Tobacco control policies and the concurrent use of smokeless tobacco and cigarettes among men, 1992-2002.

Accelerating the decline in smoking prevalence requires an understanding of changes in the concurrent use of and the substitution between different tobacco products, such as smokeless tobacco (SLT) and cigarettes. SLT could play an important role in reducing the toll of smoking-related illness and premature mortality. Research examining the role of tobacco control policies in explaining concurrent use of SLT and cigarettes has been minimal. Using the Current Population Survey Tobacco Use Supplements (CPS-TUS), we examined tobacco control policies in relationship with adult males' SLT use concurrent with smoking over the period 1992-2002. Consistent with the decline in smokeless-only and cigarette-only rates, concurrent use of SLT and cigarettes declined during the period. SLT users, faced with home or workplace smoking bans, are less likely to report smoking. Smokers with a home ban appear more likely to use SLT, but in more recent years, smokers with a workplace ban are less likely to use SLT. Tobacco excise taxes do not signal substitution between cigarettes and SLT products. Understanding current use patterns of the range of tobacco products, including their interaction with available policy levers, is vital in assessing whether changes that might promote substitution of arguably less toxic SLT products for highly toxic cigarettes are likely to lead to net public health gains or losses. Findings of the present study, in concert with other research about transitional probabilities between behavioral states, will inform the design of an effective policy framework that supports the objective of reducing tobacco-related death and disease.     

"Creative Solutions": selling cigarettes in a smoke-free world

Objective: To analyse the development and execution of the "Creative Solutions" Benson & Hedges advertising campaign to understand its social, political, and commercial implications. Methods: Searches of the Philip Morris documents and Legacy Tobacco Documents websites for relevant materials; Lexis/Nexis searches of major news and business publications; and denotative and connotative analyses of the advertising imagery. Results: Philip Morris developed the Creative Solutions campaign in an effort to directly confront the successes of the tobacco control movement in establishing new laws and norms that promoted clean indoor air. The campaign''s imagery attempted to help smokers and potential smokers overcome the physical and social downsides of smoking cigarettes by managing risk and resolving internal conflict. The slogans suggested a variety of ways for smokers to respond to restrictions on their habit. The campaign also featured information about the Accommodation Program, Philip Morris''s attempt to organise opposition to clean indoor air laws. Conclusion: The campaign was a commercial failure, with little impact on sales of the brand. Philip Morris got some exposure for the Accommodation Program and its anti-regulatory position. The lack of commercial response to the ads suggests that they were unable to successfully resolve the contradictions that smokers were increasingly experiencing and confirms the power of changing social norms to counter tobacco industry tactics.     

The impact of workplace smoking bans: results from a national survey

OBJECTIVE: To estimate the impact of workplace smoking restrictions on the prevalence and intensity of smoking among all indoor workers and various demographic and industry groups. DESIGN: Detailed cross sectional data on worker self reported characteristics, smoking histories, and workplace smoking policies were used in multivariate statistical models to examine whether workplace smoking policies reduce cigarette consumption. After analysing the distribution of policies, four main types of workplace programme were defined: (1) 100% smoke-free environments, (2) work area bans in which smoking is allowed in some common areas, (3) bans in some but not all work and common areas, and (4) minimal or no restrictions. SETTING: After environmental tobacco smoke was identified as a health hazard in the mid-1980s, workplace smoking restrictions became more prevalent. By 1993, nearly 82% of indoor workers faced some restriction on workplace smoking and 47% worked in 100% smoke-free environments. PARTICIPANTS: The database included a nationally representative sample from the tobacco use supplements to the September 1992, January 1993, and May 1993 Current Population Surveys of 97,882 indoor workers who were not self employed. MAIN OUTCOME MEASURES: Prevalence of smoking and number of cigarettes smoked daily by smokers. RESULTS: Having a 100% smoke-free workplace reduced smoking prevalence by 6 percentage points and average daily consumption among smokers by 14% relative to workers subject to minimal or no restrictions. The impact of work area bans was lessened by allowing smoking in some common areas. Smoke-free policies reduced smoking for all demographic groups and in nearly all industries. CONCLUSIONS: Requiring all workplaces to be smoke free would reduce smoking prevalence by 10%. Workplace bans have their greatest impact on groups with the highest rates of smoking.     

Tobacco industry success in preventing regulation of secondhand smoke in Latin America: the "Latin Project"

OBJECTIVE: To examine the tobacco industry's strategy to avoid regulations on secondhand smoke exposure in Latin America. METHODS: Systematic search of tobacco industry documents available through the internet. All available materials, including confidential reports regarding research, lobbying, and internal memoranda exchanged between the tobacco industry representatives, tobacco industry lawyers, and key players in Latin America. RESULTS: In Latin America, Philip Morris International and British American Tobacco, working through the law firm Covington & Burling, developed a network of well placed physicians and scientists through their "Latin Project" to generate scientific arguments minimising secondhand smoke as a health hazard, produce low estimates of exposure, and to lobby against smoke-free workplaces and public places. The tobacco industry's role was not disclosed. CONCLUSIONS: The strategies used by the industry have been successful in hindering development of public health programmes on secondhand smoke. Latin American health professionals need to be aware of this industry involvement and must take steps to counter it to halt the tobacco epidemic in Latin America.     

The lightest market in the world: light and mild cigarettes in Japan

This article reviews the history of the introduction and use of light and mild labeled cigarettes in Japan, the "lightest" market in the world. Systematic keyword and opportunistic Web site searches were conducted on tobacco industry internal documents relevant to Japan, supplemented with relevant material from the tobacco trade and sociological literatures. Certain "market quirks" of the Japanese society benefited the tobacco industry in promoting its light and mild cigarettes. Japan's is a trend-conscious society with a penchant for new fashion and products. The Japanese are innovative, with the propensity to transform concepts into something characteristically their own marked by a distinct cultural style, such as the concept of keihaku tansho ("light-thin-short-small"). With big-budget sophisticated advertising, tobacco companies developed a lucrative market for mild, light, and ultra-low-tar cigarettes. Smokers had a preference for charcoal filters, which they believed protected them. Tar numbers meant little to smokers. The transnational tobacco companies capitalized on consumer concerns about the health hazards of smoking to promote low-tar cigarettes as a safer alternative. This may be one factor that explains why smoking prevalence in Japan remains high. Light and mild cigarettes are popular in Japan because Japanese smokers believe low tar/nicotine cigarette with charcoal filters protect them and help mollify their health concerns about smoking.     

细支卷烟研究综述

为使国内研发人员准确把握国内外细支卷烟的研究现状,从细支卷烟发展的总体态势、燃吸机理、烟气的形成与传递及安全性评估等方面对细支卷烟进行了综述,并对国内烟草行业未来的细支卷烟研究方向进行了展望。结果表明:与常规卷烟相比,细支卷烟更能给人以愉悦和低风险的感知。国外烟草行业在烟支物理指标、燃吸机理、烟气成分形成与传递以及安全性评估等基础研究方面进行了大量研究,研究也较为深入。国内的相关研究起步较晚,但发展较快,主要涉及制丝、烟用材料、烟气成分以及卷烟设计等方面,研究的深度有待进一步加强。此外,国内烟草行业在燃吸机理及安全性评估方面的研究有所欠缺。      

Accuracy of parental reporting of secondhand smoke exposure: The National Health and Nutrition Examination Survey III.

The accuracy of parental reports of youth secondhand smoke exposure has received limited attention in the research literature. Such reports were compared to serum cotinine levels among participants of the National Health and Nutrition Examination Survey III who were aged 4-16 years. Likely smokers with serum cotinine values of 14 ng/ml or more and self-reported tobacco users were excluded from the analysis (n = 87), leaving 2,524 youth participants. One adult guardian, typically the parent, was asked to identify household smokers and estimate the number of cigarettes smoked in the home. Using cotinine levels of at least 0.2 ng/ml as the criterion, we found the sensitivity and specificity of any reported smokers in the home to be .65 and .92, respectively. Spearman correlations between cotinine levels and the number of smokers and the number of cigarettes consumed in the household were .67 and .68, respectively, and varied little across subgroups, including age, gender, and ethnicity of the child as well as household poverty status and educational attainment of the parent. Parental reports of household smoking alone fail to capture all youth secondhand smoke exposures, but they correlate well with cotinine levels when expressed as the number of household smokers or the number of cigarettes smoked in the household. Additional research is needed to determine whether reliance on parental reports of secondhand smoke exposure leads to bias in studies examining health outcomes in children and adolescents. Also, additional research is needed to better determine the level of secondhand smoke exposure that is biologically important in children and adolescents.     

Courtesy and the challenges of implementing smoke-free policies in Japan.

For decades, the tobacco companies have developed a worldwide campaign to oppose the creation of smoke-free environments. Public health efforts to promote clean indoor air have been uneven throughout the world, and in few places have such efforts faced as many challenges as in Japan. The Japanese market is dominated by Japan Tobacco, which is partly owned by the government, and Philip Morris International is also present in Japan. Japan Tobacco and Philip Morris International have developed campaigns promoting courtesy and tolerance that, until recently, seem to have resonated well with the public. The companies also have supported research promoting ventilation and have funded consultants to act as experts in the area of second-hand smoke exposure. Japan is a critical country to study, partly because of the strength of Japan Tobacco in the country and the growth of Japan Tobacco International in Southeast Asia and the rest of the world, and partly because of Japan's ratification of the World Health Organization Framework Convention on Tobacco Control. This paper uses tobacco industry documents to provide an overview of the tobacco industry's scientific and political efforts to stifle the development of clean indoor measures in Japan. Learning past industry strategies may assist policymakers and advocates in the development of future public health activities.     

The relationship of smoking cessation to sociodemographic characteristics, smoking intensity, and tobacco control policies.

The present study examined the relationship between recent smoking cessation activities and sociodemographic characteristics, smoking intensity, and tobacco control policies among daily smokers in the United States. The study used the U.S. Current Population Survey 1998-1999 Tobacco Use Supplement, supplemented with information on state-level tobacco control policies. The sample was limited to individuals aged 25 years or older who were smoking daily 1 year ago. We estimated frequencies and multivariate logistic equations for making a quit attempt and remaining abstinent at least 3 months. These measures were related to demographic characteristics, smoking intensity, and tobacco control policies. Younger, higher socioeconomic status (SES), and less intense (fewer cigarettes per day) daily smokers were more likely to make quit attempts, but the likelihood of remaining abstinent for those making a quit attempt was greater for older, higher SES, and heavy daily smokers. We found evidence that cessation behaviors were related to higher cigarette prices and the presence of state-level media/comprehensive campaigns, but less clear evidence exists for an association with bans restricting workplace smoking. The results indicate that certain types of smokers are more likely to attempt to quit and to have success and that the characteristics of these smokers differ. Price policies can have an important role in helping daily smokers to quit. Further research is needed regarding the role of quantity smoked.     

The menthol smoker: tobacco industry research on consumer sensory perception of menthol cigarettes and its role in smoking behavior.

The use of menthol in cigarettes is actively promoted by the tobacco industry for its perceived sensory benefits, and smokers of menthol cigarettes commonly differ from nonmenthol smokers in markers of smoking behavior and addiction. In this study, we analyzed internal tobacco industry documents to describe the relationships between sensory perception and the attitudes, preferences, and patterns of cigarette use among menthol smokers. Two unique types of menthol smoker emerged from this analysis: those who cannot tolerate the harshness and irritation associated with smoking nonmenthol cigarettes, and those who seek out the specific menthol flavor and associated physical sensation. Among the first segment of menthol smokers, menthol reduces negative sensory characteristics associated with smoking. This segment of smokers may include a large proportion of occasional smokers or young people, as well as smokers who have "traded down" to a less strong cigarette because of perceived harshness or negative health effects. Some established menthol smokers, on the other hand, appear to be tolerant of and even actively seek stronger sensory attributes, including higher menthol levels. Smokers of these "stronger" menthols have traditionally been disproportionately Black and male. Some beginning or occasional smokers may adopt menthols for their mild properties and to cover up the taste of tobacco, but then develop a stronger desire for the menthol taste over time. Future research measuring smoking behavior and evaluating cessation outcomes of menthol smokers should consider the duration of menthol use and differentiate smokers according to their reasons for using menthols.     

加热不燃烧烟草制品发展现状及展望

为使我国科研技术人员把握国际烟草企业新型烟草制品中加热不燃烧产品的特点和技术走向,对目前市场上销售及在研的加热不燃烧烟草制品进行总结和分析,并着重对加热不燃烧烟草制品烟气化学的安全性进行了综述。结果表明:在新型烟草制品领域,专利数据显示三大跨国烟草企业（菲莫烟草、英美烟草及日本烟草）更注重在加热不燃烧烟草制品方面的技术开发, 尤其是菲莫烟草;烟气化学对比分析表明加热不燃烧烟草制品是行业未来最具发展潜力的热点;在加热不燃烧烟草制品技术领域,电加热型（含混合型）在口感和降低有害成分释放方面优于碳加热型;相比于纯电加热型产品,混合型产品的有害成分释放量更低。      

Implementation of the WHO Framework Convention on Tobacco Control in mainland China

As per China's ratification of the WHO Framework Convention on Tobacco Control (FCTC), it should have implemented effective packaging and labelling measures prior to 9 January 2009 and enacted a comprehensive ban on all tobacco advertising, promotion and sponsorship prior to 9 January 2011. In addition, universal protection against secondhand tobacco smoke should have been implemented before 9 January 2011 by ensuring that all indoor workplaces, all indoor public places, all public transportation and possibly other (outdoor or quasi-outdoor) public places are free of secondhand smoke. The authors conducted a review of various sources of information to determine the current status of FCTC implementation in mainland China. Even though China has made considerable efforts to implement the FCTC, there is still a significant gap between the current state of affairs in China and the requirements of the FCTC. The Chinese tobacco monopoly under which commercial and other vested interests of the tobacco industry are jeopardizing tobacco control efforts is thought to be the most crucial obstacle to the effective implementation of the FCTC across the country.     

German tobacco industry's successful efforts to maintain scientific and political respectability to prevent regulation of secondhand smoke

Objective

To examine the tactics the tobacco industry in Germany used to avoid regulation of secondhand smoke exposure and to maintain the acceptance of public smoking.

Methods

Systematic search of tobacco industry documents available on the internet between June 2003 and August 2004.

Results

In West Germany, policymakers were, as early as the mid 1970s, well aware of the fact that secondhand smoke endangers non‐smokers. One might have assumed that Germany, an international leader in environmental protection, would have led in protecting her citizens against secondhand smoke pollution. The tobacco manufacturers in Germany, however, represented by the national manufacturing organisation “Verband” (Verband der Cigarettenindustrie), contained and neutralised the early debate about the danger of secondhand smoke. This success was achieved by carefully planned collaboration with selected scientists, health professionals and policymakers, along with a sophisticated public relations programme.

Conclusions

The strategies of the tobacco industry have been largely successful in inhibiting the regulation of secondhand smoke in Germany. Policymakers, health professionals, the media and the general public should be aware of this industry involvement and should take appropriate steps to close the gap between what is known and what is done about the health effects of secondhand smoke.     

Endotoxins in tobacco smoke: shifting tobacco industry positions.

In the 1980s, the tobacco industry started a campaign to divert attention away from secondhand tobacco smoke (SHS) as a major source of indoor air pollution in workplaces by highlighting the roles of other indoor air pollutants. The industry, working through "third parties," highlighted endotoxins, naturally occurring substances that cause numerous inflammatory reactions in humans, as an alternative explanation to SHS as causing indoor air problems. In 1995, Hasday and colleagues were the first to present findings that cigarette smoke contains significant quantities of endotoxins. This discovery surprised tobacco industry scientists. The 1999 publication of the full Hasday et al. findings received only limited media attention but got the full attention of Philip Morris scientists concerned about a new public health issue and a new basis for regulation of workplace smoking by the U.S. Occupational Safety and Health Administration, which already regulated workplace endotoxin exposures from other sources. Philip Morris undertook an internal endotoxin research project to test the Hasday et al. findings and to determine if endotoxin-free cigarettes were possible. Although experiments were conducted to remove endotoxin from the tobacco, there is no evidence that they were successful. Following confirmation of SHS as an important source of endotoxins, the scientist promoting endotoxins as an important indoor air pollutant for the tobacco industry softened his position on the role of endotoxins as indoor pollutants. The presence of endotoxins in SHS provides an additional mechanism for the adverse effects of SHS that should be researched further, and the risk of exposure should be assessed.     

What the public thinks about the tobacco industry and its products

Objectives: To assess public attitudes toward the tobacco industry and its products, and to identify predictors of attitudes supportive of tobacco industry denormalisation.

Design: Population based, cross sectional survey.

Setting: Ontario, Canada.

Subjects: Adult population (n = 1607).

Main outcome measures: Eight different facets of tobacco industry denormalisation were assessed. A denormalisation scale was developed to examine predictors of attitudes supportive of tobacco industry denormalisation, using bivariate and multivariate analyses.

Results: Attitudes to the eight facets of tobacco industry denormalisation varied widely. More than half of the respondents supported regulating tobacco as a hazardous product, fining the tobacco industry for earnings from underage smoking, and suing tobacco companies for health care costs caused by tobacco. Majorities also thought that the tobacco industry is dishonest and that cigarettes are too dangerous to be sold at all. Fewer than half of the respondents thought that the tobacco industry is mostly or completely responsible for the health problems smokers have because of smoking and that tobacco companies should be sued for taxes lost from smuggling. In particular, less than a quarter thought that the tobacco industry is most responsible for young people starting to smoke. Non-smoking, knowledge about health effects caused by tobacco, and support for the role of government in health promotion were independent predictors of support for tobacco industry denormalisation.

Conclusions: Although Ontarians are ambivalent toward tobacco industry denormalisation, they are supportive of some measures. Mass media programmes aimed at increasing support for tobacco industry denormalisation and continued monitoring of public attitudes toward this strategy are needed.

     

Smoking,social class,and gender: what can public health learn from the tobacco industry about disparities in smoking?

Objective: To discover how the tobacco industry considers social class and gender in its efforts to market cigarettes in the USA, particularly to socially disadvantaged young women. Methods: A systematic on-line search of tobacco industry documents using selected keywords was conducted, and epidemiological data on smoking rates reviewed. Results: The two largest cigarette manufacturers in the USA consider "working class" young adults to be a critical market segment to promote growth of key brands. Through their own market research, these companies discovered that socially disadvantaged young women do not necessarily desire a "feminine" cigarette brand. Conclusions: Considering the tobacco industry''s efforts, alongside the persistent and growing disparities in cigarette smoking by social class, and the narrowing of differences in smoking by gender, it is concluded that additional tobacco control resources ought to be directed toward working class women.     

Cigarette advertising and promotional strategies in retail outlets: results of a statewide survey in California

OBJECTIVE: To examine the extent and types of cigarette advertising materials in stores and to assess tobacco company compliance with the 1998 Master Settlement Agreement (MSA). DESIGN: A cross-sectional analysis of a random sample of 586 stores that sold cigarettes. SETTING: US state of California. MAIN OUTCOME MEASURES: Trained data collectors classified cigarette advertising materials by type (signs, displays, functional items), location (interior or exterior), and placement (below 3 feet (1 m) or near candy). RESULTS: California retail outlets featured 17.2 (SD 16.1) tobacco advertising materials on average, and 94% of stores featured at least some advertising. About 85% of these were within 4 feet (1.3 m) of the counter. About 50% of the stores had ads at or below 3 feet, and 23% had cigarette product displays next to candy. In violation of the MSA, 3% of stores featured signs with cartoons and 11% had large exterior signs. CONCLUSIONS: Tobacco companies are aggressively using stores to market cigarettes. Moreover, the spirit of the MSA-to protect children from cigarette advertising-has not been realised. Future studies should monitor industry use of this venue and assess the impact of exposure to cigarette advertising materials in stores on adult smokers and youth.