Abstract:
Throughout the 1990s, public health authorities in Massachusetts waged among the most prominent, and by many measures, most effective, campaigns in the US against the use of tobacco. Fueled by funds authorized by voter approval of an increase in the state tax on cigarettes in 1992, the Massachusetts Tobacco Control Program (MTCP) combined high-profile television messages with education programs in schools and workplaces. Its results were widely viewed as impressive. Seven years after its start in 1993, cigarette sales in the state had dropped by one third--more than twice the national average. Federal public health officials went on record characterizing the MTCP as a model worth following nationwide. The prominence of the program provided no guarantee that it would continue from one year to the next. Public health officials faced an annual struggle to convince state legislators to appropriate funds for the program. In addition to their record of results, health officials had, on their side, the support of a network of citizen anti-tobacco groups.
Learning Objective:
The case describes how health officials and tobacco control advocates gradually honed a legislative strategy which held budget appropriations steady, despite constant pressure for reductions from legislators unfamiliar or uneasy with the program's approach, from tobacco industry lobbying against it and, perhaps most significantly, from others competing for state funds.
