Professional Documents
Culture Documents
A Strategic Analysis of
Movement
U.S. Tobacco Control Advocacy
Rising
March 1999
Prepared by the
A DV O C A C Y INS TITUTE
Table of Contents
The Advocacy Institute is dedicated to strengthening the capacity of social and economic justice advocates, both
within the U.S. and internationally, to influence and change public policy.
Introduction
A behind-the-front lines organization, the Advocacy Institute brings together seasoned advocates and communitybased leaders to help build their capacity to advocate for just and civil societies. Skills are enhanced, ideas are nurtured into cohesive strategies, and advocates gain greater maturity and skill as movement leaders.
Executive Summary
The mission of the Advocacy Institute is realized primarily through its two programs: the Capacity Building
Program and the Tobacco Control Project.
12
The Capacity Building Program provides capacity strengthening opportunities to advocates globallythrough
training, strategic counseling, and the highly regarded Fellows Programs.
19
Founded in 1987, the Tobacco Control Project is dedicated to building an effective tobacco control movement
by developing and supporting the capacity of community-based tobacco control leaders to advocate effectively for
strong, comprehensive tobacco control policies. The Tobacco Control Project offers technical support to the
movement such as strategic guidance and counseling, dissemination of critical information and analysis, and the
electronic networks SCARCNet and SMARTalk.
27
Next Steps
33
Conclusion
37
Appendix 1
38
Appendix 2
39
Appendix 3
40
The U.S. tobacco control movement has achieved monumental progress over the past decade. The Tobacco Control
Projects consistent focus on media and policy advocacy, and strategic analysis and planning, has helped define the
terms of this historic public health debate.
The Advocacy Institute is a non-profit, tax-exempt organization under Section 501(c)(3) of the Internal Revenue
Service Code. Donations are tax-deductible to the fullest extent allowed by law. For more information about
A Movement Rising, the Tobacco Control Project, or the Advocacy Institute, please contact us at:
Advocacy Institute
1707 L St., NW Suite 400
Washington, DC 20036
phone (202) 659-8475
fax (202) 659-8484
email tobacco@advocacy.org
Visit our website at www.advocacy.org.
Introduction
n late 1998, with support from The Robert Wood Johnson Foundation and the American Cancer Society,
the Advocacy Institute undertook a comprehensive strategic analysis of the current United States tobacco
control movement. This analysis was grounded upon an extensive series of consultations with veteran tobacco
control advocates. They were asked to view the movement in light of the proposed June 20, 1997 settlement, the
failure of subsequent Congressional legislative efforts, the challenges and opportunities presented by the November
1998 multi-state settlement, and the successes and setbacks advocates have experienced at the state and local level.
The information gathering process for the analysis included:
One-on-one interviews (on the record, but anonymous) with more than 30 veteran state tobacco control coalition
leaders, program managers, and advocates (see Appendix 1);
A series of confidential, transcribed interviews with 15 national tobacco control leaders and advocates (see
Appendix 2);
Insights and strategic observations drawn from Advocacy Institutes SMARTalk, a closed facilitated email list-serve
designed to help advocates secure funding for comprehensive state tobacco control programs;
A one-day meeting of 12 veteran national and state advocates convened by Advocacy Institute on December 11,
1998 (see Appendix 3); and
Extensive reviews of the strategic analysis drafts by more than two dozen national and state tobacco control
advocates and leaders.
2. This is a view from inside the tobacco control movement. Weve reached out as best we could to the far corners
of that movement, so that we could reflect the breadth of vision and insight among advocates. But we did not reach
outside, to those close observers of the movement, such as the thoughtful journalistsand there are manywho
covert tobacco control and whose view of us might help us see the movement more objectively.
3. While the Advocacy Institute staff sought to fairly reflect the wide diversity of insights and wisdom that
generously flowed to us in the course of this process, it would not be accurate to call this a consensus document.
In the final analysis, it represents the informed judgment of Advocacy Institutes Tobacco Control Project staff.
Errors of fact, we take full responsibility for. Perceived errors of judgment, we also take responsibility for
although we are prepared to defend them.
We hope you find this analysis useful and thought-provoking.
Mike Pertschuk
Co-Director
Advocacy Institute
Karla Sneegas
Consultant
Advocacy Institute
Kay Arndorfer
Director
Tobacco Control Project
Advocacy Institute
Stephen Bobb
Program Associate
Tobacco Control Project
Advocacy Institute
Theresa Gardella
Project Manager
Tobacco Control Project
Advocacy Institute
Joel Papo
Research Associate
Tobacco Control Project
Advocacy Institute
The strategic analysis utilized the ACT-ON format (Advantages, Challenges, Threats, Opportunities and Next
Steps) to identify salient issues, and the steps that should be taken to build a stronger tobacco control movement.
The Advantages and Challenges sections address the internal strengths and weaknesses of the tobacco control
movement, while the Threats and Opportunities sections analyze the external influences that will have a direct
impact on our strategies over the next few years. In the Next Steps section, concrete actions are identified for
leaders of the tobacco control movement to consider in strengthening the national tobacco control movement
and advancing our policy objectives.
A Movement Rising: A Strategic Analysis of U.S. Tobacco Control Advocacy, March 1999 would not have been possible
without the help of our colleagues, many of whom thought we were nuts to undertake an analysis of the entire
tobacco control movement. Perhaps we are, but we did; and we are pleased to share the results with all of our
colleagues. It is our hope that this document will prove to be a stimulus and resource for the tobacco control
community as it now looks to the futureand that the utility of this analysis will be at least some measure
of reward for those who have been so generous in their counsel. We thank you all.
Before we begin, we offer three caveats:
1. By movement, we mean those people and efforts dedicated to changing public and private policies controlling
tobacco. This, of course, leaves out important activities contributing to a comprehensive tobacco control agenda,
such as perfecting and promoting effective cessation/treatment services, improving the effectiveness of school-based
education, care-provider intervention, and strengthening the quality of surveillance/evaluationexcept where such
objectives are themselves encompassed in policy or funding advocacy.
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Executive Summary
A residue of lingering resentments, valid or not, including perceived inequities in funding, perceived selfpromotion, perceived patronizing arrogance of some newcomers towards tobacco control veterans, perceived
patronizing by some national leaders of state and local leaders, and perceived conflicts of interest.
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High profile media coverage of the state attorneys general lawsuits and the multi-state settlement has left many
Americans believing that the tobacco problem has now been dealt with;
Years of exposing tobacco industry wrongdoing has left the public numbed to additional revelations, and there is
even evidence of nascent sympathy for an industry that appears to have been punished enough;
There are signs of disenchantment with tobacco control programs that do not result in immediate and dramatic
declines in youth and adult tobacco consumption;
There is increasingly harsh commentary by journalists and othersnot industry flackswho raise concerns
about the effectiveness, the fairness, the overreaching, and the political expediency of tobacco taxes and other
tobacco control objectives;
Some citizens suspect that advocates for new, large tobacco control programs are more motivated by
self-interest in potential new jobs than in the public health.
While tobacco control advocates initially heralded the state attorneys general lawsuits as opening a powerful new
front against the tobacco industry, the multi-state settlement opened the door to several threats including:
Preemptive language and other tobacco industry subversion of the state settlement enabling legislation and
appropriations;
Straitjackets on tobacco control funding, such as limiting media initiatives to ineffective just say no campaigns;
Tobacco industry payments under the settlement, even when not applied to tobacco control programs, providing
politicians an excuse for opposing any new tobacco excise tax increases.
There is no new tobacco industry, but there are efforts underway to cultivate the appearance of a contrite and
reformed industry that is now a responsible corporate citizen. This new tobacco industry is armed with an arsenal
of more subtle strategies designed to deflect public outrage and prevent implementation of programs that
aggressively attack the tobacco industry and that promise effective tobacco use reduction.
Both the Congress and the state legislatures remain treacherous forums for tobacco control, as tobacco industrybacked legislators work hand in hand with tobaccos bipartisan army of lobbyists to undermine in the shadows
what they would not dare to do in the spotlight of media attention.
Meanwhile, that critical spotlight dims as broadcasters and publishers lose interest in the old news of tobacco
fights, which are crowded out by new events and new public issue agendas.
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In Washington, DC, there may be a convergence of forces promoting the adoption by Congress of broad, strong
FDA authority over tobacco productsalthough not without struggle and risk. There is also untapped opportunity
for riding the continuing momentum towards strong local clean indoor air ordinances and private workplace
policies.
State media advocacy campaigns, supporting tobacco control funding initiatives, tailored to the political culture
and environment of each state.
This strategic analysis strongly indicates the need for additional long-term movement-building initiatives including:
Opportunities for exploiting the treasure chest of tobacco industry documents for media advocacy, renewing
public outrage at the tobacco industrys corrupt practices;
Accelerating litigation opportunities to unearth more damaging industry documents, to force settlements that
result in public health advances and to cause financial harm to the industry, precipitating tobacco price increases
which discourage use; and
Opportunities for forming new partnerships and alliances with interest groups seeking a portion of the
settlement funds.
Unity-building strategies that encompass long-term strategic planning, priority setting and consensus building
through participatory and collaborative decision-making;
Broadening movement leadership by nurturing and developing leadership capacity;
Rewarding political supporters and punishing political foes;
Broadening policy objectives beyond a youth focus;
Strengthening intra-movement communications;
Developing the capacity to engage in watch dog advocacy as states and the federal government implement new
tobacco control programs; and
The integration of international and national tobacco control advocacy.
Perhaps the most encouraging developments in 1998 occurred not in the United States but internationally.
These international opportunities include the ascension of the dynamic Dr. Gro Harlem Brundtland to
Director General of the World Health Organization (WHO). She has already set tobacco control as a top
priority and recruited an exemplary tobacco control team. WHOs priority initiativethe adoption of a
worldwide International Framework Convention for Tobacco Control that includes an international model for
national tobacco control lawscan give impetus to U.S. domestic legislative efforts, as well as those in lesser
developed countries.
Next Steps
This analysis points the way to both short-term and long-term public policy initiatives and movementbuilding needs.
Short-term common ground policy initiatives:
As of January, 1999 and at least through the current legislative sessions, several priority campaigns command broad
consensus:
Conclusion
There may never be a better opportunity than now to practice the lessons we have learned these past two years;
never a better time to repair the breaches; and never a better moment for looking ahead with deliberation. Right
now, there is agreement among advocates on the primacy of establishing strong state tobacco control programs and
an unprecedented, collaborative effort from all corners of the movement towards that end.
Further on the horizon lies the possibility of federal tobacco legislation. No serious Congressional initiative has yet
surfaced, but that is all the more reason why now is the time for a deliberative and inclusive process to work
through the salient priorities for tobacco control, to identify those non-negotiable core principles, and to distill and
talk through principled differences. As we have seen, total consensus has not been and will never be possible, but
reasoned debate, broad consensus on core issues, and civil agreement to disagree on other issues will be critical if the
tobacco control movement hopes to grow and fulfill its mission. It is our hope that this analysis will help lead in
such direction.
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1. Moral Authority
As one environmental advocate not involved in tobacco
control once remarked, You have science, truth,
health, and justice on your side. All you need to do is
keep from blowing it! Of course its not that simple,
but it is worthwhile to affirm that the strength of the
scientific verdict against tobacco use and tobaccos massive toll of disease and death remain uniquely powerful
weapons in the arsenal of tobacco control advocates.
At least equally important has been the new commitment of the national voluntary health associations to
the primacy of policy advocacy, backed by the funding
and staff resources to make that commitment a reality.
The American Cancer Society (ACS) has ratcheted up
its annual investment in national and state advocacy
from less than $1 million five years ago to its current
national advocacy budget of $8.5 million. The
American Heart Association and the American
Lung Association, though with less overall resources,
have made similar financial and policy commitments
to advocacy.
In 1995, The Robert Wood Johnson Foundation and
the American Cancer Society also created and funded
the National Center for Tobacco-Free Kids, a major
new resource which brought together expertise in
strategic communications and advocacy in both direct
federal policy advocacy campaigns and support
funding and technicalfor state and local initiatives.
Other effective advocacy and intermediary organizations have evolved to provide strategic intelligence and
expert guidance to state and local advocates, including
Americans for Nonsmokers Rights, the ASSIST
Coordinating Center at Prospect Associates, the
AMAs National SmokeLess States Program Office,
the Tobacco Control Resource Center at Northeastern
University, the Office on Smoking and Health at
CDC, and the Advocacy Institute.
Together, this new infrastructure is deployed in a wide
range of complementary roles which support policy
advocacy, including:
Direct, professional lobbying;
Established relationships of trust and confidence
with key policy makers;
State-of-the-art paid and unpaid media advocacy;
Grassroots organizing and mobilizing;
Movement outreach and alliance building;
Targeted funding of state advocacy initiatives;
State and local coalition development and technical
support;
Advocacy training and leadership capacity building;
Intra-movement intelligence dissemination and
strategic communications; and
Strategic analysis and planning.
4. Growing Diversity
As recently as the early 1990s, the tobacco control
movement and its leadership could rightly be described
as narrow, exclusive, white, mostly male, and middle
class. While tobacco control is still not a movement
that mirrors the face of America, the last five years
have seen welcome diversification. California has led
the way, with the building of multi-cultural networks
Advocacy Institute / 9
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included support for full FDA authority to protect consumers, that tobacco products not be marketed or sold
to kids, and that if there is a tax increase, a portion of
the revenue would be used to assist farmers and their
communities.
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6. A House Divided
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deeply skeptical about both the motives and effectiveness of this campaign, measuring the effects of
such advertising is extremely difficult. In addition,
proving the negativethat the ads dont work
will not be an easy task. Meanwhile, the industry
will reap the propaganda benefit of its highly
visible good works.
The industry has gained innocence by association with the state attorneys general and governors
as co-sponsors of the severely restricted counteradvertising programs mandated by the multi-state
settlement.
The companies will aggressively promote the
message that they have paid the price for past
sins by paying billions of dollars to the states in
the November 1998 settlement.
b) Demonizing tobacco control advocates. Focus
groups conducted by the industry in late 1997,
which laid the foundation for the industrys $40
million media assault on the McCain bill, revealed
that the public was prepared to believe messages
coming directly from the tobacco industry. This
proved especially true when those messages resonated
with the tax and spend, reverse Robin Hood
themes that the independent critics articulated.
So tobacco control advocates, who had long enjoyed
the trust of the public as public interest advocates,
began to be recast in the public mind as the handmaidens of tax and spend liberal politicians and
the willing tools of greedy trial lawyers. And, to
boot, the industry seized upon the complaints of
some independent critics that the advocates were
overzealous prohibitionists.
All of these negative images will predictably be
trotted out by the industrys propaganda machine
this year to tarnish the image and undermine the
credibility of tobacco control leaders and activists.
c) Using philanthropy to buy legitimacy, friends,
and the silence of potential critics. The tobacco
industry has always bought friendsnewly disclosed
documents show how such industry allies as restaurant and grocery associations have been artificially
propped up by heavy tobacco funding. But now it
has begun to aggressively reach out to various
Advocacy Institute / 23
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5. A Weakenedor Weak-WilledPresident
Tobacco control advocates have never had such
outspoken champions of tobacco control in the White
House as President Clinton and Vice President Gore.
However, the President has shown a readiness to
compromise with the Republican leadership when such
compromises meet his larger political needs. While
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4. Litigation Opportunities
a) Private litigation. One virtue of the November
1998 multi-state attorneys general settlement is that
it left intact all private litigation initiativeswhile
the June 20, 1997 proposed settlement would have
extinguished all class action lawsuits. Another
important by-product of that settlement and the
earlier individual state settlements is that the massive
attorneys fees earned as part of the settlements provide a pool of funds for trial lawyers to sustain large
cases against the costly resistance of the tobacco
companies.
This becomes more significant in the wake of the
recent California jury verdict of $51 million in an
individual action against Philip Morris, the type of
case that was long considered least threatening to
the industry.
The major cigarette manufacturers themselves have
acknowledged in recent filings with the Securities
Exchange Commission that they expect that an
increased number of tobacco cases, involving claims
for billions of dollars, will come to trial over the next
year compared to prior years when trials in these
cases were infrequent.
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5. Election Opportunities
There are candidate and issue initiative campaigns in
this country every year. When well organized and
adequately funded, tobacco control advocates have
been capable of significant advances in state excise
tax initiatives and in beating back industry-inspired
initiatives to weaken clean indoor air laws.
In closely contested legislative races in which one
candidate has taken tobacco campaign dollars and
voted against tobacco control measures, and a
strong opponent has renounced tobacco industry
contributions and focused on his or her opponents
ties to tobacco, the tobacco issue has shown
significant potency.
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6. International Opportunities
Perhaps the most encouraging developments in tobacco
control in 1998 occurred not in the U.S., but internationally, where little had stirred for many years. These
developments include:
The ascension of Dr. Gro Harlem Brundtland
to Director General of the World Health
Organization (WHO). Dr. Brundtland is a
deeply committed public health physician and,
as former Prime Minister of Norway, a skilled
political leader. She has set tobacco control as a top
priority, and has recruited a tobacco control team
from among the ranks of the most effective international tobacco control advocates, including
Judith Mackay and Derek Yach.
The election triumph of the British Labor party,
which tipped the balance in the European
Community in favor of the long-pending ban on
tobacco advertising and promotion, which has
now been adopted (though the Blair government
has just chilled Medicaid-type government
litigation by the national health service)
The evolution of U.S. international tobacco
control policy, as evidenced by the Doggett
amendment (the only significant tobacco
legislation to pass the 105th Congress) which
prohibits U.S. government agencies from
promoting tobacco abroad. Furthermore, under
President Clinton, the U.S. has supportedrather
than suppressedWHO tobacco control efforts.
The International Policy Conference on Tobacco
& Children, the first international conference on
tobacco control issues designed specifically for
legislators, will be held in Washington, DC in
March 1999. The conference, initiated by Senator
Richard Durbin (D-IL) and sponsored by The
Robert Wood Johnson Foundation and the Center
for Tobacco-Free Kids, will bring together health
ministers, legislators, and international advocates
to focus on policy solutions to the tobacco epidemic.
The lawsuits by states against the tobacco industry
have prompted the governments of other countries
to sue tobacco companies to recoup medical costs
from tobacco-related illness. Whatever the fate of
these cases, they have stimulated uncommon
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Next Steps
1. Short-term Common Ground Policy
Initiatives
2. Short-term Technical Support Needs
3. Long-term Movement Building Needs
4. Preparing for the Shift from Policy Advocacy
to Watch Dog Advocacy
5. Integrating U.S. and International Tobacco
Control Advocacy
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Conclusion
here may never be a better opportunity than now to practice the lessons we have learned these past two
years, painful as that learning process may have been, never a better time to repair the breaches, and never a
better moment for looking ahead with deliberation. Right now, there is agreement among advocates on the
primacy of establishing strong state tobacco control programsand an unprecedented, collaborative effort from all
corners of the movement towards that end. This collaboration is in itself a healing balm for past disagreements
and regrets.
Further on the horizon lies the possibility of federal tobacco legislation. No serious Congressional initiative has yet
surfaced but some of the same factors that gave rise to tobacco legislation in 1998 persist, including a mounting
burden of private litigation, a federal lawsuit to recover billions in Medicare expenses, and the President's
commitment to comprehensive tobacco control legislation.
The White House, Congressional leadership, governors, trial lawyers, and tobacco industry all have incentives
to begin again the process of negotiation and possible compromise. That is all the more reason why now is the
time for a deliberative and inclusive process to work through the salient priorities for tobacco control; to identify
those non-negotiable core principles; and to distill and talk through principled differences. As we have seen,
total consensus has not been and will never be possible. But reasoned debate, broad consensus on core issues,
and civil agreement to disagree on other issues will be critical. It is our hope that this analysis will help lead in
suchdirection.
"Hope. Realistic hope," wrote Erich Fromm, one of this century's greatest counselors, is a "decisive element in
any attempt to bring about social change." It is like "the crouched tiger" which is always ready to jump "when
the moment for jumping has come."
Have we gained enough wisdom so that when we leap, we win?
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Appendix 1
Appendix 2
Melissa Albuquerque
CDC Office on Smoking
and Health
Atlanta, GA
Amy Barkley
Coalition for Health
and Agricultural
Development
Versailles, KY
Lynn Carol Birgmann
Kentucky ACTION /
ALA
Louisville, KY
Michele Bloch
American Medical
Womens Association
Rockville, MD
Deborah Borberly
ASSIST / New Mexico
DOH
Albuquerque, NM
Serena Chen
ALA / Alameda County
Oakland, CA
Ralph DeVitto
American Cancer Society
Tampa, FL
Donna Dinkin
Public Health Leadership
Institute
Greensboro, NC
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Larry Downs
New Jersey Breathes
Lawrenceville, NJ
Pam Eidson
Georgia Division of
Public Health
Atlanta, GA
Monica Eischen
CDC Office on Smoking
and Health
Atlanta, GA
Eric Gally
Consultant
Washington, DC
Donna Grande
Full Court Press
Tucson, AZ
Kathy Harty
SmokeLess States
Program Office
Chicago, IL
Ann Marie Holen
Alaska Native Health
Board
Anchorage, AK
Bob Jaffe
Washington DOC
Seattle, WA
Judy Knapp
Minnesota Smoke Free
Coalition
St. Paul, MN
Andre Stanley
SmokeLess States
Program Office
Chicago, IL
Anne Ford
Manager of Federal Relations
National Center for Tobacco-Free Kids
Washington, DC
Matt Myers
Executive Vice President and General Counsel
National Center for Tobacco-Free Kids
Washington, DC
Lodie Lambright
ASSIST / Rhode Island
DOH
Providence, RI
Carter Steger
American Cancer
Society
Glen Allen, VA
Cliff Douglas
President
Tobacco Control Law & Policy Consulting
Ann Arbor, MI
Jeff Nesbit
Consultant
Washington, DC
Charyn Sutton
Onyx Group
Philadelphia, PA
David Kessler, MD
Dean, Yale Medical School
New Haven, CT
Jeanne Weigum
Association for
Nonsmokers
Minnesota
St. Paul, MN
Witold Zatonsky
Head, The Maria Sklodowska-Curie
Memorial Cancer Center and Institute
of Oncology
Warsaw, Poland
Phil Wilbur
Pacific Institute for
Research & Evaluation
Bethesda, MD
Russ Sciandra
Director
Center for Tobacco Free New York
Albany, NY
Seth Winick
American Cancer Society
Washington, DC
Julia Carol
Co-Director
Americans for Nonsmokers Rights
Berkeley, CA
Bill Novelli
President
National Center for Tobacco-Free Kids
Washington, DC
John Seffrin
CEO
American Cancer Society
Atlanta, GA
Judy Wilkenfeld
Special Advisor for Advertising Initiatives
Food and Drug Administration
Washington, DC
Mitch Zeller
Associate Commissioner
Food and Drug Administration
Washington, DC
Linda Crawford
National Vice President
Federal and State Government Relations
American Cancer Society
Washington, DC
Jerie Jordan
American Cancer Society
Atlanta, GA
Advocacy Institute / 39
Appendix 3
List of Participants in the Strategic Advisory Meeting, Advocacy Institute, December 11, 1998
Kay Arndorfer
Director, Tobacco Control Project
Advocacy Institute
Washington, DC
Michele Bloch
Chair, Tobacco Control and
Prevention Subcommittee
American Medical Womens Association
Rockville, MD
Mark Pertschuk
President
ANR Board of Directors
Berkeley, CA
Anne Ford
Manager, Federal Relations
Center for Tobacco-Free Kids
Washington, DC
John Garcia
Vice President, Community &
Public Health Promotion
Prospect Associates
Silver Spring, MD
Theresa Gardella
Project Manager
Advocacy Institute
Washington, DC
Cynthia Hallett
Associate Director
Americans for Nonsmokers Rights
Berkeley, CA
Rich Hamburg
Director, Legislative & Regulatory Affairs
American Heart Association
Washington, DC
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Mike Pertschuk
Co-Director
Advocacy Institute
Washington, DC
Jane Pritzl
ASSIST Field Director
Colorado Dept. of Public Health
Denver, CO
Glenn Schneider
Community Organizer
Smoke Free Maryland Coalition
Baltimore, MD
Karla Sneegas
Trainer/Consultant
Indianapolis, IN
Seth Winick
Director, State Government Relations
American Cancer Society
Washington, DC