Socio-environmental risks associated with the green tobacco sickness in farmers: a case-control study

OBJECTIVE

to determine the presence of socio-environmental risk factors for the development of Green Tobacco Sickness in workers who grow Burley tobacco.

METHOD

matched case-control study. The data collection took place in two moments: from December 2016 to January 2017 and December 2017, when the Burley tobacco was collected, through a household survey with interview application and urine collection for urinary cotinine.

RESULTS

the socio-environmental risk factors that remained associated with the disease were: bundling tobacco (p=0.047) and wearing socks (p=0.011); with protective effect were found sticking tobacco seeding of the day (p=0.006) and number of tobacco harvested per day (p=0.021).

CONCLUSION

the steps in the Burley tobacco work process increase the exposure and risk of developing the disease. By identifying these factors, it is possible to address interdisciplinary control and prevention measures.

Child Labor in Global Tobacco Production: A Human Rights Approach to an Enduring Dilemma

Tobacco production is a multi-billion-dollar global industry. Unfortunately, the cultivation of tobacco engages the labor of children throughout the world in extremely dangerous environments, which has both immediate and long-term consequences for children and society. This paper explores the human rights concerns associated with child labor in tobacco production by highlighting three countries-the United States, Kazakhstan, and Malawi-and examines the impact that the United Nations Convention on the Rights of the Child, the International Labour Organization's (ILO) Worst Forms of Child Labour Convention, and the ILO's Safety and Health in Agriculture Convention have on child labor practices in tobacco production. It also proposes general actions to address the human rights concerns related to child labor practices in tobacco production, as well as specific actions for selected countries. A human rights-based approach to reducing child labor in agriculture could create meaningful changes that improve lives and opportunities for health, education, and economic stability among children and families across the globe.

E-cigarettes and Weight Loss-Product Design Innovation Insights From Industry Patents

Objective

There is emerging evidence that e-cigarettes are being used by some to mitigate weight gain after quitting smoking, and being used to help control weight. This study sought to identify and describe patents related to innovations for e-cigarette devices associated and weight loss.

Methods

Relevant patents were identified using Google Patents with the core search terms: "electronic cigarette" OR "e-cigarette" OR "vaporizer" OR "vapourizer" AND "nicotine" AND "weight loss" OR "weight control" OR "obesity" OR "hunger". Patents were reviewed to identify and classify the innovation related to weight loss or weight control.

Results

Our search identified 23 unique patents that were filed between 2004 and 2015. Patent applications were sponsored by individual inventors (n = 7), tobacco companies (n = 5), e-cigarette companies (n = 8), pharmaceutical companies (n = 2) and a cannabis company (n = 1). More than half the patents (n = 12) were filed in the United States; other countries included China, Germany, South Korea, and South Africa. Strategies included using e-cigarette devices to deliver constituents to users that support weight loss through altered metabolism, reduced nutrient absorption, suppressed appetite, or supported healthy behavior change. In most cases (n = 18), the innovations detailed in the patents were intended to be used with an e-cigarette device that delivered nicotine to the user.

Conclusions

Companies from around the world, and from a range of industries are developing and patenting technologies related to e-cigarettes and weight loss. E-cigarettes may be presented to cigarette users as a possible solution to support smoking cessation and address the fear of weight gain.

Implications

This article presents evidence that a range of industries are innovating to design e-cigarettes or constituents to be used with e-cigarettes to deliver a variety of drugs beyond nicotine including weight loss drugs, laxatives, and nutritional supplements. This study may inform surveillance studies to systematically include weight loss as a possible motivation to use e-cigarettes. Further, market surveillance of e-cigarette products needs to monitor ingredients in e-liquids including constituents that have been historically used for weight loss or weight control. Regulations around e-cigarette marketing, promotion, product design including e-liquid constituents need to consider weight loss claims.

How tobacco companies in the United Kingdom prepared for, and responded to, standardised packaging of cigarettes and rolling tobacco

INTRODUCTION

As a result of the Standardised Packaging of Tobacco Products Regulations and Tobacco Products Directive, all packs of cigarettes (factory-made and hand-rolled) in the UK must be drab brown, display pictorial warnings on the principal display areas and contain no less than 20 cigarettes or 30 g of tobacco. The legislation was phased in between May 2016 and May 2017. Our objective was to monitor pack, brand and product changes preimplementation and postimplementation.

METHODS

Our surveillance of the cigarette market involved a review of the trade press, a monthly monitor of online supermarkets and regular visits to stores, from May 2015 to June 2017.

RESULTS

Before standardised packaging there were changes to the pack graphics (eg, redesigned packs and limited editions) and pack structure (eg, resealable inner foil) and the issue of a number of reusable tins. After standardised packaging, changes included newer cigarette pack sizes for some brand variants (eg, 23 and 24 packs). Changes to the branding prestandardised packaging included brand extensions, and poststandardised packaging included brand and/or variant name change, often with the inclusion of colour descriptors and brand migrations. Product changes prestandardised packaging included the introduction of novel filters (eg, filters with two flavour-changing capsules, tube filters, firmer filters and filters with granular additives). There was non-compliance with the legislation, with slim packs, which are not permitted, on sale after standardised packaging was implemented.

CONCLUSIONS

Our findings highlight the need to monitor developments in markets introducing standardised packaging and have policy implications for countries considering this measure.

Standardised tobacco packaging: a health policy case study of corporate conflict expansion and adaptation

OBJECTIVES

To investigate opposition to standardised tobacco packaging in the UK. To increase understanding of how transnational corporations are adapting to changes in their access to policymakers precipitated by Article 5.3 of the Framework Convention on Tobacco Control (FCTC).

DESIGN

Case study web-based documentary analysis, using NVivo V.10. Examination of relationships between opponents of standardised packaging and transnational tobacco companies (TTCs) and of the volume, nature, transparency and timing of their activities.

SETTING

UK standardised packaging policy debate 2011-2013.

PARTICIPANTS

Organisations selected on basis of opposition to, or facilitation thereof, standardised tobacco packaging in the UK; 422 associated documents.

RESULTS

Excluding tobacco manufacturing and packaging companies (n=12), 109 organisations were involved in opposing standardised packaging, 82 (75%) of which had a financial relationship with 1 or more TTC. These 82 organisations (43 actively opposing the measure, 39 facilitating opposition) were responsible for 60% of the 404 activities identified, including the majority of public communications and research production. TTCs were directly responsible for 28% of total activities, predominantly direct lobbying, but also financially underwrote third party research, communication, mass recruitment and lobbying. Active organisations rarely reported any financial relationship with TTCs when undertaking opposition activities.

CONCLUSIONS

The multifaceted opposition to standardised packaging was primarily undertaken by third parties with financial relationships with major tobacco manufacturers. Low levels of transparency regarding these links created a misleading impression of diverse and widespread opposition. Countries should strengthen implementation of Article 5.3 of the FCTC by systematically requiring conflict of interest declarations from all organisations participating in political or media debates on tobacco control.

Tobacco Control and Health Advocacy in the European Union: Understanding Effective Coalition-Building

INTRODUCTION

Coalitions of supporters of comprehensive tobacco control policy have been crucial in achieving policy success nationally and internationally, but the dynamics of such alliances are not well understood.

METHODS

Qualitative semi-structured, narrative interviews with 35 stakeholders involved in developing the European Council Recommendation on smoke-free environments. These were thematically analyzed to examine the dynamics of coalition-building, collaboration and leadership in the alliance of organizations which successfully called for the development of comprehensive European Union (EU) smoke-free policy.

RESULTS

An alliance of tobacco control and public health advocacy organizations, scientific institutions, professional bodies, pharmaceutical companies, and other actors shared the goal of fighting the harms caused by second-hand smoke. Alliance members jointly called for comprehensive EU smoke-free policy and the protection of the political debates from tobacco industry interference. The alliance's success was enabled by a core group of national and European actors with long-standing experience in tobacco control, who facilitated consensus-building, mobilized allies and synchronized the actions of policy supporters. Representatives of Brussels-based organizations emerged as crucial strategic leaders.

CONCLUSIONS

The insights gained and identification of key enablers of successful tobacco control advocacy highlight the strategic importance of investing into tobacco control at European level. Those interested in effective health policy can apply lessons learned from EU smoke-free policy to build effective alliances in tobacco control and other areas of public health.

Tobacco industry manipulation of data on and press coverage of the illicit tobacco trade in the UK

BACKGROUND

In the UK, transnational tobacco companies (TTCs) have been arguing that levels of illicit trade are high and increasing and will rise further if standardised packaging is implemented. This paper examines trends in and accuracy of media reporting of, and industry data on, illicit tobacco in the UK.

METHODS

Quantification of the volume, nature and quality of press articles citing industry data on illicit tobacco in UK newspapers from March 2008 to March 2013. Examination of published TTC data on illicit, including a comparison with independent data and of TTC reporting of Her Majesty's Revenue and Customs data on illicit.

RESULTS

Media stories citing industry data on illicit tobacco began in June 2011, 2 months after the Tobacco Control Plan for England, which heralded standardised packaging, was published. The majority of data cited are based on industry Empty Pack Surveys for which no methodology is available. For almost all parts of the country where repeat data were cited in press stories, they indicated an increase, often substantial, in non-domestic/illicit cigarettes that is not supported by independent data. Similarly, national data from two published industry sources show a sudden large increase in non-domestic product between 2011 and 2012. Yet the methodology of one report changes over this period and the other provides no published methodology. In contrast, independent data show steady declines in non-domestic and illicit cigarette penetration from 2006 to 2012 and either a continued decline or small increase to 2013.

CONCLUSIONS

Industry claims that use of Non-UK Duty Paid/illicit cigarettes in the UK is sharply increasing are inconsistent with historical trends and recent independent data. TTCs are exaggerating the threat of illicit tobacco by commissioning surveys whose methodology and validity remain uncertain, planting misleading stories and misquoting government data. Industry data on levels of illicit should be treated with extreme caution.

WHO Framework Convention on Tobacco Control in China: barriers, challenges and recommendations

AIM

The aim of this study was to analyze the barriers in the implementation of the Framework Convention on Tobacco Control (FCTC) in China and present recommendations on ways to address these challenges in tobacco control in China.

METHODS

We review the available literature on progress and explore the barriers and challenges that impede a speedier pace in the adoption of the effective tobacco control measures, and present recommendations based on in-depth knowledge of decision-making process on the implementation of FCTC in China.

RESULTS

The pace of progress in China is too slow. China faces intractable political, structural, economic and social barriers in tobacco control, which make the whole-hearted implementation of FCTC measures a painstaking process.

DISCUSSION

The authors recommend a comprehensive approach to speed up the implementation of tobacco control measures. This includes strong political leadership from the top, structural changes to the tobacco industry and government oversight of the tobacco industry, as well as advocacy and support for tobacco control from civil society at the grassroots level.

Ending tobacco-caused mortality and morbidity: the case for performance standards for tobacco products

The US Family Smoking Prevention and Tobacco Control Act and WHO Framework Convention on Tobacco Control provide us with powerful tools to reduce the death and disease caused by the use of tobacco products. One tool that can contribute substantially toward this goal is the authority to establish performance standards for tobacco products. Conjointly with reducing levels of nicotine in cigarettes, performance and quality control standards need to be established for non-combusted tobacco products. Performance standards and incentives should be provided so that tobacco companies are compelled to manufacture and market products with very low or almost non-existent toxicity (eg, nicotine-only products).

Tobacco control in the Russian Federation--a policy analysis

BACKGROUND

The Russian Federation (Russia) has one of the highest smoking rates in the world. The purpose of this study is to analyze past and current trends of the tobacco epidemic in the Russian Federation, review current tobacco control policy responses, and identify areas of opportunity for policy priorities.

METHODS

We used a policy triangle as analytical framework to examine content, context, and processes of Russian tobacco control policy. The analysis was based on secondary data on supply and demand sides of the Russian tobacco epidemic, tobacco-related economic and health effects during Russia's economic transition, and compliance of Russian tobacco policy with international standards and regulations.

RESULTS

Tobacco-promoting strategies have specifically targeted women and youth. Russia's approval of a "National Tobacco Control Concept" and draft for a comprehensive tobacco control bill increasingly align national legislature with the WHO Framework Convention on Tobacco Control (FCTC). However, several structural and cultural factors represent substantial barriers to the policy process. The influence of transnational tobacco companies on policy processes in Russia has so far impeded a full implementation of the FCTC mandates.

CONCLUSIONS

Several strategies have been identified as having the potential to reduce the prevalence of tobacco use in Russia and decrease tobacco-related national health and economic burden: adjusting national tobacco policy by raising tobacco tax from the current lowest level in Europe to at least 70%; consequent enforcement of a complete smoking ban in public places; marketing restrictions; and smoking cessation interventions integrated into primary care. Russia's tobacco control efforts need to target women and youths specifically to efficiently counter industry efforts.

Smoking in top-grossing US movies, 2011

We reviewed the number of incidents of tobacco use (almost exclusively smoking) depicted in movies in the United States in 2011 to compare that with previously reported trends. We counted use or implied use of a tobacco product by an actor in all movies whose box office gross ranked in the top 10 for at least 1 week. Total tobacco incidents per movie rose 7% from 2010 to 2011, ending 5 years of decline; incidents rose 34% per movie rated G, PG, or PG-13 and 7% per R-rated movie. The reversal of progress toward less onscreen smoking in youth-rated movies underscores the need to rate movies with tobacco imagery as R, establishing an industry-wide market incentive to keep youth-marketed movies tobacco-free.

The case for a smoker's license

Tobacco continues to kill millions of people around the world each year and its use is increasing in some countries, which makes the need for new, creative, and radical efforts to achieve the tobacco control endgame vitally important. One such effort is discussed in this PLOS Medicine Debate, where Simon Chapman presents his proposal for a "smoker's license" and Jeff Collin argues against. Chapman sets out a case for introducing a smart card license for smokers designed to limit access to tobacco products and encourage cessation. Key elements of the smoker's license include smokers setting daily limits, financial incentives for permanent license surrender, and a test of health risk knowledge for commencing smokers. Collin argues against the proposal, saying that it would shift focus away from the real vector of the epidemic--the tobacco industry--and that by focusing on individuals it would censure victims, increase stigmatization of smokers, and marginalize the poor.

Toxicological assessment of cigarette ingredients

Ingredients have been used in industrial manufacture of tobacco products since the early part of the 20th century. However, unlike other consumer goods, until now no regulatory authority has determined how tobacco ingredients should be assessed. Although there is currently no consensus on how added cigarette ingredients should be evaluated, this paper reviews some of the institutional guidance alongside published literature with a view to determining if there is a generally accepted approach in the absence of any strict regulation. Our aim was to review the recommendations, to compare them to the working practices as demonstrated from published studies, and to draw conclusions on currently used methodologies for testing ingredients added to cigarettes. The extent of testing is discussed in the light of practical and theoretical constraints and an example of an industry testing program is presented.

Survey of descriptors on cigarette packs: still misleading consumers?

AIM

In September 2008, the New Zealand (NZ) Commerce Commission issued a warning to the major tobacco companies to remove "light" and "mild" descriptors from cigarette packaging. Despite published evidence that suggested tobacco companies had started colour-coding their packs in anticipation of the Commission's decision, the investigation did not consider more general misleading packaging. This study explored changes in tobacco packaging that had been introduced to the New Zealand market, by surveying descriptors used on cigarette packs after the Commerce Commission's warning.

METHOD

A convenience sample of discarded cigarette packs were collected in four cities and six towns/rural areas between November 2008 and January 2009. The majority of packs (93%) were collected in the capital city (Wellington). Information on the descriptors and pack colours was analysed.

RESULTS

Four percent of the 1208 packs collected still included the terms "light" and "mild". Almost half the packs (42%) used a colour word (e.g. red, blue, gold) as a descriptor to indicate mildness or strength. A further 18% used other words that suggested mildness/strength (e.g. "subtle", "mellow"). A quarter of packs used a descriptor that did not connote either mildness or strength; however, the majority of these packs still appeared to be colour-coded.

CONCLUSION

Although the words "light" and "mild" have been largely removed from tobacco packaging in the New Zealand market, these words have been replaced with associated colours or other words that may continue to communicate "reduced harm" messages to consumers. Further research to test how smokers interpret the new words and colours, and how these influence their behaviour, is desirable. However, government-mandated generic (plain) packaging would remove the opportunity to communicate misleading claims and so would afford the highest level of consumer protection.

Safety assessment of diammonium phosphate and urea used in the manufacture of cigarettes

A tiered testing strategy has been employed to evaluate the potential for new ingredients, tobacco processes, and technological developments to alter the mainstream smoke or biological activity that results from burning cigarette tobacco. The foundation of this evaluation strategy is comparative testing, typically including chemical and biological assessments. In the manufacture of cigarettes, diammonium phosphate (DAP) and urea have been historically used as ingredients added to tobacco, to reconstituted tobacco sheet, and to other processed tobaccos. As part of ongoing stewardship efforts, a toxicological assessment of cigarettes with and without DAP and urea was conducted. Chemical and biological analyses were conducted for test cigarettes added 0.5% DAP and 0.2% urea in the final blend and also for those added 1.0% DAP and 0.41% urea in the final blend compared to reference cigarettes without added DAP or urea. Principal components of this evaluation included a determination of selected mainstream smoke constituent yields, an Ames assay in Salmonella typhimurium strains TA98 and TA100, a sister chromatid exchange assay in Chinese hamster ovary cells, a 13-week inhalation study of mainstream cigarette smoke in Sprague-Dawley rats, and a 30-week dermal tumor-promotion evaluation of mainstream cigarette smoke condensate in SENCAR mice. Comparative evaluations demonstrated that the addition of DAP and urea to cigarettes at up to 1% and 0.41%, respectively, does not alter the biological activity compared to reference cigarettes without DAP or urea.

Tobacco industry lawyers as "disease vectors"

OBJECTIVE

Despite their obligation to do so, tobacco companies often failed to conduct product safety research or, when research was conducted, failed to disseminate the results to the medical community and to the public. The tobacco company lawyers' role in these actions was investigated with a focus on their involvement in company scientific research, claims of attorney-client privilege and work-product cover, document concealment, and litigation tactics.

METHODS

Searches of previously secret internal tobacco industry documents located at Tobacco Documents Online. Additional searches included court transcripts, legal cases and articles obtained through Westlaw, PubMed, and the internet.

RESULTS

Tobacco company lawyers have been involved in activities having little or nothing to do with the practice of law, including gauging and attempting to influence company scientists' beliefs, vetting in-house scientific research, and instructing in-house scientists not to publish potentially damaging results. Additionally, company lawyers have taken steps to manufacture attorney-client privilege and work-product cover to assist their clients in protecting sensitive documents from disclosure, have been involved in the concealment of such documents, and have employed litigation tactics that have largely prevented successful lawsuits against their client companies.

CONCLUSIONS

Tobacco related diseases have proliferated partly because of tobacco company lawyers. Their tactics have impeded the flow of information about the dangers of smoking to the public and the medical community. Additionally, their extravagantly aggressive litigation tactics have pushed many plaintiffs into dropping their cases before trial, thus reducing the opportunities for changes to be made to company policy in favour of public health. Stricter professional oversight is needed to ensure that this trend does not continue.

Consumer acceptable risk: how cigarette companies have responded to accusations that their products are defective

OBJECTIVE

To describe arguments used by cigarette companies to defend themselves against charges that their cigarettes were defective and that they could and should have done more to make cigarettes less hazardous.

METHODS

The data for this paper come from the opening statements made by defendants in four court cases: two class action lawsuits (Engle 1999, and Blankenship 2001) and two individual cases (Boeken 2001, and Schwarz 2002). The transcripts of opening statements were reviewed and statements about product defect claims, product testing, and safe cigarette research were excerpted and coded.

RESULTS

Responses by cigarette companies to charges that their products were defective has been presented consistently across different cases and by different companies. Essentially the arguments made by cigarette companies boil down to three claims: (1) smoking is risky, but nothing the companies have done has made cigarettes more dangerous than might otherwise be the case; (2) nothing the companies have done or said has kept someone from stopping smoking; and (3) the companies have spent lots of money to make the safest cigarette acceptable to the smoker.

CONCLUSIONS

Cigarette companies have argued that their products are inherently dangerous but not defective, and that they have worked hard to make their products safer by lowering the tar and nicotine content of cigarettes as recommended by members of the public health community. As a counter argument, plaintiff attorneys should focus on how cigarette design changes have actually made smoking more acceptable to smokers, thereby discouraging smoking cessation.

Global leaf companies control the tobacco market in Malawi

OBJECTIVE

To examine the influence of US-based tobacco leaf-buying companies, Universal Corporation and Alliance One International, on Malawi's economy and trade policy in 2000-6.

DESIGN

Analyses of ethnographic data and tobacco industry documents.

RESULTS

Universal Corporation and Alliance One International, through their subsidiary companies Limbe Leaf and Alliance One, respectively, in Malawi, control policy-making advisory groups and operate a tobacco cartel to influence Malawi's economic and trade sectors. Limbe Leaf's corporate secretary and lawyer is a member of several policy-making committees that advise the Malawi government on tobacco-related trade policy. The corporate representative's presence prevents other committee members from taking positions against the tobacco industry and ensures government policy that advances industry interests to obtain low-cost tobacco. The World Bank and Malawi's Anti-corruption Bureau report allegations of collusion between Limbe Leaf and Alliance One over prices at tobacco markets. Allegations of collusion between Limbe Leaf and Alliance One prompted Malawi President Bingu Mutharika in 2006 to warn the companies to end non-competitive practices or leave the country, but there was no meaningful follow-up action. Findings from interviews with small-scale tobacco traders in Malawi suggest that Universal and Alliance One International purchase smuggled raw tobacco from the neighbouring countries, Zambia and Mozambique, undermining growers' efforts to benefit from tobacco farming in Malawi.

CONCLUSION

These actions restrict competition, depress tobacco prices for Malawi's farmers and contribute to poverty in Malawi, while keeping the country dependent on tobacco growing.

The invisible hand: how British American Tobacco precluded competition in Uzbekistan

BACKGROUND

Tobacco industry documents provide a unique opportunity to explore the role transnational corporations (TNCs) played in shaping the poor outcomes of privatisation in the former Soviet Union (FSU). This paper examines British American Tobacco's (BAT's) business conduct in Uzbekistan where large-scale smuggling of BAT's cigarettes, BAT's reversal of tobacco control legislation and its human rights abuses of tobacco farmers have been documented previously. This paper focuses, instead, on BAT's attitude to competition, compares BAT's conduct with international standards and assesses its influence on the privatisation process.

METHODS

Analysis of BAT documents released through litigation.

RESULTS

BAT secured sole negotiator status precluding the Uzbekistan government from initiating discussions with other parties. Recognising that a competitive tender would greatly increase the cost of investment, BAT went to great lengths to avoid one, ultimately securing President Karimov's support and negotiating a monopoly position in a closed deal. It simultaneously secured exclusion from the monopolies committee, ensuring freedom to set prices, on the basis of a spurious argument that competition would exist from imports. Other anticompetitive moves comprised including all three plants in the deal despite intending to close down two, exclusive dealing and implementing measures designed to prevent market entry by competitors. BAT also secured a large number of exemptions and privileges that further reduced the government's revenue both on a one-off and ongoing basis.

CONCLUSIONS

BAT's corporate misbehaviour included a wide number of anticompetitive practices, contravened Organisation of Economic Cooperation and Development's and BAT's own business standards on competition and restricted revenue arising from privatisation. This suggests that TNCs have contributed to the failure of privatisation in the FSU. Conducting open tenders and using enforceable codes to regulate corporate conduct would help deal with some of the problems identified.

Getting away with murder

A review of Allan M. Brandt's The cigarette century: the rise, fall and deadly persistence of the product that defined America (New York: Basic Books, 2007).

Should the health community promote smokeless tobacco (snus) as a harm reduction measure?

The tobacco control community is divided on whether or not to inform the public that using oral, smokeless tobacco (Swedish snus) is less hazardous to health than smoking tobacco. Proponents of "harm reduction" point to the Swedish experience. Snus seems to be widely used as an alternative to cigarettes in Sweden, say these proponents, contributing to the low overall prevalence of smoking and smoking-related disease. Harm reduction proponents thus argue that the health community should actively inform inveterate cigarette smokers of the benefits of switching to snus. However, critics of harm reduction say that snus has its own risks, that no form of tobacco should ever be promoted, and that Sweden's experience is likely to be specific to that culture and not transferable to other settings. Critics also remain deeply suspicious that the tobacco industry will use snus marketing as a "gateway" to promote cigarettes. In the interests of promoting debate, the authors (who are collaborators on a research project on the future of tobacco control) have agreed to outline the strongest arguments for and against promoting Swedish snus as a form of harm reduction.

Why the tobacco industry fears point of sale display bans

Banning the display of tobacco products represents a major step in tobacco control and will help to reduce tobacco sales.

Revising the machine smoking regime for cigarette emissions: implications for tobacco control policy

BACKGROUND

The WHO Framework Convention on Tobacco Control includes provisions for testing and regulating cigarette emissions. However, the current international standard for generating cigarette emissions--the ISO machine smoking regime--is widely acknowledged to be inappropriate for purposes of setting regulatory restrictions.

OBJECTIVE

To review alternatives to the ISO machine smoking regime and the extent to which they: 1) Represent human smoking behaviour, 2) Reduce the potential for industry exploitation, particularly in the area of risk communication, and 3) Serve as suitable measures for product regulation.

METHODS

Emissions data from 238 Canadian cigarette brands tested under the ISO and "Canadian Intense" machine smoking regimes.

RESULTS

None of the alternative smoking regimes, including the Canadian Intense method, are more "representative" of human smoking behaviour and none provide better predictors of human exposure.

CONCLUSIONS

Given that alternatives such as the Canadian Intense regime are subject to the same fundamental limitations as the ISO regime, key questions need to be addressed before any smoking regime should be used to set regulatory limits on smoke emissions. In the meantime, regulators should remove quantitative emission values from cigarette packages and more work should be done on alternative machine smoking methods.

Eliminating child labour in Malawi: a British American Tobacco corporate responsibility project to sidestep tobacco labour exploitation

OBJECTIVES

To examine British American Tobacco and other tobacco industry support of the Eliminating Child Labour in Tobacco Growing Foundation.

DESIGN

Analyses of internal tobacco industry documents and ethnographic data.

RESULTS

British American Tobacco co-founded the Eliminating Child Labour in Tobacco Growing Foundation (ECLT) in October 2000 and launched its pilot project in Malawi. ECLT's initial projects were budgeted at US2.3 million dollars over four years. Labour unions and leaf dealers, through ECLT funds, have undertook modest efforts such as building schools, planting trees, and constructing shallow wells to address the use of child labour in tobacco farming. In stark contrast, the tobacco companies receive nearly US40 million dollars over four years in economic benefit through the use of unpaid child labour in Malawi during the same time. BAT's efforts to combat child labour in Malawi through ECLT was developed to support the company's "corporate social responsibility agenda" rather than accepting responsibility for taking meaningful steps to eradicate child labour in the Malawi tobacco sector.

CONCLUSION

In Malawi, transnational tobacco companies are using child labour projects to enhance corporate reputations and distract public attention from how they profit from low wages and cheap tobacco.

Maximum yields might improve public health--if filter vents were banned: a lesson from the history of vented filters

Filter ventilation is the dominant design feature of the modern cigarette that determines yields of tar, nicotine, and carbon monoxide on smoking machine tests. The commercial use of filter ventilation was precipitated by the 1964 United States Surgeon-General's report, further advanced by the adoption of an official Federal Trade Commission test in 1967, and still further advanced by the inclusion of a gas phase (carbon monoxide) measure in 1979. The first vented-filter brand on the market in the United States (Carlton) in 1964 and the second major vented-filter brand (True) in 1966 illustrate this. Ultimately, filter ventilation became a virtually required way to make very low tar cigarettes (less than 10 mg or, even more so, less than 5 mg tar). The key to the lower tar cigarette was not, in effect, the advanced selective filtration design characteristics or sophisticated tobacco selection or processing as envisioned by experts (although these techniques were and are used); the key to the very much lower tar cigarette was simply punching holes in the filter. We propose that the banning of filter vents, coupled with low maximum standard tar, nicotine, and carbon monoxide yields, would contribute to making cigarettes much less palatable and foster smoking cessation or the use of clearly less hazardous nicotine delivery systems. It may be necessary to link low maximum yields with the banning of filter ventilation to achieve public health benefit from such maxima.

Significance of ammonium compounds on nicotine exposure to cigarette smokers

The tobacco industry publicly contends that ammonia compounds are solely used as tobacco additive for purposes of tobacco flavoring, process conditioning and reduction of its subjective harshness and irritation. However, neither objective scientific reports, nor the contents of a large number of internal tobacco company documents support this contention. The present review focuses on the hypothesis that addition of ammonium compounds to tobacco enhances global tobacco use due to smoke alkalization and enhanced free-nicotine nicotine exposure. Obviously, ammonia enhances the alkalinity of tobacco smoke. Consequently, the equilibrium shifts from non-volatile nicotine salts to the volatile free base that is more readily absorbed from the airways. The observed change in the kinetics of nicotine (i.e., shorter t(1/2) and higher c(max)) after ammoniation is, however, predominantly due to the higher concentration of nicotine in the smoke, rather than to an increase in the absorption rate of free-base nicotine in the respiratory tract. Although several findings support the hypothesis, additional studies are required and suggested to provide a proper, objective and independent scientific judgment about the effect of tobacco ammoniation on nicotine bioavailability. Scientific and public awareness of the effects of tobacco-specific ammonia compounds may stimulate global control, legislation and restriction of their use in cigarette manufacture.

How Philip Morris built Marlboro into a global brand for young adults: implications for international tobacco control

OBJECTIVE

To describe Philip Morris' global market research and international promotional strategies targeting young adults.

METHODS

Analysis of previously secret tobacco industry documents.

RESULTS

Philip Morris pursued standardised market research and strategic marketing plans in different regions throughout the world using research on young adults with three principle foci: lifestyle/psychographic research, brand studies, and advertising/communication effectiveness. Philip Morris identified core similarities in the lifestyles and needs of young consumers worldwide, such as independence, hedonism, freedom, and comfort. In the early 1990s Philip Morris adopted standardised global marketing efforts, creating a central advertising production bank and guidelines for brand images and promotions, but allowing regional managers to create regionally appropriate individual advertisements.

CONCLUSIONS

Values and lifestyles play a central role in the global marketing of tobacco to young adults. Worldwide counter marketing initiatives, coupled with strong, coherent global marketing policies such as the Framework Convention on Tobacco Control, are needed to break associations between young adult values and tobacco brands. As globalisation promotes the homogenisation of values and lifestyles, tobacco control messages that resonate with young adults in one part of the world may appeal to young adults in other countries. Successful tobacco control messages that appeal to young people, such as industry denormalisation, may be expanded globally with appropriate tailoring to appeal to regional values.

Characterization of measured menthol in 48 U.S. cigarette sub-brands

More than 25% of cigarettes sold in the United States are branded as mentholated, and these cigarettes are smoked disproportionately among populations with disparate tobacco-related health outcomes. This study is the first (independent of the tobacco industry) to report menthol for 48 popular commercially available mentholated cigarette sub-brands. The dependent variable "menthol per cigarette" was obtained by gas chromatography-mass spectrometer assay, whereas average per-cigarette milligram weight of tobacco filler ("tobacco per cigarette") was determined gravimetrically. Pearson's correlations assessed associations among continuous variables. Analyses of variance assessed mean differences on the independent variables of interest: manufacturer, brand family, industry descriptors of length (100 mm and King [85 mm]) and label (ultralight, light, medium/mild, and regular/full flavor), and a category constructed by the authors of exclusively menthol brand families (those without a non-menthol offering; Kool, Newport, and Salem) versus others (GPC, Camel, and Marlboro). Results showed menthol per cigarette and menthol per tobacco (i.e., milligrams of menthol per gram of tobacco filler) to be significantly greater in cigarettes labeled with industry descriptors of ultralight or light, belying the common consumer perception that "light" means less. Menthol per cigarette and tobacco per cigarette were significantly greater in 100-mm compared with 85-mm cigarettes. The study results are consistent with prior research that suggests menthol may be used to offset reductions in smoke delivery or impact and to facilitate compensatory smoke inhalation behaviors in smokers of cigarettes with reduced machine-measured smoke delivery. Tobacco manufacturers should be required by federal or other regulatory agencies to report the amount of menthol added to cigarettes.

Designing cigarettes for women: new findings from the tobacco industry documents

AIMS

To examine internal tobacco industry research on female smoking patterns and product preferences, and how this research has informed the design of female-targeted cigarettes and impacted smoking behavior among this target population.

DESIGN

Research was conducted through a systematic web-based search of previously secret industry documents made publicly available through the 1998 Master Settlement Agreement.

FINDINGS

This study provides evidence that the tobacco industry has conducted extensive research on female smoking patterns, needs and product preferences, and has intentionally modified product design for promotion of cigarette smoking among women. Cigarette manufacturers responded to changing female trends by focusing on social and health concerns as well as promoting dual-sex brands that also featured traditional female style characteristics.

CONCLUSIONS

Product features responsive to female-identified needs and preferences may contribute to differences in female smoking patterns. Assessment of female-targeted product differences should inform smoking cessation and prevention programs tailored to women. Overall, these findings underscore the need for further investigation of effects of targeting on smoking behavior, health outcomes and regulation of tobacco products by public health agencies.

Smokers' responses to advertisements for regular and light cigarettes and potential reduced-exposure tobacco products

This study examines smokers' responses to advertisements for potentially reduced exposure tobacco products (PREP), light cigarettes, and regular cigarettes. A convenience sample of 600 adult smokers reviewed one actual advertisement for each type of product. Smokers ranked the products on health risk, amount of tar, and carcinogenicity, and identified the messages they perceived the advertisements to convey. Smokers perceived PREP products as having lower health risks (mean = 5.4 on a scale of 1-10) and carcinogens (6.6) than light cigarettes (5.8 and 6.9, respectively, p < .001), and lights as having lower health risks and carcinogen levels than regular cigarettes (8.2 and 8.8, respectively, p <.001). The average PREP rating for level of tar (5.3) was not significantly less than the light mean of 5.4, but both were significantly less than the regular mean of 8.4 (p <.001). Although no advertisements explicitly said that the products were healthy or safe, advertisements for PREP products and light cigarettes were interpreted as conveying positive messages about health and safety. Most smokers believed that claims made in cigarette advertisements must be approved by a government agency. The results indicate that advertisements can and do leave consumers with perceptions of the health and safety of tobacco products that are contrary to the scientific evidence. Explicit and implicit advertising messages may be strengthened by the perceived government endorsement. This supports the Institute of Medicine's recommendation to regulate the promotion, advertising, and labeling of PREP tobacco products and light cigarettes. Effective regulation may need to focus on consumer perceptions resulting from advertisements rather than the explicit content of advertising text.

Source and health implications of high toxic metal concentrations in illicit tobacco products

A significant flux of heavy metals, among other toxins, reaches the lungs through smoking. Consequently, contaminated soil is usually avoided for tobacco cultivation. Here we compare the heavy metal concentrations in tobacco from a sample of 47 counterfeit products, representative of the substantial market for these products in the U.K., with their genuine equivalents and find significantly higher concentrations of heavy metals in the counterfeits. Trace element patterns suggest that over-application of fertilizers (phosphate and/or nitrate) is the most likely cause. Nitrogen isotopes showed no significant enrichment in 15N (delta15N range from +1.1 to +4.6% in counterfeits and from +2.5 to +3.3% in genuine tobaccos) as might be expected from a sewage or manure source of nitrate, and a mineral phosphate source is considered the more likely source of metals. Stable carbon isotopes in the same tobaccos have a wide range (delta13C -18.3 to -26.4%), indicating the influence of multiple controls during cultivation and possibly post-harvesting. A review of the health effects of heavy metal transfer from tobacco via smoke to the lungs indicates that habitual smokers of counterfeits may be risking additional harm from high levels of cadmium and possibly other metals.

Tobacco control policies of oncology nursing organizations

Nurses, the largest group of health care professionals, and the policies of nursing organizations, have tremendous potential to promote health and tobacco control. Policies addressing tobacco use have been implemented by a variety of national and international nursing organizations. This article reviews existing tobacco control policies in oncology nursing organizations.

Mainstream smoke constituent yields and predicting relationships from a worldwide market sample of cigarette brands: ISO smoking conditions

The study objective is evaluation of a benchmark approach for predicting mainstream smoke constituent machine-yields for conventional cigarette brands from worldwide markets. Results for ISO smoke yields support the validity of benchmarking when brands, for which yields are to be predicted, have design characteristics within boundaries established by the exploratory brands. Yields of ISO-method mainstream smoke constituents were generally well described by weighted least squares regression relationships with ISO tar (R2>0.80 and coefficient p values <0.05). The impact of the varied chemical composition of cigarette tobaccos from different regions on smoke constituent yields was recognized. Mainstream smoke nitrogen oxides and tobacco-specific nitrosamine (TSNA) yield prediction relationships improved by including tobacco nitrate or TSNA concentration factors in respective independent parameters. For carbon-filter brands, inclusion of a carbon factor improved the predicting relationships for several vapor-phase constituents. Relationships were validated with a subset of additional validation brands. Greater than 90% of the validation brands' smoke chemistry yields were within the 95% prediction intervals. Average differences between measured and predicted yields were generally within the range of one to two measurement standard deviations. The estimation methods proposed relate to machine-smoking conditions and are not intended to reflect the actual exposure of any given consumer to smoke constituents.

"It is possible he is a kind of nut": how the tobacco industry quietly promoted Dr William Whitby

Dr William Whitby was a general practitioner in Sydney who, from 1978 until about 1987, self published two books extolling the virtues of smoking and ridiculing anti-smoking claims. Privately the tobacco industry regarded him as "nutty", while nonetheless believing that his views should be promoted. They quietly supported him by distributing his book, offering legal advice, and persuading him to take media training. Many Australians would have been exposed to his views.

"Conclusions about exposure to ETS and health that will be unhelpful to us": how the tobacco industry attempted to delay and discredit the 1997 Australian National Health and Medical Research Council report on passive smoking

BACKGROUND

Major reviews of the health effects of passive smoking have been subjected to tobacco industry campaigns to refute the scientific evidence. Following the 1992 US Environmental Protection Agency review, the Australian National Health and Medical Research Council (NHMRC) initiated a review of the health effects of passive smoking. At the time of this review, evidence that environmental tobacco smoke causes disease was being increasingly accepted in courts of law and voluntary adoption of smoking restrictions was rapidly growing.

OBJECTIVE

To demonstrate how the tobacco industry attempted to delay and discredit the publication of a report on passive smoking that the tobacco industry anticipated to contain recommendations that would be unfavourable to their business.

METHODS

A search of tobacco industry documents on the Master Settlement Agreement websites was conducted using the terms and acronyms representative of the NHMRC review.

RESULTS

The tobacco industry sought to impede the progress of the NHMRC Working Party by launching an intensive campaign to delay and discredit the report. The main strategies used were attempts to criticise the science, extensive use of Freedom of Information provisions to monitor all activity of the group, legal challenges, ad hominem attacks on the credibility of the Working Party members, rallying support from industry allies, and influencing public opinion through the media.

CONCLUSIONS

The Australian tobacco industry deliberately impeded the NHMRC Working Party's progress and successfully prevented the publication of the report's recommendations. The tobacco industry's motivation and capacity to disrupt the advancement of scientific knowledge and policy in tobacco control should be recognised and anticipated.

Assessing storefront tobacco advertising after the billboard ban

This study examined storefront tobacco advertisements in 11 towns in Illinois from 1999 through 2001 to assess possible changes in these types of advertisements since the master tobacco settlement, which banned tobacco advertisements on billboards. Observers assessed the number of merchant- and industry-made tobacco storefront advertisements in Illinois stores and whether these advertisements were either brand- or price-focused. The relationship between the amount of tobacco advertisements and underage tobacco sales to minors was also explored. Findings indicated no significant relationships between tobacco advertisements and underage tobacco sales. However, industry price advertisements decreased over time because of tobacco price increases resulting from the master settlement, whereas industry brand advertisements increased over time, perhaps in an effort by the tobacco industry to retain sales of their products through brand recognition.