1. Contillo, Christine BSN, BS, RN-C

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There are nine of us, early on this warm April morning. Nine nurses who call ourselves the Nightingales convening in the Kraft Foods parking lot in East Hanover, New Jersey-a state that two weeks ago banned smoking inside all commercial establishments (except casinos). Perhaps we take comfort in the ban as we don white lab coats and prepare to mingle with the well-dressed crowd attending the annual shareholders' meeting of the Altria Group.


At dinner last night, several of us were briefed on what to expect by Ruth Malone, PhD, RN, associate professor of nursing and health policy at the University of California, San Francisco. Malone has closely examined internal tobacco company documents related to the 1998 Master Settlement Agreement, which was signed by the attorneys general of 46 states and prohibits tobacco advertising aimed at those younger than 18 years of age. She knows just how the major tobacco companies manipulated the composition of cigarettes to increase users' addiction and concealed their knowledge of the dangers of smoking.


Looking for a way to make nurses' voices heard on this issue, Malone formed the Nightingales. Her enthusiasm is infectious. This is the third year the Nightingales have attended the annual meeting in order to confront Louis C. Camilleri, chairman of the board and chief executive officer of the Altria Group, the parent company of Kraft and all of the Philip Morris Companies (Philip Morris USA commands nearly half of the U.S. tobacco market), during the shareholder question-and-answer period. Some of the Nightingales, me included, have purchased a single share of stock in order to be allowed to participate; others have come as proxies.

FIGURE. Ruth Malone ... - Click to enlarge in new windowFIGURE. Ruth Malone is happy to note that the Nightingales are making a difference. In previous years only the business portion of the Altria Group shareholder meeting has been Webcast, with discussion of shareholder proposals and all questions for the chief executive officer excluded. Last year Malone asked, "Won't you let your shareholders hear what we are saying?" This year, the entire meeting was Webcast. "Gains like these are why we need to return each year," says Malone.

Nancy Wise, MS, BSN, RN, is a certified school nurse as well as a health educator and the president of the Bergen County School Nurses Association. Rising to speak before the crowd of about 250 people, Wise reports on the higher rates of childhood asthma, sinusitis, and otitis in her school among children from households in which one or both parents smoke. She then tells the story of her father's death many years ago from lung cancer. He had begun smoking at age nine. "He died," she says "before he could cash his first Social Security check." Camilleri stands at the podium, an enormous American flag that hangs at the back of the auditorium reflected in the marble behind him. His only response before the hushed attendees is, "Thank you for your comments."


A legal advisor to the ministry of health of South Africa shows photos revealing that Marlboro cigarettes are being marketed to children, and a Maori from New Zealand demands-and surprisingly, receives-an apology for the marketing of a tobacco product called Maori Mix.


At the end of the meeting we unfurl a banner printed with copies of letters written years earlier to Philip Morris in response to a direct-mail questionnaire. Many of the smokers had died before being able to respond themselves and their bereaved families had answered instead. The letters, often heart-breaking, had remained an industry secret until uncovered by Malone, who vowed to make them public. Samples can be found on the Nightingales Web site (