Elizabeth A. Smith

The Outing of Philip Morris: Advertising Tobacco to Gay Men

OBJECTIVES This case study describes the events surrounding the first time a major tobacco company advertised in gay media. METHODS We analyzed internal tobacco company documents, mainstream newspapers, and the gay press. RESULTS Philip Morris was unprepared for the attention its entry into the gay market received. The companys reaction to this incident demonstrates that its approach to the gay community both parallels and diverges from industry strategies toward other marginalized communities. CONCLUSIONS The tobacco industrys relationship to the gay community is relatively undeveloped, a fact that may provide tobacco control advocates an opportunity for early intervention. The gay communitys particular vulnerabilities to the industry make development of gay tobacco control programs crucial to reducing gay smoking prevalence and industry presence in the community.

Cigarettes Butts and the Case for an Environmental Policy on Hazardous Cigarette Waste

Discarded cigarette butts are a form of non-biodegradable litter. Carried as runoff from streets to drains, to rivers, and ultimately to the ocean and its beaches, cigarette filters are the single most collected item in international beach cleanups each year. They are an environmental blight on streets, sidewalks, and other open areas. Rather than being a protective health device, cigarette filters are primarily a marketing tool to help sell ‘safe’ cigarettes. They are perceived by much of the public (especially current smokers) to reduce the health risks of smoking through technology. Filters have reduced the machine-measured yield of tar and nicotine from burning cigarettes, but there is controversy as to whether this has correspondingly reduced the disease burden of smoking to the population. Filters actually may serve to sustain smoking by making it seem less urgent for smokers to quit and easier for children to initiate smoking because of reduced irritation from early experimentation. Several options are available to reduce the environmental impact of cigarette butt waste, including developing biodegradable filters, increasing fines and penalties for littering butts, monetary deposits on filters, increasing availability of butt receptacles, and expanded public education. It may even be possible to ban the sale of filtered cigarettes altogether on the basis of their adverse environmental impact. This option may be attractive in coastal regions where beaches accumulate butt waste and where smoking indoors is increasingly prohibited. Additional research is needed on the various policy options, including behavioral research on the impact of banning the sale of filtered cigarettes altogether.

Private health care in developing countries.

Private healthcare provision is growing in low and middle income countries. 1 2 The poor, as well as the rich, often seek health care from private providers, including for conditions of public health importance such as malaria, tuberculosis, and sexually transmitted infections. 3 4 5 The reasons cited by users include better and more flexible access, shorter waiting, greater confidentiality, and greater sensitivity to user needs. 1 6 International policymakers are currently recommending greater use of private providers 7 8 9 on the grounds that they offer consumers greater choice; increase competition in the healthcare market; and remove state responsibility for service provision, thereby encouraging its role as regulator and guarantor. We should, however, be concerned. When examined, the quality of care offered by many private providers is poor. 1 2 10 Furthermore, poor people spend a greater proportion of their income on health care (private or public) than do the rich, often using less qualified or totally untrained private providers. We have recommended three objectives in relation to the private provision of care for conditions of public health importance: widening access, improving quality, and ensuring non-exploitative prices.11 None of these will be simple to achieve; and multifaceted interventions, involving policymakers, providers, and …

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.

Death at a discount: how the tobacco industry thwarted tobacco control policies in US military commissaries

Background: The US military is perhaps the only retailer consistently losing money on tobacco. Military stores (commissaries and exchanges) have long sold discount-priced cigarettes, while the Department of Defense (DoD) pays directly for tobacco-related healthcare costs of many current and former customers. Tobacco use also impairs short-term troop readiness. Objective: To examine the long struggle to raise commissary tobacco prices and the tobacco industry’s role in this policy effort. Methods: Analysis of internal tobacco industry documents, searches of government and military websites and newspaper databases, and interviews with key informants identified in the documents. Results: Efforts to raise commissary tobacco prices began in the mid-1980s. Opposition quickly emerged. Some military officials viewed tobacco use as a “right” and low prices as a “benefit”. Others raised issues of authority, and some saw the change as threatening the stores. The tobacco industry successfully exploited complex relationships among the Congress, the DoD, commissaries, exchanges and private industry, obstructing change for over a decade. Leadership from the Secretary and Assistant Secretaries of Defense, presidential support and procedural manoeuvring finally resulted in a modest price increase in 1996, but even then, high-level military officials were apparently threatened with retaliation from pro-tobacco Congressmen. Conclusions: The longstanding military tradition of cheap cigarettes persists because of the politics of the military sales system, the perception within the military of tobacco use as a right, and tobacco industry pressures. Against its own best interests, the US military still makes tobacco available to service members at prices below those in the civilian sector.

How the health belief model helps the tobacco industry: individuals, choice, and “information”

Objective: To analyse trial and deposition testimony of tobacco industry executives to determine how they use the concepts of “information” and “choice” and consider how these concepts are related to theoretical models of health behaviour change. Methods: We coded and analysed transcripts of trial and deposition testimony of 14 high-level executives representing six companies plus the Tobacco Institute. We conducted an interpretive analysis of industry executives’ characterisation of the industry’s role as information provider and the agency of tobacco consumers in making “choices”. Results: Tobacco industry executives deployed the concept of “information” as a mechanism that shifted to consumers full moral responsibility for the harms caused by tobacco products. The industry’s role was characterised as that of impartial supplier of value-free “information”, without regard to its quality, accuracy and truthfulness. Tobacco industry legal defences rely on assumptions congruent with and supported by individual rational choice theories, particularly those that emphasise individual, autonomous decision-makers. Conclusions: Tobacco control advocates and health educators must challenge the industry’s preferred framing, pointing out that “information” is not value-free. Multi-level, multi-sectoral interventions are critical to tobacco use prevention. Over-reliance on individual and interpersonal rational choice models may have the effect of validating the industry’s model of smoking and cessation behaviour, absolving it of responsibility and rendering invisible the “choices” the industry has made and continues to make in promoting the most deadly consumer product ever made.

Altria Means Tobacco: Philip Morris’s Identity Crisis

Philip Morris Companies, the worlds largest and most profitable tobacco seller, has changed its corporate name to The Altria Group. The company has also embarked on a plan to improve its corporate image. Examination of internal company documents reveals that these changes have been planned for over a decade and that the company expects to reap specific and substantial rewards from them. Tobacco control advocates should be alert to the threat Philip Morriss plans pose to industry focused tobacco control campaigns. Company documents also suggest what the vulnerabilities of those plans are and how advocates might best exploit them.

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.

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.

The tobacco endgame: a qualitative review and synthesis

The tobacco endgame concept reorients discussion away from the persistent control of tobacco toward plans for ending the tobacco epidemic, and envisions a tobacco-free future. A variety of policy approaches have been proposed, with many offered prior to the introduction of the unifying term ‘endgame’. We conducted a qualitative synthesis of the literature on tobacco control endgames, and drew on media accounts and discussion of analogous ideas for illustrative purposes. We identified proposals focused on the product, user, market/supply or larger institutional structures. Research on public support for these proposals was limited, but suggestive of some public appetite for endgame ideas. Advocates should be encouraged to explore new policy options and consider the goal of a tobacco-free future.