Death at a discount: how the tobacco industry thwarted tobacco control policies in US military commissaries

Background

The US military is perhaps the only retailer consistently losing money on tobacco. Military stores (commissaries and exchanges) have long sold discount‐priced cigarettes, while the Department of Defense (DoD) pays directly for tobacco‐related healthcare costs of many current and former customers. Tobacco use also impairs short‐term troop readiness.

Objective

To examine the long struggle to raise commissary tobacco prices and the tobacco industry''s role in this policy effort.

Methods

Analysis of internal tobacco industry documents, searches of government and military websites and newspaper databases, and interviews with key informants identified in the documents.

Results

Efforts to raise commissary tobacco prices began in the mid‐1980s. Opposition quickly emerged. Some military officials viewed tobacco use as a “right” and low prices as a “benefit”. Others raised issues of authority, and some saw the change as threatening the stores. The tobacco industry successfully exploited complex relationships among the Congress, the DoD, commissaries, exchanges and private industry, obstructing change for over a decade. Leadership from the Secretary and Assistant Secretaries of Defense, presidential support and procedural manoeuvring finally resulted in a modest price increase in 1996, but even then, high‐level military officials were apparently threatened with retaliation from pro‐tobacco Congressmen.

Conclusions

The longstanding military tradition of cheap cigarettes persists because of the politics of the military sales system, the perception within the military of tobacco use as a right, and tobacco industry pressures. Against its own best interests, the US military still makes tobacco available to service members at prices below those in the civilian sector.The US military includes 1.4 million active duty personnel, stationed worldwide. Their smoking prevalence is higher (33.8% in 2002) than the US Department of Defense (DoD) goal of ⩽20%,¹ exceeding the civilian rate of 23.6%.² Smoking diminishes even short‐term troop health and readiness^3,4 and increases medical and training costs.^5,6 As an authoritarian, hierarchical institution, DoD should, theoretically, be able to establish and implement strong tobacco control policies. Nonetheless, DoD sells its personnel tobacco products virtually tax free. Military health personnel and some members of Congress have long sought to address this contradiction. This case study shows how for more than a decade, the tobacco industry worked to defeat policy changes by framing cheap cigarettes as a “benefit”, mobilising Congressional and military‐affiliated allies, and exploiting DoD ambivalence about tobacco.     

Moving East: how the transnational tobacco industry gained entry to the emerging markets of the former Soviet Union-part I: establishing cigarette imports

Objectives: To identify British American Tobacco's (BAT) reasons for targeting the former Soviet Union following its collapse in 1991 and the initial strategies BAT used to enter the region.

Design: Analysis of tobacco industry documents held at the Guildford BAT archive.

Results: Desire to expand to new markets was based in part on the decline in old markets. The large population, proximity to China, scope to expand sales to women and, in Central Asia, a young population with high growth rates made the former Soviet Union particularly attractive. High consumption rates and unfilled demand caused by previous shortages offered potential for rapid returns on investment. A series of steps were taken to penetrate the markets with the initial focus on establishing imports. The documents suggest that BAT encouraged the use of aid money and barter trade to fund imports and directed the smuggling of cigarettes which graduated from an opportunistic strategy to a highly organised operation. In establishing a market presence, promotion of BAT's brands and corporate image were paramount, and used synonymously to promote both the cigarettes and the company. The tobacco industry targeted young people and women. It used the allure of western products to promote its brands and brand stretching and corporate imagery to pre-empt future marketing restrictions.

Conclusions: BAT used the chaotic conditions in the immediate post-transition period in the former Soviet Union to exploit legislative loopholes and ensure illegal cigarette imports. Governments of countries targeted by the tobacco industry need to be aware of industry tactics and develop adequate tobacco control policies in order to prevent the exploitation of vulnerable populations. Marketing restrictions that focus on advertising without restricting the use of brand or company promotions will have a limited impact.

     

Japanese spousal smoking study revisited: how a tobacco industry funded paper reached erroneous conclusions

Objectives: To provide a participant''s account of the development of a paper commissioned by the tobacco industry examining the reliability of self reported smoking status; to redress the distorted report of this Japanese spousal smoking study which evaluated the reliability and validity of self reported smoking status, and estimated confounding by diet and lifestyle factors. Design: Repeated interviews on smoking status and its verification by environmental and biological markers for environmental tobacco smoke (ETS) exposure. Setting: Urban wives in Osaka City and Sizuoka City, Japan Participants: Semi-random sampling of 200 wives in each city. From the Osaka subjects, 100 non-smoking wives were selected for the validity study. Main outcome measures: Kappa coefficient for reliability of self reported smoking status. Correlation coefficients between environmental nicotine concentration, cotinine in saliva and urine, and self reported smoking status. Results: The κ coefficient for the repeated interview was high suggesting sufficient reliability of the response. The proportion of self reported current smokers misclassified as non-smokers was equivalent to the misclassified self reported non-smokers. Ambient concentration of nicotine and personal exposure to nicotine correlated with each other and also with salivary cotinine and self reported ETS exposure but not with urinary cotinine/creatinine ratio (CCR). There was no major difference in diet and lifestyle related to husband''s smoking status. Conclusion: Self reported smoking status by Japanese wives shows high reliability. It also shows high validity when verified by both nicotine exposure and salivary cotinine, but not by CCR. A previous report questioning the credibility of self reported smoking status, based on questionable CCR, could thus be of dubious validity. In addition, possible dietary and lifestyle confounding factors associated with smoking husbands were not demonstrable, a finding not reported previously. Using all the data from this project changes the conclusion of the previous published report. In addition to the distortion of scientific findings by a tobacco industry affiliated researcher, anti-smoking campaigners made attempts to intimidate and suppress scientific activities. These distortions of science should be counteracted.     

Brand differences of free-base nicotine delivery in cigarette smoke: the view of the tobacco industry documents

The recent availability of internal tobacco industry documents provides significant insight into industry knowledge and manipulation of tobacco smoke delivery. One critical area of research is the role of smoke chemistry in determining the absorption and effects of smoke constituents, especially harm producing or pharmacologically active compounds. Independent scientific research has suggested that the nicotine dosing characteristics, hence the addiction potential of cigarettes, may be determined in part by the amount of free‐base nicotine in cigarette smoke and its effects on the location, route, and speed of absorption in the body and on the sensory perception effects of the inhaled smoke. Tobacco industry documents describe the use of a number of methods internally for measuring free‐base nicotine delivery. These include the common use of cigarette “smoke pH” as a means to estimate the fraction of free‐base nicotine in the particulate matter (PM) in cigarette smoke, as well as efforts to measure free‐base nicotine directly. Although these methods do not provide accurate absolute measures of free‐base nicotine in smoke, consistencies observed in the findings across the various manufacturers indicate: (1) real relative differences in the acid/base chemistry of the smoke from different brands of cigarettes; (2) a connection between differences in free‐base levels and brand‐dependent differences in sensory perception and smoke “impact”; and (3) levels of free‐base nicotine that are greater than have typically been publicly discussed by the industry. Furthermore, the results of these methods are generally consistent with those of a recent study from the Centers for Disease Control and Prevention which directly measured the free‐base fraction of nicotine across a range of cigarette types. Consideration of the likely fundamental importance of free‐base nicotine levels in cigarette smoke, together with the efforts discussed in the tobacco industry documents to measure such levels, indicates that the public health community would benefit from additional research to assess directly the delivery of free‐base nicotine in cigarette smoke across brands. This may be especially useful for those products (“light”, “ultralight”, “reduced carcinogen”, etc) that have been promoted, either explicitly or implicitly, as “harm reducing”.     

美国烟草业的挑战和减害研究的历史与现状

回顾了自20世纪50年代吸烟与健康科学研究兴起以来美国烟草业所面临的种种挑战,以及面对这些挑战美国烟草业采取的对策:客观承认吸烟的危害,树立良好的负责任的公众形象,加强吸烟与健康及减害理论与技术的研究,积极开发低危害卷烟产品。     

"It is possible he is a kind of nut": how the tobacco industry quietly promoted Dr William Whitby

Dr William Whitby was a general practitioner in Sydney who, from 1978 until about 1987, self published two books extolling the virtues of smoking and ridiculing anti-smoking claims. Privately the tobacco industry regarded him as "nutty", while nonetheless believing that his views should be promoted. They quietly supported him by distributing his book, offering legal advice, and persuading him to take media training. Many Australians would have been exposed to his views.     

Acute effects of cigarette smoking on global cerebral blood flow in overnight abstinent tobacco smokers.

We examined whether cerebral vascular reactivity to 5% CO2/95% O2 would be a useful, independent measure of effects of tobacco smoking on global cerebral blood flow (gCBF). The acute effects during smoking one's favorite brand of cigarettes were determined after overnight tobacco abstinence. Positron emission tomography was used to quantitatively measure gCBF using H(2)15O in 10 right-handed young-adult male volunteer tobacco smokers. After a 12-hr abstinence, gCBF measurements were repeated six times at 15-min intervals: First baseline, 5% CO2/95% O2 inhalation, first cigarette smoking, second baseline, 5% CO2/95% O2 inhalation, and second cigarette smoking. Surprisingly, no significant change was seen in mean gCBF during smoking compared with baseline. However, the increase in arterial plasma concentration of nicotine correlated inversely with gCBF. Out of 19 smoking sessions, gCBF increased in 7, decreased in 7, and was unchanged in 5 sessions. The gCBF increased during smoking when baseline gCBF was relatively low, whereas gCBF decreased when baseline gCBF was relatively high. Both vascular reactivity and estimated gCBF plus arterial nicotine concentrations were useful measures to predict the changes in measured gCBF. These individual differences result in important bimodal effects of smoking on the brains of different young adult tobacco smokers.     

Utilization of seaweed derived ingredients as potential antioxidants and functional ingredients in the food industry: An overview

Recently, a great deal of interest has been developed to isolate novel bioactive compounds from marine resources because of their numerous health beneficial effects. Among marine resources, marine algae are valuable sources of structurally diverse bioactive compounds with potential to be used against artificial food ingredients. This mini-review focuses on seaweed-derived bioactive compounds such as phlorotannins, sulfated polysaccharides, carotenoid pigments, and fucosterol with their potential antioxidant effect in the food industry as functional ingredients.     

不同滤嘴结构的电加热烟草产品烟气主要成分逐口释放规律研究

[目的]分析电加热烟草产品烟气主要成分烟碱、甘油以及1,2-丙二醇的逐口释放行为.[方法]以不同长度滤嘴中空段、聚乳酸段以及醋酸纤维段的电加热烟草产品为研究对象,检测烟气主要成分烟碱、丙二醇与甘油的烟气逐口释放量,分析烟气逐口相对释放量与逐口释放量质量分数.[结果](1)不同滤嘴结构的烟草产品烟芯中烟碱、丙二醇与甘油的...     

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.     

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.