Tobacco industry efforts to defeat the occupational safety and health administration indoor air quality rule

Distilling the distillers: examining the political activities of the Distilled Spirits Council of the United States

BACKGROUND

Understanding of the alcohol industry's means of influencing public policy is increasingly well established. Less is known, however, about the specific organisations that lead the political strategies of the alcohol industry. To fill this gap, this paper explores the Distilled Spirits Council of the United States (DISCUS), a key trade association in the United States (US), which also operates internationally.

METHODS

This study explores how DISCUS is organised and the main political activities it pursues to advance its policy interests. The study triangulates data from several sources, including DISCUS documents, as well as federal lobbying and election expenditure data.

RESULTS

This study demonstrates that DISCUS is a key political actor in the US and global alcohol policymaking context. There are identifiable strategies used by DISCUS to shape alcohol policy debates, including framing and lobbying. We also find key synergies between these strategies and identify their operation at varying levels of policy decision-making.

CONCLUSIONS

Generating more secure inferences about the nature of the alcohol industry's efforts to advance its interests, and with what success and at what cost, requires researchers to investigate other trade associations in different contexts, and use other data sources.

Can States Continue to Set the Agenda for Tobacco 21? Insights From US News Coverage Between 2012 and 2020

INTRODUCTION

Existing research on media examining the news content related to Tobacco 21 (T21) predate the adoption of most T21 laws. This study examined the discussion of T21 laws in top-circulating print media sources in the United States between 2012 and 2020.

AIMS AND METHODS

Systematic database searches using Access World News and Factiva identified T21-related news articles appearing in the top daily circulating newspapers in each state between January 2012 and December 2020 (n = 586 articles). Content analyses documented prevalence, types of articles and context related to framing of arguments for or against T21 laws.

RESULTS

Newspaper coverage of T21 was highest in 2019 (42.8% of articles). The majority were news or features (75.4%) followed by editorials or opinions (24.6%) which largely supported T21. Most articles focused on state or local T21 action. Coverage of federal T21 increased in 2019. The most common argument supporting T21 included reducing youth tobacco prevalence (64.8%) while the most frequent objection was freedom infringement (25.1%). Tobacco and vape industries began voicing support for T21 in 2019.

CONCLUSIONS

News coverage of state-level T21 in the United States began to increase in 2015 and peaked in 2019 with enactment of federal T21, a newsworthy event. As states adopt and amend T21 laws to align with federal law, advocates can use media to help shape the narrative and encourage strong T21 policies.

IMPLICATIONS

This study described the volume and content of T21 print media coverage from 2012 to 2020, including common arguments used to support and oppose T21. Arguments in support of T21 included reducing youth tobacco use, particularly use of e-cigarettes, and related health effects while arguments against T21 focused on individual rights. Support for T21 reached a tipping point in 2019, including the tobacco industry's reversal in opposing such laws. States can and should continue to improve existing T21 laws and policies and increase public awareness about critical policy components such as inspection procedures and penalties.

Philip Morris International-funded 'Foundation for a Smoke-Free World': analysing its claims of independence

The Foundation for a Smoke-Free World was launched in September 2017 with an announced 12-year funding commitment of $1 billion from Philip Morris International (PMI). The Foundation claims that its governing documents (certificate of incorporation, bylaws and a pledge agreement) ensure that it has an independent research agenda and stringent protections from conflicts of interest. We analysed the text of these governing documents. Their provisions have multiple loopholes, particularly regarding conflicts of interest. Further, these documents cannot substitute for other important documentation such as information about PMI's internal business case for investing $1 billion in the Foundation, an unwaivable conflict of interest policy, annual disclosure statements, copies of pre-Foundation establishment correspondence between key individuals, all signed contracts or salary information, none of which, as of July 2018, the Foundation has made publicly available. Even if these were released, however, it is problematic that the Foundation's fundamental purpose was decided on and its leader selected following a tobacco company-paid, privately negotiated arrangement with the Foundation's president. It cannot be regarded as independent.

Tobacco control law implementation in a middle-income country: Transnational tobacco control network overcoming tobacco industry opposition in Colombia

The objective of this paper is to examine the implementation of Colombia's tobacco control law. Methods involved are triangulated government legislation, news sources, and interviews with policy-makers and health advocates in Colombia. Colombia, a middle-income country, passed a tobacco control law in 2009 that included a prohibition on tobacco advertising, promotion, and sponsorship; and required pictorial health warning labels, ingredients disclosure, and a prohibition on individual cigarette sales. Tobacco companies challenged the implementation through litigation, tested government enforcement of advertising provisions and regulations on ingredients disclosure, and lobbied local governments to deprioritise policy responses to single cigarette sales. A transnational network including international health groups and funders helped strengthen domestic capacity to implement the law by; promoting public awareness of Ley [Law] 1335; training local health department staff on enforcement; facilitating health agencies' sharing of educational strategies; and providing legal defence assistance. This network included vigilant efforts by local health groups, which continuously monitored and alerted the media to noncompliance, engaged government officials and policy-makers on implementation, and raised public awareness. Support from international health NGOs and funders and continuous engagement by local health groups enhanced implementation capacities to counter continued tobacco industry interference and ensure effective tobacco control implementation.

Industry interests in gambling research: Lessons learned from other forms of hazardous consumption

Research indicates that the evidential bases for many harm reduction policies targeting hazardous consumptions (including tobacco, alcohol and gambling) have been distorted by commercial industries that derive revenue from such commodities. These distortions are best illustrated by research on tobacco and alcohol, which indicates similar tactics used by industries to determine favourable policy environments through engineering of evidence, among other approaches. Although there is concern that gambling research is similarly vulnerable to commercial interests, the relevant literature lags far behind other fields and the aim of this paper is to increase familiarity with tactics used by industries for influencing research. It summarises the conceptual and empirical bases for expecting conflicts between goals of public health and companies that profit from hazardous consumptions. It also summarises evidence describing practices deployed by tobacco corporations, which include third-party techniques and the selective funding of research to manufacture doubt and deflect attention away from the consequences of smoking. It then reviews both early and emerging evidence indicating similar strategies used by alcohol industry, and uses this literature to view practices of the gambling industry. It argues that parallels regarding selective funding of research and third-party techniques provide grounds for strong concern about commercial influences on gambling research, and implementation of precautionary approaches to management of vested interests.

The importance of continued engagement during the implementation phase of tobacco control policies in a middle-income country: the case of Costa Rica

OBJECTIVE

To analyse the process of implementing and enforcing smoke-free environments, tobacco advertising, tobacco taxes and health warning labels from Costa Rica's 2012 tobacco control law.

METHOD

Review of tobacco control legislation, newspaper articles and interviewing key informants.

RESULTS

Despite overcoming decades of tobacco industry dominance to win enactment of a strong tobacco control law in March 2012 consistent with WHO's Framework Convention on Tobacco Control, the tobacco industry and their allies lobbied executive branch authorities for exemptions in smoke-free environments to create public confusion, and continued to report in the media that increasing cigarette taxes led to a rise in illicit trade. In response, tobacco control advocates, with technical support from international health groups, helped strengthen tobacco advertising regulations by prohibiting advertising at the point-of-sale (POS) and banning corporate social responsibility campaigns. The Health Ministry used increased tobacco taxes earmarked for tobacco control to help effectively promote and enforce the law, resulting in high compliance for smoke-free environments, advertising restrictions and health warning label (HWL) regulations. Despite this success, government trade concerns allowed, as of December 2015, POS tobacco advertising, and delayed the release of HWL regulations for 15 months.

CONCLUSIONS

The implementation phase continues to be a site of intensive tobacco industry political activity in low and middle-income countries. International support and earmarked tobacco taxes provide important technical and financial assistance to implement tobacco control policies, but more legal expertise is needed to overcome government trade concerns and avoid unnecessary delays in implementation.

Neoliberal and Public Health Effects of Failing to Adopt Osha's National Secondhand Tobacco Smoke Rule

From the early 1980s to the present, neoliberal doctrine has called for government policies of privatization, funding cutbacks, and deregulation of public health and other domestic social programs in the belief that the market rather than the public sector can best organize and distribute crucial societal services. Proponents of a neoliberal and deregulatory mixed approach of command and control and self-regulation argue this approach provides the most adequate means to conduct regulation in the legalistic and adversarial U.S. regulatory process. In April 1994, the Occupational Safety and Health Administration issued a proposed rule to eliminate tobacco smoking in most workplace rooms, arguing secondhand tobacco smoke annually killed up to 13,700 nonsmokers. The tobacco industry purposely delayed public hearing procedures (later halted altogether by Congress and the president) primarily to advance unhindered private property rights and profits rather than submitting to a public command-and-control regulatory framework to reduce deaths due to secondhand tobacco smoke.

Labor unions: a public health institution

Using a social-ecological framework, we drew on a targeted literature review and historical and contemporary cases from the US labor movement to illustrate how unions address physical and psychosocial conditions of work and the underlying inequalities and social determinants of health. We reviewed labor involvement in tobacco cessation, hypertension control, and asthma, limiting articles to those in English published in peer-reviewed public health or medical journals from 1970 to 2013. More rigorous research is needed on potential pathways from union membership to health outcomes and the facilitators of and barriers to union-public health collaboration. Despite occasional challenges, public health professionals should increase their efforts to engage with unions as critical partners.

Disproportionate organizational injustice: a close look at facilities exempted from indoor smoking laws in Canada

Federal and provincial legislation bans smoking in indoor public spaces and workplaces, yet exemptions exist for residential facilities such as nursing homes and addiction treatment centres. In relying on ventilated smoking rooms, however, these organizations are failing to protect the health of their employees and clients. Increased use of risk messages regarding the harms of second- and third-hand smoke, together with enhanced nicotine replacement therapies for smokers, would rectify this disproportionate injustice. Such an approach must also recognize and counteract the efforts of the tobacco industry to block total indoor smoking bans.

The vector of the tobacco epidemic: tobacco industry practices in low and middle-income countries

PURPOSE

To understand transnational tobacco companies' (TTCs) practices in low and middle-income countries which serve to block tobacco-control policies and promote tobacco use.

METHODS

Systematic review of published research on tobacco industry activities to promote tobacco use and oppose tobacco-control policies in low and middle-income countries.

RESULTS

TTCs' strategies used in low and middle-income countries followed four main themes-economic activity; marketing/promotion; political activity; and deceptive/manipulative activity. Economic activity, including foreign investment and smuggling, was used to enter new markets. Political activities included lobbying, offering voluntary self-regulatory codes, and mounting corporate social responsibility campaigns. Deceptive activities included manipulation of science and use of third-party allies to oppose smoke-free policies, delay other tobacco-control policies, and maintain support of policymakers and the public for a pro-tobacco industry policy environment. TTCs used tactics for marketing, advertising, and promoting their brands that were tailored to specific market environments. These activities included direct and indirect tactis, targeting particular populations, and introducing new tobacco products designed to limit marketing restrictions and taxes, maintain the social acceptability of tobacco use, and counter tobacco-control efforts.

CONCLUSIONS

TTCs have used similar strategies in high-income countries as these being described in low and middle-income countries. As required by FCTC Article 5.3, to counter tobacco industry pressures and to implement effective tobacco-control policies, governments and health professionals in low and middle-income countries should fully understand TTCs practices and counter them.

From the American Academy of Pediatrics: Technical report--Secondhand and prenatal tobacco smoke exposure

Secondhand tobacco smoke (SHS) exposure of children and their families causes significant morbidity and mortality. In their personal and professional roles, pediatricians have many opportunities to advocate for elimination of SHS exposure of children, to counsel tobacco users to quit, and to counsel children never to start. This report discusses the harms of tobacco use and SHS exposure, the extent and costs of tobacco use and SHS exposure, and the evidence that supports counseling and other clinical interventions in the cycle of tobacco use. Recommendations for future research, policy, and clinical practice change are discussed. To improve understanding and provide support for these activities, the harms of SHS exposure are discussed, effective ways to eliminate or reduce SHS exposure are presented, and policies that support a smoke-free environment are outlined.

The politics of smoking in federal buildings: an executive order case study

Executive orders are important presidential tools for health policymaking that are subject to less public scrutiny than are legislation and regulatory rulemaking. President Bill Clinton banned smoking in federal government buildings by executive order in 1997, after the administration of George H. W. Bush had twice considered and abandoned a similar policy. The 1991 and 1993 Bush proposals drew objections from agency heads and labor unions, many coordinated by the tobacco industry. We analyzed internal tobacco industry documents and found that the industry engaged in extensive executive branch lobbying and other political activity surrounding the Clinton smoking ban. Whereas some level of stakeholder politics might have been expected, this policy also featured jockeying among various agencies and the participation of organized labor.

Evidence and argument in policymaking: development of workplace smoking legislation

Background

We sought to identify factors that affect the passage of public health legislation by examining the use of arguments, particularly arguments presenting research evidence, in legislative debates regarding workplace smoking restrictions.

Methods

We conducted a case-study based content analysis of legislative materials used in the development of six state workplace smoking laws, including written and spoken testimony and the text of proposed and passed bills and amendments. We coded testimony given before legislators for arguments used, and identified the institutional affiliations of presenters and their position on the legislation. We compared patterns in the arguments made in testimony to the relative strength of each state's final legislation.

Results

Greater discussion of scientific evidence within testimony given was associated with the passage of workplace smoking legislation that provided greater protection for public health, regardless of whether supporters outnumbered opponents or vice versa.

Conclusion

Our findings suggest that an emphasis on scientific discourse, relative to other arguments made in legislative testimony, might help produce political outcomes that favor public health.

Tobacco industry efforts to undermine policy-relevant research

The tobacco industry, working through third parties to prevent policy-relevant research that adversely affected it between 1988 and 1998, used coordinated, well-funded strategies in repeated attempts to silence tobacco researcher Stanton A. Glantz. Tactics included advertising, litigation, and attempts to have the US Congress cut off the researcher's National Cancer Institute funding. Efforts like these can influence the policymaking process by silencing opposing voices and discouraging other scientists from doing work that may expose them to tobacco industry attacks. The support of highly credible public health organizations and of researchers' employers is crucial to the continued advancement of public health.

The Philip Morris Nordic journalist program: strategies, implementation and outcomes

OBJECTIVES

To describe media strategies for the Nordic countries outlined in internal Philip Morris documents and to evaluate their implementation and outcomes.

METHODS

Systematic search of internal tobacco industry documents from the databases available on the Internet and retrieval of newspaper and magazine articles from Sweden and Finland.

RESULTS

The Philip Morris Nordic journalist program contained a broad range of strategies to communicate company views and to counteract negative publicity, including trips for journalists, media briefings and special events. While several of these strategies were implemented, the efforts were largely unsuccessful in that the media in Sweden and Finland carried few tobacco industry friendly articles. Articles defending the tobacco industry appeared mainly in business papers. However, support of smokers' rights' groups and sponsoring of cultural events generated positive publicity for Philip Morris.

CONCLUSIONS

Despite minor transient victories The Philip Morris Nordic journalist program was largely unsuccessful in providing the anticipated media coverage to question the health hazards of environmental tobacco smoke (ETS) and in preventing ETS regulation in the Nordic countries. The study further supports the notion that the internal corporate documents may expose the intents of the industry, but do not include enough information to evaluate implementation of industry's strategies or their outcomes.

Tobacco industry issues management organizations: creating a global corporate network to undermine public health

Background

The global tobacco epidemic claims 5 million lives each year, facilitated by the ability of transnational tobacco companies to delay or thwart meaningful tobacco control worldwide. A series of cross-company tobacco industry "issues management organizations" has played an important role in coordinating and implementing common strategies to defeat tobacco control efforts at international, national, and regional levels. This study examines the development and enumerates the activities of these organizations and explores the implications of continuing industry cooperation for global public health.

Methods

Using a snowball sampling strategy, we collected documentary data from tobacco industry documents archives and assembled them into a chronologically organized case study.

Results

The International Committee on Smoking Issues (ICOSI) was formed in 1977 by seven tobacco company chief executives to create common anti-tobacco control strategies and build a global network of regional and national manufacturing associations. The organization's name subsequently changed to INFOTAB. The multinational companies built the organization rapidly: by 1984, it had 69 members operating in 57 countries. INFOTAB material, including position papers and "action kits" helped members challenge local tobacco control measures and maintain tobacco-friendly environments. In 1992 INFOTAB was replaced by two smaller organizations. The Tobacco Documentation Centre, which continues to operate, distributes smoking-related information and industry argumentation to members, some produced by cross-company committees. Agro-Tobacco Services, and now Hallmark Marketing Services, assists the INFOTAB-backed and industry supported International Tobacco Growers Association in advancing claims regarding the economic importance of tobacco in developing nations.

Conclusion

The massive scale and scope of this industry effort illustrate how corporate interests, when threatened by the globalization of public health, sidestep competitive concerns to coordinate their activities. The global network of national and regional manufacturing associations created and nurtured by INFOTAB remains active, particularly in relation to the recently negotiated global health treaty, the Framework Convention on Tobacco Control. Policymakers should be aware that although these associations claim to represent only national or regional interests, they are allied to and coordinated with a confederation of transnational tobacco companies seeking to protect profits by undermining public health.

Tobacco industry efforts undermining evidence linking secondhand smoke with cardiovascular disease

BACKGROUND

The scientific consensus that secondhand smoke (SHS) increases cardiovascular disease (CVD) risk by 30% is based on epidemiological and biological evidence. The tobacco industry has contested this evidence that SHS causes CVD, but how and why they have done it has not been described.

METHODS AND RESULTS

About 50 million pages of tobacco industry documents were searched using general keywords and names of industry consultants and scientists. Tobacco industry-funded epidemiological analyses of large data sets were used to argue against an epidemiological association between SHS and CVD and smoke-free regulations, but these analyses all suffered from exposure misclassification problems that biased the results toward the null. More recent industry-funded publications report an increased risk of CVD associated with SHS but claim a low magnitude of risk. When early tobacco industry-funded work demonstrated that SHS increased atherosclerosis, the industry criticized the findings and withdrew funding. RJ Reynolds focused on attacking the biological plausibility of the association between SHS and CVD by conducting indirect platelet aggregation studies, exposure chamber experiments, and literature reviews. Although these studies also suffered from exposure misclassification problems, several produced results that were consistent with a direct effect of SHS on blood and vascular function. Instead, RJ Reynolds attributed these results to an unproven epinephrine-related stress response from odor or large smoke exposure, which supported their regulatory and "reduced-harm" product development efforts. Philip Morris' recent "reduced-harm" efforts seem supportive of a similar corporate agenda.

CONCLUSIONS

The tobacco industry attempted to undermine the evidence that SHS causes CVD to fight smoke-free regulations while developing approaches to support new products that claim to reduce harm. The industry interest in preserving corporate viability has affected the design and interpretation of their cardiovascular studies, indicating the need for great caution in current debates about future tobacco industry regulation and development of reduced-harm tobacco products.

Participation and argument in legislative debate on statewide smoking restrictions

Background

In this paper we review the relationship between participation in legislative hearings, the use of ideological arguments, and the strength of public health legislation using a theoretical construct proposed by E. E. Schattschneider in 1960. Schattschneider argued that the breadth and types of participation in a political discussion could change political outcomes.

Methods

We test Schattschneider's argument empirically by reviewing the efforts of six states to pass Clean Indoor Air Acts by coding testimony given before legislators, comparing these findings to the different characteristics of each state's political process and the ultimate strength of each state's legislation.

Results

We find that although greater participation is associated with stronger legislation, there is no clear relationship between the use and type of ideological arguments and eventual outcomes.

Conclusion

These findings offer validation of a long-standing theory about the importance of political participation, and suggest strategies for public health advocates seeking to establish new legislation.

A decade of work on organized labor and tobacco control: reflections on research and coalition building in the United States

Labor unions can and should make strong allies in tobacco control efforts. Through much of the 1980s and 1990s, however, the organized labor and tobacco control communities rarely formed coalitions to achieve mutual gains. Recently, labor unions and tobacco control organizations have begun to work together on smoking cessation programs, smoke-free worksite policies, and increased insurance coverage for cessation treatments. This paper explores the historic and present-day intersections among organized labor and tobacco control advocates. We summarize research in this area and report on our recent programmatic efforts to promote collaboration between the labor and tobacco control communities. We discuss lessons learned with the aims of promoting deeper understanding among tobacco control and labor advocates of how each views tobacco control issues, and most importantly, stimulating further collaboration toward mutual gains in protecting workers' health.

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.

The tobacco industry's role in the 16 Cities Study of secondhand tobacco smoke: do the data support the stated conclusions?

BACKGROUND

Since 1996, the tobacco industry has used the 16 Cities Study conclusions that workplace secondhand tobacco smoke (SHS) exposures are lower than home exposures to argue that workplace and other smoking restrictions are unnecessary.

OBJECTIVES

Our goal was to determine the origins and objectives of the 16 Cities Study through analysis of internal tobacco industry documents and regulatory agency and court records, and to evaluate the validity of the study's conclusions.

RESULTS

The tobacco industry's purpose in conducting the 16 Cities Study was to develop data showing that workplace SHS exposures were negligible, using these data to stop smoking restrictions by the U.S. Occupational Safety and Health Administration. The extensive involvement of R.J. Reynolds Tobacco Company and the tobacco industry's Center for Indoor Air Research in controlling the study was not fully disclosed. The study's definition of "smoking workplace" included workplaces where smoking was restricted to designated areas or where no smoking was observed. This definition substantially reduced the study's reported average SHS concentrations in "smoking workplaces" because SHS levels in unrestricted smoking workplaces are much greater than in workplaces with designated smoking areas or where no smoking occurred. Stratifying the data by home smoking status and comparing exposures by workplace smoking status, however, indicates that smoke-free workplaces would halve the total SHS exposure of those living with smokers and virtually eliminate SHS exposure for most others.

CONCLUSIONS

Data in the 16 Cities Study reveal that smoke-free workplaces would dramatically reduce total SHS exposure, providing significant worker and public health benefits.

The tobacco industry's response to the COMMIT Trial: an analysis of legacy tobacco documents

We analyzed internal tobacco industry documents that describe the industry's response to the Community Intervention Trial for Smoking Cessation (COMMIT), a multi-center community-based tobacco intervention project funded by the National Cancer Institute from 1988 to 1992. Our analysis of documents from the Legacy Tobacco Documents Library (www.legacy.library.ucsf.edu) suggests that the tobacco industry reacted to COMMIT by (1) closely monitoring trial activities, (2) confronting COMMIT in communities where it was most active, (3) distorting COMMIT findings on underage smoking data reported in the media, and (4) using COMMIT activities as practice to strengthen their attack against the subsequent ASSIST trial, falsely accusing both studies of illegal political lobbying with taxpayers' money. The tobacco industry closely monitored COMMIT activities and organized local responses to findings and activities perceived as threatening to the industry's public image or interests. Although we could not document a concerted attack by the tobacco industry that impacted the results of the COMMIT trial, data suggest that the industry used COMMIT as a learning opportunity to mount a well orchestrated and potentially damaging response to the larger American Stop Smoking Intervention Study for Cancer Prevention Trial.

Political dynamics promoting the incremental regulation of secondhand smoke: a case study of New South Wales, Australia

BACKGROUND

The history of governmental responses to the accumulation of scientific evidence about the harms of secondhand smoke (SHS) presents an intriguing case study of incremental public health policy development. Australia has long been considered a world-leader in progressive tobacco control policies, but in the last decade has fallen behind other jurisdictions in introducing SHS legislation that protects all workers. Bars, clubs and pubs remain the only public indoor spaces where smoking is legally permitted, despite SHS exposure in the hospitality industry being higher and affecting more people than in any other setting after domestic exposure. This paper examines the political dynamics that have shaped this incremental approach to SHS.

METHODS

In-depth interviews with 21 key stakeholders in the state of New South Wales (NSW), including politicians, their advisors, health officials and tobacco control advocates, were conducted and subjected to thematic content analysis. Interviewees' comments provided insights into the dynamics surrounding the debates and outcomes of SHS legislative attempts and the current political environment, and about how to progress SHS legislation.

RESULTS

SHS restrictions have been delayed by several broad factors: the influence of industry groups successfully opposing regulation; issue wear-out; and political perceptions that there is not a salient constituency demanding that smoking be banned in bars and clubs. Interviewees also provided suggestions of strategies that advocates might utilise to best overcome the current political inertia of incremental compromises and achieve timely comprehensive smoking bans.

CONCLUSION

Advocates concerned to shorten the duration of incremental endgames must continue to insist that governments address SHS fundamentally as a health issue rather than making political concessions to industry groups, and should broaden and amplify community voices calling on governments to finish the job. Publicity to the growing number of state and national governments that have successfully implemented total bans over the past decade is likely to make incrementalism an increasingly unattractive political option.

From strange bedfellows to natural allies: the shifting allegiance of fire service organisations in the push for federal fire-safe cigarette legislation

BACKGROUND

Cigarettes are the leading cause of fatal fires in the USA and are associated with one in four fire deaths. Although the technology needed to make fire-safe cigarettes has been available for many years, progress has been slow on legislative and regulatory fronts to require the tobacco industry to manufacture fire-safe cigarettes.

METHOD AND RESULTS

We conducted a case study, drawing on data from tobacco industry documents, archives, and key informant interviews to investigate tobacco industry strategies for thwarting fire-safe cigarette legislation in the US Congress. We apply a theoretical framework that posits that policymaking is the product of three sets of forces: interests, institutions, and ideas, to examine tobacco industry behaviour, with a special focus on their and others' attempts to court fire service organisations, including firefighters' unions as allies. We discuss the implications of our findings for future policy efforts related to fire-safe cigarettes and other tobacco control issues.

CONCLUSIONS

Tobacco control advocates ought to: continue efforts to align key interest groups, including the firefighters unions; contest tobacco industry "diversionary" science tactics; and pursue a state based legislative strategy for fire-safe cigarettes, building towards national legislation.

Tobacco document research reporting

OBJECTIVE

To understand the use of internal tobacco industry documents in the peer reviewed health literature.

DESIGN

Interpretive analysis of published research.

SAMPLE

173 papers indexed in Medline between 1995 and 2004 that cited tobacco industry documents.

ANALYSIS

Information about year published, journal and author, and a set of codes relating to methods reporting, were managed in N*Vivo. This coding formed the basis of an interpretation of tobacco document research reporting.

RESULTS

Two types of papers were identified. The first used tobacco documents as the primary data source (A-papers). The second was dedicated to another purpose but cited a small number of documents (B-papers). In B-papers documents were used either to provide a specific example or to support an expansive contention. A-papers contained information about purpose, sources, searching, analysis, and limitations that differed by author and journal and over time. A-papers had no clear methodological context, but used words from three major traditions--interpretive research, positivist research, and history--to describe analysis.

INTERPRETATION

A descriptive mainstream form of tobacco document reporting is proposed, initially typical but decreasing, and a continuum of positioning of the researcher, from conduit to constructor. Reporting practices, particularly from experienced researchers, appeared to evolve towards researcher as constructor, with later papers showing more complex purposes, diverse sources, and detail of searching and analysis. Tobacco document research could learn from existing research traditions: a model for planning and evaluating tobacco document research is presented.

Identifying carcinogens: the tobacco industry and regulatory politics in the United States

The process of identifying carcinogens for purposes of health and safety regulation has been contested internationally. The U.S. government produces a "Report on Carcinogens" every two years, which lists known and likely human carcinogenic substances. In the late 1990s the tobacco industry responded to the proposed listing of secondhand smoke with a multi-part strategy. Despite industry efforts to challenge both the substance of the report and the agency procedures, environmental tobacco smoke was declared by the agency in 2000 to be a known human carcinogen. A subsequent lawsuit, launched by chemical interests but linked to the tobacco industry, failed, but it produced a particular legal precedent of judicial review that is favorable to all regulated industries. The authors argue that, in this case, tobacco industry regulation contradicts academic expectations of business regulatory victories. However, the tobacco industry's participation in the regulatory process influenced the process in favor of all regulated industry.

Hedging their bets: tobacco and gambling industries work against smoke-free policies

OBJECTIVE

To describe and understand the relationship between the tobacco and gambling industries in connection to their collaborative efforts to prevent smoke-free casinos and gambling facilities and fight smoke-free policies generally.

METHODS

Analysis of tobacco industry documents available online (accessed between February and December 2003).

RESULTS

The tobacco industry has worked to convince the gambling industry to fight against smoke-free environments. Representatives of the gambling industry with ties to the tobacco industry oppose smoke-free workplaces by claiming that smoke-free environments hurt gambling revenue and by promoting ventilation as a solution to secondhand smoke. With help from the tobacco industry, the gambling industry has become a force at the American Society of Heating Refrigeration and Air Conditioning Engineers opposing smoke-free ventilation standards for the hospitality industry.

CONCLUSION

Tobacco industry strategies to mobilise the gambling industry to oppose smoke-free environments are consistent with past strategies to co-opt the hospitality industry and with strategies to influence policy from behind the scenes. Tobacco control advocates need to be aware of the connections between the tobacco and gambling industries in relation to smoke-free environments and work to expose them to the public and to policy makers.

Results of a Comprehensive Workplace Program for the Prevention and Treatment of Smoking Addiction

OBJECTIVES

To assess a comprehensive smoking prevention and treatment program in an electrical appliances company with 1600 employees.

MATERIAL AND METHODS

The program included smoking restrictions with the designation of smoking areas and the offer of smoking cessation treatment for the smokers affected. Study variables were age, sex, nicotine dependence (Fagerström Test), carbon monoxide in expired air, adherence to therapy, and smoking abstinence at 1 week, 1 month, 3 months (end of treatment), and 6 months. Successful smoking abstinence was defined as continuous abstinence from the beginning of treatment.

RESULTS

Smoking prevalence was 34.8% and 19.5% of smokers requested treatment (77.4% men and 22.6% women). Mean (SD) age was 41.3 (10.3) years. Mean score of nicotine dependence was 5.3 (2.6) and the mean quantity of carbon monoxide in expired air was 35.6 (23.7) ppm. Adherence to therapy was good in 80% of patients. Rate of abstinence was 57.5% at 6 months, signifying a 4% reduction in prevalence.

CONCLUSIONS

Workplace smoking cessation programs reduce prevalence and facilitate the establishment of smoking restrictions at the worksite. Companies are convenient settings for the implementation of programs aimed at smoking prevention and treatment.

Tobacco industry efforts to present ventilation as an alternative to smoke-free environments in North America

OBJECTIVE

To describe how the tobacco industry developed a network of consultants to promote ventilation as a "solution" to secondhand smoke (SHS) in the USA.

METHODS

Analysis of previously secret tobacco industry documents.

RESULTS

As with its other strategies to undermine the passage of clean indoor legislation and regulations, the tobacco industry used consultants who represented themselves as independent but who were promoting the industry's ventilation "solution" strategies under close, but generally undisclosed, industry supervision. The nature of the industry's use of ventilation consultants evolved over time. In the 1980s, the industry used them in an effort to steer the concerns about indoor air quality away from secondhand smoke, saying SHS was an insignificant component of a much larger problem of indoor air quality and inadequate ventilation. By the 1990s, the industry and its consultants were maintaining that adequate ventilation could easily accommodate "moderate smoking". The consultants carried the ventilation message to businesses, particularly the hospitality business, and to local and national and international regulatory and legislative bodies.

CONCLUSION

While the tobacco industry and its consultants have gone to considerable lengths to promote the tobacco industry's ventilation "solution", this strategy has had limited success in the USA, probably because, in the end, it is simpler, cheaper, and healthier to end smoking. Tobacco control advocates need to continue to educate policymakers about this fact, particularly in regions where this strategy has been more effective.