Stella Aguinaga Bialous

Tobacco industry manipulation of the hospitality industry to maintain smoking in public places

Objective: To describe how the tobacco industry used the “accommodation” message to mount an aggressive and effective worldwide campaign to recruit hospitality associations, such as restaurant associations, to serve as the tobacco industrys surrogate in fighting against smoke-free environments. Methods: We analysed tobacco industry documents publicly available on the internet as a result of litigation in the USA. Documents were accessed between January and November 2001. Results: The tobacco industry, led by Philip Morris, made financial contributions to existing hospitality associations or, when it did not find an association willing to work for tobacco interests, created its own “association” in order to prevent the growth of smoke-free environments. The industry also used hospitality associations as a vehicle for programmes promoting “accommodation” of smokers and non-smokers, which ignore the health risks of second hand smoke for employees and patrons of hospitality venues. Conclusion: Through the myth of lost profits, the tobacco industry has fooled the hospitality industry into embracing expensive ventilation equipment, while in reality 100% smoke-free laws have been shown to have no effect on business revenues, or even to improve them. The tobacco industry has effectively turned the hospitality industry into its de facto lobbying arm on clean indoor air. Public health advocates need to understand that, with rare exceptions, when they talk to organised restaurant associations they are effectively talking to the tobacco industry and must act accordingly.

Tobacco industry efforts to present ventilation as an alternative to smoke-free environments in North America

Objective: To describe how the tobacco industry developed a network of consultants to promote ventilation as a “solution” to secondhand smoke (SHS) in the USA. Methods: Analysis of previously secret tobacco industry documents. Results: As with its other strategies to undermine the passage of clean indoor legislation and regulations, the tobacco industry used consultants who represented themselves as independent but who were promoting the industry’s ventilation “solution” strategies under close, but generally undisclosed, industry supervision. The nature of the industry’s use of ventilation consultants evolved over time. In the 1980s, the industry used them in an effort to steer the concerns about indoor air quality away from secondhand smoke, saying SHS was an insignificant component of a much larger problem of indoor air quality and inadequate ventilation. By the 1990s, the industry and its consultants were maintaining that adequate ventilation could easily accommodate “moderate smoking”. The consultants carried the ventilation message to businesses, particularly the hospitality business, and to local and national and international regulatory and legislative bodies. Conclusion: While the tobacco industry and its consultants have gone to considerable lengths to promote the tobacco industry’s ventilation “solution”, this strategy has had limited success in the USA, probably because, in the end, it is simpler, cheaper, and healthier to end smoking. Tobacco control advocates need to continue to educate policymakers about this fact, particularly in regions where this strategy has been more effective.

Exposing and Addressing Tobacco Industry Conduct in Low-Income and Middle-Income Countries

The tobacco industrys future depends on increasing tobacco use in low-income and middle-income countries (LMICs), which face a growing burden of tobacco-related disease, yet have potential to prevent full-scale escalation of this epidemic. To drive up sales the industry markets its products heavily, deliberately targeting non-smokers and keeps prices low until smoking and local economies are sufficiently established to drive prices and profits up. The industry systematically flaunts existing tobacco control legislation and works aggressively to prevent future policies using its resource advantage to present highly misleading economic arguments, rebrand political activities as corporate social responsibility, and establish and use third parties to make its arguments more palatable. Increasingly it is using domestic litigation and international arbitration to bully LMICs from implementing effective policies and hijacking the problem of tobacco smuggling for policy gain, attempting to put itself in control of an illegal trade in which there is overwhelming historical evidence of its complicity. Progress will not be realised until tobacco industry interference is actively addressed as outlined in Article 5.3 of the Framework Convention on Tobacco Control. Exemplar LMICs show this action can be achieved and indicate that exposing tobacco industry misconduct is an essential first step.

Whose standard is it, anyway? How the tobacco industry determines the International Organization for Standardization (ISO) standards for tobacco and tobacco products

OBJECTIVE To describe the extent of the tobacco industry involvement in establishing international standards for tobacco and tobacco products and the industry influence on the International Organization for Standardization (ISO). METHODS Analysis of tobacco industry documents made public as part of the settlement of the Minnesota Tobacco Trial and the Master Settlement Agreement. Search words included “ISO”, “CORESTA”, “Barclay”, “compensation and machine smoking”, “tar and nicotine deliveries”, and the name of key players, in different combinations. RESULTS It is clear that the tobacco industry, through the Cooperation Centre for Scientific Research Relative to Tobacco (CORESTA), play a major role in determining the scientific evidence and suggesting the standards that are eventually adopted as international standards for tobacco and tobacco products in several areas, including the measurement of cigarette tar and nicotine yield. CONCLUSIONS ISOs tobacco and tobacco products standards are not adequate to guide tobacco products regulatory policies, and no health claims can be made based on ISOs tobacco products standards. There is an urgent need for tobacco control advocates and groups worldwide to be more involved with the work of the ISO, both directly and through their national standardisation organisations.

Junking Science to Promote Tobacco

Despite the tobacco industrys claims that it has changed its practices, the toll of tobacco-related disease and death continues to grow worldwide, and the industry continues to use a vast array of strategies to promote its products and increase profits. This commentary discusses the ways the tobacco industry has created controversy about risk assessment and about the scientific evidence of the health hazards of secondhand smoke. The authors recommend that policymakers be more vigilant and that they demand transparency about affiliations and linkages between allegedly independent scientists and tobacco companies. They also urge policymakers to be prepared for new and continuing challenges posed by the tobacco industry, because, despite the industrys claims, there is little evidence of fundamental change in its objectives.

Promoting tobacco dependence treatment in nursing education.

ISSUES There are 17.3 million nurses worldwide, the largest group of health-care professionals, and they have great potential to address the epidemic of tobacco use and its related morbidity and mortality. However, the evidence indicates that the educational preparation of nurses for tobacco control remains inadequate. APPROACH This paper provides an overview of the efficacy of nurses in the delivery of smoking cessation interventions, existing tobacco control content in nursing educational programs, model curricula, teaching resources and strategies for reducing barriers to curricular change. KEY FINDINGS Despite the efficacy of nursing intervention for tobacco cessation, lack of appropriate knowledge and/or skill presents a major problem for implementation. An important factor fostering this lack of preparation is limited tobacco control content in current nursing educational programs. Barriers to enhancing and building this curricula include lack of preparation of educators, low priority for this content in an already overloaded curricula, negative attitudes, continued smoking by nursing students and/or faculty and lack of tested curricula. The availability of new tobacco control resources, including those specifically tailored for nurses can assist educators in teaching this content and nurses in implementing interventions. IMPLICATIONS Research and changes in policy are needed to ensure that nursing education includes essential content on tobacco control. CONCLUSION Nurses can be effective in delivering tobacco cessation interventions. Efforts are needed to promote curriculum that ensures that all nursing students and practicing nurses receive tobacco control content and are competent in the delivery of interventions; and to disseminate resources to nursing educators

Nurses' perspectives of smoking initiation, addiction, and cessation

Background:It is estimated that 18% of registered nurses smoke. Although nurses can make an important contribution to national cessation efforts, continuing smoking among nurses has been cited as one of the barriers against higher nursing involvement. Objectives:To develop a national program to assist nurses in smoking cessation through an in-depth understanding of issues related to nurses’ attitudes toward smoking and quitting, and to explore nurses’ preferences for smoking cessation interventions. Methods:Eight focus groups were conducted in four states with nurses who were current or former smokers. Content analysis was used to identify major themes. Results:Four themes were identified: initiation of smoking and addiction, myths and misconceptions about quitting, overcoming addictions, and strategies for enhancing successful cessation. Nurses described addiction and cessation efforts similar to those of the general population. However, nurses experienced guilt related to their smoking, and perceived a lack of understanding by nonsmoking colleagues and managers about their need of support for smoking cessation. Nurses who had successfully quit smoking were motivated by health concerns, pregnancy, and their children. Nurses suggested many interventions that would be supportive of their quit attempts, such as worksite services and Internet-based support groups. Conclusions:Nurses expressed the need for smoking cessation interventions similar to that of the general population, and for additional support that recognizes two concerns: confidentiality about their smoking in terms of the general public, and support along with counseling with regard to their feelings of shame and guilt in relation to their public image as nurses.

Philip Morris' new scientific initiative: an analysis

In the fall of 2000, Philip Morris re-initiated an external research grants programme (“Philip Morris External Research Program”, or PMERP), the first since the dissolution of the Council for Tobacco Research (CTR) and the Center for Indoor Air Research (CIAR). The ostensible purpose of the programme is to help develop cigarette designs “that might reduce the health risk of smoking”. Internal company documents also indicate that Philip Morris urgently seeks to restore its scientific “credibility”, as part of a “new openness” in relation to the external community. The structure of the review panel—a cohort of external peer reviewers, a science advisory board, and an internal, anonymous review and approvals committee—is nearly identical to that of the CIAR. The majority of the named reviewers have had previous affiliation with the tobacco industry either as reviewers or grantees, but only a minority have done research directly on tobacco or smoking. The programmatic substance of the PMERP could be interpreted as soliciting exculpatory evidence with respect to smoking and exposure to smoke. We remain sceptical about the scientific integrity of PMERP.

Second hand smoke and risk assessment: what was in it for the tobacco industry?

OBJECTIVE To describe how the tobacco industry attempted to trivialise the health risks of second hand smoke (SHS) by both questioning the science of risk assessment of low dose exposure to other environmental toxins, and by comparing SHS to such substances about which debate might still exist. METHODS Analysis of tobacco industry documents made public as part of the settlement of litigation in the USA (Minnesota trial and the Master Settlement Agreement) and available on the internet. Search terms included: risk assessment, low dose exposure, and the names of key players and organisations. RESULTS/CONCLUSION The tobacco industry developed a well coordinated, multi-pronged strategy to create doubt about research on exposure to SHS by trying to link it to the broader discussion of risk assessment of low doses of a number of toxins whose disease burden may still be a matter of scientific debate, thus trying to make SHS their equivalent; and by attempting, through third party organisations and persons, to impugn the agencies using risk assessment to establish SHS as a hazard.

Arizona’s tobacco control initiative illustrates the need for continuing oversight by tobacco control advocates

BACKGROUND In 1994, Arizona voters approved Proposition 200 which increased the tobacco tax and earmarked 23% of the new revenues for tobacco education programmes. OBJECTIVE To describe the campaign to pass Proposition 200, the legislative debate that followed the passage of the initiative, and the development and implementation of the tobacco control programme. DESIGN This is a case study. Data were collected through semi-structured interviews with key players in the initiative campaign and in the tobacco education programme, and written records (campaign material, newspapers, memoranda, public records). RESULTS Despite opposition from the tobacco industry, Arizonans approved an increase in the tobacco tax. At the legislature, health advocates in Arizona successfully fought the tobacco industry attempts to divert the health education funds and pass preemptive legislation. The executive branch limited the scope of the programme to adolescents and pregnant women. It also prevented the programme from attacking the tobacco industry or focusing on secondhand smoke. Health advocates did not put enough pressure at the executive branch to force it to develop a comprehensive tobacco education programme. CONCLUSIONS It is not enough for health advocates to campaign for an increase in tobacco tax and to protect the funds at the legislature. Tobacco control advocates must closely monitor the development and implementation of tax-funded tobacco education programmes at the administrative level and be willing to press the executive to implement effective programmes.