Case studies in international tobacco surveillance: cigarette smuggling in Brazil

[Interference by the tobacco industry in data on cigarette consumption in Brazil]

The tobacco industry normally overestimates the illegal market's size in order to reinforce the idea of its direct relationship to the choice to increase taxes by the internal revenue administration. In Brazil, the last increase in taxes on tobacco products was in 2016. The growth of demand for illegal cigarettes has other macrosocial determinants that the industry does not take into account, such as the increase in the economic capacity to purchase legal cigarettes. The article aims to test the hypothesis of the "Brazilian consumer's economic reason" from 2015 to 2019 by comparing the estimated consumptions of illegal cigarettes, based on official government data on legal production and cigarette consumption with an "extraofficial estimate" furnished by the industry. The study also used official national data on monthly income from work. The Brazilian population's "purchasing capacity for legal cigarettes" increased systematically from 2016 to 2019, from 412 packs/month to 460 packs/month. The absolute difference between the estimate by the tobacco industry and the estimate based on official data on the volume of illegal cigarettes that were consumed increased over time, reaching +30.2 billion units in 2019. Meanwhile, legal cigarette consumption, calculated with official data, increased from 2016 through 2019 (+7.8 billion), while the industry estimated a reduction in this consumption (-9.5 billion). Policymakers should seek to base their decisions on estimates generated from official data sources, including macroeconomic data on employment and income, rather than to use estimates produced by the tobacco industry that aim to interfere in public policies.

From transit hub to major supplier of illicit cigarettes to Argentina and Brazil: the changing role of domestic production and transnational tobacco companies in Paraguay between 1960 and 2003

Background

Paraguay has reportedly been a major transit hub for illicit tobacco products since the 1960s, initially to supply markets in Argentina and Brazil and, more recently, other regional markets and beyond. However, to date there has been no systematic analysis, notably independent of the tobacco industry, of this trade including the roles of domestic production and transnational tobacco companies (TTCs). This article fills that gap by detailing the history of Paraguay’s illicit cigarette trade to Brazil and Argentina of TTC products and Paraguayan production between 1960 and 2003. The effective control of illicit cigarette flows, under Article 15 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and the Protocol to Eliminate the Illicit Trade in Tobacco Products, requires fuller understanding of the changing nature of the illicit trade.

Methods

We systematically searched internal industry documents to understand the activities and strategies of leading TTCs in Paraguay and subregion over time. We also mapped illicit trade volume and patterns using US government and UN data on the cigarette trade involving Paraguay. We then estimated Paraguay’s cigarette production from 1989 to 2003 using tobacco leaf flows from the United Nations Commodity Trade Statistics Database (UN Comtrade).

Results

We identify four phases in the illicit tobacco trade involving Paraguay: 1) Paraguay as a transit hub to smuggle BAT and PMI cigarettes from the U.S. into Argentina and Brazil (from the 1960s to the mid-1970s); 2) BAT and PMI competing in north-east Argentina (1989–1994); 3) BAT and PMI competing in southern and southern-east Brazil (mid to late 1990s); and 4) the growth in the illicit trade of Paraguayan manufactured cigarettes (from the mid- 1990s onwards). These phases suggest the illicit trade was seeded by TTCs, and that the system of supply and demand on lower priced brands they developed in the 1990s created a business opportunity for manufacturing in Paraguay. Brazil’s efforts to fight this trade, with a 150% tax on exports to Latin American countries in 1999, further prompted supply of the illicit trade to shift from TTCs to Paraguayan manufacturers.

Conclusion

This paper extends evidence of the longstanding complicity of TTCs in the illicit trade to this region and the consequent growth of Paraguayan production in the 1990s. Our findings confirm the need to better understand the factors influencing how the illicit tobacco trade has changed over time, in specific regional contexts, and amid tobacco industry globalization. In Paraguay, the changing roles of TTC and domestic production have been central to shifting patterns of illicit supply and distribution since the 1960s. Important questions are raised, in turn, about TTCs efforts to participate as legitimate partners in global efforts to combat the problem, including a leading role in data gathering and analysis.

A comparative assessment of the price, brands and pack characteristics of illicitly traded cigarettes in five cities and towns in South Africa

OBJECTIVE

The prevalence of illicitly traded cigarettes in South Africa has been reported to be 40-50%. However, these estimates do not account for the more nuanced characteristics of the illicit cigarette trade. With the goal of better understanding contraband cigarettes in South Africa, this study piloted three methods for assessing the price, brands, pack features and smoker's views about illicit cigarettes in five cities/towns. Data were collected in June and July 2012.

SETTING

A convenience sample of three South African cities (Johannesburg, Durban and Nelspruit) and two smaller towns (Musina and Ficksburg) were chosen for this study.

OUTCOME MEASURES

Three cross-sectional approaches were used to assess the characteristics of contraband cigarettes: (1) a dummy purchase of cigarettes from informal retailers, (2) the collection of discarded cigarette packs and (3) a survey of tobacco smokers.

PARTICIPANTS

For the purposes of the survey, 40 self-reported smokers were recruited at taxi ranks in each downtown site. Adults who were over the age of 18 were asked to verbally consent to participate in the study and answer a questionnaire administered by a researcher.

RESULTS

The leading reason for labelling a pack as illicit in each city/town was the absence of an excise stamp (28.6% overall), and the least common reason was an illegal tar or nicotine level (11.1% overall). The overall proportion of informal vendors who sold illicit cigarettes was 41%. Singles and packs of 20 were consistently cheaper at informal vendors. Survey participants' responses reflected varied perspectives on illicit cigarettes and purchasing preferences.

CONCLUSIONS

Each approach generated an interesting insight into physical aspects of illicit cigarettes. While this pilot study cannot be used to generate generalisable statistics on illicit cigarettes, more systematic surveys of this nature could inform researchers' and practitioners' initiatives to combat illicit and legal cigarette sales and usage.

Gender and racial inequalities in trends of oral cancer mortality in Sao Paulo, Brazil

OBJECTIVE:To analyse recent trends in oral cancer mortality, focusing specifically on differences concerning gender and race.METHODS:Official information on deaths and population in the city of Sao Paulo, 2003 to 2009, were used to estimate mortality rates from oral cancer (C00 to C10, International Classification of Diseases, 10th Revision), adjusted for age and stratified by gender (females and males) and race (blacks and whites). The Prais-Winsten auto-regression procedure was used to analyse the time series.RESULTS:During the study period, 8,505 individuals living in the city of Sao Paulo died of oral cancer. Rates increased for females (rate of yearly increase = 4.4%, 95%CI 1.4;7.5), and levelled off for men, which represents an inversion of previous trends among genders in the city. Increases were identified for blacks, with a high rate of yearly increase of 9.1% (95%CI 5.5;12.9), and levelled off for whites. Oral cancer mortality in blacks almost doubled during the study period, and surpassed mortality in whites for almost all categories.CONCLUSIONS:Mortality presented a higher increase among women than in men, and it doubled among backs. The surveillance of trends of oral cancer mortality across gender and racial groups may contribute to implementing socially appropriate health policies, which concurrently reduce the burden of disease and the attenuation of unfair, avoidable and unnecessary inequalities in health.

Cigarette pack labelling in 12 countries at different levels of economic development

With increasing restrictions on cigarette marketing, the cigarette pack itself has become a main means of marketing. We describe a method to examine cigarette labelling and use it to evaluate packs collected from 12 countries at different stages of economic development. Health warnings were present on all 115 packs of cigarettes examined, but were on the front and back panels of only 68 per cent. Promotional labels were widespread, found on packs from all countries and more numerous (although not necessarily larger) than health warning labels in 10 of the 12 countries. Deceptive terms such as 'light' and 'mild' were observed on 42 per cent of all packs examined. The simple method described here can be used to compare cigarette labelling and potentially evaluate and track the implementation of cigarette labelling policy. We found health warning legislation poorly enforced and cigarette packs widely used to promote smoking and deceive smokers about health risks. The findings underline the need for generic (plain) packaging.

Monitoring the tobacco use epidemic IV. The vector: Tobacco industry data sources and recommendations for research and evaluation

OBJECTIVE

This Vector paper (IV of V on monitoring the tobacco use epidemic) presents the data sources and methods that can be used to monitor tobacco marketing and makes recommendations for creating a national surveillance system.

METHODS

In 2002, the Vector Work Group of the National Tobacco Monitoring, Research and Evaluation Workshop identified priority indicators of tobacco marketing: tobacco brand pricing strategies, retail environment advertising and promotional allowances, gray market or smuggling activities, lobbying, direct mail marketing, tobacco brand placements in films, Internet promotions, and sponsorship at bars and events. This paper reviews and identifies data sources and gaps for these priority indicators and for 12 other indicators of interest.

RESULTS

There are 38 commercial data sites and Internet sources, as well as individual research efforts that address the priority indicators. These sources are not integrated, often costly, and limited in standardization.

CONCLUSIONS

Tobacco marketing could be more effectively monitored with the development of a national research network. Surveillance of the tobacco industry's methods to push tobacco and pull consumers can help the public health community identify new markets and campaigns, justify and tailor effective tobacco control strategies, and evaluate existing counter-marketing efforts.

Gender, economics and culture: diversity and the international evolution of smoking prevalence

AIMS

To examine whether the observed diversity between national patterns of smoking prevalence could require modification of the World Health Organization (WHO) linear model for an international 'smoking pandemic' (a worldwide epidemic) to address data from non-western countries.

METHOD

We conducted secondary research using current measures in three publicly available databases: Globalink, the International Labour Organization and the World Bank (all Internet-accessible). The measures we used are the separate percentage data for men and women on: smoking and employment and national income per capita (US$) and percentage growth per annum.

RESULTS

Regression analysis showed that women smokers were more frequent in countries with higher national income, but women were less likely to smoke in countries of rapid growth. Men were less likely to smoke in countries with higher national income, but more likely to smoke in countries of rapid growth. Two principle components together explained 62% of all the variance in the international data. The largest factor was positively correlated with the percentage of employed females, the percentage of female smokers and national income per capita, but negatively correlated with the percentage of male smokers and percentage annual. growth. The effect of female employment was not continuous, but above a threshold of 51%, was associated with a higher prevalence of female smoking. The smaller, second factor was only weakly correlated with any smoking variables.

CONCLUSIONS

In his 1994 model (subsequently adopted by the WHO) Lopez looked at historical trends in 'stages' of smoking prevalence. These have been associated with 'stages' of economic development. We extended this analysis to look at a dynamic change (% annual growth) and a social indicator (employment). Male and female smoking is affected differentially by economic change and by level of income. These are also strongly related to the percentage of women in employment. This has implications for workplace policies on smoking.

[Trends in oral cancer mortality in the city of São Paulo, Brazil, 1980-2002]

The current study assessed trends in oral cancer mortality in the city of São Paulo, Brazil, from 1980 to 2002. The official mortality information system supplied data on deaths whose underlying cause was classified as oral cancer, stratified by sex, age, and anatomic site. Death rates were estimated and adjusted by the direct method, using population data supplied by national censuses from 1980, 1991, and 2000 and a population count performed in 1996. There was an upward trend in overall cancer mortality, at a yearly rate of 0.72%. Accounting for more than one third of these deaths, tongue cancer was the main mortality category. Labial, gengival, and retromolar cancer showed a downward trend, while oropharyngeal cancer and cancer in unspecified parts of the mouth and oropharynx showed increasing mortality. Monitoring the magnitude and trends in cancer mortality can assist the planning of health initiatives aimed at reducing the disease burden from oral cancer in Brazil.

Fighting a Tobacco-Tax Rollback: A Political Analysis of the 1994 Cigarette Contraband Crisis in Canada

We identify factors that led a regional government (Quebec, Canada) to opt for a reduction of its tobacco tax to combat tobacco smuggling. Then we explore the fallout of Quebec's tobacco-tax rollback on its tobacco control policy. We conducted qualitative research using a case-study design and multiple sources of data. We applied the Advocacy Coalition Framework in respect of data collection and analysis. Advocates of the tobacco-tax rollback framed the contraband problem in a way that won the support of an array of actors. However, anti-tobacco activists succeeded in convincing the government to invest more in tobacco control. The new resources were instrumental in enhancing the activists' ability to promote legislative measures. Our approach sheds light on the tobacco industry's strategy to have governments reducing their tobacco tax. Quebec offers an example of how tobacco control activists can transform defeat into the cornerstone of a comprehensive tobacco control policy.

Complicity in contraband: British American Tobacco and cigarette smuggling in Asia

OBJECTIVES

To examine the complicity of British American Tobacco (BAT) in cigarette smuggling in Asia, and to assess the centrality of illicit trade to regional corporate strategy.

METHODS

Analysis of previously confidential documents from BAT's Guildford depository. An iterative strategy combined searches based on geography, organisational structure, and key personnel, while corporate euphemisms for contraband were identified by triangulation.

RESULTS

BAT documents demonstrate the strategic importance of smuggling across global, regional, national, and local levels. Particularly important in Asia, contraband enabled access to closed markets, created pressure for market opening, and was highly profitable. Documents demonstrate BAT's detailed oversight of illicit trade, seeking to reconcile the conflicting demands of control and deniability.

CONCLUSIONS

BAT documents demonstrate that smuggling has been driven by corporate objectives, indicate national measures by which the problem can be addressed, and highlight the importance of a coordinated global response via WHO's Framework Convention on Tobacco Control.

Cigarette advertising and female smoking prevalence in Spain, 1982-1997

BACKGROUND

Compared with northern Europe and the U.S., the widespread initiation of cigarette smoking began 20-40 years later among young women in Spain because of strong cultural prohibitions against female smoking. In this study, the authors examined the correlation between the rapid increase in female smoking prevalence and tobacco industry cigarette marketing practices in Spain during a period of rapid social liberalization.

METHODS

The authors examined age-specific, period-specific, and birth cohort-specific increases in cigarette smoking among young women in Spain in relation to internal documents from Philip Morris beginning in 1971, cigarette advertising from 1982 to 1997, and the increase in the market share of blond tobacco and "light" cigarettes preferred by women.

RESULTS

Some increase in cigarette smoking occurred among Spanish women before 1970, but the increase was substantially smaller and occurred later than in many Western countries. However, after 1970, the prevalence of cigarette smoking increased rapidly in Spanish women of all ages < 50 years. The rapid increase in female smoking coincided with massive increases in television advertising, especially to women, and increases in the market share of blond tobacco, "light cigarettes," and international tobacco brands.

CONCLUSIONS

The increase in cigarette smoking among young Spanish women illustrates how aggressive marketing can exploit periods of social liberalization and rapidly increase cigarette smoking among women, even in countries in which female smoking traditionally has been unacceptable. Strategies are needed to prevent similar increases in smoking by women elsewhere.