Pamela M. Ling

Smoking revolution: a content analysis of electronic cigarette retail websites.

BACKGROUND Electronic cigarettes (e-cigarettes) have been increasingly available and marketed in the U.S. since 2007. As patterns of product adoption are frequently driven and reinforced by marketing, it is important to understand the marketing claims encountered by consumers. PURPOSE To describe the main advertising claims made on branded e-cigarette retail websites. METHODS Websites were retrieved from two major search engines in 2011 using iterative searches with the following terms: electronic cigarette, e-cigarette, e-cig, and personal vaporizer. Fifty-nine websites met inclusion criteria, and 13 marketing claims were coded for main marketing messages in 2012. RESULTS Ninety-five percent of the websites made explicit or implicit health-related claims, 64% had a smoking cessation-related claim, 22% featured doctors, and 76% claimed that the product does not produce secondhand smoke. Comparisons to cigarettes included claims that e-cigarettes were cleaner (95%) and cheaper (93%). Eighty-eight percent stated that the product could be smoked anywhere and 71% mentioned using the product to circumvent clean air policies. Candy, fruit, and coffee flavors were offered on most sites. Youthful appeals included images or claims of modernity (73%); increased social status (44%); enhanced social activity (32%); romance (31%); and use by celebrities (22%). CONCLUSIONS Health claims and smoking-cessation messages that are unsupported by current scientific evidence are frequently used to sell e-cigarettes. Implied and overt health claims, the presence of doctors on websites, celebrity endorsements, and the use of characterizing flavors should be prohibited.

Health Effects of Light and Intermittent Smoking A Review

Current public health guidelines on the identification and treatment of smokers and the information on the health risks associated with tobacco are based on studies that focus on adult daily cigarette users.1 Daily smoking, however, is declining, and light and intermittent smoking are increasing.2,3 Light and intermittent smoking are frequently found among young people, educated people, women,4,5 and minority populations (Hispanics/Latinos, blacks, American Indians, Alaska Natives, Asian Americans, and Pacific Islanders6–9). Light and intermittent smokers pose a serious challenge to healthcare professionals because they tend not to consider themselves “smokers” and, consequently, are underidentified.10–13 This propensity not to label oneself as a smoker reinforces the belief that light and intermittent smoking do not carry significant health risks. There is no consensus on how to best define “light smoking.”7,12,14 Light smokers have been classified as smoking <1 pack per day, <15 cigarettes per day, <10 cigarettes per day, and 1 to 39 cigarettes per week.9,14 There are various subgroups of light smokers: low-rate daily smoking (<5 cigarettes per day),15 very light smoking (<6 cigarettes per day),14,16 and “chippers” who consistently smoke ≤5 cigarettes per day on the days when they do smoke.17 In the past, light smoking has been viewed as a transient practice among former heavier smokers or among tobacco users who are trying to quit.4,5,18 New research, however, shows that some light smokers maintain this consumption pattern indefinitely.11,12,19 Like light smoking, intermittent smoking is a broad term that consists of a variety of patterns of tobacco use but is generally defined as smoking on a nondaily basis.4–6,8,12,14,20–22 Social smoking is another example of intermittent smoking, which is characterized by limiting smoking to social contexts, such as parties, bars, or nightclubs.11,12 (Social smokers, unlike other types …

Tobacco Industry Youth Smoking Prevention Programs: Protecting the Industry and Hurting Tobacco Control

OBJECTIVES This report describes the history, true goals, and effects of tobacco industry-sponsored youth smoking prevention programs. METHODS We analyzed previously-secret tobacco industry documents. RESULTS The industry started these programs in the 1980s to forestall legislation that would restrict industry activities. Industry programs portray smoking as an adult choice and fail to discuss how tobacco advertising promotes smoking or the health dangers of smoking. The industry has used these programs to fight taxes, clean-indoor-air laws, and marketing restrictions worldwide. There is no evidence that these programs decrease smoking among youths. CONCLUSIONS Tobacco industry youth programs do more harm than good for tobacco control. The tobacco industry should not be allowed to run or directly fund youth smoking prevention programs.

Alternative Tobacco Product Use and Smoking Cessation: A National Study

OBJECTIVES We investigated the frequency of alternative tobacco product use (loose leaf, moist snuff, snus, dissolvables, electronic cigarettes [e-cigarettes]) among smokers and the association with quit attempts and intentions. METHODS A nationally representative probability-based cross-sectional survey of 1836 current or recently former adult smokers was completed in November 2011. Multivariate logistic regressions evaluated associations between alternative tobacco product use and smoking cessation behaviors. RESULTS Of the smokers, 38% had tried an alternative tobacco product, most frequently e-cigarettes. Alternative tobacco product use was associated with having made a quit attempt, and those intending to quit were significantly more likely to have tried and to currently use the products than were smokers with no intentions to quit. Use was not associated with successful quit attempts. Interest in future use of alternative tobacco products was low, except for e-cigarettes. CONCLUSIONS Alternative tobacco products are attractive to smokers who want to quit smoking, but these data did not indicate that alternative tobacco products promote cessation. Unsubstantiated overt and implied claims that alternative tobacco products aid smoking cessation should be prohibited.

A longitudinal analysis of electronic cigarette use and smoking cessation.

Although electronic cigarettes (e-cigarettes) are aggressively promoted as smoking cessation aids,1 studies of their effectiveness for cessation have been unconvincing.2, 3 One randomized trial comparing e-cigarettes with and without nicotine, and nicotine patch found no differences in 6-month quit rates.2 Population-based, longitudinal studies have also not shown associations between e-cigarette use and quitting.4, 5 A longitudinal, international study found that, although 85% of smokers who used e-cigarettes reported using them to quit, e-cigarette users did not quit more frequently than non-users (p=.516).4 Among US quitline callers, e-cigarette users were less likely to have quit at 7 months than non-users.5 We employed a longitudinal analysis of a national sample of current US smokers to determine whether e-cigarette use predicted successful quitting, or reduced cigarette consumption.

Smooth Moves: Bar and Nightclub Tobacco Promotions That Target Young Adults

OBJECTIVES This article describes the tobacco industrys use of bars and nightclubs to encourage smoking among young adults. METHODS Previously secret tobacco industry marketing documents were analyzed. RESULTS Tobacco industry bar and nightclub promotions in the 1980s and 1990s included aggressive advertising, tobacco brand--sponsored activities, and distribution of samples. Financial incentives for club owners and staff were used to encourage smoking through peer influence. Increased use of these strategies occurred concurrently with an increase in smoking among persons aged 18 through 24 years. CONCLUSIONS The tobacco industrys bar and nightclub promotions are not yet politically controversial and are not regulated by the 1998 Master Settlement Agreement between the industry and the states. Tobacco control advocates should include young adults in research and advocacy efforts and should design interventions to counter this industry strategy to solidify smoking patterns and recruit young adult smokers.

Nondaily and Social Smoking an Increasingly Prevalent Pattern

Nondaily and social smoking (smoking primarily in social situations) are increasingly prevalent. Social smokers differ from daily smokers in their demographics, psychological profile, and degree of nicotine addiction. Current methods used to screen for tobacco dependence often miss social smokers, who tend to self-categorize as “nonsmokers.” The available, albeit limited, literature on whether social smokers exhibit nicotine dependence is controversial. While there are no data on the direct health risks associated with social smoking, data on light active smoking and passive smoking suggest that intermittent tobacco use carries health risks, particularly for cardiovascular disease. Because social smokers consume less and tend not to show signs of nicotine dependence, pharmacotherapies, which are designed to counter withdrawal symptoms, may not be relevant. However, social smokers may be more motivated to quit when educated on the dangers of their secondhand smoke. There is a need for new research on defining the health impact of nondaily and social smoking.

How Philip Morris built Marlboro into a global brand for young adults: implications for international tobacco control.

Objective: To describe Philip Morris’ global market research and international promotional strategies targeting young adults. Methods: : Analysis of previously secret tobacco industry documents. Results: Philip Morris pursued standardised market research and strategic marketing plans in different regions throughout the world using research on young adults with three principle foci: lifestyle/psychographic research, brand studies, and advertising/communication effectiveness. Philip Morris identified core similarities in the lifestyles and needs of young consumers worldwide, such as independence, hedonism, freedom, and comfort. In the early 1990s Philip Morris adopted standardised global marketing efforts, creating a central advertising production bank and guidelines for brand images and promotions, but allowing regional managers to create regionally appropriate individual advertisements. Conclusions: Values and lifestyles play a central role in the global marketing of tobacco to young adults. Worldwide counter marketing initiatives, coupled with strong, coherent global marketing policies such as the Framework Convention on Tobacco Control, are needed to break associations between young adult values and tobacco brands. As globalisation promotes the homogenisation of values and lifestyles, tobacco control messages that resonate with young adults in one part of the world may appeal to young adults in other countries. Successful tobacco control messages that appeal to young people, such as industry denormalisation, may be expanded globally with appropriate tailoring to appeal to regional values.

Emotions for sale: cigarette advertising and women's psychosocial needs

Objective: To explore messages of psychosocial needs satisfaction in cigarette advertising targeting women and implications for tobacco control policy. Methods: Analysis of internal tobacco industry documents and public advertising collections. Results: Tobacco industry market research attempted to identify the psychosocial needs of different groups of women, and cigarette advertising campaigns for brands that women smoke explicitly aimed to position cigarettes as capable of satisfying these needs. Such positioning can be accomplished with advertising that downplays or excludes smoking imagery. As women’s needs change with age and over time, advertisements were developed to reflect the needs encountered at different stages in women’s lives. Cigarette brands for younger women stressed female camaraderie, self confidence, freedom, and independence; cigarette brands for older women addressed needs for pleasure, relaxation, social acceptability, and escape from daily stresses. Conclusions: Psychosocial needs satisfaction can be communicated without reference to cigarettes or smoking. This may explain why partial advertising bans are ineffective and comprehensive bans on all forms of tobacco marketing are effective. Counter-advertising should attempt to expose and undermine the needs satisfaction messages of cigarette advertising campaigns directed at women.

The vector of the tobacco epidemic: tobacco industry practices in low and middle-income countries

PurposeTo understand transnational tobacco companies’ (TTCs) practices in low and middle-income countries which serve to block tobacco-control policies and promote tobacco use.MethodsSystematic review of published research on tobacco industry activities to promote tobacco use and oppose tobacco-control policies in low and middle-income countries.ResultsTTCs’ strategies used in low and middle-income countries followed four main themes—economic activity; marketing/promotion; political activity; and deceptive/manipulative activity. Economic activity, including foreign investment and smuggling, was used to enter new markets. Political activities included lobbying, offering voluntary self-regulatory codes, and mounting corporate social responsibility campaigns. Deceptive activities included manipulation of science and use of third-party allies to oppose smoke-free policies, delay other tobacco-control policies, and maintain support of policymakers and the public for a pro-tobacco industry policy environment. TTCs used tactics for marketing, advertising, and promoting their brands that were tailored to specific market environments. These activities included direct and indirect tactis, targeting particular populations, and introducing new tobacco products designed to limit marketing restrictions and taxes, maintain the social acceptability of tobacco use, and counter tobacco-control efforts.ConclusionsTTCs have used similar strategies in high-income countries as these being described in low and middle-income countries. As required by FCTC Article 5.3, to counter tobacco industry pressures and to implement effective tobacco-control policies, governments and health professionals in low and middle-income countries should fully understand TTCs practices and counter them.