It was a made-in-Massachusetts export to New York City: a graphic television advertising campaign starring former smoker and cancer survivor Ronaldo Martinez, his tinny, robotic voice warning of the consequences of cigarettes.
And the ads appeared to jolt even hard-boiled New Yorkers, with smoking rates declining significantly among Hispanics and men at large in the city at the very time in 2006 when the commercials ran.
Those ads used to run in Massachusetts, too, as a centerpiece of the state's landmark tobacco-control campaign. But they vanished in 2001 and never returned, a victim of budget cuts, even though the state has collected hundreds of millions of dollars in cigarette taxes each year and tens of million s more from a settlement with cigarette makers.
In 2006, at the same time New York was running the Massachusetts ads and reporting a drop in smoking rates, cigarette sales were increasing in the Bay State. New York spent more on its mass media campaign that year than Massachusetts, once a world leader in antismoking efforts, spent on its entire tobacco-control budget.
The Massachusetts Legislature voted last week to reinvigorate the tobacco-control program, boosting its budget to $12.75 million for next year, from $8.25 million this year. The state's new public health commissioner, John Auerbach, is vowing to use some of the money to resume antismoking advertising, although he is making no promises about which spots will be used.
Martinez, along with a young mother stricken with emphysema and a former Marlboro man then battling lung cancer, emerged as the iconic faces of tobacco control in Massachusetts, a campaign emulated around the world. Antismoking forces are calling for the ads' return to the airwaves as proof that the state is serious once more about reducing the leading cause of preventable deaths.
"When the funding was cut, I felt so sad, because we had the opportunity to spread the message to the state," said Martinez, who lived in South Boston then, but has since moved to New York. He is the only one of the three featured in the ads still living. "We had thousands of adolescents watching. We had the opportunity to save thousands of lives."
New York decided to adopt the ads featuring Martinez, as well as other grab-the-viewer-by-the-throat commercials, when that city's smoking rates flattened in 2005 after declining steadily for several years. The city had raised cigarette taxes and imposed a smoking ban in restaurants and bars, and that helped lower rates for a while.
"Then what we wanted to find were ads that we considered hard-hitting," said Sarah B. Perl, in charge of tobacco control in the New York City Department of Health and Mental Hygiene.
And that is when they found the Martinez ads, airing them from January through June last year. A report publshed last month in a federal health journal showed that between 2005 and 2006, smoking rates in New York City dropped 11.6 percent among men and 15.2 percent among all Hispanics, declines considered statistically significant. Smoking levels overall declined, too, but at a rate that could have happened by chance.
New York health authorities, who spent $10 million on the ads and other media, cannot say definitively that the ads caused the drop in smoking. But they said there is strong circumstantial evidence correlating the two. In the same six months the commercials were showing, calls to a city smoking hotline more than tripled, compared with the same period a year before, from about 7,500 to about 30,000.
"This is a long battle; you have to consistently reinvigorate your program," said Perl, whose agency is now running different ads made in the Bay State. "Massachusetts made this campaign possible. We feel a certain indebtedness to Massachusetts."
The men who presided over the Massachusetts Tobacco Control Program and created the Martinez ad are hoping for a return of the compelling ads.
When Greg Connolly, then chief of tobacco control in Massachusetts, first decided to launch an antismoking blitz over the airwaves in 1993, he debuted ads showing children in a gymnasium calling for a smoke-free Massachusetts.
"It was a flop," with little response from smokers, Connolly said.
In 1996, the Bay State borrowed ads from Australia, showing the ailing arteries of smokers. The ads were powerful, but not powerful enough.
"At that point, we said, 'This is a good strategy, but we need a face on it,' " Connolly said.
Juan Mandelbaum, president of the Watertown communications agency Geovision, discovered Martinez and created a series of ads that depict him using a machine to give him the voice that throat cancer stole at the age of 39. He talks in the ads about how cigarettes -- he averaged a pack to a pack-and-a-half a day -- deprived him of his dream of becoming a baseball umpire, made it impossible for him to swim, and made taking a shower an onerous chore.
All of the antismoking ads were yanked after the Sept. 11 attacks, considered too graphic for the time. The plan was to put them back on, but that never happened.
"The thing that was really painful for me at the time was I felt we were doing our best work," said Mandelbaum, whose mother, a smoker, died from lung cancer. "We had finally figured things out, and we were making a difference."
From the time the powerful antismoking ads started running in 1996 until they went off the air in 2001, the percentage of Massachusetts adults who smoke dropped from 22.7 to 19.5. Those rates have continued to decline, although more slowly, since 2001, and state figures show that cigarette sales actually rose in 2006, climbing about 3 percent from the year before.
A survey of smokers who had quit that was directed by Lois Biener, a researcher at the University of Massachusetts at Boston, found that smokers who had recently quit cited the television ads as the most important factor that persuaded them to drop the habit.
"One would hope that with a new administration that is committed to improving health programs in Massachusetts that they would be able to revive these ads," Biener said.
The tobacco-control budget reached a high of more than $54 .3 million in 2000, plummeting to $2.5 million in 2004, during the administration of Governor Mitt Romney, before climbing again. A spokesman for the former governor said yesterday that "efficiencies were maximized in all areas of government and spending was closely examined, and in many cases reduced."
Governor Deval Patrick has said he is committed to rebuilding tobacco control, and the Legislature agreed to increase the budget to $12.75 million for the coming budget year, about $3 .5 million less than Patrick wanted.
Auerbach, the public health commissioner, said that he "definitely wants to do advertising" and will decide within two weeks how the funding will be spent.
One of his predecessors, Dr. Howard K. Koh, said it is "a bittersweet irony that the New York success has been fueled by Massachusetts ads that haven't run here for years."
Stephen Smith can be reached at firstname.lastname@example.org.