As the American Cancer Society leads the nation in observing the annual Great American Smokeout on Thursday, Nov. 20, the USF College of Public Health can celebrate its role in Florida’s fight against big tobacco.

Dr. Phillip J. Marty, COPH professor in the Department of Community and Family Health, associate vice president of USF Health and interim chair of pathology and cell biology in the Morsani College of Medicine, was a COPH professor when he became involved with the state’s anti-tobacco efforts that made world news in the 1990s.

“In 1991, I got plugged into the American Cancer Society, and they asked me to serve as chair for a new committee that they were structuring to address the tobacco concerns we had across the state, and of course, it was developing on the national level, as well,” he recalled.

“In Florida, we had the TriAgency Coalition on Smoking or Health comprised of the American Society, the American Heart Association and the American Lung Association.  This group had periodic meetings of which I became a part, and an tobacco action agenda was developed to deal with legislative issues that we felt were important on the state level.”

That alliance resulted in the creation of the ACS Lung Cancer Task Force which began to focus on state policies related to clean indoor air and youth access to tobacco products.  The other members of the TriAgency were also actively supporting this work.

“When I got involved in it,” Marty said, “I thought, ‘Gosh, we’ve got this big tobacco industry, which is a coalition in itself, and they have people all over Tallahassee.  There’s no way we’re going to be able to get much through the legislature.’  We could certainly advocate, and we could increase awareness, but I wasn’t very optimistic about any inroads in legislation.”

Marty became more encouraged, he said, when he realized how many legislators were willing to play David to a Goliath public health threat.

“It was a great issue for legislators,” he said.  “It had public visibility, it was controversial, and their efforts were on the right side of the public’s health.  With a nucleus of people, we began to develop some real interest in improving state policy related to tobacco products.  The Clean Indoor Air Act was already on the books, and what we ended up doing was strengthening it.  Likewise with Youth Access, we added a number of aspects to that bill that helped to protect the kids.”

For the first time, retailers had to secure licenses to sell tobacco products.  They were required to place tobacco behind their counters and enforce a minimum purchaser age of 18, IDs required.  The law also created an educational campaign.  Vending machines, a common source of cigarettes, were removed from public locations.

In 1993, the same year Marty became interim dean of COPH, the ACS sunsetted the  Lung Cancer Task Force, and with collaboration from the TriAgency, replaced it with the Tobacco-Free Florida Coalition, with Marty as its initial chair.  Years later, the Coalition, which held its first training conference in Tampa in 1994, would in turn be discontinued.  The Florida Department of Health eventually created the Tobacco Advisory Council to provide consultation to Florida’s surgeon general on tobacco-related policy and issues.

While the legislative strides had been laudable, the Tobacco-Free Florida Coalition had its biggest victory ahead of it, and it would be a stunner.

“We had about 60 organizations in the state that got behind the Medicaid third-party lawsuit, and they were pretty big advocates across the state to help Gov. Chiles.  We brought him down here to the College of Public Health and had a great student and public rally.  We also brought in Dr. David Kessler, FDA commissioner at that time, to address his efforts to regulate tobacco products through the FDA.”

Marty and colleagues also published articles in numerous state, national and international journals related to their research on tobacco use in Florida.  In 1994, Marty and others had articles published in the Journal of the Florida Medical Association addressing the tobacco control program created by the Coalition, the State Department of Health, the TriAgency, and many other professionals involved in tobacco advocacy work.

At about the same time, Marty was part of a workshop that educated legislators on the public health issues of youth tobacco use and youth access.  That workshop led to the Youth Access to Tobacco legislation eventually passed by the legislature.  Marty also traveled regularly to Tallahassee to address legislative committees on tobacco legislation, a task he really didn’t relish.

Although the focus and setting had changed, the efforts were not new for Marty, who earlier in his career had been involved with anti-tobacco efforts at the University of Arkansas, where he had concentrated on the threat of smokeless tobacco.  In Arkansas at that time, a decline in youth smoking had provided cover for an arguably more insidious threat.

“I thought we were seeing a shift in product,” Marty said.  “So we did some epidemiologic, community-based studies, and found significantly high rates of regular use among children, up to nearly 40 percent.”

True, the kids weren’t smoking.  They were “dipping and chewing,” a behavior that would threaten to snuff more lives under the guise of a safer tobacco alternative.  Marty and colleagues published their findings in the American Journal of Public Health, leading directly to their being invited to a National Institutes of Health Consensus Development Conference.  The conference led to a surgeon general’s “Report on the Health Hazards of Smokeless Tobacco,” and in turn to new regulations aimed at keeping smokeless tobacco away from kids.

“I felt that if there was any time in my career when I might have influenced some important public health policy, it was probably that work.  And I think my work here in Florida with the legislature probably has had some benefit, but you never know,” he said with a laugh.

“It was the work of a lot of people.  Charlie Mahan was the State Health Officer, and when he came down here as dean in 1995, we continued to work with the legislature and with the voluntary health agencies in the public health sector across the state to keep this topic in the forefront.”

The state filed its suit against big tobacco in 1995.  Florida and four other states settled with Liggett Group in 1996.  The following year, the “big four” – R.J. Reynolds, Phillip Morris, Brown and Williamson, and Lorillard – settled with the Sunshine State alone for $11.3 billion, still the largest single-state tobacco settlement.

Predictably, the Goliaths that controlled 97 percent of the tobacco industry admitted nothing, but their industry finally would be financially accountable for the state’s tobacco carnage.  Florida’s settlement was the second state tobacco victory among three other state settlements, with Mississippi being a month ahead of Florida but receiving a much smaller financial pay-out.  A “master settlement” with 46 other states followed a year later.  Nearly half of Florida’s take from its solitary action was subsequently funneled into local education, prevention and intervention programs.

Marty continues his efforts as a member of the state surgeon general’s Tobacco Advisory Council, concentrating on the countless new ways the tobacco industry persists in pushing its product on the public, including hookah pipe use, scores of variously flavored tobaccos, and even a dissolvable tobacco that resembles Tic Tacs.  He also provides administrative supervision to USF Health’s Area Health Education Center.  Much of the work of the Center’s work is focused on tobacco cessation and provides this work through a $2.6-million State Department of Health contract that is funded from the Tobacco Trust Fund that was created by the State tobacco settlement.

“The college played an important role in the early efforts of addressing tobacco use in the state,” Marty said.  “I know there were things going on before we ever got here, but they really picked up steam in the early ’90s and led to things that we benefit from today, like the State Tobacco Trust Fund that helps support one of the very best tobacco prevention programs in the nation.  It’s a legacy that’s pretty significant, and one that our faculty, staff and students in the College contributed to.  It should be a point of pride for all of us.”

Story by David Brothers, College of Public Health.