Discrimination against European Americans in Anti-Tobacco Funding

Request to Amend Section 104360 H & S Code due to its racially discriminatory effects on European American (“white”) youth and adults, as evidenced by the administration of anti-tobacco programs.

I. The Law.

A. Proposition 99, a California Initiative was passed by the voters in 1988 to collect an additional tobacco sales tax and use the monies to counter the devastating effects of tobacco use by all of its citizens.

Prop. 99, in part reads:

“Section 2---(e) To reduce the incidence of cancer, heart and lung disease and to reduce the economic cost of tobacco use in California, it is the intent of the people of California to increase the taxes on cigarettes and tobacco and do all of the following:

(1) Reduce smoking and other tobacco use among children.
(2 ) Support medical research into tobacco-related cancer, heart and lung disease.
(3 ) Treat people suffering from tobacco related diseases.
(4 ) In recognition of the uncompensated costs of tobacco-related illness, support treatment of patients who cannot afford to pay for services.”

B. Section 104360 H & S Code, is the 1989 State enabling legislation that was written, passed and became operative, and reads in part:

“The following target populations, at a minimum, shall be the focus of the campaign implemented pursuant to this article:

(a) School-age youth and their families in their schools and in the community.
(b) Black, Hispanic, Native American, Asian-Pacific populations, pregnant women and current smokers*.” (emphasis added).

The definition of “current smokers” was amended by the Center for Disease Control in 1992 and amended by the California TCS in 1996, to mean a positive response to the question: “Have you used or smoked a cigarette in the past 30 days? Even if you have taken only one puff of a cigarette you would be considered a “current smoker”. According to Bill Ruppert, Chief Data Analysis and Evaluation Unit this new definition “is probably more of a test of experimentation”. He wrote that the new definition caused the prevalence to go up one percentage point. (Attachment A ).

II. INTRODUCTION

Our American concept of equal treatment and fair play demands that all racial, ethnic, and gender groups in American be equally protected from the devastating effects of tobacco use, and to enjoy the full benefits of Government funded programs.

Unfortunately, this report appears to indicate that some government and non-profit agencies focus far less on the problems of European Americans (“whites”) than they do on other groups, and in some cases those groups use tobacco at lower rates.

Good health for all Americans should be the goal of government and non-profit agency programs, especially when those programs are government funded. We are hopeful that this report will help bring that concept to its true fruition.

A. What this Report will Reveal:

1. When the State legislature passed Section 104360 H&S Code in 1989, the daily cigarette smoking rate among high school seniors for “white” students was 21.7% and for black students 6.%. The legislature failed to list “whites” as a “target population” for anti-tobacco programs, at a minimum. while listing “minorities” with lower rates as “target populations”.

Ironically, by 1993 the rate for black senior high school students had decrea sed to 4.4% while the “white” rate increased to 22.9%. ( MMWR CDC Surveillance Summaries, November 18, 1994 Vol.43/No.SS-3 (Attachment B).

2. Although European Americans (“whites”) have the highest rates of smoking of the major racial/ethnic groups in California, for both adults and youth, (See Attachment I & J), the California Department of Health Services, Tobacco Control Section (TCS) is currently offering grants of $300,000-$600,000 and will “give first funding priority to to the four major ethnic groups by reserving the right to award a minimum of two applicants within the African American, Asian Pacific Islander, American Indian and Hispanic/Latino population groups, prior to awarding to other special population applicants.” ( Attachment C )

3. Although the African American senior high school students smoking rate was dramatically reduced from 26.8% to 4.4% between 1976 and 1993, and “white” students only reduced their smoking rate from 28.8% to 22.9%, during the same period, the CDC has not funded a study to determine why that occurred. (See Attachment B).

Yet the CDC was willing to fund a study because of the disparity of rates between black male and female rates of smoking. (See Attachment D-2).

4. News story, San Jose Mercury News April 28,1999, “Smoking rises among minority teens.” Surgeon general’s report warns of “time bomb” for young tobacco users.” “The report on minority smoking habits looks at four ethnic groups; blacks, Hispanics, Asian-Pacific Islanders and American Indians/Alaska Natives.”

“Smoking among black teens has increased 80% over the past six years, three times as fast as among “white” students, the report said.” (Attachment E.)

However, the Surgeon General’s report did not mention that the Institute for Social Research, University of Michigan shows that rates of smoking for high school seniors in the United States , between 1992 and 1997 increased from a rate:

“Whites” 31.8% to 41.8%
Blacks 8.7% to 14.3%
Hispanics 25% to 26.6 percent
in that six year period.

The actual increase between 1992 and 1997 was, “white”+8.9%; black+5.6%; Hispanic+ 0.9%. “Whites” had the greatest increase: +8.9%. (Attachment F ).

An October 29, 1999 report for 1998, indicates that the youth rates for current user high school rates are: “whites” 78.6%; black 43.3%; Hispanic 53%. Frequent users, meaning smoking 20 of the past 30 days showed significantly higher rates for “whites”-65% as compared to blacks- 23.5% and Hispanics at 24.1%. ( Attachment F-1).

Comment: There appears to be less concerned about the significant differences in both current smoker rates and the frequency user rates between “whites” and other racial/ethnic groups when “whites” have the higher rates.

III. California Situation and an Appeal to State Senator Jackie Speier.

Senator Speier’s letter, dated December 17, 1999 indicates that Doug Robins, California Health Program Specialist, Tobacco Control Section (TCS) assured the Senator’s office that Section 104360 H&S Code “ in no way deters their outreach efforts away from European American youth”. (Attachment G).

Also attached was a letter, dated November 24, 1999 from Donald O. Lyman, M.D. Chief, California Division of Chronic Disease and Injury Control to Senator Speier, wherein he verifies that Section 104360 H&S Code, written in 1989 lists “...blacks, Hispanics, Native-Americans and Asian Americans” as “target populations”, at a minimum.” Note: European Americans “whites” were not specifically listed as a “target population”. (Attachment H ).

IV. European/American Issues Forum Disagree with the TCS Office.

A. When the State legislature passed Section 104360 H&S Code in 1989, the daily cigarette smoking rate among high school seniors for “white” students was 21.7% and for black students 6.%, and yet the legislature failed to list “whites” as a “target population” for anti-tobacco programs, at a minimum. while listing “minorities” with lower rates. By 1993 the rate for black senior high school students had decreased to 4.4% while the “white” rate increased to 22.9%. ( MMWR CDC Surveillance Summaries, November 18, 1994 Vol.43/No.SS-3
(See Attachment B).

V. Tobacco Use Statistics, 1998*

Adults Youth 12-17 years old.
"White" 20.4% 12.4%
Blacks 19.2% 04.0%
Hispanics 15.4% 10.2%
Asian/Other 13.8% 09.5%

*Prepared by the California Department of Health Services, Tobacco Control Section, August 13, 1999 (Attachment I and J )
Note: Bill Ruppert cautions that the above are telephone interviews and school surveys would be approximately double. (Attachment J1)

VI. Smoking Related Lung Cancer Death Rates, 1995*

A. Racial breakdown of death rates, per 100,000 of male American smokers, and who contracted lung cancer, 1995:

“Whites” 53.7
Blacks 80.5
Hispanics 25.8
Asia/Pacific Islander 25.2

*National Center for Health Statistics ( See Attachment E )

B. Number of Smokers by race in Millions.

According to CDC’s 1993 Tobacco Information and Prevention Sourcepage, there were 39.1 million current “white” smokers, 5.5 million black smokers and 2.9 million Hispanic smokers in the United States. (http://www.cdc.gov/needphp/osh/tab_3.htm (Attachment K)

As a rough estimate:

If there are approximately 19.5 million current “white” male smokers and a mortality rate of 53.7 per 100,000, there would be 537 per million deaths x 19.5 million male “white” smokers or 10472 white male lung cancer deaths per year.

And even if we counted ALL 5.5 million current black smokers as males, at a mortality rate of 80.5 per 100,000, there would be 805 per million deaths x 5.5 million male smokers or 4,428 black male lung cancer deaths per year.

That is about 2 ½ “white” male deaths for every black male death.

VII. Current Anti Tobacco Grant Funding NOT Directed to ”Whites”.

Notwithstanding the tremendous disparity in senior high school racial smoking rates (MMWR CDC’s Surveillance Summaries, (Attachment H ) , and California Department of Health Services, Tobacco Controls Section’s own prepared statistical reports that indicate that both “white” youth (12-17 yrs.) and “white” adults have a higher rate of smoking (Attachment I & J) they are currently offering Grants that focus on major racial/ethnic groups, other than European Americans (“Whites”), as follows:

The California Tobacco Control Section is currently accepting bids for funding grants between $300,000 and $600,000 for Fiscal years 2000-2001, 2001-2002 and 2002-2003. RFA TCS-00-101.

The Notice for application titled , FUNDING ALERT, October 8, 1999 reads in part, “...The purpose of this RFA is to fund projects that reach California’s special populations, such as racial/ethnic communities, socio-economically disadvantaged populations, Eastern European immigrants, gay/lesbian communities and others. Funding preferences will be given to applications that promote community norm change interventions.” ( See Attachment L ).

The Request for Application (RFA TCS-00-101) page 1 reads: “The California Department of Health Services/Tobacco Control Section (CDHS/TCS) will give first funding priority to the four major ethnic groups by reserving the right to award a minimum of two applicants within the African American, Asian Pacific Islander, American Indian and Hispanic/Latino population groups prior to awarding funds to other special population applicants. (See Attachment C ).

Note: The TCS offered a workshop on Grant Writing for #RFA-00-100 and 101 at the Radison Hotel, Sacramento 12/14/99, presented by Todd Rogers, Ph. D, Stanford University—Consultant to TCS. “The workbook Writing Your Application for Funding” was funded by the TCS with Proposition 99 Funds. Page #2 recommends talking to Ethnic Networks. Calabro asked Doug Robins if there were Networks for European Americans (“Whites”) and he answered in the negative. (See also Attachment M )

Comment: European Americans (“Whites”), California’s major racial/ethnic group, with the highest and similar rates of smoking does not have a network to assist them, but other racial/ethnic groups do have networks that appear to be encouraged and supported by the Tobacco Control Section.

Note: On 12/29/99 Bill Ruppert of the California Department of Health, Tobacco Control Section faxed a document that indicates that both “white” adults and “white” 12-17 year olds have a HIGHER tobacco use rate than any other racial/ethnic group, but no funding priority. ( See Attachment I & J)

VIII. Other State Funded Anti-Tobacco Programs NOT directed at “whites”.

Robin Shimizu of the California Health Department, TCS provided the European/American Issues Forum, by telephone, with tobacco use statistics for adults and youth (12-17 yrs.) in 1997 as follows:

Youth—White-14.4%; black-2.9%; Hispanic 10.9% ; all other 8.4%.

Adults—”white” 19.1%; black 22.9%; Hispanic 15%; all others 17%.

Ms. Shimizu told me that the TCS specifically targeted and expended the following funds for anti-tobacco programs as follows:

1) $1.2 million for Asian Pacific Islanders,

2) $1 million for African Americans and

3) $1.7 million for Hispanics, and

No money or programs for anti tobacco programs specifically targeting “whites”, notwithstanding their having the highest youth smoking rate and next highest for adults. She told Calabro he should tell here where to spend money on “whites”, and that their funds were limited.

IX. Federal Funded Research for Minorities, not for “whites”.

A. A major concern we have is that according to CDC report “MMRW, CDC Surveillance Summaries” , Table 12, page 34 the daily cigarette smoking rate for African American high school seniors dramatically decreased from 26.8 % to 4.4% between 1976 and 1993 while the “white” high school senior rate decreased from 28.8% to 22.9% and yet no one has made a study or report to determine why the “white” students continued to smoke at such a high rate, and why the African American students rate dropped so dramatically. The black students rate decreased by 83.6% while the “white” rate decreased by 24%. That is a significant difference that should be noted and studied. T argeted by the tobacco industry and it not being noted? (See Attachment B above).

Editorial Note: CDC funded research to help explain the differences* between the current smoking** of non- Hispanic black males who’s rate nearly doubled from 1991 (14.1%) (1) to 1995 (27.8%) , but among non-Hispanic black female students remained stable (11.3% in 1991 [1] and 12.2% in 1995). [ Tobacco Use and Usual Sources of Cigarettes Among High School Students US-1995, CDC, Morbidity and Mortality Weekly Report, May 24. 1996, Volume 45, No. 20. pages 413-418. ] (See Attachment D-2 )

CDC did not fund research to explain the dramatic smoking rate change differences that occurred between “white” (28.8%) and black high school seniors (26.8%) in 1976 to 1993 smoking rates for “whites” of (22.9%) vs. blacks (4.4%).
( See Attachment B )

**Note: In 1992 the US CDC definition of current smoking** was changed to include students who reported product use on 1 or more of the 30 days preceding the survey. “Whites” show a higher daily tobacco product use in a 30 day period, than any other racial/ethnic group. (See Attachment A above)

**Note: In 1996, California changed their definition to fit with US CDC definition. Bill Ruppert, Chief of TBS Data Analysis and Evaluation Unit wrote that defining a one day tobacco use in 30, as a current smoker is more properly a “test of experimentation.” and therefore not a current smoker, as previously defined. He wrote that it added one point to the prevalence rates. (See Attachment A ).

X. Lack of Interest for “white” Tobacco Users.

A. From our experience, neither government or private non-profit agencies appear interested in the tremendous disparity in smoking rates between the two racial groups, and they continue to show interest in African American and other “minority” youth, but not with European American youth. Below are some examples:

1. Three federal examples of attention to “minorities” are as follows:

a) The report “Preventing Tobacco Use Among Young People”, A Report of the US Surgeon General, Chapter 5-Tobacco Advertising and Promotional Activities” does not mention European Americans tobacco users, but specifically studied “Ads that Target Blacks” and women. (US Printing Office, S/N 017-001-00491-0) (Attachment N ).

b) At a Glance: “Tobacco Use Among U.S. Racial/Ethnic Minority Groups”

A Report of the Surgeon General 1998, studied African Americans, American

Indians and Alaska Natives, Asian Americans and Pacific Islanders and Hispanics, but NO study about tobacco use among “whites”, even though the report clearly indicated:

“ Most African American, Asian Americans and Pacific Islanders and Hispanics smokers smoke fewer than 15 cigarettes a day. Heavy smoking--25 or more cigarettes a day—is most common among American Indians and Alaska Natives, but still lower than among “whites” who smoke.” ( emphasis added) (Attachment O).

This must be taken into account now that the new Federal and State definition for “current smokers” includes people who smoke one day in 30 days.

c) “Surgeon General’s Report Warns of Health Reversals as Minority Teen Smoking Increases” 4/28/98 The report indicates”... “Rapid increases in smoking by minority teenagers threaten to reverse the progress against lung cancer among minority populations which was made during the early 1990’s.” * (Attachment P )

However, the Institute for Social Research, University of Michigan shows that rates of smoking for high school seniors in the United States , between 1992 and 1997, increased from a rate of 31.8% for “whites” to 41.8%; blacks from a rate of 8.7% to 14.3% and Hispanics from a rate of 25% to 26.6 percent in that six year period. The actual increase between 1992 and 1997 was, white+8.9%; black+5.6%; Hispanic+ 0.9%. “Whites” had the greatest increase: +8.9%. ( See Attachment F ).

Note: We Need to Study “white” high school senior smoking rates.

Respectfully, we call the Surgeon General’s attention to the fact that there appears to be a significantly higher rate of tobacco use by “white” teenagers, and that should generate concern for an seeking an answer as to why their rates have remained so high while African Americans teen smoking rates were reduced by 6 times, between 1976 and 1993. (See B above)

2. Two examples of State Program attention directed to “minorities” :

a) Newspaper item, “Anti-Smoking campaign focuses on minorities”—” A state-sponsored anti-smoking ad campaign aimed at California’s large communities of Latinos, blacks and Asians will take to the airwaves and billboards next week, health officials said Thursday.” ( San Jose Mercury News, July 18, 1997) (Attachment Q ).

b) Newspaper item, “Anti-Smoking campaign pays off for Viet males- 2 year drive results in 6% fewer smokers, UCSF study shows.” (SJ Mercury News. July 29, 1997) (Attachment R).

3. Three San Mateo County Programs direct attention to “minorities” :

a) Anti-Tobacco program grants were made for Daly City,

2) East Palo Alto and
3) Pilipino Bayanihan Resource Center. Total $35,000. (January/June 30, 1997) (Attachment S ). (All basically minority communities).

Note 1: San Mateo County Press Release December 31, 1997 reports that “White high school junior smokers are the heaviest users with 21% reporting that they smoked on a regular basis during the last 30 days... We have statewide data that shows that the tobacco industry is specifically marketing its products to ethnic communities***, according to Edith Cabuslay, Project Director of the San Mateo County Tobacco Prevention Program. We concentrated a lot of our efforts on counteracting tobacco industry influences in ethnic communities. The survey shows that we may have forgotten a large portion of the student population, which is now smoking in increasing numbers.” (Attachment T ).

***Comment: If the state indicates that “white” students are smoking at the highest rate for all racial ethnic groups, and a correlation has been established between tobacco use and advertising, how is it that the state has not provided data showing that the tobacco industry has been targeting the heaviest smokers who are “white”. (See Attachment J).

Note 2: The San Mateo County Anti-Tobacco Coalition indicates the race of the member organizations representative. Most are listed as “Caucasian” (“white”), and yet it appears that “white” students were “forgotten”? See Note 1 above. (Attachment U).

4. Two Non Profit Programs direct attention to “minorities” & women:

a) “The American Heart Association, American Lung Association and the American Cancer Society as the Coalition on Smoking supports legislation that seeks to restrict or prohibit unregulated tobacco advertising, promotion and advertising to young people, minorities and women.” * “Tobacco Industry’s Targeting of Minorities and Women”. (Attachment V ).

But, why do they Not seek to prohibit promotion and advertising for “white” males?

b) The American Heart Association itself has written that improvement in health benefits from quitting smoking increases life expectancy by 5 yrs. for males vs. 3 yrs. for females and the US Department of Health and Human Services reports that men’s death rates from smoking are twice the rate of women and yet, there is little focus specifically on the issue of men and smoking. (Attachment W and X).

Note: Prevalence of “Smokeless” Tobacco Use by “whites”.

The U.S. Department of Health and Human Services, Morbidity and Mortality Weekly Report, May 24, 1996, Volume 45, No.20, pages 413-418 indicates that the percentage of high school students use of smokeless tobacco by “whites” to be 14.5 %, blacks-2.2% and Hispanics 4.4%. (Attachment Y).

XI. R.J. Reynolds Company “Joe Camel” Court Settlement.

The European/American Issues Forum issued a News Release, September 16, 1997 concerning the R.J. Reynolds Company, Joe Camel Campaign Settlement seeking documents from Judge Paul H. Alvarado’s court to identifying the intended targets for the Joe Camel Campaign. Letter to Judge Alvarado. (Attachment Z-1 and Z-2 ).

A. Reports Indicates “whites” and Hispanics smoke Camel Cigarettes.

1. Table 13, 1994 US Surgeon General’s report of 12-18 year olds, “Teenage Attitudes and Practice Survey, US”, indicates that in 1989 “whites” preferred Camel’s 8.4 % vs. black 3.1% and Hispanic 7.6%. A later survey indicate a higher use by “whites” and Hispanics and lower use by blacks. (Attachment Z-3).

2. Table 1, “Teenage Attitudes and Practices Survey II, 1993” of current smokers indicates that “whites” smoke Camels at 14.4 % of the time compared to other brands, blacks at “0” and Hispanics at 10.1%. ( MWWR Vol. 43, No 32 August 19, 1994, US Department of Health and Human Services, Public Health Service. ( Attachment Z-4).

There are ample studies that show a correlation between advertising and promotion of tobacco products and tobacco use, and it would appear that the higher use of Camel cigarettes by “whites” and Hispanics is an indication that they were most often the targeted population by R.J. Reynolds Company during their “Joe Camel “ campaign. Therefore it seems reasonable that the settlement monies should be spent on anti-tobacco programs on those who were targeted; “whites” and Hispanics.

B. California Counties NOT interested in using Settlement monies for anti-tobacco programs for the targets of the Joe Camel campaign.

1. We wrote to the ten California counties involved and requested that the settlement monies be spent for anti-tobacco programs targeting European American and Hispanic youth, since they were the target of the campaign. San Mateo Supervisor Richard Gordon indicated he would support our request, but that has not happened according to the Tobacco Control Section of the San Mateo County Health Department. The other counties were not interested.

XII. Conclusion

It appears that from the documentation in this report that there may be problems in the area of equal attention to all racial, ethnic and gender groups in some of the Anti-Tobacco Programs and institutions responsible for administering them. Amending Section 104360 of the Health and Safety Code will move our system to be more equitable.

XIII. Recommendations

1. We respectfully request that the office of Honorable Senator Jackie Speier prepare and introduce a bill into the California Senate that will amend Section 104360 Health and Safety Code to specifically include European Americans as a “target population”, at a minimum, for anti tobacco programs.

2. That a bill be prepared and introduced to study the negative health impact upon European Americans caused by the alleged racial discriminatory administration of the State of California’s Anti-Tobacco Programs.

3. That a Resolution be prepared and introduced to seek a California Attorney Generals investigation to determine if there has been a deliberate and contrived effort to misappropriate Proposition 99 cigarette tax funds to disfavor European Americans, who continue to suffer from the cruel and devastating effects of smoking and chewing tobacco.

Prepared by:
Louis Calabro
President EAIF
January 7, 2000

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