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.     

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.     

ASHRAE Standard 62: tobacco industry's influence over national ventilation standards

OBJECTIVE: To describe the role of the tobacco industry in the development of ventilation standards for indoor air quality by influencing the American Society of Heating, Refrigeration, and Air Conditioning Engineers (ASHRAE). METHODS: Review of tobacco industry documents available on the internet between January 2001 and March 2002. Search terms included "ASHRAE", "ventilation", "minutes", "memo", and the names of key players and organisations as identified in the initial searches. Analysis of ASHRAE and other relevant documents publicly available and the personal files of a Standard 62 committee member; interviews of a selected number of ASHRAE players; observation of an ASHRAE meeting. RESULTS: The tobacco industry has been involved in the development of ventilation standards for over 20 years. It has successfully influenced the standard and continues to attempt to change the standard from a smoke-free framework into an "accommodation" framework. The industry acts directly and through consultants and allies. The major health groups have been largely absent and the health interests have been poorly represented in standard development. While concentrated in the USA, ASHRAE standards are adopted worldwide. CONCLUSION: The tobacco industry determined that allowing smoking in ventilation standards for indoor air quality was a high priority and dedicated significant human and financial resources to ensure that its interests were represented. The health groups, until recently, have largely ignored the policy implications for tobacco control of standard development. This situation is changing, but unless health groups maintain high visibility within ASHRAE, the tobacco industry may succeed in creating a standard that ignores the dangers of secondhand smoke.     

Gesundheitliche Risiken durch Tabakrauchbelastung in Gastronomiebetrieben

Tobacco smoke is a complex mixture of thousands of components. Some 250 of these are toxic or carcinogenic. Exposure to second-hand smoke is associated with an increased risk of cardiovascular diseases, stroke, respiratory diseases, and lung cancer. In Germany every year more than 3300 persons are dying from diseases caused by second-hand smoke. In German hospitality venues, where actually smoking is allowed, there is a high exposure to second-hand smoke. Experience from other countries, where the hospitality industry is already smoke-free, shows that smoke-free policies ameliorate the air quality and the health of hospitality workers. Separated smoking rooms as well as ventilation and filtration means are no alternative to completely smokefree environments. Eingegangen: 21. Mai 2007; angenommen 30. Mai 2007     

Tobacco industry consumer research on socially acceptable cigarettes

Objective: To describe tobacco industry consumer research to inform the development of more "socially acceptable" cigarette products since the 1970s. Methods: Analysis of previously secret tobacco industry documents. Results: 28 projects to develop more socially acceptable cigarettes were identified from Philip Morris, RJ Reynolds, British American Tobacco, and Lorillard tobacco companies. Consumer research and concept testing consistently demonstrated that many smokers feel strong social pressure not to smoke, and this pressure increased with exposure to smoking restrictions. Tobacco companies attempted to develop more socially acceptable cigarettes with less visible sidestream smoke or less odour. When presented in theory, these product concepts were very attractive to important segments of the smoking population. However, almost every product developed was unacceptable in actual product tests or test markets. Smokers reported the complete elimination of secondhand smoke was necessary to satisfy non-smokers. Smokers have also been generally unwilling to sacrifice their own smoking satisfaction for the benefit of others. Many smokers prefer smoke-free environments to cigarettes that produce less secondhand smoke. Conclusions: Concerns about secondhand smoke and clean indoor air policies have a powerful effect on the social acceptability of smoking. Historically, the tobacco industry has been unable to counter these effects by developing more socially acceptable cigarettes. These data suggest that educating smokers about the health dangers of secondhand smoke and promoting clean indoor air policies has been difficult for the tobacco industry to counter with new products, and that every effort should be made to pursue these strategies.     

Gesundheitliche Risiken durch Tabakrauchbelastung in Gastronomiebetrieben

Tobacco smoke is a complex mixture of thousands of components. Some 250 of these are toxic or carcinogenic. Exposure to second-hand smoke is associated with an increased risk of cardiovascular diseases, stroke, respiratory diseases, and lung cancer. In Germany every year more than 3300 persons are dying from diseases caused by second-hand smoke. In German hospitality venues, where actually smoking is allowed, there is a high exposure to second-hand smoke. Experience from other countries, where the hospitality industry is already smoke-free, shows that smoke-free policies ameliorate the air quality and the health of hospitality workers. Separated smoking rooms as well as ventilation and filtration means are no alternative to completely smokefree environments.     

Smoke-free air policies: past, present and future

Smoke-free policies have been an important tobacco control intervention. As recently as 20 years ago, few communities required workplaces and hospitality venues to be smoke-free, but today approximately 11% of the world's population live in countries with laws that require these places to be smoke-free. This paper briefly summarises important milestones in the history of indoor smoke-free policies, the role of scientific research in facilitating their adoption, a framework for smoke-free policy evaluation and industry efforts to undermine regulations. At present, smoke-free policies centre on workplaces, restaurants and pubs. In addition, many jurisdictions are now beginning to implement policies in outdoor areas and in shared multiunit housing settings. The future of smoke-free policy development depends on credible scientific data that documents the health risks of secondhand smoke exposure. Over the next 20 years smoke-free policies will very likely extend to outdoor and private areas, and changes in the types of tobacco products that are consumed may also have implications for the nature and scope of the smoke-free policies of the future.     

Smoke-free cafe in an unregulated European city: highly welcomed and economically successful

Objective: In a unique setting with two identical cafes, which only differed in their smoking ordinances, this study assessed the influence of smoking policies on the choice of the cafe, investigated regulatory preferences among customers, and evaluated the claim that smoking cafes have better sales performance in a city without smoking bans.

Methods: In a parallel assessment, customers of both cafes answered a questionnaire. Sales were compared and air pollutants were measured to confirm air quality differences.

Results: The two customer groups (n = 177) differed only with regard to smoking status (p < 0.01). The smoking regulation was the most often cited selection criterion (83%). In the non-smoking café, 89% indicated that they were usually annoyed by smoke in coffee houses, and 62% would avoid or leave cafes for this reason. Two thirds stated that all cafe/restaurants should offer the opportunity of a smoke-free environment. However, almost half stated that mandatory regulations are not needed and that customers should make individual arrangements based on tolerance and courtesy. Those who were informed about the health effects of secondhand smoke were more likely to call for clear policies. Whereas sales showed no differences, tips were 22% (p < 0.001) higher in the non-smoking cafe.

Conclusion: In a generation raised in smoking friendly environments, customers paradoxically ask for a landmark shift towards smoke-free opportunities, while substantially adhering to the tobacco industry paradigm of promoting "tolerance" rather than smoke-free policies. Given the clear preference of a large number of customers, hospitality businesses could, however, greatly profit from offering smoke-free environments even in the absence of regulatory policies.

     

Public health foundations and the tobacco industry: lessons from Minnesota

Objective: To investigate whether private foundations can be created in a way that will insulate them from attacks by the tobacco industry, using the Minnesota Partnership for Action Against Tobacco (MPAAT) as a case study.

Design: Information was collected from internal tobacco industry documents, court documents, newspapers, and interviews with health advocates and elected officials.

Results: The creation of MPAAT as an independent foundation did not insulate it from attacks by tobacco industry allies. During 2001–2002, MPAAT was repeatedly attacked by Attorney General Mike Hatch and major media, using standard tobacco industry rhetoric. This strategy of attack and demands for information were reminiscent of previous attacks on Minnesota's Plan for Nonsmoking and Health and the American Stop Smoking Intervention Study (ASSIST). MPAAT was ultimately forced to restructure its programme to abandon effective community norm change interventions around smoke-free policies and replace them with less effective individual cessation interventions. Neither MPAAT nor other health advocates mounted an effective public response to these attacks, instead relying on the insider strategy of responding in court.

Conclusion: It is not possible to avoid attacks by the tobacco industry or its political allies. Like programmes administered by government agencies, tobacco control foundations must be prepared for these attacks, including a proactive plan to educate the public about the principles of community based tobacco control. Public health advocates also need to be willing to take prompt action to defend these programmes and hold public officials who attack tobacco control programmes accountable for their actions.

     

Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry

Data sources: Researchers sought all studies produced before 31 August 2002. Articles published in scientific journals were located with Medline, Science Citation Index, Social Sciences Citation Index, Current Contents, PsychInfo, Econlit, and Healthstar. Unpublished studies were located from tobacco company websites and through internet searches. Study selection: 97 studies that made statements about economic impact were included. 93% of the studies located met the selection criteria as determined by consensus between multiple reviewers. Data extraction: Findings and characteristics of studies (apart from funding source) were classified independently by two researchers. A third assessor blind to both the objective of the present study and to funding source also classified each study. Data synthesis: In studies concluding a negative impact, the odds of using a subjective outcome measure was 4.0 times (95% confidence interval (CI) 1.4 to 9.6; p = 0.007) and the odds of not being peer reviewed was 20 times (95% CI 2.6 to 166.7; p = 0.004) that of studies concluding no such negative impact. All of the studies concluding a negative impact were supported by the tobacco industry. 94% of the tobacco industry supported studies concluded a negative economic impact compared to none of the non-industry supported studies. Conclusion: All of the best designed studies report no impact or a positive impact of smoke-free restaurant and bar laws on sales or employment. Policymakers can act to protect workers and patrons from the toxins in secondhand smoke confident in rejecting industry claims that there will be an adverse economic impact.     

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.     

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

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

Tobacco industry 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.

     

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.

     

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

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

The Virginia Slims identity crisis: an inside look at tobacco industry marketing to women

Objectives: Because no prior studies have comprehensively analysed previously secret tobacco industry documents describing marketing female brands, the Virginia Slims brand was studied to explore how Philip Morris and competitors develop and adapt promotional campaigns targeting women.

Methods: Analysis of previously secret tobacco industry documents. The majority of the documents used were from Philip Morris.

Results: The key to Virginia Slims advertising was creating an aspirational image which women associated with the brand. Virginia Slims co-opted women's liberation slogans to build a modern female image from 1968 through to the 1980s, and its market share grew from 0.24% to 3.16% during that time period. Ironically, the feminist image that worked very well for the brand was also the reason for its subsequent problems. Philip Morris experienced unprecedented losses in market share in the early 1990s, with a decline in market share for four consecutive years from 3.16% to 2.26%; they attributed this decline to both the fact that the brand's feminist image no longer appealed to young women aged 18–24 years, and increased competition from more contemporary and lower priced competitors. Throughout the 1990s, attempts to reacquire young women while retaining Virginia Slims loyal (now older) smokers were made using a "King Size" line extension, new slogans, and loyalty building promotions.

Conclusions: Tobacco advertisers initially created distinct female brands with aspirational images; continued appeal to young women was critical for long term growth. The need for established brands to evolve to maintain relevance to young women creates an opportunity for tobacco counter-marketing, which should undermine tobacco brand imagery and promote aspirational smoke-free lifestyle images. Young women age 18–24 are extremely valuable to the tobacco industry and should be a focus for tobacco control programmes.

     

Litigation in Argentina: challenging the tobacco industry

Objective

To evaluate the processes and outcomes of tobacco litigation in Argentina and to analyse the strategies of the tobacco industry to oppose litigation using tobacco industry documents.

Methods

A systematic search of tobacco industry documents on the internet dating from 1978 to 2002. Law library searches using Argentinean official and unofficial reports systems were combined with computerised online searches.

Results

There have been at least 15 failed litigation cases in Argentina and the tobacco industry presented a concerted defence in every claim regardless of cost. We categorised 11 cases as product liability and nicotine addiction, two as health care reimbursement, and two as criminal law and secondhand smoke. Industry strategies included hiring legal consultants from prestigious international and Argentinean law firms and developing litigation prevention programmes. Industry monitored legal academic meetings, controlled the development of new product liability legislation, obtained favourable opinions from experts, and closely observed the development of litigation in Argentina.

Conclusion

The strategies used by the industry have been successful in preventing recovery for tobacco injuries through litigation. Argentinean health advocates and lawyers need to be aware of the roles and strategies of the tobacco industry in order to develop effective litigation in Argentina.     

Tobacco industry litigation strategies to oppose tobacco control media campaigns

Objective

To document the tobacco industry''s litigation strategy to impede tobacco control media campaigns.

Methods

Data were collected from news and reports, tobacco industry documents, and interviews with health advocates and media campaign staff.

Results

RJ Reynolds and Lorillard attempted to halt California''s Media Campaign alleging that the campaign polluted jury pools and violated First Amendment rights because they were compelled to pay for anti‐industry ads. The American Legacy Foundation was accused of violating the Master Settlement Agreement''s vilification clause because its ads attacked the tobacco industry. The tobacco companies lost these legal challenges.

Conclusion

The tobacco industry has expanded its efforts to oppose tobacco control media campaigns through litigation strategies. While litigation is a part of tobacco industry business, it imposes a financial burden and impediment to media campaigns'' productivity. Tobacco control professionals need to anticipate these challenges and be prepared to defend against them.     

The Living Tomorrow Project: how Philip Morris has used a Belgian tourist attraction to promote ventilation approaches to the control of second hand smoke

Study objective: To examine the involvement of Philip Morris in Living Tomorrow 2 and determine the rationale behind its involvement.

Design: Research was conducted through a web based search of internal tobacco industry documents made publicly available through litigation.

Main results: For approximately €1 000 000 Philip Morris (now Altria) became a co-initiator of Living Tomorrow 2, a tourist complex in Belgium that aims to demonstrate how we will be living in the future. In addition to promoting the company and its grocery products, Philip Morris is using the complex and its website to promote ventilation as a means of accommodating smokers and non-smokers in the indoor environment. Particular emphasis was placed on the bar and restaurant areas. Despite the rationale for its involvement, Philip Morris fails to acknowledge its role as a cigarette manufacturer. As a form of corporate sponsorship Philip Morris thought its involvement could evade any European tobacco advertising ban.

Conclusions: Philip Morris is using a tourist attraction to promote its views on control of second hand smoke (SHS) and accommodation of smokers and non-smokers in the indoor environment. However, ventilation does not deal with the health effects of SHS. Policymakers must be cognisant of the devious tactics the industry employs to promote its own agenda, especially in relation to indoor air quality and smoking in public places. Tobacco control legislation should be continually modified and strengthened in response to the changing activities of the tobacco industry as it strives to evade existing legislation and deter the advent of new legislation.

     

Public reaction to the portrayal of the tobacco industry in the film The Insider

OBJECTIVES: To assess public perceptions of the tobacco industry and behavioural intentions for tobacco use in response to watching the film The Insider. DESIGN: Self administered pre-film survey conducted immediately before viewing and post-film telephone survey conducted within 1-5 weeks of viewing. SETTING: Two commercial cinemas in Melbourne, Australia. SUBJECTS: 323 cinema patrons were recruited before screening of target films. 182 watched The Insider, 141 watched Erin Brockovich. INTERVENTIONS: Subjects watched one of two films: The Insider which featured information about unethical conduct by the tobacco industry and negative information about the health effects of smoking, or the "control" film Erin Brockovich which had an analogous plot without anti-tobacco content. MAIN OUTCOME MEASURES: Pre-film questionnaire: assessed movie viewing habits, demographic characteristics, smoking status, attitudes towards the tobacco industry, intentions for smoking. Post-film questionnaire: assessed same attitudes and intentions plus questions on the film viewed and perceptions of smoking prevalence. RESULTS: 266 (82%) subjects completed the post-film survey. Attitudes toward the tobacco industry were unfavourable at baseline. Those who saw The Insider held more negative views of business conduct by the tobacco industry than those who saw Erin Brockovich, once pre-existing attitudes to the industry were controlled for. The Insider also appears to have promoted a short term reduction in intentions to smoke. CONCLUSIONS: Results of this study suggest that if people were recurrently exposed to anti-tobacco content in movies there is potential for a more substantial and lasting impact on attitudes toward the tobacco industry and smoking.