For more than 50 years, tobacco companies preyed upon the young and old alike. They hid their own research about how addictive nicotine is. They manipulated the levels of nicotine in tobacco products to make them more addictive and harder to quit. They promoted their products with deceptive tactics that made them appealing to young children and more desirable to adults. They even flavored their products with menthol to help mask side effects from smoking, such as sore throats.
These practices earned them lifelong customers and enviable profits. Tobacco use skyrocketed to become the number one cause of preventable death in the nation. Every state endured the financial hardship of paying to treat diseases like lung cancer and emphysema. For more than five decades, the predatory practices of tobacco companies went unchallenged by government.
Mississippi Sets the Standard
On May 23, 1994, Mississippi fired the first shot heard around the world to change the way the tobacco industry does business. Mississippi sought to make them pay for the damage they had done, recover monies taxpayers spent treating tobacco-related diseases and to stop marketing practices designed to recruit our children as customers. After a tough, long fight, Mississippi was not only successful for its own citizens, but led the fight for the entire nation.
The results were unprecedented: a $4 billion settlement for Mississippi; a $246 billion settlement for all the states. Tobacco billboards came down. Advertising practices were curtailed. Tobacco companies were forced to admit that nicotine was addictive and that smoking causes cancer, heart disease and emphysema. This victory stands as one of the top public health events and is the largest settlement in the history of America. And best of all, Mississippi led the way.
A Promise Made
Inherent to the tobacco settlement agreement for Mississippi was a promise to fund prevention and cessation programs designed to reverse the trend of tobacco use in Mississippi. We needed a program that could actually prevent young people from ever starting this deadly habit, and help those already addicted to tobacco to quit. No one knew exactly what would work, but hundreds of organizations offered assistance to help. The prevention promise made was realized through the formation of The Partnership for a Healthy Mississippi.
A Promise Kept
In 1997, Jackson County Chancery Judge William Myers approved an order placing $62 million in escrow for the state to develop a tobacco prevention pilot program unique to Mississippi. As directed by the court, Attorney General Mike Moore began assembling public and private organizations to discuss the best features for such a program.
Following eight (8) months of collaboration among health organizations, American Cancer Society, American Heart Association, American Lung Association of Mississippi, the Mississippi State Department of Health, law enforcement organizations, the Mississippi Department of Education and others, the plan was presented to the court and approved on June 5, 1998. What emerged is today The Partnership for a Healthy Mississippi.
A seven-member board of directors was elected by these many member organizations. Along with a few new members, all original board members still serve today. Board members serve on a voluntary basis.
Programs Shaped by Research
In order to reduce tobacco use, a cultural shift had to occur in the way Mississippians feel about and engage in tobacco use. In-depth research and science-based practices were used to formulate a comprehensive tobacco prevention and control program. Among the key resources used to develop The Partnership’s comprehensive programs were:
- The PRECEDE/PROCEED model, developed by Lawrence Green and Marshall Kreuter during the 1970s, is a step-by-step approach to assist in creating appropriate health promotion projects. The model is grounded in multi-disciplinary theories that view health issues as phenomena that are embedded in relatively consistent and enduring behavioral patterns. Further, its perspective of health education targets individuals, their social network, organizational and social contexts, as well as related policies.
- Centers for Disease Control and Prevention Best Practices (CDC) is a model guideline that includes tobacco prevention programmatic and funding recommendations for each state. Based on 1990 census numbers, CDC recommends that Mississippi spend at least $18.8 million and up to $46 million on tobacco prevention programs annually. Programmatic areas include: community and school-based programs, enforcement of tobacco policies, statewide programs, counter-marketing, cessation, surveillance and evaluation, and administration and management. The Partnership incorporates all of these program areas, along with a few enhancements that make our comprehensive outreach truly unique to Mississippi. These enhancements include a school tobacco nurse program, a college program and a faith-based initiative.
- Research conducted by Archetype Discoveries and Yankelovich Partners provided a framework for messaging to youth based on the ways they learn at different ages. The research identified two distinct groups: the Age of Reason (ages 6-11) and Age of Rebellion (ages 12-18). This information was used to develop two counter-marketing campaigns, as well as four age-appropriate youth programs for school and community-based programs.
Proving The Partnership Works
Research and program development continued throughout 1998, with all programs becoming fully-operational during 1999. Because Mississippi was the first state to reach a settlement agreement with the industry, and one of the first to implement a comprehensive tobacco prevention program, all eyes were on our state to see if indeed this approach could make a dent in the 50-year head start held by the tobacco industry.
When the results of the 2000 Youth Tobacco Survey were compiled by the Mississippi State Department of Health and the Centers for Disease Control and Prevention, we had in-hand definitive proof. From 1999-2000, the first year that comprehensive prevention programs were in place throughout Mississippi, we realized a:
- 10% decrease in the number of high school students using cigarettes
- 21% decrease in the number of public middle school students currently using cigarettes
- 19% decrease in the number of African American high school students currently using cigarettes; and
- 31% decrease in the number of African American middle school students currently using cigarettes.
In December 2000, the Attorney General of Mississippi presented these findings to the Chancery Court of Jackson County. The court reviewed The Partnership’s programs, processes, budget, audit and impact, and agreed to extend program funding in perpetuity.
Since that time, The Partnership has continued to refine, develop and implement effective, comprehensive tobacco prevention programs statewide. The CDC Best Practices model, PRECEDE/PROCEED framework, and archetypal research remain the building blocks for program components. The Youth Tobacco Survey (YTS) and Youth Risk Behavioral Survey (YRBS), conducted in alternate years by the Mississippi State Department of Health (in conjunction with CDC), remain the gold-standard of surveillance and evaluation.
Results from YTS and YRBS surveys, behaviors regarding tobacco continue to improve throughout all parts of Mississippi and among all age groups. The 2004 YTS results, the most recent available show that since 1999:
- Smoking among public high school students is down 32 percent
- Smoking among public middle school students is down 48 percent
- Smoking among private high school students is down 42 percent
- Since 2000, smoking among private middle school students is down 42 percent.
The Partnership evolved into a premier tobacco prevention program that served as a model for other states to follow. We were indeed living up to the charge issued by the state’s tobacco settlement to reduce tobacco use and improve the culture of health for all Mississippians.
However, due to funding cuts, The Partnership is no longer able to organize the comprehensive programs that have effectively cut tobacco use and saved lives across Mississippi. Today, with limited financial resources and a strong will to continue the fight against Big Tobacco, The Partnership maintains its school and community-based programs, as well as its role in coordinating policy efforts from the local to state level.
