October 2005

Grant Results

National Program

SmokeLess States(R) National Tobacco Policy Initiative

SUMMARY

From mid-2001 to mid-2004, the Smoke-Free New Hampshire Alliance, with the American Lung Association 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 its achievements are:

  • The Smoke-Free New Hampshire Alliance received the New Hampshire Public Health Association's 2003 Friend of Public Health Award.
  • Five New Hampshire communities (Colebrook, Columbia, Hampstead, Keene and Randolph) passed local clean indoor air ordinances. Unfortunately, a ruling by the state Supreme Court in August 2003 overturned these ordinances, enforcing preemption. Keene chose to keep its ordinance in place and "on the books," although it was not enforceable. No restaurants in Keene or Colebrook have reverted to allow smoking.
  • New Hampshire was unable to achieve its policy goals during its SmokeLess States grant, primarily because of a political environment that was opposed to advancing tobacco prevention and control policy, according to former project director Deborah Hornor.

Funding
RWJF provided $1.6 million for this project. Other sources — including the American Lung Association, the American Heart Association and the American Cancer Society — contributed approximately $410,000 to support lobbying and other activities; no RWJF funds were used to support lobbying. (See Appendix 1 for a list of additional supporters.)

 See Grant Detail & Contact Information
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THE PROBLEM

By 2001, 24 percent of adults (including 16 percent of pregnant women) and 31 percent of high school students in New Hampshire smoked. Each year, approximately 4,000 New Hampshire youth (under the age of 18) become new daily smokers.

New Hampshire had a weak history of tobacco control:

  • The cigarette excise tax, at 52 cents per pack, was one of the lowest in the nation.
  • The state dedicated no state funding to tobacco-prevention programs. Since 1994, the New Hampshire Tobacco Prevention Program had been funded solely by the federal Centers for Disease Control and Prevention.
  • Although New Hampshire received $48 million a year from the Master Settlement Agreement, the New Hampshire legislature allocated only $3 million per year for tobacco control.

With these limited resources, New Hampshire found it difficult to counter the influence of the tobacco industry.

The Smoke-Free New Hampshire Alliance — a broad-based coalition of the major health organizations in the state (including the American Lung Association), the New Hampshire Tobacco Prevention Program, the business community, health insurers, community-based tobacco prevention groups and citizens — was established in 1994 to increase the number of youth growing up tobacco-free in the state. The alliance helped create local tobacco-prevention coalitions and a membership network of youth involved in community-level tobacco prevention and cessation activities.

By 2001, the alliance had expanded its mission to focus on public policy and legislative initiatives that aim to reduce the disability, disease and death caused by tobacco use. In addition to preventing children from starting to smoke or use other forms of tobacco, the alliance sought to promote and provide access to cessation/treatment for smokers, reduce the public's exposure to secondhand smoke, and reduce the impact of tobacco on those communities and people most affected by tobacco use. Working with other organizations, the alliance conducted campaigns for clean indoor air ordinances in several communities; this legislation was either defeated or rescinded.

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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

New Hampshire received its SmokeLess States grant in 2001, when the program was in its second phase (2000–2004), which focused exclusively on working to change tobacco policy. The Smoke-Free New Hampshire Alliance, with the American Lung Association as the lead organization focused on restructuring its governing body, membership activities and committee components, and on building local capacity to conduct effective education/outreach and advocacy in order to:

  • Increase the cigarette excise tax.
  • Adopt clean indoor air ordinances at the local and state level.
  • Increase the allocation of funds from the Master Settlement Agreement to tobacco prevention to form a comprehensive tobacco-control program.

The Smoke-Free New Hampshire Alliance's key activities included:

  • Working with other coalitions on campaigns to increase the cigarette excise tax: The alliance worked with the Alliance for a Healthy New England (composed of Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont) and the New Hampshire Healthy Families Campaign (a coalition of more than 160 organizations across the state established to work on a campaign to increase the tobacco tax and dedicate the revenue to tobacco prevention and control and increasing access to health care).
  • Providing technical and financial assistance to the town of Colebrook to protect its voter-enacted clean indoor air ordinance and fight the state's preemption law.
  • Conducting three studies:
    • On the economic impact of increasing the tobacco tax, by PolEcon Research in Dover, N.H., in March 2003. The alliance used the study findings — which showed that an excise tax increase could generate more than $134 in revenue per year, reduce tobacco consumption by 11 percent and not result in a loss of jobs — to anchor its message about the positive impact of a tax increase.
    • On clean indoor air, by the University of New Hampshire at Durham in March 2004. The study found that 88 percent of New Hampshire voters believe that secondhand smoke is a health hazard in the workplace and 71 percent favor the passage of a statewide law prohibiting smoking in all New Hampshire workplaces.
    • On the City of Keene clean indoor air ordinance, by the University of New Hampshire in January 2003.
  • Conducted public opinion polling on an increased cigarette excise tax in spring 2002 and spring 2003 using the University of New Hampshire's Granite State Poll, a quarterly survey of the state's adults.

By the end of the project, the Smoke-Free New Hampshire Alliance had increased in size and diversity to more than 160 health organizations, hospitals, faith communities, health-related professional associations and others. Alliance members included the American Cancer Society, the American Heart Association, the American Lung Association, AARP, the American College of Nurse Midwives, the New Hampshire Dental Society and the New Hampshire Federation of Teachers. The alliance raised $410,000 in additional funds for its activities (see the Appendix for a list of additional funders). All lobbying activities were supported by matching funds.

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RESULTS

The following were among the key project results reported to RWJF:

  • New Hampshire was one of three states to participate fully in the pilot of the Tobacco-Free Action Network, an online advocacy tool sponsored by the Center for Tobacco-Free Kids. The center was founded and is supported by RWJF (ID#s 028086 [see Grant Results], 028929, 029600 and 035929 [see Grant Results] and 047346). Through the Tobacco-Free Action Network, the Smoke-Free New Hampshire Alliance increased its database of tobacco-control advocates by 66 percent and disseminated informational alerts to these advocates on critical tobacco policy issues, along with simple steps they could take to achieve policy change. The other states in the Tobacco-Free Action Network pilot were Ohio and Massachusetts.
  • The Smoke-Free New Hampshire Alliance helped create citizens who are knowledgeable about the harms of tobacco and the need for tobacco prevention and control efforts. According to Hornor, "New Hampshire made significant progress in increasing public awareness of and support for the need for policy measures to address the impact of tobacco in the state." For example, nearly 90 percent of voters support an increase in the tobacco tax and the use of the revenue for tobacco prevention and health care access, according to the 2003 poll.
  • The Smoke-Free New Hampshire Alliance raised the bar for New Hampshire legislators on their accountability for their actions on public health issues. Through a combination of community meetings, educational advertising, newspaper op-eds and the Legislative Report Card, the alliance forced legislators to publicly address their stand on tobacco prevention and other public health issues. Its "Legislative Report Card" for tobacco-control advocates listed specific tobacco-related legislative bills and the votes by legislators.
  • The Smoke-Free New Hampshire Alliance received the 2003 Friend of Public Health Award from the New Hampshire Public Health Association for its work on the New Hampshire Healthy Families Campaign to increase the tobacco excise tax.
  • Five New Hampshire communities (Colebrook, Columbia, Hampstead, Keene and Randolph) passed local clean indoor air ordinances. Unfortunately, the state Supreme Court overturned these ordinances in August 2003, enforcing preemption in the state. The ruling prohibits communities from enacting clean indoor air policies that are more stringent than those of New Hampshire's Indoor Smoking Act. Keene chose to keep its ordinance in place and "on the books," although it was not enforceable. No restaurants in Keene or Colebrook have reverted to allow smoking.
  • New Hampshire was unable to achieve its policy goals during its SmokeLess States grant, primarily because of a political environment which was opposed to advancing tobacco prevention and control policy, according to Deborah Hornor, former project director. The governor at the time, Craig Benson, was elected on a promise of "no new taxes," including tobacco taxes, and he vowed to veto any tobacco tax increases. The state's long-lasting budget deficit also worked against efforts to secure funding for tobacco prevention and control. For example, in April 2003, the New Hampshire legislature voted to eliminate all funding for tobacco prevention and control from the Master Settlement Agreement, instead funneling the $48 million annually into an education and general fund to help offset the state's deficit.

Communications

Project staff established a Web site (www.smokefreenh.org, no longer active) with information about the Smoke-Free New Hampshire Alliance and its policy efforts and developed and disseminated a newsletter (The Tobacco-Free Times) and fact sheets. It widely disseminated its Legislative Report Card for tobacco-control advocates, which listed specific tobacco-related legislative bills and the votes by legislators. See Bibliography for details.

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LESSONS LEARNED

  1. Communication is vital to strengthening a coalition. New Hampshire erred on the side of over communicating with Smoke-Free New Hampshire Alliance partners and found that this increased the coalition's cohesiveness and effectiveness. (Project Director/Sweeney)
  2. When operating with a small staff, it is important to provide team-building opportunities and offer cross training. New Hampshire worked with a staff of five (at most), but found that by working well together they could accomplish a great deal quickly and under stressful circumstances. (Project Director/Sweeney)
  3. Be prepared to seize media opportunities. The Smoke-Free New Hampshire Alliance found that by being overly prepared and thoroughly trained in their media work they could capture almost all strategic media opportunities to advance their issues and the organization. (Project Director/Sweeney)

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AFTER THE GRANT

Because of limited resources, the state has divided tobacco-prevention advocacy efforts among several groups: For example, the alliance will focus on clean indoor air and the New Hampshire Department of Health and Human Services Division of Public Health Services will work on securing annual funding from the Master Settlement Agreement for tobacco control. After the RWJF SmokeLess States grant ended, the alliance used remaining funds to support a statewide coordinator through May 2005.

In December 2004, the Smoke-Free New Hampshire Alliance received a $75,000, one-year grant from RWJF under its national program, Tobacco Policy Change: A Collaborative for Healthier Communities and States (ID# 052388). New Hampshire is using these funds to promote clean indoor air. Tobacco Policy Change: A Collaborative for Healthier Communities and States is a three-year, $12-million program to provide resources and technical assistance for local, regional and state-based organizations and tribal groups interested in implementing effective tobacco prevention and cessation policy initiatives.

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GRANT DETAILS & CONTACT INFORMATION

Project

Smoke-Free New Hampshire Alliance

Grantee

American Lung Association of New Hampshire (Bedford,  NH)

  • Amount: $ 1,600,000
    Dates: June 2001 to May 2004
    ID#:  041926

Contact

Mindy Sweeney
(603) 641-8866
mindy@nhlung.org

Web Site

http://www.lungnh.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 the Smoke-Free New Hampshire Alliance

Cash Contributions

  • American Cancer Society, $285,000
  • American Lung Association of New Hampshire, $75,000
  • American Heart Association, $10,000
  • Campaign for Tobacco-Free Kids, $40,000

In-Kind support

  • Campaign for Tobacco-Free Kids
  • Gang of Four, $85,000 in print and other advertising

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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

Tastefully Tobacco Free: Guide to 100% Smoke-Free Dining in New Hampshire, Fourth Edition. Bedford, N.H.: Smoke-Free New Hampshire Alliance, 2002.

"New Hampshire Residents Strongly Support a $1 Tobacco Tax Increase!" Bedford, N.H.: Smoke-Free New Hampshire Alliance, 2002. (Fact sheet.)

"Economic Benefits of Smoke-Free Workplaces." Bedford, N.H.: Smoke-Free New Hampshire Alliance, 2002. (Fact sheet.)

New Hampshire Healthy Families Campaign: PolEcon Research Study. Bedford, N.H.: Smoke-Free New Hampshire Alliance, 2003.

"Create a Better Future for New Hampshire's Children…Raise the Tobacco Tax." Bedford, N.H.: Smoke-Free New Hampshire Alliance, 2003. (Fact sheet.)

"Tobacco Tax and Cigarette Sales – New England and New York." Bedford, N.H.: Smoke-Free New Hampshire Alliance, 2003. (Fact sheet.)

"University of New Hampshire Survey Center Poll Shows that New Hampshire Residents Favor a $1 Increase in the Tobacco Tax." Bedford, N.H.: Smoke-Free New Hampshire Alliance, 2003. (Fact sheet.)

Smoke-Free New Hampshire Alliance City of Keene Smoking Ordinance Survey, 2003. Bedford, N.H.: Smoke-Free New Hampshire Alliance, 2003.

Legislative Report Card. Bedford, N.H.: Smoke-Free New Hampshire Alliance, 2003.

Survey Instruments

"The Fiscal and Economic Impacts of Increasing the Tobacco Tax in New Hampshire," PolEcon Research, fielded 2003.

"Smoke-Free New Hampshire Alliance City of Keene Smoking Ordinance Survey," The Survey Center of the University of New Hampshire, fielded January 2003.

"Smoke-Free New Hampshire Indoor Air Survey," The Survey Center of the University of New Hampshire, fielded March 2004.

World Wide Web Sites

www.smokefreenh.org, no longer active, included information on the Smoke-Free New Hampshire Alliance, its partners, its activities and tobacco-related issues. Bedford, N.H.: Smoke-Free New Hampshire Alliance, 2002.

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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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