Tobacco industry surveillance of public health groups: the case of STAT (Stop Teenage Addiction to Tobacco) and INFACT (Infant Formula Action Coalition)

'To be honest, I'm really scared': perceptions and experiences of intimidation in the LMIC-based tobacco control community

BACKGROUND

It is well-evidenced that environmental or human rights advocacy comes with risks for those involved. Much less is known about the risks of tobacco control advocacy despite the emphasis on tobacco industry conduct. This study explores the experiences and perceptions of intimidation among members of the tobacco control community in low- and middle-income countries (LMICs).

METHODS

We interviewed six experts representing each of the World Health Organization (WHO) regions to inform an online survey conducted among the LMIC-based tobacco control community. Thematic analysis was used for analysing qualitative data while quantitative data were analysed descriptively.

RESULTS

Twenty-three participants from five WHO regions completed the survey. Almost three-quarters of survey participants reported that they, or another member of the tobacco control community in their country, had experienced intimidation. The most frequently reported forms of intimidation were discreditation on social or traditional media, legal threats/action and threatening messages. Physical intimidation, theft/burglary, cyberattacks and surveillance were individually rare but reported collectively by over 40% of participants. Results suggested intimidation might be increasing and changing in nature, and undermines tobacco control efforts: it affects organisations' capacity and agenda, their ability to build relationships with those needed to advance policy, as well as the well-being of individuals. Participants used a range of strategies in response to intimidation and reported that they would benefit from better support.

CONCLUSION

This exploratory study suggests that intimidation is a crucial challenge for the tobacco control community. There are several measures the global tobacco control community could take, including establishing an international support mechanism and building capacity to deal with intimidation and draw attention to it.

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

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

Philip Morris's Project Sunrise: weakening tobacco control by working with it

OBJECTIVE

To analyse the implications of Philip Morris USA's (PM's) overtures toward tobacco control and other public health organisations, 1995-2006.

DATA SOURCES

Internal PM documents made available through multi-state US attorneys general lawsuits and other cases, and newspaper sources.

METHODS

Documents were retrieved from several industry documents websites and analysed using a case study approach.

RESULTS

PM's Project Sunrise, initiated in 1995 and proposed to continue through 2006, was a long-term plan to address tobacco industry delegitimisation and ensure the social acceptability of smoking and of the company itself. Project Sunrise laid out an explicit divide-and-conquer strategy against the tobacco control movement, proposing the establishment of relationships with PM-identified "moderate" tobacco control individuals and organisations and the marginalisation of others. PM planned to use "carefully orchestrated efforts" to exploit existing differences of opinion within tobacco control, weakening its opponents by working with them. PM also planned to thwart tobacco industry delegitimisation by repositioning itself as "responsible". We present evidence that these plans were implemented.

CONCLUSION

Sunrise exposes differences within the tobacco control movement that should be further discussed. The goal should not be consensus, but a better understanding of tensions within the movement. As the successes of the last 25 years embolden advocates to think beyond passage of the next clean indoor air policy or funding of the next cessation programme, movement philosophical differences may become more important. If tobacco control advocates are not ready to address them, Project Sunrise suggests that Philip Morris is ready to exploit them.

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

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

Nursing's involvement in tobacco control: historical perspective and vision for the future

There is little evidence that nursing organizations have played a major leadership role in addressing tobacco control at the political level, and none have addressed collectively, in any sustained way, the role of the tobacco industry, the primary vector of the tobacco disease epidemic. The aims of this article are (a) to explore what accounts for organized nursing's relative quiescence about tobacco industry and (b) to elucidate why a nursing voice would be especially effective in addressing the industry as a vector of the tobacco disease epidemic. Drawing on the internal tobacco industry documents research, and incorporating a critical theoretical perspective on education, research, and practice, it is argued that tobacco cessation cannot be viewed solely as an individual problem but must be understood in a sociopolitical context and promoting a nursing agendum on cessation research and practice requires educating (and energizing) nurses on the sociopolitics of tobacco. Because of nurses' numbers, class status, political capital, and moral authority in society, they are the group of health professionals whose voices are needed urgently at this historical moment to help avert the global tobacco epidemic. The Nightingales is an example of a nursing group involved in activism against the tobacco industry, applying findings from research on the industry to engage nurses in tobacco control activism, research, and education. The cessation research agenda should include research on the tobacco industry and how its activities influence cessation, how political activism influences cessation, and how critical education may advance cessation research, policies, and practices.

The perimetric boycott: a tool for tobacco control advocacy

OBJECTIVES

To propose criteria to help advocates: (1) determine when tobacco related boycotts may be useful; (2) select appropriate targets; and (3) predict and measure boycott success.

METHODS

Analysis of tobacco focused boycotts retrieved from internal tobacco industry documents websites and other scholarship on boycotts.

RESULTS

Tobacco related boycotts may be characterised by boycott target and reason undertaken. Most boycotts targeted the industry itself and were called for political or economic reasons unrelated to tobacco disease, often resulting in settlements that gave the industry marketing and public relations advantages. Even a lengthy health focused boycott of tobacco industry food subsidiaries accomplished little, making demands the industry was unlikely to meet. In contrast, a perimetric boycott (targeting institutions at the perimeter of the core target) of an organisation that was taking tobacco money mobilised its constituency and convinced the organisation to end the practice.

CONCLUSIONS

Direct boycotts of the industry have rarely advanced tobacco control. Perimetric boycotts of industry allies offer advocates a promising tool for further marginalising the industry. Successful boycotts include a focus on the public health consequences of tobacco use; an accessible point of pressure; a mutual interest between the target and the boycotters; realistic goals; and clear and measurable demands.

Moving East: how the transnational tobacco industry gained entry to the emerging markets of the former Soviet Union-part II: an overview of priorities and tactics used to establish a manufacturing presence

OBJECTIVES

To explore how British American Tobacco (BAT), having established cigarette imports, responded to the opportunities for investment in cigarette manufacturing in the former Soviet Union (FSU).

DESIGN

Analysis of documents held at the BAT archive in Guildford, UK.

RESULTS

Considerable priority was attached to investing in the FSU. This led BAT to undertake a major organisational change and to intense competition to acquire assets. BAT used flawed economic arguments to persuade cash starved governments that its investment would reap economic rewards. It offered excise advice that disadvantaged governments while benefiting BAT, confused issues over pricing, and avoided competitive tendering. BAT targeted agriculture ministries, using its expertise in leaf production to differentiate itself from other potential investors. It subverted the principles of corporate social responsibility to promote itself as a business partner. BAT's task was made easier by the naivety of post-Soviet governments and by the international financial organisations' support for rapid economic reform. The latter permitted tobacco transnationals to penetrate markets before effective competitive tendering processes had been established, giving them the opportunity to minimise prices and establish monopolies.

CONCLUSIONS

Many of the arguments employed when penetrating post-Soviet markets were highly misleading but governments lacked expertise to realise this. There is a need to build tobacco control capacity in transition economies, within and outside government, to ensure that governments are better informed of the true economic and health impacts of tobacco. Rapid transition from socialist to market economies without establishing regulatory institutional structures may be dangerous when investing companies use business practices that fall short of international standards.

Where there's smoke there's money: tobacco industry campaign contributions and U.S. Congressional voting

BACKGROUND

Tobacco use is the leading preventable cause of death in the United States. A direct contributor to this massive health burden is the effectiveness of the tobacco industry's activities, including campaign contributions.

METHODS

Voting records of 527 members of the 106th U.S. Congress were obtained for 49 tobacco-related bills between 1997 and 2000. Tobacco industry political action committee (PAC) contributions for each member were summed from 1993 to 2000. A cross-sectional, multilevel model was constructed that predicts voting behavior based on amount of contributions, political party, home state, and amount of state tobacco agriculture. The data were analyzed in 2002, 2003, and 2004.

RESULTS

A total of $6,827,763 was received by the legislators from 17 tobacco industry PACs, an average of $12,956 per member. Senate Republicans received the most money (mean $22,004), while Senate Democrats received the least ($6,057). Republicans voted pro-tobacco 73% of the time and Democrats voted pro-tobacco only 23% of the time (p <0.001). Pro-tobacco voting percentage varied significantly by state (intraclass correlation coefficient=0.27, p <0.001). The amount of PAC money received by a member of Congress was positively associated with voting pro-tobacco (p <0.01), even after controlling for political party, state, and state tobacco farming. For Democrats in Congress who voted pro-tobacco, for every $10,000 contribution they received, they were 9.8% more likely to do so. On the other hand, for Republicans who voted pro-tobacco, for every $10,000 received, they were only 3.5% more likely to do so.

CONCLUSIONS

Tobacco industry contributions, political party, and state-level factors influence the voting behavior of Congress members. In the 106th Congress, Republicans voted pro-tobacco over three times as often as Democrats. However, for those Democrats who voted pro-tobacco, the relationship between receiving tobacco industry PAC money and a pro-tobacco vote was stronger than it was for Republicans.

Public health under attack: the American Stop Smoking Intervention Study (ASSIST) and the tobacco industry

We describe the tobacco industry's response to the American Stop Smoking Intervention Study (ASSIST). Tobacco industry documents from the University of California, San Francisco/Legacy Tobacco Documents Library and industry Web sites were analyzed. LexisNexis and the Library of Congress's Thomas Web site were searched for legislative history. We found that the tobacco industry considered ASSIST a major threat because of its emphasis on policy and creation of local tobacco control infrastructures. The industry mobilized resources for a well-coordinated attack on ASSIST. Although industry executives were sometimes frustrated in their efforts, they ultimately had a chilling effect on ASSIST. This evidence suggest that tobacco control advocates should expect a vigorous response from the tobacco industry to policy advocacy efforts, particularly at the local level.

Implications of the tobacco industry documents for public health and policy

The release of previously secret internal tobacco industry documents has given the public health community unprecedented insight into the industry's motives, strategies, tactics, and data. The documents provide information that is not available from any other source and describe the history of industry activities over the past 50 years. The documents show that the tobacco industry has been engaged in deceiving policy makers and the public for decades. This paper begins with a brief history of the tobacco industry documents and describes the methodological challenges related to locating and analyzing an enormous number of poorly indexed documents. It provides an overview of selected important findings of document research conducted to date, including analyses of industry documents on nicotine and addiction, product design, marketing and promotion, passive smoke, and internal activities. The paper concludes with a discussion of the implications of tobacco document research for public health and the application of such research to fields other than tobacco control.

Thinking the "unthinkable": why Philip Morris considered quitting

OBJECTIVE

To investigate the genesis and development of tobacco company Philip Morris's recent image enhancement strategies and analyse their significance.

DATA SOURCES

Internal Philip Morris documents, made available by the terms of the Master Settlement Agreement between the tobacco companies and the attorneys general of 46 states, and secondary newspaper sources.

STUDY SELECTION

Searches of the Philip Morris documents website (www.pmdocs.com) beginning with terms such as "image management" and "identity" and expanding as relevant new terms (consultant names, project names, and dates), were identified, using a "snowball" sampling strategy.

FINDINGS AND CONCLUSIONS

In the early 1990s, Philip Morris, faced with increasing pressures generated both externally, from the non-smokers' rights and public health communities, and internally, from the conflicts among its varied operating companies, seriously considered leaving the tobacco business. Discussions of this option, which occurred at the highest levels of management, focused on the changing social climate regarding tobacco and smoking that the tobacco control movement had effected. However, this option was rejected in favour of the image enhancement strategy that culminated with the recent "Altria" name change. This analysis suggests that advocacy efforts have the potential to significantly denormalise tobacco as a corporate enterprise.