The 1998 Master Settlement Agreement: a public health opportunity realized--or lost?

On November 23, 1998, a legal settlement of historic proportions took place. The five major U.S. tobacco manufacturers signed an agreement with 46 states, the District of Columbia, and five U.S. territories to settle pending lawsuits by compensating the states for Medicaid costs of treating smoking-related illness. This multistate Master Settlement Agreement (MSA) seemed to herald a new era in public health as it provided a potential source of funds for state-based tobacco-control programs (estimated at U.S.$206 billion for the first 25 years) and also banned an array of advertising and marketing efforts to attract young people to tobacco. Five years after the settlement, however, it appears that most states have not committed a significant portion of the funds for tobacco prevention efforts but rather have used the money to support other state needs. Moreover, tobacco companies have continued aggressive marketing efforts to reach youth.

An analysis of tobacco industry marketing to lesbian, gay, bisexual, and transgender (LGBT) populations: strategies for mainstream tobacco control and prevention.

Research on adult tobacco use consistently shows a higher prevalence among lesbian/gay/bisexual/transgender (LGBT) populations than among the general population-reasons why are largely unknown, and counterstrategies are critical. Tobacco industry marketing, uncovered when the Master Settlement Agreement (MSA) forced companies to share its internal documents, provided insight. The American Legacy Foundation uncovered the industry campaign Project SCUM (Sub-Culture Urban Marketing) aimed at gays and the homeless. The formerly secret documents revealed specific marketing toward LGBT, whose rates increased when the MSA banned youth (but not other population) advertising. The industry reaches out to LGBT persons through direct and indirect advertising, community outreach, and sponsorships. Messages to LGBT have been relatively absent from advertising until recently, creating receptivity to such overtures. Reducing LGBT smoking rates is a public health challenge that will require exceeding the sense of validation tobacco advertising has created in LGBT communities.

Building capacity for success: the Tobacco Technical Assistance Consortium.

The Master Settlement Agreement with the tobacco industry has infused resources into tobacco control and prevention, which has helped fund tobacco control programs at the national, state, and local levels. Many tobacco control programs face challenges in areas such as strategic planning, fiscal operations, advocacy, and personnel management. To provide technical assistance to these programs, the Robert Wood Johnson Foundation, the American Legacy Foundation, and the American Cancer Society combined resources to fund the Tobacco Technical Assistance Consortium (TTAC). TTAG, housed at the Rollins School of Public Health at Emory University, provides support for tobacco control programs and matches requests for technical assistance with consultants who have the appropriate expertise. TTAC is a valuable addition to tobacco control and prevention resources and is a viable component within a school of public health.