TEPP tried to get the long form anti-tobacco clips they made into the movie theaters, but at the time the theaters would not put Public Service Announcement anti-tobacco commercials before movies.Riester’s contract with TEPP was set to expire December 2000, but because TEPP was so impressed with Riester’s performance, TEPP extended the contract another 6 months before bidding for TEPP’s next five-year media contract commenced. The Tobacco Merchants Association newsletter said this delay in opening the bidding process on the new media contract would “anger the agency’s competitors who were hoping to bid for the contract when it was due for review.”Because of the widespread recognition of Riester’s campaign,the agency seemed poised to renew their contract. However, in June 2001 ADHS awarded the E.B. Lane advertising firm TEPP’s media contract. Riester was shocked at the decision,especially since E.B. Lane was the highest bidder for the contract, taking 17 percent of TEPP media money in fees, compared to roughly 10 percent Riester proposed for their continued campaign.The five-year contract had at the time an estimated billing of $7 to $10 million in advertising and $3 to $5 million in public relations per year, making it the most lucrative media contract in Arizona.156 Beau Lane’s firm teamed with eight specialty firms that focused on regional advertising and specific market segments, specifically, ethic minorities. Lane called the multicultural components of their proposal “absolutely key” to winning the bid.Riester, along with the Moses Anshell advertising agency,grow tables for greenhouse which had also bid for the contract, filed complaints in July 2001 over the bidding process conducted in June 2001, challenging the seven-member evaluation committee’s decision to award TEPP’s media contract to E.B. Lane.They objected that “the state did not follow its own evaluation criteria and did not keep records of how committee members scored their bids.”
The highly funded Riester advertising campaign in Arizona led some legislators and pro-smoking advocates to attack TEPP’s expenditures, arguing that the media campaign was extravagant. This argument appeared in a November 2001 speech in which Gov. Hull told the Arizona Legislature, in an effort to shift $10 million a year in TEPP’s advertising budget to general health programs, “I don’t want one child to even start [smoking]. But when it comes down to either a new anti-smoking slogan or a doctor visit for a sick patient at the state hospital, in my book the patient comes first.”In this address Hull proposed the Legislature strip $60 million from TEPP over 5 years to pay for much needed services and to keep the state fiscally afloat. Hull’s comment is a standard pro-tobacco rhetorical strategy used against media campaigns.ADHS senior staff told TEPP employees that the reason they chose E.B. Lane over Riester was because “their company and their sub-contractors they worked with were more culturally competent. They had subcontractors that worked with Hispanics, they had subcontractors that worked with Native Americans…”The changing of contracts was seen internally as taking TEPP contract funds and “spreading it around” to other agencies, to let Arizonan know TEPP was not defined by a single slogan or advertising scheme.19 Because of the imbroglio surrounding TEPP’s lack of transparency in their media contract decision process and their repeated RFP process due to irregularities, the transition to E.B. Lane as the succeeding media contractor was rocky. The perception that E.B. Lane received the contract due to Cathy Bischoff’s personal politics and that “Cathy picked them out” because Bischoff could not handle Riester’s creative independence, reinforced the negative association between a new era of micro-managing in TEPP and a less edgy media campaign with E.B. Lane.During FY2002, the year the media campaign roughly transitioned from Riester to E.B. Lane, TEPP aired far less anti-tobacco advertising.
Not only had they already used the advertisements they had developed, but the legislative budget diversions made TEPP leadership overcautious of overspending their halved budget . Nonetheless, a 2005 CDC Morbidity and Mortality Weekly Report found that out of 37 states, Arizona was ranked ninth highest in monthly anti-tobacco television advertisements seen by adolescents aged 12 to 17 between the years 1999-2003,160 indicating that even with the lack of media in FY2002 TEPP still had a relatively high tobacco control media presence. Figure 12 shows the pronounced drop in 2002 and 2005 in radio and television anti-tobacco messaging perceived by Arizonans. This drop in visibility likely had an impact on youth initiation of tobacco use. Youth prevalence increased as anti-tobacco media diminished between 2002 and 2005, according to the Arizona Tobacco Survey and the Youth Tobacco Survey.8, 109 With less spending on media and a less aggressive marketing strategy, thousands of youth started smoking that would not have had TEPP’s mediathe campaign.To TEPP’s credit, it ran smoke free media spots the summer before the 2006 November elections, although this a case of tobacco control advocates leading TEPP into action rather than TEPP taking the initiative. As of September 2007, a Maricopa County Tobacco Use Prevention Program /Arizona Fire Department three minute counter advertisement available on TEPP’s website, mentioned for the first time in TEPP history the tobacco industry’s efforts to get kids to smoke.It was not clear if the advertisement will be made into television commercials or used for other purposes. Like California’s early “Industry Spokesman,” this gesture toward using messaging proven to be effective in preventing youth tobacco initiation was a step in the right direction, even though as of December 2007 TEPP did not have an integrated media campaign.TEPP’s media campaign, despite its early acclaim from FY1997-FY2001, has failed to effectively keep up with Arizona’s tobacco prevention and cessation needs. Changing from the Riester firm which concentrated heavily on visually and emotionally impacting prevention television and radio campaigns tied in thematically with local projects to E.B. Lane’s focus on many separate smaller campaigns targeting specific demographics, dissipated public discussion and awareness of TEPP’s messages.
With the TEPP budget diversions cutting into media expenditures more than any other area, media contractors had fewer opportunities to maintain the public “buzz” the FY1997-2001 campaign generated.The local projects and the media campaign are TEPP’s main programmatic components benefitting the public. Not only are local projects the main point-of-service for cessation, prevention, and education, but they reach disparate populations and inform their local communities about tobacco control. Yet in 2006, even these basic elements only provided minimum services, with no solid media contracts or cohesive anti-tobacco campaign tying together TEPP’s various efforts. Except for periods between FY1997 and FY2001, when TEPP local projects used Riester’s media campaign as their thematic basis, coordination between the statewide media campaign and local TEPP projects has always been tenuous,grow tables for wheels as the local projects often did not have a message tied in with the statewide media campaign. County Health Departments provide the bulk of TEPP’s tobacco control services, from educating in schools about the consequences of smoking, to providing cessation services, to addressing workplace smoking and secondhand smoke issues. Starting in 1999, when programmatic content restrictions were lifted, TEPP made it a priority to provide outreach to disparate populations to reduce the burden of disease, and created a variety of programs targeting these groups that were less targeted by TEPP’s mass media approach. For example, Ashes-to-Ashes, a group providing outreach to African-American communities, attends relevant events and works with community organizations to help African-Americans address tobacco issues.In Pima County alone, Arizona’s second most populous after Maricopa, several groups work in tobacco control including Tobacco-Free Ways and Students Working Against Tobacco , in addition to the county health services and minority outreach programs. The Promotores de Salud represented one of TEPP’s flagship local projects active from 1996 through 2007. The Promotoras system of community health workers and health educators was especially strong in Yuma county. The Promotoras, operating largely in Arizona’s rural farming communities and border towns such as Dateland, San Luis, Somerton, Wellton, Cochise County, and Yuma, are voluntary lay health workers in the orchards and fields, guided by the model’s creator, Emma Torres . Originally funded by the Farmworker Justice Fund, through TEPP’s Arizona Cessation, Training, and Evaluation program, the Promotoras provide tobacco cessation services in the field to underserved Hispanic and Native populations, bringing cultural competence to tobacco prevention and cessation in this marginalized population.TEPP engaged the Promotoras because of the opportunity for people who lived in the community to deliver the message.
Funding for Promotoras tobacco control from TEPP has decreased since 2000, and in the second half of 2007 the Promotoras received no TEPP funding. More than a reflection of the program’s merit, this funding cut reflected TEPP’s shift in leadership with a new staff and priorities. Grassroots tobacco control programs and organizations providing prevention and cessation services flourished when they were fed resources, both financial and informational, by TEPP. Nonetheless, the local projects were barred from advocating for clean indoor air ordinances, leaving this work up to independent tobacco control advocates, private foundations, and the voluntary health organizations.TEPP provides direct cessation services, including the Arizona Smoker’s Helpline and programs through county health care facilities that subsidize pharmacotherapies for cessation and provide counseling. ASHline, operated by the University of Arizona since its inception but funded by TEPP after FY1997, fields all of the quitline calls in Arizona in English and Spanish.ASHline provides recorded information, live phone counseling, and referral services to community-based classes offered once a week in each county. While the ASHline came under TEPP’s umbrella since TEPP’s beginning, face-to-face counseling classes and pharmacotherapy cessation services did not start until 1998. Before 1998, ASHline’s services were largely informational. ASHline received roughly $1.3 million annually during FY1997-2007 for telephone and related internet quit services, with between 9,000 and 12,000 calls per year, with 6,000 of these becoming new cessation clients . In 2001-2002, 43% of current smokers said they tried to quit in the last year, according to the Arizona Adult Tobacco Survey,and in 2005 46% of smokers reported they tried to quit during the last year.In 2003, 15% of all TEPP cessation clients reporting in year follow-up surveys that they had not used tobacco in the last 30 days.However, in FY2005 and FY2006, only 10% of cessation clients were still quit after three months.TEPP’s prevention and cessation efforts are also coordinated with the quitline. The Arizona Cessation Training and Evaluation project served as TEPP’s cessation training consortium from 1997-2003. ACTEV followed evidence-based guidelines for smoking cessation published by the Agency for Healthcare Research and Quality and coordinated these efforts through a triuniversity consortium of Arizona State University, the University of Arizona, and Northern Arizona University. When ACTEV was eliminated in the program cuts in FY2002, cessation certification was outsourced to the University of Arizona under a streamlined version termed Health Care Partnerships. Only in FY2007 did the Health Care Partnership begin treating as many cessation clients as ACTEV did preFY2002. The Healthcare Partnership “provides evidence-based, tobacco dependence treatment continuing education, certification, and training programs that are adapted for a variety of communities.” Implemented by the University of Arizona, the Healthcare Partnership holds workshops and trains healthcare professionals in smoking cessation skills, including their courses Tobacco 101 and a three-tiered training program for cessation specialists. This cessation training program is given to all local projects contractors, and provides Promotoras and other health service providers with the specific knowledge and techniques to address tobacco control, focusing on prevention and cessation. As elsewhere, when Arizona actively advertised ASHline services, TEPP gained significantly more cessation clients than during periods without publicity. ASH received few calls between August and November 2006 because TEPP cessation services were reduced after TEPP lost its previous Office Chief. Yet after the success of Arizona’s statewide clean indoor air act and the subsequent cessation media campaign run by TEPP for smokers who wanted to quit as part of their New Year’s resolution, calls to ASH and requests for cessation services reached close to 500 in the first week of January2007 with the ad campaign running.In comparison, ASH received roughly 160 calls a week during the same period the previous year. In 2007 TEPP successfully attracted more smokers to ASH , and because of statewide policy changes and tobacco tax increases, more smokers sought TEPP’s cessation assistance.