Upon arriving at The Robert Wood Johnson Foundation as president in 1990, Steven Schroeder encouraged the board and the staff to confront the tremendous public health damage of tobacco. Not long ago he said:

When I interviewed with the Foundation board, I told them I thought the Foundation should get more involved with substance abuse—that they were missing an opportunity. When I told the staff members that, and asked them to think about it, they didn’t want to do tobacco. Ultimately, the staff came around, and our board members felt the same way, but they were worried about the power of the legal industries, the alcohol and the tobacco industries, to resist what we might do and to make things ugly for us—to sully the good name of The Robert Wood Johnson Foundation.

When we proposed to go at this issue, we had a very spirited debate on the board. We actually had an eight-to-eight tie, with some board members thumping the table saying, “We shouldn’t do this; we’re a health care foundation.” Fortunately, the mission of the Foundation is health care and health. By being able to bring the question back to the mission and the data, we were able to break the tie.

What also helped to break the stalemate was some creative thinking by one of the trustees. Because reluctant board members were deeply troubled by the legality of tobacco use, the trustee suggested placing the focus on underage smokers—for whom tobacco use was and is against the law. With the legal issue thus resolved, the board endorsed that thrust. In 1991, the Foundation awarded a grant to Stop Teenage Addictions to Tobacco. Two years later, it began funding the SmokeLess States® National Tobacco Policy Initiative. Now almost a decade old, SmokeLess States continues to fund development and implementation of statewide strategies to reduce tobacco usage through education, treatment, and public policy. Among other techniques, the program seeks to increase the excise tax on cigarettes and the number of places having a smoke-free environmental policy.

A different approach to grappling with smoking on the national level came later, taking shape in Paris at the ninth World Conference on Tobacco and Health in October of 1994. Held every three years, this conference is part postgraduate seminar on sources and methods to combat smoking addiction and part old-time-religion tent revival intended to rally and energize the faithful. Foundation vice president Nancy Kaufman, who had been hired in 1991 for her background in public health and substance abuse, was part of The Robert Wood Johnson Foundation delegation to the conference. “People involved in tobacco control come to these conferences from all over the world,” she says. “Some are academics, some work for governments, and some are true on-the-ground advocates who are not professionally trained in health at all. At that meeting in Paris, I was bowled over. I saw all this incredible tobacco control activity going on in other countries. We looked like we were in the Stone Age by comparison.”

At that conference, Kaufman brought together a dedicated group of tobacco control advocates to try to figure out what the antismoking movement in the United States could do to catch up with its more assertive and innovative foreign counterparts. Included in the group of Americans in Paris were Matt Myers, a Washington anti-tobacco attorney; John Bloom, a lawyer and consultant for the National Cancer Society; John Slade, a physician and professor at the University of Medicine and Dentistry of New Jersey; Greg Connolly, director of the tobacco control program for the state of Massachusetts; and Michael Beachler, then a senior program officer at The Robert Wood Johnson Foundation. The group gathered between sessions of the conference, and the idea of a national center—a home base for the antismoking movement—began to form.

The germ of this idea had already been planted in a Foundation study conducted by Elaine Arkin earlier in 1994.² “We hired Elaine Arkin to surf for ideas that would improve communication and education efforts that would denormalize tobacco,” says Beachler, who is now the director of Penn State’s Rural Health Policy Center. Arkin talked with a great many of the experts in the field, synthesized their ideas, and brought them to the Foundation’s attention. “She came back with a series of options, one of which was a national center that would act as a central clearinghouse—the place where tobacco opponents could congregate to create their message. What we ended up doing was different, but her work put the idea of a national center on the horizon.”

The Tobacco Institute was the public relations arm of the tobacco industry. Armed with a multimillion dollar budget and using a combination of savvy Washington political maneuvering and sophisticated advertising and public relations campaigns, the Institute sought to manipulate public opinion on smoking and to counter claims that smoking is unhealthy and potentially deadly.³ For more than four decades, despite the mounting scientific evidence on the adverse health effects of smoking cigarettes, it was remarkably successful.⁴ The problem was that although the Tobacco Institute offered the media one-stop shopping for the pro-tobacco spin on events and information, there wasn’t just one place journalists could go for a rebuttal. Anti-tobacco forces were fragmented across numerous public health and public interest organizations, and opposition to the tobacco lobby was not the sole mission of any of them—“Tobacco was just one more item on a long list of issues these organizations cared about. We were like guerrillas, firing spears and darts at panzer tanks,” says Joe Marx, currently a senior communications officer for The Robert Wood Johnson Foundation who, at the time, directed media relations for the American Heart Association.

To the extent that they were organized at all, the anti-tobacco “guerrillas” worked out of the Coalition on Smoking or Health, a loose confederation of representatives of the American Cancer Society, the American Lung Association, and the American Heart Association. “The overriding weakness of the coalition was that it was rather an exclusive club,” says Beachler, “and it was limited in what it could bring to the table in terms of organizational and political muscle. What was needed was a big tent of people who could really push and mobilize on a specific issue.”

Moreover, the Coalition on Smoking or Health was strapped for resources. “The Coalition never had the resources to do the job” says Matt Myers, a former civil rights attorney who was executive director of the Coalition and is now president of the National Center for Tobacco Free Kids. The Coalition responded to legislation proposed by Big Tobacco and to the industry’s media blitzes, but only rarely did it initiate activities of its own.

The idea of having a national center with not just a communications focus but also a policy-making edge took shape at those informal meetings in Paris. The challenge was how to create an organization that would seize the initiative and function as a Tobacco Institute for the good guys. The concept of being proactive was to be a giant step forward. Not only would the center serve the press, providing information, documentation, and sound bites for the anti-tobacco point of view, it would also work for measures to denormalize tobacco.

Shortly after the Paris conference, Kaufman and Beachler met with Steven Schroeder and proposed the idea of a new organization. With a green light from Schroeder, the pair began putting it together. The concept was not without risk. For The Robert Wood Johnson Foundation at that time, tobacco control was a controversial activity.

Although the Foundation’s antismoking activities in the early 1990s had been modest, they had not gone unnoticed by the tobacco industry, which had already fired one warning shot across the bow, over the SmokeLess States program. To gear up for a public-health-oriented series of TV commercials concerning smoking and children, the Foundation’s grantee in Colorado had held an open bidders’ conference for firms interested in producing the ads. Although a tobacco tax referendum on raising the state tax on a pack of cigarettes was to go before Colorado voters in the fall of 1994, the proposed public health messages had nothing to do with cigarette taxes. Nevertheless, a tobacco industry lawyer attended the bidders’ conference, and reported back to the Washington law firm of Covington & Burling, long affiliated with the tobacco industry. Covington & Burling sent an intimidating letter to The Robert Wood Johnson Foundation, alleging that the Foundation was using its money illegally, and threatening IRS involvement.

Although the Colorado public health campaign was surely an aggressive use of Foundation funds, staff members had ascertained beforehand that any use of grant monies would stay nonpolitical. Nevertheless, the letter from Covington & Burling generated considerable anxiety when it arrived, as Michael Beachler recalls:

The letter hit the Foundation doorstep about three weeks before we were to make a presentation to the board about launching what would become Tobacco-Free Kids. We had to make the fact that we’d gotten this semithreatening letter from the tobacco industry part of the presentation. We crafted a strategy that reassured the trustees that the Foundation knew what it was doing, and that we were on the right side of the law. We also made it perfectly clear that no Robert Wood Johnson Foundation funds could be used for lobbying.

The Foundation did not, however, want to support this new organization all by itself. For political and symbolic reasons, it needed other partners at the table that believed this was an important concept. It contacted the leadership of the American Cancer Society, the American Heart Association, and the American Lung Association—organizations that were the nucleus of the Coalition on Smoking or Health—as well as with other activists in the public health community. With their moral support and the financial the backing of the American Cancer Society and the American Heart Association, in September of 1995 The Robert Wood Johnson Foundation provided funding for a coordinating committee that would eventually become the nucleus of the National Center for Tobacco-Free Kids. The project began on a hope and a shoestring—and on the serendipitous availability of William D. Novelli.

A founder of the Washington, D.C., social marketing firm of Porter Novelli, Bill Novelli had been in the number-two position at CARE, but had just left to take a sabbatical at the Annenberg Center at the University of Pennsylvania. He was all but literally pen-in-hand, ready to sign a year’s lease in Philadelphia in connection with his teaching position, but it didn’t take much cajoling for him to change his plans and become the first president of the National Center for Tobacco-Free Kids. What would make someone give up the comfort of a visiting professorship? As Novelli says:

The sabbatical was going to be a real respite—I was going to take a course, teach a course, drink some beer, and go to football games. Then Dr. Tom Houston of the American Medical Association called to tell me that the Food and Drug Administration was about to assert jurisdiction over tobacco, and that we needed to get something going. Shortly thereafter, Nancy Kaufman called and offered me the presidency of the Center for Tobacco-Free Kids. I saw this as a major opportunity to really make a difference, to tackle something that had a huge, huge payoff. That was number one. Number two, the tobacco industry is the kind of entity that really gets your juices flowing.

The third thing was that when I retired from Porter Novelli, I told myself that I was going to really go for the gold. I wanted to have opportunities to work with great people and do great things. I said to myself, “This will be a hell of a lot more fun than a sabbatical. This will be a great fight.”

Shortly after Labor Day in 1995, with borrowed office space and what was literally a skeleton crew, Novelli began gearing up for battle with the tobacco industry. The battle was surely coming—just the month before, the White House and the Food and Drug Administration announced their intention to assert jurisdiction over tobacco. Although the Center for Tobacco-Free Kids was still in its infancy, the organization had already registered as a blip on Big Tobacco’s radar. “They play hardball,” Novelli says. “Within a month of when I started, there was a blurb about me in the Wall Street Journal, about Bill Novelli coming back to Washington to run Tobacco-Free Kids. About a week later, I got a call from a guy who was working at a PR agency that services Philip Morris. He said, ‘Bill, they’re doing a dossier on you. They’re asking all kinds of questions.’”

Big Tobacco was also shaken by a series of paid advertisements that the Center took out starting in the fall of 1995. “We wanted to create as much public outrage as we could,” Novelli says. “We wanted to isolate the tobacco industry from the standpoint of their role in corporate America, and not make them seem like just another corporation or industry.” Says Matt Myers, who officially joined the Center as vice president at the launch in June, 1996 and became president in 1999 when Bill Novelli resigned to head the AARP:

This was the first time that the tobacco control movement had the ability to buy advertising, and it put the world on notice that Tobacco-Free Kids existed. The ads were remarkably successful.

In the fall of 1995, Steven Schroeder, Nancy Kaufman, and Bill Novelli approached John Seffrin, chief executive officer of the American Cancer Society, about partnering with The Robert Wood Johnson Foundation in underwriting the National Center for Tobacco-Free Kids. Seffrin supported the concept, and got the approval of the Cancer Society’s board for a financial commitment of $10 million over a five-year period. Buoyed by the presence of a solid financial and political partner, in January 1996, The Robert Wood Johnson Foundation authorized a grant of $20 million to support the National Center for Tobacco-Free Kids. (In 1999, the Foundation renewed and augmented its grant to the Center, awarding it $50 million for the period from April 1999 through March 2004.)

The Center originally had four objectives:

1. To develop a national strategy for reducing youth tobacco use
2. To serve as a media center that would develop national information efforts to prevent youth tobacco use and counter the promotional efforts of the tobacco industry
3. To provide intensive technical assistance to state and community public education efforts to improve their effectiveness
4. To broaden the base and the depth of national organizational support to reduce youth tobacco use.⁵

Given the nature of the Center’s work, the Foundation re-emphasized that its funds could not be used for lobbying purposes.⁶

Those who had been active in the Coalition on Smoking OR Health were most affected by creation of the Center for Tobacco-Free Kids. Part of Matt Myers’ responsibility was to soothe the ruffled feathers, especially among members of the Coalition, and to get the public health community to support the big new kid on the block in the antismoking movement.

Keeping peace and harmony within the public health community was essential, since all hands would be needed on deck to build public support for the FDA in its decision to assert jurisdiction over tobacco. Toward that end, one of the first objectives of Tobacco-Free Kids was to ratchet the anti-tobacco/pro-FDA activity level upward across the board, both in Washington and elsewhere.

As part of this effort, the Center for Tobacco-Free Kids began a series of discussions with public health organizations about why FDA jurisdiction over tobacco was important, and to prepare them to become public spokespersons about the question. It also began working with the American Heart Association, the American Cancer Society, the American Lung Association, the American Medical Association, and the American Academy of Pediatrics on the stand-and-be-counted issue of getting pledges of support from elected officials for the FDA’s decision. “It was anticipated that the tobacco industry would go into Congress to try to cut off the FDA before it could ever move forward,” Myers says. “Our goal was to beat them to the punch—to build as visible and as broad a base of support as possible that would send a signal to opponents that they would fail if they tried to kill it.”

For a fledgling organization, coordinating all these activities in its first year of existence meant that Novelli, Myers, and the rest of the staff had to hit the ground running. Even so, they soon had to pick up the pace. While the issue of FDA jurisdiction over tobacco started working its way through Congress, a number of states had filed suit against the tobacco industry, seeking to recoup the cost of treating people who had developed cancer, emphysema, and other diseases as a result of smoking. Several litigating states had entered clandestine preliminary conversations with the Liggett group, one of the smaller tobacco companies—discussions that were expected to lead ultimately to a financial settlement. Early in 1996, a number of the state attorneys general approached Myers about opening channels of communication with the public health community.⁷ As Myers recalls:

The attorneys general secretly came to me to say they were pretty close to an agreement. They thought it was important to have the public health community see their settlement as a victory, and asked to me to review the agreement, and to act as a liaison—which I did. From that time on, I was in regular contact and communication with the state attorneys general, so that when they began a second round of negotiations with Liggett, they asked us to participate with them—which I did. That was not particularly controversial, but it was an important period when the relationship with the AGs developed very closely.

At about the same time, a number of the state attorneys general began a very tentative dialogue with other corporations in the tobacco industry, and with the White House, about the possibility of a much broader agreement, and with it a much heftier financial settlement. “When we got wind of that, we went into the White House to warn them about sham deals, which has been the history of tobacco industry settlements in the past, and to make clear to the White House that the public health community intended to scrutinize any agreements very closely,” Myers says. “Bruce Lindsey, special assistant to the president, and I talked on a regular basis.”

In March 1997, representatives of the tobacco industry approached the attorneys general and indicated that they had a very serious offer they wanted to put on the table. Concurrently, they communicated their intentions to the White House, which told them to call the National Center for Tobacco-Free Kids, and insisted that the organization had to be part of any discussions that would take place. Things moved quickly from then on, and from April 3 through June 20, 1997, Myers was an active participant in negotiations between the state attorneys general and Big Tobacco. For the first two weeks, those negotiations took place entirely in secret. On April 16, however, the Wall Street Journal broke the story that the talks were going on.⁸ The revelation generated both widespread news coverage and a firestorm within the public health community.

The more militant antismoking activists felt that they had been sold down the river. Believing themselves betrayed, they were outraged by the idea that discussions were occurring at all: for them, it was an article of faith that one did not negotiate with the tobacco industry, any more than one would bargain with the Devil himself. Stanton Glantz, a professor at the University of California, San Francisco and founder of Americans for Non-Smokers Rights, argued, “In negotiating with the industry, Matt Myers chose to ignore a consensus among public health groups not to enter a deal with the industry. . . . Participation in the decision-making process has been kept to a small circle; history shows that broader involvement serves the public health.”⁹ Further, he felt that “the tobacco-control community now has a real opportunity to end the tobacco industry in this country. If that opportunity is lost, it will be because the National Center for Tobacco-Free Kids lost it for us.”¹⁰

Rep. Henry Waxman (Democrat of California), another who had staunchly opposed the tobacco industry for many years, was upset at Myers’s attempting to negotiate legislation with the industry. “I was critical of Matt Myers and whoever else was in there. They didn’t coordinate with their colleagues in the advocacy world; they didn’t coordinate with their allies on the Hill.”¹¹

From the outset, however, there was an inner circle within the public health community that was clued into the discussions. As a result of the prior settlement discussions between the attorneys general and the Liggett Group, Myers and Novelli had come to believe that further dialogue with the tobacco industry was in the offing even before the first overtures from Big Tobacco were made, and they had determined to prepare for that eventuality. In fact, even before negotiations with the tobacco industry as a whole had begun, Myers and several others had called together public health advocates to discuss the possibility that there would eventually be some form of compromise agreement offered. “We expected that the tobacco industry would make an offer secretly to the White House or to Congress, and we told our colleagues that we believed it was important that there be a discussion of what the public health community wanted out of any proposals,” says Myers. However, the public health community could not, even at that early stage, agree upon goals and strategies. “It was our frustration at our inability to generate a broad, more public dialogue that led Bill Novelli and me to convene the leaders of the major public health organizations in private to begin to discuss these issues.”

Beginning in January, 1997, and extending all the way through the negotiation period, Bill Novelli and Matt Myers conferred with an informal executive group that included the CEOs of the American Cancer Society, the American Heart Association, and the American Lung Association; the highest ranking representative of the Academy of Pediatrics; and a past president of the American Medical Association.

With this all-star kitchen cabinet as a sounding board, Novelli and Myers began gaming mock negotiation scenarios a full four months before discussions actually got under way in April. “They all had the opportunity to think through choices, to take a look at what they were willing to give up, what they weren’t willing to give up,” Myers says. Once the talks began, “the group got regular briefings, even before the negotiations became public knowledge. Bill and I set up conference calls with them every couple of days, in which I briefed them about what was being discussed and what the issues were.”

As Novelli recalls:

Matt and I talked every night, and we’d discuss how to make the deal better. Can we add something on smoking in the workplace, or smoking in public places? We were also keeping our allies—John Seffrin at the American Cancer Society; Dudley Hafner, CEO of the American Heart Association; Lonnie Bristow, past president of the American Medical Association; and John Garrison, CEO of the American Lung Association—abreast of what was going on. We didn’t tell our staff. We felt that the negotiations had to be essentially secret. Once they became public, it was a bonfire.

“Sound and fury, light and anger, vitriol, nervousness—it was probably the most trying time the Center ever had,” Myers says. “While the negotiations were going on, I made little more than token appearances at the office. A huge burden fell to Bill to manage the uproar and to manage the public response.”

After the negotiations became public knowledge, discussions continued to take place, and progress continued to be made.With great fanfare the agreement was announced on June 20, 1997. It required the tobacco industry to make annual payments estimated to total $368.5 billion in the first 25 years and to continue indefinitely. “The settlement was signed by all of the attorneys general, but not by us,” Myers says. “We took the position that it wasn’t for us to sign or not sign. We were there as advisers, not parties.”

Tobacco control provisions in the deal included:

• Full FDA authority over tobacco, including the power to curtail tobacco marketing and to reduce and/or eliminate harmful ingredients and components, including nicotine
• Significant curtailment of tobacco marketing, that included but exceeded restrictions proposed by the FDA in 1996
• A ban on all outdoor and Internet advertising
• The elimination of all human images and cartoon characters in tobacco ads
• Restrictions on point of sale advertising and vending machines
• A ban on all brand name sponsorship, the use of tobacco brand names on nontobacco items, like hats and t-shirts, and a ban on free giveaways of nontobacco items based on the purchase of tobacco products
• Severe limits on tobacco ads in magazines with large youth readership
• Nationwide restrictions on youth access to tobacco products
• The adoption of tougher more visible new health warnings on packs and ads
• Nationwide standards to curtail exposure to secondhand smoke
• Penalties of up to $2 billion a year if youth smoking rates did not fall by 50% in 7 years and 60% in 10 years
• $1.5 billion a year to be used for tobacco cessation and $1 billion a year for tobacco-prevention efforts

In exchange, the companies won freedom from class action lawsuits and from the award of punitive damages based on prior acts by tobacco manufacturers, as well as a $5 billion annual ceiling on the total amount of damages the tobacco industry would be required to pay to successful litigants.

After the terms of the settlement were announced, the National Center for Tobacco-Free Kids and Myers personally became targets of opportunity for outraged anti-tobacco activists who had opposed the discussions, and for those who believed the settlement to be a sellout of the public interest. “The fact that we had, even before it became public, asked the other public health organizations if they would like to participate, and urged several of them to do so, didn’t make an awful lot of difference to outsiders,” Myers says. Among the most vocal opponents of the settlement were Rep. Henry Waxman, outgoing FDA chief Kessler, former Surgeon General Koop, and consumer advocate Ralph Nader.

“The National Center for Tobacco-Free Kids is performing exactly the wrong role,” said Waxman, a longtime tobacco foe. “They seem to have forgotten that their original mission was to be advocates, not back-room negotiators.”¹²

Nader wrote to Myers and his colleagues:

A disturbing transformation is discernible in the approach of the public health advocates who have been involved in the litigation settlement negotiations. . . . While they originally promised only to support an exploration of the negotiation option, they have now become active proponents of a settlement deal. . . . This premature support for a settlement suggests that those involved in the negotiations and their close supporters have become invested in the negotiation process, and that this has distorted their ability to evaluate clearly the costs and benefits of a deal. At a minimum, the venality and historic duplicity of the tobacco industry are sufficient for any public health advocate not to lend credence to any tobacco industry deal that immunizes it from the only branch of government whose processes they could not buy or rent—the judiciary.¹³

A committee to review the settlement, organized by Waxman and chaired by Koop and Kessler, condemned the settlement. Even Dudley Hafner of the American Heart Association denounced the plan as “totally unacceptable.” “These provisions have been very well lawyered by the tobacco industry to thwart gains already made,” Kessler told reporters after the settlement was announced. “It’s giving away the farm.”¹⁴

The fate of “the farm” did not, of course, rest solely, or even primarily, with the Center for Tobacco-Free Kids. The various attorneys general who were plaintiffs in the lawsuits had the most to say about the final terms of settlement. Significantly, however, who those AGs were, and how many there were, changed as negotiations went on. At the outset, the small cadre of participating attorneys general shared a common belief that the tobacco industry should reimburse the states for the health care costs they had incurred and were likely to incur in the future. Between April and June, however, the number of states that were suing the tobacco companies grew geometrically, if only because nobody wanted to be left off the gravy train. What happened, according to Myers, is that

the state attorneys general who cared about the public health issues dominated those discussions and the results reflected their concerns. The new state attorneys general who became involved, however, were so anxious to reach an agreement that they undermined any opposition to the provisions granting the tobacco industry relief from class actions and punitive damages.

The state attorneys general had been promised by the White House, which had monitored the negotiations closely, that President Clinton would declare his support for the settlement within twenty-four hours of its public announcement. Myers was not surprised when several days, weeks, and even months later, the AGs were still waiting. “As the one Washington person in the group, I kept saying to the AGs, ‘You guys are pretty sophisticated, but if you believe that one, I’ve got a bridge to sell you.’ And in fact what the White House did was to step back and say, ‘I’m going to wait and see which way the wind is blowing. And you guys who I pushed out on this limb—you sort of stay out there awhile. When there’s a consensus, we’ll be right there to support you.’”¹⁵

The June 20 settlement needed federal legislation to become effective, and the Republican leadership of the Senate sent the matter to the Commerce Committee, chaired by John McCain, Republican of Arizona. Although until that time McCain had never evinced much interest in the subject of tobacco, he now took the issue seriously and asked for help from the National Center for Tobacco-Free Kids in drafting legislation that would implement the agreement between the AGs and the tobacco companies. “We’d already developed a relationship with him,” Myers says. “He came to us saying, ‘I’m going to start holding hearings. I want to explore this issue, and it would be my goal to introduce a bill that the whole public health community could endorse, and I don’t intend to consult with the tobacco industry about what ought to be in it.’”

Myers worked with McCain’s office to put a bill together.¹⁶ Introduced in March 1998, it breezed through the Commerce Committee in April by a vote of nineteen to one—but without the endorsement of the public health community. Not only that, but Koop and Kessler strongly opposed enacting the terms of the settlement into legislation. Koop testified before the Commerce Committee that “The settlement gives the tobacco industry everything it wants, but shortchanges the public health.”

Myers says:

I believe that not supporting the bill is one of the most serious mistakes the public health community has ever made. It was truly the most far-reaching anti-tobacco bill that’s ever been considered in this country. Both David Kessler and C. Everett Koop decided that the bill still wasn’t good enough. Had the public health community endorsed the bill at that point, it probably would have flown to the floor of the Senate and passed with eighty votes. As it was, however, because the public health community was divided, Trent Lott announced that he thought the Senate needed more time to study the issue.

What happened after that proved once more that politics makes strange bedfellows. Progressive Democrats introduced amendments to put more teeth in the law, and were supported not only by their liberal confreres but by arch conservatives as well—though for diametrically opposite reasons. The former group was trying to strengthen the bill, but the latter was trying to turn it into a “Christmas tree,” festooned with riders and provisos ensuring that it would never pass.

Lott, the Senate majority leader, put the bill on hold for six weeks, a delay that allowed the tobacco industry to conduct their TV advertising against the bill. The bill was then on the floor of the Senate for a full month, the longest that any piece of proposed legislation had been on the Senate floor since the days of the civil rights movement, and long enough for the tobacco manufactureres to go after McCain’s bill with a vengeance. They threw all of their considerable advertising, political, and financial resources into the battle. The tobacco industry announced its opposition, launched a $40 million TV advertising campaign criticizing the bill as pork-barrel legislation, and then spent $60 million more lobbying against the bill.

Despite Big Tobacco’s big guns, Bill Novelli still believed that the antismoking forces would carry the day. “The tobacco industry basically said, ‘The public health community can’t be trusted. The Senate has loaded up this bill, and the provisions are far too onerous. Not only are we walking away from this legislation, we’re going to kill it.’ When that happened, I said to myself, ‘They can’t win this. They’re going to go to the people; they’re going to put up a huge advertising campaign, and it’s going to be a bust, because nobody is going to believe the tobacco industry . . .’—and I was wrong.” On June 17, nearly a year to the day after the original settlement was first announced, the fate of McCain’s bill came down to a vote on the Senate floor over a filibuster. “A total of fifty-seven senators—out of the sixty we needed—voted in favor of breaking it,” Myers recalls sadly, “and forty-two voted against, which meant the bill died—and with it the opportunity to make a giant leap forward in tobacco control.”

“The only thing I think I might have done differently,” Novelli says, “would have been to go back to Steve Schroeder at The Robert Wood Johnson Foundation and say, ‘Steve, I need another $50 million right now.’ If we had been able to fight them dollar for dollar, or at least close to it, we might have been able to apply enough pressure to negate their message and to force the legislation through. Everything else I think we did as best we could, with as much courage as we had, and as many resources as we had.”

The failure to pass enabling legislation at the federal level put the state attorneys general back to square one. Because most of them had never intended to take their lawsuits to trial, they still needed to strike a bargain with the tobacco companies. Unfortunately, this was no secret. Just two weeks after the downfall of the McCain bill, confidential negotiations resumed, this time without any representatives from the public health community at the table. Although Myers maintained his back door communication with those AGs who had been part of the original group of litigants, everyone knew they were negotiating in a distinctly different political landscape. “The folks who were our friends had limited power,” he says. “There were four or five who had always believed in what they did, and really wanted to get the best deal for the public that they could, but they didn’t have a lot of leverage, because everybody knew that the threat of going to trial wasn’t real. The vast majority of the AGs who had suits pending had only one question: how much do I get and when do I get it?” At the end of the day, what had started as a public health issue had come down to getting Big Tobacco to “show me the money,” in the Jerry Maguire catchphrase of the moment.

The demise of the McCain bill marked the beginning of a new chapter for the Center for Tobacco-Free Kids as well. Of necessity, this phase began with an embrace of the inevitable—the acceptance that there would be another, and probably weaker settlement between the attorneys general and the tobacco industry.

At what might understandably have been considered a dark hour, the staff rallied and dug in for a long, hard slog in the trenches. “Even while Congress was turning away from tobacco, the level of energy out of this office was ramping up, not down,” Myers says. Because of the urgency involved in dealing with the FDA issue, the state attorneys general lawsuit and the McCain bill, one of the Center’s original objectives—to provide intensive technical assistance to state and community efforts—had to this point been secondary to efforts at the federal level. Now, however, it took center stage.

The time had come to sharpen the skills of local antismoking activists—to work with them to hone their marketing and public relations skills. “I call it ‘professionalizing the movement,’” the Foundation’s Joe Marx says. “The people involved with tobacco control had the passion and had been fighting the good fight for years and years, but needed the kind of savvy, innovation, and creativity that Bill Novelli brought with him.”

Novelli and Myers brought in outside professionals—it didn’t matter whether they knew anything about tobacco and about the tobacco industry; they knew how to create advertising messages that had an impact on people. Today the Center maintains advisers and an inventory of supplies that can equip and energize antismoking activists in all fifty states with data, game plans, and communications materials.

Over the summer and the fall of 1998, the Center began mobilizing state by state. “We immediately got out talking points to public health advocates all over the country,” Myers says. “With funding from The Robert Wood Johnson Foundation, we organized a conference in which we brought together tobacco control advocates from every state. We prepared briefing materials for them, to arm them to return home and begin working for the use of settlement money for tobacco prevention.” On November 23, 1998, the attorneys general for 46 states¹⁷ and the tobacco industry announced the completion of another agreement. The Master Settlement Agreement¹⁸ includes the following provisions:

• Elimination of most but not all outdoor advertising
• Termination of cartoon images in marketing—Joe Camel was gone, but the Marlboro man lives on
• Dissolution of the Tobacco Institute, the Council on Tobacco Research, and the Center for Indoor Air Research
• Prohibition of youth targeting in marketing
• Prohibition of product placement in films and television
• Curtailment of vending machines to adults-only facilities

Matt Myers comments that the Master Settlement Agreement was far weaker and narrower than either the June 1997 agreement or the McCain legislation. “It did not provide the FDA with authority over tobacco. It did not penalize tobacco companies if youth smoking rates did not decline. It did not set standards for protection against secondhand smoke. It did not strengthen or revise health warnings on tobacco products or ads. There was nothing in the agreement that required retailers be licensed, that ingredients in tobacco products be disclosed or that harmful ingredients in tobacco products be removed. It did not require that any money be used for tobacco prevention or cessation, and the $300 million a year that was provided to the American Legacy Foundation for five years had restrictions on it.”

By the time the Master Settlement Agreement was announced, local activists were ready to rumble. The National Center for Tobacco-Free Kids had already laid the groundwork to do battle in every state in the union and had prioritized about twenty states to be the focus of legislative action. “We produced state-specific data, so that representatives from every state would have fact sheets indicating the number of smokers, how much the tobacco industry spends, and how much the state spends on health care to deal with smoking-related illnesses,” Myers says. “They didn’t have to reinvent that wheel every time they needed information.”

Once the settlement was announced, one of the functions of the Center was to keep antismoking advocates abreast of what their fellow activists were doing. Among the innovations that evolved during this period was use of the Internet for exchanging information and ideas among tobacco control activists. People in Ohio could compare notes with advocates in Washington or Rhode Island. The communication was both informative and energizing. “When bills with identical language popped up in four different states, we could generally figure out that they had been written by someone from a tobacco company, because we knew from talking to one another that it wasn’t just a coincidence when this suddenly started happening,” Myers says. “I think it was the first time that individuals in various states who are fighting these battles didn’t perceive themselves as isolated islands, but, rather, as part of a national network.”

The Center for Tobacco-Free Kids also put its Washington-based advertising expertise in service to local and state antismoking activists. “We had our agency create flexible model ads that could be used in a number of ways,” Myers says. “If an ad fit a theme in a given state, advocates could simply drop in the names and figures as needed. They didn’t have to incur any creative costs at all; all they needed to do to run the ad was to buy space or time. It was a huge financial bonus.”

Since the settlement, the Center for Tobacco-Free Kids has pushed a broad agenda designed to increase funding for tobacco prevention and cessation, to protect against second-hand smoke, and to increase state taxes on tobacco products. It has also worked to deveop nationwide support for providing the FDA with jurisdiction over tobacco. As the battleground shifted to the states, the professionalization of the movement began to pay off. “We’ve learned how to do it,” Myers says. “Four years ago, Maine had the highest teenage smoking rate in the nation, over 39 percent. In four years, that number has gone down to 25 percent. Mississippi and Florida are right behind them—and both of them used settlement money to do it. There is no single magic bullet—we’re dealing with a complex human behavior. The states that have succeeded have taken a multipronged, multifaceted approach, and that’s what’s critical—the combination of mass media advertising, funding for local community groups, and school-based programs. Taken together, they’ve been found to be more effective than enforcement of the laws against sales to minors.”

“For too long we’ve found lung cancer rates to be an acceptable fact of life,” Matt Myers says. “They’re no more of an inevitability and necessity than polio. We’re not used to funding tobacco prevention. If we saw it as the equivalent of a vaccine against lung cancer—and it is—then the money wouldn’t be an issue. We can now say with a fair degree of scientific certainty that we know how to significantly reduce the incidence of tobacco use among kids. We do not yet know how to eliminate it, or to reduce it to a minimally acceptable level, but we do know how to dramatically impact it—and that’s a start.”