October 2005

Grant Results

National Program

SmokeLess States(R) National Tobacco Policy Initiative

SUMMARY

From mid-2001 to mid-2004, the Protect Montana Kids coalition, with the American Cancer Society as the lead organization, conducted statewide activities to reduce tobacco use, particularly among children and youth.

The project was part of the Robert Wood Johnson Foundation (RWJF) national program SmokeLess States®.

Key Results
Among the key results of the project are the following:

  • Montana increased its cigarette excise tax to $1.70 per pack — one of the highest tobacco taxes in the country — and increased taxes on spit tobacco and other tobacco products.
  • Montana made headway in establishing smoke-free communities, including passage of a comprehensive smoke-free ordinance in Helena, Montana's capitol, and a smoke-free ordinance in Bozeman, which covered all workplaces except for bars and casinos. In 2005, after RWJF's funding ended, the 59th Montana Legislature passed the Montana Tobacco-Free Schools and Clean Indoor Air Act.
  • Protect Montana Kids and other organizations successfully challenged the constitutionality of a limited preemption statute in the state Supreme Court.
  • Montana secured $3.2 million from its Master Settlement Agreement (32 percent) for tobacco prevention and control, up from the $400,000 previously set aside for this purpose.

Funding
RWJF provided $1,057,959 for this project. Montana also received four grants from the program's Special Opportunities Grant Fund. Other sources — including the Campaign for Tobacco-Free Kids, the American Heart Association and the American Cancer Society — contributed over $500,000 to support lobbying and other activities; no RWJF funds were used to support lobbying. (See Appendix 1 for a list of additional funders.)

 See Grant Detail & Contact Information
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THE PROBLEM

By 2001, 21 percent of adults in Montana smoked and the state had one of the highest smokeless tobacco rates — 6 percent — in the country (smokeless tobacco is tobacco or a tobacco blend that is chewed, inhaled or sucked on).

The tobacco industry had branded the state as "Marlboro Country." Although smoking levels were high, smoking-cessation services were scarce — 32 of Montana's 56 counties had no local tobacco-cessation programs and only three of the top 30 health plans in the state provided tobacco-cessation benefits to members. Moreover, the tobacco industry's influence in the state was strong:

  • Philip Morris and other tobacco companies poured millions of dollars into the state each year to fight local and state efforts to curb tobacco use.
  • The tobacco industry had close ties to the governor and legislative leaders.
  • Philip Morris was building an executive "dude ranch" in the state as a retreat house in which tobacco industry staff could develop industry strategy.

A loosely connected group of tobacco prevention organizations, including the American Cancer Society, the American Heart Association and the American Lung Association, had been working together since 1996 to prevent tobacco use in Montana.

Their efforts had resulted in two local clean air ordinances, improvements in youth access laws and a comprehensive tobacco-prevention program using funds from the Master Settlement Agreement. However, limited resources and lack of coordination hampered their efforts.

In March 2000, the Governor's Advisory Council on Tobacco Use Prevention released a five-year strategic plan for the state's Tobacco Use Prevention Program. In 2001, the American Cancer Society, the American Heart Association and the American Lung Association established Protect Montana Kids, a statewide coalition to coordinate tobacco advocacy efforts. That same year, the Montana legislature cut funding for tobacco disease prevention from $3.5 million annually to $380,000 annually.

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RWJF STRATEGY

In February 1991, the RWJF Board of Trustees established three new grantmaking goals for the Foundation; goal number three, as outlined in the Foundation's 1990 annual report, was "to promote health and prevent disease by reducing harm caused by substance abuse."

After exploring the landscape of tobacco prevention and control — at both the state and federal level — RWJF program staff concluded that a private-sector voice was needed in the arena of tobacco control.

To fill the gap in private-sector tobacco-control activities identified by RWJF staff, the RWJF Board of Trustees in April 1993 authorized up to $10 million for a four-year program, SmokeLess States: Statewide Tobacco Prevention and Control Initiatives, to support statewide efforts to reduce tobacco use, particularly among children and youth. In 2000, the program's name changed to SmokeLess States: National Tobacco Policy Initiative to reflect the focus on tobacco control advocacy only.

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THE PROJECT

Montana received its SmokeLess States grant in 2001, when the program was in its second phase (2000–2004), focusing only on change in tobacco policies. Protect Montana Kids, with the American Cancer Society as the lead organization, focused on increasing the cigarette excise tax, securing additional funding for tobacco prevention and control from the Master Settlement Agreement, and enacting strong local clean indoor-air ordinances. Protect Montana Kids worked under the umbrella of a coalition of 24 health care groups called the Alliance for a Healthy Montana.

Protect Montana Kids' key activities included:

  • Expanding the coalition's membership base: Although the sole focus of Protect Montana Kids was to advance tobacco disease-prevention policy, the coalition needed to collaborate with a broader base of organizations in order to pursue various legislative initiatives. On an as-needed basis, Protect Montana Kids formed strategic alliances with partners from the Alliance for a Healthy Montana, including: AARP Montana, Blue Cross/Blue Shield of Montana, Montana Academy of Pediatricians, Montana Physicians for Prevention and Montana Senior Citizen Association.
  • Strategic planning, grassroots organizing and communications activities, including public education, media advocacy and training. Activities included strategic plans for campaigns to change tobacco policy related to clean air, the cigarette excise tax, and the Master Settlement Agreement, and a media campaign to frame tobacco issues as the future of the health of Montana children versus the profits of the tobacco industry. The coalition conducted grassroots organizing activities with physicians, groups working on economic and women's issues, and others.
  • Conducting statewide polls to test the public's reaction to tobacco-prevention policies, including a poll in Helena after the passage of limited preemption legislation weakened the clean indoor air ordinance by allowing smoking in bars and casinos.

Montana also received four grants from the RWJF SmokeLess States Special Opportunities Grant Fund, administered by the national program office, which provided extra money to funded states for additional projects to enhance the impact of their efforts. The grants were for:

  • A statewide public education campaign on tobacco prevention and clean indoor air, as well as a strategic public education and outreach campaign prior to a special session of the Montana Legislature which considered preemption legislation ($249,734 in 2001). The legislation was defeated.
  • Creation of a tribal tobacco policy track at the Many Voices, One Message — Keep Tobacco Sacred conference, sponsored by five western states (Alaska, Idaho, Montana, Oregon and Washington) in June 2002 in Polson, Mont., to share tobacco prevention and control information, and to continue the dialogue between American Indians and their cultural partners around tobacco disease-prevention policy ($125,650, 2002). (See Appendix 2 for more information about this track.)
  • Grassroots organizing work in Bozeman and Billings and in Native American communities ($249,929).
  • Legal work surrounding the repeal of the limited preemption law and an assessment of the need for a legal technical assistance center in Montana ($54,500). The Montana State Supreme Court recently ruled that the limited preemption law does not restrict local communities from passing strong clean indoor air ordinances.

Protect Montana Kids contracted with M&R Strategic Services, a marketing communications firm in Missoula, Mont., for assistance with strategic planning, grassroots organizing and communications activities, and with Harstad Strategic Research, a polling and market research firm in Boulder, Colo., to conduct the polls. The coalition raised more than $500,000 in additional funds, along with in-kind contributions, for its activities (see Appendix 1 for a list of additional funders). All lobbying activities were supported by matching funds.

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RESULTS

Project staff reported the following key project results to RWJF:

  • Montana increased its cigarette excise tax to $1.70 per pack — one of the highest tobacco taxes in the country — and increased taxes on spit tobacco and other tobacco products:
    • Montana increased its cigarette excise tax from 18 cents to 70 cents per pack in 2003 and to $1.70 per pack in 2004.
    • Montana increased the excise tax on spit tobacco to 50 cents per ounce and the excise tax on all other tobacco products by 25 percent of the price which wholesalers pay for these products in 2004.
    • The increased excise tax generated a projected $40 million in revenue annually that supports new health care programs and expanded health care services (e.g., a prescription drug program for the needy and expanded Medicaid services) for Montana residents.
  • Montana made headway in establishing smoke-free communities:
    • In 2004, Bozeman, home of Montana State University, passed a smoke-free ordinance that made all workplaces smoke-free with the exception of bars and casinos where tobacco smoke does not infiltrate into smoke-free areas.
    • Helena, Montana's capitol, passed a comprehensive smoke-free ordinance in 2001 before the city commission and defended it at the ballot box in June 2002. This ordinance was altered in 2003 by the passage of a limited preemption bill, which put authority over tobacco control at the state rather than the local level. Protect Montana Kids and other organizations challenged the constitutionality of the 2003 limited preemption statute in the state Supreme Court. In December 2004, the Montana Supreme Court ruled that the limited preemption legislation did not apply to local communities, which could adopt their own clean indoor air ordinances. Helena was unable to put the ordinance back into effect due to a pending lawsuit. In April 2005, the Montana First Judicial Court upheld the constitutionality of Helena's smoke-free ordinance. Although Helena could technically enforce the ordinance, other unresolved issues may prevent the city from doing so. (For more details, see Appendix 3.)
    • In 2005, after RWJF funding ended, the state legislature passed the Montana Tobacco-Free Schools and Clean Indoor Air Act. This law, which was effective October 2005, makes all school campuses smoke-free and all public and work places smoke-free. Some bars and casinos are exempted until September 2009. The law also preempts local communities from passing stronger local ordinances until September 2009.
  • Montana secured $3.2 million (32 percent) from its Master Settlement Agreement for tobacco prevention and control, up from the $380,000 previously set aside for this purpose. This was passed as a ballot initiative in 2002; 65 percent of Montana voters voted in its favor. Although the state's previous governor (Judy Martz) had earmarked much of this money for general health care needs, the 2004 governor elect, Brian Schweitzer, included full funding of tobacco prevention and control at 32 percent of the Master Settlement Agreement in the proposed budget he submitted to the Montana legislature. In 2004, the legislature appropriated $3.2 million for tobacco prevention and control.
  • Protect Montana Kids created Physicians for Prevention, a network of physicians who work to advance tobacco-prevention policies. The network includes more than 300 physicians with at least 50 who have been active in at least one of the issue campaigns.
  • Protect Montana Kids partnered with American Indians in creating a network of American Indian prevention advocates and a Toolkit for Tobacco Prevention:
    • The coalition worked with and provided guidance to the American Indian tobacco advocates who created TP:SKINS, a national network of American Indian prevention advocates dedicated to advancing tobacco disease prevention policy in their communities. An on-staff American Indian organizer spearheaded this work.
    • The coalition worked with American Indian tobacco disease-prevention advocates to create a Toolkit for Tobacco Prevention Advocates in Montana. The toolkit, which respects the ceremonial and sacred use of traditional tobacco among American Indians, includes tobacco policy options, fact sheets on tobacco, and guidelines for using the media to provide tobacco education and prevention.
  • Protect Montana Kids built its advocacy network to more than 9,000 citizens. Protect Montana Kids recruited citizens through its clean indoor air and tax campaigns and its Web site.

Communications

Protect Montana Kids disseminated its Toolkit for Tobacco Prevention Advocates in Montana to American Indian communities to guide them in their tobacco policy advocacy efforts and developed and presented a tribal tobacco policy track at the Many Voices, One Message — Keep Tobacco Sacred conference in June 2002 in Polson, Mont.

The project fostered the writing and publication of letters to the editor and op-ed pieces in state newspapers. According to project director David McAlpin, "Montana Editorial Boards have widely endorsed the adequate funding of a statewide tobacco prevention program, the importance of secondhand smoke ordinances — and the right of local communities to pass such health protections — as well as a significant increase in the tobacco tax."

Protect Montana Kids also disseminated several brochures. See the Bibliography for details.

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LESSONS LEARNED

  1. Coalitions should include the broadest possible base of members because it is their shared expertise and commitment that sustains the work. In Montana, the coalition's opponents — the tobacco and casino industries — had many incentives to undermine the efforts of the Montana coalition over the long term in order to regain their profits. It was the drive and dedication of coalition members that kept Protect Montana Kids moving forward. (McAlpin/Project Director)
  2. Organizations working under grants should think about other sources of funding and post-grant sustainability from the start of the project. Montana initially targeted most of its fundraising to support lobbying activities and only began to think about financial sustainability in the last year of the grant. "Our efforts were totally policy-focused because of the limited duration of funding," explained Nei. "Instead, from the outset, the project director should spend part of the time addressing sustainability." (Nei/Steering Committee Member)
  3. Advocacy efforts should be mission-driven and not funder-driven. Funders come and go. However, a strong mission — such as raising excise taxes and/or implementing clean indoor air ordinances — encourages individuals and organizations to coalesce around policy advocacy efforts. (McAlpin/Project Director)
  4. Good field work is the key to effective policy advocacy. A strong combination of community organizing, polling and earned media (e.g., letters to the editor, editorials) can move a policy issue forward. This model, which Montana applied to tobacco prevention, could also be applied to other causes such as obesity and diabetes. (McAlpin/ Project Director)
  5. Polling is essential to policy advocacy. When developing effective tobacco-control policies, it is crucial to use polling to actually test various policies rather than to simply determine where the public stands on a particular issue. Working with an organization skilled in this type of polling — as opposed to the more academic issue polling — assures a smooth process and trustworthy results. (Nei/Steering Committee Member)
  6. Working on policy advocacy with American Indians involves interacting with separate sovereign nations and individual community-health advocates and recognizing the Native American culture. Montana's coalition was able to partner with American Indian advocates because the coalition took the time to develop trust in the relationships, and it recognized the sacred role noncommercial tobacco plays in the lives of many American Indians. (Nei/Steering Committee Member)

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AFTER THE GRANT

Protect Montana Kids continues to function, under the leadership of the American Cancer Society. The coalition has developed a strategic fund raising plan and hopes to incorporate as a 501(c)3 nonprofit organization. Protect Montana Kids plans to focus its efforts on increasing the number of local communities with clean indoor air ordinances, securing funding for tobacco disease prevention and increasing the cigarette excise tax. The coalition is also planning to expand it mission to include work on other chronic disease prevention and public health policy development efforts. Protect Montana Kids continues to provide outreach and education on tobacco use prevention to legislators and legislative advocates throughout the state.

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GRANT DETAILS & CONTACT INFORMATION

Project

Montana SmokeLess States(R) Initiative

Grantee

American Cancer Society, Northwest Division (Missoula,  MT)

  • Amount: $ 1,057,959
    Dates: June 2001 to May 2004
    ID#:  041906

Contact

Kristin Page Nei
(406) 728-1004
Kristin.nei@cancer.org

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Other Cash and In-Kind Contributors to Protect Montana Kids Legislative and Education Campaigns

Cash Contributions

  • AARP Montana
  • Alliance for a Healthy Montana
  • American Cancer Society
  • American Heart Association
  • American Lung Association of the Northern Rockies
  • BlueCross BlueShield of Montana
  • Deaconess Billings Clinic
  • Havre Encourages Long-Range Prevention
  • League of Women Voters
  • MHA … An Association of Montana Healthcare Providers
  • Montana Association for Disability Services
  • Montana Chapter-American Academy of Pediatrics
  • Montana Children's Initiative
  • Montana Council for Maternal and Child Health
  • Montana Dental Association
  • Montana Department of Health and Human Services
  • Montana Diabetes Association
  • Montana Kids First
  • Montana Medical Association
  • Montana Nurses Association
  • Montana Pharmacy Association
  • Montana Physicians for Prevention
  • Montana Public Health Association
  • Montana Public Interest Research Group
  • Montana Senior Citizen Association
  • Montana Tobacco-Use Prevention Resource Center
  • National Center for Tobacco-Free Kids
  • New West Health
  • Protect Montana Kids
  • St. Vincent Healthcare
  • WEEL

In-Kind Support

  • All cash contributors were also in-kind contributors.
  • Numerous local tobacco coalitions contributed in-kind support.


Appendix 2

Many Voices, One Message - Keep Tobacco Sacred Conference: Tribal Tobacco Policy Track (June 2002, Polson, Mont.)

The policy track was intended to begin a dialogue among American Indian and other tribal tobacco use prevention advocates about the tobacco policy infrastructure within American Indian and Alaska Native communities. The policy track included sessions on the need for tobacco policies, involving youth in policy development and tribal tobacco taxation. RWJF funds also supported the cost of American Indian and Alaska Natives traveling to and attending the conference.

The grant also funded a face-to-face meeting and survey to gauge the interest in continuing the dialogue around commercial tobacco policy in American Indian communities. The American Indian advocates determined that there was a need for an American Indian Tobacco Policy Network. This group of American Indians from across the country and their cultural allies worked to create TP:SKINS (Tobacco Policy: Sharing Knowledge in Native Societies). The network developed a vision and mission statements, guiding principals, bylaws and a one-year workplan. TP:SKINS went on to elect its American Indian Leadership and successfully applied for another RWJF grant through the SmokeLess States Washington Breathes Coalition.


Appendix 3

Helena's Smoke-Free Ordinance and its Preemption Challenge

The limited preemption bill that Montana passed in 2003 to overturn Helena's smoke-free ordinance received strong backing from the tobacco industry. To fight this bill, Protect Montana Kids hired legal assistance (with an RWJF Special Opportunities Grant), conducted a poll and lobbied the legislature. All lobbying efforts were supported entirely by funders other than RWJF.

The poll found that 75 percent of the public disagreed with the limited preemption bill and still strongly supported the more comprehensive ordinance, thereby providing evidence of the value of ongoing education and outreach on the ills of secondhand smoke to effectively battle limited preemption.

In lobbying the legislature, Protect Montana Kids used the results of the Helena Heart Study. Led by Richard Sargent, M.D., and Robert Shepard, M.D., physicians at St. Peter's Community Center in Helena, the Helena Heart Study, determined that:

  • The number of hospital admissions for heart attacks in Helena dropped by 40 percent during the six-month period (June 5, 2002 to December 3, 2002) that smoking was banned in all workplaces and public places.
  • Outside of Helena, hospital admissions for heart attacks increased during this same time period.
  • When the smoke-free workplace law was suspended, admission rates for heart attacks rebounded to normal levels.

The study results were published in the British Medical Journal in April 2004 and were widely discussed nationally and internationally as evidence of the positive impact of smoke-free ordinances on death rates. Sargent and Shepard continue to speak in both national and international venues about tobacco use prevention and secondhand smoke. Protect Montana Kids used the Helena Heart Study findings to anchor the health message about secondhand smoke in lobbying to the Montana legislature to overturn the limited preemption. In addition, both Sargent and Shepard were heavily involved with Protect Montana Kids. They served as spokespersons and experts testifying on many tobacco- and health-related issues. Sargent was treasurer for the Protect Montana Kids tobacco tax initiative and the Helena Clean Indoor Air initiative.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Reports

"What Would It Take to Save the Lives of Hundreds of Montana Kids, Every Year?" Missoula, Mont.: Protect Montana Kids, 2002.

"This Is My Husband Dan — He Could Tell You About Secondhand Smoke…" Missoula, Mont.: Protect Montana Kids, January 2002.

"Tool Kit for Tobacco Disease Prevention Advocates in Montana." Missoula, Mont.: Protect Montana Kids, October 15, 2002.

Tobacco Disease Prevention Policies and Politics in Montana: An Assessment of the 2003 Montana Legislative Session," Missoula, Mont.: Protect Montana Kids, January 2004.

"An Update on Tobacco Tax Policy and Public Health In Montana." Missoula, Mont.: Protect Montana Kids, April 2004.

"Montana Tobacco Control Institute: Feasibility Study Results," Helena, Mont.: The Mitchell Group and Lombardi Strategic Communications Consulting, May 2004.

World Wide Web Sites

www.mrss.com/case_studies/protect_montana_kids.html, the Web site of Protect Montana Kids, contains information about the project.

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Report prepared by: Karin Gillespie
Reviewed by: Lori De Milto
Reviewed by: Molly McKaughan
Program Officer: Karen Gerlach
Program Officer: Michelle Larkin

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