WASHINGTONFew were aware of the American Legacy Foundation
until last February when it televised and then temporarily pulled two
antitobacco advertisements, one of which showed body bags being
stacked outside the headquarters of Philip Morris.
Legacy was created as an educational and research organization by the
Master Settlement Agreement (MSA), which ended lawsuits against the
tobacco industry by 46 states and 5 US territories. The
foundations charges include a nationwide sustained
advertising and education program to discourage the use of
tobacco products by the young.
Legacy temporarily withdrew its gritty TV ads after complaints by
tobacco companies that they violated an MSA clause that bars any
vilification of the industry by the foundation. The TV
spots were restored in April, and Legacy president Cheryl Healton,
DrPH, vows the foundation will aggressively pursue its mission
to reach teens with empowering messages.
Dr. Healton joined Legacy last December from Columbia University,
where she served as head of the Division of Sociomedical sciences and
associate dean for program development at the School of Public
Health. In this interview, Dr. Healton discusses the foundations
antitobacco efforts with ONI Washington Bureau Chief Patrick Young.
ONI: Can you effectively reach teens without having to repeatedly
battle the tobacco industry over the vilification clause?
Dr. Healton: The evidence is mounting that one must empower
young people as wary consumers in order to have an effective
antitobacco campaign for youth. It is much less important with
adults, where the goal is cessation. With kids, the goal is to ensure
they never start the habit, and because they are a continuing target
of the industry, you really do have to lay out the facts for them.
We try to do it in humorous ways and in ways that will capture their
imagination, but our goal is not to vilify the industry. Our goal is
to run an effective antitobacco campaign, which is what the MSA
specifically says we must run. There have now been four studies, all
of which conclude that one of the pillars of an effective campaign is
awareness of the tobacco industrys tactics.
ONI: You have said the foundations ads have an edge. Why is
that necessary with teenagers?
Dr. Healton: Teenagers like to take control of their lives,
and they have varying levels of responses to authority figures. But
clearly, a campaign that puts them in the drivers seat is more
likely to get a buy-in with them than one that has a hierarchical,
authoritarian, topdown message, such as Dont
The edge helps break through the noise and gets the message out to
kids. I wouldnt be honest if I didnt say that currently
funded antitobacco campaigns actually have many of the features of a
campaign that is destined to fail. That is not what we want. We want
to reduce youth tobacco use. We believe we can do it within a
language in which they live.
ONI: Will this same edge be carried over into the foundations
classroom education programs?
Dr. Healton: The classroom education programs are just now
getting their first attention by the foundation. We are a relatively
new organization, and we are talking to a range of organizations,
many of them corporate entities that have an interest in educational
materials for young people.
I doubt that these materials will have exactly the same edge, since
many of those efforts are going to focus on younger kids. We are not
particularly focusing our ad campaign on in-school students, but on
kids at risk of smoking, many of whom actually are not all that
engaged in school, including the 15- to 18-year-olds who have dropped out.
ONI: What role are teens playing in the foundations activities?
Dr. Healton: Teens have played a role in almost every aspect
of the campaign, and in many ways, they are leading it. We brought
about 100 teens together last September, two from every state, to
kick things off, brainstorm ideas, and talk to advertising
The teenagers later met as a joint committee through conference calls
and in person sometimes, as well as through email and faxing, to give
feedback and ideas on story boards, on concepts for advertisements,
on how to shape the website, etc.
In June, we had a National Youth Summit with 1,000 teens present to
train, network, and brainstorm further in order to move the campaign forward.
ONI: Are states asking the foundation to help fund their
antismoking efforts rather than using their own settlement money?
Dr. Healton: All of our grant programs for states require a
match from the state. If a state is not willing to put any money in,
then it wont receive Legacy Foundation funding.
We have been very proactive in communicating to the states that the
foundation is not a replacement for state-based tobacco activities.
When the existence of the foundation is evoked as a reason not to do
something on a state level, that is really just a subterfuge.
ONI: How does your charge to track and monitor youth smoking and
substance abuse differ from the HHS Household Survey and other
Dr. Healton: Our survey goes from 6th to 12th grade, and every state
that applies for our grant has to do the survey on a statewide level.
So our survey will have data that will be reliable both as a
national, overarching indicator for youth tobacco use and on the
It will be the first time that we will be able to take the country as
a model and say, These 10 states had X policy and their youth
smoking rates are X, and these 10 states had Y policies and their
smoking rates are Y.
ONI: Your charter includes an assignment to select an educational
or medical institution as an affiliate. Have you chosen one?
Dr. Healton: My guess is that we will have formal linkages
with multiple universities. Before I came here, a letter went out to
approximately 30 to 40 academic medical centers and universities
asking them to write about how they might be helpful to the
Since my arrival, I have revisited all of the responses, and we
currently have discussions going on with four or five academic health
sciences centersin some cases, a medical school, in other
cases, a school of public health.
ONI: What will be the medical affiliates role?
Dr. Healton: One of the requirements of the MSA is that the
foundation develop a systematic program of evaluation and research.
That mandate is very broad and presently funded at the level of about
$25 million. We have a standing contract with an excellent research
consortium, headquartered in Research Triangle Park, NC. We also will
have periodic special evaluations of demonstration projects that the
foundation undertakes, and we have many other ad hoc research needs.
For example, the foundation has made a major commitment to understand
the needs of special populations with regard to tobacco. Only limited
work has been done in particular populationsNative Americans,
Hispanics, and African Americans. We will seek to form an affiliation
with some institution that has a high concentration of minority
faculty and a strong track record in conducting research in minority
ONI: Do you have any plans to work with oncology groups?
Dr. Healton: Probably we will end up doing that. There is one
goal that is not an official goal of the foundation, but about which
there is much discussion, and that is the issue of differential
access to cancer- and cardiovascular-related screening and
intervention to interdict tobacco-related illness. The foundation
might want to work aggressively with other groups to move this gap in
access up the policy agenda.
ONI: What do you hope will be your legacy as Legacy president ?
Dr. Healton: I would like the foundation to have been
effective with regard to its goals. I would certainly want to have
created a range of programs that do not duplicate other antitobacco
activities that are already taking place. For the first time, this
country has a foundation solely dedicated to addressing the issue of
tobacco use. It is my hope that we will find an appropriate place in
the American landscape.