Dillenberg initially argued that restricting the program’s scope occurred as a byproduct of the limited funds. However, Dillenberg may have been forced to limit the scope of the campaign by Governor Symington’s attempts to sabotage the program.In a 2006 interview, Matt Madonna, one of the key members of the 1994’s Arizona for a Healthy Future coalition that created TEPP, said, “there was a time when the [ADHS] chief was a puppet of the governor [Symington] and the governor was not in favor of doing anything that was going to block tobacco… We had to focus on pregnant women and children and that [decision] came right out of the governor’s office [emphasis added].”TEPP’s central administrative staff in Phoenix comprises its structural core, while TEPP services mainly operate through local projects at the county level and statewide contractors for media and evaluation . During its period of the high per capita funding from FY1998-2001, the US Centers for Disease Control and Prevention reported that Arizona smoking prevalence dropped rapidly , from 23.1% in 1996 to 18.3% in 1999.The CDC also noted that the decline in smoking occurred across low income and low education groups, decreasing health disparities. The Arizona Adult Tobacco Survey comparisons by the ADHS led the CDC in the 2001 Mortality and Morbidity Weekly Report to write: “On the basis of these findings, if all states implemented comprehensive programs similar to those in Arizona,garden grow table the national health objective for 2010 of reducing the adult smoking rate by half during this decade could be achieved.”One analysis estimated that roughly 61 percent of the reduction in smoking between 1993 and 2002 was due to price increases on tobacco products and 38 percent due to media campaigns.

Our previous report, Tobacco Control in Arizona concluded that despite securing stable funding for TEPP, “health advocates have generally failed to force the state to run an effective anti-tobacco program.”Initially, TEPP was prevented by the Symington administration from collecting baseline data on both youth and adult smoking prevalence before the media program started.Standardization of evaluation and surveillance did not become streamlined and consolidated into a single agency until after 2002 when Proposition 303’s language required TEPP to uniformize its procedures in this area by mandating biennial reports presented to the Arizona Legislature.TEPP since its inception in 1995 experienced a high rate of staff turnover, both among office employees and the Office Chief. Several factors contributed to Office Chief and staff turnover, including uncompetitive remuneration, hiring from within ADHS instead of seeking external applicants, and making the Office Chief position political by having it be an appointed position and at the will of the ADHS director instead of the position covered by the state merit employment procedures. The Office Chief position is subject to removal by executive branch superiors, which has contributed to more conservative and less effective programming, especially regarding media. Jesse Nodora, the second longest serving person in TEPP’s office from 1995-2005 observed in a 2006 interview, “the program went through four office chiefs in my tenure, from Martha Cliff to Rosalie Lopez to Kathy Bischoff to Patricia Tarango. And, you know, oddly enough, none of those people were ever recruited externally, under open searches, which is kind of the typical thing” for government recruitment at the manager-level and above.This lack of external job postings in the hiring process dragged into the equation political alliances and debts from hiring internally, and hindered the Office Chief from furthering TEPP’s aims to their fullest capability.

Especially during the years 2003-2006 when the program was in administrative and financial disarray and turnover was even more detrimental to the organization, the constantly vacant Office Chief position made it difficult for TEPP to sustain a consistent program. While TEPP’s local projects service providers kept TEPP from collapsing, the central administrative decision-making harmed the program and prevented it from being effective. The legislative budget cuts brought programmatic problems which were exacerbated by poor administrative handling of TEPP’s new financial situation, causing the dismantling of more programs than necessary. The Arizona Republic ran stories in 2001 describing how Governor Hull’s proposed TEPP defunding “guts” or “would end the nationally known… anti-smoking campaign.”Then-TEPP Office Chief Cathy Bischoff appears to have taken that prediction as a directive. Disproportionately decreasing the amount spent on media – TEPP’s most effective tool for tobacco prevention – while building up a reserve of unspent funds in TEPP’s Health Education Account weakened Arizona’s tobacco control program more than the actual budget diversions themselves required. As Office Chief of TEPP from 2000-2003 Bischoff played a decisive role in undoing Arizona’s successful tobacco control program. Nina Jones remarked that Bischoff “took a sinking ship [TEPP] and let it sink,”138 refusing to spend TEPP’s available funds on media efforts, and cutting key programs. Bischoff helped create the situation in TEPP as if Hull had gotten her originally requested $60 million from TEPP rather than the actual $32.8 which was transferred. Instead of aggressively sustaining existing programs which had proven successful, Bischoff instead wiped out the Arizona Cessation Training and Evaluation unit, the Arizona Tobacco Information Network, and other effective programs that TEPP developed. When many of these programs were cut, up to a year after the original budget cuts, TEPP had already been voter protected, its funds secured. Yet instead of spending the full revenue it received yearly, TEPP began building up a reserve of unspent funds it could have used instead to maintain and bolster its programs. From 2003 through 2006 TEPP endured large gaps of time without an Office Chief.

While Patricia Tarango filled the Office Chief role from mid-2004 through the first half of 2006, Tarango provided TEPP with only the minimal leadership and programming required to keep it afloat, and from June 2006 to March 2007 the Office Chief position was again vacant. In 2006 ADHS Director Sue Gerard invited TEPP’s oversight committee, the TRUST Commission, to assist in a nationwide search for a new TEPP Office Chief. Gerard also included a higher salary range, which gave tobacco control advocates and ADHS staff optimism they would be able to retain future officers.13 On January 29, 2007, ADHS announced Wayne Tormala as the new Office Chief of TEPP.142 The Bureau Chief Position paid $106,000, increased from previous TEPP Office Chief salaries from 2004 to 2006 of $69,000 and $80,000. While Tormala had no experience in tobacco control, he had worked as the City of Phoenix’s Community Initiatives Coordinator, and was viewed as a leader who could bring disparate members of Arizona’s tobacco control community together. Several TRUST Commission members noted as a positive sign Tormala’s willingness to attend a TEPP-TRUST Commission retreat to help foster relations between the program and the oversight committee. Previous TEPP directors had viewed the TRUST Commission less as an ally to reducing tobacco use and more as a committee they were forced to present reports to. In 2007, TEPP restructured,greenhouse grow tables completely replacing its central office staff, with no employees working in TEPP in 2005 remaining. TEPP also engaged in a lengthy strategic planning campaign, aiming to receive input from all those invested in Arizona tobacco control, such as county health departments, service providers, local project coordinators, and tobacco control advocates. TEPP also changed its name in December 2007 to BTEP – the Bureau of Tobacco Education and Prevention – in an effort to emphasize that TEPP was turning over a new leaf, breaking from the negative connotations some Arizonan leaders linked with TEPP’s history.Arizona’s anti-tobacco counter-advertising has never challenged the tobacco industry and seldom has squarely addressed the issue of addiction. While this policy originally resulted from ADHS Director Jack Dillenberg’s decision,no subsequent ADHS director decisively expanded TEPP’s media campaign to focus on secondhand smoke or tobacco industry manipulation. From 1996- 1998 TEPP focused roughly half of its resources on its media campaign while limiting its focus to pre-adolescent and pregnant women, opening it up to adult cessation in 1998 and nominally to secondhand smoke in 1999. From 1996 to mid-2001, TEPP contracted with Riester~Robb , a Phoenix-based advertising agency to handle its media campaign.

TEPP’s contract was the largest public media contract in the state at the time.Because ADHS Director Jack Dillenberg had limited TEPP’s media audience to only children and pregnant women and their spouses, Riester believed the target audience would best be reached by approaching tobacco as “gross” and disgusting, accentuating dramatizations of the short- and long-term effects of tobacco .Riester’s “teeth-staining, tumor-causing, smelly, puking habit” tagline was widely recognized, and TEPP went on to sell at-cost more than 2 million pieces of the “tumor-causing”- branded merchandise to local projects contractors from TEPP and schools and prevention agencies across Arizona, with substantial sales to other states’ tobacco control programs as well.The “tumor-causing” campaign was highly visible in Arizona from 1996 through 2001, depicting tobacco as a gross habit with severe adverse health consequences. A popular component of Riester’s initial 1996 “tumor-causing” campaign included a Hummer-towed 46-foot interactive traveling anti-tobacco exhibit that youth could walk through termed the “Ash Kicker.” TEPP Office Chief Rosalie Lopez at the time called the Ash Kicker “a pied piper that is leading [children] to a tobacco-free life.”By the end of 1997, 27% of Arizona teenagers had toured the Ash Kicker, and in 1998 Riester revamped the Ash Kicker as a “bio-hazard laboratory under siege from the effects of tobacco,” remodeling the previous version into a decaying human body, diseased by tobacco use.While there is no evidence that the Ash Kicker actually affected the smoking behavior of youth, it did provide media attention and served as a high-profile attraction that would bring youth to anti-tobacco events. Riester’s graphic television commercials contained shocking and humorous images geared toward adolescents. Numerous Riester~Robb commercials won awards and have been used by 38 states and Canada.One of them, “Theater Snacks,” shows a girl, thinking she’s sipping her soft-drink, inadvertently drinking out of her date’s spit tobacco cup at the movies, shrieking in horror as the character in the movie does. “P.P.” shows two boys smoking on a street corner. Their smoke hits the face of their Jack Russell Terrier, which in response urinates on the lit cigarette. “Maggots” depicts a girl who is smoking, who finds that her face soon falls apart and disintegrates with maggots crawling out of her mouth. This advertisement achieved high recall rate and impact on kids but offended a large number of adults. A TEPP employee at the time noted that “‘Maggots’ offended people inside the movement too.”While the target audience, kids, could handle it, the adults could not, and controversy created by the public backlash the advertising agency received reached the point where Riester included a warning announcement before the commercial notifying viewers of the graphic content of the commercial.Because graphic intensity and grossness were thought to be effective in reaching young viewers, Riester’s “Smoking Drill” later created in 2000 elevated these qualities to a new level.The graphically repulsive and gross Riester commercials were effective in getting the attention of viewers , according to evaluations by the University of Arizona for TEPP.The 1999 Arizona Adult Tobacco Survey Report released in May 2000, showed a 21 percent drop in Arizona adult tobacco use prevalence from 1996 to 1999. The ADHS acting director at the time credited Riester’s media campaign as the major contributing component.In September 1998, TEPP launched its first cessation media campaign, breaking the previous bar on tobacco-prevention counter-advertising to adults. Their “Chuck” and “Carlos” cessation campaigns were each comprised of a series of TV spots showing the protagonists’ progression toward quitting tobacco to encourage smokers to meet the challenges of quitting. Quitline calls increased dramatically during this period, as it was tied in with the commercials. While their “Chuck” campaign was a success, Riester-Robb and TEPP soon realized through the very low response rates from Spanish-speakers to the “Carlos” advertisements that language translations required accompanying cultural translation to succeed.TEPP used social marketing to disseminate their anti-tobacco message through print, TV, radio, movie on-screen billboards, websites, mall kiosks, and outdoor billboards. In an effort to mitigate Hollywood’s glamorization of tobacco in the movies, in FY1999 TEPP budgeted $156,000 for six different pre-movie on-screen billboard stills in 50 theaters across Arizona.