Strong tobacco control program requirements and secure funding are not enough: lessons from Florida

Abstract

Florida's Tobacco Pilot Program (TPP; 1998-2003), with its edgy Truth media campaign, achieved unprecedented youth smoking reductions and became a model for tobacco control programming. In 2006, 3 years after the TPP was defunded, public health groups restored funding for tobacco control programming by convincing Florida voters to amend their constitution. Despite the new program's strong legal structure, Governor Charlie Crist's Department of Health implemented a low-impact program. Although they secured the program's strong structure and funding, Florida's nongovernmental public health organizations did not mobilize to demand a high-impact program. Implementation of Florida's Amendment 4 demonstrates that a strong programmatic structure and secure funding are insufficient to ensure a successful public health program, without external pressure from nongovernmental groups.

FIGURE 1—

Declines in current smoking prevalence rates among Florida youths during the Tobacco Pilot Program Truth campaign (1998–2002) and the BTPP (2008–2010). Note. BTPP = Bureau of Tobacco Prevention Program. Solid line is regression fit allowing for slope changes at the end of the Truth campaign and beginning of the BTPP campaign.

FIGURE 2—

Contrasting anti-smoking ads in Florida. Note. The Tobacco Pilot Program Truth television ad (left image) depicts the Demon Award presented to the tobacco industry for “most deaths in a single year”; the Florida Department of Health contractor Macro International's purported test of industry denormalization message with focus groups (right box) consists of a single text slide.