Richard L. Barnes

The Tobacco Industry’s Role in the 16 Cities Study of Secondhand Tobacco Smoke: Do the Data Support the Stated Conclusions?

Background Since 1996, the tobacco industry has used the 16 Cities Study conclusions that workplace secondhand tobacco smoke (SHS) exposures are lower than home exposures to argue that workplace and other smoking restrictions are unnecessary. Objectives Our goal was to determine the origins and objectives of the 16 Cities Study through analysis of internal tobacco industry documents and regulatory agency and court records, and to evaluate the validity of the study’s conclusions. Results The tobacco industry’s purpose in conducting the 16 Cities Study was to develop data showing that workplace SHS exposures were negligible, using these data to stop smoking restrictions by the U.S. Occupational Safety and Health Administration. The extensive involvement of R.J. Reynolds Tobacco Company and the tobacco industry’s Center for Indoor Air Research in controlling the study was not fully disclosed. The study’s definition of “smoking workplace” included workplaces where smoking was restricted to designated areas or where no smoking was observed. This definition substantially reduced the study’s reported average SHS concentrations in “smoking workplaces” because SHS levels in unrestricted smoking workplaces are much greater than in workplaces with designated smoking areas or where no smoking occurred. Stratifying the data by home smoking status and comparing exposures by workplace smoking status, however, indicates that smoke-free workplaces would halve the total SHS exposure of those living with smokers and virtually eliminate SHS exposure for most others. Conclusions Data in the 16 Cities Study reveal that smoke-free workplaces would dramatically reduce total SHS exposure, providing significant worker and public health benefits.

Regulating the disposal of cigarette butts as toxic hazardous waste

The trillions of cigarette butts generated each year throughout the world pose a significant challenge for disposal regulations, primarily because there are millions of points of disposal, along with the necessity to segregate, collect and dispose of the butts in a safe manner, and cigarette butts are toxic, hazardous waste. There are some hazardous waste laws, such as those covering used tyres and automobile batteries, in which the retailer is responsible for the proper disposal of the waste, but most post-consumer waste disposal is the responsibility of the consumer. Concepts such as extended producer responsibility (EPR) are being used for some post-consumer waste to pass the responsibility and cost for recycling or disposal to the manufacturer of the product. In total, 32 states in the US have passed EPR laws covering auto switches, batteries, carpet, cell phones, electronics, fluorescent lighting, mercury thermostats, paint and pesticide containers, and these could be models for cigarette waste legislation. A broader concept of producer stewardship includes EPR, but adds the consumer and the retailer into the regulation. The State of Maine considered a comprehensive product stewardship law in 2010 that is a much better model than EPR. By using either EPR or the Maine model, the tobacco industry will be required to cover the cost of collecting and disposing of cigarette butt waste. Additional requirements included in the Maine model are needed for consumers and businesses to complete the network that will be necessary to maximise the segregation and collection of cigarette butts to protect the environment.

Enacting Tobacco Taxes by Direct Popular Vote in the United States: Lessons from 20 Years of Experience

Background: Tobacco tax increases reduce tobacco use, can provide funds for tobacco prevention and enjoy broad public support. Because of tobacco industry influence in legislatures, US public health advocates have shifted the venue for tobacco tax policymaking to direct popular vote 22 times since 1988. Methods: We combined case studies of individual state campaigns with tobacco industry documents to identify strategies related to outcome. Results: The tobacco industry developed a voter segmentation model to determine which tobacco tax increases it could defeat. Two industry arguments arising from this model often were raised in losing campaigns—the tax increase did not dedicate enough to tobacco control and hospitals and health maintenance organisations would profit. The industry effectively influenced early voters. Success was associated with building a strong base of public support before the campaign, dedicating sufficient funds to tobacco control, avoiding proposals largely devoted to financing hospitals and other medical service providers, effectively engaging grassroots and framing the campaign with clear justifications for cigarette tax increases. Conclusions: Tobacco tax ballot measures commonly allocated substantial funds to medical services; tobacco companies are becoming more successful in making this use of funds an issue. Proponents’ campaigns should be timed to account for the trend to voting well before election day. Ballot measures to increase tobacco taxes with a substantial fraction of the money devoted to tobacco control activities will probably fare better than ones that give priority to funding medical services.

Strong Tobacco Control Program Requirements and Secure Funding Are Not Enough: Lessons From Florida

Floridas Tobacco Pilot Program (TPP; 1998-2003), with its edgy Truth media campaign, achieved unprecedented youth smoking reductions and became a model for tobacco control programming. In 2006, 3 years after the TPP was defunded, public health groups restored funding for tobacco control programming by convincing Florida voters to amend their constitution. Despite the new programs strong legal structure, Governor Charlie Crists Department of Health implemented a low-impact program. Although they secured the programs strong structure and funding, Floridas nongovernmental public health organizations did not mobilize to demand a high-impact program. Implementation of Floridas Amendment 4 demonstrates that a strong programmatic structure and secure funding are insufficient to ensure a successful public health program, without external pressure from nongovernmental groups.

Environmental Tobacco Smoke: Barnes et Al. Respond

We are gratified that Jenkins does not dispute the central findings of our study (Barnes et al. 2006), namely, that a) the 16 Cities Study grew out of the tobacco industry’s plan to block any Occupational Safety and Health Administration (OSHA) standard on secondhand tobacco smoke; b) RJ Reynolds Tobacco was the originator of the 16 Cities Study and exercised substantial control of the research at all times; c) Jenkins et al. (1996) combined exposure data from restricted and unrestricted smoking workplaces and compared exposure data in an inappropriate manner that produced results the industry could cite to support its claim that workplace secondhand smoke (SHS) exposures were low compared with household exposures during its efforts to defeat indoor smoking restrictions; and d) a proper analysis of the data Jenkins presented indicates that smoke-free policies would halve the total SHS exposure of those living with smokers and virtually eliminate exposure for most others, supporting the need for smoke-free workplaces [and the polar opposite conclusion of Jenkins et al. (1996)]. [Compare Figures 1 and 2 of our article (Barnes et al. 2006)]. The disagreement appears to be in how transparent or opaque these facts were to the reader of Jenkins’ original article on the 16 Cities Study (Jenkins et al. 1996) and to OSHA. In his letter, Jenkins ignores our Table 2 (Barnes et al. 2006), which contrasts the actual roles that RJ Reynolds and other agencies played in the design, conduct, and management of the 16 Cities Study compared with how these roles were described by Jenkins in his publications and direct testimony. We did not say that he did not disclose that he was working for the tobacco industry; we presented evidence that the disclosures in his articles did not completely reflect the role that the industry played in conceiving of and controlling the study. In addition, lengthy cross-examination of Jenkins during the OSHA hearings was required to reveal the extensive involvement of RJ Reynolds, and that revelation was incomplete (OSHA 1995). We also would like to address a few other small points. First, far from “deliberate selection of data,” we followed standard snowball methodology (Malone and Balbach 2000) for searching the industry documents; we identified > 500 relevant industry documents, as well as court records and the published literature, as a basis for our article (Barnes et al. 2006). We did analyze the full public 16 Cities data set when preparing our article, but we did not cite it because we were able to present our analysis based on summary results from the published articles (Jenkins and Counts 1999; Jenkins et al. 1996). We did not mention the Dunn–Wiley trial (Dunn and Wiley et al. v. RJR Nabisco Holdings Corp. et al. 1993) in Indiana because the ruling was on a motion to strike Jenkins’ testimony because of procedural issues relating to disclosure of expert witness testimony in advance of trial, not a challenge to the conduct of the 16 Cites Study, as made in the Brion case (Dunn and Wiley et al. v. RJR Nabisco Holdings Corp. et al. 1998). Nothing in Jenkins’ letter contradicts our conclusion that he and his colleagues presented the data from the 16 Cities Study in a way that conformed to the stated objective of the Tobacco Institute’s “OSHA Projects” to “encourage adoption of a ventilation standard and to discourage adoption of a smoking ban or of a standard that requires separate ventilation for areas where smoking is allowed” (Tobacco Institute 1991). Indeed, as noted above—and unchallenged by Jenkins—a proper presentation of the 16 Cities data [Figures 1 and 2 of Barnes et al. (2006)] shows that employees in “smoking workplaces” have significant levels of SHS exposure and that smokefree workplaces substantially reduce overall exposure to SHS. This conclusion remains important because the tobacco industry and its allies still rely heavily on the 16 Cities Study in opposing regulation of SHS exposures.