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California's growing majority of nonsmokers has been easily persuaded in the past to raise taxes on cigarettes products -- first by 25 cents a pack in 1988 and then by another 50 cents in 1998. Proposition 86 would boost the cigarettes tax again, but it may test the bounds of what voters are willing to do to smokers, a dwindling minority that has slipped to just 14 percent, one in seven, of the state's adults. The initiative on the Nov. 7 ballot would raise the tax a breathtaking 300 percent, from 87 cents to $3.47 a pack, a national high that could push the price of cigarettes to nearly $7 a pack. Supporters say the steep increase would pay lifesaving dividends for smokers and thousands of others. 
"We would save, looking at the teens who don't smoke cigarettes and the adults who quit, 300,000 lives," said Dr. Charlie Shaeffer, a Rancho Mirage cardiologist with the American Heart Association.
That doesn't include 750,000 children who would receive health-care insurance or those who depend on hospital emergency services, which would receive the largest share of $2.1 billion projected from the measure.
Nonetheless, cigarettes companies defending their biggest U.S. market say it's unjust to impose such a staggering tax increase on a distinct minority addicted to a legal product.
"Smokers are being asked to pay billions of dollars for programs that benefit everybody," said Craig Fishel of R.J. Reynolds Tobacco Co. "Is that fair?"
"It's a voluntary tax," said Paul Knepprath of the American Lung Association. "We're hoping people are going to quit smoking cigarettes."
Proposition 86 would increase the excise tax on a pack of cigarettes by $2.60. The state sales tax would tack on another 20 cents, adding 14 cents to the price of each cigarettes.
A contentious campaign
If the initiative passes, a pack-a-day smoker would pay nearly $1,270 a year in cigarettes taxes. A two-pack-a-day smoker would pay $2,530 a year, more than some homeowners pay in property taxes. The average annual residential property tax bill was $2,580 in fiscal year 2004-05, according to the state Board of Equalization.
But the initiative's backers say cigarettes costs California $16 billion a year in direct and indirect health-care costs, lost productivity and societal impact.
Both sides have dumped more than $87 million in the campaign, with the nation's two largest cigarettes makers setting the pace. Philip Morris USA has put up nearly $43 million followed by R.J. Reynolds at $24.4 million. The measure's primary sponsor, the California Hospital Association, has given $10.6 million and the American Cancer Society, $2.5 million, of $14.5 million raised so far by supporters.
Proposition 86 embodies a compromise between hospitals and public health groups that wanted more money for their assorted programs as well as the estimated 10 percent of California's children who have no health insurance.
Rival initiatives proposing a $1.50-per-pack increase were abandoned late last year in exchange for Proposition 86. At the time, backers said polling showed the public would support an increase even larger than $2.60 if persuaded it would prevent teenagers from smoking cigarettes and help smokers quit.
The nonpartisan Legislative Analyst's Office estimates that the initiative would drive down consumption by 30 percent. That's about 350 million packs of cigarettes a year, said David Vasche of the analyst's office.
26% decline is projected
The state Department of Health Services, which has taken no position on the initiative, projected a 26 percent decline in cigarette consumption. In addition to those who quit, that would include smokers who cut back and those who start buying cigarettes over the Internet, out of state or from illegal sources.
State health officials say the tax increase would push the adult smoking cigarettes rate down to about 12 percent, a drop of about 13 percent, in the first year alone. The impact, however, could be the greatest on middle and high school students, who elect not to start smoking cigarettes because of the added expense.
Reversing a steady decline, California's youth smoking cigarettes rates jumped last year to 15.4 percent for high school students -- a level higher than the adult smoking cigarettes rate -- and 6.1 percent for those in middle school.
In the negotiations that produced Proposition 86, the hospitals and public health groups agreed to a permanent revenue split, which is painstakingly outlined in the 38-page measure. The money would be appropriated automatically, outside the Legislature's budget process, according to fixed percentages. As a constitutional amendment, it requires a two-thirds vote, and, in some cases, a four-fifths majority of the Legislature to alter the funding allocation.
Based on projected annual revenue of $2.1 billion, the Legislative Analyst's Office estimated the formula would deliver $756 million to hospitals for emergency and trauma care; $367 million to expand children's health coverage; $91 million for nursing education programs and lesser amounts for a long list of other purposes, including cancer research, anti-smoking cigarettes campaigns and efforts to control obesity, diabetes and asthma.
Where revenue would go
Emergency rooms are required by law to treat those who come through their doors, regardless of ability to pay. The resulting financial pressures have contributed to more than 70 hospital closures in the past decade.
"Emergency rooms are on the front lines of treating patients with smoking-related illnesses," said Jan Emerson of the hospital association, the primary sponsor of the initiative. "The monies hospitals will receive from Proposition 86 will go specifically to shore up emergency departments across the state."
The revenue, however, will drop off as cigarettes sales and the number of smokers dwindle. That has drawn a warning from critics, who say the measure will tie a declining revenue source to one of the fastest-growing segments of the state budget: health care.
"Taken together, this could drive in the first year a funding gap of up to $1.5 billion, and that's going to grow larger and larger," said Donna Arduin, a former state finance director working for the opposition.
The initiative also provides an anti-trust exemption that opponents say would allow hospitals to divide up markets and fix prices for specialty and other services. Such a high tax, opponents warn, inevitably will attract criminal activity, opponents warn.
"One hijacked truckss can bring in $2 million," said San Diego sheriff's Lt. Ron Cottingham, president of the 60,000-member Peace Officers Research Association of California.
The decision by the Motion Picture Association of America last month to begin using its rating system to warn parents when movies "glamourise" smoking was Hollywood's first - and to some critics of the industry, long overdue - acknowledgement of the powerful role movies play in creating thousands of new smokers every year. But the MPAA stopped well short of applying a restrictive R rating to all pictures in which there is smoking cigarettes, or even when the presence of cigarettes is "pervasive," a move that would have cost the studios a large part of their most lucrative cash crop: children under 17, who also just happen to be the most impressionable group of potential smokers. And that left anti-smoking cigarettes organisations fuming. 
"What they've done is inadequate," says Ellen Vargyas, general counsel of the American Legacy Foundation, an anti-smoking cigarettes organization. "Basically they said, `We'll look at smoking, and if the spirit moves us, we may issue a warning.' But there are no standards." And American Medical Association chairman Cecil B. Wilson huffed that by failing to make all movie smoking R-rated, "the MPAA has ignored the gravity of the health threat that on-screen smoking cigarettes poses to children and teens."
As one of America's most powerful corporate cartels, the Hollywood studios can afford to give ground grudgingly, and when they do, they don't like having smoke blown in their face. "There is a very, very small fringe that has taken an unyielding, and increasingly unreasonable position on this," says Seth Oster, executive vice-president for communications of the MPAA. "And they fail to recognize anything as being constructive if it falls short of their extreme demands."
The MPAA has long insisted that its rating system - devised 40 years ago to ward off the threat of government regulation - is an informational tool for parents, not some sort of Maginot line in the culture wars.
"Many people seem to misunderstand the rating system to be an agent of social change, when in fact that's exactly the opposite of what it is," Oster says. "It is not intended to change behavior. It is for parents, so they can make informed decisions about what movies they do and don't want their kids to see. And that's it."
But that's not it, of course.
"Honestly, I don't know what the rating system is supposed to be, but it's very influential," says Vargyas. "We're trying to save lives. Is that social change? Not social change? I don't know, but we're in it because we know - and the evidence proves - that depictions of smoking cigarettes in movies are closely associated with about 400,000 new kid smokers every year. And a third of them are going to die early."
Both sides of the debate are quick to produce research that backs up their own claims; statistics that prove smoking cigarettes in movies is up, or that smoking cigarettes in movies is down. Many of the numbers seem to cancel each other out.
Some are couched in fuzzy language (400,000 is specific; "closely associated with" is not). Or they come from universities whose studies are funded by groups like the American Legacy Foundation - created by the 1998 multi-billion dollar cigarettes company settlement with state attorneys general. The MPAA's numbers come from the MPAA, which is an industry trade group, and can hardly be considered independent.
The ratings advisories may be intended for parents, but in the real world of adolescent multiplex surfing, it's left to the kids to sort it all out. Matt Draper, a 13-year-old eighth-grader at North Star Academy in Redwood City, California, says that seeing an actor smoking cigarettes in a movie wouldn't influence him to try cigarettes. "Not really," he says, "because I know it's just a movie and it's fake. I think violence is worse than cigarettes."
So does Redwood City high school sophomore Jason Dean, 15. "Seeing someone's head getting blown off - all bloody and gory - that's what everyone wants," he says. "But seeing someone smoke cigarettes is more of an everyday thing. You see people smoking cigarettes outside of restaurants. Gore is going to reign supreme over smoking."
Cigarettes and the movies have been entwined since pictures began to talk in 1927, when actors suddenly found themselves needing something to do while the words came out. As movie stars began exhaling those beautiful silvery clouds on screen, the country was enveloped in a wreath of smoke. Cigarettes production in the United States jumped more than 1200 percent between 1910 and 1930.
Unlike sex, violence and bad language - all reined in by the old Hollywood production code, and today by the ratings system - smoking cigarettes in movies wasn't merely tolerated, it became the essence of screen glamour.
The most famous example of this was the 1942 drama Now, Voyager, in which Paul Heinreid's character lights a cigarettes for himself, then one for Bette Davis' character, and for a moment has two lit cigarettes dangling from his lips. That image became so iconic that for the rest of his life, Heinreid was unable to go out in public without women begging him to light their cigarettes.
Bogart and Bacall? Their famous romance was launched over a cigarettes in To Have and Have Not, and continued offscreen until he died of throat cancer at age 57. In movies as in the military, the rule was "smoke `em if you got `em." Some research suggests that there is more cigarettes in films than in real life.
The MPAA says smoking now will be treated on a par with violence, sexual situations and bad language. But it created an exemption from more restrictive ratings for movies such as the Edward R. Murrow biopic Good Night, and Good Luck, in which the smoking cigarettes is deemed "historically accurate." (Ratings board chairwoman Joan Graves has said that picture would probably still get a PG rating, but would now come with a "pervasive smoking cigarettes" warning.)
But with no such exemptions for historically accurate depictions of sex or violence, the one thing the ratings board seems to have assured is that it will apply its standards inconsistently.
"I don't think anybody ever actually died from hearing the f-word," Vargyas says. "The motion picture industry needs to step up to the plate and say, `Now we know. We didn't know, but now we do. What we're selling is the only consumer product that, when used as directed, kills.'"
Washington - The federal agency charged with keeping food and drugs from harming Americans may soon be asked to take a consumer product that kills more than 400 000 people a year and make it safer. The product is the cigarettes - generally acknowledged as anything but safe. Smoking cigarettes accounts for nearly one in five deaths in the United States. That toll can be reduced, cigarettes foes say, and they point to a bill widely expected to pass a key Senate committee on Wednesday as the tool to make it happen. The legislation would give the Food and Drug Administration the same authority over cigarettes and other tobacco products that the regulatory agency already has over countless other consumer products. It is an authority the Supreme Court ruled in 2000 that the FDA does not have. But neither is it something the agency necessarily wants, according to past comments by FDA commissioner Dr Andrew von Eschenbach. Regulate cigarettes components The bill would allow the FDA to regulate the levels of tar, nicotine and other harmful components of cigarettes products. Cigarettes smoke contains more than 4 000 chemicals, more than 40 of which are known to cause cancer. New products would need FDA approval before they could be sold, according to the legislation. It also would authorise the FDA to set national standards for cigarettes and other tobacco products to control how they are made, as well as force the disclosure of their ingredients, including compounds and additives, and in what quantities. That, supporters claim, should help expose and ultimately limit the ways cigarettes are engineered to the detriment of the public's health. "If the FDA only prevented cigarettes companies from manipulating their products to make it easier to start and harder to quit, it will make a major contribution to reducing the number of people who die," said Matthew Myers, president of the National Centre for Tobacco-Free Kids, a supporter of the legislation, which has faltered in previous Congresses. No such thing as a safe cigarettes? No one among those for or against the Senate bill, mirrored by matching legislation in the House, believes it could result in a safe cigarettes. There is consensus that there is no such thing. But those against the bill maintain it could create that impression. "It would still be a deadly product. They are not going to make it a safe product by taking out particular smoke cigarettes constituents. The problem is the public is going to perceive the product is safe because the FDA has assumed jurisdiction," said Dr Michael Siegel, a Boston University School of Public Health professor. But advocates say the bill would at a minimum give the FDA the authority to go where the scientific evidence takes it and only then make decisions based on that science to reduce the harm caused by cigarettes. "There is a broad range of actions that the FDA potentially could take, some of which we understand now and some we can only see dimly," said the University of California, San Diego's Dr David Burns, scientific editor of several surgeon general's reports on cigarettes. "To say that there's nothing we can do is nihilistic in thinking and inconsistent with science." Manipulating ingredients The bill also would keep cigarettes companies from tinkering with their products in ways that would make them any more dangerous, supporters add. "The cigarettes industry would not be allowed to manipulate the ingredients - like increase nicotine or decrease nicotine or whatever they do - without disclosing it. The bill would put the burden of proof on industry to demonstrate to the FDA that what they're doing would not be more harmful," said M Cass Wheeler, chief executive officer of the American Heart Association. When asked for some likely targets that regulators could tackle, Centres for Disease Control and Prevention chemist David Ashley rattled off more than a half dozen compounds in tobacco and smoke that worry scientists, even though it's unclear just how beneficial removing or reducing their levels would be. They include: Nitrosamines, a potent carcinogen. The burley tobacco used in American cigarettes is especially high in nitrosamines. Acetaldehyde, a potential carcinogen that may make tobacco more addictive. It's produced when sugars, added to cigarettes, are burned. Cadmium and lead, two heavy metals that are toxic. Their levels generally depend on the environmental conditions where the cigarettes was grown. The elegance of the bill, Myers said, is it would not dictate to the FDA how to proceed. Health effects long-term "This bill wisely doesn't try to predict what a cigarette will look like once FDA begins to take action. Instead, it says to the scientists at the FDA, 'You have the power to require changes in cigarettes products in whatever ways you believe,"' Myers said. But Ashley, an expert in the constituents of cigarettes and tobacco smoke, cautions that cigarettes are a very complex product, and have traditionally changed with time as manufacturers tinker with them. "One problem from a scientific standpoint is the product changes so often but the health effects are long-term. The cigarettes people are smoking today aren't the cigarettes of 10 years ago," Ashley said, adding: "It's hard to link a change in the products to a particular health end point because there's nothing you can get your hands around." Another expert called the task of figuring out how to reduce tobacco's harm basic "bread-and-butter stuff" for the FDA. "This is what they do all the time: develop performance criteria for products," said Jack Henningfield, an addiction expert and former cigarettes researcher at the National Institute on Drug Abuse. That in turn would act as an incentive for cigarettes companies to create products that are less harmful, he added. FDA can't determine if a cigarettes is safe As for the FDA, commissioner von Eschenbach said recently he wouldn't want his agency put in the position where it had to determine a cigarettes is safe. Nor would it appear that the agency could approve any new cigarettes, even if it were purportedly safer, under the legislation, said Senator Richard Burr, who opposes the bill. " It's an impossible pathway to understand at an agency tasked with a mission that is to prove safety and efficacy," said Burr, adding that could keep any new reduced-harm cigarettes product from coming on the market. Philip Morris USA, maker of Marlboro, America's top-selling cigarettes brand, supports the bill. RJ Reynolds Tobacco Co and others oppose the legislation, saying its restrictions on advertising would help cement Philip Morris' No 1 market position. | |||||||||||||||||||
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