control advocates developed during 2008 should be maintained: continue to promote comprehensive local smoke-free ordinances, while avoiding any action on clean indoor air in the General Assembly.

Cigarette consumption among people 15 years or older peaked in Switzerland in the early 1970's with 3,700 cigarettes per capita and per year, followed by a decline to 2,800 cigarettes per capita and per year in 1994. After a decline of the proportion of smokers from 37% in 1980 to 31% in 1992, this proportion has increased again to 33% in 1997. Women, particularly the young, and children and adolescents, have shown a continued increase in smoking prevalence, despite the focus of tobacco prevention efforts on children and adolescents. Every year, over 10,000 people die from tobacco use in Switzerland, about a sixth of all annual deaths in Switzerland, making smoking the leading preventable cause of death in Switzerland. This number is more than 20 times higher than the number of deaths caused by illegal drugs. The tobacco excise tax in Switzerland is the lowest in Western Europe. The laws governing tobacco products, their marketing and sales, are weak and have little practical effect on the tobacco industry. There is no meaningful protection of nonsmokers from the toxic chemicals in secondhand tobacco smoke, in public places or work places. A ten-country survey on people's experiences and attitudes concerning tobacco and smoking in 1989, commissioned by Philip Morris International, showed that Swiss people were aware of secondhand smoke's adverse effects on health, but only a minority favored government regulations for smoking in restaurants and workplaces. A first comprehensive 5-year tobacco prevention program, 1996 to 1999, issued by the Swiss Federal Office of Public Health lacked adequate financial resources, focus on specific interventions, cooperation between partners for tobacco prevention, and program coordination and management. It ignored the role of the tobacco industry. As a result of recent events in the US and WHO's active engagement of the tobacco industry, the draft five-year plan for tobacco prevention in Switzerland for 2001 to 2005 identifies the tobacco industry as a major obstacle to tobacco prevention. Until the recent merger of British American Tobacco (BAT) with Burrus-Rothmans in 1999, the single most important tobacco company in Switzerland was Philip Morris (PM), with a market share of close to 50% (and close to 25% for Marlboro alone). Since the merger, the tobacco market is dominated by PM and BAT, each with a market share of cigarette sales between 45% and 50%. As was the case in the US, in the early 1960's, the scientists in Swiss tobacco industry research laboratories (in this case, FTR (Fabriques de Tabac Réunies) / Philip Morris) accepted and discussed the dangerous effects of smoking on health in internal company communications. At that time, these scientists earnestly tried to find ways to reduce the carcinogenic effects of cigarettes through elimination of carcinogenic components. Contrary to privately expressed views, tobacco industry's public position in Switzerland was that there was ongoing controversy in the issue whether smoking caused diseases or not. The "controversy" was nurtured through regular media briefings and scientific meetings with carefully chosen scientists who would publicly support the industry's position, but without declaring their liaisons with the tobacco industry. Relationships with these industry "consultants" or "witnesses" were maintained through direct payments and indirectly through funding of their research. By late 1980's the tobacco industry had identified the decline of social acceptability of smoking in Europe as a major threat to its viability. This recognition led to the development of a comprehensive strategy to fight the secondhand smoke issue. "Courtesy and tolerance" and economic arguments were used to divert the public's and policy makers' attention from the health issue. The resulting strategies were often devised in consultation with executives of other Philip Morris subsidiaries and Philip Morris International headquarters in New York. Well aware of its low credibility with the public, journalists were given interviews and told not to mention the tobacco company's name in the newspaper article. Official publications, such as "Smoking and Mortality in Switzerland" by the Federal Office of Public Health, the report on the respiratory effects of secondhand smoke by the US Environmental Protection Agency, as well as original scientific publications, such as an article in the American Journal of Respiratory and Critical Care Medicine, dealing with secondhand smoke and respiratory symptoms in Switzerland (SAPALDIA study) written by a group of Swiss scientists, were massively attacked by the tobacco industry. The tobacco industry employed "consultants" and politicians with industry ties, who used standard industry arguments. One of the most active industry consultants in Switzerland was Peter Atteslander, a Swiss citizen and professor at the University of Augsburg in Germany. He wrote white papers for the tobacco industry and reported from meetings worldwide. Atteslander appeared to be the essence only member of the Switzerland-based "Arbeitsgruppe für Gesundheitsforschung (AGEF) ("Working Group on Health Research"), which published his work without disclosing the ties to the tobacco industry. To fight smoking restrictions in restaurants and hotels, the tobacco industry developed a strong ally in the hospitality association, the International HoReCa. The secretary general of International HoReCa at the time was Dr. Xavier Frei, also president of the SCRA (most likely the Swiss Café and Restaurant Association). The hospitality association made extensive use of tobacco industry resources and repeatedly printed tobacco industry positions in hospitality industry newsletters, without the members of International HoReCa or SCRA being informed about the close ties between their organization and the tobacco industry. The "accommodation program," a well-known tobacco industry strategy to preempt regulatory measures against smoking in restaurants and workplaces first developed in the United States, was used in Switzerland. The fact that even the logo was the same as the one used in the US is another illustration of tobacco industry's recycling of strategies and tactics worldwide. The shift of focus from the problem of secondhand smoke to one of indoor air quality in general was (and remains) a major strategy used by the tobacco industry worldwide to dilute the problem of secondhand smoke with other indoor air pollutants and ventilation of buildings. To this end, an indoor air quality control company with close ties to the tobacco industry, ACVA Atlantic Inc., USA, later renamed Healthy Buildings International, HBI, collected data which was used extensively by the tobacco industry to further their goal of downplaying the role of secondhand smoke as a major component of indoor air pollutant. Employees of HBI were sent to Switzerland to collect data on Swiss office buildings, and the data were used in the newsletters of HoReCa to support the accommodation program and against non-smoking regulations. HBI has been discredited in the US. The tobacco industry tried to influence smoking policy in airplanes through partial funding of IFAA's (International Flight Attendants Association) world congresses. This influence was established through close relationship with the president of the association, a common industry strategy in influencing organizations. When, in the wake of smoke-free flights in the US and other countries, Swissair finally introduced smoke-free flights, it was heavily criticized in newspaper articles by the Swiss "Smokers Club," and later the Swiss "Club of Tobacco Friends," whose president and founder is a former public relations official for the tobacco industry. The Swiss Cigarette Manufacturers Association successfully influenced smoking policy in railway trains through letters to the publishers of newspapers and direct lobbying toward cantonal authorities and the head of the national railways. Two referendums on tobacco and alcohol advertising bans in 1979 and 1993 were rejected by Swiss voters despite pre-referendum polls favoring advertising bans through a strong and lasting alliance of the tobacco industry with the advertising agencies and the print media. The tobacco industry successfully kept itself behind the scenes in order to avoid negative publicity while financing the anti-advertising ban campaigns and supplying the alliance against advertising bans with well-crafted arguments by tobacco industry public relations and law firms through the International Tobacco Information Center, INFOTAB. The tobacco industry and its allies used economic and political arguments, such as purported effects on employment, state tax revenues, and individual and corporate freedom to fight the advertising bans. Close relationships with officials and politicians were emphasized and maintained through regular meetings with the head of the political parties and briefings of the "tobacco caucus" in the parliament. This caucus gave the tobacco industry the means to stay well informed about the political agenda and to easily influence the political process in their favor. While Switzerland has some of the most progressive and innovative public health promotion programs, most public health advocates underestimate the power of, and driving forces behind, a tobacco industry, and only few of them have confronted the industry directly.

The tobacco industry is a potent force in Albany. Since 1983 (not including 1988-89, were data are not available) tobacco interests spent $1.3 million on campaign contributions to candidates and political party committees. Of this, $277,905 went to legislative candidates, $38,650 went to candidates for constitutional office, and the remaining $1 million went to party committees. The members of the 1997-98 legislature who collected the most money from campaign contributions were Assemblymember Jeffrey Klein(D-Bronx)($16,275), Assembly Speaker Sheldon Silver (D-Manhattan)($10,425), Assemblymember Michael Bragman (D-Onondaga)($8,420), Senator Ronald Stafford (R-Plattsburgh)($7,500), and Senate Majority Leader Joseph Bruno (R-Brunswick)($7,300). The tobacco industry spent $5.9 million on lobbying expenditures between 1992 and 1998. Of the $998,884 contributed to party committees between 1983 and 1998 (not including 1988-89), $815,840 (81.7%) was donated after 1994, when contributors realized that contributions to party committees were unlimited. As in other states, the tobacco industry donates more to Republicans than Democrats; Republican party committees received $752,709 (75%) of the money between 1983-98, while Democrats received $191,175 (19%). The information we have on tobacco industry political activity is incomplete and underestimates the magnitude of tobacco industry activity. Between 1998 and 1999, the tobacco industry was found to have under-reported its lobbying expenses on several occasions. In 1998, the Tobacco Institute admitted to under-reporting by $443,572 and in 1999, Philip Morris admitted to under-reporting lobbying expenses 15 times over the period 1993-96. These developments indicated that the lobbying law was ineffective at providing accurate information for public disclosure, and prompted a revision of the law in 1999. However, the revision is insufficient to prevent this kind of influence to be accumulated by an industry such as the tobacco industry. These contributions are having an effect on policy making. On the average, for each $1000 contributed to an individual legislator, that legislator scored 1.82 points more pro-tobacco on a 0 to 10 scale. At the same time, legislators who support the tobacco industry are rewarded; for each 1 point more pro-tobacco, contributions increase by an average of $380. Republican legislators were more pro-tobacco than Democrats by an average of 1.39 points. As in most states, in New York State, progress in tobacco control begins at the local level. New legislation is generally passed first on Long Island, which inspires New York City to do the same. Legislation passed in New York City sparks progress in the upstate area, and until the Pataki Administration, at the state level. The importance of localities passing restrictions to initiate the momentum to pass state legislation is why preemptive state legislation is a major threat to tobacco control in New York State. The documents released through state litigation of the tobacco industry have played a critical role in the passage of tobacco control legislation in the face of an unsympathetic legislature and Governor. Advocates in other states should recognize that researching the documents can help them pressure political leaders and recognize industry front groups. The Long Island counties of Suffolk and Nassau lead the tobacco control movement in the downstate area, whereas Erie County sets the standard upstate. The ASSIST program has been successful in setting up local coalitions and galvanizing against industry tactics. The industry organizes and finances "grassroots" coalitions, and "smokers' rights" groups such as the National Smokers Alliance, mobilizes its Tobacco Action Network, forms alliances with other organizations affected by anti-tobacco bills and finances groups such as the United Restaurant, Hotel, and Tavern Association to oppose clean indoor air legislation. It promotes "studies" claiming that tobacco control legislation will hurt the hospitality business, even though objective studies have consistently shown no effect or a positive effect on the hospitality industry. At the state level the industry has sought to preempt local tobacco control activity; at the local level, the industry tries to pass weak laws promoting "accommodation" to prevent the passage of effective tobacco control policies. New York tobacco control advocates have vigorously – and generally successfully – opposed these efforts. Since 1986, New York City has distinguished itself as a national leader in tobacco control legislation. While its clean indoor air laws have not been the strongest in the country, they are remarkable in light of the city's size and the fact that Philip Morris' corporate headquarters are located in New York City. The city was also one of the first localities to sue the tobacco industry. Both Nassau County and Niagara County Boards of Health enacted regulations (in 1994 and 1998, respectively) to eliminate smoking in restaurants. However, both were overturned in lawsuits sponsored by the tobacco industry. Both rulings determined that the Boards of Health were in violation of the state constitution because they considered economics in their decisions. These decisions have discouraged counties from using Boards of Health to pass clean indoor air regulations. When Republican George Pataki succeeded Democrat Mario Cuomo as governor in 1994, state tobacco control legislation abruptly ceased. Pataki ignored the Health Department's tobacco advisory panel, the Commission for a Healthy New York, and only formulated tobacco control programs when he feared criticism from the media. Between 1990 and 1998 Pataki accepted $8050 from the tobacco industry. In November 1998, forty-six states agreed to a $206 billion dollar settlement with the tobacco industry. The agreement settled the states' claims for smoking-related Medicaid costs. New York State received $25 billion to be paid over 25 years as a result of the settlement agreement. In December 1999, health advocates, working the other interests, were able to increase the tobacco tax by 55 cents and dedicate part of the tobacco settlement funds to fund health care in New York State. New York's cigarette tax of $1.11 per pack is the highest in the nation. Of the approximately $1.5 billion generated annually by the settlement and additional tobacco tax, only $37 million annually is dedicated to the state tobacco control program. During the 1999 legislative session, the New York Medical Society supported the Civil Justice Reform Act which would provide the tobacco industry protection against product liability litigation. The tobacco industry has probably used every strategy they have developed in fighting tobacco control policies in New York State. Despite these daunting challenges, advocates have achieved many notable successes and recognized and avoided counterproductive compromises. They have done so by exposing tobacco industry front groups and affiliations and holding politicians and organizations accountable for their actions.

• After making substantial progress on tobacco control in the mid-1990s, the tobacco industry has stifled tobacco control activities in Washington through a mixture of campaign contributions and legal challenges. • Political campaign contributions have remained steadily high throughout the 1990s. Philip Morris, RJ Reynolds, the Tobacco Institute, Lorillard, Brown & Williamson, and the Smokeless Tobacco Council contributed $362,298 to campaigns in 1996 through 2000 election cycles: $114,123 in the 1996 election cycle, $109,975 in 1998, and $138,200 in 2000. • From 1996-2000, 92% of these campaign contributions by the tobacco industry were to Republican candidates, party contributions, and soft money. • The largest lifetime recipients of campaign contributions were Clyde Ballard ($16,830, R-East Wenatchee), William Grant ($7,400, D-Franklin), Dan McDonald ($7,246, R-King), and Pat Scott ($5,490, D-Snohomish). Ballard and Grant are both powerful in the House leadership; Ballard is the Co-Speaker of the House of Representatives, and Grant is the House Democratic Caucus Chair. McDonald was the Majority Leader of the Senate from 1996-1999, and prior to that, he chaired the powerful Ways and Means Committee. • The tobacco industry has also spent heavily on lobbying; from 1996-2000, the industry spent $1,864,086 to lobby members of the legislature and the state administrative offices. This includes lobbyists' salaries and perks given to legislators such as holiday gifts, entertainment and meals. • Washington and its Attorney General, Christine Gregoire, played an active role in the state tobacco trials and subsequent 46 state settlement (known as the Master Settlement Agreement) in 1998. The legislature reserved $100 million of the settlement money for a new Department of Health tobacco control program. • Department of Health officials and health advocates had requested $26 million to begin the tobacco control program, but, because of pressure from the Republican members, the legislature only allocated $15 million for the first year, about half of what the federal Centers for Disease Control and Prevention recommends for Washington State. • Attempts to pass local smoking regulations, with provisions stricter than the 1985 Clean Indoor Air Act, have been hampered by an ambiguous legal question about whether the Clean Indoor Air Act preempts local legislation. Puyallup, the only city attempting to pass a smokefree restaurant ordinance, rescinded it after being challenged with an industry-funded lawsuit without seeking a court ruling on the issue of preemption. The fact that the Attorney General's office has not issued a formal decision on this issue has contributed to the reluctance from local governments. This circumstance has allowed the tobacco industry to stop local clean indoor air regulations. • Spokane has adopted a voluntary approach to controlling secondhand smoke in restaurants with their Big Air Program. Many restaurants in the City and County of Spokane have become voluntarily smokefree since the program was initiated in 1996. Although city officials initiated their program independently, it is very similar to the tobacco industry's voluntary smoking regulations through their "accommodation" and "red light/green light" programs. • The industry has also orchestrated legal pressure to attack the federally-funded ASSIST tobacco control project with allegations of "illegal lobbying" and filed a complaint to the Public Disclosure Commission. While the ASSIST project has ended, the tobacco industry successfully used this experience to discourage health departments and advocates from using the policy process to promote tobacco control. • Several counties, including King, Snohomish, Pierce and Spokane passed outdoor and color advertising restrictions between 1996 and 1999. These measures abolished all outdoor billboards and restricted advertising in stores to small, black and white posters. The industry supported challenges that overturned these restrictions on the grounds that they were preempted by federal law and a violation of the First Amendment. The industry prevailed in the federal Ninth Circuit Court of Appeals and the defendants agreed not to appeal in exchange for the industry not demanding that its legal fees be paid. This situation has stopped similar legislation in Washington. Similar laws were upheld elsewhere in the United States and as of early 2001 the issue was under review at the US Supreme Court. If the Supreme Court upholds such laws, Washington authorities may seek to reinstate them. • Health advocates, who could play a decisive role in anti-tobacco campaigns, have been hindered by the lack of a continuously functioning statewide coalition in Washington. The former group, Tobacco Free Washington Coalition, was funded in large part by a grant from ASSIST. Without ASSIST funding, the statewide coalition could not procure the resources to continue operations. Many advocates limited their efforts to smaller, local coalitions which dilutes their strength as a statewide lobbying force. A new group, Washington Alliance for Tobacco Control and Children's Health (WATCH), was created in 1998 to replace Tobacco Free Washington. They are a broad-based coalition funded by their member organizations. They lobbied in 1999 to ensure that money from the tobacco settlement went to fund health services and that the Department of Health's tobacco programs received adequate funding. • WATCH, together with the Washington Restaurant Association, sponsored Senate Bill 5993 which passed the Senate in March 2001. The bill would ensure more smokefree restaurants, but it has several flaws including exceptions for restaurants where minors are prohibited and the creation of a task force to study ventilation systems. The tobacco industry often advocates ventilation systems to dilute smokefree restaurant legislation and perpetuate controversy around the fact that no ventilation system can completely remove secondhand smoke from an enclosed environment. • In general, the tobacco industry has succeeded in stalling tobacco control efforts in Washington State. Although advocates, local public health officials, the Department of Health, the Attorney General, and some influential members of the legislature are all in favor of broad-based, fully funded, tobacco control education programs and increased Clean Indoor Air legislation, these advocates have not mobilized the resources necessary to overcome the legal and political impediments the industry has created.

The tobacco industry is a major political and legal force in Ohio through campaign contributions, lobbying and litigation. The tobacco industry has become a major source of campaign contributions to legislative candidates and political party committees. In the 1981-1982 election cycle, the tobacco industry contributed $3,970 to candidates and parties. In 1995-1996, the tobacco industry contributed $55,440 to candidates and parties. A majority of tobacco industry contributions to legislative candidates and political are contributed to the Republican party. During the 1991-92 and 1993-1994 electoral cycles, the tobacco industry contributed 54% and 53%, respectively, of their legislative and political party contributions to the Republican party. During the 1995-1996 electoral cycle, the tobacco industry contributed 77% of their legislative and political party contributions to the Republican party. In contrast to other states, there is not a statistically significant relationship between tobacco industry campaign contributions and legislative behavior in Ohio. Several health related groups, such as Anthem Blue Cross and Blue Shield, and United Health Care of Ohio, Association of Physician Assistants, the Ohio Health Information Management Association, and Ohio Dietetic Association are represented by lobbyists who also represent the tobacco industry. This pattern of representation raises the possibility of conflict of interests among lobbyists who represent the tobacco industry and health groups. Franklin County in 1994 and Knox County in 1995 had formulated regulations making almost all or all public places smokefree. These regulations were rejected in Ohio courts. Since these defeats, there has been no progress (except voluntarily) on smokefree public places. Tobacco control advocates and organizations have effectively organized in preventing preemptive youth access legislation from passing in the Ohio state legislature.

The tobacco industry is a major political and legal force in the state of Washington through campaign contributions, lobbying, and filing lawsuits. The tobacco industry has become a major source of campaign contributions to legislative candidates. In the 1985-86 legislative session, the tobacco industry contributed $31,100 to legislative candidates. Contributions reached a peak during the 1989-90 legislative session when the tobacco industry contributed $119,059 to legislative candidates. During the current 1995-1996 election cycle, the tobacco industry has contributed $69,573 to legislative candidates between January 1, 1995 to September 30, 1996. Tobacco industry contributions to legislative candidates is expected to exceed the 1993-1994 amount of $70,524. During the 1993-1994 legislative session, the combined contributions of Philip Morris, RJ Reynolds, and the Tobacco Institute ranked eighth among top contributors to legislative campaigns in Washington. In the past few election cycles, there has been a significant shift in tobacco industry contributions away from the Democratic party and towards the Republican party in Washington. During the 1989-90 election cycle, 47 percent of tobacco industry contributions to legislators, legislative candidates, political parties and party controlled committees went to the Republican party. Contributions to Republicans increased to 60 percent in the 1991-1992 election cycle and 66 percent in the 1993-1994 election cycle. Between January 1, 1995 and September 30, 1996, the tobacco industry contributions to the Republican party has increased to 83 percent. The tobacco industry makes significant contributions to legislative leaders. House Speaker Clyde Ballard has received $11,880 in tobacco industry contributions since 1986, more than any other current legislator. All Republican House Leaders have received tobacco industry contributions and generally had more pro-tobacco industry policy scores. In the Senate, where the Democrats held a one vote majority during the 1995-1996 session, Majority Leader Sid Snyder received $3,600 from the tobacco industry throughout his career. Valoria Loveland, the Democratic Caucus Chair, received $1,600 in tobacco industry contributions during the 1995-1996 electoral cycle. In addition to providing campaign contributions, the tobacco industry is active in lobbying members of the legislature and the administration. In 1993 and 1994, the tobacco industry spent $643,188. The trend suggests that the tobacco industry will exceed that amount during the 1995-1996 session. In 1995, the tobacco industry spent $368,660 in lobbying expenditures, an increase in the rate of lobbying expenditures over the previous election cycle. The tobacco industry became an especially active lobby in 1991 and 1992, after a number of local smoke free and youth access ordinances were passed in Washington cities and counties. A statistical relationship exists between tobacco industry campaign contributions and state legislative behavior. The more money a legislator receives, the less likely he or she is to support tobacco control efforts. The tobacco industry also tends to contribute more money to legislators that have supported the industry in the past. Besides campaign contributions and lobbying, the tobacco industry has used legal tactics to slow down tobacco control activity in the state of Washington. Legal action by the tobacco industry has 1) lead the city of Puyallup to rescind a smoke-free restaurant ordinance, 2) forced the Department of Labor and Industries to defend their clean indoor air regulations in Superior court, and 3) has created an atmosphere of intimidation among organizations associated with Project ASSIST. Despite the highest tobacco tax in the nation, none of the money raised from tobacco taxes has been earmarked for tobacco prevention or cessation programs. The state of Washington is among 19 states and counties that is suing the tobacco industry in order to recover health and medical costs associated with tobacco related illnesses.

The tobacco industry is a major political and legal force in Pennsylvania through campaign contributions, lobbying and litigation. The tobacco industry has become a major source of campaign contributions to legislative candidates, state constitutional office candidates, and political party committees. In the 1979-1980 election cycle, the tobacco industry contributed $3,600 to candidates and parties. In 1995-1996, the tobacco industry contributed $65,850 to candidates and parties. A majority of tobacco industry contributions to legislative candidates and political parties have shifted from the Democratic party to the Republican party. During the 1991-92 and 1993-1994 electoral cycles, the tobacco industry contributed 40% and 38%, respectively, of their legislative and political party contributions to the Republican party. During the 1995-1996 electoral cycle, the tobacco industry contributed 53% of their legislative and political party contributions to the Republican party. A relationship exists between tobacco industry campaign contributions and state legislative behavior. The more money a legislator receives, the less likely he or she is to support tobacco control efforts. The tobacco industry also tends to contribute more money to legislators that have supported the industry in the past. Legislative behavior significantly influenced the level of tobacco industry contributions in 1993-1994, but did not in 1995-1996. Several health related groups, such as Abington Memorial Hospital, Blue Cross-Blue Shield, Blue Cross of Northeastern Pennsylvania, Lehigh Valley Hospital and the Family Health Council are represented by lobbyists who also represent the tobacco industry. This pattern of representation raises the possibility of conflict of interests among lobbyists who represent the tobacco industry and health groups. Pennsylvania was one of the first states to pass statewide legislation (the 1988 Clean Indoor Air Act) that preempts localities from enacting stronger clean indoor air ordinances than that of statewide law. Lower Merion township was the first locality in Pennsylvania to ban all cigarette vending machines in 1991. However, an injunction sought by local cigarette vending machine companies prevented Lower Merion from enforcing its ordinance. Although the constitutional merits of the case were never decided, the failure of health organizations and public officials to defend the ordinance and the threat of lawsuits by cigarette vending machine companies stopped the spread of ordinances that completely ban cigarette vending machines. The creation of the Uptown Coalition represented a significant broadening of the tobacco control community to explicitly include the African-American community, and represented the first time a specific tobacco brand was derailed in 1990. The Uptown Coalition remains active in Philadelphia local tobacco control efforts. Pennsylvania tobacco control organizations have unsuccessfully attempted to pass statewide youth access legislation. The inclusion of preemption in statewide youth access legislation has divided the Pennsylvania tobacco control community.

The tobacco industry is a major political and legal force in Wisconsin through campaign contributions, lobbying and litigation. The tobacco industry is a major source of campaign contributions to legislative candidates, state constitutional office candidates, and political party committees. In the 1987-88 election cycle, the tobacco industry directly contributed $9,079 to legislators and candidates. In the 1995-96 election cycle the tobacco industry directly contributed $41,125. A majority of tobacco industry campaign contributions to legislative candidates and political parties have shifted from the Democratic party to the Republican party. In the 1987-1988, 1989-1990, and 1991-1992 elections cycles, the tobacco industry contributed 47%, 30% and 44%, respectively, of their legislative and political party contributions to the Republican party. During the 1993-1994 and 1995-1996 electoral cycle, the tobacco industry contributed 51% and 62%, respectively, of their legislative and political party contributions to the Republican party. A relationship exists between tobacco industry campaign contributions and state legislative behavior. The more money a legislator receives, the less likely he or she will support tobacco control efforts. Several health related groups, such as the Health and Hospital Association, the Wisconsin Association of HMOs, and the Employer Health Care Cooperative Alliance, are represented by many of the same lobbyists as the tobacco industry. This pattern of representation raises the possibility of conflict of interests among lobbyists who represent the tobacco industry and health groups. Madison was the first city in Wisconsin to pass a smokefree restaurant ordinance. Middleton and Shorewood Heights, suburbs of Madison, have also passed smoke free restaurant ordinances. Attempts at other smokefree ordinances have failed. Fond du Lac passed a ban on self service displays in 1991. However, a state circuit court and a state appellate court ruled that a 1985 state law preempts localities from passing more stringent local ordinances regarding minors' access to tobacco. Tobacco control efforts in Wisconsin have been characterized by a series of isolated initiatives with little structure or institutional support. This failure of the public health community to develop an institutional base capable of following through on victories or retooling from defeats may explain the lack of progress in tobacco control in Wisconsin.

The tobacco industry has been active in Texas politics for over 25 years. It spends money on lobbying, campaign contributions, legislative events and gifts in order to gain favor with the legislature and attempt to control the agenda set for tobacco control efforts. Political campaign contributions–reported only by Philip Morris–have remained high throughout the 1990s. Philip Morris reported contributing $556,250 to legislative, judicial and statewide candidates between 1988 and 2001. In recent years, their contributions to statewide officeholders and judicial candidates have decreased as their legislative contributions have increased. In each election cycle, 1998-1999 and 2000- 2001, Philip Morris contributed $51,000 to legislative candidates. The 3 largest lifetime recipients of campaign contributions in the legislature were all Senators: David Cain ($8,250, D-Mesquite), Ken Armbrister ($5,500, D-Victoria), and Chris Harris ($5,500, R-Arlington). The largest recipient of tobacco money from the statewide offices was former Lt. Governor Bob Bullock who received $36,500 from the tobacco industry from 1988-1996. The tobacco industry has also spent heavily on lobbying, although it is impossible to calculate the exact amounts. When lobbyists' report their fees to the Texas Ethics Commission, they are only required to report a fee range for each of their clients, not the exact amount that they were paid by each client. For example, a lobbyist would select between the ranges of $0-$10,000, $10-$25,000, $25-$50,000, etc. However, given these estimates, we can determine that from 1993-2001, the tobacco industry spent between $4,660,000-$9,640,000 on lobbyists' fees to influence the legislature. Texas' only statewide tobacco control laws are Senate Bill 55 (by Senator Zaffarini, DLaredo) and House Bill 119 (by Rep. Hirschi, D-Wichita Falls), both passed during the 1997 legislative session. SB 55 is the "Texas Tobacco Law" which establishes strict penalties for retailers who sell tobacco to minors and for minors in possession of tobacco products. The tobacco industry fought heavily against the legislation. The provisions in SB 55 which impose penalties upon minors are controversial among public health advocates because they distract attention from retailers and clerks who sell tobacco to minors. HB 119 is an ingredient disclosure bill, requiring manufacturers who sell tobacco products in Texas to report their ingredients to the Texas Department of Health. The tobacco industry uses allies like the Texas Restaurant Association, the Texas Retailers Association and the Texas Association of Business and Chambers of Commerce (TABCC) in order to shield its involvement in tobacco control issues. Restaurant owners are mobilized to oppose smoking restrictions and retailers testify against youth access and advertising restrictions. The TABCC opposed the state's lawsuit against the tobacco industry, with coaching on the issue from tobacco industry lobbyists. The tobacco industry has partnered with and heavily sponsored the activities of the Texas Civil Justice League (TCJL) in order to enact tort reform legislation which protects the industry from prosecution. In the tort reform and products liability legislation during the 1993 and 1995 sessions, the tobacco industry and TCJL limited punitive damage awards and the rights of plaintiffs to sue the tobacco industry for smoking-related illnesses. In 1996, then- Attorney General Dan Morales was the third Attorney General to sue the tobacco industry. He settled the case in 1998, prior to the 46 state settlement known as the Master Settlement Agreement. Texas' suit against the industry resulted in a $17.3 billion dollar settlement. From the money that the state has received as of 2001 ($1.8 billion), only $30 million has been spent on tobacco control programs from 1999-2001. In 1999, the state legislature deposited $200 million into a tobacco trust fund to be used for statewide tobacco control programs. However, the legislature only allowed for the interest on that money to be spent for tobacco control (about $9 million annually). The Texas Department of Health, charged with developing a tobacco control program with that small amount of money, was required to focus their efforts in East Texas. The Texas Department of Health comprehensive tobacco control program has been very successful, however, their attempts to secure more funding and expand the program statewide have failed. In 2001, the Legislature only increased funding for the program to $12 million annually. The Centers for Disease Control's Best Practices recommends that a state with the size and population of Texas should spend between $103 million - $180 million annually for an effective tobacco control program. Texas' only statewide smoking regulations, the 1975 Clean Indoor Air Act, sets up minimum standards for smoke-free public places. All of the state's effective smoking regulations have been passed by local governments. Most of the regulations simply establish smoking and nonsmoking sections in workplaces and restaurants. In recent years, several communities, including some surrounding the state capitol in Austin and the West Texas town of El Paso, establish 100% smoke-free public places, including workplaces and restaurants. El Paso's smoking ordinance, passed in 2001, also establishes smoke-free bars, the first ordinance of its kind in Texas. Beginning with the initiative of a sixth grade student, Lubbock enacted a strong clean indoor air ordinance. The tobacco industry, working with the Restaurant Association and Libertarians, opposed the ordinance. After the city council enacted the ordinance, the Libertarians forced a referendum. Tobacco control advocates mounted a vigorous defense and the ordinance was ratified by voters in May, 2002, with 64% voting for it. While tobacco control advocates, generally working through the voluntary health agencies, are showing increasing aggressiveness and effectiveness in working at the local level, they are still unwilling to confront the tobacco industry's allies in the state legislature, which explains their failure to force Texas to mount a strong state tobacco control program despite the millions of dollars made available by the state's tobacco settlement.

North Carolina, the top U.S. tobacco producing state and home to RJ Reynolds and Lorillard tobacco companies, has a historic, economic, and social legacy tied to tobacco, creating particular resistance to tobacco control efforts. The tobacco manufacturers historically relied on tobacco grower organizations, which had more influence on political and public opinion than tobacco manufacturers, to act on their behalf to shape policy in North Carolina. To influence policymakers, between 1996 and 2008, the tobacco industry contributed nearly $1.3 million to North Carolina political parties and individual candidates for state-level office, focusing contributions around pivotal elections, with candidates for governor and key legislative leadership being the largest recipients. There is a statistically significant relationship between the amount of tobacco industry campaign contributions a legislator received and his or her support for pro-tobacco policies. In 1969, North Carolina became the last state in the nation to enact an excise tax on tobacco, a modest 2 cents. Due to the passage of the 1969 excise tax, the Tobacco Institute increased its lobbying presence in 1972. As early as the late 1960s, the tobacco manufacturers anticipated that if North Carolina increased their tobacco excise tax other states would follow. They devoted considerable resources to defeating tobacco excise tax increase proposals, and as a result there were only small incremental increases in the tax during the 1990's and 2000's, still placing North Carolina 45th for tobacco excise taxes in 2011 (at $0.45 per pack). North Carolina was one of a few states, and the only tobacco growing state, that participated in both the National Cancer Institute COMMIT (1986-1995) and ASSIST (1991-1998) studies. ASSIST allowed the state to create a lasting tobacco control infrastructure by setting up local tobacco control coalitions in the majority of key media markets throughout the state. The resulting state tobacco control infrastructure remained active even after the studies ended and was still active in 2011. Beginning in the late 1980s, local jurisdictions began adopting policies to restrict smoking in publicly owned government buildings. By 1993, 15 counties and 22 cities had some kind of policy to restrict public smoking including in restaurants throughout North Carolina. In response to health advocates' growing success in passing local clean indoor air ordinances and board of health regulations, in 1993 the tobacco industry secured passage of a weak, preemptive state "dirty air" law which only allowed local jurisdictions to pass smoking restrictions for 90 days. (Eighty-nine more communities passed ordinances during his 90 day window.) The tobacco industry sued and invalidated the local county board of health regulations, prompting the tobacco control advocates to implement a strategy to "chip away" at resistance to tobacco control policies, beginning with youth access laws. In 1997 advocates began working to implement voluntary tobacco free school campus policies, an important step in changing social norms around tobacco use, with support in 2000 from Gov. James Hunt (D). By 2007, 75 percent of the school districts were voluntarily tobacco free when the state legislature enacted legislation requiring all school districts to be 100% tobacco free by August 1, 2008. North Carolina attorney general Michael Easley (D) did not sue the tobacco industry in the mid-1990s, but was one of the negotiators of the Master Settlement Agreement in 1998. He filed a pro-forma suit in 1998 so North Carolina could benefit from the cash payouts in the MSA, amounting to $4.6 billion over the first 25 years of the MSA for North Carolina. In 1999, the Legislature allocated 75% of North Carolina's MSA money to diversify the state's tobacco dependent economy and 25% to health related programs, of which a small portion was spent on youth-oriented tobacco-related projects beginning in 2002. In 2000, the Department of Health and Human Services Tobacco Prevention and Control Branch, along with tobacco control advocates, created the Vision 2010 strategic plan for the tobacco control part of the MSA money, including youth prevention programs and tobacco free school campuses, adding resources and funding for programming. The federal tobacco quota buyout in 2004 exacerbated the rift between the tobacco growers and manufacturers, resulting in reduced tobacco farmers' opposition to tobacco control policies. Tobacco control advocates successfully used this lack of opposition to begin a push for stronger tobacco control laws. Despite tobacco manufacturers' opposition, between 2003 and 2009 state tobacco control advocates built strong coalitions including nontraditional partners such as the hospitality industry, cultivated relationships with key legislators, and generated grassroots support resulting in 100% tobacco free schools, prisons and hospitals, and 100% smokefree government buildings, long-term care facilities, restaurants, and bars, effectively "chipping away" at preemption. In 2009 North Carolina became the first tobacco growing state to implement a statewide 100% smokefree restaurant and bar law. The 2009 law also partially repealed preemption, giving local governments the authority to enact more stringent restrictions on outdoor public property. Private workplaces remained preempted. Between 2003 and 2009, it was not uncommon for a state legislator to receive campaign contributions from the tobacco industry and then vote in favor for tobacco control policies, suggesting declining tobacco industry influence among policymakers. Tobacco control gains in North Carolina were incremental and required continue persistence and coordinated collaboration among tobacco control advocates, which allowed meaningful policies to be implemented. Tobacco control advocates should continue to work to strengthen state tobacco control laws including 100% smokefree workplaces, repealing preemption of all smokefree laws, and securing higher excise taxes. Advocates should continue to leverage the existing divergence between the interests of tobacco manufacturers and growers by promoting alternative crop production and uses for tobacco, and coalition building to further strengthen the states tobacco control policies. -

The tobacco industry's trend of giving generously to California legislators continued in the 1997-1998 election cycle. Between January 1, 1997, and December 31, 1998, the tobacco industry contributed $615,145 to state legislators and legislative candidates. Since 1991-1992, campaign contributions to legislative candidates and parties by the tobacco industry favored the party in power. However, in the 1997-1998 election cycle, reflecting increasingly partisan contributions by the tobacco industry, Republicans received 81 percent of tobacco industry campaign contributions even though the Democrats controlled both houses of the Legislature. The tobacco industry contributed a total of $848,635 to state legislators and legislative candidates, state constitutional officers, political parties and party controlled committees for the 1997-1998 election cycle. This total is less than the three previous election cycles in the 1990s, and is in part most likely due to the passage of Proposition 208, which placed spending limits on individuals, corporations, and PACs for 1997. On a per member basis, California legislators received more money than the members of Congress, $5,117 per member compared to $4,373 per member. For the 1997-1998 election cycle, Senator Minority Leader Ross Johnson (R- Irvine) the top recipient in California Senate ($111,500) received more money than Senator Lauch Faircloth (R-North Carolina), the top recipient in the United States Senate ($87,999). In addition, Assembly Minority Leader Bill Leonard (R- Rancho Cucamonga) received more tobacco industry campaign contributions ($82,250) than Representative Edward Whitfield (R-Kentucky), who was the top recipient of tobacco industry campaign contributions in the House of Representatives ($34,000). On January 1, 1998, California enacted the country's first state-wide smoke free bar law as an extension of the state smoke free workplace law. The tobacco industry attempted nine times to either delay the enactment of the law, or have the law repealed. The tobacco industry, working primarily through the National Smokers' Alliance, sought to undermine the law by depicting the issue as unfair to small businesses, and problematic in terms of enforcement. Even so, health advocates prevented the law from being repealed. In November 1998, California elected a Democrat to the governorship for the first time since 1982. Governor Gray Davis had begun to remedy the actions of the Wilson Administration in debilitating the state funded California Tobacco Control Program. Though the funding levels for the Proposition 99 programs were at the voted mandated levels, two suits filed against the state for misappropriation of Proposition 99 funds in 1991 and 1995 remain pending. Governor Davis vetoed $32 million the Legislature had appropriated for anti-smoking education programs. On June 12, 1997, the State of California became the 37th state to file suit against the tobacco industry. The state sought damages for violations of California Business and Professions Code and recovery of public health care expenditures for tobacco related disease. The state's claims for medicaid reimbursement were dismissed. The remaining claims were consolidated with the City of Los Angeles, the City and County of San Francisco et al., and two private citizen suits against the tobacco industry. These suits were settled by the Multi-State Master Settlement Agreement in November 1998. California will receive approximately $25 billion of the $206 billion settlement over the next 25 years from the industry. In September 1999, the Legislature passed a bill to have these funds dedicated for health services in the state. Other civil action suits against the tobacco industry are scheduled to be heard beginning in January 2000. These suits are mainly union trust fund suits against the industry, as well as local government failure to warn suits under Proposition 65, the state's toxic enforcement act. In November 1998, the California voters passed Proposition 10, which resulted in the creation of local agencies throughout the state that will promote child development programs and educational campaigns. The proposition won by a vote of 50.5% to 49.5%, despite the $29,397,147 the tobacco industry spent to defeat it. The program is funded by an additional $.50 tax on cigarettes, and a commensurate tax increase on other tobacco products. The tax increase, along with a price hike from the industry, sales of cigarettes in California decreased 28.6 percent for the first 6 months of 1999.