How Good a Deal Was the Tobacco Settlement?: Assessing Payments to Massachusetts

We estimate the increment in Massachusetts Medicaid program costs attributable to smoking from December 20, 1991 to 1998. We describe how our methods improve upon earlier estimates of analogous costs at the national level. Current costs to the Massachusetts Medicaid program approximate the payments to Massachusetts under the tobacco settlement of November 1998. Whether these payments are viewed as appropriate compensation for Medicaid costs over time depends upon the rate of increase in future health care costs, the rate of decline in smoking, the proportion of smoking that should be attributed to the actions of the tobacco companies and the likelihood the state would have prevailed at trial. The costs to the Medicaid program are dwarfed by the internal costs to smokers themselves.     

Nicotine Addiction: Implications for Public Health Policy

Although the morbidity and mortality caused by cigarette smoking occur in adulthood, the initiation of tobacco use and the development of nicotine addiction typically occur during adolescence. The purpose of this paper is to examine the determinants of nicotine addiction, focusing on the development of addiction in youth, and to explore implications for public health policy. An understanding of the pharmacological and nonpharmacological factors that determine the course of nicotine addiction is critical in developing rational policies regarding tobacco products. The Food and Drug Administration's rule to regulate cigarettes and smokeless tobacco products is discussed. The fact that smokers typically make the transition from casual use to nicotine addiction during adolescence argues for developing and implementing effective prevention efforts and smoking cessation treatment programs that are youth-oriented.     

"We mentally ill smoke a lot": identity, smoking, and mental illness in America

Most of the history of the tobacco industry over the last few decades has focused on the conflicts between tobacco industry leaders who promoted smoking and tobacco control advocates who warned of the health consequences. Yet a view of this conflict from the perspective of smokers who are also mentally ill raises questions about how to frame public health policy for these individuals. Mentally ill consumers wrote to the tobacco industry between the 1970s and 1990s and expressed their commitment to smoking and to cigarette companies, despite their awareness of the health risks. This paper explores the relationship between mentally ill consumers, the tobacco industry, and public health in the United States through letters written by mentally ill smokers.     

Historical Overview of Tobacco Legislation and Regulation

In this paper we describe the legislative and regulatory history of tobacco control efforts and discuss ways in which the debate over tobacco control has been framed. From a regulatory perspective, primary concern is how to balance the individual's legal use of tobacco products with society's obligation to limit the use of a lethal product. Our review demonstrates the progress tobacco control advocates have made in enacting statewide legislation and local ordinances, especially during the past fifteen years, to restrict both smoking in public places and youth access to tobacco products. Nevertheless, this progress may be threatened by a powerful and determined tobacco industry. We discuss various strategies for determining how and where to allocate tobacco control resources.     

Taxation and anti-smoking campaigns: Complementary policies in tobacco control

We examine the optimal design of policies directed at regulating tobacco consumption through two types of instruments: taxation and anti-smoking mass media campaigns. We find that the main role of taxation is to correct for the population-average internal costs of smoking, while anti-smoking campaigns serve a complementary role. Namely, they add to the social welfare benefits of tobacco regulation as they are relatively more effective than taxation at discouraging smoking by individuals characterized by low degrees of self-control and high smoke-related health     

Public opinion on bilingual education in Colorado and Massachusetts

In 2002, voters in Massachusetts and Colorado faced identical ballot initiatives to remove bilingual education programs from the public schools. The measure passed in Massachusetts and failed in Colorado. This paper investigates the debates over the issue in these two states. It provides insight into how people reason with respect to minority politics. It also helps to make sense of the states’ divergent outcomes. Content analysis of letters-to-the-editor reveals that voters are motivated by ethnic competition and fiscal concerns, as existing theories would predict. Additionally, citizens debate which kinds of programs work best for English learners and take stands on how these youngsters can be successful in life. The inter-state comparison reveals that a major factor distinguishing the two statewide debates was ethnic paternalism, a logic often used by members of ethnic majorities to justify restrictive policy decisions on the basis of what they think is best for the affected population. The analysis shows that themes related to doing what is best for English learners were significantly more salient in Massachusetts than Colorado. This finding implies that where public debate over this issue is framed in terms of helping minority youth, the fate of bilingual education is not secure.     

Mindfulness and Interpersonal Communication

Many social problems can be traced to interpersonal communicationdifficulties, just as many proposed interventions to solve social ills also depend on effective interpersonal communication. This article examines three potential relationships between states of mind and social interaction followed by illustrations from research related to five exemplar social issues—developing effective programs for solving workplace communicationproblems, training the public to detect scams and hoaxes, reducing stereotyping and cross-cultural misunderstanding, managing interpersonal conflict, and constructing effective public health campaigns. We conclude by considering the likely inhibiting and facilitating effects of mindfulness-mindlessness on socially relevant transactions.     

Hacks, Flacks, and Counter-Attacks: Cigarette Advertising, Sponsored Research, andControversies

The tobacco industry promotes friendly "experts" and uses public relations tactics to produce uncertainty around research results that threaten it. This inhibits public policies responsive to these research findings. These tactics, long used against medical science, are now being used to counter the studies challenging to the myth that cigarette advertising is of no import. The numerous weaknesses of the industry-advanced argument are discussed, drawing particularly on the literature of consumer behavior, marketing, and advertising. The vast preponderance of evidence indicates that cigarette advertising plays a meaningful role in influencing the perceptions, attitudes, and smoking behavior of youth. Denials of these effects, without brand new and compelling evidence, are highly suspect.     

Social Construction and Policy Implementation: Inmate Health as a Public Health Issue*

Objectives. This article develops and tests a concise multi‐stage approach for assessing the impact of social construction on the implementation of public programs designed to benefit negatively constructed groups. The framework suggests that negative constructions lead to policy choices that create problems in the implementation process. These problems prevent the accomplishment of key subobjectives necessary for ultimate program success. Methods. We test the utility of the framework in an analysis of a key public health issue—the spread of HIV/AIDS and tuberculosis in prisons. Despite great strides in the treatment and prevention of these diseases outside prison walls, the incidence and severity of both in the incarcerated population has increased dramatically over the last five years. We hypothesize that the problem of inadequate funding, arising from the negative social construction of this unique target population, is to blame. Results. In an analysis of 50 state correctional systems, we find that states with the most negative constructions of criminals and potential criminals spend dramatically less on inmate health, relative to other states. Conclusions. Our analysis suggests that inadequate funding levels in states with negative constructions of criminals and potential criminals jeopardizes the implementation of prison programs targeted at the prevention and treatment of HIV/AIDS and tuberculosis.     

Assessing Statewide Need for Older Adult Health Promotion Services: The Oklahoma Experience

ABSTRACT

The growing senior population and persistent poor health status of seniors in Oklahoma compels a fresh look at what health promotion services would be well received. Surveys were distributed to a list of registered voters aged 65 and older in Oklahoma with a total of 1,248 surveys returned (19.8%). Survey items asked about interests in services, classes, and activities, plus current barriers to accessing and/or engaging in such programs. To account for survey weighting, Rao-Scott Chi-Square Tests were performed to determine differences by demographic characteristics. We identified services, classes, and activities that were (and were not) of interest to seniors in Oklahoma with legal assistance (52.1%), exercise classes (46.6%), internet classes (40.7%), and indoor exercise activities (45.5%) receiving the highest level of interest. Barriers to interest in participating in programs included not wanting to go and not knowing availability of such services. The results of this survey provide useful data on health promotion gaps for seniors, interests and barriers to engaging in such activities, and guidance for statewide program development. Future program development needs to be focused on areas of interest for older adults, including legal assistance, exercise classes, and internet classes.     

Judicial Approaches to Tobacco Control: The third Wave of Tobacco Litigation as aTobacco Control Mechanism

Tobacco products liability litigation is one of the most potentially effective means of controlling the sale and use of tobacco. Recent factual developments—concerning (1) the addictiveness of nicotine, (2) tobacco industry knowledge of this addictiveness, and (3) the industry's efforts to conceal its knowledge from the public while making its products more addictive—make it unlikely that the tactics used successfully by the tobacco industry in the first (1954 to 1973) and second (1983 to 1992) waves of tobacco litigation will succeed in the third wave of tobacco litigation. Victory in any of these cases would result in a transfer of costs from injured states or individuals to the tobacco industry. Such a transfer of costs would likely have the immediate impact of raising cigarette prices and thereby lowering cigarette consumption. The long-term effects of a victory would probably be much more devastating to the industry.     

A New National Health Agenda: Providing the Public With Accurate Information

For decades the recommendations provided by federal agencies have been decidedly one-sided, focusing on the dangers of obesity and need for weight loss. Therefore the public has been presented with incomplete and inaccurate information, which has stagnated our understanding of health. The primary objective needed for a new national health agenda is for the government to provide the public with complete and accurate information about health, weight, and dieting. In order for federal agencies and congress to promote a new national health agenda that reflects a more accurate understanding of the research, the author recommends the following policy changes: (1) the recognition of the health threat imposed by the thinness pursuit and eating disorders, (2) the promotion of weight stability rather than weight loss, (3) ensuring that the conclusions of federal agencies are neutral rather than serving special interest groups, (4) the protection of the consumer from harmful diet programs and drugs, and (5) the providing of public education campaigns emphasizing physical and psychological health rather than efforts for advancing such a national health-centered agenda.     

Tobacco Farming and Public Health: Attitudes of the General Public and Farmers

The tobacco industry remains a formidable influence in thwarting tobacco control efforts, in part because industry leaders have raised policymaker and public concern about how tobacco control might negatively impact tobacco farmers. In this study, we interviewed a random, stratified sample of 528 tobacco farmers in the Southeast and 991 U.S. residents about issues related to tobacco farmers. We found that a majority of the U.S. public expressed the belief that U.S. taxpayers subsidized tobacco farmers. This belief, combined with the strong opposition to tobacco farmer subsidies (15 percent thought there should be subsidies), likely play a role in public attitudes toward tobacco farmers. At the same time, however, we found reasonably strong public support for efforts to help tobacco farmers transition to new enterprises, although the public underestimates tobacco farmer interest in diversification. For example, two of three Americans believe that the government should help farmers make a living other than growing tobacco and over half thought that taxpayers should help pay for such programs. These data illustrate potential common ground for elected officials to consider as they attempt to concomitantly address the needs of farmers and the interests of the public. Ultimately, if the interests of tobacco farmers can be made clearly to the general public, and vice versa, pro-health and pro-farmer policies might well become a reality     

PUBLIC WEALTH,PUBLIC HEALTH,AND PRIVATE STEALTH: EXAMINING THE BLACK MARKET IN CIGARETTES IN AUSTRALIA

Taxes on tobacco provide a significant income for the Australian government — $5.1 billion in 2001. At the same time, health officials are making strenuous efforts to reduce smoking, particularly among teenagers. Some economists suggest that raising taxes on tobacco will produce more revenue while at the same time lowering smoking rates, particularly among youths who have less discretionary spending power than adults. But a by‐product of excise tax in Australia has been the emerging market in “chop‐chop,” tobacco diverted from legal channels by growers who receive considerably higher prices for a part of their yield than they can obtain from legal manufacturers. The article details this situation and suggests that only bold solutions may be able to reduce tensions in tax policies, smoking rates and the “chop‐chop” black market.     

What is the (Net) Cost to Government of Homelessness Programs?

Homelessness programs may improve the health, well‐being, financial security, labour market and housing outcomes of clients. This, in turn, may result in decreased utilisation of health and justice services, reduced child residential care costs, lower housing management costs, lower income support payments and higher revenue from increased income tax payments. When costed, such impacts represent whole‐of‐government savings or cost offsets to the provision of homelessness programs. This paper provides indicative estimates of the value of potential savings or cost offsets in two areas, namely, the health and justice fields from homelessness program interventions. Our key finding is that homelessness programs have the potential to save over twice the value of the capital and recurrent funding of homelessness programs on the basis of health and justice cost offsets alone.     

Gender in/and/of Health Inequalities

The relationship between gender and health inequalities is potentially complicated, raising questions for health and social research, practice and policy. In this paper, I use two population health case studies – obesity and smoking – to explore the interplay between gender and socioeconomic position. The cases show that, on its own, neither dimension of inequality affords a comprehensive picture of these significant risks to public health. Furthermore, historical change in the socioeconomic and gendered distribution of these health risks suggests that gender is best considered as a dynamic and layered form of differentiation, rather than as a simple or stable dichotomy. A more nuanced approach to the analysis of gender and health has the potential to generate both more fruitful research and more effective health and social policy.     

A stress process model of family caregiver service utilization: factors associated with respite and counseling service use

This study examines whether caregivers' differential utilization of respite and counseling support services is associated with different situational stress processes. A multinomial regression analysis was conducted to compare respite users, counseling users, and those who used neither service, using data collected on a statewide random sample of 1,643 California caregivers providing assistance to individuals aged 50 or older. Compared with caregivers who used neither service, respite service users were more likely to have demanding care situations giving rise to physical symptoms of stress, and were more likely to use community services for the care recipient to augment their care. In contrast, counseling service users were more likely to be managing the meaning of their care situation by seeking out information about services and talking with a confidant about their situation, while coping with both emotional and physical symptoms of stress. Tailoring caregiver interventions to meet the support needs and coping strategies stemming from diverse caregiving situations and caregiver characteristics may increase the likelihood that those interventions will be effective in alleviating or preventing deleterious secondary stress frequently experienced by family caregivers.     

Men's Domestic Violence Treatment Groups

A survey of all 13 men's domestic violence treatment groups in North Carolina found that such programs were similar in program philosophy and goals but highly divergent in group struc- ture. All programs utilized a feminist orientation which viewed domestic violence as resulting from socio-cultural and social learn- ing factors. Groups generally focused on the development of anger control, problem solving, and communication skills. Groups dif- fered widely in their agency affiliation, relationship with the court as referral source, degree of structure, leadership patterns, number of members, number of sessions, degree of co-ordination between men's and women's programs; follow-up procedures; and sophisti- cation of program evaluation. The diversity of men's domestic violence group treatment models is a result of grassroots laissez faire program development. This diversity offers opportunities to test the effectiveness of various group approaches. Considerations for men's domestic violence treatment programs are outlined. In addition, the need for systematic program evaluation and a statewide co-ordinating mechanism is dis- cussed.     

Improved Risk Information,the Demand for Cigarettes,and Anti-Tobacco Policy

This paper purports to develop a simple microeconomic model designed to shed light on behavioral change induced by improved information about smoking risks. It predicts the conditions in which improved information indeed increases the demand for cigarettes. After recalling the economic rationale of an anti-tobacco policy, the article points out a few startling implications of improved information about the risks of smoking.     

Expectancies and Mental Models as Determinants of Adolescents' Smoking Decisions

Cigarette smoking has been identified as the single most preventable source of mortality and morbidity in the United States. Experimentation with tobacco typically begins in adolescence, and smoking during this period is one of the strongest and most consistent predictors of adult smoking status. In the present paper, we review several prominent decision models that have been applied to adolescent smoking, and point out important limitations of these models. We then propose a new process-oriented framework of decision-making based on the concept of mental models, and discuss the implications of this framework for developing effective smoking prevention and cessation interventions for adolescents.