Debi Austin spoke loudest after surgeons removed her cancerous vocal cords.
Austin was the woman with the hole in her throat who stars in perhaps the most compelling anti-tobacco ad ever made. You don't forget it once you've seen it. You probably forced your kids to watch it, though when it first aired in 1997, a squeamish television station manager placed a warning on the screen against allowing children to see it.
Looking into the camera, Austin tells us she had her first cigarette when she was 13, and tried to quit but couldn't.
"They say nicotine isn't addictive," she says as a cigarette burns in an ashtray. She grasps the cigarette, holds it to the hole in her throat, a stoma, tilts her head back, shuts her eyes and draws deeply. "How can they say that?" she said, as the smoke curls back out of the hole.
Debi Austin died Feb. 22 at age 62 at a San Fernando Valley hospital, after spending decades battling emphysema and cancer and, for the final 17 years of her life, the tobacco industry.
In 1988, when about a fourth of Californians smoked, voters approved an initiative that raised tobacco taxes by 25 cents per pack. California's Department of Public Health tobacco control unit used that money to produce many anti-tobacco ads.
In one, the Marlboro Man confides he has cancer. Others warn young men that smoking causes impotence and tell young women that it wrinkles their skin. Tobacco industry executives are shown lying as they swear to Congress that tobacco is not addictive. Mock tobacco executives chortle about how they trick kids into smoking.
The ad titled "Voicebox" is the most memorable. It almost didn't happen.
In 1996, the ad firm Asher & Associates, hired by the state, contacted cancer survivor organizations trying to find someone willing to appear in a public service spot, and found Austin. She refused. Why would she want to tell the whole world how dumb she had been?
Two days later, she and her sister, Deena White, who shared a Canoga Park home, were getting ready to go out to dinner when White's daughter, Joy, then about 3, drew a dark spot on her throat.
"Now we can be twins," Joy told Aunt Debi, as Deena recalled the other day.
Austin dug through the trash can until she found the ad company phone number, and enlisted in the fight against tobacco – a "brawl," as she said in a video two years ago. Tobacco had ensnared her, but she vowed that she wouldn't let the industry trap her niece.
Christine Steele, who led the ad team that created the spot, was at the filming in 1996, and recalled Austin's belief that she had been duped by an industry that sought to earn profit at the expense of its customers' health.
"It was embarrassing and humiliating for her," Steele told me. "Her way to get back at the tobacco industry was to put herself out there."
Once the ad began airing, Austin would be recognized whenever she went out. Donna Shalala, then U.S. Health and Human Services secretary, singled out the ad as pivotal in the fight against tobacco.
"It stopped people cold in their tracks," Steele said. "By showing viewers how tobacco had caused one woman's ruin, the ad illustrated how addictive smoking is, and how angry its victims become."
Austin was no angel, her sister said. She ran away from home, married young, and like some children of the 1960s migrated to the emerald mountains of southern Humboldt County.
She moved back to the San Fernando Valley after her husband died in 1981 and worked in the telecommunications industry, but wasn't able to quit smoking until after she made "Voicebox." By then, her health had been destroyed. Over the years, she had breast cancer, stomach cancer, cancer of the larynx, and, finally, cancer of her tongue.
As she fought for breath, she made more commercials, and spoke to students. She made more than one school administrator blanch with her salty language. She also left an impression. A young doctor introduced himself during one of her many hospital stays by saying he became inspired to go into medicine after seeing her talk when he was a kid, her sister said.
"The worse I look, the more impact I have on my audience," she told a Contra Costa Times reporter in 2010. "If I walked in with a scarf over my neck, it wouldn't send home nearly the impact than if they saw it."
In 1988, when there were 28 million Californians, residents inhaled 2.5 billion packs of cigarettes a year. Now there are 39 million of us, and consumption has fallen to 970 million packs a year.
Only 12 percent of us smoke, a testament to good sense, the power of the state's social marketing, and angry activists like Debi Austin.
California will spend $45 million on its anti- tobacco effort this year, less than half of the $95 million spent in 1989, the first year after voters approved the tax.
Because of its success, the tobacco control unit is putting itself out of business. As smoking declines, tobacco tax revenue falls. But there's another reason. The tobacco industry is skilled at killing tobacco tax increases.
California's 87- cent per pack tax on cigarettes places it 33rd among the 50 states. Texas, whose governor touts his state's low taxes, charges a $1.41 per pack tax. Arizona charges $2 a pack.
Nevada's tax is lower than California's. But in Nevada, where more than 20 percent of the people smoke, women have the nation's second-highest death rate from lung cancer. California was the only state where lung cancer deaths dropped among women between 2001 and 2005.
In their quest to generate revenue, legislators this year have introduced bills to raise taxes on bullets and soda. In an indication of the tobacco industry's clout, no legislator proposed a tobacco tax hike.
Bullet or soda taxes might have some social benefit. But tobacco taxes clearly lead to improved health. Experts know that smoking declines by 4 percent for every 10 percent increase in prices, which is why tobacco companies work hard to block tax hikes.
Health care advocates talk of trying to win a tobacco tax increase later this year. An extra $1.50 per pack tax would cut smoking significantly, particularly if some money is earmarked for anti-tobacco efforts. However, Republicans and some Democrats find common ground in their aversion to tobacco taxes.
The politics are clear. Since 2000, tobacco companies have spent $125 million on California campaigns. They spent $45 million last year, much of it to defeat an initiative to raise tobacco taxes.
Tobacco industry money gives it clout. But Austin was able to talk back, thanks to the $175,000 that California's tobacco control unit spent to produce "Voicebox."
Austin wanted to stay alive until she had spoken to a million kids. She didn't think she reached that goal, her sister said. She was wrong. Doctors had removed her larynx. But she spoke to many millions. We couldn't stop watching.