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August 20th, 2014:

Framing Pictorial Cigarette Warning Labels to Motivate Young Smokers to Quit



The Family Smoking Prevention and Tobacco Control Act requires new pictorial warnings for U.S. cigarette packs, but enactment has been delayed by tobacco industry lawsuits. Research can inform implementation of the pictorial warning requirement and identify ways to optimize their public health impact post-implementation. This study investigated the impact of warning label message framing on young smokers’ motivation to quit, examining cessation self-efficacy, and perceived risks as moderators of message framing impact.


Smokers ages 18-30 (n = 740) completed baseline measures and were randomized to view 4 images of cigarette packs with pictorial health warnings featuring gain- or loss-framed messages. Motivation to quit was assessed after participants viewed the pack images. Linear models accounting for repeated measures and adjusting for baseline covariates examined the impact of message framing and interactions with baseline self-efficacy to quit and perceived risks of smoking.


Loss-framed warnings prompted significantly greater motivation to quit among smokers with high self-efficacy compared with smokers with low self-efficacy. Among smokers with low self-efficacy, gain-framed messages were superior to loss-framed messages. Gain-framed warnings generated significantly greater motivation to quit among smokers with high perceived risks compared with smokers with low perceived risks. Among smokers with high perceived risks, gain-framed messages were superior to loss-framed messages.


A combination of pictorial warnings featuring risk-based (i.e., loss-framed) and efficacy-enhancing (i.e., gain-framed) information may promote better public health outcomes. Research is needed to investigate how strategically framed warning messages impact smokers’ behaviors based on their pre-existing attitudes and beliefs in real-world settings.

Widow’s $27b win rattles tobacco bosses

Even by the standards of American court payouts the US$23.6 billion ($27.5 billion) jury award to Cynthia Robinson, the widow of a long-term smoker, is a jaw-dropping sum.

Robinson filed suit in Florida in 2008 alleging that RJ Reynolds, America’s second-biggest cigarette firm, deliberately hid the addictive nature and health risks posed by its products from her late husband, Michael Johnson.

Reynolds, which makes Camel, Pall Mall, Kool, Winston and other brands, vowed to appeal against what it calls a “runaway” verdict.

“The damages awarded are grossly excessive and impermissible under state and constitutional law,” said Jeff Raborn, vice-president and assistant general counsel for Reynolds. He said the verdict went “far beyond the realm of reasonableness and fairness” and was confident it “will not be allowed to stand”.

Naturally, the victors saw things differently. “The jury was outraged with the concealment and the conspiracy to conceal that smoking was not only addictive but that there were deadly chemicals in cigarettes,” Christopher Chestnut, one of Robinson’s legal team, told the New York Times.

And Chris Hansen, president of the American Cancer Society Cancer Action Network, said the judgment showed “jurors, much like the public itself, did not think the tobacco industry has paid its share for its unconscionable record of public deception, fraud and predatory marketing that has resulted in massive loss of life”.

The verdict is the largest single award dating from a US$145 billion class action verdict against Big Tobacco, rejected by Florida’s Supreme Court in 2006. But that ruling came with a caveat which has been a boon for litigants. The court accepted that smoking caused disease and tobacco firms were negligent. If plaintiffs can prove addiction and that smoking led to death or sickness, they have a case.

Although Robinson’s payout may be reduced on appeal, her win could signal death by a thousand cuts for Big Tobacco. Johnson, a hotel shuttle bus driver, began smoking at 13 and was a chain smoker, repeatedly failing to give up. He died in 1996, aged 36, leaving two children, one of 20 million Americans to succumb in the past half-century, according to the Cancer Society. Despite a 1964 warning by the US Surgeon-General that smoking causes lung cancer, the tobacco industry proved invulnerable against litigants, insisting smoking and cancer were not linked.

In fact, its own research proved the opposite. In 1961 Helmut Wakeham, research director with Philip Morris, said carcinogens were found in “practically every class of compound in cigarette smoke”. Despite this and other internal proof that smoking was lethal, in 1994 the heads of America’s top seven cigarette companies testified to Congress that they believed “nicotine is not addictive”.

This fiction was debunked by whistleblower Jeffrey Wigand, the vice-president of research and development at Brown & Williamson. He revealed the US firm enhanced addiction by adding chemicals to cigarettes and genetically modified tobacco. Wigand’s expose provoked national outrage and 46 states filed suit.

In 1998 they won US$368 billion to recoup smoking-related health costs. The Master Settlement Agreement (MSA) also released 14 million internal industry documents, cached in the Legacy Tobacco Documents Library at the University of California San Francisco. Besides Wakeham’s comments, time bombs include the Sub-Culture Urban Marketing project, or SCUM, targeted at gays, lesbians and homeless people in the 1990s.

“That information, which is egregious, has been used in multiple trials, including the Florida one,” says Chris Bostic, deputy director for policy at Action on Smoking and Health (ASH). He suggests the jury wanted to punish Reynolds “so they would rethink if this was a profitable business to be in”.

Nonetheless, despite legal reversals, including a 2006 US case that convicted cigarette companies of racketeering for their acts of fraud and deception, using laws normally designed to fight the Mafia, and tighter legal restraints, such as the 2009 Tobacco Control Act, which gives the US Food and Drug Administration authority over the industry, Big Tobacco remains very profitable.

In 2012 the industry, dominated internationally by British American Tobacco, Philip Morris, Imperial and Japan Tobacco, had a retail value of US$697 billion, with over 5.8 trillion cigarettes sold worldwide. Many are puffed in Latin America, Africa and Asia as the industry seeks new markets, using World Trade Organisation rules and buyouts to vanquish old state-based monopolies.

And with cigarette sales forecast to decline in the US, the industry is aggressively wooing new customers with electronic cigarettes.

Philip Morris alone has spent US$650 million on “next generation cigarettes”. The FDA has yet to rule if e-cigarettes – reusable metal tubes that heat nicotine and release vapours – are harmful. But anti-smoking groups fear they will “re-normalise” the habit, so kids think smoking is glamorous. A public comment period for FDA rules ends in August, with the earliest date for regulation seen as 2017, leaving states and cities to fill the vacuum with their own ordinances.

Today, 18 per cent of US adults smoke, as some states levy high cigarette taxes and adopt aggressive laws against second-hand smoke. This shift is less evident in the South – home to Johnson – and the Midwest, so that in Kentucky, for example, the adult smoking rate is 30 per cent. And though the MSA bans advertising aimed at “youth”, Bostic says Big Tobacco targets the “young” market.

The “sweet spot” to entice new smokers is 15 to 18 – in nations without public health campaigns, such as Indonesia, it is 5 to 8 – and ASH argues youngsters are incapable of gauging the long-term health impacts.

Meanwhile, the industry spends big – around US$1 million an hour goes on advertising – and courts powerful pals. Each year the industry contributes over US$1.6 million to federal candidates and spends some US$16.6 million lobbying Congress, says ASH. Even more is spent at state and local level, while public relations firms and front groups work to depict the industry in a benign light.

One billion people smoke worldwide. The six million who die each year include five million smokers and 600,000 who breathe their fumes. By 2030 the death toll is expected to reach eight million a year, with 80 per cent in the global south.

And while tobacco killed 100 million in the 20th century it is predicted to kill one billion this century. It is the only legal product that, when used as intended, kills.

“Tobacco use alone costs the world 1 to 2 per cent of its GDP each year,” former New Zealand Prime Minister Helen Clark told the UN this month. Global GDP in 2013 was US$75 trillion, with 1 per cent worth US$575 billion – more than the GDP of all low-income nations.

Countering the industry has become a global chess game. Opponents want to exclude it from the rights that will accrue under the proposed Trans-Pacific Partnership and ASH is lobbying the 12 nations involved. While Malaysia has come on board, the US has fought ASH’s proposals.

– AP

Saturday Jul 26, 2014

Hawaii Bill would raise tobacco buying age to 21

By Kristine Uyeno Published: July 24, 2014

Some Honolulu City Councilmembers are trying to raise the age of those who can buy tobacco products on Oahu.

Councilmember Stanley Chang and Chair Ernie Martin introduced a bill Thursday that would raise the minimum age from 18 to 21.

Similar moves have been made in other parts in the United States including the Big Island.

“Why are you proposing this?” KHON2 asked.

“Tobacco is one of the leading killers in the United States and 95% of all smokers become addicted when they’re under the age of 21,” Chang said.

Chang believes raising the legal age to buy tobacco products would save lives. It would also follow in the footsteps of the Big Island, where a similar law just began three weeks ago.

“It’s a growing trend nationwide, so we think the City and County of Honolulu should be at the cutting edge of that trend too,” Chang said.

The bill that was introduced on Thursday, would also raise the age for those buying electronic smoking devices including e-cigarette products that don’t contain nicotine.

Volcano E-cigs is one company that sells electronic cigarettes in Hawaii. A company official told me this move would not affect their business.

“The majority of customers are first off, long-term former tobacco smokers,” said Scott Rasak with Volcano E-Cigs.

Rasak says the company does have customers under the age of 21 and if this bill beomes law, it would limit their options.

“We believe strongly in a different alternative, a smarter alternative, giving people options and what this bill does is it specifically limits their ability to explore their options,” Rasak said.

“Do you agree with this move or not?” KHON2 asked.

“Well I think probably if you’re an adult at 18, you got to be able to make your own decisions,” a Honolulu resident said.

“I think that it should be raised because I’m just against smoking overall,” another said.

First reading of this bill is scheduled for next moth. If passed, the bill would become law in January.

Nine facts about tobacco company lobbying

The tobacco industry has often been accused of using underhand tactics to oppose regulations that threaten its profits. Karen Evans-Reeves, research officer for the Tobacco Control Research Group at the University of Bath, with input from colleagues Silvy Peeters and Rachel Rose Jackson, outlines some of the key moments in the struggle to break a deadly addiction.

1. In England, tobacco kills over 79,000 people every year.
Deaths from tobacco exceed the total killed by obesity, alcohol and illegal drugs in England, in addition to road traffic accidents and HIV infection in Great Britain, combined. Tobacco is addictive and most of its users become hooked in childhood.

2. Under oath in 1994, tobacco company chief executives denied nicotine was addictive but their own documents showed they had known otherwise since the 1960s.

Thirty years before the testimony, the vice-president of US tobacco company Brown & Williamson wrote: ‘We are, then, in the business of selling nicotine, an addictive drug.’ By the 1970s tobacco companies were deliberately manipulating other cigarette ingredients to enhance the addictive effect of nicotine. In carefully worded testimonies each chief executive stated only that they did not believe that nicotine was addictive and therefore escaped prosecution for perjury.

3. For decades after the link between smoking and lung cancer was scientifically proven, the tobacco industry deliberately caused public confusion about the health impacts of tobacco.

In 1953, following advice from public relations firm Hill and Knowlton, tobacco companies created the Tobacco Industry Research Committee promising smokers that they would get to the bottom of the smoking and health issue. However, it rarely focused its research on smoking, focusing instead on every other conceivable cause of cancer. In 1998, Judge Gladys Kessler ordered the dissolution of the Committee stating that it was little more than ‘a sophisticated public relations vehicle based on the premise of conducting independent scientific research – to deny the harms of smoking and reassure the public’.

4. The marketing of nicotine addiction is lucrative.

Despite declining smoking rates, the tobacco companies’ profits are still climbing each year and their profit margin, an indicator of a company’s profitability, is higher than most other consumer product companies. In 2011, the UK tobacco market leader Imperial Tobacco had a profit margin of 39.5 per cent, compared to Diageo’s 31.8 per cent and Unilever’s 15.1 per cent.

5. Tobacco companies use tobacco packaging as a marketing tool – the pack is important.

Tobacco companies have vehemently opposed the introduction of plain packaging for cigarettes, claiming that the policy will not deter children from starting to smoke. However, in Philip Morris’s own words: ‘In the absence of any other marketing messages, our packaging … is the sole communicator of our brand essence. Put another way, when you don’t have anything else, our packaging is our marketing.’

6. Some tobacco companies pay third parties to promote their messages while hiding their involvement.

To enhance the credibility of their arguments and give the impression that others support their position, tobacco companies use a range of third-party techniques. They hire scientists, create, finance and manage front groups, fund think tanks (such as the Institute of Economic Affairs) and numerous business associations, which then act as the tobacco industry’s spokespersons.

7. Some tobacco companies have been involved in smuggling their own cigarettes on a global basis and are still subject to investigation for ongoing involvement in this trade.

Internal company documents reveal that smuggling was an integral part of tobacco companies’ business strategies. They make profit when they sell to the distributor regardless of whether the cigarettes are subsequently sold in legal or illegal channels. Smuggling can benefit tobacco companies because it keeps cigarettes affordable to smokers who may otherwise quit. Simultaneously, companies can also argue that illicit trade is worsening because tax is too high, lobbying the government to reduce tax and therefore cigarette price.

8. Some people doubt that tobacco companies would market e-cigarettes and other nicotine products in a way that would benefit public health.

Lessons from the past have shown that tobacco companies’ interest in reduced risk products was mostly driven by the threat of regulation driving down cigarette sales. For example, when British American Tobacco was considering investing in smokeless tobacco in the 1970s and 1980s, it said it had ‘no wish to aid or hasten any decline in cigarette smoking’. Internal documents reveal that at this time harm reduction was considered a ‘reputation management initiative’ to rehabilitate their image and allow them to be seen as ‘policy partners’ with access to policy makers in the UK and abroad.

9. Not only have tobacco companies influenced tobacco regulation, they have influenced how policy is made.

British American Tobacco, working together with other corporations whose products have been accused of being damaging to health, managed to secure changes to the EU regulatory framework that makes stakeholder consultation mandatory and requires a detailed business impact assessment of each policy. BAT anticipated these changes would make it much harder to pass public health policies in the future and this appears to be the case as a second public consultation has just taken place on the potential impacts of plain packaging in the UK.