What hinders implementation of the WHO FCTC Article 5.3? - The case of South Korea

The aims of this study are to identify what hinders implementation of the WHO Framework Convention on Tobacco Control (FCTC) Article 5.3 in Korea, and to provide suggestions for the implementation of Article 5.3. Official governmental documents on tobacco control were reviewed. We also searched news articles for data triangulation. There were three factors that hindered the implementation of Article 5.3 in Korea. Firstly, there has been legal conflict between two tobacco-related laws, one of which is designed to promote the tobacco industry. The other is designed to promote public health. Secondly, the government has had economic interests in the tobacco industry, and its lack of action to effectively regulate the tobacco industry's corporate social responsibility (CSR) practices has hindered the implementation of Article 5.3. Thirdly, the tobacco industry's lobby and active interference in the policy-making process has been a barrier. To fully implement Article 5.3, this study suggests: defusing legal conflict between tobacco-related laws; not considering tobacco industry as a stakeholder; regulating tobacco industry's CSR activities; raising awareness of tobacco industry interference; securing transparency between the government and tobacco industry; and establishing a core group or a committee under the government to implement Article 5.3.

Should states and local governments regulate dietary supplements?

Federal regulation of dietary supplements in the United States is governed by the Dietary Supplement Health and Education Act of 1994. The law has been criticized as weak and ineffective. Alarming research has emerged demonstrating that supplements may be mislabelled, contaminated, adulterated with dangerous or unknown compounds, or sold at toxic doses. As a result, the health community has raised concerns about the safety and quality of dietary supplements. Increased federal oversight is an important avenue for improving supplement safety; however, states and local governments may also pursue strategies to strengthen the overall regulatory control of dietary supplements. States and local governments have substantial experience in regulating other products that pose a risk to public health, such as tobacco. Additionally, much has been learned about the tactics the tobacco industry has employed to protect its interests. Lessons learned may be applied to new regulatory efforts aimed at improving the safety of dietary supplements at the state and local levels. Copyright © 2015 John Wiley & Sons, Ltd.

Oklahoma Retailers' Perspectives on Mutual Benefit Exchange to Limit Point-of-Sale Tobacco Advertisements

Businesses changing their practices in ways that support tobacco control efforts recently have gained interest, as demonstrated by CVS Health's voluntary policy to end tobacco sales. Point-of-sale (POS) advertisements are associated with youth smoking initiation, increased tobacco consumption, and reduced quit attempts among smokers. There is interest in encouraging retailers to limit tobacco POS advertisements voluntarily. This qualitative exploratory study describes Oklahoma tobacco retailers' perspectives on a mutual benefit exchange approach, and preferred message and messenger qualities that would entice them to take voluntary action to limit tobacco POS advertisements. This study found that mutual benefit exchange could be a viable option along with education and law as strategies to create behavior change among tobacco retailers. Many retailers stated that they would be willing to remove noncontractual POS advertisements for a 6-month commitment period when presented with mutual exchange benefit, tailored message, and appropriate messenger. Mutual benefit exchange, as a behavior change strategy to encourage voluntary removal of POS tobacco advertisements, was acceptable to retailers, could enhance local tobacco control in states with preemption, and may contribute to setting the foundation for broader legislative efforts.

Inhaling Democracy: Cigarette Advertising and Health Education in Post-war West Germany, 1950s-1975

In the late 1960s and early 1970s, the West German government was faced with the challenge of addressing a damaging health behaviour, smoking, in the context of an emerging late modern democracy, when the precedent for addressing that behaviour was set in the Nazi past. This paper details the two-pronged approach which the government took: seeking restrictions on cigarette advertising, whilst educating young people to adopt positive health behaviours in the face of pressure to smoke. This approach can be understood in the social and economic context of the time: an economic commitment to the social market economy worked against restrictions on the sale of cigarettes; whilst concerns about past authoritarian structures prompted the health authorities to seek novel ways of addressing smoking, emphasising choice. In a nuanced way, post-war anti-smoking strategies were a response to West Germany's National Socialist past, but more importantly, a signal of an increasingly international outlook.

Can demand-side policies stop the tobacco industry's damage? Lessons from Turkey

Trade and investment liberalisation in the post-1980 period allowed the penetration of transnational tobacco companies into the Turkish market. State control over the market was gradually removed and tobacco farming, manufacturing, trade and consumption were reshaped in line with the needs of transnational tobacco companies. The resultant increase in product proliferation and aggressive marketing strategies led to a dramatic rise in cigarette consumption in the 1990s, making Turkey a market with one of the sharpest consumption increases in the world. While Turkey implemented demand-side tobacco control policies to reduce consumption after 1996, it continued to stimulate manufacturing and trade in a conflicting way. The Turkish case verifies that the liberalisation process facilitated by the state under the auspices of international institutions conflicts with tobacco control. Liberalisation paves the way for market expansions of transnational tobacco companies that resist tobacco control in their drive for profit. Current global tobacco control policies, with no interest in controlling manufacturing, have limited effect on consumption. The Turkish case indicates the necessity of establishing public control over tobacco manufacturing and trade from a public health perspective.

The impact of the tobacco retail outlet environment on adult cessation and differences by neighborhood poverty

AIMS

This study examined the impact of tobacco retail outlets on cessation outcomes over time among non-treatment-seeking smokers and assessed differences by neighborhood poverty and individual factors.

DESIGN

Observational longitudinal cohort study using geospatial data. We used generalized estimating equations to examine cessation outcomes in relation to the proximity and density of tobacco retail outlets near the home.

SETTING

Eight large Designated Media Areas across the United States.

PARTICIPANTS

A total of 2377 baseline smokers followed over three waves from 2008 to 2010.

MEASUREMENTS

Outlet addresses were identified through North American Industry Classification System codes and proximity and density measures were constructed for each participant at each wave. Outcomes included past 30-day abstinence and pro-cessation attitudes.

FINDINGS

Smokers in high poverty census tracts living between 500 m and 1.9 km from an outlet were over two times more likely to be abstinent than those living fewer than 500 m from an outlet (P < 0.05). Density within 500 m of home was associated with reduced abstinence [odds ratio (OR) = 0.94; confidence interval (CI) = 0.90, 0.98) and lower pro-cessation attitudes (Coeff = -0.07, CI = -0.10, -0.03) only in high poverty areas. In low poverty areas, density within 500 m was associated with greater pro-cessation attitudes (OR = 0.06; CI = 0.01, 0.12). Gender, education and heaviness of smoking did not moderate the impact of outlet proximity and density on cessation outcomes.

CONCLUSIONS

In the United States, density of tobacco outlets within 500 m of the home residence appears to be negatively associated with smoking abstinence and pro-cessation attitudes only in poor areas.

Permissiveness toward tobacco sponsorship undermines tobacco control support in Africa

School personnel, who are respected members of the community, may exert significant influence on policy adoption. This study assessed the impact of school personnel's permissiveness toward tobacco industry sponsorship activities on their support for complete bans on tobacco advertisements, comprehensive smoke-free laws and increased tobacco prices. Representative data were obtained from the Global School Personnel Survey for 29 African countries (n = 17 929). Adjusted prevalence ratios (aPR) were calculated using multi-variable Poisson regression models to assess the impact of permissiveness toward tobacco sponsorship activities on support for tobacco control policies (p < 0.05). The median of prevalence of support for different tobacco control policies among all countries was as follows: complete ban on tobacco advertisements (84.9%); comprehensive smoke-free laws (92.4%) and tobacco price increases (80.8%). School personnel who believed that the tobacco industry should be allowed to sponsor school events were significantly less likely to support complete bans on tobacco advertisements [aPR = 0.89; 95% confidence interval (CI) 0.84-0.95] and comprehensive smoke-free laws (aPR = 0.95; 95% CI 0.92-0.98). In contrast, support for complete tobacco advertisement bans was more likely among those who believed that the tobacco industry encourages youths to smoke (aPR = 1.27; 95% CI 1.17-1.37), and among those who taught about health sometimes (aPR = 1.06; 95% CI 1.01-1.11) or a lot (aPR = 1.05; 95% CI 1.01-1.10) compared with those who did not teach about health at all. These findings underscore the need to educate school personnel on tobacco industry's strategies to undermine tobacco control policies. This may help to build school personnel support for laws intended to reduce youth susceptibility, experimentation and established use of tobacco products.

Waiting for the opportune moment: the tobacco industry and marijuana legalization

CONTEXT

In 2012, Washington State and Colorado legalized the recreational use of marijuana, and Uruguay, beginning in 2014, will become the first country to legalize the sale and distribution of marijuana. The challenge facing policymakers and public health advocates is reducing the harms of an ineffective, costly, and discriminatory "war on drugs" while preventing another public health catastrophe similar to tobacco use, which kills 6 million people worldwide each year.

METHODS

Between May and December 2013, using the standard snowball research technique, we searched the Legacy Tobacco Documents Library of previously secret tobacco industry documents (http://legacy.library.ucsf.edu).

FINDINGS

Since at least the 1970s, tobacco companies have been interested in marijuana and marijuana legalization as both a potential and a rival product. As public opinion shifted and governments began relaxing laws pertaining to marijuana criminalization, the tobacco companies modified their corporate planning strategies to prepare for future consumer demand.

CONCLUSIONS

Policymakers and public health advocates must be aware that the tobacco industry or comparable multinational organizations (eg, food and beverage industries) are prepared to enter the marijuana market with the intention of increasing its already widespread use. In order to prevent domination of the market by companies seeking to maximize market size and profits, policymakers should learn from their successes and failures in regulating tobacco.

Sleeping with the enemy: the United Nations Development Programme and its position on the non-communicable disease epidemic

The United Nations Development Programme's (UNDP) position on non-communicable diseases (NCDs) is undermined by a key issue at the global institutional level. Fundamentally, the nature of the relationship between international development agencies and the tobacco industry is at odds with the professed public health priorities of the former. At its core, the business model of the tobacco industry is premised on the sale of addictive and disease-causing substances that fuel NCDs in the first place. The role of the United Nations system and, in particular, UNDP is to 'build nations that can withstand crisis', not to collaborate with entities that profit from crises. This simple and well-established fact cannot be overlooked. We outline an array of conflict of interests. If the effects of NCDs are ever to be reversed, then international agencies such as the UNDP ought to adhere to ethical standards in choosing partners and avoid conflict of interests. In the absence of this, the UNDP may well compromise its own agenda and proliferate NCDs rather than containing them.

An observational study of retail availability and in-store marketing of e-cigarettes in London: potential to undermine recent tobacco control gains?

OBJECTIVES

E-cigarette companies and vendors claim the potential of e-cigarettes to help smokers reduce or quit tobacco use. E-cigarettes also have the potential to renormalise smoking. The purpose of this study was to describe the availability and in-store marketing of e-cigarettes in London, UK stores selling tobacco and alcohol.

DESIGN

Observational study.

SETTING

Small and large stores selling alcohol and tobacco in London, UK.

PRIMARY AND SECONDARY OUTCOME MEASURES

The number of stores selling e-cigarettes, the number of stores with an interior or exterior e-cigarette advertisement, the number of stores with an e-cigarette point-of-sale movable display, store size, deprivation index score for store's corresponding lower super output area.

RESULTS

Audits were completed in 108 of 128 selected stores. 62 of the audited stores (57%) sold e-cigarettes. E-cigarette availability was unrelated to store size. There was a statistically non-significant trend towards increased availability in more deprived areas (p=0.069). 31 of the 62 stores (50%) selling e-cigarettes had a point-of-sale movable display, with all but one found in small stores. Two small stores had interior advertisements and eight had exterior advertisements. No advertisements were observed in large stores.

CONCLUSIONS

This audit revealed widespread availability of e-cigarettes and in-store marketing in London, UK. Even if e-cigarettes prove to be an effective cessation aid, their sale and use are resulting in an increasing public presence of cigarette-like images and smoking behaviour. After decades of work to denormalise smoking, these findings raise the question of whether e-cigarettes are renormalising smoking.

The analysis of mainstream smoke emissions of Canadian 'super slim' cigarettes

BACKGROUND

Super slim cigarettes are a relatively new type of cigarette in Canada, and an analysis of select toxicants in the mainstream smoke emissions of the super slim cigarette was conducted.

METHOD

The yields of selected toxicants in the mainstream smoke emissions of six brands of super slim cigarettes were compared with the Canadian Benchmark, which represents the cigarette designs most commonly found in Canada. A super slim cigarette was also compared with a 'Reference Cigarette' to study the impact of the significantly reduced circumference on mainstream smoke emissions.

RESULTS

Compared with the Canadian Benchmark, the yields of carbon monoxide, the carbonyls, volatiles and the aromatic amines were significantly lower for the super slim cigarette, but the yields of formaldehyde and ammonia were significantly higher. For brands containing a mixed tobacco blend, the yields of tobacco-specific nitrosamines were increased significantly. The reduced circumference of the super slim cigarette resulted in a lower tobacco weight, which together with filter ventilation resulted in lower yields of many toxicants. However, the reduced circumference increased significantly the yields of formaldehyde and phenols in mainstream smoke emissions.

CONCLUSIONS

The notably slimmer design of the super slim cigarette resulted in lower yields of some toxicants in the mainstream smoke emissions. However, there were also significant increases in some toxicant levels in the mainstream smoke emissions including formaldehyde, ammonia and the phenols. There are no changes in emission levels that have been shown to reduce exposure or risk in a way that is meaningful, and therefore, the super slim cigarette should not be considered a 'less harmful' cigarette.

The impact of cigarette pack shape, size and opening: evidence from tobacco company documents

AIMS

To use tobacco industry documents on cigarette pack shape, size and openings to identify industry findings on associations with brand imagery, product attributes, consumer perceptions and behaviour.

METHODS

Internal tobacco industry research and marketing documents obtained through court disclosure contained in the Legacy Tobacco Documents Library were searched using keywords related to pack shapes, sizes and opening methods. The search identified 66 documents related to consumer research and marketing plans on pack shape, size and openings, drawn from 1973 to 2002.

RESULTS

Industry research consistently found that packs that deviated from the traditional flip-top box projected impressions of 'modern', 'elegant' and 'unique' brand imagery. Alternative pack shape and openings were identified as an effective means to communicate product attributes, particularly with regard to premium quality and smooth taste. Consumer studies consistently found that pack shape, size and opening style influenced perceptions of reduced product harm, and were often used to communicate a 'lighter' product. Slim, rounded, oval and booklet packs were found to be particularly appealing among young adults, and several studies demonstrated increased purchase interest for tobacco products presented in novel packaging shape or opening. Evidence from consumer tracking reports and company presentations indicate that pack innovations in shape or opening method increased market share of brands.

CONCLUSIONS

Consumer research by the tobacco industry between 1973 and 2002 found that variations in packaging shape, size and opening method could influence brand appeal and risk perceptions and increase cigarette sales.

Tobacco in the Arab world: old and new epidemics amidst policy paralysis

The Arab world is comprised of 22 countries with a combined population of ∼360 million. The region is still at the initial stages of the tobacco epidemic, where it is expected to witness an increase in smoking levels and mounting tobacco-related morbidity and mortality in the future. Still, the bleak outlook of the tobacco epidemic in the Arab world continues to be faced with complacency in the form of underutilization of surveillance systems to monitor the tobacco epidemic and prioritize action, and failure to implement and enforce effective policies to curb the tobacco epidemic. Understandably, the focus on the Arab world carries the risk of trying to generalize to such a diverse group of countries at different level of economic and political development. Yet, tobacco control in the Arab world faces some shared patterns and common challenges that need to be addressed to advance its cause in this region. In addition, forces that promote tobacco use, such as the tobacco industry, and trends in tobacco use, such as the emerging waterpipe epidemic tend to coalesce around some shared cultural and socio-political features of this region. Generally, available data from Arab countries point at three major trends in the tobacco epidemic: (1) high prevalence of cigarette smoking among Arab men compared with women; (2) the re-emergence of waterpipe (also known as hookah, narghile, shisha, arghile) smoking as a major tobacco use method, especially among youth and (3) the failure of policy to provide an adequate response to the tobacco epidemic. In this review, we will discuss these trends, factors contributing to them, and the way forward for tobacco control in this unstable region.

Supporting Pacific Island countries to strengthen their resistance to tobacco industry interference in tobacco control: a case study of Papua New Guinea and Solomon Islands

Tobacco use is the biggest single preventable cause of non-communicable diseases (NCDs) in the Western Pacific region. Currently, 14 Pacific Island countries have ratified the WHO Framework Convention on Tobacco Control (FCTC) and, in having done so, are committed to implementing tobacco control measures aligned with the FCTC. Progressing strong and effective tobacco control legislation is essential to achieving long term gains in public health in small island countries. However, survey evidence suggests that pervasive tobacco industry interference serves to undermine tobacco control and public policy in several Pacific countries. An initiative was developed to provide dedicated, in-country technical support for developing legislation and policy to support implementation of Article 5.3 of the FCTC in the Solomon Islands and Papua New Guinea. This paper examines the factors that have assisted the two Pacific countries to make progress in implementing Article 5.3 and what this might mean for supporting progress in other Pacific settings. A document analysis was undertaken to identify the process and outcome of the intervention. Two significant outputs from the project including having identified and documented specific examples of TII and the development of draft legislation for Article 5.3 and other key resources for public servants both within and outside the health sector. Key determinants of progress included a motivated and engaged Ministry of Health, active civil society group or champion and access to media to prepare tobacco industry related material to stimulate public and policy sector debate.

Understanding tobacco industry pricing strategy and whether it undermines tobacco tax policy: the example of the UK cigarette market

AIMS

Tobacco tax increases are the most effective means of reducing tobacco use and inequalities in smoking, but effectiveness depends on transnational tobacco company (TTC) pricing strategies, specifically whether TTCs overshift tax increases (increase prices on top of the tax increase) or undershift the taxes (absorb the tax increases so they are not passed onto consumers), about which little is known.

DESIGN

Review of literature on brand segmentation. Analysis of 1999-2009 data to explore the extent to which tax increases are shifted to consumers, if this differs by brand segment and whether cigarette price indices accurately reflect cigarette prices.

SETTING

UK.

PARTICIPANTS

UK smokers.

MEASUREMENTS

Real cigarette prices, volumes and net-of-tax- revenue by price segment.

FINDINGS

TTCs categorise brands into four price segments: premium, economy, mid and 'ultra-low price' (ULP). TTCs have sold ULP brands since 2006; since then, their real price has remained virtually static and market share doubled. The price gap between premium and ULP brands is increasing because the industry differentially shifts tax increases between brand segments; while, on average, taxes are overshifted, taxes on ULP brands are not always fully passed onto consumers (being absorbed at the point each year when tobacco taxes increase). Price indices reflect the price of premium brands only and fail to detect these problems.

CONCLUSIONS

Industry-initiated cigarette price changes in the UK appear timed to accentuate the price gap between premium and ULP brands. Increasing the prices of more expensive cigarettes on top of tobacco tax increases should benefit public health, but the growing price gap enables smokers to downtrade to cheaper tobacco products and may explain smoking-related inequalities. Governments must monitor cigarette prices by price segment and consider industry pricing strategies in setting tobacco tax policies.

What is known about tobacco industry efforts to influence tobacco tax? A systematic review of empirical studies

OBJECTIVE

To systematically review studies of tobacco industry efforts to influence tobacco tax policies.

METHODS

Searches were conducted between 1 October 2009 and 31 March 2010 in 14 databases/websites, in relevant bibliographies and via experts. Studies were included if they focused on industry efforts to influence tobacco tax policies, drew on empirical evidence, were in English and concerned the period 1985-2010. In total, 36 studies met these criteria. Two reviewers undertook data extraction and critical appraisal. A random selection of 15 studies (42%) was subject to second review. Evidence was assessed thematically to identify distinct tobacco industry aims, arguments and tactics.

RESULTS

A total of 34 studies examined industry efforts to influence tax levels. They suggest the tobacco industry works hard to prevent significant increases and particularly dislikes taxes 'earmarked' for tobacco control. Key arguments to counter increases are that tobacco taxes are socially regressive, unfair and lead to increased levels of illicit trade and negative economic impacts. For earmarked taxes, the industry also frequently tries to raise concerns about revenue allocation. Assessing industry arguments against established evidence demonstrates most are unsupported. Key industry tactics include: establishing 'front groups', securing credible allies, direct lobbying and publicity campaigns. Only seven studies examined efforts to influence tax structures. They suggest company preferences vary and tactics centre on direct lobbying.

CONCLUSIONS

The tobacco industry has historically tried to keep tobacco taxes low using consistent tactics and misleading arguments. Further research is required to explore efforts to influence tax structures, excise policies beyond the USA and recent policies.

Policy functions of smoking control in Japan

Analysis of policy functions, with a focus on their major participants, elicits a clear picture of the decision-making process for smoking control in Japan. Activities of various advocacy groups have affected the functions of policy, including: Intelligence, Promotion, Prescription, Invocation, Application and Appraisal. In fulfilling these functions, they have affected every issue they faced by creating, transforming and propagating information in line with their interests and by influencing government decisions using coalition-building and the lobbying of elected officials. Furthermore, they have determined the development and implementation of various programs, even assuming key roles in substantiating the decisions. On the other hand, political leverage by the tobacco industry, exercised through various policy functions, intimidated the government leadership and eventually controlled its actions. When the nonsmokers' rights groups emerged, they gradually started to take part in policy functions, sometimes in cooperation with the health agency. The initial and final forms of smoking control policies in society have been deeply affected by the involvement of these groups.

Non-cigarette tobacco products: what have we learnt and where are we headed?

A wide variety of non-cigarette forms of tobacco and nicotine exist, and their use varies regionally and globally. Smoked forms of tobacco such as cigars, bidis, kreteks and waterpipes have high popularity and are often perceived erroneously as less hazardous than cigarettes, when in fact their health burden is similar. Smokeless tobacco products vary widely around the world in form and the health hazards they present, with some clearly toxic forms (eg, in South Asia) and some forms with far fewer hazards (eg, in Sweden). Nicotine delivery systems not directly reliant on tobacco are also emerging (eg, electronic nicotine delivery systems). The presence of such products presents challenges and opportunities for public health. Future regulatory actions such as expansion of smoke-free environments, product health warnings and taxation may serve to increase or decrease the use of non-cigarette forms of tobacco. These regulations may also bring about changes in non-cigarette tobacco products themselves that could impact public health by affecting attractiveness and/or toxicity.

Tobacco industry success in Costa Rica: the importance of FCTC article 5.3

OBJECTIVE

To analyze how the tobacco industry influenced tobacco control policymaking in Costa Rica.

MATERIALS AND METHODS

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

RESULTS

During the mid-to-late 1980s, Health Ministry issued several advanced (for their time) smoking restriction decrees causing British American Tobacco (BAT) and Philip Morris International (PMI) to strengthen their political presence there, resulting in passage of a weak 1995 law, which, as of August 2011, remained in effect. Since 1995 the industry has used Costa Rica as a pilot site for Latin American programs and has dominated policymaking by influencing the Health Ministry, including direct private negotiations with the tobacco industry which violate Article 5.3's implementing guidelines of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC).

CONCLUSIONS

The Costa Rica experience demonstrates the importance of vigorous implementation of FCTC Article 5.3 which insulates public health policymaking from industry interference.

"Below the Line": The tobacco industry and youth smoking

BACKGROUND

This paper provides a comprehensive account of how the tobacco industry, over time, has promoted its products to young people.

METHOD

A comprehensive search of tobacco industry documents relating to youth smoking was conducted using documents available on the World Wide Web through the Master Settlement Agreement.

RESULTS

The documents provide evidence that the industry invested great time and resources in developing strategies to attract young people through Youth Smoking Prevention strategies (including education strategies) and marketing to youth. The results include information from published literature and direct excerpts from the tobacco industry documents.

CONCLUSION

The tobacco industry documents confirm that the tobacco industry has promoted and supported strategies that are ineffective in reducing smoking by youth, and opposed strategies that have proven to be effective. It is clear from the documents reviewed that the industry values the youth market and through a number of measures continues to promote its products to young people.

Big tobacco "pull out all stops" for a landmark example: The Burswood Casino case

BACKGROUND

With the aid of internal tobacco industry documents, this paper provides a chronology of events documenting the role of the Philip Morris tobacco company in the 1993 litigation case against the Burswood International Resort Casino (BIRC). The paper also examines the implications of this case for the regulation of second hand smoke exposure.

METHOD

A systematic keyword search and analysis of internal tobacco industry documents was conducted using documents available on the World Wide Web through the Master Settlement Agreement.

RESULTS

The industry documents provide comprehensive evidence that the Philip Morris tobacco company provided assistance to the BIRC in its defence against action by the Western Australian government. The Philip Morris tobacco company, along with others, sought to publicise and promote the outcome as a 'landmark example' to lobby against the implementation of indoor smoking bans.

CONCLUSION

Philip Morris' investment in the BIRC defence demonstrated the industry's recognition of the potential significance of the case beyond Western Australia. Involvement in the BIRC case assisted the wider tobacco industry by helping to prolong smoking at casinos and other Australian hospitality venues. The findings contribute to our understanding of the history of tobacco industry strategies implemented in Western Australia and internationally to slow tobacco control progress, and the preparedness of the tobacco industry to exploit favourable developments originating anywhere in the world.

Second-hand smoke exposure and mitigation strategies among home visitation workers

OBJECTIVES

Protection of workers from second-hand smoke (SHS) in occupational settings is an important policy priority, yet little attention has been given to SHS protection for home visitation health workers, who number almost 2 million in the USA. Self-reported SHS exposure, SHS mitigation strategies and suggestions for further SHS exposure reduction approaches were obtained from home visitation health workers in Massachusetts.

METHODS

A cross-sectional survey was conducted among Massachusetts Early Intervention workers (N=316) at their state-wide conference in April 2010.

RESULTS

Eighty-three per cent of respondents reported at least 1 hour per month of SHS exposure, and 16% reported at least 11 hours per month. Nevertheless, only 22% of workers counselled clients on maintaining a smoke-free home. Fewer than 30% of workers had ever voiced concerns to their employing agency, and just 12% had raised their concerns directly with clients. Only 14% stated that their agency had rules designed to protect workers from SHS.

CONCLUSIONS

SHS exposure occurs frequently among home visitation health workers. The data point to a substantial population who are not protected from SHS exposure by formal policies.

Direct disease-inducing effects of menthol through the eyes of tobacco companies

OBJECTIVE

Menthol is an important additive in most tobacco products and is an identifying characteristic of many brands. We assessed tobacco companies' research on direct disease-inducing effects of menthol and menthol cigarettes.

METHODS

A search was conducted among documents included in the Legacy Tobacco Documents Library. Relevant documents addressed subject areas such as pharmacology, short-term and long-term effects and biomarkers of smoking exposure.

RESULTS

The documents contain little internal industry research on the disease-inducing effects of menthol. Most information in the tobacco industry documents are reviews of the published biomedical literature, from which the companies concluded that menthol did not have any direct disease-inducing effects. Evidence that contradicted this conclusion was downplayed. Except for one study, there was no evidence of the companies following up on positive findings in the literature with their own studies. In one case, results were presented at a public scientific meeting concluding that 'There were no effects from addition of menthol to test or reference cigarettes', when a company's internal pathology analysis contradicted this statement.

CONCLUSION

The available industry documents suggest that tobacco companies conducted little research on the potential disease-inducing effects of menthol and did not pursue studies that suggested adverse effects.