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Voiceover:
Closed captioning of this program on UNC-TV is made possible, in part, by a grant from the F.M. Kirby Foundation.
Voices:
“Maybe I smoke just one.”
“Tobacco pays the bills; that’s the bottom line.”
“Just a big ol’ bad habit.”
“People were almost afraid to talk anything against tobacco.”
“Tobacco is a way of life. We’ve been in it all our lives. We plan to stay there.”
“The fundamental bedrock of North Carolina’s economy was tobacco. That’s not true today.”
Voiceover:
Funding for this program was made possible, in part, by the Robert Wood Johnson Foundation, dedicated to improving the health and healthcare of all Americans… and from contributions from UNC-TV viewers like you.
Narrator (Chip Muller, host):
Tobacco, almost as far as the eye can see. When you consider tobacco and cigarettes together, no other state in the nation produces more than North Carolina. These leaves are green now. But when they’re dried they turn golden. Tobacco has been gold to North Carolina: the state’s economic engine for over a century. On the other hand, smoking is a costly habit that can cause lethal health problems. North Carolina has one of the highest percentages of smokers young and old in the country.
I’m Chip Muller. Over the next hour we’ll show you tobacco’s historical importance to the state, the leaf’s impact on health and politics here, and we’ll show you how the tobacco industry is are trying to adapt to new economic reality.
Billy Carter:
We’re just uniquely qualified because of our soil types.
Narrator:
Billy Carter is a tobacco farmer in Moore County. In many ways, the story of tobacco in the state starts here: in the North Carolina soil.
Billy Carter:
We have a lot of sandy soils which tobacco grows well in. The soils are not overly rich. The plant gets stressed over its entire growing season and we have a long growing season. All of that makes for very aromatic, very desirable types of tobacco.
Lynn Wagner, Executive Director, Tobacco Farmlife Museum:
Tobacco as an industry has been important to the u.s. since before there was a united states. So to go back to the beginning is to go back literally to the beginning.
Narrator:
The earliest record of tobacco here dates back over six hundred years. Historians say Native Americans smoked tobacco at religious and social gatherings. Lynn Wagner of the Tobacco Farm Life Museum says they passed on the practice to European settlers as early as the 1500s.
Lynn Wagner:
One of the reasons England was interested in this part of the world is that tobacco grew so well on the east coast of the United States.
Narrator:
During Colonial times here, some historians say tobacco was the most valuable commodity in existence.
Lynn Wagner
Tobacco was used for trade to bring family members over to the colonies. So to go way back, tobacco has always been important.
Narrator:
Though tobacco growing here dates back centuries, historians say large-scale tobacco farming did not take off in North Carolina until the 1880s.
Lynn Wagner:
That’s when tobacco became such an important economic stimulus in this area. Because there was a market to sell the tobacco. Until that period, all our farmers were sustenance farmers. They grew what they needed. If they had extra they sold it. To buy what they couldn’t grow. But when the market came here, that’s when you saw towns boom.
John Harriss:
I like to hear the auctioneer. It’s ingrained, I guess for someone been in the business a long time, and I have. I started in 1934.
I worked the warehouse weighing tobacco.
Narrator:
John Harriss is a long-time Wilson resident and tobacco industry worker.
John Harriss:
Well, Mr. Moore, you’ve been here a long time, too.
Narrator:
For three decades he was a sales manager for the Wilson Tobacco Board of Trade.
John Harriss:
Wilson was just a whistle stop on the railroad back in the 1800s. When tobacco—they started having the warehouses in Wilson-- attracting farmers with tobacco, it was a big cash crop so the town grew. Finally about 1919 after WWI, Wilson became the largest tobacco, flue-cured market in the U.S. and probably the world at that time.
Lynn Wagner:
It brought it cash. It brought cash. It brought something that could be sold and you’d have cash dollars, which, in turn, made it possible to buy goods. It made it possible to buy new shoes, new clothes, new tractors, new farm equipment, to upgrade your house, bring in electricity, put in telephones, put in plumbing. It brought cash to the economy, which in turn stimulated growth in the towns.
Narrator:
Tobacco markets started sprouting up in Wilson, in part, because of increasing demand from the tobacco processing industry taking off in the center of the state. This is the Duke family farm where Washington Duke first grew and packaged loose tobacco. The farm was deep in wooded Durham County.
Dale Coats, Manager, Duke Homestead
Durham was essentially a railroad station village of, maybe, two hundred people when the Dukes lived on this farm.
Narrator:
Duke wasn’t the first tobacco manufacturer, but he was soon to become the biggest. Duke’s business expanded rapidly and moved into Durham, acting as a seed for the city.
Dale Coats:
They began hiring people to work in their factory. People moved here to work not only for the Dukes, but other manufacturers and Durham literally grew up around that tobacco industry. Durham would not have existed without the Dukes creating the need for a labor force here and helping to build the town.
Narrator:
In the 1880s, the Dukes started manufacturing cigarettes. They were the first to mechanize the process, cutting manufacturing costs in half. In one generation W. Duke Sons and Company grew into the world’s largest cigarette manufacturer under the name American Tobacco. In fact, the company became so large that the U.S. Supreme Court declared it a monopoly in 1911 and ordered a break-up of the trust. American Tobacco survived, though in a smaller size. Parts of the old American Tobacco company emerged as new corporations: Liggett and Meyers in Durham. Lorillard in Greensboro. Brown and Williamson and R.J. Reynolds in Winston-Salem.
Today RJR is the country’s second largest cigarette manufacturer and still calls Winston-Salem home. North Carolina became a center for U.S. cigarette manufacturing. For many, cigarette manufacturing was part of the fabric of the community. The businesses made huge sums of money. Heirs to the family fortunes gave generously to the community.
Dale Coats:
Duke tobacco money was directly involved in moving Trinity College to Durham in 1892. That school name later was changed to Duke University. Duke would not be here today without Duke family tobacco money. It was in the later years that James B. Duke created the Duke endowment in 1924. That money specifically was designated for certain purposes, one of them being support of Duke and other colleges, helping to create what became Duke Medical Center, also support of rural Methodist churches…
Narrator:
…and children’s services agencies like orphanages and day cares. Heirs to the R.J. Reynolds tobacco fortune also created a number of foundations that support charities across North Carolina.
Dale Coats:
The philanthropy by many of these early tobacconists has been really essential over time to the state’s growth.
Narrator:
On a more modest scale, the success of the cigarette manufacturers in North Carolina brought prosperity to agricultural parts of the state in the twentieth century. Tobacco farming was one of the most profitable ways for people in rural areas to make a living. Dorman Whitley is a retired tobacco farmer. He used to work this land in Wilson County, like his father before him. His father moved his family here in the 1930s.
Dorman Whitley, retired farmer:
We were living in Selma. My father had a store up there. But he lost it during the depression. Lost the store, went bankrupt. We were going to come up here and farm. Growing up on the farm, I was a little feller, six years old. We had our chores. Maybe I had to feed the mules, something like that. We always had something to do. I never had a desire to be a farmer. It was a different life; and I never intended to come back and come back to the farm.
Narrator:
But his life took a different course. After getting out of the Navy after WWII, Dorman Whitley’s father asked his son to come back.
Dorman Whitley:
My daddy was getting’ old. He wasn’t able to look after the farm. It fell on me to look after mom and dad. So I finally agreed and took over the farm. We had cotton, we had corn, but tobacco was the mainstay of the farm. The whole county, the whole county was tobacco. That was the backbone of it.
Lynn Wagner, Tobacco Farmlife Museum
…and if you just go back a generation or two, most people grew up on a farm, or had grandparents who were farmers, or in the summer they worked in a farm. So it’s that close to everyone’s heart, the remembrance of their heritage.
Narrator:
Though the state’s tobacco heritage has been a source of pride for many North Carolinians… and tobacco and cigarettes formed the economic foundation for North Carolina’s prosperity… the history of tobacco in the state started to change in the 1960s. In the winter of 1964 the U.S. Surgeon General released a report that said that smoking cigarettes can cause Cancer and other serious illnesses. That report alone changed many people’s perspective on tobacco—even some in the business.
Dorman Whitley:
I had a pack of cigs in my pocket. My brother in law was on the couch. I threw my cigarettes on floor and said, ‘how bout you throwing yours in there, too?’ Okay, he threw his in there, too. He never smoked another cigarette. But I did. Sometimes in the seventies I quit all of it. I haven’t chewed or smoked in some twenty, thirty years. And I’m proud of it.
Narrator:
The surgeon general’s report increased public awareness of the dangers of smoking. It’s been followed by decades of research into the illnesses that smoking can cause. Dr. Adam Goldstein is a primary care physician for UNC Hospitals. He’s examining one of his patients, Jerry Stuckey. Dr. Goldstein is an expert on diseases caused by smoking.
Adam Goldstein, M.D. UNC Hospitals
Certainly everyone knows about lung cancer. Most people know about heart problems, heart disease, heart attacks, blockages, (Jerry interjects) strokes…
Narrator:
Jerry helps with the list.
Jerry Stuckey:
I’ve had a stroke and two heart attacks. I’ve had five bypasses. Since then, everything just started going down.
Narrator:
Now, Jerry wrestles with COPD—chronic obstructive pulmonary disease.
Jerry Stuckey:
I can’t get catch my breath. Sometimes it lasts thirty minutes, sometimes 45 minutes to a hour. Your air is just cut off it seems like.
Narrator:
Jerry is 60 years old. He has been seeing Dr. Goldstein for eight years. Nearly every visit, they talk about the obvious.
Adam Goldstein, M.D.:
We always try to work on stopping smoking. That’s something we’ve tried. It hasn’t worked. Even in the face of knowing this hurts him.
Jerry Stuckey:
Oh, he’s told me, told me, told me, he don’t want me smoking. I know he don’t want me smoking. I know I shouldn’t, but I do.
Jed Rose, Ph.D., Duke University
Cigarettes are really one of the most addictive things around.
Narrator:
Dr. Jed Rose is co-inventor of the nicotine patch, the medicated strip that helps smokers quit. Today he runs the nicotine research program at the Duke University Medical Center.
Jed Rose:
If you talk to smokers who are also users of so-called hard drugs, heroin and cocaine or who are alcoholic, they often will tell you that it’s much more difficult to quit smoking cigarettes than to give up those other addictions.
Narrator:
Della Lipscomb signed up for Rose’s study. She’s blowing air into a machine that proves she has not smoked since her last visit. The fact that she’s even trying to quit shows she’s unique. There are about 46 million smokers in the U-S right now. According to the CDC, 41 percent of American smokers tried to quit in the year 2000. Dr. Rose says the odds are not good.
Jed Rose
Of smokers who try to quit—the odds of succeeding on any given attempt are really pretty small with current treatments that are available. More than 80% of those who try to quit will relapse over the next weeks or months.
Della Lipscomb, smoker:
A lot of times I went through coughing spells, i couldn’t sleep at night. I know it’s bad for your heart. Make your heart-- I had a couple EKGs. My heart beats irregular. Fast sometimes, sometimes slow.
Narrator:
Like so many who have come before her, Della has tried to quit, and has failed several times.
Della Lipscomb:
Although you know you have all these problems, and you try to quit, but, you say well, maybe i smoke just one. But it never happens with just one. You end up smoking a whole pack and you are right back where you was.
Narrator:
Given the dangers of smoking, and the difficulty many have quitting, public health professionals in North Carolina are concerned about three key statistics that distinguish North Carolina from most other states.
North Carolina has one of the highest percentages of adult, youth and pregnant smokers. In the year 2000, according to the Centers for Disease Control, 26 percent of adults in North Carolina smoked. That’s the sixth highest percentage in the country. Public health researchers say North Carolina also stands out in the percentage of kids who smoke.
Leah recently graduated from a high school in Durham. She says she started smoking when she was sixteen. Research indicates that almost all smokers start when they are teenagers.
Leah (trying to quit):
I’d always heard that I wouldn’t gain weight if I smoked. But when I started smoking, when I stopped playing volleyball and stopped working out, I started smoking and I gained twenty pounds, so that didn’t work. I don’t want to be a smoker. But it really is addictive. You hear when you’re young not to smoke. You never think about it, you think they’re just saying that, they’re just saying that. But now some of friends’ my little sisters want to start smoking and I’m like don’t start. You’ll never quit.
Narrator:
A 1999 survey showed that almost one out of every three North Carolina high school students smokes— then the sixth highest rate in the country.
The same study showed that fifteen percent of the state’s middle-schoolers said that they smoke.
That rate was almost two-thirds higher than the national average.
UNC School of Public Health professor Kurt Ribisl says the number of smokers in middle school is a concernif the trend continues…
Kurt Ribisl, Ph.D. UNC School of Public Health
…and this group graduates to high school and has a higher smoking rate, we’ll see a big uptake, a big increase in smoking rates in NC, and disease outcomes 10-20 years later.
Narrator:
A more recent 2001 survey actually showed a decrease in the prevalence of youth smoking in North Carolina. The percentage of high school smokers fell to 28 percent. The same study showed a significant drop in the number of middle-schoolsmokers: down to 11%. These figures are in line with national averages, welcome news to the public health community. But doctors say the high numbers of young people still smoking in the state suggests a significant burden on these children—and our health care system—down the road.
Leah:
I wish that I could stop; I really do and I think that if I had some motivation, if I had motivation to quit I would.
Narrator:
In addition to North Carolina’s high ranking in the percentage of kids and adults who smoke, statistics show that North Carolina also has one of the highest percentages of pregnant smokers in the country.
Smokers like Sheila Howell. She says it’s how she handles stress and it’s the same way she coped during her nine months of pregnancy.
Sheila Howell:
I had just been laid off from work. Was ready for him, but wasn’t quite sure if I could take care for him because I just lost my good job and everything… just a lot of ups and downs.
Narrator:
Howell says she knows smoking isn’t healthy. Her son weighed just 5 pounds when he was born. Doctors say low birth weight is one of the risks of smoking while pregnant.
Sheila Howell:
I’ve tried to quit before, but it didn’t last very long. The most I went for was a month. Went right back to it. Just a big old bad habit.
Narrator:
Statewide, Howell isn’t alone. North Carolina has the sixth highest percentage of pregnant smokers in the country. The North Carolina State Center for Health Statistics says in 2001, statewide 14 percent of all live births were to mothers who smoked throughout pregnancy… that’s compared to 12 percent nationally. In some counties, the rate is much higher than the state average. Stokes County, where Sheila Howell lives, has one of the highest percentages of them all: 28 percent in 2001.
Colleen Bridger was Health Director of Stokes County in 2001.
Colleen Bridger, Gaston County Health Director, former Stokes County Health Director:
The feeling is, oh gosh, I know it’s really hard that you really want to quit and you can’t, but do you really fully understand the dangers that you’re exposing your child to?
Narrator:
Doctors explain when a person smokes nicotine and carbon monoxide replace oxygen in the blood. That slows the baby’s growth. Studies suggest that smoking while pregnant increases a woman’s risk of delivering premature babies. It increases the chance of miscarriage, stillbirth, sudden infant death syndrome, and other illnesses. Experts say about seventy percent of female smokers quit when they learn that they’re pregnant. But almost all go back to smoking after their baby is born.
Colleen McBride, Duke University:
We need to emphasize that pregnancy is an opportunity to quit for life, that this is a change in role, you’re becoming a parent and that is not something that ends in 9 months.
Narrator:
Public health experts say that high percentage of smokers in the state has roots in tobacco’s traditional importance. Dr. Leah Devlin is the state health director.
Dr. Leah Devlin, State Health director:
Tobacco has a long history in North Carolina. It’s been an important part of family life, economy and business in North Carolina. Over time, historically there has been more acceptance of tobacco use in the state.
David Altman, Ph.D.
Attitudes about tobacco play a role, and, norms about tobacco play a role in the uptake of tobacco use. So if you live in a state, as we do, where tobacco is celebrated as being a source of income, as being a cultural icon, as building important institutions, your attitude about tobacco and about your own personal use of it will be affected.
Narrator:
But all of the public health professionals we spoke to add that there are other factors that contribute to the comparatively high percentage of smokers in North Carolina.
They say state policy is another key factor.
David Altman:
We know there are a variety of things that can be implemented at the state level that can be effective. A state excise tax increase on tobacco as one example would have a dramatic effect on the health of North Carolinians.
Kurt Ribisl:
States that have higher cigarette taxes have lower smoking rates because—especially among youth—because youth are very price sensitive. So when you increase the price of cigarettes, fewer youth will take up smoking. Youth will be more likely to quit.
Narrator:
Many states across the country recently increased their cigarette tax—some dramatically. North Carolina currently levies a 5-cent excise tax on each pack of cigarettes. Only two states in the nation charge less: Kentucky and Virginia. Now New Jersey charges the most of any state: $2.05 a pack, according to the organization Tobacco-Free Kids.
Dr. Leah Devlin:
The low cigarette tax does contribute to increased smoking rates in teens in North Carolina.
Narrator:
Public health professionals add that North Carolina smoking rates would be lower if the state had a ‘comprehensive tobacco cessation program’, a state-sponsored campaign designed to prevent people from starting to smoke in the first place, and designed to help smokers quit.
Meg Molloy, Executive Director, NC Prevention Partners:
Tobacco cessation is the most cost effective intervention that a health care system can do and it’s also the most underdone one in the country. It’s clear that we have evidence that it works.
Narrator:
Meg Molloy is the executive director of NC Prevention Partners, a group that is trying to improve the health of people across the state. She says that comprehensive smoking prevention programs take a multi-faceted approach.
Meg Molloy:
There’s a synergy that goes together when there’s media to help people never start smoking, when there’s school interventions in place, when there are quitting services out there, we need see it all move together to see a maximum gain.
Narrator:
Meg Molloy says Arizona, for instance, has a successful telephone quit line. Molloy suggests that North Carolina start one, too.
Meg Molloy:
Working hours and after work hours if a smoker wants to quit they can call and get the latest scientific advice, they can get referred to a local physician or program, they can help them if they need medication management, but that helps them through the process of quitting.
Narrator:
Kurt Ribisl says that a comprehensive campaign should also include state-funded ads aimed particularly at teens.
Kurt Ribisl:
They’re avid consumers of media.
Sample Ad:
You can get under my skin, but you’ll never get inside.
Kurt Ribisl:
Tobacco companies spend about a million dollars per hour marketing their products. It’s really important to have a good counter-marketing campaign.
Sample ad:
I’m not you, I’m not you.
Kurt Ribisl:
So offering the types of commercials that aired in states like Massachusetts, California and Florida would make a big impact on NC.
Sample Ads:
I choose not to smoke. I decide not to chew.
What would you do if you found out your death was being planned? He’s seizing!
They say nicotine isn’t addictive. How could they say that?
Narrator:
Other states funded these television ads. Sponsors say these ads are designed to inform viewers and balance the myriad images of smokers that teens see everyday in movies…
Movie 500 Cigarettes:
Hey, main man there’s no smoking in my cab (lights up a cigarette himself).
Narrator:
…and major magazines like Cosmo and Rolling Stone . North Carolina teens already see anti-smoking messages through nationally cablecast programming like MTV. The major national effort is called the Truth Campaign, which actually receives major funding from cigarette manufacturers.
But health experts say nationally cablecast ads aren’t enough—that the state should fund ads locally. The U-S Centers for Disease Control says that ideally North Carolina should spend about $118 million a year on tobacco prevention and cessation. The CDC says at a minimum, the state should spend $42 million dollars a year.
In the fiscal years 2002 and 2003, North Carolina did not spend any taxpayer money on tobacco prevention and cessation, according to the Tobacco Prevention and Control Branch of the Division of Public Health. The CDC ranks North Carolina last among all states’ spending on such programs.
Colleen Bridger:
The bottom line is you get one or two years worth of funding to start up a project and then there’s no continuation funding and in public health if there’s no continuation of funding it’s really hard to continue a program.
Narrator:
Despite the high cost of a comprehensive cessation campaign, health experts say it’s worth it.
Though tobacco farming and cigarette manufacturing provide jobs ,income and tax revenue to the state-- experts say smoking costs the state in many hidden ways.
Leah Devlin, D.D.M., Director, Division of Public Health, NC Department of Health and Human Services
Tobacco use contributes to the rising cost of health care which all of us have to support.
Adam Goldstein, M.D.
One out of every four to one out of every three patients in the hospital today is there due to a tobacco-related disease.
Leah Devlin, D.D.M.
the leading causes of death in N.C. are the same as the rest of the country: cardiovascular disease, cancer, stroke and diabetes in that order. All of those have a major risk factor, which is tobacco use. That translates into tremendous costs for those illnesses and a percentage of those are picked up by the Medicaid program which is funded by the taxpayers. And of course, even for the private insurers, their costs are going up all the time, too, driven by, a lot of the time, chronic diseases which have tobacco use as a risk factor.
Narrator:
The organization Tobacco Free Kids estimates that smoking costs North Carolina taxpayers at least 1.6 billion dollars per year, or $528 per household per year. Most of that is money the state and federal government pay to treat smokers’ illnesses through Medicare program. Thus, experts say, reducing the number of smokers or the number of smoking-related illnesses can save the state -- and taxpayers -- money.
The American Legacy Foundation, for instance, says for every dollar California spends on tobacco cessation programs they save over three dollars of taxpayer money. And California has seen a fifty percent reduction in cigarette consumption after implementing higher cigarette taxes, a media campaign and a quit line.
Meg Molloy:
They have seen a 14% reduction in lung cancer rates, which is extraordinary health improvement. So there’s no question that this is going to save money. To individuals, to the hospital system, to the state.
Narrator:
But if smoking is so costly to the state, why hasn’t North Carolina tried a comprehensive smoking cessation campaign?
We asked Lyons Gray who recently retired from the state house of representatives. The republican represented Winston-Salem for thirteen years, home to R.J. Reynolds. He says that the tobacco and cigarette industries had power in the legislature.
Lyons Gray:
Their influence when I came in the late eighties was much stronger than it was today. People almost afraid to talk anything against tobacco. And any reference to the state’s number one economy at the time was done very carefully.
Narrator:
And, he says, this influence affected the legislature’s willingness to adopt health-promoting legislation.
Lyons Gray:
Well, there was a very strong reluctance among colleagues here in the general assembly to address health concerns that may have been raised by critics of the tobacco industry. And when you saw bills that would take tobacco money to fix health concerns there was, I think, a strong reluctance—probably almost a very strong resistance to do it in the early days when I was here.
Bob Parker, Wake Forest University Baptist Medical Center:
Common sense will tell you: we’re in a tobacco state. Obviously there’s a lot of tobacco industry. There are a lot of tobacco growers who live on tobacco. Yes, there’s a lot of sympathy for the pressure that’s come on tobacco and I think there would be in any tobacco state.
Narrator:
Representative Gray says many legislators’ goal was to preserve the economic vitality of the cigarette and tobacco industries.
Lyons Gray:
Because you’re really talking about people’s lives at that point and did you really want to put people out of business? And put people out on the streets with no jobs?
State Sen. John Kerr (D) Goldsboro
This right here’s our tobacco.
Narrator:
State Sen. John Kerr’s district includes Green County the biggest tobacco-growing county in the state. He says that he doesn’t want to pass legislation that will hurt the tobacco industry.
State Sen. John Kerr
Tobacco pays the bills. That’s the bottom line. It generates a tremendous amount of exports for North Carolina and it brings in cash money.
Narrator:
Many public health researchers say the cigarette tax was a good example of this political dynamic in the 2002 legislative session. A record eight cigarette tax increase bills were introduced that year. None of them came up for a vote. State Senator David Hoyle co-chairs the finance committee, which has to okay new taxes.
State Sen. David Hoyle (D) Gastonia
We have about 12000 jobs in the cigarette manufacturing business. These jobs pay $50-$70 thousand per year. That’s vital to this state. We’re told by studies that everyday tobacco manufacturing companies pay into the state treasury or local governments through property taxes about three million dollars a day. That’s a lot of money. And it’s a very important industry to us. The fact that our textile jobs are gone, our furniture jobs are leaving, you know, we could run the tobacco companies right out of this state. And we’re indebted to the tobacco industry for what they have done for our state over the last hundred years, not withstanding the health implications.
Activists at a Rally in Washington, D.C.:
Tell them what we’re here about. Let them know that tobacco is a way of life. It’s not some passing fad. That we’ve been in it all our lives and we plan to stay there.
Lyons Gray:
You want to kill the golden goose? You look at the tax revenue, you look at the employment revenue —not just manufacturers, but take distributors, and retailers, growers, farmers, allotment holders. You add it all up and the economic impact is extraordinary on this state.
Narrator:
Economist Blake Brown feels that this is an overstatement. The N.C. State professor explains that North Carolina laws such as the cigarette tax have little impact on tobacco farmers’ and cigarette manufacturers’ success in the state. Though a relatively large percentage of North Carolinians smoke, the numbers are small from a national perspective.
Dr. Brown points out that in 2000 nationwide smokers consumed 425 billion cigarettes. In the same year North Carolinians smoked about 16.9 billion cigarettes…less than four percent of national consumption.
Blake Brown, Ph.D., Economics Department, North Carolina State University
So we’re a very small portion of domestic consumption across the nation.
Narrator:
More populous states in the U.S. account for a much larger percentage of cigarette sales and thus have a larger impact on N.C. cigarette manufacturing and tobacco growing.
Blake Brown:
Because we have a small share of the total consumption in the nation, an increase in the cigarette taxes here will not have a large impact on overall consumption in the U.S. It may impact our consumption here.
Because of that the impact on the state’s economy would not be huge in terms of the loss of cigarette manufacturing or tobacco production.
Narrator:
If a higher cigarette tax will not have a significant financial impact on North Carolina some wonder why the state does not increase the tax? Farmer Billy Carter:
Billy Carter:
It’s difficult to argue the economics of that to the farmer. He’s exactly right, i appreciate what he’s saying. We could raise our tax enough here to help our state some, and it’s not going to hurt us nearly as much as California jacking it up like they have and particularly New York, large consumption states. But you have to think, you have to be loyal to the economy of this state.
Narrator:
Actually tobacco experts say significant international economic forces are impacting the cigarette manufacturing and tobacco-growing industries much more than state policy. Cigarette manufacturers are dealing with declining demand for cigarettes. According to the U.S.D.A., over the 1990s, American cigarette consumption dropped by about twenty percent. Industry observers think this trend will probably be sustained by the recent cigarette tax increases in other U.S. states.
On top of that, American cigarette manufacturers are buying less tobacco from American farmers and more from farmers in other countries. According to USDA statistics, in 1964 American-made cigarettes used to contain almost all American tobaccos. Now, only about half of the tobacco in U.S.-made cigarettes is grown in the U.S.
Billy Carter:
When they spend billions of dollars on advertising, the total input of the tobacco that they buy this year doesn’t approach what they spend on advertising in a year. So for the benefit of having a stable industry like we have in the u.s., one that will never be nationalized, when they don’t have to worry about political unrest, very stable situation, you would hope that they would buy considerably more tobacco here in the us.
Narrator:
We asked R.J. Reynolds to explain their buying decisions, but they declined to comment.
These trends together-- less domestic demand for cigarettes plus more demand for tobacco grown overseas-- caused the U.S. government to cut the amount of tobacco that U.S. farmers could grow, under what is called the quota system.
Billy Carter:
So we’re basically at 52 percent of where we were six years ago. It’s just like you go into a car dealer and say, ‘You sold a hundred units last year, you can only sell 50 this year. That’s it.’ there’s no way you can prepare for that kind of decline. There are many farmers who are no longer in business. We had agricultural suppliers who considered tobacco to be the mainstay of their business and in every rural community in N.C. You have a lot of agribusiness which no longer exists or is forced to consider something else.
State Sen. John Kerr:
This country has some serious structural problems. Our economy is in shambles. We have lost the textile industry, the furniture industry. I think they want to run the tobacco industry out and I don’t know what’s going to be left? Where are we going to generate the tax base to pay for all that we need to do in human services?
Narrator:
Economists say there’s another reason why demand for cigarettes and tobacco is going down: a massive lawsuit against the country’s major cigarette manufacturers. Ironically, many in the state are pinning hope for North Carolina’s rural areas on the funds the state will receive from the settlement. Dozens of states across the country sued cigarette companies to recoup money they spent paying to treat people with smoking-related illnesses.
North Carolina joined that lawsuit; and helped negotiate a settlement with cigarette makers. In 1998, then-Attorney General Mike Easley signed the so-called ‘master settlement agreement.
Mike Easley:
It is the largest financial recovery in history.
Narrator:
Under terms of the deal Brown and Williamson, Phillip Morris and North Carolina companies R.J. Reynolds and Lorillard have to pay states about $211 Billion dollars over 25 years. North Carolina’s share will be about 6.5 Billion dollars. The settlement also restricts cigarette companies’ advertising practices.
Mike Easley:
This consent decree sets out very specifically the conduct in which the tobacco industry may and may not engage in the future. And has the teeth of the courts’ contempt power behind it.
Narrator:
Many observers call the moment ‘historical’.
Dr. Leah Devlin:
I think the tobacco settlement was actually national history. In that it was a recognition that there are health care costs that states need to be compensated for that are due to tobacco use. Those funds coming into the state represents a wonderful opportunity for investment in prevention.
Narrator:
But the bulk of the settlement money is going to farmers and so-called ‘tobacco-dependent communities. Economists correctly predicted that cigarette companies would have to raise the price of cigarettes to pay for the huge master settlement agreement or MSA. As cigarette prices go up, demand goes down.
Blake Brown, Ph.D.:
I think the theory of it was that the MSA will affect u.s. consumption, cigarette production, tobacco production in the state. North Carolina had more to lose from the MSA because of its dependence on tobacco. So the idea was to take money from MSA payments and try to create jobs and help local economies to transition from dependence on tobacco to other things.
Narrator:
North Carolina set up four groups in total to distribute the money. There’s the Health and Wellness Trust Fund Commission, the only one of these groups solely dedicated to improving health in the state. There’s the Tobacco Trust Fund which gives grants to organizations helping tobacco farmers directly.
In 2002, Tobacco Trust Fund money went to groups retraining tobacco farmers for new careers and to tobacco farmers looking to grow and market new kinds of crops. There’s the Phase 2 Tobacco Settlement Administration Services. That organization gives money directly to tobacco farmers and workers harmed by lower demand for tobacco. So far, Phase II has doled out over $510 million.
Billy Carter:
If it were not for certain Phase II tobacco settlement payments were implemented it would be astounding to people how many farms would no longer be in business, be bankrupt, essentially.
Narrator:
The fourth group is the Golden LEAF Foundation, which gives out grants to organizations developing new ways for tobacco-dependent communities to make money or improve services as the tobacco industry declines. So far Golden LEAF has given out over 100 million dollars, including a quarter-million dollar grant to Chuck Talbot, a researcher at North Carolina A & T State University. He’s looking for ways to make a small-scale hog farm profitable.
Chuck Talbot, Ph.D., Professor, North Carolina A & T State University:
Two generations ago, I think many tobacco farmers had a diversified farm. Also included hogs. Smaller producers with an electric fence, black plastic pipe, small huts that we have here can get in with a very small investment, a loan. I’m very grateful for the money from golden leaf, because we have an opportunity to say ‘yes’, we’re ready to get started. We have a coordinator who can go out and make sure farmers are raising their animals correctly. Without that assistance, it would be difficult to start.
Narrator:
But some in the public health community criticize the small percentage of money that the state has dedicated to the health issues that drove the lawsuit against the cigarette companies in the first place.
Bob Parker
Man I was just elated. I wanted to get on that health and wellness trust fund commission. I wanted to be a part of making the people of North Carolina healthier.
Narrator:
Bob Parker works at the Wake Forest University Baptist Medical Center in Winston-Salem. He was also nominated to the Health and Wellness Trust Fund Commission.
Bob Parker:
You know, for me, someone who’s been in public health knowing that tobacco is the number one risk for the number one, two, and three leading causes of death and reasons for premature death in our society, I would like to think we would go after tobacco first.
Narrator:
But the commission’s first dedication of cash went to the creation of a new program to help poor elderly people buy prescription medication. Under the plan, the Health and Wellness Trust Fund will spend $32 million a year for three years to help uninsured seniors pay for prescription drugs. The commission is headed by Lt. Governor Beverly Purdue.
North Carolina Lieutenant Governor Beverly Purdue
Folks who have worked their whole life and find themselves with a limited income and have to choose literally between food and medicine. And that’s wrong. So the folks on the commission, wonderful, talented people 17 other people from across the state … agreed that this whole initiative for the very poorest of older North Carolinians and who can’t afford to buy drugs was the right way to start.
Lt. Gov. Beverly Purdue:
Thank each of you for believing in the plan.
Narrator:
Parker was the only commission member to vote against the plan, and says it focuses too much on cure. He says the state should fund programs that prevent health problems in the first place. He uses the image of a high cliff to describe his vision:
Bob Parker:
…and we’re doing miraculous things in medical care to help people who have fallen over the cliff. The idea of this health and wellness trust fund money--it is the first money that we’ve had in NC to really make an impact to really build a fence at the top of the cliff to keep people from falling over.
Narrator:
But then the commission made its second allocation of cash. In winter of 2002 the Health And Wellness Trust Fund Commission pledged money to combat teen smoking, voting unanimously to spend 6 point two million dollars a year for three years.
Lt. Gov. Beverly Purdue:
This money will help put programs in communities and projects across North Carolina that work at the grassroots level to help kids and their families understand the health consequences of choosing to smoke at an early age.
Narrator:
In April of 2003 the Health and Wellness Trust Fund Commission started a six-month radio campaign on twenty stations across North Carolina.
Clip of Health and Wellness Trust Fund-Funded Advertisement:
The worst part isn’t dying from the diseases tobacco causes… it’s living with them.
Narrator:
Health activists applauded the Commission’s dedication of money to fight teen smoking, even though six point two million dollars a year fell far short of the CDC recommendation of a minimum of 42 million dollars. And out of the approximately three quarters of a billion dollars of tobacco settlement money that groups have distributed so far, only two-and-a-half percent has been dedicated to preventing smoking-related disease.
David Altman, Ph.D.:
I think frankly it’s been a travesty how the state has dealt with its investments in tobacco settlement money. I think at a minimum we should be investing 25% at a minimum to health. And preferably more. We need investments in economic development, we need investments in historically tobacco-dependent communities, but we also need investment in core public health programming. We’re not getting that.
Lt. Gov. Purdue:
It’s certainly not enough in my mind, either. I think you’d be less than honest if you said it was enough. But it is enough for a big first step and it was a big win today for teenagers in NC. It’s the most money ever invested in NC. We’ve done so little as a state and the whole issue of tobacco and the health concerns surrounding tobacco has actually been off the table for a long time because of the political realities of tobacco being the number one cash crop of the state.
Narrator:
Farmers say even the huge sums of money from the tobacco settlement will not be enough to insure a vibrant future for North Carolina’s tobacco industry. Tobacco industry groups, for instance, are looking abroad-- for new markets of smokers. Right now, they say no nation is more enticing than China.
Graham Boyd, Executive Vice President, North Carolina Tobacco
It will have to prove itself but we’re working diligently. More people smoke in china than live in the US. So if you’re a tobacco grower and you think about the possibility of china becoming largest export customer, that’s worth working for.
Narrator:
And researchers at North Carolina State University are looking for uses for tobacco that have nothing to do with smoking. Scientists say they think they can manipulate the plants’ DNA to turn the tobacco leaf into a health-promoting product that can carry pharmaceutical drugs.
Graham Boyd:
Tobacco, agronomically speaking, is the easiest genetically manipulated plant that we have under any type of cultural production. That’s why it’s amazing that tobacco, the whipping boy of some people’s health concerns may actually be the vehicle through which a lot of health solutions are derived.
Chip Muller, Host:
But for now, North Carolina’s tobacco and cigarette industries depend on smokers for success. And North Carolina is left to grapple with complicated health and economic issues that surround the industries.
Narrator:
North Carolina still lives the legacy of a state built on tobacco. In Winston-Salem, Greensboro and Durham cigarette manufacturers employ thousands of people. Their operations still put millions of dollars into the state treasury. Though economists say tobacco is not as important to farming communities as it once was, it remains a pillar of the rural economy and one of North Carolina’s most important crops.
Billy Carter:
It’s the most consistent profit maker. It’s not most profitable thing per acre, but year in, year out we have some concept of what the return per acre will be.
Narrator:
Many citizens feel indebted to industries that provided the economic foundation for the development and prosperity of the state. Many North Carolina cities and towns bear the indelible mark of a century of dominance of the tobacco industry.
Dale Coats:
Particularly in a town like Durham you can see a farm where the family started. You can go downtown and see the industry at least the buildings, campus, facilities he created, which was huge… go right across town and see the philanthropy-- the university where they gave the money-- all in the same community.
Narrator:
As you’ve seen over the past hour, there is another side to this story.
Lyons Gray:
The issue over health has been there in people’s psyche for a long, long time. And it’s just whether people wanted to recognize it or not.
Jerry Stuckey:
I had a triple bypass. The second day they wanted me to walk. I started walking. I go down to this lounge place. Here sits at least ten just had bypass surgery. All of them sitting there smoking. (laughs) they didn’t say anything about smoking.
Narrator:
Jerry Stuckey says he can’t quit. Leah told us she plans to quit. And Della Lipscomb? She went back to smoking. Doctors and public health researchers call for state funding of a comprehensive tobacco cessation program. North Carolina will have tens of millions of dollars from the tobacco settlement to spend each year for the next 25 years and beyond. Health activists call it the chance of a lifetime.
Bob Parker:
I don’t want to be sitting here ten years from now, and say I’ve worked on this trust fund commission for ten years and saw where we were with some health status indicators and see that we’re in the same place in ten years. What a disservice to these people. What a shame on us.
Narrator:
Public health professionals challenge the state to look toward the future… toward new industries.
David Altman, Ph.D.:
Durham used to be a city of tobacco. Built on tobacco, known for tobacco. How does Durham advertise itself now? It’s the city of medicine. We have one of the best medical centers around in Duke. Winston-Salem, N.C. was Reynolds’ town. Reynolds headquartered here. Reynolds used to be the leading employer here. Now they’re third. Who’s the leading employer? The medical school and the medical center.
Narrator:
In many ways, across the state, public health experts, farmers, rural community leaders and even cigarette manufacturers say they are trying to make a new history for the state.
Lt Gov. Purdue:
I think that all of us, especially those of us who have lived here for a long time understand that the fundamental bedrock of NC’s economy was tobacco. That’s not true today.
David Altman, Ph.D.:
It’s difficult to walk away from a product, a commodity, a way of life that has been part parcel of your being , your family’s identity. Your community’s identity. But that’s the reality. What we need to do is not hang on to the past. We need to find creative ways to face the future. We need to make investments in commodities and biz practices and policy that will help to sustain our communities.
Voiceover:
Funding for this program was made possible, in part, from a grant from the Robert Wood Johnson foundation, dedicated to improving the health and healthcare of all Americans. And by contributions from UNC-TV viewers like you.
Closed captioning of this program on UNC-TV is made possible, in part, by a grant from the F.M. Kirby Foundation.
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