Tobacco use is responsible for 35% of cancer deaths, from cancers of the lung, oral cavity, larynx, esophagus, bladder, stomach, pancreas, kidney, uterus, cervix, and liver. Lung cancer is the leading cause of cancer death-- killing 160,000 Americans every year -- and tobacco is responsible for 90% of these deaths. While on one hand, health professionals have advocated policies designed to reduce tobacco consumption, through increased taxation, nonsmokers' rights, tobacco education, and restrictions on tobacco advertising and promotion, the tobacco industry advocates policies designed to facilitate and protect the manufacture, promotion, sale, and use of tobacco. We propose to continue our study the activities of the tobacco industry and tobacco control advocates at the state and local level through four related specific aims: (1) Prepare detailed histories of the evolving implementation of state tobacco tax initiatives (California Proposition 99, Massachusetts Question 1, and Arizona Proposition 200), including monitoring of tobacco industry activity to counter public health programs and the efforts of public health advocates to defend and implement successful tobacco control programs. (2) Prepare four in-depth case studies (one per year) of tobacco industry and health community activities relating to local or state tobacco control. (3) Continue to document the role of the tobacco industry in the creation and further development of the smokers' rights movement, including its social and ideological message, and the effects of this strategy on tobacco control activities by public health officials, and how the public health community can deal with the tobacco industry's efforts to prevent implementation of effective tobacco control programs. (4) Investigate the philosophical, organizational, and political impediments of schools as sites to deliver tobacco control messages including the activities of the tobacco industry to influence school-based tobacco control programs, and how schools relate to other community-based tobacco control efforts, particularly in states with major tobacco control initiatives. These goals will be achieved through a series of case studies and comparative analysis of the activities of tobacco control professionals and the tobacco industry at the state and local level around the United States. The results will assist health professionals in developing and implementing policies to reduce tobacco use and the attendant burden of cancer and other tobacco-induced diseases.
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