Within the next fe\v bceeks, representatilres of the Women vs. Smoking Network appeared on NRC Nic~17fl!/ NLTIT, CBS 771is Mov/I~u~, CBS Ew~I~II;; N<~i~~~, the Ml~cNril-Lchwr Ncw~Horl~, Ni~l7tmfcl7, and Nightli77e. Representatives Lvere also interviewed by major national newspapers, including L/S,4 Todny; by numerous local papers; by CBS Radio Network, the Black Radio Network, and National Public Radio; and by local talk S~OM'S. Last, repre- sentatives were asked to testify on the topic at con- gressional hearings. The network follolved up on the publicity bv spotlighting several different projects, including a petition to the tobacco compa- nies to adhere to their o\\`n \roluntarv code of cor- porate ethics. Even the cigarette's proposed name dre\V criti- cism. Groups in North Dakota and South Dakota objected to the name, as did Sioux tribal organiza- tions, because "Dakota" means "friend" or "allv" in the Sioux language. These groups formed a coa- lition of more than 4U organizations and collected 25,000 signatures on a petition objecting to the USC of the word and demanding that R.J. Revnolds cease chairman Joe Garagiola by lawmakers and Secretary of Health and Human Services Donna Shalala. >lore than S70 million in electronic media coverage has been generated directly from NSTEP efforts. In addition, NSTEP activities appear to have substantially in- creased the coverage of smokeless tobacco issues in the print media. Before NSTEP there were approxi- mately 500 print articles annually devoted to smoke- less tobacco; since NSTEP that number has climbed to Components of Community Programs Community Advocacy and Mobilization Electronic Networking Interactive communication technologies, such as computer networks, have been used extensively by advocacy groups for reducing tobacco use. For ex- ample, daily communications played an important selling the cigarette, rvhich had been test-marketed, as planned, beginning in April 1YYO. The Women VS. Smoking Nettvork provided strategic counsel- ing and technical support to the grassroots coali- tion and \vas instrumental in helping arrange a press conference in Washington, DC, in June 1990, which featured then Surgeon General Antonia Novello, Senator Larry Pressler (R-SD), and others objecting to the marketing plan. Although advocacy groups \vere able to gen- crate considerable community and media mobili- zation, R.J. Reynolds continued test-marketing. Advocates felt they had raised national concern about the targeting of cigarette advertising, al- though this impression was not directly verified through survey research. Dakota cigarettes were \vithdra\vn trvo years later, however, because the brand did not sell as well as officials had hoped 04~77c~icn77 Mcrlit-111 iV~w 1992). In this instance, al- though ad\,ocates might attribute the end result to the effective use of the media to promote the agenda for reducing tobacco use, the demise of the Dakota brand \vas probably more attributable to market forces. more than 5,000. One article alone appeared in more than 800 netzspapers on a given Meekend, and NSTEP estimated the value of this media coverage at $15 mil- lion. A recent survey of major league baseball players and coaches found that more than 44 percent of smoke- less tobacco users want to quit in the next six months, perhaps attributable to NSTEP's active participation in educating ballplayers during spring training. part in the response to Philip Morris' Bill of Rights Tour (see the text box later in this chapter). Many active, functioning networks now provide communication services to assist in efforts to reduce tobacco use. The Institute for Global Communications, based in San Francisco, \vas an early provider of issue- specific networks to the general public. PeaceNet and EcoNet, which were dev~eloped in 1 YH6, are among the most widelv used and well known of the institute's networks. As of October 1994, the institute reported a combined membership of 12,000 people from 130 coun- tries (Moore 1994). Within these networks, and others like them, are smaller groups focused on a specific as- pect of an issue or a particular policy. For instance, among HandsNet's 2,500 member organizations, which span the nonprofit sector, is a forum linking 200 community coalitions on substance abuse. This forum, managed by the Boston-based group Join Together and supported by the Robert Wood Johnson Foundation, provides on-line technical assistance to these coalitions. The forum also provides news summaries and infor- mation available on funding opportunities and proposed legislation. Several networks link people who work in health- related areas. In 1993, the Public Health Network pro- vided forums, e-mail service, and databases for its membership, which was composed of nearly 600 users from state and local health agencies and of program directors who were members of the CDC's Public Health Leadership Institute. In 1998, this network was replaced by the Information Network for Public Health Officials. Established by the CDC's Pub- lic Health Practice Program Office, the network links the public health community to the Internet and pro- vides access to on-line information. Planned l'arent- hood Federation of America hosts PI'XNet, a network for its affiliates in regional and national offices, pri- marily for communication within the organization itself. During the lYYOs, the CDC offered the electronic resource WONDER to public health officials, acade- micians, and others so that thev were able to commu- nicate via e-mail with and ha;,e access to the CDC's databases of health data. The advent of the Internet, including Web-based e-mail and list serv technology, has facilitated the exchange of public health informa- tion for health professionals and the public. CDC now offers its health data, materials, databases, electronic journals, and other resources on its Web site at www.cdc.gov. In 1990, the Advocacy Institute founded SCARCNet, a multiuser interactive bulletin board that served the tobacco control community. (The history of the bulletin board's sponsoring organization-the resource center known by the acronym SCARC-is discussed in "Impact of Direct Ad\;ocacy," later in this chapter.) When SCARCNet ceased in January 2000, it had more than 1,000 subscribers and was circulated to thousands of readers throughout the wrorld on vari- ous networks. SCARCNet's most popular feature \~as the "Daily Bulletin," which each day summarized major newspaper and journal stories on reducing to- bacco use (Advocacy Institute 1994). The "Daily Bul- letin" was accompanied by a "Morning Briefing," which put these news stories in perspective for the tobacco control community. The contents of the "Dailv Bulletin" stories were retained and stored in a data- base that is currently available for searching at \vww.tobacco.org. Another notable feature of SCARCNet was the publication of "Action Alerts." These two-page summaries of current issues requir- ing immediate action included objectives for action, suggested actions, media bites, quotes, and talking points and were sent to SCARCNet as needed (on av- erage, twice per month). The conferencing section on SCARCNet, called the "Strategy Exchanges," provided a forum for planning, counseling, and experience sharing. The technology allowed for concurrent but separate discussions on discrete issues, such as clean indoor air, tobacco advertising and promotion, tobacco pricing policies, and minors' access to tobacco prod- ucts. Since its inception in 1990 to its final edition on January 31, 2000, SCARCNet, along with its global counterpart GLOBALink, became an important re- source for the tobacco control community. In Febru- ary 2000, the American Legacy Foundation began its support of a newly designed and enhanced news ser- vice system that harnesses advances in Web technol- ogy to build on SCARCNet's valued features. This system provides users with the leading national news stories and also includes a news service that allows users to receive a customized selection of other stories based on their geographic location and specialty areas of greatest personal interest (e.g., advertising, en- forcement, etc.). SCARCNet has served as a model for other pub- lic health advocacy networks. Examples include Safety Net (an advocacy network for violence prevention) and the Marin Institute's ALCNet (a network for alcohol control advocates), which is modeled closely after SCARCNet. ALCNct has been used for media advo- cacy as Lvell, particularly to facilitate strategy devel- opment to counteract certain alcohol products and promotions. As with other modalities used for social change, the precise role of on-line networks-one element in a multifaceted approach-is difficult to define. Al- though process measures are available (e.g., frequency of interactions and message traffic), they do not assess the basic value of computer links in furthering the agenda for reducing tobacco use, nor is it likely (as is noted at the beginning of this chapter for social inter- ventions overall) that their efficacy can be precisely estimated. Current enthusiasm for the mechanism, however, rvill probably ensure its continuation, and accrued anecdotal experience-to date, quite positive- \vill provide the ultimate judgment. Direct Advocacy History md Actizlitirs National-level activities, including the lz'ork of the Coalition on Smoking OR Health (see "Further Regulatory Steps" in Chapter 5; see also "Communitv Mobilization," earlier in this chapter) and others (see Chapter 2 and USDHHS lYHYb), have played a promi- nent role in the evolving policy changes concerning the reduction of tobacco use. Of equal interest, from the point of vie\v of the potential impact of ad\.ocacy, are decentralized grassroots organizations. The nonsmokers' rights movement originated in the early 1970s (see "From Antismoking to Nonsmok- ers' Rights" in Chapter 2). It consisted of individuals acting on their own and of small grassroots organiza- tions of people irritated bv ETS or con\,inced that theil health suffered from it. &ring this period, the docu- mented adverse health effects of ETS were first being brought to the public's attention (Steinfeld 1972; U.S. Department of Health, Education, and Welfare 1972). As research documenting these health hazards accu- mulated, nonsmokers' rights organizations gre\v in number and strength. Many of the early grassroots organizations used the acronym GASP to represent similar titles, includ- ing the Group Against Smokers' Pollution, the Group Against Smoking Pollution, the Group to Alleviate Smoking in Public Places, and Georgians Against Smoking Pollution. Other acronyms w-ere also used, including FANS (Fresh Air for Nonsmokers), TAPS (Texans Against Public Smoking), and ANSR- pronounced "answer"- (Association for Nonsmokers Rights). Organizations were small, poorly funded, and often run from home by volunteers. Initially, many nonsmokers' rights organizations simply provided a forum for nonsmokers to express their concerns about smoking and ETS. These groups helped legitimize their members' complaints and em- power them to take protective actions. Such actions required courage, assertiveness, and no small measure of tact, since smoking in public areas was normative at the time. Group members might thus learn how to politely ask people to refrain from smoking; or to ob- viate direct confrontation with smokers, groups might provide members with signs, cards, or buttons asking people not to smoke in their presence. Early in the movement, nonsmokers' rights associations adopted public policy change as an important goal. Groups began to work for passage of measures to restrict public smoking. Such regulations are often referred to as clean indoor air laws (see "Clean Indoor Air Regulation" in Chapter 5). To encourage these measures, an early GASP organization produced a "Bill of Rights" that stated, in part, that Non-Smokers have the right to breathe clean air, free from harmful and irritating tobacco smoke. This right supersedes the right to smoke when the tlvo conflict. Non-Smokers have the right to express-firmly but politely-their discomfort and adverse reactions to tobacco smoke. . Non- Smokers have the right to take action through legislativ-e channels, social pressures or any other legitimate means-as individuals or in groups- to pre\:ent or discourage smokers from polluting the atmosphere and to seek the restriction of smoking in public places (Group Against Smokers' Pollution, n.d.1. O\rer time, manv organizations moved to encom- pass broade r policy goals for reducing tobacco use- in particular, thev sought M-ays to decrease tobacco use by minors. Lariely as a consequence of those efforts, direct advocacy and public policy change became im- portant parts of these organizational strategies. In some communities, nonsmokers' rights orga- nizations Marked in isolation. In others, they formed associations lvith medical societies, voluntary health associations, and other organizations; the result was a more intense effort to ensure passage of desired legis- lation. Despite initial obstacles, in many communities nonsmokers' rights associations were a driving force in moving their allies toward a legislative approach to reducing tobacco use. For example, one of the earliest and most influential nonsmokers' rights organizations was California GASP, founded in 1976, which eventu- ally became Americans for Nonsmokers' Rights (ANR). ANR is now the principal national-level tobacco control group devoted primarily to promot- ing legislation for clean indoor air. In California, ANR helped support the passage of such ordinances in many localities. Partly as a result of ANR's work, California has more local ordinances for clean indoor air than any other state. ANR has served as a national consultant to other groups pursuing such legislation. Impact of Direct Adz~ocncy In retrospect, the grassroots organirations can bc> seen as ha\.ing -\lorked to diminish the Iegitimacv of tobacco use in the txye3 of the public anJ the crt~dibil- it\, of the tobacco indu~tr\. Tht> passage ofordinanct~s c3gainst public smoking (see "Clean Indoor Air Regu- lation" in Chapter 5) occurred over se\~eral years, dur- ing cvhich a shift in public opinion about smoking became evident. During the 1960s and 197Os, the right to smoke was largely unquestioned. In more recent vears, declining smoking prevalence and public opin- ion polls have indicated an increasing intolerance for public smoking (USDHHS lY8Yb). The work of non- smokers' rights organizations is coeval with these legal, epidemiologic, and social changes. Sorting out cause and effect is difficult, but the nonsmokers' rights movement seems to have contributed to the changing social norm (Glantz 1987). There were, however, some important exceptions to the emerging nonsmoking norms. By the mid-lY80s, it was apparent that both the traditional educational efforts and the passage of ordinances to protect non- smokers from ETS had a limited effect on young people's smoking-related attitudes and behaviors (USDHHS 1994). Efforts to reduce smoking appeared unable to reduce the prevalence of smoking among teenagers (Lynch and Bonnie 1994), and smoking prevalence among white females began increasing sharply during the 197Os, as did the prevalence of smokeless tobacco use among males. The failure to decrease smoking among young people is as difficult to assess as is the success observed among adults (particularly among adult men). Ana- lyzing the effect of prevention activities on young people must include weighing the hampering effects of advertising and promotional efforts backed bv the tobacco industry's enormous marketing budget (see "Advertising and Promotion " in Chapter 5; DiFranza et al. 1991; Pierce et al. 1991; Lynch and Bonnie 199-I; USDHHS 1994). Whate\.er the interplay of the forces involxred, the result is that protobacco actixitv directed at those entering the market has been generaIl\, suc- cessful. An exception is the continued decline in pre\`a- lence among young African Americans, particularly among young women (USDHHS lY98). Perhaps some of the shortfall in grassroots efforts to reduce tobacco use is associated Lvith the earlv iso- lation of these groups from the established naiional advocacy organization. Anecdotally, there is evidence of a culture clash. When the nonsmokers' rights move- ment emerged in the 197Os, many medical and volun- tary health organizations decried \vhat they perceived as the unprofessional, indecorous, confrontational ap- proach that these activists took to an issue that had previously fallen in the domain of the traditional pub- lic health structure. Some traditional organizations in the public health arena may also have felt that grassroots organizations were infringing on their "turf" and their fund-raising base. For their part, nonsmokers' rights associations objected to lvhat they saw as the overly cautious, mea- sured approach of researchers, medical associations, and volunteer health associations, whose efforts seemed to have done little to solve the problems ot day-to-day exposure to ETS. The grassroots organi- zations urged voluntary health organizations to exam- ine their mission statements and dedicate appropriate resources to cost-effective solutions to reducing to- bacco use. In time, both approaches acknowledged that the lack of coordination and cohesion was a significant barrier to their efforts. The groups noted that, in con- trast, the tobacco industry operated as a monolith through the coordinated efforts of the Tobacco Insti- tute, a lobbying and public relations organization representing the industry. This insight led to the emer- gence of several groups-somewhat disparate in their approaches-that attempted to bridge some of the dis- tance between the grassroots and national approaches to reducing tobacco use. Among the oldest of these groups is DOC (Doc- tors Ought to Care), which was founded in 1977 as a national coalition of health professionals, students, and concerned individuals. DOC groups take an activist approach to public health problems and sponsor com- munity projects and events on reducing tobacco use and other issues. From the outset, members chose COP trontational programs, such as counteradvertising and picketing industry-sponsored sports events, to delegitimize the tobacco industry and focus attention on its acti\-ities bv involving both physicians and voung people in advocacy activities. DOC groups use &tire, ridicule, and parody in their work to appeal to children and teenagers (Blum 1982); for example, they have sponsored "Emphysema Slims" tennis matches featuring appearances by "Martina Nosmokanova." DOC also maintains a large archive of activities related to the tobacco industry, including past advertising campaigns and marketing strategies (Mintz 1995). The acti\+ties of DOC are similar in style, if not content, to those of the Australian organization Billboard Utilising Graffitists Against Unhealthy Promotions (BUGA-UP), which was founded in 1979. BUGA-UP members, some of whom are physicians, have used unconven- tional tactics, such as spray-painting billboards that advertise tobacco products (Jacobson 1983). Another group is Stop Teenage Addiction to To- bacco (STAT), which \vas founded in 1985 with the aim of reducing tobacco use among minors. From its inception, STAT aimed to unite the medical and scientific arm and the grassroots arm of the movement to reduce tobacco use. Although STAT frequently ap- proaches tobacco issues from the activist perspective, the organization has long included key members of the medical and public health establishment in its leadership. DOC, STAT, and other groups have attempted to make the activist, confrontational ap- proach to reducing tobacco use acceptable to the more conservative medical and voluntary health organiza- tions. Partly because of these efforts, an activist approach is now an important component of the move- ment (see the text box "Bill of Rights Tour"). Another impetus for a more unified movement \vas the establishment of the Smoking Control Adlro- cacy Resource Center (SCARC) at the Advocacy Insti- tute in 1987. The Adlrocacy Institute's mission-to study, analvze, and teach public interest advocacy- included a'focus on smoking reduction as a model public interest movement. The institute received fund- ing from the Henry J. Kaiser Family Foundation to establish SCARC. Rather than be a frontline organ- Tation, SCARC proposed to help build the mo\,ement's infrastructure. As such, SCARC \vould be v-ielved as a neutral player and \t,ould not vie I\Tith the movement's other organizations in seeking media, voluntary, or funding sources. Since its formation, SCARC has served three important roles as convener, tobacco industry monitor, and center for strategic development, training, and counseling (Butler 1990). Media Advocacy Media advocacy for reducing tobacco use was developed during the lY8Os by a small number of ac- tivists working primarily in the United States, Canada, Australia, and the United Kingdom. The attendees at the September 1985 International Summit of Smoking Control Leaders resolved to produce a handbook that would provide guidance on using the media to sup- port tobacco control. The resulting document, Smoke Si~rlals: T/V .S~~lr~kirl;~ Corlfvol Mcdin Hnr2itEook Pertschuk 19871, describes many of the important themes and skills needed for using what would later be dubbed "media advocacy." In January 1988, the Advocacy In- stitute convened a t\vo-day consensus workshop, sponsored bv the NCI, that produced a second hand- book on media advocacy, M&i17 SfrntL>lltj 1981-1996. BOS- ton: Health and Addictions Research, 1997. Butler J. The "Dakota Papers." Paper presented at the Seventh World Conference on Tobacco and Health; Mar 30, 1990; Perth (Australia). Buzina R, Keys A, Mohacek I, Marinkovic M, Hahn A, Blackburn H. Coronary heart disease in seven coun- tries. V. Five-year follow-up in Dalmatia and Slavonia. Circzrlntion 1970;41(4 Suppl):I40-151. Carleton RA, Lasater TM, Assaf AR, Feldman HA, McKinlay S, and the Pawtucket Heart Health Program Writing Group. The Pawtucket Heart Health Program: community changes in cardiovascular risk factors and projected disease risk. Amv+can ]ourm/ of Public Htwlth 1995;85(6):777-85. Centers for Disease Control. State coalitions for pre- vention and control of tobacco use. Morbidity nd Mor- tdity Weekly RqJorf 1990;39(28):476-84. Centers for Disease Control and Prevention. Changes in the cigarette brand preferences of adolescent smokers- United States, 1989-1993. Morbidity ard Mortnlity Weekly Report 1994; 43(32):577-81. Centers for Disease Control and Prevention. Cigarette smoking before and after an excise tax increase and an antismoking campaign-Massachusetts, 1990-1996. Morbidity nut1 Mar-fnlify Weekly Report 1996;45(44): 966-70. Centers for Disease Control and Prevention. Tobacco tax initiativre-Oregon, 1996. Morbidity ad Mortality h'wkly Report 1997;46(11):246-8. Centers for Disease Control and Prevention. 7998 Pvo- SYI~/!~ RricfirIS Rook. Atlanta: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1998. Centers for Disease Control and Prevention. Best PI.~c- tim ftw Colllp,,t~/It~rfsii~t~ Tth~co Corztm-ol Progmzs-August 2999. Atlanta: Centers for Disease Control and Preven- tion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1999a. Centers for Disease Control and Prevention. Decline in cigarette consumption following implementation of a comprehensive tobacco prevention and education program-Oregon, 1996-1998. Morbidity md Mortal- ity Wefkly Report 1999b;48(7):140-3. Centers for Disease Control and Prevention. Tobacco use among middle and high school students-Florida, 1998 and 1999. Morbidity nr~ll Mortnlify Weekly Report 1999c;48(12):248-53. Chaloupka FJ, Grossman M. Price, tobacco corlfrol /JO/~- tics 01111 youfh making. Working paper no. 5740. Cam- bridge (MA): National Bureau of Economic Research, 1996. COMMIT Research Group. Community Intervention Trial for Smoking Cessation (COMMIT): summary of design and intervention. ]ozir1rfl/ CJf tl?e Notioml Carzcer Iustitutc 1991;83(22):1620-8. COMMIT Research Group. Community Intervention Trial for Smoking Cessation (COMMIT): I. Cohort re- sults from a four-year community intervention. Amrri- c11n Juurnal of Public Henlfh 1995a;85(2):183-92. COMMIT Research Group. Community Intervention Trial for Smoking Cessation (COMMIT): Il. Changes in adult cigarette smoking prevalence. Amkcnr~ \our- tm2 of Public Health 1995b;85(2):193-200. Connolly GN, Harris JE. Evaluating antismoking ad- vertising campaigns [letter]. jourrznl qf the Amricarz Medical Associatiotz 1998;280(11):964-5. Crawford M, Headen S, Luke D, McGloin T. Latest re- search: youth and teens. Presented at the National Conference on Tobacco and Health; Ott 26-28, 1998; St. Paul (MN). Cummings KM, Clarke H. The Use of Counter-Advertisiizg as II Tobacco USC Dctrrrel~t md Annlysis of Pem'ir~g Federal Tobacco Legislation. Policy Analysis No. 8. Washington: Advocacy Institute, Health Science Analysis Project, 1998. DiFranza JR, McAfee T. The Tobacco Institute: help- ing youth say "yes" to tobacco. ]mrrm/ of Fnnzily Pmc- fice 1992;34(6):694-6. DiFranza JR, Richards JW, Paulman PM, Wolf-Gillespie N, Fletcher C, Jaffe RD, Murray D. RJR Nabisco's car- toon camel promotes Camel cigarettes to children. ~oI[,,~ llal of the Americalz Mrdicnl Associntiorl 1991;266(22): 3149-53. Downie RS, Tannahill C, Tannahill A. Hcflltll Pronto- tion: Models a& Vnl~rcs. 2nd ed. Oxford: Oxford Uni- versity Press, 1996. Dwyer T, Pierce JI', Hannam CD, Burke N. Evaluation of the Sydney "Quit. For Life" anti-smoking campaign. Part 2: changes in smoking prevalence. Mcnicnl ]our- tzal of Austmlia 1986;144(7):344-7. Egger G, Fitzgerald W, Frape G, Monaem A, Rubinstein I', Tyler C, McKay B. Results of large scale media anti- smoking campaign in Australia: North Coast "Quit for Life" programme. British Mrdic171 ]ourml 1983;287 (6399):11254X Elder JP, McGraw SA, Rodrigues A, Lasater TM, Ferreira A, Kendall L, Peterson G, Carleton RA. Evalu- ation of two community-wide smoking cessation ~011. tests. Preuentiue Medicine 1987;16(2):221-34. Elder JP, Schmid TL, Dower I', Hedlund S. Commu- nity heart health programs: components, rationale, and strategies for effective interventions. Iollrrzal of Pub/ii Henltl7 Policy 1993;14(4):463-79. Eriksen MP. Social forces and tobacco in society. Pa- per presented at the Robert Wood Johnson Founda- tion Conference, New Partnerships and Paradigms for Tobacco Prevention Research; May 6-9, 1997; Sundance (UT). Farquhar JW. The community-based model of life style intervention trials. Anrerican [our& of Epidemiology 1978;108(2):103-11. Farquhar JW, Fortmann SP, Flora JA, Taylor B, Haskell WL, Williams PT, Maccoby N, Wood PD. Effects of communitywide education on cardiovascular disease risk factors: the Stanford Five-City Project. Journal of the Auwicarl Medical Associatiun 1990;264(3):359-65. Farquhar JW, Fortmann SI', Maccoby N, Haskell WL, Williams PT, Flora JA, Taylor CB, Brown BW Jr, Solomon DS, Hulley SB. The Stanford Five-City Project: design and methods. America/l ]ourml of Epidemiology 1985;122(2):323-34. Farquhar JW, Maccoby N, Wood I'D, Alexander JK, Breitrose H, Brown BW Jr, Haskell WL, McAlister AL, Meyer AJ, Nash JD, Stern MI? Community education for cardiovascular health. Lnrmt 1977;1(8023):1192-5. Farquhar JW, Magnus PF, Maccoby N. The role of pub- lic information and education in cigarette smoking controls. Candiiztr ]our/m/ of Public Hrnlfh 1981;72(6): 412-20. Fcdcrnl Register. US Department of Health and Human Services, Food and Drug Administration. Regulations restricting the sale and distribution of cigarettes and smokeless tobacco to protect children and adolescents (21 CFR Parts 801,803,804,807,820, and 897), 61 Fed. Reg. 44396 (1996). Fidanza F, Puddu V, Imbimbo AB, Menotti A, Keys A. Coronary heart disease in seven countries. VII. Five- year experience in rural Italy. CircuIntioH 1970;41 (4 Suppl): 163-175. Reduciirg Tobmco Use Fisher EB Jr. The results of the COMMIT trial [edito- rial]. Amt>ricnn Iorrrr~nl of Public Hrnlt11 1995;85(2): 159-60. Fisher EB, Auslander WF, Munro JF, Arfken CL, Brownson RC, Owens NW. Neighbors for a Smoke Free North Side: evaluation of a community organization approach to promoting smoking cessation among Af- rican Americans. Am~ricn~7 ]ourrml ofPublic Hcwlfh 1998; 88(11):1658-63. Florida Department of Health. 2000 Florida Youth To- bacco Survey results. f`loridn l'oi/th TP/JL~L.~-o S177wy 2000;3(1). Flynn BS, Worden JK, Seeker-Walker RH, Pirie PL, Badger GJ, Carpenter JH. Long-term responses of higher and lower risk youths to smoking pre\.ention interventions. P~~`ilc~)7tiilc .Medicij~t, 1997;26(3):389-94. Fortmann SP, Tay!or CB, Flora JA, Jatulis DE. Changes in adult cigarette smoking prevralence after 5 vears of community health education: the Stanford Fivre-City Project. An7cvicc7~7 ]01rrr7nl of E~`ill~,~lfiol~,~!/ 1993;137(1): 82-96. Gail MH, Byar DP, Pechacek TF, Corle DK, for the COMMIT Study Group. Aspects of statistical design for the Community Intervention Trial for Smoking Cessation (COMMIT). Co17f~ol/~`d Clirlical Triclls 1992;13(1):6-21. German Cardiovascular Prevention Study Group. The German Cardiovascular Prevention Study (GCP): de- sign and methods. E~~vcI[J~~~ Henrf /OUYI~R~ 1988;9(10): 1058-66. Giovino GA, Schooley MW, Zhu B-P, Chrismon JH, Tomar SL, l'eddicord JP, Merritt RK, Husten CG, Eriksen Ml? Surveillance for selected tobacco-use behaviors-United States, 1900-1994. Morbidity 1717d Mortality Weekly Report 1994;43(SS-3):1-43. Glantz SA. Achieving a smokefree society [editorial]. Circulation 1987;76(4):746-52. Glantz, SA. Preventing tobacco use-the youth access trap [editorial]. A1~7~k717 ~mrrrznl of P~hlic Hrnlfl7 1996; 86(2):156-S. Glantz SA, Begay ME. Tobacco industry campaign con- tributions are affecting tobacco control policymaking in California. /onr)znl of tl7e ~4mericnr7 Medim Associu- tio~ 1994;272(15):1176-82. Glasgow RE, Cummings KM, Hyland A. Relationship of worksite smoking policy to changes in employee tobacco use: findings from COMMIT. Community In- tervention Trial for Smoking Cessation Tobacco Con- Irol 1997;6(2 Suppl):S44-8. Glasgow RE, Klesges RC, Mizes JS, Pechacek TF. Quit- ting smoking: strategies used and variables associated w,ith success in a stop-smoking contest. Journal of Corr- sulfir7; accessed June 6,200O. Green LW, Kreuter MW. Hcnlflz Prmuotior~ Pln,717ing: At7 Eil7rcatioml nrrd Ewiuorzn7entrrl A~~Jvo~I. 2nd ed. Moun- tain View (CA): Mayfield Publishing Company, 1991. Green LW, Richard L. The need to combine health edu- cation and health promotion: the case of cardiovascu- lar disease prevention. P~on7otion 1717d Educatiofz Dee 1993:11-7. Group Against Smokers' Pollution. Norr-Smokers' Bill of Rights. College Park (MD): Group Against Smokers' Pollution, n.d. Gutzwiller F, Nater B, Martin J. Community-based primary prevention of cardiovascular disease in Swit- zerland: methods and results of the National Research Program (NRP 1A). Prc~~nfizlc Medicirlr 1985;14(4): 482-91. Hamilton JL. The demand for cigarettes: advertising, the health scare, and the cigarette advertising ban. RcTijil,itl c)f Ecor7mrii.s (711d Statistics 1972;54(4):401-11. Hcnlfh I'r'olrloticirr I,ltc~rrrnric~,lnl. The Jakarta Declaration on leading health promotion into the 21st century. Hen/t/r ~I-O~JlOfiOl7 ~/~frr~u?tiot~a~ 1997;12(4):261-4. Heller K. The slow burn: cigarettes, cancer and blacks. T/zr PI7iladclpl~ia Irlquiwr Mngxir~c, May 20, 1990:14, 1% 20, 30, 32-34, 36. Hoffmeister H, Mensink GBM, Stolzenberg H, Hoeltz J, Kreuter H, Laaser U, Nussel E, Hullemann K-D, v. Troschke J. Reduction of coronary heart disease risk factors in the German Cardiovascular Prevention Study. PrCr?CjrfiDc Medicirlc 1996;25(2):135-45. Hu T-w, Sung HY, Keeler TE. Reducing cigarette consumption in California: tobacco taxes vs an anti- smoking media campaign. Amrricar~ ]our1m1 (!f Public- HcDI~Jz 1995;85(9):1218-22. Independent Evaluation Consortium. Firm/ Report OIL the I~zdepfvd~~7t Emluatiorl of f/w Califorr2in 7rh7cro Cofl- trol Prezwrfiorr and Edw~fiorr Prqram: W17w I D0fa, 1996- 1997. Rockville (MD): The Gallup Organization, 1998. Institute of Medicine. Sfnfc Plnp~rm Cn11 Rdli; accessed June 6,200O. Thompson B, Corbett K, Bracht N, Pechacek T. Com- munity mobilization for smoking cessation: lessons learned from COMMIT. Hcnlth Prow&w Iflternnfiorzal 1993;8(2):69-83. Tobacco Education and Research Oversight Commit- tee. Tosum a Tobacco-Free California: Mastering the Chal- Iclzges, 199_5-1997. Sacramento (CA): Tobacco Education and Research Oversight Committee, 1995. Tobacco Education Oversight Committee. Toward II Tnbncco-Fwc Cnliforrlia: A Master Plafz to Red~cr Calif~r- rlirrrls' U.$r @ %b~cm. Sacramento (CA): Tobacco Edu- cation Oversight Committee, 1991.