British Columbia capital regional district 100% smokefree bylaw: a successful public health campaign despite industry opposition

Objective: To describe how the British Columbia Capital Regional District successfully passed, implemented, and enforced a 100% smokefree bylaw in all public places, including restaurants and bars, despite an aggressive campaign by the tobacco industry (acting through the hospitality industry) to stop it. Methods: Information was obtained from news reports, internal tobacco industry documents, reports, public documents, and interviews with key players. Tobacco industry documents were accessed between February and April 2002. This project was approved by the University of California San Francisco committee on human research. Results: As in the USA and elsewhere in the world, the tobacco industry in British Columbia, Canada, recruited and created hospitality associations to fight against the district smokefree bylaw. They used the classic industry rhetoric of individual rights and freedoms, economic devastation, and ventilation as a solution. Public health authorities were able to counter industry strategies with a strong education campaign, well written bylaws, and persistent enforcement. Conclusion: It is possible to overcome serious opposition orchestrated by the tobacco industry and develop and implement a 100% smokefree bylaw in Canada. Doing so requires attention to detail in drafting the bylaw, as well as a public education campaign on the health dangers of secondhand smoke and active enforcement to overcome organised resistance to the bylaw. Jurisdictions considering smokefree bylaws should anticipate this opposition when developing and implementing their bylaws.     

US news media coverage of tobacco control issues

Objective

To characterise the relative amount and type of daily newspaper, local and national TV newscast, and national news magazine coverage of tobacco control issues in the United States in 2002 and 2003.

Design

Content analysis of daily newspapers, news magazines, and TV newscasts.

Subjects

Items about tobacco in daily newspapers, local and national TV newscasts, and three national news magazines in a nationally representative sample of 56 days of news stratified by day of week and season of the year, from 2002 and 2003.

Main outcome measures

Story theme, tobacco topics, sources, story prominence, story valence (orientation), and story type.

Results

Tobacco coverage was modest over the two‐year period as estimated in our sample. Only 21 TV stories, 17 news magazine stories, and 335 daily newspaper stories were found during the two‐year sampling period. Noteworthy results for the newspaper data set include the following: (1) government topics predominated coverage; (2) government action and negative health effects topics tended not to occur together in stories; (3) tobacco stories were fairly prominently placed in newspapers; (4) opinion news items tended to favour tobacco control policies, while news and feature stories were evenly split between positive and negative stories; and (5) tobacco coverage in the southeast, which is the country''s major tobacco producing region, did not differ from the rest of the country.

Conclusion

Results suggest mixed support in news coverage for tobacco control efforts in the United States. The modest amount of news coverage of tobacco is troubling, particularly because so few news stories were found on TV, which is a more important news source for Americans than newspapers. When tobacco was covered, government themed stories, which often did not include mentions of negative health effects, were typical, suggesting that media coverage does not reinforce the reason for tobacco control efforts. However, some results were encouraging. For example, when newspapers did cover tobacco, they accorded the stories relatively high prominence, thus increasing the chance that readers would see tobacco stories when they were published.     

Can media advocacy influence newspaper coverage of tobacco: measuring the effectiveness of the American stop smoking intervention study's (ASSIST) media advocacy strategies

OBJECTIVE: To compare the rate and slant of local tobacco control print media coverage in ASSIST (American stop smoking intervention study) states as compared with non-ASSIST states. METHODS: Local tobacco control policy articles, editorials, and letters to the editors published from 1994 to 1998 clipped from all daily local newspapers in the USA were analysed (n = 95 911). The main hypothesis tested for the existence of an interaction between ASSIST intervention and time. This interaction would represent a change in the difference between ASSIST and non-ASSIST states over the course of the intervention. RESULTS: No evidence of an ASSIST-year interaction was found. However, a main effect for ASSIST was significant for the percentage of articles with the model predicting higher rates of articles for ASSIST states. Similarly the rate of letters to the editor expressing protobacco control views was higher in ASSIST states than non-ASSIST states. No main effects or interactions were found for analyses of percentage of protobacco control editorials. Models controlled for a measure of preintervention tobacco control conditions at baseline. CONCLUSIONS: The presence of an ASSIST main effect should be interpreted with caution because of the quasi-experimental design and the lack of information on article rates before the ASSIST intervention. Nonetheless, these preliminary findings suggest some possible effects of the media advocacy activities of ASSIST when controlling for differences in states' initial tobacco control conditions.     

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.     

Political realities of statewide smoking legislation: the passage of California's Assembly Bill 13

OBJECTIVE: To prepare a history of the enactment of California Assembly Bill 13 (AB 13), a state law prohibiting smoking in most workplaces passed in 1994, and to discuss its initial impacts. METHODS: Data were gathered from open ended interviews with representatives of voluntary health organisations, local government organisations, and principal legislators involved in the process, as well as observers around the state who could provide insight into the legislative process. Information was also obtained from legislative hearings and debates, public documents, letters and personal communications, internal memoranda, and news reports. RESULTS: The success of local tobacco control legislation in California led to a situation in which some health groups were willing to accept state preemption in order to attract the support of the state restaurant association for a bill. The decision to accept this preemption compromise was made by the state level offices of the voluntary health agencies without consulting the broader tobacco control community within California. In contrast, local tobacco control advocates did not accept this compromise, in part because of their belief that local legislation was a better device to educate the public, generate media coverage, and build community support for enforcement and implementation of clean indoor air and other tobacco control laws. Enactment of AB 13 was associated with a slowing of all local tobacco control legislation, including youth oriented laws. CONCLUSIONS: Because its supporters initially doubted that AB 13 would pass, there was never an effort to reconcile the policy differences between state oriented and locally oriented tobacco control policies. This lack of consensus, combined with the political realities inherent in passing any state legislation, led to a bill with ambiguous preemption language which replaced the "patchwork of local laws" with a "patchwork of local enforcement."


     

Print media coverage of research on passive smoking

OBJECTIVE: To assess the extent and content of newspaper and magazine coverage of research on passive smoking. DESIGN: Content analysis of newspaper and magazine articles. SUBJECTS: Articles reporting on passive smoking research published in newspapers (n = 180) or magazines (n = 92) between January 1981 and December 1994. MAIN OUTCOME MEASURES: Numbers of articles, conclusions of articles, sources quoted, numbers and characteristics of research studies cited, presence of tobacco advertising. RESULTS: The number of newspaper and magazine articles reporting on passive smoking research increased from four in 1981 to 57 in 1992 and 32 in 1994. Sixty-two per cent (168/272) of articles concluded that the research on passive smoking is controversial. Tobacco industry representatives were quoted significantly more often in newspaper articles (52%, 94/180) than magazine articles (12%, 11/92) (p<0.0001). Of 121 different research studies cited in the lay press articles, only 15 were from tobacco-industry sponsored projects or publications. In magazines, acceptance of tobacco industry advertising was associated with the conclusion that research on passive smoking is controversial (p<0.0001). CONCLUSIONS: Although research on the harmful effects of passive smoking accumulated between 1981 and 1994, lay press coverage of the research maintained that the science was controversial. Few research studies were cited to support the industry's claim that passive smoking is not harmful to health. However, tobacco industry representatives who were critical of the research methods used to study the health effects of passive smoking were frequently quoted.     

Media advocacy and newspaper coverage of tobacco issues: a comparative analysis of 1 year's print news in the United States and Australia.

Tobacco control advocates now recognize the value of influencing news coverage of tobacco; news coverage influences attitudes and behavior as well as policy progression. It is, however, difficult to assess the progress of such efforts within a single national and temporal context. Our data represent the first systematic international comparison of press coverage of tobacco issues. Tobacco articles from major daily newspapers in Australia (12 newspapers; 1,188 articles) and the United States (30 newspapers; 1,317 articles) were collected over 1 year (2001). The analysis shows that coverage in the two countries was similarly apportioned between hard news (>70%) and opinion pieces. Similarly, stories in both countries were most likely to recount positive events. The substantive focus of coverage, however, differed, as did the expression of hostile opinion toward tobacco control efforts (United States, 4%; Australia, 7.1%). Although secondhand smoke and education, cessation, and prevention efforts were covered widely in both settings, these topics dominated coverage in Australia (29.2%) more than in the United States (17.6%), where a more diffuse set of tobacco topics gained relative prominence. The difference in policy conditions seems to offer contrasting opportunities for advocates in the two countries to use newspapers to promote helpful tobacco control messages for both behavior and policy change.     

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.

     

News media coverage of smoking and health is associated with changes in population rates of smoking cessation but not initiation

OBJECTIVE: To determine whether changes in news media coverage of smoking and health issues are associated with changes in smoking behaviour in the USA. DESIGN AND MAIN OUTCOME MEASURES: Issue importance in the US news media is assessed by the number of articles published annually in major magazines indexed in The Reader's Guide to Periodical Literature. Annual incidence rates for cessation and initiation in the USA were computed from the large, representative National Health Interview Surveys (1965-1992). Patterns in cessation incidence were considered for ages 20-34 years and 35-50 years. Initiation incidence was examined for adolescents (14-17 years) and young adults (18-21 years) of both sexes. RESULTS: From 1950 to the early 1980s, the annual incidence of cessation in the USA mirrored the pattern of news media coverage of smoking and health, particularly for middle aged smokers. Cessation rates in younger adults increased considerably when second hand smoke concerns started to increase in the US population. Incidence of initiation in young adults did not start to decline until the beginning of the public health campaign against smoking in the 1960s. Among adolescents, incidence rates did not start to decline until the 1970s, after the broadcast ban on cigarette advertising. CONCLUSIONS: The level of coverage of smoking and health in the news media may play an important role in determining the rate of population smoking cessation, but not initiation. In countries where cessation has lagged, advocates should work to increase the newsworthiness of smoking and health issues.     

The passage and initial implementation of Oregon's Measure 44

OBJECTIVE: To prepare a history of the passage and early implementation of Ballot Measure 44, "An Act to Support the Oregon Health Plan", and tobacco control policymaking in Oregon. Measure 44 raised cigarette taxes in Oregon by US$0.30 per pack, and dedicated 10% of the revenues to tobacco control. METHODS: Data were gathered from interviews with members of the Committee to Support the Oregon Health Plan, Measure 44's campaign committee, as well as with state and local officials, and tobacco control advocates. Additional information was obtained from public documents, internal memoranda, and news reports. RESULTS: Although the tobacco industry outspent Measure 44's supporters 7 to 1, the initiative passed with 56% of the vote. Even before the election, tobacco control advocates were working to develop an implementation plan for the tobacco control programme. They mounted a successful lobbying campaign to see that the legislature did not divert tobacco control funds to other uses. They also stopped industry efforts to limit the scope of the programme. The one shortcoming of the tobacco control forces was not getting involved in planning the initiative early enough to influence the amount of money that was devoted to tobacco control. Although public health groups provided 37% of the money it cost to pass Measure 44, only 10% of revenues were devoted to tobacco control. CONCLUSIONS: Proactive planning and aggressive implementation can secure passage of tobacco control initiatives and see that the associated implementing legislation follows good public health practice.     

The tobacco settlement: an analysis of newspaper coverage of a national policy debate, 1997-98

OBJECTIVE: To examine the framing of tobacco policy issues in the news media during the national tobacco settlement debate of 1997-98. The major aims were (1) to describe the extent of newspaper coverage of each of the specific components of the proposed tobacco settlement; (2) to identify the tobacco control frames, and the dominant frame, appearing in each newspaper article; and (3) to examine trends in tobacco control frames over time. DESIGN: A content analysis was performed on 117 articles related to national tobacco legislation appearing in the Washington Post from 1 January 1997 through 18 June 1998. MAIN OUTCOME MEASURES: (1) Major policy themes of the settlement referred to or implied in each article; (2) major frames used to discuss the problem of tobacco in each article. RESULTS: The generation of new revenue was the dominant theme of the articles, appearing as a major focus in 44% (52) of the articles. Other than the issues of Food and Drug Administration regulation of tobacco and restrictions on cigarette advertising, the public health policy aspects of the tobacco settlement received little attention. The problem of tobacco was portrayed as one of youth smoking in 55% (64) of the articles, but as one of a deadly product in none of the articles. CONCLUSIONS: Future discussions of comprehensive tobacco policy should be driven by a more specific discussion of the precise programme and policy mechanisms by which tobacco use can be most effectively prevented and controlled. The public health community must find ways to frame the tobacco issue more broadly than simply as one of youth smoking.     

Tobacco industry successfully prevented tobacco control legislation in Argentina

Objective: To evaluate how transnational tobacco companies, working through their local affiliates, influenced tobacco control policymaking in Argentina between 1966 and 2005. Methods: Analysis of internal tobacco industry documents, local newspapers and magazines, internet resources, bills from the Argentinean National Congress Library, and interviews with key individuals in Argentina. Results: Transnational tobacco companies (Philip Morris International, British American Tobacco, Lorillard, and RJ Reynolds International) have been actively influencing public health policymaking in Argentina since the early 1970s. As in other countries, in 1977 the tobacco industry created a weak voluntary self regulating code to avoid strong legislated restrictions on advertising. In addition to direct lobbying by the tobacco companies, these efforts involved use of third party allies, public relations campaigns, and scientific and medical consultants. During the 1980s and 1990s efforts to pass comprehensive tobacco control legislation intensified, but the organised tobacco industry prevented its enactment. There has been no national activity to decrease exposure to secondhand smoke. Conclusions: The tobacco industry, working through its local subsidiaries, has subverted meaningful tobacco control legislation in Argentina using the same strategies as in the USA and other countries. As a result, tobacco control in Argentina remains governed by a national law that is weak and restricted in its scope.     

Tobacco industry strategy to undermine tobacco control in Finland

Objective: To identify and explain tobacco industry strategy in undermining tobacco control measures in Finland and results of these interferences in tobacco policy development during the 1980s and early 1990s.

Methods: Tobacco industry documents, which have been publicly available on the internet as a result of litigation in the USA, were analysed. Documents were sought by Finland and by names of organisations and tobacco control activists. Documents were accessed and assessed between September 2000 and November 2002. Tactics of the tobacco industry activities were categorised as presented by Saloojee and Dagli.

Results: The international tobacco companies utilised similar strategies in Finland as in other industrial markets to fight tobacco control and legislation, the health advocacy movement, and litigation. These activities slowed down the development and implementation of the Tobacco Act in Finland. However, despite the extensive pressure, the industry was not able to prevent the most progressive tobacco legislation in Europe from being passed and coming into force in Finland in 1977 and in 1995.

Conclusion: Denying the health hazards caused by tobacco—despite indisputable scientific evidence—decreased the credibility of the tobacco industry. Strategy of denial was falsely chosen, as health advocacy groups were active both in society and the parliamentary system. The strong influence of the tobacco industry may have in fact increased the visibility of tobacco control in Finland as the litigation process was also drawing attention to negative health effects of tobacco. Therefore the tobacco industry did not manage to convince public opinion. However, the tobacco industry did obtain experience in Finland in how to object to tobacco control measures.

     

When the tobacco industry controls the news: KKR, RJR Nabisco, and the Weekly Reader Corporation

BACKGROUND: The Weekly Reader Corporation was acquired in 1991 by K-III Communications, whose majority shareholder is Kohlberg Kravis Roberts & Co. (KKR), best known for its leveraged buyout of tobacco conglomerate RJR Nabisco. Among other student newspapers, Weekly Reader publishes Current Events for students in grades 6-10 (ages 11-16). OBJECTIVE: To explore how KKR's ownership might have affected the content of tobacco- related news stories in Current Events, which reaches students at the very ages when many begin to experiment with tobacco. METHODS: A content analysis was conducted of 182 issues of Current Events, 71 pre- acquisition and 111 post-acquisition. Tobacco-related news was reported in four articles in the pre-acquisition issues and in 12 articles in the post-acquisition issues. RESULTS: The content of tobacco-related news stories shifted after KKR's acquisition to portray tobacco as a "forbidden fruit" that is attractive to teenagers. This was done by focusing on new policies and programmes to discourage teenagers from smoking, the mythical threat of prohibition, and the supposed popularity of smoking, while giving relatively little attention to the health consequences of tobacco use. CONCLUSIONS: After engineering a stock swap with Bordens in 1995, KKR no longer directly owns RJR Nabisco stock. This case study underscores the need for public health advocates to be watchful of the tobacco industry's efforts to control public access to news about tobacco.


     

Tobacco industry influence on the definition of tobacco related disorders by the American Psychiatric Association

Objective: The Diagnostic and statistical manual of mental disorders, third edition (DSM-III), published by the American Psychiatric Association (APA) in 1980, included the first official definitions by the APA of tobacco dependence and tobacco withdrawal. Tobacco industry efforts to influence the DSM-III were investigated. Method: Searches of previously secret tobacco industry documents, primarily the University of California San Francisco Legacy Tobacco Documents Library and British American Tobacco collections. Additional information was collected through discussions with editors of DSM-III, and library and general internet searches. Results: The tobacco companies regarded the inclusion of tobacco dependence as a diagnosis in DSM-III as an adverse event. It worked to influence the content of the DSM-III and its impact following publication. These efforts included public statements and private lobbying of DSM-III editors and high ranking APA officers by prominent US psychiatrists with undisclosed ties to the tobacco industry. Following publication of DSM-III, tobacco companies contracted with two US professors of psychiatry to organise a conference and publish a monograph detailing controversies surrounding DSM-III. Conclusions: The tobacco industry and its allies lobbied to narrow the definition of tobacco dependence in serial revisions of DSM-III. Following publication of DSM-III, the industry took steps to try to mitigate its impact. These actions mirror industry tactics to influence medical research and policy in various contexts worldwide. Such tactics slow the spread of a professional and public understanding of smoking and health that otherwise would reduce smoking, smoking induced disease, and tobacco company profits.     

提升烟草行业软实力的思考和建议

基于软实力理论研究成果、国家软实力建设要求和烟草行业软实力的实际现状，本文探讨了烟草行业软实力的内涵和构成要素，即文化感召力、战略领导力、学习创新力、社会责任力、舆论引导力和风险抵御力。遵循软实力建设规律，提出了把观念变革作为先决条件，把顶层规划和机制建设作为前提支撑，把处理好“三个关系”作为重要原则，把加强智库建设作为重点工程，把提升烟草行业形象作为落脚点的基本要求，并从烟草行业软实力构成的六个方面分别给出了相应提升建议。      

Development and destruction of the first state funded anti-smoking campaign in the USA

Background: Minnesota was the first state in the USA to implement a large state funded tobacco control programme (in 1985). Despite evidence of effectiveness, it was dismantled in 1993.

Objective: To describe and analyse how and why these events transpired and identify lessons for tobacco control advocates facing similar challenges in the 21st century.

Design: Case study based on previously secret tobacco industry documents, news reports, research reports, official documents, and interviews with health advocates and state government officials.

Results: Unable to defeat funding for this campaign in 1985, the tobacco industry organised groups which eliminated it later. Despite the programme's documented effectiveness, it was dismantled based on claims of fiscal crisis. These claims were not true; the real debate was what to do with the state's surplus. Health advocates failed to challenge the claim of fiscal crisis or mobilise public support for the programme.

Conclusions: Simply quoting evidence that a tobacco control programme is effective does not ensure its continuing survival. Claims of fiscal crisis are an effective cover for tobacco industry efforts to dismantle successful programmes, particularly if health advocates accept these claims and fail to mobilise political pressure to defend the programme.

     

Effects of cigarette tax on cigarette consumption and the Chinese economy

OBJECTIVES: To analyse a policy dilemma in China on public health versus the tobacco economy through additional cigarette tax. METHODS: Using published statistics from 1980 through 1997 to estimate the impact of tobacco production and consumption on government revenue and the entire economy. These estimates relied on the results of estimated price elasticities of the demand for cigarettes in China. RESULTS: Given the estimated price elasticities (-0.54), by introducing an additional 10% increase in cigarette tax per pack (from the current 40% to 50% tax rate), the central government tax revenue would twice exceed total losses in industry revenue, tobacco farmers' income, and local tax revenue. In addition, between 1.44 and 2.16 million lives would be saved by this tax increase. CONCLUSIONS: Additional taxation on cigarettes in China would be a desirable public policy for the Chinese government to consider.