A qualitative framing analysis of how firearm manufacturers and related bodies communicate to the public on gun-related harms and solutions

"Stop, don't touch, run away!": reconceptualizing firearm industry-funded youth education programs as corporate political activity

BACKGROUND

Injuries represent a major threat to child health globally. In the US, firearm injuries are the leading cause of death among children and adolescents. Despite limited evidence of their effectiveness industry-funded bodies promote the delivery of their youth education programs while lobbying against firearm control policies. This article analyzes how the National Rifle Association (NRA) frames issues of gun ownership, safety and the role of the Eddie Eagle GunSafe® program as an effective firearm safety intervention and examines how the design, promotion and delivery of the program serves the corporate political interests of the firearm industry at the expense of public health.

METHODS

We conducted an analysis of Eddie Eagle Gunsafe® program-related materials and the NRA's practices to promote the program's legitimacy and effectiveness, by applying published taxonomies of corporate framing and action strategies. Data were collected from the program-specific websites and other NRA outlets to capture the breadth of strategies used by the NRA.

RESULTS

The NRA's education-related practices support the firearm industry's political agenda. The NRA adopts framing and action strategies that present the presence of firearms in homes and communities as inevitable and normal, and the education of children through the delivery of their "lifesaving" program as the common-sense and effective way of keeping children safe from firearm injuries. They make misleading claims about the effectiveness of the Eddie Eagle Gunsafe® program while undermining the credibility of those who advocate for child safety, including mothers and public health actors.

CONCLUSION

The delivery of the Eddie Eagle GunSafe® program needs critical scrutiny as is increasingly applied to other industry-funded initiatives. Policies based on a recognition that children and adolescents are safest when their homes and communities are free of firearms are needed. Findings from this analysis are relevant beyond the US and can be used to inform the governance of child safety and injury prevention globally. Analysis of the firearm industry extends the literature on the commercial determinants of health to an important new sector with significant impacts on global health.

Reclaiming the narrative: countering harmful commercial discourses

The discourses promoted by powerful commercial actors whose business activities are damaging to health undermine the potential for the transformational changes urgently needed to address pressing public health and environmental threats globally. This piece provides an analysis of corporate discursive practices and the mechanisms through which they contaminate scientific and policy debates and harm public and environmental health. We refer to this phenomenon as 'discursive pollution' to reflect the parallels between the effects of informational strategies and the commercial activities of harmful industries. It aims to contribute to the literature on the commercial determinants of health by offering a cross-industry perspective of discursive practices and the contradictions that underpin industry-favourable discourses. We propose how the health community can facilitate the construction of alternative discourses by revealing the contradictions and assumptions underpinning industry-favourable discourses.

Tobacco industry narratives of e-cigarette use in the UK: a qualitative framing analysis

Public health actors have expressed concerns over the entry of the tobacco industry into the UK e-cigarette market. It is important to be aware of the tobacco industry's involvement and stated aims for e-cigarettes in the UK, given their historical attempts to divert attention from and escape responsibility for the harms caused by combustible cigarettes. The use of e-cigarettes amongst young people in the UK has remained constant, despite the law prohibiting sales to adolescents and claims by manufacturers and others that they are designed solely as a tool to quit smoking. This study sought to examine how tobacco-related organizations in the UK e-cigarette market frame the use of e-cigarettes. Publicly available materials between September 2015 and June 2023 were collected from four transnational tobacco companies which have invested in the e-cigarette category, and from a UK e-cigarette trade association. A qualitative framing analysis of materials was conducted guided by relevant frameworks from the Commercial Determinants of Health literature. The analysis identified seven framings used by tobacco-related organizations relevant to e-cigarette usage in the UK. These were: co-opting of harm reduction; consumer choice; following the 'evidence'; insufficient evidence; the right kind of regulation; 'us' and 'them' rhetoric and marketing and advertising. By highlighting tobacco-related organizations' e-cigarette framings and contradictions, this study raises awareness of the rhetorical strategies used by the industry which aim to relegitimize tobacco companies in the political and public spheres.

Lobbying in the Sunlight: A Scoping Review of Frameworks to Measure the Accessibility of Lobbying Disclosures

BACKGROUND

While anyone can lobby governments, most lobbying is driven by commercial interests. Due to limited government disclosures, it is often challenging to get a clear picture of who is lobbying whom or why. To help make lobbying more visible to the public, we set out to develop a framework of key criteria for best practice government lobbying disclosures.

METHODS

We undertook a systematic scoping review of peer-reviewed and grey literature to identify frameworks for measuring or evaluating lobbying transparency. We screened the titles and abstracts of 1727 peer-reviewed and 184 grey literature articles, assessing 230 articles for eligibility. Following screening, we included 15 frameworks from six peer-reviewed and nine grey literature articles in our review. To create our framework of lobbying disclosures, we thematically coded the 15 included frameworks and used an iterative process to synthesise categories.

RESULTS

The 15 frameworks covered more than only lobbying disclosures, with the most common other theme about enforcement and compliance. Most frameworks were developed to evaluate lobbying transparency in particular jurisdictions, with the United States the most common. Of the 15 frameworks analysed, those developed by non-governmental organizations (NGOs) focused mainly on improving lobbying regulations, while most peer-reviewed studies developed frameworks to measure, compare and evaluate lobbying regulations. We developed a Framework fOr Comprehensive and Accessible Lobbying (FOCAL). It comprised eight primary categories (scope, timeliness, openness, descriptors, revolving door, relationships, financials, and contact log) covering 50 total indicators.

CONCLUSION

Government transparency plays a crucial role in facilitating access to information about commercial political activities like lobbying. Our framework (FOCAL) offers a template for policy-makers to develop or strengthen regulations to improve lobbying transparency so commercial political influence strategies are more visible and subject to public scrutiny. This is an important step towards rebalancing influence toward the public interest.

Political violence, racial violence, and new gun ownership: results from the 2023 National Survey of Gun Policy

BACKGROUND

U.S. firearm sales surged during the COVID-19 pandemic, with many purchases by first-time firearm owners. The 2023 National Survey of Gun Policy sought to understand the public health implications of this surge by comparing the purchasing motivations and firearm policy views of pandemic-era first-time purchasers to prior gun owners.

METHODS

We fielded a nationally representative public opinion survey of U.S. adults (n = 3096) from 1/4/23 to 2/6/23. We oversampled for gun owners and Black, Hispanic, and Asian Americans. Survey weights were applied to generate representative estimates. New gun owners were identified through affirmative responses to: "Have you bought any guns since January 1, 2020?" and "Did you buy your first gun after January 1, 2020?" Recent purchasers were additionally asked whether concerns of 1) political or 2) racial violence motivated their purchase. Purchase motivations and gun policy support were examined among new and prior gun owners (n = 1002) and compared using logistic regression and predictive probabilities.

RESULTS

Overall, 11% of respondents reported purchasing a gun since 1/1/20, 35% for the first time. Among recent purchasers, larger proportions of Democrat, Black, Asian, and Hispanic respondents were new gun owners than Republican or white respondents. Compared to prior owners, odds were 4.5-times higher that new gun owners' recent purchase was motivated by racial violence and 3.2-times higher for political violence. Majority support was found for protective gun policies, with few differences by purchase recency or motivations. The only policy for which support by new and prior gun owners differed significantly was the permit-to-purchase policy (76% v. 63%, respectively). Similarly, few significant differences in support were observed when stratifying by purchase motivation. Notably, both those who reported recent purchase motivations of racial violence and of political violence expressed significantly higher support for a "stand-your-ground" policy compared to those who did not report such motivations.

CONCLUSIONS

Racial and political violence appear to be larger concerns among new gun owners, motivating purchasing among demographic groups with traditionally lower gun ownership rates. These findings suggest a need for safety assurances amid racial and political tensions and growing gun ownership. Gun owners' support for such policies remains strong.

Complex Interventions for a Complex System? Using Systems Thinking to Explore Ways to Address Unhealthy Commodity Industry Influence on Public Health Policy

BACKGROUND

Interventions are needed to prevent and mitigate unhealthy commodity industry (UCI) influence on public health policy. Whilst literature on interventions is emerging, current conceptualisations remain incomplete as they lack considerations of the wider systemic complexities surrounding UCI influence, which may limit intervention effectiveness. This study applies systems thinking as a theoretical lens to help identify and explore how possible interventions relate to one another in the systems in which they are embedded. Related challenges to addressing UCI influence on policy, and actions to support interventions, were also explored.

METHODS

Online participatory workshops were conducted with stakeholders with expertise in UCIs. A systems map, depicting five pathways to UCI influence, and the Action Scales Model were used to help participants identify interventions and guide discussions. Codebook thematic analysis was used to analyse the data.

RESULTS

Fifty-two stakeholders participated in 23 workshops. Participants identified 27 diverse, interconnected and interdependent interventions corresponding to the systems map's pathways that reduce the ability of UCIs to influence policy. These include, for example, reform policy financing; regulate public-private partnerships (PPPs); reform science governance and funding; frame and reframe the narrative, challenge neoliberalism and gross domestic product (GDP) growth; leverage human rights; change practices on multistakeholder governance; and reform policy consultation and deliberation processes. Participants also identified four potential key challenges to interventions (ie, difficult to implement or achieve; partially formulated; exploited or misused; requires tailoring for context), and four key actions to help support intervention delivery (ie, coordinate and cooperate with stakeholders; invest in civil society; create a social movement; nurture leadership).

CONCLUSION

A systems thinking lens revealed the theoretical interdependence between disparate and heterogenous interventions. This suggests that to be effective, interventions need to align, work collectively, and be applied synchronously to different parts of the system, including multiple levels of governance. Importantly, these interventions need to be supported by intermediary actions to be achieved. Urgent action is now required to strengthen healthy alliances and implement interventions.

The Commercial Determinants of Violence: Identifying Opportunities for Violence Prevention through a Public Health-Based Framework Analysis

Violence has immediate and long-term repercussions for the health of individuals and communities. Recent increases in the understanding of public health approaches to violence prevention have focused on the policies and practices of government, health, and other public sector agencies. However, the roles of commercial bodies in fostering and preventing violence remain largely unaddressed. The wealth and influence of some companies now exceeds that of many countries. Consequently, it is timely to explore the roles of commercial processes in violence. Using a conceptual framework for the commercial determinants of health, we examine seven practices: political; scientific; marketing; supply chain and waste; labor and employment; financial; and reputational management. We include areas directly linked with violence (e.g., firearms) and those that indirectly impact violence through the following: design and promotion of products; employment practices; and impacts on environment, poverty, and local resources. A range of avoidable commercial behaviors are found to increase levels of violence including the following: lobbying practices; distortion of scientific processes; polluting manufacture and supply lines; poor employee protections; financial investment in organizations and regimes associated with violence; and misleading communications and marketing. We conclude commercial actors can take action to ensure their workers, clients, suppliers, and distributors help prevent, not promote, violence. New technologies such as artificial intelligence are transforming corporate processes and products and offer opportunities to implement violence prevention through commercial developments (e.g., monitoring online content). International regulation of commercial behaviors is needed to prevent interpersonal and interstate conflict and harms to health and trade.

The Commercial Determinants of Health and Evidence Synthesis (CODES): methodological guidance for systematic reviews and other evidence syntheses

BACKGROUND

The field of the commercial determinants of health (CDOH) refers to the commercial products, pathways and practices that may affect health. The field is growing rapidly, as evidenced by the WHO programme on the economic and commercial determinants of health and a rise in researcher and funder interest. Systematic reviews (SRs) and evidence synthesis more generally will be crucial tools in the evolution of CDOH as a field. Such reviews can draw on existing methodological guidance, though there are areas where existing methods are likely to differ, and there is no overarching guidance on the conduct of CDOH-focussed systematic reviews, or guidance on the specific methodological and conceptual challenges.

METHODS/RESULTS

CODES provides guidance on the conduct of systematic reviews focussed on CDOH, from shaping the review question with input from stakeholders, to disseminating the review. Existing guidance was used to identify key stages and to provide a structure for the guidance. The writing group included experience in systematic reviews and other forms of evidence synthesis, and in equity and CDOH research (both primary research and systematic reviews).

CONCLUSIONS

This guidance highlights the special methodological and other considerations for CDOH reviews, including equity considerations, and pointers to areas for future methodological and guideline development. It should contribute to the reliability and utility of CDOH reviews and help stimulate the production of reviews in this growing field.

Pharmaceutical company responses to Canadian opioid advertising restrictions: A framing analysis

The pharmaceutical industry's promotion of opioids in North America has been well-documented. Yet despite the clear consequences of improperly classifying pharmaceutical company messaging and frequently permissive approaches that allow the pharmaceutical industry to self-regulate its own advertising, there has been scarce investigation to date of how pharmaceutical industry stakeholders interpret definitions of "advertising." This study explores how variations of "marketing" and "advertising" are strategically framed by the different actors involved in the manufacturing and distribution of pharmaceutical opioids. We employed a framing analysis of industry responses to Health Canada's letter to Canadian manufacturers and distributors of opioids requesting their commitment to voluntarily cease all marketing and advertising of opioids to health care professionals. Our findings highlight companies' continuing efforts to frame their messaging as "information" and "education" rather than "advertising" in ways that serve their interests. This study also calls attention to the industry's continual efforts to promote self-regulation and internal codes of conduct within a highly permissive federal regulatory framework with little concern for violations or serious consequences. While this framing often occurring out of public sight, this study highlights the subtle means through which the industry attempts to frame their promotion strategies away from "marketing". These framing strategies have significant consequences for the pharmaceutical industry's capacity to influence healthcare professionals, patients, and the general public.