Association between Tobacco Industry Interference Index (TIII) and MPOWER measures and adult daily smoking prevalence rate in 30 countries

BACKGROUND

This study aimed to investigate the impact of tobacco industry interference on the implementation and management of tobacco control and the tobacco epidemic using the Tobacco Industry Interference Index (TIII) and MPOWER-a package of measures for tobacco control-and adult daily smoking prevalence in 30 countries.

METHODS

The TIII was extracted from the Global Tobacco Industry Interference Index 2019 and Global Center for Good Governance in Tobacco Control (GGTC). MPOWER measures and adult daily smoking prevalence rate were extracted from the World Health Organization (WHO) report on the global tobacco epidemic in 2021. We assessed the ecological cross-lagged association between TIII and MPOWER scores and between TIII and age-standardized prevalence rates for adult daily tobacco users.

RESULTS

Tobacco industry interference was inversely correlated with a country's package of tobacco control measures (β = -0.088, P = 0.035). The TIII was correlated with weaker warnings about the dangers of tobacco (β = -0.016, P = 0.078) and lack of enforcement of bans on tobacco advertising promotion and sponsorship (β = -0.023, P = 0.026). In turn, the higher the TIII, the higher the age-standardized prevalence of adult daily tobacco smokers for both sexes (β = 0.170, P = 0.036). Adult daily smoking prevalence in males (β = 0.417, P = 0.004) was higher in countries where the tobacco industry received incentives that benefited its business.

CONCLUSION

Where the interference of the tobacco industries was high, national compliance with the Framework Convention on Tobacco Control (FCTC) was lower, and the prevalence of adult daily smokers higher. National governments and global society must work together to minimize the tobacco industry's efforts to interfere with tobacco control policies.

[Tobacco industry strategies to attract new and young smokers]

"Tobacco industry strategies to attract new and young smokers .Tobacco consumption, the paradigm of an industrial pandemic, has been declining in recent years around the world, following implementation of the recommendations of the WHO Framework Convention on Tobacco Control (FCTC). To survive, the four transnational companies that control the market must adapt their strategy, which they do by shifting from the tobacco trade to the wider nicotine trade through the promotion of new products (electronic cigarettes and heated tobacco products). However, two intangible but well-established facts remain: the initiation to tobacco/nicotine consumption occurs almost exclusively during childhood; on the other hand and that age group is very sensitive to marketing and purchasing impulses. Therefore, the industrials must target young people and ease their access to their products. Once the initial nicotine intake has been established, the drug takes over and enforces continuous consumption due to its highly addictive nature. Nonetheless, as explicit targeting of the youth is not a socially acceptable practice, the industry will conceal its strategy behind the façade of promoting harm reduction for adult smokers who wish to do this. Although communication channels are recent, such as the Internet, social media, platforms and more generally, what is commonly accepted as « communication below the line  », the methods that aim at reinforcing established nicotine consumption as a social norm are of the same nature as those previously used for the promotion of cigarettes: glamour, seduction, youth, motorsports, tech, adventure, independence, maturity. Unfortunately, the rate of smoking among young people in France remains high due to the effectiveness of this marketing, combined with the easy accessibility to the product, due to non-compliance by tobacco sellers with the current legislation prohibiting sales to minors."

["Nicotine industry: risk reduction,an exclusively financial objective"]

Nicotine industry: harm reduction, an exclusively financial objective The knowledge of tobacco smoking health effects, combined with the implementation of measures efficient on its use, leads to tobacco sale reduction with tobacco industry financial losses that, in order to survive, has to recruit new young consumers, and maintain current smokers' use. The industry promotes a new way for tobacco use that, according to it, would reduce harm: heat-not-burn tobacco. But, there is currently no independent scientific proof for such a harm reduction. In the meantime, it promotes a confusion among electronic cigarettes and heat-not-burn tobacco. Heat-not-burn tobacco is promoted via foundations, NGOs, prestigious third parties, mechanic sports financing, and publicity with a strong marketing targeting young people through social networks. The current French regulation concerning smoked tobacco, including plain pack and high taxes, doesn't apply on heat-not-burn tobacco.

Memoranda of understanding: a tobacco industry strategy to undermine illicit tobacco trade policies

OBJECTIVE

Analyse the transnational tobacco companies' (TTCs) memoranda of understanding (MoUs) on illicit trade and how they could undermine the WHO Framework Convention on Tobacco Control (FCTC) and the Protocol to Eliminate Illicit Trade in Tobacco Products (Protocol).

METHODS

Review of tobacco industry documents and websites, reports, news and media items using standard snowball search methods.

RESULTS

Facing increasing pressure from governments and the FCTC to address illicit tobacco trade during the late 1990s, TTCs entered into voluntary partnerships embodied in MoUs with governments' law enforcement and customs agencies. One of the earliest known MoUs was between Philip Morris International and Italy in 1999. TTCs agreed among themselves to establish MoUs individually but use the Italian MoU as a basis to establish similar connections with other governments to pre-empt more stringent regulation of illicit trade. TTCs report to have signed over 100 MoUs since 1999, and promote them on their websites, in Corporate Social Responsibility reports and in the media as important partnerships to combat illicit tobacco trade. There is no evidence to support TTCs' claims that these MoUs reduce illicit trade. The terms of these MoUs are rarely made public. MoUs are non-transparent partnerships between government agencies and TTCs, violating FCTC Article 5.3 and the Protocol. MoUs are not legally binding so do not create an accountability system or penalties for non-compliance, rendering them ineffective at controlling illicit trade.

CONCLUSION

Governments should reject TTC partnerships through MoUs and instead ratify and implement the FCTC and the Protocol to effectively address illicit trade in tobacco products.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Internet little cigar and cigarillo vendors: Surveillance of sales and marketing practices via website content analysis

INTRODUCTION

Cigar sales have nearly doubled as cigarette sales have dropped, and large cigars have been replaced by little cigars and cigarillos (LCCs). Many LCCs are flavored, are perceived as less harmful than cigarettes, and have become increasingly available from e-commerce sources. We conducted surveillance of the online retail environment in 2013 and 2014 for LCCs in order to describe characteristics of Internet tobacco vendors selling LCCs and their sales and marketing practices, youth access practices, and their practices in relation to cigarette and other tobacco product sales.

METHODS

In 2013, we identified and manually screened 32,446 websites, yielding 500 unique Internet LCC vendors. In 2014, we identified 511 vendors selling LCCs from a list of 31,239 manually screened websites. We then selected 249 in 2013 and 263 in 2014 for content analysis focusing on six domains including demographics, youth access, payment and delivery, products for sale, promotions and claims, and prices.

RESULTS

Just over half of vendors in both years were located solely in the U.S. with 70.1% of those selling flavored LCCs in 2013 and 76.1% in 2014. Nearly half only used proven ineffective age verification strategies and another 10% made no attempts to verify age at all. Most vendors accepted credit cards and advertised using the United States Postal Service. Half of vendors featured a variety of health warnings and most featured promotions.

CONCLUSIONS

Federal bans on flavored cigarettes and restrictions on age verification, payment, and shipping for Internet tobacco sales should be extended to include LCCs.

Can a good tree bring forth evil fruit? The funding of medical research by industry

BACKGROUND

Systematic reviews analysing the influence of funding on the conduct of research have shown how Conflicts of Interest (COIs) create bias in the production and dissemination of data.

SOURCES OF DATA

The following is a critical analysis of current opinions in respect to COIs created by industry funding of medical research in academic institutions.

AREAS OF AGREEMENT

Effective mechanisms are necessary to manage COIs in medical research, and to prohibit COIs that clearly affect validity of research conduct and outcomes.

AREAS OF CONTROVERSY

While most hold that industry investment in university research is not a barrier to good science, there are questions about how securing funding opportunities might be prioritized over the risks of potential COIs. It is argued that COIs are inherent risks to research integrity, requiring the strengthening of current governance frameworks.

GROWING POINTS

The focus on COIs, created by the ostensibly categorical actions of industry, challenges the evolving research priorities within academic institutions.

AREAS TIMELY FOR DEVELOPING RESEARCH

Less well-defined COIs are equally culpable to financial ones, in terms of the systemic damage they do to science. So, are they appropriately managed as risks within university research settings?

Are the tobacco industry's claims about the size of the illicit cigarette market credible? The case of South Africa

BACKGROUND

The tobacco industry claims that illicit cigarette trade in South Africa is high and rising. This is often used as an argument not to increase the tobacco excise tax or to regulate tobacco products.

OBJECTIVES

To determine how the tobacco industry's estimates of the size of the illicit cigarette market have changed over time.

METHODS

Published media articles were obtained from South African Press Cuttings; published articles and press releases were sourced from the internet. The period of interest is 1990-2012.

RESULTS

Between 1990 and 2012 we found 90 newspaper articles and press statements that emphasised the tobacco industry's view on illicit trade. Articles that reported on action taken against illicit trade were excluded. Between 2006 and early 2011 the Tobacco Institute of Southern Africa, a body representing the interests of large cigarette companies, reported that South Africa's illicit cigarette market share was 20%. This share increased to 25% in late 2011 and 30% in 2012. In a 2012 presentation by Tobacco Institute of Southern Africa to National Treasury the illicit market share in 2008 was indicated as 7.9%, compared with claims in that year that the illicit market share was 20%. Industry findings that the illicit market decreased in 2007 and 2008 were not reported in the press.

CONCLUSIONS

The tobacco industry has adjusted previous estimates of the illicit trade share downwards to create the impression that illicit trade is high and rising. If previous estimates by the tobacco industry were incorrect the credibility of current estimates should be questioned.

Quantifying the influence of the tobacco industry on EU governance: automated content analysis of the EU Tobacco Products Directive

Objective

The tobacco industry spends large sums lobbying the European Union (EU) institutions, yet whether such lobbying significantly affects tobacco policy is not well understood. We used novel quantitative text mining techniques to evaluate the impact of industry pressure on the contested EU Tobacco Products Directive revision.

Design

Policy positions of 18 stakeholders including the tobacco industry, health NGOs and tobacco retailers were evaluated using their text submissions to EU consultations and impact assessments. Using Wordscores to calculate word frequencies, we developed a scale ranging from 0–tobacco industry to 1–public health organisations, which was then used to track changes in the policy position of the European Commission's 2010 consultation document, its 2012 final proposal and the European Parliament and Council's approved legislation in March 2014.

Results

Several stakeholders’ positions were closer to the tobacco industry than that of health NGOs, including retailers (ω=0.35), trade unions (ω=0.34) and publishers (ω=0.33 and ω=0.40). Over time the European Commission's position shifted towards the tobacco industry from ω=0.52 (95% CI 0.50 to 0.54) to ω=0.40 (95% CI 0.39 to 0.42). This transition reflected an increasing use of words pertaining to business and the economy in the Commission's document. Our findings were robust to alternative methods of scoring policy positions in EU documents.

Conclusions

Using quantitative text mining techniques, we observed that tobacco industry lobbying activity at the EU was associated with significant policy shifts in the EU Tobacco Products Directive legislation towards the tobacco industry's submissions. In the light of the Framework Convention on Tobacco Control, additional governance strategies are needed to prevent undue influence of the tobacco industry on EU policy making.

Transparency as a remedy against racketeering: preventing and restraining fraud by exposing Big Tobacco's dirty secrets

The 1990s state litigation that resulted in the tobacco industry's initial document disclosure obligations fully expired in 2010. These obligations have been extended and enhanced until 2021 through a federal lawsuit against the tobacco industry over violations of the Racketeer Influenced Corrupt Organizations Act (RICO). In this special communication, we summarise and explain the new legal framework and enhanced document disclosure obligations of the major US tobacco companies. We describe the events leading up to these new requirements, including the tobacco companies’ failed attempt to close the Minnesota Tobacco Document Depository, the release of 100 000 documents onto the companies’ document websites discovered to have been publicly available at the Minnesota Tobacco Document Depository but not online, and the addition of over 2300 documents to those websites, which are also now publicly available at Minnesota after being secured for years in a separate, non-public storage room at the Minnesota Tobacco Document Depository. We also detail the document indexing enhancements and redesign of the University of California, San Francisco's Legacy Tobacco Documents Library website, made possible by the RICO litigation, and which is anticipated to be released in September 2014. Last, we highlight the public health community's continued opportunity to expose the US tobacco industry's efforts to undermine public health through these new search enhancements and improved document accessibility and due to the continuously growing document collection until at least 2021.

Towards a greater understanding of the illicit tobacco trade in Europe: a review of the PMI funded 'Project Star' report

BACKGROUND

Following a legal agreement with the European Union (EU), Philip Morris International (PMI) commissions a yearly report ('Project Star', PS) on the European illicit cigarette trade from KPMG, the global accountancy firm.

METHODS

Review of PS 2010 report. Comparison with data from independent sources including a 2010 pan-European survey (N=18,056).

FINDINGS

Within PS, data covering all 27 EU countries are entered into a model. While the model itself seems appropriate, concerns are identified with the methodologies underlying the data inputs and thus their quality: there is little transparency over methodologies; interview data underestimate legal non-domestic product partly by failing to account for legal cross-border sales; illicit cigarette estimates rely on tobacco industry empty pack surveys which may overestimate illicit; and there is an over-reliance on data supplied by PMI with inadequate external validation. Thus, PMI sales data are validated using PMI smoking prevalence estimates, yet PMI is unable to provide sales (shipment) data for the Greek islands and its prevalence estimates differ grossly from independent data. Consequently, comparisons with independent data suggest PS will tend to overestimate illicit cigarette levels particularly where cross-border shopping is frequent (Austria, Finland, France) and in Western compared with Eastern European countries. The model also provides data on the nature of the illicit cigarette market independent of seizure data suggesting that almost a quarter of the illicit cigarette market in 2010 comprised PMI's own brands compared with just 5% counterfeited PMI brands; a finding hidden in PMI's public representation of the data.

CONCLUSIONS

PS overestimates illicit cigarette levels in some European countries and suggests PMI's supply chain control is inadequate. Its publication serves the interests of PMI over those of the EU and its member states. PS requires greater transparency, external scrutiny and use of independent data.

Has the tobacco industry evaded the FDA's ban on 'Light' cigarette descriptors?

BACKGROUND

Under the Family Smoking Prevention and Tobacco Control Act (FSPTCA), the Food and Drug Administration (FDA) banned the use of "Lights" descriptors or similar terms on tobacco products that convey messages of reduced risk. Manufacturers eliminated terms explicitly stated and substituted colour name descriptors corresponding to the banned terms. This paper examines whether the tobacco industry complied with or circumvented the law and potential FDA regulatory actions.

METHODS

Philip Morris retailer manuals, manufacturers' annual reports filed with the Massachusetts Department of Public Health, a national public opinion survey, and market-wide cigarette sales data were examined.

RESULTS

Manufacturers substituted "Gold" for "Light" and "Silver" for "Ultra-light" in the names of Marlboro sub-brands, and "Blue", "Gold", and "Silver" for banned descriptors in sub-brand names. Percent filter ventilation levels, used to generate the smoke yield ranges associated with "Lights" categories, appear to have been reassigned to the new colour brand name descriptors. Following the ban, 92% of smokers reported they could easily identify their usual brands, and 68% correctly named the package colour associated with their usual brand, while sales for "Lights" cigarettes remained unchanged.

CONCLUSIONS

Tobacco manufacturers appear to have evaded a critical element of the FSPTCA, the ban on misleading descriptors that convey reduced health risk messages. The FPSTCA provides regulatory mechanisms, including banning these products as adulterated (Section 902). Manufacturers could then apply for pre-market approval as new products and produce evidence for FDA evaluation and determination whether or not sales of these products are in the public health interest.

Receptivity to cigarette and tobacco control messages and adolescent smoking initiation

BACKGROUND

Tobacco industry cigarette advertising is associated with increased adolescent smoking, while counter tobacco advertising is associated with reduced smoking. As these campaigns compete for influence, there is a need to understand their inter-relationship on youth smoking.

METHODS

This study reports data from a national population of families (n=1036) with an oldest child aged 10-13 years, identified by random digit dialling. Parent and child dyads completed baseline questionnaires in 2003. Adolescents were resurveyed in 2007-2008 (response rate 74%). Adjusted logistic regression explores associations between receptivity to cigarette and tobacco control advertising and adolescent smoking initiation.

RESULTS

In 2007-2008, 57.9% of adolescents reported a favourite tobacco control advertisement and 43.3% reported being receptive to cigarette advertisements. Thirty per cent reported receptivity to cigarette and tobacco control advertisements. Among those receptive to cigarette advertising, having a favourite anti-smoking advertisement had a borderline significant association with a 30% lower smoking rate. Anti-industry tobacco control messages were three times more likely to be favourites of those who were receptive to cigarette advertising than other tobacco control advertising.

CONCLUSIONS

Receptivity to tobacco control advertising appeared to ameliorate the promotion of initiation from cigarette advertising. Anti-industry advertising appears to be the most effective counter for tobacco control and should be considered for wider use. A larger longitudinal study is needed to confirm these findings.

'To quarterback behind the scenes, third-party efforts': the tobacco industry and the Tea Party

Background

The Tea Party, which gained prominence in the USA in 2009, advocates limited government and low taxes. Tea Party organisations, particularly Americans for Prosperity and FreedomWorks, oppose smoke-free laws and tobacco taxes.

Methods

We used the Legacy Tobacco Documents Library, the Wayback Machine, Google, LexisNexis, the Center for Media and Democracy and the Center for Responsive Politics (opensecrets.org) to examine the tobacco companies’ connections to the Tea Party.

Results

Starting in the 1980s, tobacco companies worked to create the appearance of broad opposition to tobacco control policies by attempting to create a grassroots smokers’ rights movement. Simultaneously, they funded and worked through third-party groups, such as Citizens for a Sound Economy, the predecessor of AFP and FreedomWorks, to accomplish their economic and political agenda. There has been continuity of some key players, strategies and messages from these groups to Tea Party organisations. As of 2012, the Tea Party was beginning to spread internationally.

Conclusions

Rather than being a purely grassroots movement that spontaneously developed in 2009, the Tea Party has developed over time, in part through decades of work by the tobacco industry and other corporate interests. It is important for tobacco control advocates in the USA and internationally, to anticipate and counter Tea Party opposition to tobacco control policies and ensure that policymakers, the media and the public understand the longstanding connection between the tobacco industry, the Tea Party and its associated organisations.