hard-working american families, reigning in our out-of-control debt, and ensuring america maintains a strong national defense. to meet these goals, we can come together now to replace the president's sequester, not with more tax increases, but with better, more responsible spending cuts that would our budget on a path to balance in 10 years.thank you for your tim. may god bless the women and men of our armed forces and may he continue to bless the united states of america. >> a discussion about a new state marijuana laws. then a discussion of the executive order regarding cyber security regulations. then kathleen sebelius on mental-health treatment and the affordable care act. >> the women themselves in many cases were interested in politics but had no vehicle to

express that in their own lives. so they were attracted to men who were going to become politically active or were already politically active. >> each of them i find intriguing. probably half of them in particular because they are so obscure. half of these women probably would be almost totally unrecognizable to most men and women on the street. >> is resident state, first ladies, and a fluent and -- this day, first ladies. from martha washington to michelle obama. season one begins monday night at 9:00 eastern and specific on c-span, seize their radio and c- span.org.

watch live at 2:00 p.m. eastern on c-span. >> last november, colorado and washington voters passed a ballot initiatives making their states the first to legalize marijuana for nonmedical purposes. the impact was the topic of discussion monday hosted by the rand corporation. health policy chester, economist and behavioral scientists talked about the restrictions on the use, sale and advertising of marijuana and tobacco. this is an hour and 50 minutes. >> some of this is related to licensing and regulations have discussed before. alex, you will go third here so that you have a warning. first we will welcome -- first we will welcome frank chaloupka back. >> thanks.

we will move quickly through this. these are things i can spend hours talking about. smoke-free air policies. these of the primary restrictions on tobacco use that we have. these are generated by try to protect non-smokers from exposure to tobacco smoke. the sciences have advanced and we understand what the harmful consequences of second-hand smoke are for non smokers. this is something that was first hinted at in the 1972 surgeon general's report. there was discussion about how harmful chemicals would be harmful to non smokers as well.

this is the start of the nonsmokers rights union in the u.s. we did have some policies on the books for a long time in some states. many laws against smoking in food preparation. but starting in 1973, we see the adoption of state policies aimed at protecting the health of non- smokers. connecticut in 1974 goes to restaurants. minnesota limited smoking in private work sites. these early policies were different from the ones we have now and allow for not smoking and smoking sections. so, partial restrictions. over time, the policies get stronger and stronger. to the point by 2003, we had every state having some policy. the turning point came in 2006

with the surgeon general report that summarize the evidence of health consequences after exposure to secondhand smoke. simply separating smokers and nonsmokers, things like that, would not be enough to protect. today, we do have a dobans on -- we do have comprehensive bans on smoking. the most comprehensive prohibit smoking in restaurants, bars, all work places, as well as a in gambling establishments. about a third of the population is covered by comprehensive policies like that at either the state or local level. the new have policies where they do some of those venues but not all of them.

i have also seen these policies go global. the first country to adopt a policy was norway and the first to implement it was ireland. italy, turkey, france, places like that have gone completely smoke-free. a lot of evidence in terms of their impact on tobacco use. we see strong evidence that when these policies are adopted, you see support grow. compliance and that being fairly high and the policies tend to be self and forcing. ries, evenf countires smokers will support smoke-free policies in public places. this is our stars to drive behavior among kids.

they are not going to be so susceptible to smoke being banned in bars. you create a culture where non- smoking is the norm. you start to see that show up but until things like the adoption of private policies that restrict smoking or ban smoking in homes. the key thing is that in addition to protecting nonsmokers, this leads to reductions. smoke free workplace policies are effective in getting smokers to quit are cut back. really enhanced when they are done as part of a comprehensive package of tobacco control measures. assemble association between smoking prevalence rates at the state level and comprehensiveness of smoke-free policies. the basic story is that young adults smokers presence is

lower and the state's coast aug. policies. we see the same things when it comes to adults smoking. social norms about tobacco changes the results of these smoke-free policies. the approval of smoking has risen in parallel to the adoption of these policies over time. this is an area where there is a lot of ongoing developments. the most active areas are with respect to restrictions on malta unit housing as well as various outdoor venues -- on multi unit housing as well as

various outdoor venues. minimum age is to sell, strong penalties are retailers who violate these policies. we have also seen the adoption of policies that target kids. they have stronger penalties including things like driver's license suspension. and limits on the distribution of free samples. with these policies, they are not like smoke-free policies. they require consistent, strong enforcement for them to be effective in achieving compliance with the policies. good in force will require a variety of different factors -- good enforcement will require a variety of different factors. they need to be done frequently.

states have had these policies in place, sometimes going back to the turn-of-the-century or the early 1900's. what we saw as -- we saw is people were not paying attention to them. people could buy whatever tobacco products they wanted. then the minimum legal drinking age that i adopted. -- drinking age got adopted. in 1992, there was a requirement of states adopt a minimum legal purchase age of 18 and show there were getting effective compliance with these policies. the fda got involved as well in the first try to get jurisdiction over tobacco in the late 1990's. the program was very well in force. it is presumed under the family

smoking and prevention act of 2009. -- it has resumed under the family smoking and prevention act of 2009. policies get stronger, they're being forced, states are demonstrating compliance. the plant now -- non compliance in 2011 was down to 8.5%. 1 in 12 retailers were selling a product to youth. these have been effective in reducing kids perception on how easy it is to get tobacco products. the red line is noncompliance rates. the others are kids perceptions of availability upper -- of tobacco products.

a lot of attention was paid to the fact that these policies were targeting retailers. there were not doing anything about what some risk -- what some perceive the problem to be witches by tobacco to begin with. you can see the growth of those policies over time as well. many states are going after kids as well. and looks like good news policies are being adopted. when it comes to the evidence on the impact on kids tobacco use, the evidence is that is mixed and shows there is no association between strong use access policies and use smoking rates. the perception is you have to get high compliance on people, about 10%. that still means one in 10 retailers will sell to kids. they probably know which are likely to sell.

we find no association between the comprehensiveness, youth access policies and prevalence rates. there is an issue about compliance and you need to have high compliance before you can reduce under age access and as a result, tobacco use. overall i would say there is little evidence these policies have any impact on tobacco use among kids. the simple association for the purchase possession and use policies, and looks like it is going in the wrong direction. that is a big supporter of those

policies. when it comes to tobacco marketing, but has been a lot of work in the area starting with the 1989 surgeon general report. both encouraging kids to consume. some of the political economy about how strong tobacco control policies might be adopted. there has been a lot of research. lots of problems in the types of studies that get done. over time, what we have seen is evidence has gotten stronger to the point now where we see good evidence that there is a strong causal relationship between exposure to tobacco company

marketing and tobacco use. really nice summary of the evidence came out a few years ago. lilly strong conclusions -- really strong conclusions. that gives you some reason for going after marketing restrictions on tobacco. in the u.s., the first of these payments until 1969. -- the first of these came in 1969. that captured a few other restrictions on tobacco company marketing. marketing that's best -- that

targeting kids and used cartoons and things like that. if you look at this, you can see the overall spending on tobacco companies, marketing activities over time. the settlement agreement comes in in 1998. does not do anything to slow down the tobacco marketing. these restrictions not having much of an effect. the partial restrictions lead tobacco companies to innovate and come up with other marketing strategies. it is what is happening with the mix of tobacco marketing practices over time. if they go back to late 1970's, the red bar is what people usually think about when it think about marketing.

the part that is much more important is the green part. that's what tobacco companies are spending on price promotions. na coincidentally, the shift starts when economists start publishing about the affects the price. the put more of their budget to price promotions. the families looking and prevention act of 2009 gives at the eight the authority to further limit marketing -- givse the fda the authority to further limit marketing to youth. tate and locald still - governments.

this eliminates that federal preemption and says government can limit the time, place, or manner of tobacco company marketing. providence was the first one to do it. about a year-and-a-half ago, it adopted a policy that bans the retention of key patents -- the acceptance of coupons. tobacco companies challenged that under the first amendment. it suggests governments have the ability to regulate tobacco company marketing. the first amendment is not the and all. if we look at what is happening globally, over time, we have

seen the spread an increase in the comprehensiveness of the types of marketing bans in place. this started out by banning advertising and various channels. to cover all the sorts of traditional advertising, they moved -- then the most policies recently added to the strength of these policies. the most comprehensive ones and ban the retail displays of tobacco products. which is something we can do when it comes to marijuana. as marijuana several countries have abandoned these displays. these have been challenged in the courts as well. so far the courts have upheld those types of bans. and tehen plain packaging.

australia has tried to ban that as well. the research is convincing showing these comprehensive advertising bans are effective in reducing tobacco use. partial bans are not so effective. the other thing i want to talk about is not on the list but i figured i would add it. the idea of counter marketing. this is an area where we can learn a lot also that could be useful. when it comes to counter marketing, there has been a few efforts overtime. the first was the fairness factor on tv in the late 1960's. king adds,o smotkin

there had to be one anti- smoking ad. then after the broadcast advertising ban, those ads disappeared from tv then be merged in 1989. the cigarette excise tax was raised in california. it included funds for an mass media public education campaign. california did it first, then massachusetts and other states followed suit. something we could do in the marijuana area.

the american legacy foundation was created and they case until a national public education campaign. we have joe chemo instead of joe camel. the body bags from the truth campaign ads. and stronger counter marketing. the one thing we know is that these work. it is not so much how much is dedicated to counter marketing but how much is going into programs at the state level. you can see the increases over time until the economy turn back and then the the early 2000's and they cut funding. tobacco companies are still out spending comprehend the tobacco

control programs. despite that, we have good evidence that these programs account marketing is very effective over tobacco use. very affected in getting kids to not to go to back use. seems to have its biggest effect at the early stages of uptake. increases risk perceptions, strengthens anti-smoking norms. looking at perceived risk, the states spend more on a comprehensive programs. kids perceive greater risk to tobacco products. strong evidence confirms what is shown here in the picture. a few lessons learned. this is the comparison of social norms between cigarettes and

marijuana. bringing us back to why we are trying to learn from tobacco. we have done a good job of changing norms around tobacco. most kids disapprove of tobacco use. in recent years, things are going the other way with marijuana. not too different in the early 1990's. big gap now between tobacco and marijuana use. i am not sure how to explain this. a real drop in pursuit risks from a regular marijuana use in recent years among kids. we can learn a lot from the experiences with tobacco. comprehensive restrictions on use of tobacco products have reduced tobacco use, strength and social norms against tobacco. the same thing can be done when it comes to marijuana.

that is part of the colorado polis a -- colorado policy. restrictions on sales, i am sure we will hear a different perspective but we talk about on alcohol. these by themselves will not be sufficient. they need to be part of a broader comprehensive campaign. they need to be enforced. but they are important to making sure kids to not have ready access to retail channels. with marketing restrictions, there is no reason we can as far from where we are now. there are states marketing marijuana products. the first amendment issues will be different in this case. used to have federal prohibition. there is the reason we cannot have a comprehensive ban on all advertising promotion and spot to ship when it comes to the marketing of marijuana. the counter market is affected if price is going to fall.

we need to do something to push things in the other direction. account marketing campaign -- the counter marketing campaign with tobacco could be effective when it comes to marijuana. more information is all on the web site. thank you. [applause] >> thank you, frank. i encourage you if you have any insights on the first amendment issues with respect to marijuana, please send them in and we will share them audience. next i will introduce william shadel, a senior behavioral scientists here at rand. he holds faculty it appointments at the university of pittsburgh where he is a member of the behavioral program. he has been publishing firm over a decade -- publishing for over

a decade on issues relating to the psychology of advertising. he is a consulting scientist on the tobacco reality research network. as well as the communications researcher with nida. i think he will have some valuable insights for us. [applause] >> thank you. i think it is an interesting convergence of our talks, frank. i will not be redundant. i will try not to be with some of the detail the permission you provided but i will try to provide something more of my perspective as a psychologist to understand some of the why's and

how answers. about why or how we should be introduced -- we should be interested in tobacco advertising. we talk about tobacco. to a compass a lot of different things -- to encompass a lot of different things. most of this literature has been done with cigarettes. there's not much in terms of the evidence for what we should be concerned for smokeless. we do not know much about some of these new advertising initiatives. the e-cigarettes, all of a sudden you see tobacco advertisements on tv and you have not seen these things in 40 years. we will have to attend to from

occurred -- from a tobacco perspective and a broader perspective. if i were to think about this, the central goal for regulating tobacco is to reduce use exposure. we do know there are effects of adults. in my pocket them to want to smoke or prevent people from wanting to quit. but the main goal here for the regulation of tobacco advertising is to reduce youth exposure. as for a lot of reasons here, too. i like tobacco advertising. release more people design this stuff. they know what they are doing -- really smart people designed this stuff. they know what they are doing. there is an ad up there that

says a reach for a lucky with the tickets from 1929. the whole idea of the weight control properties of cigarettes. now clinically with adults smokers, it was something the tobacco industry was well on top of early in the faces of their advertising. you certainly will see down until the bottom left, an advertisement for candy cigarettes. which you do not see any more. pour joe camle. -- poor joe camel. that was an instrumental campaign. you will see the power walla asa with anience stores

blast of tobacco advertising. the good news is that there has been a reduction in some of the places kids see this stuff. but part of the reason we started to get concerned about this, is that they can be a lot of different permission for kids. not just in the old days. we saw superman bursting through a marlboro insignia. that does not occur anymore. but even the ones out there now some in law that information

about the product and what it will do for you. use is norman the three uc ever- present all over the place. -- you see it all over the place. in his heart to go around and not to this blast of advertising -- it's hard to go around and not see this last of advertising. this stuff is all over the place. the other thing that is important is this idea that ads convey the message that tobacco users will come to embody the people who were portrayed in the

end. display the't typical and state smoker. someone who has been smoking for 60 years, who maybe has cancer and so forth. the portrait people in these helpful kinds of ways. -- they portray these people in helpful kinds of ways. there is sure acceptance, which we know is important for adolescents. kids start to think and develop expectations or beliefs about tobacco.

i too will be able to control my weight, maybe it is good to make a few good whenever i feel bad. as kids go through adolescence, they are trying on different tasks about what it wanted be like when they grow up? for kids they are having a more difficult time and seeing those questions, particularly early on in adolescence. it will be more appealing to them. part of the reason -- concerned about regulating not just exposure affects but the contents of ads. and can they convey the ads themselves? this is particularly true now. in the old days, -- now it is a

very clever usage of colors. so there's still some affirmation being conveyed by the advertisements -- some information being conveyed about the advertisements. we are thinking here, if you want to think about the advertising has been ubiquitous, all. it is a critic -- it is creating a system where people's belief systems shift overtime to the point where the become more positive. they do not look sick, they look like they're having a good time.

so softens the target. gives kids a more positive attitude to smoking which then lead to securities. some studies have looked at whether exposure leads to changes which leads to smoking uptake. put together all the various studies that have been conducted on tobacco and cigarette advertising, the camera with the following conclusion. the effects are strongest as far as the effect of exposure on smoking or tobacco use behavioral kids. the effect was a little less of kids being exposed to advertising after the army tried smoking.

i see an advertisement for newport, and if they want to smoke, i will go outside in my office and have a cigarette. the advertising tends to be potent before early stages of smoking because that is the fourth nicotine attest to jump on board. did it terms of changing norms of police, you have this initial -- in terms of changing norms, you have this initial -- getting kids removed from never smoking to smoking. they start to get with false --

hdrawals.th dol its effects are far less them what they are. this will be -- i do not want to send a lot of time on this because frank has but a lot of time detailing some of these different efforts that an initiative. i was surprised to see it go into effect until -- it went into effect after the was granted a large audience watching on television. we have the master settlement agreement done again.

advertising in transit and so forth, all the way down the line. then the camp -- and the tobacco control act of a few years ago. it did a lot of things with regard to marketing. there were other regulatory options. as a consequence of the tobacco control act. it is important for thinking about -- challenges to commercial free-speech, the industry seems happy to lydgate at this point. there might be more sick --

more ways which might limit retail ads for tobacco products. reducing the number of advertisements. outside at the pumps, you see it. the industry pays for those. there might be ways to limit them. limit the size of tobacco even further. eliminating the power walls of tobacco products. hiding the ball high cabinets, putting them someplace else. the anti-smoking counter advertising at retail locations. the industry -- this come directly from industry websites.

we were ahead of the curve here in terms of limiting product placement in movies and so forth. we do not pay for product placements in movies that are rjr. , cigarette the picture attracted healthy looking persons. those restricting tobacco advertising works, and our specific studies. the permission spanked presented earlier i always put billions in italics

because it strikes me. there was certainly a lot of attention toward the amount of money the industry was spe spending on this. it was a billion dollars. that is not trivial. that gives us a clue in terms of how the shibusiness has shifted. in 1970, there was 60% of advertising. that dropped out after the ban in 1971.

pulling of sale locations. the red line there. it's huge spike. the industry is spending a substantial dollars to get their products up in front as they go into convenience stores. and a lot of money for science. -- for signate. we had college students carry around a little computers. they were supposed to indicate when they were exposed. when you compare the different outlets. compared to the smoking, internet, print advertising and so forth. this is the wave.

we have to think carefully about the point of sale of our men. that might be the only place left where the injury has -- the industry has a viable incentive to advertise it seems like they are probably happy to litigate that. studies of advertising restrictions. usually, tobacco advertising restrictions are embedded within the host of tobacco control i committees. it is hard to pinpoint whether there is a specific affect for marketing.

for the few studies that have done this, a single survey said restrictions were associated with more-smoking norms among kids. there was an experimental study that had kids look at magazines that have tobacco advertisements in that. studies -- two experimental studies have shown if you show kids and the smoke and advertisements prior to seeing smoking advertising, it could have the effect of a inoculating the kids against the effects. other research shows.

some issues and challenges. could be related to some of the issues we have been discussing here with regard to marijuana. ongoing litigation by the industry on the grounds that the advertising violence, commercial free-speech is forcing us to challenge ourselves about thinking about how we can possibly regulate and restrict tobacco advertising in more? i do not think it will happen in the u.s. the will force us to think about what empirically a chemical steps can we take towards restricting advertising. the point of sale of berman, there are a lot of places.

is there a way we can regulate advertising in those specific locations? we need to do a lot more research on this. the implications for regulating marketing firm new products that are not currently addressed or under the authority of the fda at this particular point. what do we do about counter advertising? with the most appropriate level and to a shrinking tobacco controlled environment? the we can effectively counter advertise to counteract the effect. thank you. [applause]

>> we are going to switch from tobacco and alcohol. we will talk about restrictions and advertising to some degree. before we do that, alex, are you there? maybe he is not there. one of the point i wanted to raise -- specify nothing about advertising does not mean advertising not occur. right now, we have medical marijuana. there is no specification about advertising and lee have dispensaries that advertising in local newspapers. advertising occurs without any specifications with respect to limits or desires.

but we think about marijuana policy, it is probably better to think in advance about what sort of advertising the want -- do you want consumers exposed to? not thinking about it means that it will happen regardless. alex, are you on? i think we lost alex. for the moment, we will see if we can get him back. >> i am back. >> great. terrific. no problem. we are ready to handed over to you. >> thank you. there many variations from state to state with alcohol policy. there are many specific dimensions of the overall system.

we talked about the state monopoly stuff a lot but there are other dimensions. we limit the hours of sale of alcohol. when you study that, on one in corporate city in a metropolitan area changes its closing hours from 1:00 a.m. to 2:00 am, it is hard to see much affected that. but when the hours of sale are change in a broader context, like they did in the u.k., and then we can see effects of that. in their limited traditions of sales, that as the sunday -- when sunday sales, to a

place, there have been an increase, in incidents. localities and states are beginning home deliveries or relating home deliveries. studies suggest some% of people order they're out of. -- suggest 10% order their call hall. alochol. there is restrictions of al chohol at community events. the events that is supposed to be family-oriented and so forth, you do not want alcohol to have a role. the density has been widely

studied. it is very complex with the look of the neighborhood, city level, state level. the density of alcohol matters. if you raise the density of retail outlets by 10%, he gets about a 4% increase in consumption are violence, things like that. we have a lot of restrictions on the location of alcohol. not too close to a church or school. that has not been a guy with a much. it is a tradition. we stretching the type of -- restricting the types of alcohol and varmints.

them have all this server licensing stuff. -- then we have all this server licensing stuff. training seems to have little to no effect. when it is part of a licensing system where the clark and servers of all, are licensed. when it is universal in their states tenders for adequate training and all of training. there is literature that suggests of those types of laws have effect in reducing risks. then there is a whole area of server liability.

if there is an untold consequences. the classic case is a person leaving a bar and then getting into a car crash. what we know from that is that the regulation is key. the individual quirks -- clerks has smaller facts. the management of the al the sectors the high turnover shows it focused on the individual to work in the abbas, is not as promising and effective.

we do a lot of these other things that are somewhat similar to the back of -- similar to tobacco. a lot of times you can i use alcohol at parks, beaches, generally is not allowed. sometimes it is allowed but with tight restrictions. with communities are really concerned, they tend to increase those restrictions on prohibiting drinking in those public places. we prohibit using out on cars data and other locations are

cause i -- stadiums and other location.are a cause quais --- quasi location. there is some stuff that's specific to alcohol. this happy hour discount things. there have been several studies of those that suggest they have have public health benefits in reducing the intoxication. then this thing about the message environment. a lot of public policy.

there are these regulatory policies around the message of varmint. there are mandatory warning signs of a point of purchase. a lot of states require posters warning pregnant women not to drink or that it is risky, things like that, have to be .osted deb localities can regulate billboard. there is activity there. the warning labels on the process -- then a the warning labels on the product. in morning that is nothing like the graphic -- a warning that is nothing like the graphic.

we talked a lot about underage access already. the minimum drinking age was a major change. states after prohibition set their age. most the 21. some at 18, 19, or 20. then in the early 1970's, we lowered that. continental did and went down in their age. in the late 1970's, with evidence accumulating, that trend reversed. it is consistent set of legal changes have a significant

effect in reducing car crashes and violence and consumption of alcohol by teenagers. kegs are a large amount of alcohol. they are serial number. it is required to be recorded by the seller at the time of focus. the contract to purchase the enhancement of driver's license doctorate there is a lot of activity around fake ids.

the id's have been improved so they are harder to produce. the homeland security thing that happened changes this a bit and make it a much bigger offense.