Volume 13 Number 4, 2003
SMUDGING THE “GOLDEN LEAF:” A COMMUNICATION CAMPAIGN TO
REDUCE THE BURDEN OF TOBACCO IN KENTUCKY
Stuart L. Esrock*
Joy L. Hart
Greg B. Leichty
University of Louisville
Tobacco has a lengthy history and powerful legacy in Kentucky. It has long been an important cash crop, generating as much as $900 million for the state economy (Kentucky ACTION, 2001). Kentucky remains the United States’ second leading tobacco producer (University of Kentucky College of Agriculture, 2002) and has been the home of several tobacco companies and cigarette manufacturers. Over the years, tens of thousands of families in the state have depended on tobacco for their livelihoods. Even today, Kentucky is still home to almost 45,000 tobacco farms, the most of any state in the nation and almost three times more than its nearest rival (President’s Commission on Improving Economic Opportunity, 2001).
Like thoroughbred horses and bourbon, tobacco has become a romanticized icon that represents Kentucky to residents and to some visitors. In a recent interview, Kentucky tobacco-control advocate Paul Kiser said:
For generations, tobacco was the number one source of agricultural revenue for farmers in Kentucky. Although this has recently changed, this fact, plus the long-time presence in Kentucky of two of the largest cigarette manufacturers in the world, has led to the development of an unassailable, benevolent, communal opinion of tobacco. The conviction held by the believers reaches nearly mythical levels as evidenced by the frequently used epithet, the “golden leaf.”
Indeed, tobacco has long been the cultural lodestone of rural Kentucky communities. Kentucky author Wendell Berry (1993), a nationally celebrated essayist and leader of the sustainable agriculture movement, described the rural culture of his youth this way:
It is hardly too much to say that we were a tobacco culture. Our nationality was more or less American. Our religion was nominally and sometimes approximately Christian. But our culture was largely determined by tobacco, just as the culture of the Plains Indians was determined by the horse. (p. 54)
Not only do rural Kentuckians depend upon tobacco for their livelihoods, tobacco rituals are also the social lifeblood of rural communities. Berry (1993) nostalgically recalled the busy seasons of tobacco from his youth:
Because so much handwork was involved in the growing of tobacco, it was a very sociable crop. "Many hands make light work," people said, and so one of the most attractive customs of our tobacco culture was "swapping work" . . . At these times, neighbors helped each other in order to bring together the many hands that lightened work. Thus these times of hardest work were also times of big meals and of much talk, storytelling and laughter. . . . And so I cannot help but look on our tobacco culture with considerable affection and gratitude. (p. 55)
In such an environment, it is not surprising that until very recently it was nearly a taboo topic to talk about regulating tobacco products. In this cultural milieu, it also is not surprising that Kentucky leads the nation in the percentage of smokers and in the consequences of attendant illness like cancer, heart disease, and emphysema. This case study describes a recent attempt to change the situation--a communication campaign to increase the excise tax on cigarettes. The analysis is based on firsthand accounts of a researcher who worked for nearly one year in this activist movement, formal and informal interviews with key organizers, and campaign materials. The campaign organization and its communication strategies are discussed as an exemplar for social change activism in a hostile environment.
According to Bennett (2000), the time is ripe to study participation and civil society because of vast economic, political, and social changes. This case fits that research agenda by describing how the effort to reduce smoking has been structured, discussing implications for the communicative practices of other activist campaigns, and pointing toward potential research directions for scholars particularly interested in social movements and issues management.
Tobacco and Communication
Since the U. S. Surgeon General’s 1964 publication of landmark research on the negative health implications of smoking, tobacco has become an important focal point for studies across a wide variety of disciplines (e.g., medicine, public health, education, economics, sociology, political science, and communication). This diverse literature has a number of potential implications for communication researchers interested in campaigns to promote and sustain lower smoking rates among adult and youth populations.
Paralleling the increased recognition of the social and health implications of cigarette smoking and general tobacco use, a growing body of research examines tobacco consumption. Across this literature, multiple foci have been addressed, including sales compliance with tobacco-purchasing minimum age laws (e.g., DiFranza, Celebucki, & Mowery, 2001) and legal cases on environmental tobacco smoke (e.g., Sweda, 2001). One clear theme within this literature centers on efforts to lessen or eliminate tobacco use (Abernathy, O’Grady, & Dukeshire, 1998; Bonnie, 2001; Eisner, Smith, & Blanc, 1998; Hanson & Kysar, 2001; Heloma, Jaakkola, Kahkonen, & Reijula, 2001; Karr, 1997).
Growing research attention has been directed at tobacco campaigns of various types. For example, Benoit and Harthcock (1999) assessed an advertising campaign targeting tobacco companies for seeking to addict youth to tobacco and regarding their lobbying practices. Their examination focused on the use of multiple strategies to draw attention to the objectionable behavior of the tobacco industry. Tanne (1996) analyzed the American Medical Association’s (AMA) campaign against Joe Camel. The AMA sought to educate youth regarding the many risks of smoking and to portray not using tobacco as “cool.” Nathanson (1999) examined both the tobacco and gun control movements. Glantz and Balbach (2000) asserted that successful strategies employed in previous campaigns, such as advertisements attacking cigarette producers, were a call for action from the general public and a legislative message.
Other studies have focused on the efforts of the tobacco industry to achieve their goals. Muggli, Forster, Hurt, and Repace (2001) analyzed the tobacco industry’s disinformation campaign regarding the effects of secondhand tobacco smoke. A number of tactics were employed in this disinformation campaign (e.g., masking involvement by hiring paid scientific consultants to make “unbiased” scientific presentations, write editorials, author comments to scientific bodies such as the Environmental Protection Agency, and give media interviews). Magzamen and Glantz (2001) studied how the tobacco industry worked to persuade legislators and engaged in public relations efforts to sabotage California’s law for smoke-free bars. Their findings also suggested that the tobacco industry tried to marshal grassroots efforts and used the media in furthering their company purposes.
According to Menashe and Siegel (1998), policy-making bodies and health workers have known of the many dangers of tobacco use for several decades. However, a variety of tobacco products remain easily available. Such products have remained widely accessible and legal, these researchers argue, partially because advocates for tobacco control have not been able to develop a consistent communication campaign forceful enough to overcome the powerful tobacco industry. Despite the staggering negative statistics regarding tobacco’s harmful outcomes and increased public acceptance of these facts, the tobacco industry continues to be a wealthy and powerful force in the United States, especially in terms of its forceful lobbying efforts. In spite of some progress, the anti-tobacco movement has had considerable difficulty thwarting the industry’s efforts (Menashe & Siegel, 1998).
Although ample evidence shows that tobacco harms and kills, the use of tobacco remains the predominant public health problem in the United States, and the tobacco industry continues to influence policies governing public health (Kozlowski, Henningfield, & Brigham, 2001; Menashe & Siegel, 1998). The tobacco industry strategy of framing the issue in terms of individual freedom (i.e., personal autonomy to behave as one chooses) has resonated with members of the U.S. Congress and with the general public. To succeed, anti-tobacco activists must reject tobacco industry frames and reframe issues. This reframing must define support of proposed tobacco policies as resonant with long-celebrated U.S. values of personal autonomy, freedom of choice, and fair enterprise (Leichty & Warner, 2001; Menashe & Siegel, 1998). Certainly, well-developed message strategies are essential in a tobacco-control communication campaign.
Fox (2001) suggested that controlling tobacco fits with necessary criteria for public health legislation. Kessler and Myers (2001) argued that legislation is the best choice for reducing the public health costs of smoking, and Fox (2001) asserted that tobacco legislation needs to be a fundamental facet of lessening tobacco-related deaths. Due to the failure of national tobacco legislation, the fight to control youth access to tobacco products is shifting to the individual states (Sweeney & Rose, 1998).
This case study focuses on one such battle in Kentucky. One of the researchers was integrally involved in the development of a statewide tobacco-control initiative from August, 2001 through May, 2002. This researcher was on a university-sponsored sabbatical and was invited to help oversee the communication aspects of the initiative, based on previous professional campaign and media experience as well as earlier pro-bono work with the sponsoring agency. It was understood by members involved with this initiative that the researcher would be simultaneously gathering data about the campaign (e.g., media used and lines of argument introduced). All campaign participants were, thus, aware of the participant observer’s dual role as researcher and campaign strategist. This relationship was even announced in meetings with people from across Kentucky who were interested in the tobacco-control initiative. Furthermore, all campaign participants quoted in this case study signed Human Subjects Review agreements, allowing verbatim quotation and full identification.
Based on the unique opportunity to gain full access to the process of planning and implementing of a major public health initiative, the researcher accepted the invitation to participate from the campaign and its sponsoring agency. This researcher, therefore, was involved in all of the communication activities analyzed in this case study, including coordinating, supervising, and, in some instances, actually executing the tactics for the campaign detailed in the following pages. These activities included strategic communication planning, Web site development, advertising, and public relations.
Although not directly involved in the development or execution of these communication strategies, the other authors of this case kept abreast of the campaign (e.g., through conversations with the participant observer and media coverage) and later analyzed a number of campaign materials. These researchers brought an external perspective to the analysis of the case materials, reducing potential bias that may have occurred from the participant observer’s role. The case also was written retrospectively, giving the participant observer time to reflect and gain perspective about the events that transpired.
The corpus of materials analyzed included the organization’s communication plan, campaign documents (e.g., brochures, news releases, and advertisements), media coverage of the initiative across the state, traffic studies from Web sites, four in-depth interviews with key campaign personnel (which were recorded and transcribed), the participant observer’s field notes, and several informal follow-up interviews. The researchers reviewed these materials and identified the critical points in the evolution of the campaign.
The following sections describe the problem of tobacco in Kentucky, the organization involved in the initiative, general tobacco-control communication strategies and the specific communication strategies in this campaign to raise the cigarette excise tax, and the results achieved. Finally, we identify implications for future research and other social change movements.
Kentucky, Smoking, and Activism
Tobacco is a deeply-rooted facet of the culture in Kentucky and other tobacco-producing states (Noland, 1996). Kentuckians have long been passionate about the crop, given its preeminent status in their agriculture, but their fervor became virulent 100 years ago, fueling the mythology that surrounds the “golden leaf.” In 1904, Kentucky farmers formed a “protective association” to defend themselves against the tactics of large tobacco manufacturers. They destroyed factories and corporate-owned crops and even murdered some other planters (Borio, 1993). Although the group disbanded in 1915, even today the vestiges of their zeal linger. In Kentucky, tobacco remains king.
The state has the nation’s highest adult smoking rate, with nearly one-third of Kentucky adults smoking tobacco (Centers for Disease Control [CDC], 2002). Not coincidentally, the Commonwealth of Kentucky has the highest lung cancer death rate per capita in the nation, and nearly 8,000 residents die annually due to tobacco-related illnesses (CDC, 2002). Kentucky spends $1 billion each year treating tobacco-related illnesses, including lung cancer and heart disease (Lindbloom, 2002b).
Kentucky youth also smoke at alarming rates. This statistic echoes other research suggesting youth in tobacco-producing states are particularly at risk for smoking because of high usage rates among their immediate and extended families, lax school policies, school agriculture programs, and the fact that even some teachers and school principals grow tobacco (Noland, 1996). Given that 90% of all smokers start before they reach the age of 18 (U.S. Department of Health and Human Services, 1994) and that one-third will die prematurely from the habit (CDC, 1996), the youth usage figures in the state of Kentucky are particularly troublesome. Kentucky claims the fourth highest high school smoking rate and the worst middle school rate in the United States. Kentucky high school students' smoking rate is 37% compared to the national average of 28%, and the middle school rate is more than twice the national average, 21.5% versus 9.2% (Hahn, Plymale, & Rayens, 2001). Each year, more than 14,000 Kentucky children become new daily smokers, and, at current rates, nearly 114,000 of all children alive today in the state will die prematurely from smoking if nothing is done (Lindbloom, 2002b).
It is against this backdrop that public health organizations and officials have been operating in Kentucky to promote social change that results in the state’s residents living healthier, longer lives. These groups advocate tobacco education, prevention and cessation programs, and legislation designed to decrease smoking. One such organization involved in the effort to reduce the impact of cigarettes and tobacco is Kentucky ACTION.
The Campaign Organization
Kentucky ACTION (The Alliance to Control Tobacco in Our Neighborhoods) started as a youth tobacco education group. In 1986, the Kentucky chapters of the American Cancer Society, American Heart Association, and American Lung Association formed Tobacco Free Young Kentuckians to inform teens about the effects of tobacco. This was the first comprehensive effort in the state of Kentucky to address the problem of youth smoking. Beyond education programs, Tobacco Free Young Kentuckians worked with the Kentucky Department of Public Health on some of the state's first publicly funded cessation programs.
In 1994, funding from a Robert Wood Johnson Foundation grant was used to officially form Kentucky ACTION for the purpose of increasing tobacco education programming. Over the ensuing years, the scope of the group’s activity expanded, and, eventually, ACTION was seen as a central clearinghouse for tobacco and health matters in the state. The organization then moved into the public policy field for the first time with the tobacco Master Settlement Agreement (MSA).1 ACTION successfully lobbied the state legislature to devote some MSA revenues to fund prevention and cessation programs around Kentucky. With the implementation of these programs, ACTION moved into public policy advocacy on tobacco issues.
As the scope of the group’s work progressed, so too did its reputation grow. Heather Wehrheim, ACTION’s manager of grassroots advocacy, was first introduced to the group in 1997 when she was working for the American Cancer Society. It became apparent to her that when it came to tobacco-control matters, ACTION was the "go to" group in the state. In a recent interview with one of the researchers, she said:
During the Master Settlement advocacy in 1998, I realized how big of a player this group was. Their two-man staff did a phenomenal job of mobilizing grassroots groups across Kentucky to advocate for settlement money to go for tobacco-control efforts. I was impressed with the visibility and credibility this coalition had in the media and with health organizations throughout the state.
Since the MSA campaign, the group has worked to increase the number of smoke-free public spaces, funded clear indoor air initiatives at the local level, and trained hundreds of Kentucky youth in tobacco prevention and advocacy. Today, Kentucky ACTION operates with a full-time staff of five and has an active steering committee consisting of education/advocacy personnel from the cancer, heart, and lung groups. The organization also has an advisory council of health and education organizations from across the state.
Kentucky ACTION has become a well-known and well-respected regional voice for tobacco control. The group is a central coordinator of policies and a resource for information concerning tobacco-control issues and enforcement matters. Former ACTION chair Mike Kuntz, who also serves as the director of advocacy and education for the American Lung Association of Kentucky, is of the opinion that the group has helped to validate the tobacco-control movement in Kentucky, particularly in the public policy arena. During an extended interview, Kuntz said:
The biggest progress has been our legitimacy in Frankfort [the Kentucky state capital], our legitimacy with public policy makers. I’m not saying that they are listening all the time. I’m not saying that they are following our direction all the time. I’m not saying that we have champions there but I would say that now, they are listening at least. We don’t have a seat at the table but we are standing in the room at least.
Despite ACTION’s successes, tobacco-control advocate Kiser says that smoking continues to be the number one public health problem in Kentucky, given the state’s abnormally high disease and mortality rates related to tobacco. Realizing the continuing problem, ACTION decided to become more aggressive on the public policy front and attempt to achieve the pinnacle of tobacco-control initiatives: a significant increase in the state cigarette excise tax. In 2000, Kentucky ACTION applied for and received major grants from the Robert Wood Johnson Foundation and other public health interests totaling $3.5 million to focus efforts on a campaign designed to raise the state cigarette excise tax for the first time in over 30 years.
The Excise Tax Issue
Bringing about important social change, such as reducing the effects of tobacco in Kentucky, calls for comprehensive solutions. To reduce smoking in the state and sustain change in that regard, a broad-based coalition must participate. Families, tobacco retailers, schools, healthcare professionals, community organizations, and both adults and youth all have important roles to play in reducing the health impact that tobacco inflicts on the state every year.
Of the many anti-smoking strategies that these groups can promote, changes in public policy have the broadest potential impact on the problem. Several states, most notably California and Arizona, have reduced smoking rates through publicly funded, comprehensive prevention and cessation programs. California has cut its tobacco consumption by 50% since 1990, and Arizona’s smoking rate has dropped by 21% since 1996, after both states funded such programs (Kentucky ACTION, 2002).
National tobacco-control experts, however, suggest that, for maximum impact, raising the price of cigarettes through excise tax increases is the most effective method to reduce tobacco use, particularly among youth. For every 10% increase in the price of cigarettes, there is a 4% decrease overall in smoking and a 7% decrease among youth (Chaloupka, 1999).
Kiser, who serves as the manager of advocacy and education for ACTION, says that in Kentucky, a 75-cent per pack increase in the state cigarette excise tax would result in a nearly 15% lower youth smoking rate and a 5% lower adult smoking rate. According to Kiser, projections (based on research from the Washington, DC-based Campaign for Tobacco-Free Kids) indicate that the tax hike also would result in 40,000 fewer future youth smokers and would help prevent 20,000 smoking-related deaths over the lifespan of the current Kentucky population. The authors’ analysis of federal CDC statistics showed a significant and sizable negative correlation between a state’s level of excise taxes and the death rates associated with tobacco (r = -.49, p < .01). Although causality is difficult to prove because states with lower smoking rates may be more likely to have higher taxes, this correlation is consistent with the hypothesis that cigarette excise taxes diminish tobacco consumption. Furthermore, a 75-cent per pack Kentucky excise tax increase would generate an estimated $300 million annually in state revenues and would result in a healthcare savings of $974 million for the state over the lifespan of the current Kentucky population (Lindbloom, 2002a).
At three cents a pack, the Kentucky cigarette excise tax has not been raised since 1970. It is the second-lowest rate in the nation and is only 5% of the national average of 60 cents a pack. It is also only about 2% of the nation's highest excise tax of $1.51 per pack in Massachusetts. With such potential benefits to a cigarette excise tax, a state revenue crisis resulting from a slumping economy, and the lack of an increase in three-plus decades, an outside observer would think that Kentucky would be a prime target for increasing the cigarette excise tax.
Powerful cultural and political forces in Kentucky, however, make such a policy action far from certain. As Kiser explained:
A significant increase in a tobacco excise tax in Kentucky faces many challenges not encountered in most other states. Due to the fact that tobacco has been such a fiscally beneficial crop for our farmers, combined with a historically strong industry presence, a lot of the general public and the vast majority of our legislators have been misinformed and made to believe that if any pro-health action is taken with regard to tobacco use, it would be a direct assault on the farmers who still rely on tobacco for their livelihoods. When the word “tax” is added, these historical misconceptions combine to severely increase the standard barriers faced by all excise tax campaigns such as industry-backed pro-smoking groups, general anti-tax movements, retailers’ associations, and the industry lobbying itself.
During the summer of 2001, Kentucky ACTION began the campaign to create a groundswell of grassroots support for an excise tax increase on cigarettes. The group, however, did not limit its communication efforts only to promoting the tax. Instead, ACTION continued its longstanding effort to educate the public about the dangers of tobacco and the necessity to enact comprehensive tobacco-control programs. In that way, the group hoped to enhance the tobacco-control movement in the state. Building its constituency would not only benefit ACTION in the short term on the issue of increasing the cigarette excise tax but it would also motivate and empower the public to take action on additional tobacco-control issues in the future.
As part of this effort, ACTION worked to increase the “noise” level about the disingenuous business practices of tobacco companies. Kiser believes that this communication strategy is a vital component in building public support for any tobacco-control issue:
Essentially, only smokers have any positive feelings about the industry, but if the majority of the population that doesn’t really have anything to do with “big tobacco” is not kept aware of how underhanded the industry can be or, worse yet, if they are duped by industry ads to believe that “big tobacco” has changed and has suffered enough, no headway will ever be made in any tobacco-control campaign. The tobacco industry has, and will always, make a product designed to addict and kill its users. The methods by which they achieve their astonishing success are very rarely, if ever, done in a respectable manner and these actions need to be brought to light so that lawmakers and the general public will be concerned enough to get involved and make educated decisions.
The biggest hurdle that the tobacco-control movement faced in Kentucky was the sense that the proposal could not succeed. Hirschmann (1991) noted that the topos of futility (i.e., nothing can be done about the problem) has been one of the most persistent and effective obstacles to proposals for progressive change in Western societies. In Kentucky, many state officials and legislators thought the effort to raise the excise tax was doomed from the beginning. Representing this view, Alex Rose, a spokesperson for the State Revenue Cabinet, observed, “The past history of attempts to do this have proven futile” (Haukebo, 2001, p. E1).
Kuntz noted that the perception that the proposal could not succeed undergirded a general apathy by the public on many political issues in the state of Kentucky:
Our biggest foe in this isn’t the legislators--it’s apathy. I mean, people just don’t give a damn, they just don’t care. They are not motivated enough to come out about public policy issues in general. It’s just very hard to move them on an issue.
In this context, raising noise and stirring up outrage at the practices of tobacco companies have been crucial communication strategies for combating public indifference. Beyond maintaining the noise level, ACTION has made a conscious effort to continue in its role as an information clearinghouse for tobacco control and public health officials and organizations. As Kiser noted:
By actively pursuing, consulting, and providing information and other resources or materials for individuals and other smaller coalitions across the state, we continue to establish and maintain our own credibility, which will carry over to our excise tax campaign. Our grassroots efforts will be supported due to the ability to draw on those we have assisted for support. These efforts also benefit Kentucky ACTION by guaranteeing our presence and developing clout for future tobacco-control initiatives in the state once this initiative is completed.
During the first year of the campaign to raise the cigarette excise tax, ACTION implemented a variety of strategies to communicate its general tobacco-control message. The group wrote editorial columns and promoted news stories across Kentucky that criticized the tobacco industry for unscrupulous marketing practices, especially those that ACTION believed illegally target youth. The group used public relations efforts to publicize a wide variety of tobacco-control news stories, ranging from the Great American Smoke-Out to illegal sales of single cigarettes to new cigarette packaging that they alleged unfairly targets minority groups. These efforts not only helped to promote various matters important to the organization but also promoted ACTION as an important community resource on tobacco issues.
ACTION also coordinated and promoted special events that brought together individuals and organizations interested in tobacco-related topics. The organization sponsored the state’s first tobacco “summit” for tobacco-control coordinators and public and private health officials from across Kentucky and then later coordinated the state’s first African-American tobacco-control conference. Each event, based on the anticipated media coverage, was designed to enhance the organization’s activist reputation both within the tobacco-control community and to the outside public.
In the fall of 2001, ACTION redesigned its site on the World Wide Web (www.kyaction.com). The redesigned site provided basic information about the organization and served as an interactive platform with which ACTION could communicate with users. In addition, it provided general tobacco-control information to those within the movement, and, thereby, helped to extend ACTION’s efforts to serve as an information resource and clearinghouse. James Reed, the Web designer, believes that the site nicely supplemented other media efforts to provide users with on-demand, detailed information. In a recent interview, Reed said:
With Kentucky ACTION, you’ve got over 100 pages of content. Obviously, you can’t communicate that volume of information through other paid media. One way to think of this is that your traditional media can act as something of a teaser--you know, communicate the bigger ideas--and then people who have any kind of interest, whether it is negative or positive, can go to the Web site to get more information than they could ever get elsewhere.
ACTION sent a traditional printed newsletter, monthly electronic news, and both mail-based and email alerts to a database totaling more than 1,700 individuals and organizations. The database had been built over time, based on people signing lists that indicated at least some level of interest in tobacco-control issues. No annual fees or dues were required because ACTION’s goal is to get as many people involved in the movement as possible. In an interview, Assistant Director of Communications, Tiffany White, expressed her belief that the aim of these communication strategies was to maintain the involvement of constituents on a wide array of issues:
The ultimate goal is to keep Kentucky ACTION volunteers, public health organizations, and tobacco-control advocates continuously informed about policies and laws pertaining to tobacco use on a statewide level. Our mission is to build a strong network of support that will allow us to influence legislative change in the area of tobacco control. Through our newsletter, emailings, and alerts, we want to establish ourselves as the primary resource for information about these issues.
Perhaps the most elaborate of ACTION’s general tobacco-control communication strategies is its youth program. The organization sponsors a statewide youth coalition called Project START (Students Taking Action Regarding Tobacco) that includes nearly 500 teens who take part in special education and training programs, as well as organized lobbying with Kentucky lawmakers. Youth in the program learn about the dangers of tobacco, how to speak out against smoking, how to educate others about the problem, and how to enact policy changes. They also take part in special events ranging from calling on restaurants to go smokeless to creating sidewalk chalk murals exhorting the dangers of tobacco on the front steps of an international tobacco company (which attracted media coverage).
People around the U.S. and the state of Kentucky are taking note of the youth-oriented activities. The 2001-2002 Project START Chair (Katherine Klem, a Louisville high school sophomore) was named the national youth tobacco-control advocate of the year by the Campaign for Tobacco-Free Kids. In Kiser’s opinion, the youth program is a “crucial component” in building credibility with Kentucky lawmakers. As he explained:
In spite of stereotypes, youth generally care very much about their futures and the well being of others. Youth do not like to be manipulated, targeted, or used by anyone. Youth have a great deal of energy, a strong yearning for knowledge, and a desire to help achieve goals that interest them. The voice of youth is a very powerful one regardless of the topic. When youth rally around an issue like tobacco control, they generate a great deal of interest and discussion that only serve to benefit that campaign. This is especially true when the issue that policy-makers are considering is one that directly affects the future wellbeing of the kids themselves.
Thus, in the opinion of campaign organizers, the inclusion of youth helped ACTION to achieve its goals and more widely publicize its message.
Excise Tax Campaign Communication
Even as it maintained its general tobacco-control messages, ACTION simultaneously began a communication campaign that specifically focused on the excise tax issue. Based on lessons learned from other states that successfully passed excise tax increases and on the counsel of national organizations such as the Campaign for Tobacco-Free Kids, ACTION reached crucial strategic conclusions about its campaign. Grassroots manager Wehrheim said that the group decided that although it would need to talk to the state’s voters, in general, about the issue, it would specifically target college-educated women, 25-44 years of age. As she explained:
First of all, these women typically have young children, and they are more likely to be touched on an emotional level by the message that smoking is a risk to them and to children. Educated voters are also more likely to act on their feelings regarding this issue or any other issue, whether it means calling their legislator or visiting the polls.
Realizing the potential emotive pull that children have for the primary audience of mothers, ACTION decided to focus its campaign around the idea that raising the excise tax equates with protecting kids from the dangers of tobacco. Although there are numerous potential messages that could be communicated about the excise tax issue, such as the potential revenue to the state or healthcare benefits, the theme of “protecting children” was adopted to diminish public opposition to the proposal. This frame is consistent with the advances in tobacco control in the 1990s that occurred after advocates successfully reframed smoking from being an issue of individual choice to an issue of protecting youth from tobacco addiction (see Leichty & Warner, 2001).
The planning team decided to create a separate “brand” identity for the excise tax campaign rather than using the existing ACTION “brand.” The Kentucky Health Investment for Kids (KHIK) moniker was adopted for all campaign communication pertaining to the excise tax, and it was used to label the coalition of groups around the state that signed onto resolutions asking the Kentucky legislature to implement the initiative. Although the ACTION steering committee of representatives from the Cancer, Heart, and Lung Associations worked with ACTION personnel to manage and implement all excise tax campaign activities, everything was done under the banner of KHIK to magnify the importance of the initiative and to draw attention to its unique nature. The new brand highlighted the campaign’s frame of protecting the state’s children and investing in their future. New identity materials were developed specifically for the KHIK entity, including a logo, letterhead, and envelopes.
The KHIK entity also developed its own Web site (www.khik.org) separate from the ACTION page to serve as a specific tool for social change organizing and activism. According to Reed, this site was designed to be more than an electronic brochure about the excise tax issue:
The reason we wanted to be on the Web was to disseminate information, but then the idea of that information being to inform and then motivate people who have a favorable opinion of the cause to then take action. In this case, it is to write or call their legislators and try to get the initiative that KHIK represents passed.
The KHIK Web site also provided an immediate email link to a user’s lawmakers, including a guide to help those who did not know their state senators or representatives.
The KHIK campaign initially relied on face-to-face meetings to take the excise tax message to the public. Grassroots meetings were held across Kentucky with health professionals, public officials, religious groups, and others who expressed an interest in tobacco-control matters. Kuntz said that the intent of these meetings was to present the excise tax issue, motivate and inspire attendees, encourage them to make contact with lawmakers, and enlist them to help spread the word. Simultaneously, ACTION’s lobbyists and steering committee members were meeting and communicating with state lawmakers and representatives of other important interest groups to gauge support and to determine potential sponsors for a tax-increase measure.
In January 2002, as the Kentucky state legislature began its session, a statewide KHIK radio and newspaper advertising campaign was launched. The 8-week campaign suggested that anyone would help a child in peril and that a cigarette excise tax increase was effectively a way to save and protect endangered children. Although designed primarily to give widespread mass media exposure to the excise tax-increase initiative, the ads also directed readers/listeners to call an 800-number or to visit the Web site for more information about the proposal.
Simultaneously, a public relations blitz, which had already started, began to gather momentum. The PR campaign included visits to newspaper editorial boards around the state to foster columns about the tax, “letters to the editor” for publication in newspapers, news releases, and features. A series of special events included a news conference to announce results of a statewide poll showing significant support for the tax increase and a Project START lobby day at the state capitol. Later, KHIK participated in a special kid’s carnival at which members of the coalition distributed imprinted balloons and pens and gathered in excess of 400 signatures on petitions.
Beyond the email links on the Web page, several other specific communication strategies were implemented to foster direct public contact with state lawmakers to urge support for the excise tax issue. ACTION used its internal database listing to send both postcards and email to constituents under the KHIK banner, asking recipients to contact legislators to express support for the excise tax. Later, a telemarketing firm was hired to contact voters across the state, gauge their support, and then patch them through to their state representative to lobby for the measure. More than 1,000 callers were placed into direct contact with their representative as a result of this effort.
Campaign Results and Future Directions
ACTION’s communication strategies to build support for a cigarette excise tax were combined with a legislative/lobbying drive and other grassroots activities. The first year of the campaign culminated in February 2002, with the introduction of House Bill 677 in the Kentucky legislature to raise the cigarette excise tax by 44-cents per pack.
The measure had bipartisan support, with nine Democrats and two Republicans as co-sponsors, including the late sponsorship of the Majority Leader of the House. Revenue from the proposed cigarette excise tax increase (plus the first Kentucky tax ever on smokeless products and cigars) was earmarked for mental health and substance abuse services, education, child dental care, and tobacco prevention and cessation programs. Sponsoring lawmakers argued that the 44-cent proposal was potentially more palatable than the 75 cents that KHIK was promoting. However, the legislators also had symbolic reasons for the bill: The 44-cent per pack increase represented the fact that Kentucky, at that time, was number 44 in the nation in funding of mental health services. Despite being pleased with the bill’s sponsorship, the coalition of tobacco-control supporters was somewhat disappointed by the whittling down of figures that KHIK originally proposed. In fact, with a 44-cent increase, Kentucky would still place well below the national excise tax average.
The excise tax issue became a topic of discussion on radio and television talk shows and the subject of front-page newspaper stories and was subjected to extensive media polling. Although ACTION was unable to account for excise tax coverage in each of the state’s 300 media outlets, it did document newspaper and television coverage in the state’s largest markets, plus newspaper stories in key legislative districts and discussion on the state’s most influential news/talk radio stations. Media coverage that was tracked included approximately 60 newspaper stories, 50 television reports, dozens of “letters to the editor” and radio reports/talk show appearances, and more than 40 print editorials and opinion columns. The vast majority of these editorials, including multiple columns in each of the state’s three-highest circulation newspapers (the Louisville Courier-Journal, the Lexington Herald-Leader, and the Cincinnati-based Kentucky-Post), supported the tax. In terms of setting the public agenda through media coverage, KHIK’s campaign was successful.
More than 200 citizens contacted Kentucky ACTION about the issue in the 2-month period after the tax bill was introduced. Although 75% of those calling were against the tax, the email that ACTION received was split nearly 50-50 between those supporting and opposing the proposal. Kiser said he was surprised that the emails weren’t as negative as the phone calls, because he expected that only smokers, anti-tax zealots, or others really against the proposal would bother to contact the group to express outrage.
ACTION’s efforts notwithstanding, lawmakers allowed the cigarette excise tax bill to die without public debate. The measure was assigned to the Kentucky House Appropriations and Revenue Committee, and although the bill was listed on one public hearing agenda, the panel chair never allowed a public discussion on the tax hike. Kuntz suggested that the lack of debate resulted from tobacco’s preeminent status in Kentucky and other legislation that superceded discussion of the tax increase, plus a lack of house leadership actively supporting the bill. Subsequent outcry in some media was loud, particularly given Kentucky’s budget woes. Sponsoring lawmakers, Kentucky ACTION, and other public health advocates vowed to return until the legislation passed. Kuntz said that the next time KHIK will need to improve its efforts to recruit top legislative leaders:
I’m sure we could have done a little better on the communication side of this. We could have gotten on a few more morning shows or on more talk radio shows, something like that. But overall, those goods were delivered pretty solidly. Grassroots was a little down from that . . . but by doing the phone banking and the grassroots meetings and our constituent list that already exists, we did OK at that. We know that every key legislator heard from 20 to 30 people, and that is pretty solid. So, it ultimately comes down to legislative. Our people did not meet with leadership and did not get any leadership buy-in on the tax increase. And you can’t get them to buy-in if you don’t meet with them. And I think that was our overall Achilles’ heel.
Despite the death of House Bill 677 in the spring of 2002, the leadership of KHIK believed that it met its first-year goals for the excise tax campaign. Kiser strongly believes that they made great strides, both with the public and the state legislature:
The plan for the first year was simply to establish KHIK as an organization and make some noise about a tobacco excise tax increase. This was to begin the process of educating both the general public and our legislators about the merits of such a tax and raise the awareness of this tax as a partial solution to a myriad of problems plaguing our state, most notably, the atrocious youth smoking rate. Based on the level of public discussion, on both sides of the issue, this was undeniably achieved. The fact that we had a bill introduced, and a good bill at that, with 11 bipartisan co-sponsors, took us well above and beyond our expectations for the first year.
Echoing these sentiments, first-year campaign chair Kuntz said:
We had a wonderful bill, so legislatively we were successful to that degree. We have a great bill to model after next year, a bill that some people around the state took note of. They liked the way the money was parceled out; the ones getting the money resonated, so that was important. But it was obviously successful because we gained so much support from the media.
Through its communication efforts, the organization generated widespread media attention and public awareness of the excise tax issue. Although no subsequent public opinion polling has yet been done, the excise tax issue has been placed on the public’s radar screen in Kentucky because of ACTION’s efforts. In the first year of its excise tax campaign, ACTION spent $163,000 on its marketing communication efforts with substantially increased funding for the subsequent 2 years already pledged from the Robert Wood Johnson Foundation, American Cancer Society, American Heart Association, American Lung Association, and Campaign for Tobacco-Free Kids.
The KHIK “brand” was established through advertising and publicity. This was done to identify the excise tax campaign with the theme of helping children. The success of the publicity campaign in this regard was evident in print articles and editorials generated by the campaign. An analysis of 20 randomly selected print articles and editorials2 showed that the KHIK coalition was referred to by name in connection with the excise tax initiative an average of two times per piece (range = 0 to 5 mentions). In two articles, Kentucky ACTION was mentioned rather than KHIK; in one instance, Kentucky ACTION and KHIK were both mentioned. Certainly lawmakers, public health organizations, and, at least to some extent, the media knew that KHIK was being organized and implemented by Kentucky ACTION. However, given that the intent was to focus on the excise tax issue and the broad coalition of groups behind it, it is unlikely that the general public knew of the link between ACTION and KHIK. The effort to build KHIK’s separate identity will continue; however, the message communicated as the campaign evolves will move beyond the surface level of generating public awareness. In 2003, the campaign in Kentucky will include a more focused effort at education about the benefits of raising the excise tax.
Many other states are already moving in the direction of increasing anti-tobacco measures, with increased funding for prevention and cessation programs and a proliferation of excise tax measures. A total of 18 states debated excise tax proposals in 2001 and 5 passed. In the first half of 2002, 29 additional measures surfaced, with 5 passing and 5 more heading toward approval (Bailey, Edsall, & Kirchoff, 2002). These successes should add momentum to the KHIK campaign. As Kuntz said, these facts do not go unnoticed by Kentucky lawmakers:
We are greatly aided by what is happening nationally. The progress that states like California, Massachusetts, those types of states have had . . . even though they [Kentucky lawmakers] sometimes try to dig their heels in and say, “We are Kentucky. We are different.” They don’t want to be a backward state.
This case study makes several contributions to the literature on social change movements and issues management. In the face of entrenched opposition and formidable social obstacles, social change activists must continue to be opportunistic. Saul Alinsky (1971), the patron saint of community organizers, observed that campaign “tactics means doing what you can with what you have” (p. 126). Social activists must, thus, identify opportunities and exploit the opposition’s mistakes. Much of the work of social organizing must be fluid and opportunistic. Alinsky also noted that “accident, unpredictable reactions to your actions, necessity and improvisation dictate the direction and nature of tactics . . . the tactic itself comes out of the free flow of action and reaction” (p. 165).
The analysis of the KHIK campaign revealed opportunities that were successfully exploited and some opportunities that were not capitalized on. The Commonwealth of Kentucky is one of the least likely places for a cigarette excise tax proposal to be taken seriously. Invoking the theme of futility (Hirschmann, 1991), some citizens and lawmakers assert that it will be impossible to enact such a proposal in the state. Moreover, they express doubts that the effort will actually suppress youth smoking (e.g., youth who want to smoke will find a way to smoke). However, as Conrad and Millay (2001) pointed out, a window of rhetorical opportunity sometimes presents itself and can be momentarily exploited. Although the opposition to proposals such as a cigarette excise tax increase may be relatively constant, there were several opportunities that this particular campaign took advantage of to generate the momentum needed to introduce the bill into the legislature.
Several new opportunities for creative framing of the issue emerged in the 2002 phase of the KHIK campaign. The most important of these was that Kentucky faced a significant shortfall in its budget during the recession of 2001 and 2002 and, consequently, lawmakers were searching for possible sources of additional revenue to shore up the state budget. In this environment, legislators faced the reality of having to cut state services for mental health and children (“Raise Kentucky’s,” 2002). In the past several years, political leaders in the state had taken great pride in pointing to strides made in reducing the number of uninsured children (Young & Sturgeon, 2002) and celebrating a 25% decline in infant mortality in Kentucky through the decade of the 1990s. This improvement in infant mortality moved Kentucky from one of the lowest states on this indicator to the national average (“Rate of Infant Deaths,” 2001). The probability of relinquishing these types of hard won gains was anathema to many legislators.
In this climate, KHIK framed the cigarette excise tax as the solution to the state’s financial woes, beyond its primary frame as a measure to protect the state’s children. Pointing out that some state services could be enhanced or retained by simply bringing the excise tax up to the national average made the excise tax proposal more palatable to some legislators (“Raise Kentucky’s,” 2002). This strategy will need to be exploited more fully in the 2003 phase of the campaign, at least in terms of communication with lawmakers. If the shortfall in state revenue persists several more years as projected, representing the excise tax as a responsible fiscal solution should become an increasingly potent strategy. The recession of 2001-2002 provided a short-term opportunity to get a hearing with some legislators that would have been much more difficult under normal economic conditions.
The most important obstacle to the KHIK proposal, however, is the pervasive sentiment against new taxes in the state. Forty-eight legislators, including all 20 Republican Senators in the majority in the state Senate, had pledged not to raise new taxes, even if it required significantly cutting state services during a recession (Hawpe, 2002a). The failure to get a hearing for the excise tax increase must be considered in the context of the fact that the legislature also failed to discuss such modest bills as a proposal to enact a half-cent tax on disposable beverage containers to clean up dumps and roadsides or another proposal to levy the same miniscule state excise tax on smokeless tobacco products that was already laid on cigarettes. One editorial writer chastised the legislature’s attitude on raising revenue this way:
As members of the 2002 General Assembly lay down on the job, they appear to have swallowed a draught of AGASP-Anti-Government and Self-Preservation elixer. It’s an old nostrom that conservatives peddle. Drunk on it and flat on their backs, the legislators in Frankfort have ignored the most pressing public business. (Hawpe, 2002b, p. A8)
In response to the intransigence about tax proposals, KHIK members began initial efforts to frame the excise tax for legislators as a “user’s fee” that works to save or at least offset healthcare expenditures for the state. This frame could have been better emphasized as an effective counterpoint to the anti-tax movement. In this line of argument, the campaign can assert that the state subsidizes tobacco use at a rate of more than $1 billion a year through tobacco-related healthcare costs associated with Medicare and Medicaid.  Highlighting future savings in medical outlays that would occur with reduced smoking rates reemphasizes the point that state government would have additional money for essential services beyond the revenues generated from the tax hike. If the second phase of the KHIK campaign is to be successful, this argument will need to be further developed and exploited at every opportunity. Until the “new tax” frame is defused or reframed, the overall success of the KHIK campaign to raise the excise tax is unlikely.
The biggest disappointment for the initial year of the campaign was the failure to get a public hearing for the proposal. This disappointment was attributable to failing to secure the timely endorsement of the governor and/or key legislators in leadership. The House Majority Leader agreed at the eleventh hour of the legislative session to add his name as a co-sponsor for the bill, with the hope that his support would provide enough impetus to push the effort forward (“Supporters Push,” 2002). However, his last-minute support was too late to give momentum to the effort. In subsequent years, KHIK will need to win the support of some powerful members of leadership to advance its agenda further. This case shows that extensive media attention and public support are useful in a legislative campaign only to the extent that they command the attention and, ultimately, the support of the administration and legislative leaders.
The constancy of severe opposition to a proposal should not obscure the point that the receptivity other important audiences have for a given proposition may vary considerably over time. If the level of opposition to a proposal seems overwhelming, social activists need not despair, for an opportunity may appear that is more favorable for launching and executing a successful campaign. Such moments of “rhetorical opportunity” may be brief but they are real, and they can be successfully used to create genuine social change (e.g., Conrad & Millay, 2001).
Beyond focusing on important moments in time that provide opportunity, this case reaffirms the need to address key audiences most likely to take action on the issue at hand. Rather than attempting to communicate with an indifferent mass public about an initiative for social change, activists must recognize that the audiences that are predisposed to or have a prior interest in the topic are most likely to respond to campaign messages (Mendelsohn, 1973). Social organizing requires that one prioritize the audiences for targeted communication. As the resources of social organizers will invariably be smaller than well-financed opponents, grassroots organizing must be judicious in mobilizing its base. On the basis of advice of national experts, it was determined that college-educated women with children constituted the most receptive audience for the Kentucky excise tax initiative. Using this strategy enabled KHIK to mount a credible level of legislative contact with a relatively small audience and, thereby, allowed for a much more efficient expenditure of campaign resources.
This case study also points to the growing importance of employing both traditional and non-traditional media to disseminate and reinforce campaign messages (Myhre & Flora, 2000). In particular, this case analysis illustrates the important mix between media in which campaign organizers control the message content (e.g., advertisements, brochures, and Web pages) and mediated messages controlled by others (e.g., news). In previous campaigns and social movements, the traditional news media have been found to play a critical role in increasing awareness and activism (Ryan, Carragee, & Schwerner, 1998). Not surprisingly, these media were of obvious importance here. Especially through newspaper and television coverage, the campaign gained visibility and legitimacy. In part, however, the use of newer media (e.g., Web sites and emails) and traditional media (e.g., printed news releases and media alerts, newsletters, and advertisements), where messages could be controlled by campaign organizers, provided the group with important credibility. The cross-fertilization of messages, in media controlled by the campaign and those controlled by news sources, resulted in a wide dissemination of information. Of particular importance is that this distribution of information resulted in the campaign’s message reaching its primary target audience, women with children, as well as the general voters across the state. In addition, individuals in the target and general audiences likely received the campaign information across multiple media (Myhre & Flora, 2000).
Accordingly, this case illustrates that, even in rhetorically difficult situations, a well-planned, sustained, multipronged campaign can generate positive results. For example, although House Bill 677 was not successful, public awareness was increased, positive publicity and news coverage were generated, grassroots support was mobilized, and key legislative and public supporters signed on and pledged their support for future campaigns.
As noted in this and other studies of social change (e.g., Conrad & Millay, 2001; Esrock, Hart, D’Silva, & Werking, 2002; Hallahan, 1999; Pezzullo, 2001; Ryan et al, 1998), message framing is crucial. This case study illustrates the importance of initial framing. Successful campaigns must have both a consistent message strategy and flexibility in adapting their messages. When a public is cynical, apathetic, or fails to see the importance of an issue because its members are enmeshed in it, the initial message frame and the subsequent reframing are critical in securing interest. One potentially successful message strategy involves placing the issue in an emotional context that will move people to take action (Hart, Esrock, D’Silva, & Werking, 2001). Although beyond the scope of this case study, future research should explore such framing and message strategy in depth. For example, Conrad and Millay (2001) examined how groups can co-opt and capitalize on the rhetorical positions of their opponents. Their study illustrates how the rhetorical flux of public discourse allows openings for new message strategies to take hold and redefine collective thinking. Understanding of such processes can be further developed by more in-depth analyses of this type. Examples such as the KHIK case would appear to be excellent for longitudinal analysis as the issue is reframed and the campaign evolves over the coming years.
From this framing perspective, Kentucky ACTION appears to have an important advantage that can be used in the future. The organization and its causes (tobacco control, generally, and the excise tax, specifically) provide a natural dichotomy on which it is easy to take a moral stance. KHIK is on the “right” side and can capitalize on its “noble” purposes, when compared to the “sinister ploys” of big tobacco. Whereas anti-government and pro-smoking opposition argue that government regulation and taxation should not be employed as instruments for social change, a strong segment of the public and media are sympathetic to anti-smoking/public health messages, especially when the frame of protecting children from tobacco addiction and exploitation is employed.
Despite ACTION’s ongoing efforts and successes, Kentucky continues to fall further behind a more tobacco-conscious nation where other states are making more progress with higher excise taxes and well-funded education, control, and prevention and cessation programs. Relatively speaking, Kentucky still has inflated smoking (and lung cancer) rates and a lagging cigarette excise tax. The remaining task for KHIK is to educate, persuade, and motivate sympathetic citizens to overcome opposition to the excise tax proposal.
Even with the progress being made at the national level, public health advocates warn that tobacco continues to have massive negative effects both in the United States and around the world. After reviewing recent research findings about the toll of tobacco from the American Medical Association, a national newspaper for physicians opined, “The message can be summed up in one sentence: Despite some positive developments, the tobacco picture is very grim, and much more work remains to be done” (American Medical News, 2002). Therein, perhaps, lies the ultimate lesson for any group seeking social change: Although progress can be made, sustaining change means that an activist’s work is never truly completed.
*Authors' Note: Stuart Esrock, Joy Hart, and Greg Leichty are Associate Professors in the Department of Communication at the University of Louisville. Contact Information: E-mail: email@example.com, firstname.lastname@example.org, email@example.com
1. The Master Settlement Agreement (MSA) settled the lawsuits between the states’ attorneys general and the major tobacco companies. This agreement includes restrictions on marketing and advertising and compensated states for tobacco health-related costs (e.g., through Medicaid). For example, Kentucky is receiving several hundred million dollars from this settlement over a 20-year period, and there has been considerable dispute among various political constituencies as to how these monies should be allocated. Kentucky ACTION has advocated spending a portion of this funding for the purposes of tobacco education and control.
2. These news stories and editorials were randomly selected from KHIK’s campaign press file. This file was virtually exhaustive of all print articles published in the Kentucky press.
3. Medicare and Medicaid are U.S. national health care programs. Medicare covers the aging and people with disabilities. Medicaid covers people with low incomes.
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