Philippe Boucher's Rendez-vous with . . . Peter Jacobson
Rendez-vous with . . . Peter Jacobson
Coauthor of Combating Teen Smoking: Research and Policy / Associate Professor, Department of Health Management and Policy University of Michigan School of Public Health
Ann Arbor, Michigan, USA
By pdj@umich.edu
By Philippe Boucher
Rendez-vous 114
Monday, November 12 2001
PB : Thank you Peter for accepting our rendez-vous.
May I ask you to introduce yourself ?
Peter Jacobson: My name is Peter Jacobson and I am an Associate Professor in the Department of Health Management and Policy at the University of Michigan School of Public Health. About 10 years ago, I became interested in tobacco control research, largely because of the health toll from cigarette smoking. My first project dealt with the political evolution of tobacco control laws. Then I conducted a study of how those laws are implemented and enforced. Following that study, I turned my attention to youth tobacco control. Along with several colleagues at the University of Michigan and RAND, I published Combating Teen Smoking: Research and Policy Strategies (University of Michigan Press, 2001). Right now, I am participating with Ken Warner in planning a conference (funded in part by the Robert Wood Johnson Foundation) on innovative strategies in youth tobacco control.
Q1. Combating teen smoking often refers to the MSA as an opportunity to seize while it appears today that most states have decided against using the MSA funds to expand tobacco control programs. Since most of the expected funding has not materialized don't the recommendations about the best use of this money sound now like wishful thinking? Could it be that the book was completed when there was still some hope about the use of MSA funds by the states? How do you feel today about the states handling of MSA funds? Do your recommendations remain the same?
PJ: It is most unfortunate that the states have not done a better job in allocating the MSA funds to tobacco control efforts. Yet it does not follow that the book's suggestions regarding how to spend the money were wishful thinking. For one thing, it is important to reiterate the message that the MSA money should be spent for tobacco control. For another, there are over 20 years left on the MSA account. Just because money hasn't been spent so far doesn't mean that tobacco control advocates should capitulate to how it will be spent in the future.
b. Thus, I still have hope that at least some of the money will be allocated toward tobacco control. It is up to tobacco control and other public health advocates to make the case to the public that allocating the MSA funds to tobacco control is a wise investment. So far, I don't think we have made a convincing case. One reason for writing the book was to provide advocates with a strong rationale and a strong set of supporting evidence for investing in tobacco control.
c. I am not satisfied with how the states have handled the MSA. In Michigan, for example, exactly $0 have been allocated for tobacco control efforts. This is unacceptable. While states have other needs, keeping children for initiating tobacco use should be a high priority. The promise of the MSA was that the states would use the money to invest in tobacco control. That they have not remains a failure of the MSA process.
d. My recommendations remain the same.
Q2. On page 43, when you expose the differences between the "establishment organizations" and the more "grass-roots" ones you write that "politicians respond to arguments about protecting children". If that was the case, how do you explain the failure of so many states legislatures to use MSA funds for tobacco control programs?
PJ: There are several possible explanations. First, tobacco control advocates have not made an effective case for spending the money on tobacco use prevention. We need to be more forceful advocates for our position. Second, the legislators have not been convinced about the efficacy of Tobacco control programs. We need to do a much better job of conveying the information in the book to policymakers that these programs work. Third, tobacco lobbyists remain very powerful at the state level. The last thing the tobacco lobby wants is spending on programs designed to discourage smoking. The industry's lobbying has undoubtedly had a debilitating influence on how the money has been spent. Finally, states have a variety of needs. Most states unfortunately treated the MSA as a general revenue source, and simply allocated the money to competing needs. We need to change the culture so that such disregard for public health will have political consequences.
Q3. You seem to endorse the "willingness of policy makers to fine underage youth for using tobacco products" although as you precise these strategies have not yet been evaluated and are highly contentious among tobacco control advocates (p.212 and 238). How come?
PJ: When I first considered this issue, I felt that fining kids was tantamount to blaming the victim, so I opposed it. But as we were writing the book, I reconsidered. It now seems to me that if we are serious about discouraging teen smoking, we ought to consider whether fines would actually discourage teen smoking. If so, what's the objection? After all, we fine kids for public consumption of alcohol. Why should the two be treated differently? What we recommend is rigorous empirical studies to evaluate whether fines work to discourage youth smoking. While I hardly believe that Draconian measures are appropriate, a small fine coupled with smoking cessation programs might be effective and are certainly worth a demonstration effort.
Q4. About the development of cessation programs you say that "it may be necessary to provide adolescent smokers with either free cessation therapies or subsidies to pay for them" (p.232). How do you assess today the price of NRTs? As many other drugs could they be too expensive for a lot of would be quitters (of any age)? Should the US copy New Zealand that just divided by half the cost of nrts (already heavily subsidized)?
PJ: Although I would certainly like to see the federal and state governments subsidize the cost of NRT, that's not likely to happen any time soon. I think that such subsidies should be high on advocates' agenda for how the state should spend the MSA dollars. These therapies are promising and should be encouraged. The real problem is encouraging the development of NRTs for youths. Right now, there are good products for adults, but they are not necessarily available for kids. We need far more investment in cessation and NRT therapies for children.
Q5. Stanton Glantz has embarked in a crusade against smoking in films. He recommends (like Connie Pechman) showing anti-smoking ads before the feature film and lobbying the industry to prevent insidious product placement. What is your opinion about the impact of smoking in films on young smokers and what could/should be done about it?
PJ: I agree with Stan's approach. I doubt that removing such influences from the movies will have a dramatic effect by itself. But the cumulative message about the social undesirability of cigarettes will make a big difference. Smoking in movies contributes to the overall glamorization of tobacco. Anything that undermines that message should be viewed positively. Thus, continuing the anti-smoking advertising campaign is vital to making tobacco use socially unacceptable. Except for Stan's efforts, there's no national voice opposing the movie industry's use of tobacco products. We need to develop more effective national strategies to convince the movie industry that using tobacco in its movies is neither an artistic nor a commercial advantage.
Q6. Is there anything else you would like to add?
PJ: Yes. Tobacco use among youths remains unacceptably high. We need to place greater pressure on the states to spend the MSA money wisely. We know that tobacco control works. We need to do a better job of articulating that message to the public and to our elected representatives.
PB: Thank you Peter for taking the time to be with us today.
P.S: the other coauthors of Combating Teen Smoking: Research and Policy Strategies (University of Michigan Press, 2001) are: Paula Lantz, Kenneth Warner, Jeffrey Wasserman, Harold Pollack and Alexis Ahlstrom. Rendez-vous is supported by a contract from the Robert Wood Johnson Foundation
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