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.

Menthol's potential effects on nicotine dependence: a tobacco industry perspective

OBJECTIVE

To examine what the tobacco industry knows about the potential effects menthol may have on nicotine dependence.

METHODS

A snowball strategy was used to systematically search the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu/) between 22 February and 29 April, 2010. Of the approximately 11 million documents available in the Legacy Tobacco Documents Library, the iterative searches returned tens of thousands of results. We qualitatively analysed a final collection of 309 documents relevant the effects of menthol on nicotine dependence.

RESULTS

The tobacco industry knows that menthol overrides the harsh taste of tobacco and alleviates nicotine's irritating effects, synergistically interacts with nicotine, stimulates the trigeminal nerve to elicit a 'liking' response for a tobacco product, and makes low tar, low nicotine tobacco products more acceptable to smokers than non-mentholated low delivery products.

CONCLUSION

Menthol is not only used in cigarettes as a flavour additive; tobacco companies know that menthol also has sensory effects and interacts with nicotine to produce tobacco products that are easier to smoke, thereby making it easier to expose smokers, especially those who are new and uninitiated, to the addictive power of nicotine.

Menthol sensory qualities and smoking topography: a review of tobacco industry documents

OBJECTIVE

To determine what the tobacco industry knew about the potential effects of menthol on smoking topography-how a person smokes a cigarette.

METHODS

A snowball strategy was used to systematically search the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu) between 1 June 2010 and 9 August 2010. We qualitatively analysed a final collection of 252 documents related to menthol and smoking topography.

RESULTS

The tobacco industry knew that menthol has cooling, anaesthetic and analgesic properties that moderate the harshness and irritation of tobacco. Owing to its physiological effects, menthol contributes to the sensory qualities of the smoke and affects smoking topography and cigarette preference.

CONCLUSION

Our review of industry studies suggests that the amount of menthol in a cigarette is associated with how the cigarette is smoked and how satisfying it is to the smoker. If menthol in cigarettes was banned, as the US Food and Drug Administration (FDA) is currently considering, new/experimental smokers might choose not to smoke rather than experience the harshness of tobacco smoke and the irritating qualities of nicotine. Similarly, established menthol smokers might choose to quit if faced with an unpleasant smoking alternative.

Menthol cigarettes and smoking cessation behaviour: a review of tobacco industry documents

OBJECTIVE

To determine what the tobacco industry knew about menthol's relation to smoking cessation behaviour.

METHODS

A snowball sampling design was used to systematically search the Legacy Tobacco Documents Library (LTDL) (http://legacy.library.ucsf.edu) between 15 May to 1 August 2010. Of the approximately 11 million documents available in the LTDL, the iterative searches returned tens of thousands of results. A final collection of 509 documents relevant to 1 or more of the research questions were qualitatively analysed, as follows: (1) perceived sensory and taste rewards of menthol and potential relation to quitting; and (2) motivation to quit among menthol users.

RESULTS

Menthol's cooling and anaesthetic effects mask the short-term negative physiological effects of smoking such as throat pain, burning and cough. This provides superficial physical relief as well as psychological assurance against concerns about the health dangers of smoking that would otherwise motivate smokers to quit. Menthol smokers, particularly women, perceive the minty aroma of menthol cigarettes to be more socially acceptable than non-menthol cigarettes.

DISCUSSION

Consumers believe menthol's sensory effects equate to health protections and that menthol cigarettes are more socially acceptable than non-menthol cigarettes. Menthol in cigarettes may encourage experimenters who find non-mentholated cigarettes too harsh, including young or inexperienced users, to progress to regular smoking rather than quitting, and may lessen the motivation to quit among established menthol smokers. The perception of menthol cigarettes as more socially acceptable lessens the impact of smoking denormalisation on quitting motivation. Menthol makes cigarettes easier and more palatable to smoke and less desirable to quit among established smokers. Fewer smokers quitting contributes to the incidence of tobacco-related diseases.

Menthol cigarettes and smoking initiation: a tobacco industry perspective

OBJECTIVES

To determine what the tobacco industry knew about menthol cigarettes and the initiation of smoking.

METHODS

Based on Food and Drug Administration staff-supplied research questions we used a snowball sampling strategy to search the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu) between February and April 2010. Of the approximately 11 million documents available in the LTDL, the iterative searches returned tens of thousands of results. Researchers reviewed 2634 documents and 128 were deemed relevant to one or more of the research questions.

RESULTS

The documents show that menthol is added to cigarettes in part because it is known to be an attractive feature to inexperienced smokers who perceive menthol cigarettes as less harsh and easier to smoke and because of their availability from friends and family. Second, the tobacco industry found that some youths smoke menthols because they perceive them to be less harmful than non-menthol cigarettes. A key product design issue concerns whether to increase brand menthol levels to appeal to the taste preferences of long-term menthol smokers or keep menthol levels lower to appeal to inexperienced smokers. Marketing studies showed that the companies carefully researched the menthol segment of the market in order to recruit younger smokers to their brands. The industry tracked menthol cigarette usage by age, gender and race to inform product development and marketing decisions.

CONCLUSIONS

Menthol is a prominent design feature used by cigarette manufacturers to attract and retain new, younger smokers.

Marketing of menthol cigarettes and consumer perceptions: a review of tobacco industry documents

OBJECTIVE

To examine tobacco industry marketing of menthol cigarettes and to determine what the tobacco industry knew about consumer perceptions of menthol.

METHODS

A snowball sampling design was used to systematically search the Legacy Tobacco Documents Library (LTDL) (http://legacy.library.ucsf.edu) between 28 February and 27 April 2010. Of the approximately 11 million documents available in the LTDL, the iterative searches returned tens of thousands of results from the major US tobacco companies and affiliated organisations. A collection of 953 documents from the 1930s to the first decade of the 21st century relevant to 1 or more of the research questions were qualitatively analysed, as follows: (1) are/were menthol cigarettes marketed with health reassurance messages? (2) What other messages come from menthol cigarette advertising? (3) How do smokers view menthol cigarettes? (4) Were menthol cigarettes marketed to specific populations?

RESULTS

Menthol cigarettes were marketed as, and are perceived by consumers to be, healthier than non-menthol cigarettes. Menthol cigarettes are also marketed to specific social and demographic groups, including African-Americans, young people and women, and are perceived by consumers to signal social group belonging.

CONCLUSIONS

The tobacco industry knew consumers perceived menthol as healthier than non-menthol cigarettes, and this was the intent behind marketing. Marketing emphasising menthol attracts consumers who may not otherwise progress to regular smoking, including young, inexperienced users and those who find 'regular' cigarettes undesirable. Such marketing may also appeal to health-concerned smokers who might otherwise quit.

Enticing the New Lad: Masculinity as a Product of Consumption in Tobacco Industry-Developed Lifestyle Magazines

We demonstrate how an industry promoted and defined masculinity as a product of consumption. We analyze previously-secret tobacco industry documents and the content of two tobacco industry-produced magazines, Unlimited (from Philip Morris, makers of Marlboro) and Real Edge (from Brown & Williamson, makers of Lucky Strike), which were distributed to millions of young adult men from the late 1990s and early 2000s to promote their tobacco brands. We find that Unlimited and Real Edge exhibited similar themes previously reported to typify "new lad" magazines, but with risky behaviors in the forefront. We build upon the existing masculinity literature by providing insight into how corporations study and interpret cultural constructions of masculinity, and then use masculinity as both a vehicle and a product of consumption.

A review of the impacts of tobacco industry privatisation: Implications for policy

State-owned tobacco companies, which still account for 40% of global cigarette production, face continued pressure from, among others, the International Monetary Fund (IMF), to be privatised. This review of available literature on tobacco industry privatisation suggests that any economic benefits of privatisation may be lower than supposed, because private owners avoid competitive tenders (thus underpaying for assets), negotiate lengthy tax holidays and are complicit in the smuggling of cigarettes to avoid import and excise duties. It outlines how privatisation leads to increased marketing, more effective distribution and lower prices, creating additional demand for cigarettes among new and existing smokers, leading to increased cigarette consumption, higher smoking prevalence and lower age of smoking initiation. Privatisation also weakens tobacco control because private owners, in their drive for profits, lobby aggressively against effective policies and ignore or overturn existing policies. This evidence suggests that further tobacco industry privatisation is likely to increase smoking and that instead of transferring assets from state to private ownership, alternative models of supply should be explored.

The case for OFSMOKE: how tobacco price regulation is needed to promote the health of markets, government revenue and the public

Mainstream economic theory outlines four main causes of market failure and it is already well established that two of these (information failure and externalities) exist in a tobacco market. A third cause of market failure, market power, is also a serious problem in many tobacco markets. Market power--combined with unintended and often overlooked consequences of tobacco tax policies, notably that gradual increases in specific taxes may allow the industry to disguise significant price increases--has, at least in high income countries, given cigarette manufacturers considerable pricing power and profits. This paper examines ways this market failure could be addressed and proposes as a solution a system of price cap regulation wherein a cap is placed on the pre-tax cigarette manufacturers' price but not on the retail price that consumers face. Well established in the utilities industry, price cap regulation would set a maximum price that cigarette companies can charge for their product based on an assessment of the genuine costs each firm faces in its operations and an assumption about the efficiency savings it would be expected to make. Such a system would achieve three main benefits. First, it would address the problem of market failure and excess profits while simultaneously allowing current tobacco control policies, including tax and price increases, to expand--thus tax increases would remain a central tenet of tobacco control policies and retail prices could continue to increase. Second, it would increase government revenue by transferring the excess profits from the industry to the government purse. Third, it would bring numerous public health benefits. In addition to addressing market power, while simultaneously allowing tobacco control policies to expand, it could offer a means of preventing down-trading to cheaper products and controlling unwanted industry practices such as cigarette smuggling, price fixing and marketing to the young. The paper outlines in some detail how such a system might be developed in the UK, while briefly exploring how it could be applied elsewhere, including in markets with state monopolies.

Tobacco point-of-sale advertising in Guatemala City, Guatemala and Buenos Aires, Argentina

OBJECTIVES

To determine tobacco point of sale advertising prevalence in Guatemala City, Guatemala and Buenos Aires, Argentina.

METHODS

Convenience stores (120 per city) were chosen from randomly selected blocks in low, middle and high socioeconomic neighbourhoods. To assess tobacco point of sale advertising we used a checklist developed in Canada that was translated into Spanish and validated in both countries studied. Analysis was conducted by neighbourhood and store type.

RESULTS

All stores sold cigarettes and most had tobacco products in close proximity to confectionery. In Guatemala, 60% of stores had cigarette ads. High and middle socioeconomic status neighbourhood stores had more indoor cigarette ads, but these differences were determined by store type: gas stations and supermarkets were more prevalent in high socioeconomic status neighbourhoods and had more indoor cigarette ads. In poorer areas, however, more ads could be seen from outside the stores, more stores were located within 100 metres of schools and fewer stores had 'No smoking' or 'No sales to minors' signs. In Argentina, 80% of stores had cigarette ads and few differences were observed by neighbourhood socioeconomic status. Compared to Guatemala, 'No sales to minors' signs were more prevalent in Argentina.

CONCLUSIONS

Tobacco point of sale advertising is highly prevalent in these two cities of Guatemala and Argentina. An advertising ban should also include this type of advertising.

'To prove this is the industry's best hope': big tobacco's support of research on the genetics of nicotine addiction

BACKGROUND

New molecular techniques focus a genetic lens upon nicotine addiction. Given the medical and economic costs associated with smoking, innovative approaches to smoking cessation and prevention must be pursued; but can sound research be manipulated by the tobacco industry?

METHODOLOGY

The chronological narrative of this paper was created using iterative reviews of primary sources (the Legacy Tobacco Documents), supplemented with secondary literature to provide a broader context. The empirical data inform an ethics and policy analysis of tobacco industry-funded research.

FINDINGS

The search for a genetic basis for smoking is consistent with industry's decades-long plan to deflect responsibility away from the tobacco companies and onto individuals' genetic constitutions. Internal documents reveal long-standing support for genetic research as a strategy to relieve the tobacco industry of its legal responsibility for tobacco-related disease.

CONCLUSIONS

Industry may turn the findings of genetics to its own ends, changing strategy from creating a 'safe' cigarette to defining a 'safe' smoker.

Policy-driven tobacco control

BACKGROUND

Since the passage of Proposition 99, California's comprehensive tobacco control programme has benefited from a localised policy adoption process that allows for the innovation and diffusion of strong local tobacco control policies throughout the state.

METHODS

The policy adoption continuum is described in the context of California's smoke-free workplace movement, and the influence of policy-driven tobacco control initiatives on social norms, behaviour and the public's health was examined.

RESULTS

The Smoke-free California policy adoption continuum reflects a general approach for policy innovation and diffusion that builds social acceptance and influences social norms, while minimising unintended consequences and creating best practices in tobacco control. California's local smoke-free workplace policies have reduced secondhand smoke exposure and supported attitude and behaviour changes. The effects of local policy adoption led to the nation's first statewide smoke-free workplace law.

CONCLUSIONS

Proposition 99 created an unprecedented tobacco control infrastructure that supported local policy innovation and diffusion to influence social norms and behaviours. Tobacco control policy efforts should address campaign challenges, oppose pre-emption and confront tobacco industry influence. Advocates must be cautious of pursuing a statewide policy prematurely, as it may result in a weak and/or pre-emptive policy that can stymie local policy efforts and prolong the adoption of a meaningful statewide policy.

Cigarette labeling policies in Latin America and the Caribbean: progress and obstacles

OBJECTIVE

To describe cigarette labeling policies in Latin America and the Caribbean as of August 2010.

MATERIAL AND METHODS

Review of tobacco control legislation of all 33 countries of the region; analysis of British American Tobacco (BAT)'s corporate social reports; analysis of information from cigarette packages collected in 27 countries.

RESULTS

In 2002, Brazil became the first country in the region to implement pictorial health warning labels on cigarette packages. Since then, six more countries adopted pictorial labels. The message content and the picture style vary across countries. Thirteen countries have banned brand descriptors and nine require a qualitative label with information on constituents and emissions. Tobacco companies are using strategies commonly used around the world to block the effective implementation of WHO Framework Convention on Tobacco Control (FCTC)'s Article 11.

CONCLUSIONS

Since 2002, important progress has been achieved in the region. However, countries that have ratified the FCTC have not yet implemented all the recommendations of Article 11 Guidelines.

Reported exposure to pro-tobacco messages in the media: trends among youth in the United States, 2000-2004

PURPOSE

Document changes from 2000 to 2004 in youth reports of exposure to pro-tobacco messages in the mass media, including images of smoking and tobacco advertising.

DESIGN

Comparison of cross-sectional data from three waves of the school-based National Youth Tobacco Surveys conducted in 2000 (N= 33,772), 2002 (N= 23,439), and 2004 (N= 23,540).

SETTING

Public and private middle schools and high schools across the United States.

SUBJECTS

Students in grades 6 through 12.

MEASURES

Smoking status; exposure to images of smoking on television and in movies; exposure to advertisements for tobacco products in stores, on the Internet, and in newspapers and magazines; demographic data.

RESULTS

Youth exposure to pro-tobacco messages declined within all media channels studied from 2000 to 2004, except the Internet. Despite these declines, most youth in the United States remain exposed to pro-tobacco messages: 81% saw images of smoking on television or in movies (down from 90%), 85% saw tobacco ads in stores (down from 88%), 50% saw tobacco ads in newspapers and magazines (down from 66%), and 33 % saw tobacco ads on the Internet (up from 22%).

CONCLUSION

Despite recent progress in this area, most youth in the United States are still at increased risk of smoking as a result of exposure to pro-tobacco messages in the mass media.

False promises: the tobacco industry, "low tar" cigarettes, and older smokers

To investigate the role of the tobacco industry in marketing to and sustaining tobacco addiction among older smokers and aging baby boomers, We performed archival searches of electronic archives of internal tobacco company documents using a snowball sampling approach. Analysis was done using iterative and comparative review of documents, classification by themes, and a hermeneutic interpretive approach to develop a case study. Based on extensive marketing research, tobacco companies aggressively targeted older smokers and sought to prevent them from quitting. Innovative marketing approaches were used. "Low tar" cigarettes were developed in response to the health concerns of older smokers, despite industry knowledge that such products had no health advantage and did not help smokers quit. Tobacco industry activities influence the context of cessation for older smokers in several ways. Through marketing "low tar" or "light" cigarettes to older smokers "at risk" of quitting, the industry contributes to the illusion that such cigarettes are safer, although "light" cigarettes may make it harder for addicted smokers to quit. Through targeted mailings of coupons and incentives, the industry discourages older smokers from quitting. Through rhetoric aimed at convincing addicted smokers that they alone are responsible for their smoking, the industry contributes to self-blame, a documented barrier to cessation. Educating practitioners, older smokers, and families about the tobacco industry's influence may decrease the tendency to "blame the victim," thereby enhancing the likelihood of older adults receiving tobacco addiction treatment. Comprehensive tobacco control measures must include a focus on older smokers.

Is tobacco a gay issue? Interviews with leaders of the lesbian, gay, bisexual and transgender community

This study examined the extent of tobacco industry funding of lesbian, gay, bisexual and transgender (LGBT) organisations and whether leaders of these organisations thought tobacco was a priority health issue for their community. We interviewed leaders of 74 LGBT organisations and publications in the USA, reflecting a wide variety of groups. Twenty-two percent said they had accepted tobacco industry funding and few (24%) identified tobacco as a priority issue. Most leaders did not perceive tobacco as an issue relevant to LGBT identity. They saw smoking as a personal choice and individual right rather than as a health crisis fuelled by industry activities. As such, they were reluctant to judge a legal industry, fearing it might lead to having to evaluate other potential funders. They saw tobacco control as divisive, potentially alienating their peers who smoke. The minority who embraced tobacco control saw the industry as culpable and viewed their own roles as protecting the community from all harms, not just those specific to the gay community. Lesbian, gay, bisexual and transgender tobacco-control advocates should reframe smoking as an unhealthy response to the stresses of homophobia to persuade leaders that tobacco control is central to LGBT health.

Challenging the epidemiologic evidence on passive smoking: tactics of tobacco industry expert witnesses

OBJECTIVE

To analyse the statements given by tobacco industry defence witnesses during trial testimonies and depositions in second-hand smoke cases and in parallel, to review criticisms of epidemiology in industry-funded publications in order to identify strategies for discrediting epidemiologic evidence on passive smoking health effects.

METHODS

A collection of depositions and trial testimony transcripts from tobacco industry-related lawsuits filed in the United States during the 1990s, was compiled and indexed by the Tobacco Deposition and Trial Testimony Archive (DATTA). Statements in DATTA made by expert witnesses representing the tobacco industry relating to the health effects of passive smoking were identified and reviewed. Industry-supported publications within the peer-reviewed literature were also examined for statements on exposure misclassification, meta-analysis, and confounding.

RESULTS

The witnesses challenged causation of adverse health effects of passive smoking by citing limitations of epidemiologic research, raising methodological and statistical issues, and disputing biological plausibility. Though not often cited directly by the witnesses, the defence tactics mirrored the strategies used in industry-funded reports in the peer-reviewed literature.

CONCLUSION

The tobacco industry attempted to redirect the focus and dialogue related to the epidemiologic evidence on passive smoking. This approach, used by industry experts in trial testimony and depositions, placed bias as a certain alternative to causation of diseases related to passive smoking and proposed an unachievable standard for establishing the mechanism of disease.

The future of tobacco regulation: a response to a proposal for fundamental institutional change

There is much debate about the future of tobacco regulation. Some have argued that to achieve maximum possible reduction in the harm tobacco causes, new regulatory models that involve fundamental institutional change must be adopted. The tobacco industry will continue to undermine tobacco control, and, so it is argued, we must change the way in which it operates if we are to be able to make the necessary progress. Such proposals may have an immediate appeal, especially for those frustrated that progress in tobacco control is not as rapid as they would hope--with all the avoidable loss of life and livelihoods that that entails--but they need to be carefully analysed and assessed, and much thought must be applied before spending time and resources advocating for them. One such proposal, advanced by Borland, involves the establishment of a monopsonistic statutory purchasing agency and wholesale distributor of tobacco products. Borland argues the relative benefits of such a model as compared to a more "conventional" model. On close examination, the benefits of the Borland proposal, as compared to the conventional model, appear overstated, and the Borland proposal introduces significant regulatory problems. There is still much that can be achieved in tobacco regulation through more conventional approaches, and within the "existing system". We should be wary of allowing the understandable allure of new or radical approaches to distract us from this reality.

Brand differences of free-base nicotine delivery in cigarette smoke: the view of the tobacco industry documents

The recent availability of internal tobacco industry documents provides significant insight into industry knowledge and manipulation of tobacco smoke delivery. One critical area of research is the role of smoke chemistry in determining the absorption and effects of smoke constituents, especially harm producing or pharmacologically active compounds. Independent scientific research has suggested that the nicotine dosing characteristics, hence the addiction potential of cigarettes, may be determined in part by the amount of free-base nicotine in cigarette smoke and its effects on the location, route, and speed of absorption in the body and on the sensory perception effects of the inhaled smoke. Tobacco industry documents describe the use of a number of methods internally for measuring free-base nicotine delivery. These include the common use of cigarette "smoke pH" as a means to estimate the fraction of free-base nicotine in the particulate matter (PM) in cigarette smoke, as well as efforts to measure free-base nicotine directly. Although these methods do not provide accurate absolute measures of free-base nicotine in smoke, consistencies observed in the findings across the various manufacturers indicate: (1) real relative differences in the acid/base chemistry of the smoke from different brands of cigarettes; (2) a connection between differences in free-base levels and brand-dependent differences in sensory perception and smoke "impact"; and (3) levels of free-base nicotine that are greater than have typically been publicly discussed by the industry. Furthermore, the results of these methods are generally consistent with those of a recent study from the Centers for Disease Control and Prevention which directly measured the free-base fraction of nicotine across a range of cigarette types. Consideration of the likely fundamental importance of free-base nicotine levels in cigarette smoke, together with the efforts discussed in the tobacco industry documents to measure such levels, indicates that the public health community would benefit from additional research to assess directly the delivery of free-base nicotine in cigarette smoke across brands. This may be especially useful for those products ("light", "ultralight", "reduced carcinogen", etc) that have been promoted, either explicitly or implicitly, as "harm reducing".

The tobacco industry and pesticide regulations: case studies from tobacco industry archives

Tobacco is a heavily pesticide-dependent crop. Because pesticides involve human safety and health issues, they are regulated nationally and internationally; however, little is known about how tobacco companies respond to regulatory pressures regarding pesticides. In this study we analyzed internal tobacco industry documents to describe industry activities aimed at influencing pesticide regulations. We used a case study approach based on examination of approximately 2,000 internal company documents and 3,885 pages of U.S. Environmental Protection Agency documents obtained through Freedom of Information Act requests. The cases involved methoprene, the ethylene bisdithiocarbamates, and phosphine. We show how the tobacco industry successfully altered the outcome in two cases by hiring ex-agency scientists to write reports favorable to industry positions regarding pesticide regulations for national (U.S. Environmental Protection Agency) and international (World Health Organization) regulatory bodies. We also show how the industry worked to forestall tobacco pesticide regulation by attempting to self-regulate in Europe, and how Philip Morris encouraged a pesticide manufacturer to apply for higher tolerance levels in Malaysia and Europe while keeping tobacco industry interest a secret from government regulators. This study suggests that the tobacco industry is able to exert considerable influence over the pesticide regulatory process and that increased scrutiny of this process and protection of the public interest in pesticide regulation may be warranted.