Patricia A. McDaniel

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.

Understanding Philip Morris’s pursuit of US government regulation of tobacco

Objective: To investigate Philip Morris’s support of US Food and Drug Administration (FDA) regulation of tobacco products and analyse its relationship to the company’s image enhancement strategies. Data sources: Internal Philip Morris documents released as part of the Master Settlement Agreement. Methods: Searches of the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu) beginning with such terms as “FDA” and “regulatory strategy” and expanding to include relevant new terms. Results: Philip Morris’s support for government regulation of tobacco is part of a broader effort to address its negative public image, which has a damaging impact on the company’s stock price, political influence, and employee morale. Through regulation, the company seeks to enhance its legitimacy, redefine itself as socially responsible, and alter the litigation environment. Whereas health advocates frame tobacco use as a public health policy issue, Philip Morris’s regulatory efforts focus on framing tobacco use as an individual choice by informed adults to use a risky product. This framing allows Philip Morris to portray itself as a reasonable and responsible manufacturer and marketer of risky products. Conclusions: Philip Morris’s ability to improve its image through support of FDA regulation may undermine tobacco control efforts aimed at delegitimising the tobacco industry. It may also create the impression that Philip Morris’s products are being made safer and ultimately protect the company from litigation. While strong regulation of tobacco products and promotion remain critical public health goals, previous experiences with tobacco regulation show that caution may be warranted.

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.

Creating the “Desired Mindset”: Philip Morris's Efforts to Improve Its Corporate Image Among Women

Through analysis of tobacco company documents, we explored how and why Philip Morris sought to enhance its corporate image among American women. Philip Morris regarded women as an influential political group. To improve its image among women, while keeping tobacco off their organizational agendas, the company sponsored womens groups and programs. It also sought to appeal to women it defined as “active moms” by advertising its commitment to domestic violence victims. It was more successful in securing womens organizations as allies than active moms. Increasing tobaccos visibility as a global womens health issue may require addressing industry influence.

Self-defense training and women's fear of crime☆

Abstract This study investigated the relationship between self-defense training and womens fear of crime and feelings of physical competence. Forty-nine women enrolled in Positive Action self-defense courses in Hamilton, New Zealand, participated in the study, completing a pre- and post-test that measured fear of eight specific crimes and feelings of confidence regarding their ability to defend themselves successfully from individual and group attacks. The pre-test was also given to a control group consisting of women enrolled in physical fitness coarses at the YWCA. After participating in the training, students reported a significant reduction in fear of all eight crimes and a significant increase in their confidence in their ability to defend themselves. Comparisons between the pretraining scores of the test group and the control group revealed that the control group reported a significantly lower mean fear of rape and also felt more confident that they would be able to defend themselves from one unarmed attacker; however, after participating in the course, the test group reported a significant increase in confidence compared to the control groups initial confidence level, suggesting that even women with some degree of confidence in their physical competence might benefit from participation in the course.

“I always thought they were all pure tobacco”: American smokers’ perceptions of “natural” cigarettes and tobacco industry advertising strategies

Objective: To examine how the US tobacco industry markets cigarettes as “natural” and American smokers’ views of the “naturalness” (or unnaturalness) of cigarettes. Methods: Internal tobacco industry documents, the Pollay 20th Century Tobacco Ad Collection, and newspaper sources were reviewed, themes and strategies were categorised, and the findings were summarised. Results: Cigarette advertisements have used the term “natural” since at least 1910, but it was not until the 1950s that “natural” referred to a core element of brand identity, used to describe specific product attributes (filter, menthol, tobacco leaf). The term “additive-free”, introduced in the 1980s, is now commonly used to define natural cigarettes. Tobacco company market research, available from 1970 to 1998, consistently revealed that within focus group sessions, smokers initially had difficulty interpreting the term “natural” in relation to cigarettes; however, after discussion of cigarette ingredients, smokers viewed “natural” cigarettes as healthier. Tobacco companies regarded the implied health benefits of natural cigarettes as their key selling point, but hesitated to market them because doing so might raise doubts about the composition of their highly profitable “regular” brands. Conclusion: Although our findings support the idea advanced by some tobacco control advocates that informing smokers of conventional cigarettes’ chemical ingredients could promote cessation, they also suggest that such a measure could increase the ubiquity and popularity of “natural” cigarettes. A more effective approach may be to “denaturalise” smoking.

British American Tobacco's partnership with Earthwatch Europe and its implications for public health.

Abstract This paper explores a partnership between British American Tobacco (BAT) and the environmental organisation Earthwatch Europe (EE) and considers its implications for countries implementing Article 5.3 of the World Health Organization Framework Convention on Tobacco Control. We reviewed approximately 100 internal BAT documents, interviewed EEs former executive director and examined media accounts and BAT and EE websites. We analysed materials by reviewing them iteratively, identifying themes, constructing a timeline of events and assembling a case study. BAT sought a partnership with EE to gain a global ally that could provide entrée into the larger non-governmental organisation (NGO) community. EE debated the ethics of working with BAT, resolving them in BATs favour and taking a narrow view of its own overall organisational mission. To protect its reputation, EE delayed public disclosure of the partnership. Instead, EE promoted it to policy-makers and other NGOs, extending BATs reputation and reach into influential circles. The potential for normalising the tobacco industry presence within government through NGO partnerships and the benefits that accrued to BAT even when the partnership was not being publicised show why governments seeking to protect effective tobacco control policies from industry influence need to consider ways to identify and discourage ‘hidden’ NGO partnerships.

Covering their butts: responses to the cigarette litter problem

Background Cigarette butt litter is a potential target of tobacco control. In addition to its toxicity and non-biodegradability, it can justify environmental regulation and policies that raise the price of tobacco and further denormalise its use. This paper examines how the tobacco industry has managed the cigarette butt litter issue and how the issue has been covered in the media. Methods We searched the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu/) using a snowball strategy. We analysed data from approximately 700 documents, dated 1959–2006, using an interpretive approach. We also searched two newspaper databases, Lexis/Nexis and Newsbank, and found 406 relevant articles, dated 1982–2009 which we analysed quantitatively and qualitatively. Results The tobacco industry monitored and developed strategies for dealing with the cigarette litter issue because it affected the social acceptability of smoking, created the potential for alliances between tobacco control and environmental advocates, and created a target for regulation. The industry developed anti-litter programs with Keep America Beautiful (KAB) and similar organisations. Media coverage focused on industry-acceptable solutions, such as volunteer clean-ups and installation of ashtrays; stories that mentioned KAB were also more frequently positive towards the tobacco industry. Among alternative approaches, clean outdoor air (COA) laws received the most media attention. Conclusions Cigarette litter, like secondhand smoke, is the result of smoker behaviour and affects nonsmokers. The tobacco industry has tried and failed to mitigate the impact of cigarette litter. Tobacco control advocates should explore alliances with environmental groups and propose policy options that hold the industry accountable for cigarette waste.

People over profits: Retailers who voluntarily ended tobacco sales

Background Tobacco retailers are key players in the ongoing tobacco epidemic. Tobacco outlet density is linked to a greater likelihood of youth and adult smoking and greater difficulty quitting. While public policy efforts to address the tobacco problem at the retail level have been limited, some retailers have voluntarily ended tobacco sales. A previous pilot study examined this phenomenon in California, a state with a strong tobacco program focused on denormalizing smoking and the tobacco industry. We sought to learn what motivated retailers in other states to end tobacco sales and how the public and media responded. Methods We conducted interviews with owners, managers, or representatives of six grocery stores in New York and Ohio that had voluntarily ended tobacco sales since 2007. We also conducted unobtrusive observations at stores and analyzed media coverage of each retailer’s decision. Results Grocery store owners ended tobacco sales for two reasons, alone or in combination: health or ethics-related, including a desire to send a consistent health message to employees and customers, and business-related, including declining tobacco sales or poor fit with the store’s image. The decision to end sales often appeared to resolve troubling contradictions between retailers’ values and selling deadly products. New York retailers attributed declining sales to high state tobacco taxes. All reported largely positive customer reactions and most received media coverage. Forty-one percent of news items were letters to the editor or editorials; most (69%) supported the decision. Conclusion Voluntary decisions by retailers to abandon tobacco sales may lay the groundwork for mandatory policies and further denormalize tobacco. Our study also suggests that high tobacco taxes may have both direct and indirect effects on tobacco use. Highlighting the contradictions between being a responsible business and selling deadly products may support voluntary decisions by retailers to end tobacco sales.

It is time to plan the tobacco endgame

It is essential for the UK to extend its focus beyond tobacco control to plan a tobacco free future