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.     

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.     

Women and tobacco in Indonesia

OBJECTIVES: To present a broad exploration of the relationship of women and tobacco in Indonesia and to describe action on tobacco and health specific to women taken by government and non-government agencies. DATA SOURCES: Published and unpublished prevalence surveys, official documents, vernacular newspapers, secondary sources, unstructured interviews, and personal observations. STUDY SELECTION: Data on smoking prevalence among women was primarily sought from official household surveys but several smaller scale local surveys were also examined. The only representative national household data on smoking prevalence from 1995 suggested a national prevalence for occasional and regular smoking of 2.6% for women aged 20 years or older. Smaller, local level surveys had reported rates varying from 4% for junior high school girls, and 2.9% for women undergraduates at a provincial university, to 6.4% of women in a representative sample in Jakarta. Claims that the incidence of female smoking is increasing cannot be confirmed due to an absence of comparable national longitudinal data. CONCLUSION: Although Indonesian women are conspicuous in growing and processing tobacco, their rates of smoking are low in comparison with their male compatriots and internationally. Anecdotal evidence suggests that their disinclination to smoke is commonly attributed to cultural values, which stigmatise women smokers as morally flawed, while at the same time sanctioning smoking by men. Although there is little evidence of tobacco advertising directly targeting women, Indonesian health activists interviewed by the author felt that women are increasingly taking up smoking due to a weakening of stigma and to Western cultural influences. Cultural factors in the low rates of smoking among Indonesian women deserve closer investigation as they have proved to be a major source of health protection, albeit within a stigmatising context. More also needs to be known about the dynamics of female tobacco use in Indonesia and the factors contributing to marked geographical variations in smoking prevalence.     

Sex and race differences in young people's responsiveness to price and tobacco control policies

OBJECTIVE: To determine if there are differences in young people's responsiveness to price and tobacco control policies for population subgroups and to examine whether or not these differences, if they exist, can explain sex and racial differences in trends in the prevalence of smoking in young people in the United States. DESIGN: Use cross-sectional and intertemporal variation in local and state tobacco control policies and prices to calculate demand responses to these policies using regression analysis techniques. SUBJECTS: A nationally representative sample of American eighth grade (ages 13-14 years), 10th grade (15-16 years) and 12th grade (17-18 years) students obtained from the 1992-1994 Monitoring the Future surveys. MAIN OUTCOME MEASURE: Thirty-day smoking prevalence. RESULTS: Young men are much more responsive to changes in the price of cigarettes than young women. The prevalence elasticity for young men is almost twice as large as that for young women. Smoking rates of young black men are significantly more responsive to changes in price than young white men. Significant differences in responsiveness to particular tobacco control policies also exist. These differences, however, explain relatively little of the differences in smoking prevalence among young population subgroups. CONCLUSIONS: Policymakers need to keep in mind that there is not a "one-size fits all" strategy for discouraging smoking among young people.     

Nicotine dependence versus smoking prevalence: comparisons among countries and categories of smokers

OBJECTIVES: To collect available international data on nicotine dependence as defined by the Fagerstrom Test of Nicotine Dependence, and to compare levels of dependence among countries and categories of smokers. DATA SOURCES: Published and unpublished studies known to the authors and a search of EMBASE from 1985-1995. STUDY SELECTION: Studies included were those based on a nationally representative sample of a country's population, or a sample of smokers seeking cessation assistance. DATA SYNTHESIS: Smokers who seek help in stopping smoking are much more dependent than the average smoker. Men consistently score higher on dependence than women. Ex-smokers appear to have lower dependence than current smokers. A country with low smoking prevalence, the United States, seems to have smokers with higher dependence scores than countries where smoking is more prevalent (such as Austria and Poland). CONCLUSIONS: Successful tobacco control may result in a higher dependence among the remaining smokers (due to selective quitting by low-dependent smokers). The remaining highly dependent smokers may need more intensive treatment.


     

Sharing the blame: smoking experimentation and future smoking-attributable mortality due to Joe Camel and Marlboro advertising and promotions

BACKGROUND: Despite public denials, internal tobacco company documents indicate that adolescents have long been the target of cigarette advertising and promotional activities. Recent longitudinal evidence suggests that 34% of new experimentation occurs because of advertising and promotions. OBJECTIVE: To apportion responsibility for smoking experimentation and future smoking-attributable mortality among major cigarette brands attractive to young people (Camel and Marlboro). DATA SOURCES, SETTING, AND PARTICIPANTS: Data were from confirmed never-smoking adolescents (12-17 years old) responding to the 1993 (n = 2659) and 1996 (n = 2779) population-based California Tobacco Surveys. MAIN OUTCOMES: Adolescents named the brand of their favourite cigarette advertisements and tobacco promotional items. Using these "market shares" and the relative importance of advertising and promotions in encouraging smoking, we estimated how many new experimenters from 1988 to 1998 in the United States can be attributed to Camel and Marlboro. From other data on the natural history of smoking, we projected how many future deaths in the United States can be attributed to each brand. RESULTS: Although Camel advertisements were favoured more than Marlboro and other brands in 1993 and 1996, the "market share" for promotional items shifted markedly during this period from Camel and other brands towards Marlboro. We estimated that between 1988 and 1998, there will be 7.9 million new experimenters because of tobacco advertising and promotions. This will result in 4.7 million new established smokers: 2.1, 1.2, and 1.4 million due to Camel, Marlboro, and other brands' advertising and promotions, respectively. Of these, 1.2 million will eventually die from smoking-attributable diseases: 520,000 from Camel, 300,000 from Marlboro, and the remainder from other brands. CONCLUSIONS: Our analysis provides a reasonable first estimate at sharing the blame for the long-term health consequences of smoking among the major brands that encourage adolescents to start smoking.     

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.

     

Role of slotting fees and trade promotions in shaping how tobacco is marketed in retail stores

OBJECTIVE: To examine how the retail environment in which tobacco is sold has changed because of the slotting fees and trade promotions paid by the tobacco companies. Public policy options for dealing with this environment are also evaluated. DATA SOURCES: A literature review, telephone interviews, and observation. RESULTS: The tobacco companies have been dramatically increasing the volume of slotting fees and trade promotions they pay to retailers, creating a more tobacco friendly retail environment containing self service displays and ample point-of-sale advertising. Critics express concern that these payments have kept prices lower and more varied than they might be otherwise, created more opportunities for pilferage and underage selling, and provided more youth exposure to tobacco promotions. Public policy makers could either ban these payments, institute policies designed to mitigate their harmful effects, or leave the situation as it is, relying on enforcement of existing statutes as well as market forces to reduce harm. Actions that might mitigate harmful effects would include putting minimum retail prices on tobacco products, banning self service displays, requiring retailers to be licensed, and adding more warning signs at the point of sale. CONCLUSION: Additional research is needed before determining the most appropriate public policy stance.     

Patterns of smoking in Bulgaria

BACKGROUND: Although the rate of smoking-related deaths in Bulgaria is still relatively low, in international terms, it has been rising rapidly. This is likely to become worse in the future as Bulgaria faces growing pressure from transnational tobacco companies. There is, however, little information on patterns of smoking, which is necessary for development of effective policies to tackle tobacco consumption. OBJECTIVE: To describe the pattern of smoking in Bulgaria and its relationship with sociodemographic factors. DESIGN: Multivariate analysis of data on patterns of tobacco consumption from a multi-stage nationwide survey of 1550 adults. SETTING: Bulgaria, in 1997. MAIN OUTCOME MEASURE: Prevalence of current cigarette smoking. RESULTS: 38.4% of men and 16.7% of women smoke. Smoking rates are strongly associated with age, with 58% of men and 30% of women aged 30-39 smoking whereas only 5% of men aged 70 years and older and almost no women of this age smoke. Smoking is more common in cities, among those who are widowed or divorced, or who do not own their home. There is no clear association with household income or, for men, with education, although there is a suggestion that smoking may be more common among more highly educated women. CONCLUSIONS: The observed pattern of smoking indicates the need for a robust policy to tackle smoking in Bulgaria, especially among the young in large cities, informed by a better understanding of why smoking rates vary among different groups.     

Smoking on the rise among young adults: implications for research and policy

This paper investigates hypotheses regarding the cause of the recent apparent increase in young adult smoking, compares trends in smoking among young adults with trends in the use of other substances, and considers the implications for youth tobacco control research and policy. Time series analyses of national data suggest that the recent observed increase in smoking among young adults is primarily an artefact of the almost simultaneous increase in smoking among high school students. In addition, however, it also appears that there have been real changes in smoking patterns among young adults. While many questions remain regarding recent trends in tobacco and other drug use among adolescents and young adults, what is known leads to a clarion call for increased intervention and policy action for the prevention and control of tobacco use among young adults in the USA.     

Effectiveness of comprehensive tobacco control programmes in reducing teenage smoking in the USA

OBJECTIVE: To describe the extent to which comprehensive statewide tobacco control programmes in the USA have made progress toward reducing teenage smoking. DATA SOURCES: Literature search of Medline for reviews of effectiveness of programme and policy elements, plus journal articles and personal request for copies of publicly released reports and working papers from evaluation staff in each of the state programmes of California, Massachusetts, Arizona, Oregon, and Florida. STUDY SELECTION: All studies, reports, and commentaries that provided information on aspects of programme implementation and evaluation. DATA SYNTHESIS: Statewide comprehensive programmes show high levels of advertising recall and generally positive improvement in smoking related beliefs and attitudes among teenagers. More fully funded programmes lead to increased mass media campaign advertising and community initiatives; a greater capacity to implement school based smoking prevention programmes; and an increase in the passage of local ordinances that create smoke free indoor environments and reduce cigarette sales to youth. The combination of programme activity and increased tobacco tax reduce cigarette consumption more than expected as a result of price increases alone, and these effects seem to apply to adolescents as well as adults. Programmes are associated with a decline in adult smoking prevalence, with these effects observed to date in California, Massachusetts, and Oregon. Arizona and Florida have yet to examine change in adult prevalence associated with programme exposure. California and Massachusetts have demonstrated relative beneficial effects in teenage smoking prevalence, and Florida has reported promising indications of reduced prevalence. Arizona has yet to report follow up data, and Oregon has found no change in teenage smoking, but has only two years of follow up available. One of the most critical factors in programme success is the extent of programme funding, and consequent level of programme implementation, and the degree to which this is undermined by the tobacco industry and other competitors for funding. CONCLUSIONS: Despite the different strengths and combinations of programme messages and strategies used in these comprehensive programmes, there is evidence that they lead to change in factors that influence teenage smoking, and to reductions in teenage smoking.     

Eyes on the prize: transnational tobacco companies in China 1976-1997

Internal tobacco industry documents relevant to China as published on www.tobaccoarchives.com located between 31 May and 1 August 1999 were searched. Documents describing the ambitions and conduct of transnational tobacco companies (TTCs) in China between 1976 and 1997 were located and reviewed in three sections: part A-early identification of market potential and attempts to enter the market, and improve trade and technology; part B-marketing and promotion efforts; part C-efforts to pre-empt legislation, control the smoking and health debate, and undermine the anti-tobacco lobby.     

A systematic review of interventions for preventing tobacco sales to minors

OBJECTIVE: To assess the effectiveness of interventions to reduce underage access to tobacco by deterring shopkeepers from making illegal sales. METHOD: Systematic literature review. DATA SOURCES: The Cochrane Tobacco Addiction group specialised register and Medline. Studies of interventions to alter retailer behaviour were identified. The terms used for searching combined terms for smoking and tobacco use with terms for minors, children or young people, and retailers, sales or commerce. STUDY SELECTION: Studies in which there was an intervention with retailers of tobacco, either through education about, or enforcement of, local ordinances. The outcomes were changes in retailer compliance with legislation (assessed by test purchasing), changes in young people's perceived ease of access to tobacco products, and changes in smoking behaviour. Controlled studies with or without random allocation of retail outlets or communities, and uncontrolled studies with pre- and post intervention assessment, were included. DATA EXTRACTION: Two reviewers assessed studies for inclusion. One extracted data with checking by the second. DATA SYNTHESIS: The results were synthesised qualitatively, with greater weight given to controlled studies. Thirteen of 27 included studies used controls. RESULTS: Giving retailers information was less effective in reducing illegal sales than active enforcement and/or multicomponent educational strategies. No strategy achieved complete, sustained compliance. In three controlled trials, there was little effect of intervention on youth perceptions of access or prevalence of smoking. CONCLUSIONS: Interventions with retailers can lead to large decreases in the number of outlets selling tobacco to youths. However, few of the communities studied in this review achieved sustained levels of high compliance. This may explain why there is limited evidence for an effect of intervention on youth perception of ease of access to tobacco, and on smoking behaviour.     

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.     

Tobacco use among young adults in Norway, 1973-95: has the decrease levelled out?

OBJECTIVE: To describe the prevalence of tobacco use among young Norwegian adults, 1973-1995. DESIGN: Cross sectional personal and telephone surveys. SETTING: Norway, 1973-1995. PARTICIPANTS: Population based samples of Norwegians aged 16-74 years. RESULTS: A trend to a decline in tobacco use among young adult Norwegians during the 1960s and 1970s levelled out during the 1980s. Hence, the total prevalence of smoking in Norway decreased by only two percentage points from 1980 to 1993, as compared to approximately 10 percentage points in many other European countries. An increase in smoking prevalence (and in the use of snuff among males) in the age group 16-19 years has been observed in recent years. Thus smoking prevalence among young males and females in 1995 was comparable to that observed in the early 1980s. CONCLUSIONS: Trends in tobacco use reflect an underutilization of preventive measures in general, and health education measures in particular. Financial resources appropriated for health education and information were reduced by 90% during the 1980s.


     

Smoking behaviour among young adults: beyond youth prevention

Objective: There is a widespread assumption that smoking behaviour is largely established by the age of 18 years. As a result, smoking prevention has focused almost exclusively upon youth. However, recent trends suggest that young adulthood may be an important—and largely overlooked—period in the development of regular smoking behaviour. The current study sought to examine patterns of tobacco use among young adults (aged 18–29 years) and to address the implications for tobacco control policy.

Design: Data are presented from the 2003 Canadian Tobacco Use Monitoring Survey, a national survey of smoking behaviour (n = 10 559, response rate 89%).

Main outcome measures: Measures of smoking behaviour, smoking initiation, susceptibility to smoking, and occupational status.

Results: A total of 1.4 million or 28% of young adults in Canada currently smoke, the highest proportion among all age groups. The prevalence of daily smoking rose from 8% among youth to 22% among young adults, and approximately one fifth of smokers tried their first cigarette after the age of 18 years. Smoking behaviour among young adults was also distinct from older smokers: young adults were more likely to be occasional smokers and reported lower daily consumption. Finally, smoking prevalence and cessation rates varied substantially within subgroups of young adults, as characterised by occupational setting.

Conclusions: Dramatic increases in the proportion and intensity of smoking occurs after the age of 18 years. Smoking behaviour among young adults is distinct from both youth and older adults, and warrants immediate attention from the public health community.

     

"The contemporary, irreverent brand of youth with an independent streak": BAT's youth promotions in Myanmar

"British American Tobacco strongly believes children should not smoke, and smoking should only be for adults who understand the risks associated with it. Our Group companies support and run programmes worldwide tackling underage smoking, and we are committed to pooling our resources and experience globally with others in the tobacco industry--and with governments and NGOs--to help prevent youth smoking. Along with the other two largest international tobacco groups--Philip Morris International and Japan Tobacco International--our Group companies have funded and supported more than 130 Youth Smoking Prevention (YSP) programmes in more than 70 countries. We fully support laws and regulations on a minimum age for buying tobacco products, and penalties for retailers who break the law. Our company policy worldwide is not to market to anyone under 18 years old, or more if the law in a particular country sets the age higher."--BAT website November 2003.     

Tobacco use is increasing in popular films

OBJECTIVE: To study the presentation of smoking in motion pictures. DESIGN: This study examined tobacco use in a random sample of five of the top 20 grossing films each year from 1990-1996 and combined these data with our earlier study of tobacco use in films that covered 1960- 1990. MAIN OUTCOME MEASURES: Rate of tobacco use per minute of film, characters who are smoking, motivation to smoke. RESULTS: The overall rate of tobacco use appears to have "bottomed out" in the 1980s and is now increasing back to levels observed in the 1960s. The presentation of tobacco use in films is increasingly discordant with reality, because tobacco use in the population continues to drop. Films continue to portray smokers as successful white males, although portrayal of smoking among women is increasing. CONCLUSIONS: The gap between the representation of tobacco use in films and the reality of tobacco continues to widen, with the prevalence of smoking among lead characters four times the smoking prevalence among comparable individuals in society at large.


     

Prevalence of tobacco use in Eritrea: results from a noncommunicable disease risk factor survey.

The prevalence of noncommunicable diseases in Eritrea is increasing. Tobacco use is a recognized risk factor for most of these diseases, especially cardiovascular disease. No data have been published on tobacco use in Eritrea. The present study sought to establish the prevalence of tobacco smoking in Eritrea. The World Health Organization STEPwise approach was used for the survey, conducted in 2004 on a random national sample size of 2,460 subjects (response rate = 93.7%). The prevalence of tobacco smoking in the general population was 8.1%; the prevalence was 15% among men, compared with 0.6% among women. Prevalence rates were higher in those older than 45 years of age. The prevalence of tobacco smoking was higher among Muslims (11.4%) than Orthodox Christians (5.8%), and among alcohol drinkers (10.2%) than nondrinkers (6.6%). The majority of tobacco users (89.3%) used commercially available cigarettes. A study on knowledge, attitudes, and practices regarding tobacco use is needed to determine the behavioral factors leading to tobacco smoking among the vulnerable groups.