'Public enemy no. 1': Tobacco industry funding for the AIDS response

Tobacco industry presence and practices in Mozambique: a 'chaotic' but worthy market

BACKGROUND

Mozambique has experienced a series of tobacco industry consolidations both in tobacco leaf buying and processing, and in cigarette manufacturing and marketing. The growth of the tobacco industry presence in Mozambique was followed by an increase in tobacco industry's Corporate Social Responsibility (CSR) activities. This is the first paper to describe the history of tobacco industry activities in Mozambique, a party to the WHO Framework Convention on Tobacco Control (FCTC).

METHODS

We reviewed industry documents and associated web-based information. Industry documents (1990-2021) were identified through University of California San Francisco's Truth Tobacco Industry Documents Library. We followed with a search of web-based sources pertaining to the tobacco industry in Mozambique. We complemented our analysis with select media sources to identify statements by government officials in relation to the tobacco industry. We mapped major tobacco industry players, industry partnerships and corresponding CSR activities.

RESULTS

Tobacco production increased substantially in Mozambique in the 1990s when tobacco companies began targeting African countries. The increased attention to tobacco production, trade and sales in Mozambique was coupled with greater industry involvement in CSR activities. We identified 10 tobacco industry CSR programmes in Mozambique. Most of the CSR programmes focus on health including HIV/AIDS, social issues and environmental issues.

CONCLUSIONS

Similar to other tobacco-growing countries, the industry facilitated an increase in tobacco production and continues efforts to increase the tobacco consumption market while engaging in CSR activities focused on social and environmental issues. As in other countries, CSR initiatives in Mozambique enhance industry's reputation. Importantly, these CSR programmes and partnerships breach national laws and the provisions of the FCTC. The continuation of these programmes suggests limited attention within government to protect public policy from industry interference in compliance with Article 5.3 of the FCTC.

Content Analysis of the Corporate Social Responsibility Practices of 9 Major Cannabis Companies in Canada and the US

IMPORTANCE

The cannabis industry has sought to normalize itself and expand its markets in the 21st century. One strategy used by companies to generate positive public relations is corporate social responsibility (CSR). It is critical to understand these efforts to influence the public and politicians given the risks of increased cannabis use.

OBJECTIVES

To analyze cannabis industry CSR behaviors, determine their characteristics, and compare their practices with those of the tobacco industry.

DESIGN, SETTING, AND PARTICIPANTS

This qualitative study of CSR activities conducted between January 1, 2012, and December 31, 2021, evaluated 9 of the 10 largest publicly traded cannabis companies in the US and Canada. Data were collected from August 1 to December 31, 2021. The 10th company was excluded because it engaged in cannabis-based pharmaceutical sales but not CSR. A systematic review of corporate websites and Nexis Uni was performed, resulting in collection of 153 news articles, press releases, and Web pages. Charitable and philanthropic actions were included. Themes were identified and interpreted using modified grounded theory.

MAIN OUTCOMES AND MEASURES

CSR activities and spending.

RESULTS

Nine major cannabis companies in the US and Canada engaged in CSR activities that encouraged increased consumption and targeted marginalized communities. Companies claimed these activities would mitigate the harms of cannabis prohibition, promote diversity, expand access to medical cannabis, and support charitable causes. They developed educational programs, sustainability initiatives, and voluntary marketing codes and used strategies similar to those used by tobacco companies to recruit public interest organizations as allies.

CONCLUSIONS AND RELEVANCE

These findings suggest that cannabis companies developed CSR strategies comparable to those used by the tobacco industry to influence regulation, suggesting that cannabis companies should be included when addressing commercial determinants of health.

Exposure to tobacco and e-cigarette advertisements by sexual identity status among high school students

INTRODUCTION

The literature on tobacco advertising among sexual minorities is relatively scarce. This study examined the association between exposure to tobacco products and e-cigarettes advertisements and sexual identity.

METHODS

Data were from the 2020 National Youth Tobacco Survey (n = 7223). The prevalence of exposure to tobacco marketing through various channels was estimated among high school students and by sexual identity subgroups. Multivariable logistic regressions were used to examine the association between sexual identity status and exposure to tobacco and e-cigarette advertisements.

RESULTS

The proportion of sexual minority adolescents who reported exposure to tobacco and e-cigarette advertisements was higher than heterosexuals. In multivariable analysis, gay or lesbian youth (aOR 1.45, 95% CI, 1.04-2.02) had higher odds of any exposure to tobacco and e-cigarette advertisement than heterosexuals. Regarding the channel of advertisement exposure, sexual minorities were more likely to be exposed via newspapers/magazines for cigarettes or other tobacco products. Likewise, gay or lesbian youth and those not sure about their sexual identity had higher odds of exposure via newspapers/magazines for e-cigarettes. Analysis stratified by sex showed significant differences, with gay or lesbian males more likely to be exposed to any tobacco and e-cigarette advertisements via the internet, newspapers/magazines, and TV/streaming services. Males not sure about their sexual identity are more likely to be exposed to tobacco and e-cigarette advertisements via newspapers/magazines.

CONCLUSIONS

Overall, sexual minority adolescents had high exposure to tobacco products and e-cigarette advertisements, especially males. Prevention and intervention efforts targeting this population could help reduce the well-established tobacco use disparities.

Tobacco control policies in the 21st century: achievements and open challenges

Noncommunicable diseases (NCDs), including cancer, are responsible for almost 70% of all deaths worldwide. Tobacco use is a risk factor common to most NCDs. This article discusses tobacco control policies and highlights major achievements and open challenges to reduce smoking prevalence and attributable morbidity and mortality in the 21st century. The introduction of the WHO Framework Convention on Tobacco Control in 2005 has been a key achievement in the field and has already facilitated a drop in both smoking prevalence and exposure to secondhand smoke. Indicatively, the size of the worldwide population benefiting from at least one cost‐effective tobacco control policy has quadrupled since 2007. In addition, plain cigarette packaging has been successfully introduced as a tobacco control policy, surmounting efforts of the tobacco industry to challenge this based on trade and investment law. Nevertheless, tobacco control still faces major challenges. Smoking prevalence needs to be further reduced in a rather expedited manner. Smoke‐free environments should be extended, and the use of plain tobacco packaging with large pictorial health warnings for all tobacco products should be further promoted in some parts of the world. Some of these measures will require prompt determination and diligence. For example, bold political decisions are needed to significantly increase real prices of tobacco products through excise taxes, ban added ingredients that are currently used to increase the attractiveness of tobacco products and ban the tobacco industry's corporate social responsibility initiatives. Finally, the debate on harm reduction strategies for tobacco control still needs to be resolved.

Disparities in adult cigarette smoking and smokeless tobacco use by sexual identity

BACKGROUND

While there have been reductions in rates of tobacco use in the general population in recent years, rates remain high among sexual minority populations (SMP). Prior studies often group SMP as one category due to limited data. This study examined the association between sexual identity status and tobacco use (cigarette and smokeless tobacco use) among U.S. adults.

METHODS

Data from the 2014-2017 Behavioral Risk Factor Surveillance System were analyzed to examine the association between sexual identity (lesbian or gay, bisexual, other, not sure, and heterosexual or straight) and tobacco use. A propensity score analysis was conducted to address potential imbalance among group characteristics.

RESULTS

Lesbian/gay and bisexual groups had significantly higher odds of being an every day smoker (OR = 1.83, 95 % Confidence Interval (CI) 1.59-2.10; OR = 1.36, 95 % CI 1.19-1.55, respectively) and current smoker (every day or some days) (OR = 1.71, 95 % CI 1.52-1.93; OR = 1.44, 95 % CI 1.29-1.62, respectively) compared to straight adults. In terms of smokeless tobacco products, lesbian and gay adults had lower odds of every day and current use. However, significant differences were found in the separate analysis conducted for males and females. While gay and bisexual males had lower odds of smokeless tobacco use, lesbians had significantly higher odds when compared to the straight population. Bisexual females were also more likely to be current users of smokeless tobacco.

CONCLUSIONS

Significant heterogeneity in tobacco use was found among sexual minority subgroups. Findings demonstrate the importance of subgroup analysis of SMP. These results have implications for prevention and cessation targeting.

Marketing of e-cigarettes to vulnerable populations: An emerging social justice issue

PURPOSE

To describe the practice of e-cigarette marketing to vulnerable populations and to suggest strategies to help reduce e-cigarette use.

CONCLUSIONS

E-cigarette companies target vulnerable populations through civil rights, freedom marketing, and advertising strategies, which may perpetuate continued tobacco disparities in these populations.

PRACTICE IMPLICATIONS

Health care providers have the responsibility as social justice advocates to engage in efforts to reduce e-cigarette use among vulnerable populations. We must increase knowledge, education, and training specific to e-cigarettes. Awareness of marketing strategies related to vulnerable populations is necessary to develop and implement counter strategies.

Cigarette smoking, e-cigarette use, and sexual identity among high school students in the USA

Although tobacco use has decreased in the general population in recent years, smoking remains high among subpopulations. This study examined whether sexual identity is associated with cigarette smoking and e-cigarette use among high school students. Data were drawn from the US Youth Risk Behavior Surveillance System (n = 28811). We grouped participants according to sexual identity status. Propensity score matching technique was used to address covariate imbalance among sexual identity groups. Subgroup analyses were performed for male and female students. Of the four sexual identity groups analyzed in this study, bisexual adolescents had significantly higher odds of cigarette smoking (cigarette smoking, OR, 1.61; 95% CI, 1.24-2.08; cigarette smoking for ≥ 10 days, OR, 1.79; 95% CI, 1.28-2.51; cigarette smoking for ≥ 20 days, OR, 2.04; 95% CI, 1.38-3.03). Further, in a sex-based subgroup analysis, results showed significant differences, with bisexual females more likely to smoke cigarettes and use e-cigarettes for ≥ 20 days compared with heterosexual female adolescents.Conclusions: Sexual identity status is strongly associated with cigarette smoking and e-cigarette use. Female bisexual adolescents have an increased risk of cigarette smoking and e-cigarette use for ≥ 20 days. While tobacco control policies have been effective in reducing cigarette use in the general population, targeting policy toward sexual minorities is an important consideration. What is Known: • Sexual minority groups face a disproportionate amount of stress and have a heightened risk of substance use. • Methodological concerns exist in the extant literature, including limited data at the national level. What is New: • Propensity score matching was used to account for imbalances in sexual identity subgroups, and findings show significant heterogeneity in cigarette and e-cigarette use among sexual minority high school students. • Sexual identity status is strongly associated with cigarette smoking and e-cigarette use, especially among bisexual identity female subgroup.

Does Experienced Discrimination Explain Patterns of Menthol Use Among Young Adults? Evidence from the 2014 San Francisco Bay Area Young Adult Health Survey

BACKGROUND

Young adults are at high risk for using flavored tobacco, including menthol and underrepresented populations, such as Latino and African American young adults, are at particular risk.

OBJECTIVES

The purpose of this study is to identify sociodemographic correlates of menthol use among young adult smokers and examine the potential role of experienced discrimination in explaining any associations.

METHODS

We conducted a probabilistic multimode household survey of young adults (aged 18-26) residing in Alameda and San Francisco Counties in California in 2014 (n = 1,350). We used logistic regression to evaluate associations between menthol cigarette use and experienced discrimination among young adult smokers as well as with respect to sociodemographic, attitudinal, and behavioral predictors. Interactions between experienced discrimination and race/ethnicity, sex and LGB identity were also modeled.

RESULTS

Latino and non-Hispanic Black young adult smokers were more likely to report current menthol use than non-Hispanic Whites, while those with college education were less likely to do so. Experienced discrimination mediated the relationship between race and menthol use for Asian/Pacific Islander and Multiracial young adult smokers with odds of use increasing by 32 and 42% respectively for each additional unit on the experienced discrimination scale. Conclusions/Importance: Latino and African American young adult smokers have disproportionately high menthol use rates; however, discrimination only predicted higher use for Asian/Pacific Islander and Multiracial young adult smokers. Limits on the sale of menthol cigarettes may benefit all nonwhite race/ethnic groups as well as those with less education.

From Colonization to Globalization: A history of state capture by the tobacco industry in Malawi

Malawi, the world's most tobacco dependent country, has long defended the tobacco industry as essential to its economy. The impoverished living conditions of tobacco farmers, however, raise questions about the true benefits accruing to the country. While the government and industry often blame public health advocates for declining leaf prices, and thus lower returns to farmers, this article scrutinises these claims from a historical perspective. It argues that a context of state capture has characterised Malawi's tobacco industry, originating with colonisation and evolving since to become increasingly entrenched. The analysis is divided into four periods: colonial (1890s-1964); national (1964-1981); liberalisation (1981-2004) and accelerated globalisation (2004 to present). Each period demonstrates how industry interests influenced government institutions and policies in ways that increased dependence on a crop that only benefits a minority of Malawians. Today, a transnational elite prospers at the expense of local growers.

Tobacco industry globalization and global health governance: towards an interdisciplinary research agenda

Shifting patterns of tobacco production and consumption, and the resultant disease burden worldwide since the late twentieth century, prompted efforts to strengthen global health governance through adoption of the Framework Convention on Tobacco Control. While the treaty is rightfully considered an important achievement, to address a neglected public health issue through collective action, evidence suggests that tobacco industry globalization continues apace. In this article, we provide a systematic review of the public health literature and reveal definitional and measurement imprecision, ahistorical timeframes, transnational tobacco companies and the state as the primary units and levels of analysis, and a strong emphasis on agency as opposed to structural power. Drawing on the study of globalization in international political economy and business studies, we identify opportunities to expand analysis along each of these dimensions. We conclude that this expanded and interdisciplinary research agenda provides the potential for fuller understanding of the dual and dynamic relationship between the tobacco industry and globalization. Deeper analysis of how the industry has adapted to globalization over time, as well as how the industry has influenced the nature and trajectory of globalization, is essential for building effective global governance responses. This article is published as part of a thematic collection dedicated to global governance.