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

Objectives

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

Design

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

Results

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

Conclusions

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

Tobacco industry litigation to deter local public health ordinances: the industry usually loses in court

Background: The tobacco industry uses claims of state preemption or violations of the US Constitution in litigation to overturn local tobacco control ordinances.

Methods: Collection of lawsuits filed or threatened against local governments in the USA; review of previously secret tobacco industry documents; interviews with key informants.

Results: The industry is most likely to prevail when a court holds that there is explicit preemption language by the state legislature to exclusively regulate tobacco. The industry has a much weaker record on claims of implied preemption and has lost all challenges brought under equal protection claims in the cases we located. Although the tobacco industry is willing to spend substantial amounts of money on these lawsuits, it never won on constitutional equal protection grounds and lost or dropped 60% (16/27) of the cases it brought claiming implied state preemption.

Conclusions: Municipalities should continue to pass ordinances and be prepared to defend them against claims of implied preemption or on constitutional grounds. If the ordinance is properly prepared they will likely prevail. Health advocates should be prepared to assist in this process.

     

Exposure to fine and ultrafine particles from secondhand smoke in public places before and after the smoking ban, Italy 2005

Background

A smoking ban in all indoor public places was enforced in Italy on 10 January 2005.

Methods

We compared indoor air quality before and after the smoking ban by monitoring the indoor concentrations of fine (<2.5 μm diameter, PM_2.5) and ultrafine particulate matter (<0.1 μm diameter, UFP). PM_2.5 and ultrafine particles were measured in 40 public places (14 bars, six fast food restaurants, eight restaurants, six game rooms, six pubs) in Rome, before and after the introduction of the law banning smoking (after 3 and 12 months). Measurements were taken using real time particle monitors (DustTRAK Mod. 8520 TSI; Ultra‐fine Particles Counter‐TRAK Model 8525 TSI). The PM_2.5 data were scaled using a correction equation derived from a comparison with the reference method (gravimetric measurement). The study was completed by measuring urinary cotinine, and pre‐law and post‐law enforcement among non‐smoking employees at these establishments

Results

In the post‐law period, PM_2.5 decreased significantly from a mean concentration of 119.3 μg/m³ to 38.2 μg/m³ after 3 months (p<0.005), and then to 43.3 μg/m³ a year later (p<0.01). The UFP concentrations also decreased significantly from 76 956 particles/cm³ to 38 079 particles/cm³ (p<0.0001) and then to 51 692 particles/cm³ (p<0.01). Similarly, the concentration of urinary cotinine among non‐smoking workers decreased from 17.8 ng/ml to 5.5 ng/ml (p<0.0001) and then to 3.7 ng/ml (p<0.0001).

Conclusion

The application of the smoking ban led to a considerable reduction in the exposure to indoor fine and ultrafine particles in hospitality venues, confirmed by a contemporaneous reduction of urinary cotinine.     

Tobacco industry strategies to undermine the 8th World Conference on Tobacco or Health

Objective: To demonstrate that Philip Morris and British American Tobacco Company attempted to initiate a wide ranging campaign to undermine the success of the 8th World Conference on Tobacco or Health held in Buenos Aires, Argentina, in 1992.

Data sources: Publicly available tobacco industry documents housed in Minneapolis, Minnesota, USA; Guilford, UK; on-line document websites; and telephone interviews with informed parties.

Study selection: Those documents determined to be relevant to the companies' campaigns against the 8th World Conference on Tobacco or Health.

Data extraction: Revision of chapter VIII of the July 2000 WHO report by a committee of experts, entitled: Tobacco company strategies to undermine tobacco control activities at the World Health Organization: report of the committee of experts on tobacco industry documents.

Data synthesis: Internal documents describe proposed media and science orientated campaigns developed by BAT, Philip Morris, and their consultants to divert attention away from the conference.

Results and conclusion: This work shows that the tobacco industry has the resources and vested interest to combat perceived threats in its regional operating markets, in this case its Latin American market. It is important for the worldwide public heath community to become aware of the numerous ways in which the tobacco industry and its front groups can work against international tobacco control meetings, even including the manipulation of or working with other public health groups to oppose tobacco control efforts. Future world conference planners and participants should be aware that the tobacco industry is likely to continue to employ such methodology. There is no reason to think that the industry is paying less attention to such conferences in the present or future. Rather, it is likely the industry will adopt and expand strategies that were successful while abandoning those that were not effective. Required disclosure of financial support by all participants at all tobacco scientific conferences is recommended. For the tobacco control community, we also recommend careful coalition building and networking with other public health groups on the ways tobacco is implicated in other public health issues.

     

Environmental tobacco smoke exposure in public places of European cities

Background: Exposure to environmental tobacco smoke (ETS) has important public health implications. The results of the first European multi-centre study that measured ETS exposure in a range of public places (transport, educational settings, and leisure facilities such as bars and restaurants) are presented.     

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.

     

Second-hand tobacco smoke in public places in urban and rural China

Objective

To assess airborne nicotine concentrations as an indicator of second‐hand smoke (SHS) exposure in public places in both urban and rural areas of China.

Design

Measurement of vapour‐phase nicotine concentration using a common protocol in all locations. A total of 273 samplers were placed for 7 days in urban and rural areas of China, including Beijing and the capital city, and a county (rural) area of the following provinces: Sichuan (Chengdu/Mianzhu), Jiangxi (Nanchang/Anyi) and Henan (Zhengzhou/Xin''an).

Setting

Samplers were placed in hospitals, secondary schools, city government buildings, train stations, restaurants and entertainment establishments (internet cafes, mahjong parlours and karaoke bars) in each location.

Main outcome measure

The time‐weighted average airborne concentration of nicotine (μg/m³) was measured by gas chromatography.

Results

Airborne nicotine was detected in 91% of the locations sampled. Beijing had the highest nicotine concentrations in most indoor environments (median 3.01 μg/m³) and Chengdu had the lowest concentrations (median 0.11 μg/m³). Overall, restaurants and entertainment establishments had the highest nicotine concentrations (median 2.17 and 7.48 μg/m³, respectively). High nicotine concentrations were also found in government buildings and in train stations.

Conclusions

The data collected in this study provide evidence that SHS exposure is frequent in public places in China. Environmental nicotine concentrations in China provide evidence for implementation and enforcement of smoke‐free initiatives in public places in China and indicate the need for protecting the public from exposure to SHS.Tobacco use causes death and disease not only among those who actively smoke but also among those who are exposed to second‐hand smoke (SHS) in indoor environments.^1,2 Over the past two decades, evidence on the adverse health effects of SHS exposure has led to initiatives worldwide to reduce exposure in public places, workplaces, homes and transportation environments. Although cities and entire countries, including New York City and State, Italy, Ireland, Norway and Scotland, have passed legislation banning smoking in all public places, most countries and particularly the low‐income to middle‐income countries, such as China, do not have effective policies in place to reduce active and passive smoking. Making indoor environments smoke‐free has not been easy; in many countries, a majority of men smoke and the tobacco industry has vigorously attempted to counter the growing call for smoke‐free indoor environments. Industry efforts include attempts at discrediting scientific evidence on the health effects of SHS, subverting regulatory initiatives, and advancing ineffective alternatives to eliminate smoking indoors.³ In addition, many countries lack data documenting exposure of the population to SHS.China is a particularly critical nation in the global effort to control tobacco use. China has the largest population of smokers in the world: over 350 million of its 1.2 billion people.⁴ Governments, including the Chinese government, are increasingly becoming aware of the significant impact of the tobacco epidemic on their citizens.⁵In August 2006, the Chinese government ratified the World Health Organization''s Framework Convention on Tobacco Control, and some Chinese cities, government departments and organisations have now adopted rules and regulations banning smoking in public places and workplaces. Recently, a deputy to the China legislature called for a ban on smoking in all public places.⁶ However, progress has been hindered by the high prevalence of smoking and a general view that smoking is acceptable.⁴ There is also concern about the possible negative economic impact of tobacco control policies, especially in the rural and less‐developed areas of China.To develop the required evidence for advancing tobacco control, we measured airborne nicotine concentrations in various locations across China. In this study, we report the results of an assessment of nicotine concentrations in schools, hospitals, government offices, train stations, facilities, restaurants and entertainment establishments in urban and rural areas of China.     

Tobacco use and readiness to quit smoking in low-income HIV-infected persons.

The study aim was to identify covariates of smoking status and readiness to quit that encompassed key sociodemographic and health status variables, health-related quality of life, drug use and unprotected sex, and tobacco use variables in a cohort of low-income persons living with HIV. We also examined the impact of HIV diagnosis on smoking cessation. The sample (N = 428) was mostly male (59%) and Black (53%) or Hispanic (30%), and had a high school education or less (87%). Mean age was 40 years. Two-thirds of participants were current smokers, 19% former smokers, and 16% never smokers. Current smokers smoked a mean of 16 cigarettes/day for 22 years; 42% were in the precontemplation stage of readiness to quit smoking, 40% were contemplators, and 18% were in preparation. Most current smokers (81%) reported receiving medical advice to quit smoking. Multivariate logistic regression analyses indicated that current smokers, compared with former smokers, were more likely to use illicit drugs, perceive a lower health risk for continued smoking, and report less pain. Current smokers, compared with nonsmokers (former and never smokers), were more likely to report greater illicit drug use in their lifetime, current illicit drug use, and less pain. A multiple linear regression indicated that greater current illicit drug use, greater emotional distress, and a lower number of quit attempts were associated with lower stage of readiness to quit smoking. These findings confirm a high prevalence of smoking among HIV-infected persons and suggest a complex interplay among drug use, pain, and emotional distress that impact smoking status and, among smokers, readiness to quit. Tobacco control programs for HIV-infected persons should build motivation to quit smoking and address salient barriers to cessation--such as comorbid drug use, emotional distress, pain, and access to and coverage for treatment--and should educate smokers regarding the HIV-specific health benefits of cessation.     

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.