Publicity bans and health warnings: a 74-nation resume of oppression

A tabulation of official or officially inspired restrictions on tobacco advertising and of rules governing health warnings in 74 countries, based on data compiled by the National Clearinghouse for Smoking and Health, shows that restrictions are widespread in many advanced countries but less prevalent elsewhere. 37 countries, primarily in developing areas but including Bulgaria, Greece, and Portugal, had no present or pending restrictions on advertising or requirements for health warnings. In addition, advertising restrictions were absent but pending in Brazil, Israel, and Mexico, and daytime advertising restrictions on television and radio were in effect in Colombia, Ecuador, Guatemala and Peru. 20 developed countries plus Burma, Iraq, South Korea, Saudi Arabia, Singapore, Turkey, and Zambia ban television and radio advertising of cigarettes; 11 countries ban cigarette advertising in the press; 14 countries ban television and radio advertising of other tobacco products; and 8 countries ban advertising of other tobacco products in the press. Health warnings are required on cigarette packs only in Canada, Costa Rica, Ecuador, Ireland, New Zealand, Japan, Panama, Peru, the UK, the US, and some areas of Australia. No countries require health warning labels on other tobacco products, and only Australia, Canada, Panama, Peru, and the UK require health warnings in advertisements.     

What public health strategies are needed to reduce smoking initiation?

Smoking initiation is a key behaviour that determines the future health consequences of smoking in a society. There is a marked difference in smoking patterns around the world, driven by initiation rates. While a number of high-income countries have seen smoking prevalence decline markedly from peak, many low-income and middle-income countries appear to still be on an upward trend. Unlike cessation where changes are limited by nicotine dependence, rates of smoking initiation can change rapidly over a short time span. Interventions that can be effective in achieving this include increases in the price of tobacco products, mass media anti-smoking advertising, smoke-free policies, smoking curricula in schools, restrictions on marketing opportunities for the tobacco industry as well as social norms that lead to restrictions on adolescents' ability to purchase cigarettes. Comprehensive tobacco control programmes that aim to denormalise smoking behaviour in the community contain all of these interventions. Rapid reductions in smoking initiation in adolescents have been documented in two case studies of comprehensive tobacco control programmes in California and Australia. Consistent and inescapable messages from multiple sources appear to be key to success. However, the California experience indicates that the rapid decline in adolescent smoking will not continue if tobacco control expenditures and the relative price of cigarettes are reduced. These case studies provide strong additional evidence of the importance of countries implementing the provisions of the Framework Treaty on Tobacco Control.     

Glamour puff

Australia has a total ban on tobacco advertising and promotion . . .but tobacco marketing goes on.     

Consequences of marketing exceptions in the Master Settlement Agreement: exposure of youth to adult-only tobacco promotions.

The Master Settlement Agreement between a consortium of tobacco companies and 46 states contains many restrictions on tobacco sales and advertising that were designed to reduce youth exposure to tobacco promotions. Most of the restrictions include an exception for "adult-only" facilities. The present study investigated the extent to which youth are being exposed to marketing that is presumably limited to adults. Using data from a statewide random-digit-dialed survey of 3,863 Massachusetts youth aged 12-17 years, we found that about half of all youth in this age group reported seeing cigarettes advertised at events, concerts, bars, or clubs in the past 12 months, and that about 5% of youth in this age group reported being present at a venue where free samples of cigarettes were being distributed. Youth exposed to this marketing were those most at risk for progression to established smoking. To our knowledge, this is the first study to estimate youth exposure to advertisements designed for adult-only venues. In light of the large body of evidence that exposure to tobacco advertising and promotion increases tobacco use among youth, our findings demonstrate the need to close the "adult-only" loophole.     

Cigarette advertising in Mumbai, India: targeting different socioeconomic groups, women, and youth

Background: Despite a recent surge in tobacco advertising and the recent advertising ban (pending enforcement at the time of this study), there are few studies describing current cigarette marketing in India. This study sought to assess cigarette companies' marketing strategies in Mumbai, India.

Methods: A two week field study was conducted in Mumbai in September 2003, observing, documenting, and collecting cigarette advertising on billboards, storefronts and at point of sale along two major thoroughfares, and performing a content analysis of news, film industry, and women's magazines and three newspapers.

Results: Cigarette advertising was ubiquitous in the environment, present in news and in film magazines, but not in women's magazines or the newspapers. The four major advertising campaigns all associated smoking with aspiration; the premium brands targeting the higher socioeconomic status market utilised tangible images of westernisation and affluence whereas the "bingo" (low priced) segment advertisements invited smokers to belong to a league of their own and "rise to the taste" using intangible images. Women were not depicted smoking, but were present in cigarette advertisements—for example, a woman almost always accompanied a man in "the man with the smooth edge" Four Square campaign. Advertisements and product placements at low heights and next to candies at point of sale were easily accessible by children. In view of the iminent enforcement of the ban on tobacco advertisements, cigarette companies are increasing advertising for the existing brand images, launching brand extensions, and brand stretching.

Conclusion: Cigarette companies have developed sophisticated campaigns targeting men, women, and children in different socioeconomic groups. Many of these strategies circumvent the Indian tobacco advertising ban. Understanding these marketing strategies is critical to mimimise the exploitation of loopholes in tobacco control legislation.

     

Tobacco interests or the public interest: 20 years of industry strategies to undermine airline smoking restrictions

Objectives

To understand the evolution of 20 years of tobacco industry strategies to undermine federal restrictions of smoking on aircraft in the United States.

Design

We searched and analysed internal tobacco industry records, public documents, and other related research.

Results

The industry viewed these restrictions as a serious threat to the social acceptability of smoking. Its initial efforts included covert letter‐writing campaigns and lobbying of the airline industry, but with the emergence of proposals to ban smoking, the tobacco companies engaged in ever increasing efforts to forestall further restrictions. Tactics to dominate the public record became especially rigorous. The industry launched an aggressive public relations campaign that began with the promotion of industry sponsored petition drives and public opinion surveys. Results from polling research that produced findings contrary to the industry''s position were suppressed. In order to demonstrate smoker outrage against a ban, later efforts included the sponsorship of smokers'' rights and other front groups. Congressional allies and industry consultants sought to discredit the science underlying proposals to ban smoking and individual tobacco companies conducted their own cabin air quality research. Faced with the potential of a ban on all domestic flights, the industry sought to intimidate an air carrier and a prominent policymaker. Despite the intensification of tactics over time, including mobilisation of an army of lobbyists and Congressional allies, the tobacco industry was ultimately defeated.

Conclusions

Our longitudinal analysis provides insights into how and when the industry changed its plans and provides public health advocates with potential counterstrategies.     

Why did Swiss citizens refuse to ban tobacco advertising?

A ban on tobacco advertising is one of the major tools to promote tobacco control. Swiss citizens recently refused to modify the Swiss Constitution to ban tobacco advertising. This case study shows how a strong alliance among the tobacco industry, the state, the media, and sports and cultural activities planners made it difficult for people to make an informed decision. The promoters of the ban were unable to provide counter-arguments to the mostly fallacious claims made by the opponents regarding the likely health and economic impact of this ban. A comparison to successful campaigns in Canada and New Zealand provides insight regarding factors missing in the Swiss campaign which might have been useful in obtaining support from Swiss citizens.


     

Understanding the vector in order to plan effective tobacco control policies: an analysis of contemporary tobacco industry materials

This paper builds on tobacco document research by analysing contemporary materials to explore how the global tobacco market has changed, how transnational tobacco companies (TTCs) are responding and the implications for tobacco control. The methods involved analysis of a variety of materials, including tobacco company annual reports, investor relations materials, financial analyst reports, market research reports and data. Once China, where TTCs have little market share, is excluded, global cigarette volumes are already declining. Nevertheless, industry profits continue to increase. This pattern is explained by the pricing power of TTCs-their ability to increase prices faster than volumes fall, a consequence of market failure. Pricing power is now fundamental to the long term future of TTCs. Consequently, and in light of growing regulations, the business model of the TTCs is changing. Product innovation is now a key marketing technique used to drive consumers to buy more expensive (ie, profitable) premium cigarettes. Contrary to established wisdom, high tobacco excise rates, particularly where increases in excise are gradual, can benefit TTCs by enabling price (profit) increases to be disguised. Large intermittent tax increases likely have a greater public health benefit. TTC investments in smokeless tobacco appear designed to eliminate competition between smokeless tobacco and cigarettes, thereby increasing the pricing power of TTCs while enabling them to harness the rhetoric of harm reduction. Monitoring TTCs can inform effective policy development. The value maximising approach of TTCs suggests that a ban on product innovation and more informed tobacco excise policies are needed.     

How tobacco companies ensure prime placement of their advertising and products in stores: interviews with retailers about tobacco company incentive programmes

Background: About 81% of cigarette manufacturers' marketing expenditures in the USA is spent to promote cigarette sales in stores. Relatively little is known about how these expenditures help the manufacturers achieve their marketing goals in stores. A better understanding of how tobacco companies influence the retail environment would help researchers and tobacco control activists to monitor industry presence in stores.     

How Philip Morris unlocked the Japanese cigarette market: lessons for global tobacco control

Background: The Framework Convention on Tobacco Control includes tobacco advertising restrictions that are strongly opposed by the tobacco industry. Marketing strategies used by transnational tobacco companies to open the Japanese market in the absence of such restrictions are described.

Methods: Analysis of internal company documents.

Findings: Between 1982 and 1987 transnational tobacco companies influenced the Japanese government through the US Trade Representative to open distribution networks and eliminate advertising restrictions. US cigarette exports to Japan increased 10-fold between 1985 and 1996. Television advertising was central to opening the market by projecting a popular image (despite a small actual market share) to attract existing smokers, combined with hero-centred advertisements to attract new smokers. Philip Morris's campaigns featured Hollywood movie personalities popular with young men, including James Coburn, Pierce Brosnan, Roger Moore, and Charlie Sheen. Event sponsorships allowed television access despite restrictions. When reinstatement of television restrictions was threatened in the late 1980s, Philip Morris more than doubled its television advertising budget and increased sponsorship of televised events. By adopting voluntary advertising standards, transnational companies delayed a television advertising ban for over a decade.

Conclusions: Television image advertising was important to establish a market, and it has been enhanced using Hollywood personalities. Television advertising bans are essential measures to prevent industry penetration of new markets, and are less effective without concurrent limits on sponsorship and promotion. Comprehensive advertising restrictions, as included in the Framework Convention for Tobacco Control, are vital for countries where transnational tobacco companies have yet to penetrate the market.

     

Literature review and summary of perceptions, attitudes, beliefs, and marketing of potentially reduced exposure products: communication implications.

Potentially reduced exposure products (PREPs) have continued to enter the market during the 1990s and first part of the 21st century. Attempts by the tobacco industry to develop and market products with implied reductions in adverse health effects (i.e., harm reduction) are not new. Over the last half of the 20th century, the tobacco industry developed and marketed several products that purported to reduce the health risks associated with smoking cigarettes. Among these were filtered cigarettes in the 1950s and light and ultra-light cigarettes in the 1970s and 1980s. This review summarizes published and unpublished research that is directly relevant to the marketing, advertising, and communication about PREPs. The marketing strategies for these new products do not appear to differ from those used by the tobacco industry for light and ultra-light cigarettes. Although smokers report not using the new products in large numbers because of dissatisfaction with taste, they are interested in using products with reduced risk. Despite the absence of explicit health claims by the industry for PREPs, many smokers believe that these products are safer based on the advertising claims of reduced exposure and a belief that claims are approved by the government. No data are available to indicate that PREPs are useful for prevention or cessation of smoking, nor does specific research exist to suggest what health communication messages will provide smokers with accurate information about these products.     

Use of corporate sponsorship as a tobacco marketing tool: a review of tobacco industry sponsorship in the USA, 1995-99

OBJECTIVE: To describe the nature and extent of tobacco company sponsorship in the USA during the period 1995-99 and analyse this sponsorship in a marketing context. DESIGN: A cross-sectional study of tobacco company sponsorships identified through a customised research report from IEG Inc, and from internet web site searches. METHODS: First, a customised report was received from IEG Inc, which identified sponsorship activities for Philip Morris, RJ Reynolds, Brown & Williamson, Lorillard, and US Tobacco for the years 1997 and 1998. Second, the internet was systematically searched for tobacco industry sponsorships during the period 1995-99 by the same parent companies and their respective brands. RESULTS: During the period 1995-99, tobacco companies sponsored at least 2733 events, programmes, and organisations in the USA. Sponsorships involved all 50 states and the District of Columbia, and the minimum total funding amount of these sponsorships was $365.4 million. Tobacco corporate sponsorships involved numerous small, community based organisations, both through direct funding and through grants to larger umbrella organisations, and many of these organisations were part of the public health infrastructure. CONCLUSIONS: Tobacco corporate sponsorship serves as an important marketing tool for tobacco companies, serving both a sales promotion and public relations function. Public health practitioners need to develop better surveillance systems for monitoring tobacco sponsorship, to seek out alternative funding sources for tobacco company sponsored events and organisations, and to consider promoting a ban on tobacco sponsorship, possibly linking such regulation to the creation of alternative funding sources.     

Attitudes and experiences of restaurateurs regarding smoking bans in Adelaide, South Australia

OBJECTIVES: To determine compliance with a voluntary code of practice (VCP) for restricting smoking in restaurants and to canvass the attitudes of restaurateurs towards tougher smoking restrictions. DESIGN: Cross-sectional survey conducted in 1996 using a telephone questionnaire. SETTING: Metropolitan restaurants and cafes in Adelaide, South Australia. PARTICIPANTS: 276 (86.8%) of a sample of randomly selected owners and managers. MAIN OUTCOME MEASURES: Restaurant non-smoking policies, reported and anticipated change in business, and restaurateurs' attitudes towards smoking restrictions. RESULTS: 26.8% of restaurants had a total smoking ban; 40.6% restricted smoking some other way; and 32.6% permitted unrestricted smoking. Only 15.1% of restaurants with a ban or restrictions had used the VCP to guide the development of their policy, and only half of these were complying with it. Although 78.4% of those with bans and 84.4% of those with restrictions reported that their non-smoking policy had been associated with either no change or a gain in business, only 33.3% of those allowing unrestricted smoking expected that this would be the case, if they were to limit smoking. A total of 50.4% of restaurateurs, including 45.3% of those with no restrictions, agreed that the government should ban smoking in all restaurants. CONCLUSIONS: The VCP made an insignificant contribution to adoption of non-smoking policies, and compliance with the code was poor. Despite concerns about loss of business, there was considerable support for legislation which would ban smoking in all dining establishments.     

Impact of the Tobacco Price Support Program on tobacco control in the United States

OBJECTIVES—To evaluate the impact of the United States Tobacco Price Support Program (TPSP) on domestic cigarette consumption and the potential political impact of the TPSP on efforts to reduce smoking.
DATA SOURCES—Published studies known to the authors and a search of AGRICOLA from 1980 to 1996.
STUDY SELECTION—Studies published in a refereed journal or research reports published by an accredited university or institution.
DATA SYNTHESIS—The TPSP decreases cigarette use by increasing the price of cigarettes. The price increase resulting from the TPSP, however, is small—about one cent per pack. The resulting decrease in cigarette consumption is also very modest—an estimated 0.23%. However, the TPSP creates tobacco quota owners, who have a strong financial interest in opposing measures to reduce smoking. The TPSP also changes the political influence of tobacco farmers by keeping a large number of small farmers in tobacco production.
CONCLUSIONS—The negative impact of the TPSP (opposition to tobacco control measures) is probably greater than the positive impact of the programme (reducing smoking). Therefore, the net impact of the TPSP on tobacco control efforts is likely to be negative.


Keywords: cigarette consumption; Tobacco Price Support Program; United States     

Discrete choice experiment of smoking cessation behaviour in Japan

Background

In spite of gradual increases in tobacco price and the introduction of laws supporting various anti‐tobacco measures, the proportion of smokers in Japan''s population is still higher than in other developed nations.

Objective

To understand what information and individual characteristics drive smokers to attempt to quit smoking. These determinants will help to realise effective tobacco control policy as a base for understanding of cessation behaviour.

Method

Discrete choice experiments on a total of 616 respondents registered at a consumer monitoring investigative company.

Results

The effect of price is greater on smokers with lower nicotine dependence. For smokers of moderate and low dependency, short term health risks and health risks caused by passive smoking have a strong impact, though the existence of penalties and long term health risks have little influence on smokers'' decisions to quit. For highly dependent smokers, non‐price attributes have little impact. Furthermore, the effects of age, sex and knowledge are also not uniform in accounting for smoking cessation.

Conclusion

Determinants of smoking cessation vary among levels of nicotine dependency. Therefore, how and what information is provided needs to be carefully considered when counselling smokers to help them to quit.     

Surveillance of tobacco industry retail marketing activities of reduced harm products.

With the introduction of potential reduced exposure products (PREPs) and the interest in studying tobacco harm reduction, sound research and surveillance are needed to examine and understand the distribution and availability of PREPs in communities, as well as the tobacco industry's marketing practices surrounding these products. We examined the availability and marketing of PREPs in a national sample of tobacco retail stores. We also compared the price of PREPs to those of premium brand cigarettes and examined the distribution of PREPs in comparison with premium brand cigarettes by store type, urbanization, region, and race/ethnicity. We found that PREPs are not widely available, are priced similarly to leading cigarette brands, and have few promotional offers. We also found some significant differences in the distribution of PREPs and cigarettes, as well as in the distribution of Ariva and Omni, by store type and community demographics. The fact that this study used data collected nationally emphasizes the importance of these findings and helps shed some light on the tobacco industry's PREP marketing strategies. This study's national sample provides a unique perspective that needs to be replicated if and when other PREPs are widely marketed.     

Determinants of seafood consumption in Norway: lifestyle,revealed preferences,and barriers to consumption

Little research attention has previously been paid to understand the complementary relationship between the consumption of seafood and variation in lifestyle factors. The present paper seeks to address this question by hypothesizing that the consumption of seafood is strongly influenced both by the variation in lifestyle factors and consumer's experience with available products in the market. Understanding the main lifestyle factors influencing consumption behaviour and seafood demand is important for marketers who want to increase the product values both for the consumers and themselves. A recursive sequential model of the decision-making process is used to evaluate the effect of socio-demographic variables, consumption of other dinner dishes, other lifestyle variables, and attitudes towards seafood on consumption amongst women of three major seafood categories at-home. The most important finding which can be influenced through the marketing process is that product attributes more than beliefs concerning price are important perceived barriers for consumption. The presence of school-aged kids in the household and regional residence influences what kind of seafood is consumed, while total consumption increases with increasing size of the household, increasing age and higher education. This indicates that there is a potential for suppliers to increase the sales value through marketing of high quality products which satisfy experienced and higher educated consumers, while families with kids should be satisfied through marketing of value-added product forms.     

Non-cigarette tobacco products: what have we learnt and where are we headed?

A wide variety of non-cigarette forms of tobacco and nicotine exist, and their use varies regionally and globally. Smoked forms of tobacco such as cigars, bidis, kreteks and waterpipes have high popularity and are often perceived erroneously as less hazardous than cigarettes, when in fact their health burden is similar. Smokeless tobacco products vary widely around the world in form and the health hazards they present, with some clearly toxic forms (eg, in South Asia) and some forms with far fewer hazards (eg, in Sweden). Nicotine delivery systems not directly reliant on tobacco are also emerging (eg, electronic nicotine delivery systems). The presence of such products presents challenges and opportunities for public health. Future regulatory actions such as expansion of smoke-free environments, product health warnings and taxation may serve to increase or decrease the use of non-cigarette forms of tobacco. These regulations may also bring about changes in non-cigarette tobacco products themselves that could impact public health by affecting attractiveness and/or toxicity.     

Welfare analysis of changing food prices: a nonparametric examination of rice policies in India

The paper examines the welfare impact of the Indian government’s rice price policies in the light of the global food crisis of 2007–08 using a nonparametric approach for regression and density estimation. In particular, the impact of a ban on export of rice and increased farm gate price support for farmers, implemented to keep domestic consumer prices lower and producer prices higher than they would otherwise have been, was analysed. The net impact of the export ban was positive, as it was able to cushion the Indian population (84 % of whom are net consumers of rice) from the adverse effects of the crisis. However, the extent of welfare varied among different household types, as the poor in India are heterogeneous in nature. Thus agriculture-price policies do not have a homogenous effect on the poor in India. The majority of rice-producing farmers are relatively poor but benefitted from the increase in farm gate prices. Poor households that did not cultivate rice were the worst affected in the food crisis, as their budget share of rice is higher than that of rich households.