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About

The Center for Tobacco Control Research and Education provides a focal point for work designed to reduce the 5 million deaths a year tobacco and the tobacco industry cause each year. The work of the Center spans policy and historical research, economics, and science. The work is designed to inform and improve the effectiveness of public health interventions to reduce tobacco use. It works closely with the UCSF Library's efforts to collect and preserve previously secret tobacco industry documents, such as those available at the Truth Tobacco Industry Documents Library (https://www.industrydocumentslibrary.ucsf.edu/tobacco/).

The Director is:
Stanton A. Glantz, PhD
Professor of Medicine
Suite 366 Library
530 Parnassus
University of California
San Francisco, CA 94143-1390
phone: (415) 476-3893
fax: (415) 514-9345
email: glantz@medicine.ucsf.edu

Books

Center for Tobacco Control Research and Education

There are 417 publications in this collection, published between 1990 and 2018.
Economic Studies and Related Methods (8)

Economic and Health Effects of a State Cigarette Excise Tax Increase in California

The Coalition for a Healthy California is sponsoring a comprehensive statewide ballot initaitve to rasie the tobacco excise tax by $2.60 per pack of cigarettes in order to provide funding to qualified hospitals for emergency services, nursing education and health insurance to eligible children. This paper uses the best possible science to estimate the effect of a new tax on cigarette consumption, adult and youth smoking rates, tax revenues, and long term health outcomes. The additional tax would raise the average price of cigrettes to $6.55 per pack.

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Postprints from the CTCRE (54)

Every document and picture tells a story: using internal corporate document reviews, semiotics, and content analysis to assess tobacco advertising.

In this article we present communication theory as a conceptual framework for conducting documents research on tobacco advertising strategies, and we discuss two methods for analysing advertisements: semiotics and content analysis. We provide concrete examples of how we have used tobacco industry documents archives and tobacco advertisement collections iteratively in our research to yield a synergistic analysis of these two complementary data sources. Tobacco promotion researchers should consider adopting these theoretical and methodological approaches.

The Tobacco Industry and Pesticide Regulations: Case Studies from Tobacco Industry Archives

Tobacco is a heavily pesticide-dependent crop. Because pesticides involve human safety and health issues, they are regulated nationally and internationally; however, little is known about how tobacco companies respond to regulatory pressures regarding pesticides. This study analyzes internal tobacco industry documents to describe industry activities aimed at influencing pesticide regulations. We use a case study approach based on examination of approximately 2,000 internal company documents and 3,885 pages of U.S. Environmental Protection Agency documents obtained through Freedom of Information Act requests. The cases involve methoprene, the ethylene bisdithiocarbamates, and phosphine. We show how the tobacco industry successfully altered the outcome in two cases by hiring ex-agency scientists to write reports favorable to industry positions regarding pesticide regulations for national (Environmental Protection Agency) and international (World Health Organization) regulatory bodies. We also show how the industry worked to forestall tobacco pesticide regulation by attempting to self-regulate in Europe, and how Philip Morris encouraged a pesticide manufacturer to apply for higher tolerance levels in Malaysia and Europe while keeping tobacco industry interest a secret from government regulators. This study suggests that the tobacco industry is capable of exerting considerable influence over the pesticide regulatory process and that increased scrutiny of this process and protection of the public interest in pesticide regulation may be warranted.

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Other Recent Work (4)

The New York Profile: A review of New York's tobacco prevention and control program

Partners identified the following strengths and challenges of New York’s tobacco control program:

• The experience and leadership of the DOH; TCP Director was a major strength of the program.

• Clean indoor air efforts throughout the state were also a strength.

• Partners were concerned about the security of funding due to the large state and city budget deficits.

• The highly politicized DOH environment and slow grant process were viewed as barriers to the program.

• Little support from state policymakers and the influence of the tobacco industry made implementing a comprehensive program challenging.

Can Ventilation Control Secondhand Smoke in the Hospitality Industry?

A panel of ventilation experts assembled by OSHA and ACGIH concluded that dilution ventilation, used in virtually all mechanically ventilated buildings, will not control secondhand smoke in the hospitality industry (e.g., restaurants, bars, casinos). The panelists asserted that a new and unproved technology, displacement ventilation, offered the potential for up to 90% reductions in ETS levels relative to dilution technology. However, this assertion was not substantiated by any supporting data. Air cleaning was judged to be somewhere between dilution and displacement ventilation in efficacy, depending on the level of maintenance. The panel also failed to quantify the ETS exposure or risk for workers or patrons either before or after the application of the new technology. Panelists observed that building ventilation codes are not routinely enforced. They also noted the lack of recognized standards for acceptable ETS exposure as well as the lack of information on typical exposure levels. However, indoor air quality standards for ETS have been proposed in the scientific literature, and reliable mathematical models exist for predicting pollutant concentrations from indoor smoking. These proposed standards and models permit application of an indoor air quality procedure for determining ventilation rates as set forth in ASHRAE Standard 62. Using this procedure, it is clear that dilution ventilation, air cleaning, or displacement ventilation technology even under moderate smoking conditions cannot control ETS risk to de minimis levels for workers or patrons in hospitality venues without massively impractical increases in ventilation. Although there is a scientific consensus that ETS is a known cause of cancers, cardiovascular diseases, and respiratory diseases, although ETS contains 5 regulated hazardous air pollutants, 47 regulated hazardous wastes, 60 known or suspected carcinogens, and more than 100 chemical poisons, the tobacco industry denies the risks of exposure, opposes smoking bans, promotes ventilation as a panacea for ETS control, and works for a return to laissez-faire concerning smoking in the hospitality industry. Smoking bans remain the only viable control measure to ensure that workers and patrons of the hospitality industry are protected from exposure to the toxic wastes from tobacco combustion.

The New York Profile: A review of New York's tobacco prevention and control program

Strong policy changes, respectable funding, and new direction at the Department of Health Tobacco Control Program (DOH TCP) have contributed to the next phase of New York’s tobacco control efforts. New York has been able to pass strong legislation in the areas of product placement, penalties for sales to minors, an excise tax increase, and a fire safe cigarettes law, despite somewhat unsupportive state policymakers. An improving tobacco control network and the work of local tobacco control champions helped push local clean indoor air policies, which led to a strong statewide clean indoor air law. These positive changes should lead to more progress by tobacco control advocates in New York provided funding can be maintained in the face of a large budget deficit.

Program Strengths & Challenges

Partners identified the following strengths and challenges of New York’s tobacco control program:

• The experience and leadership of the DOH TCP Director was a major strength of the program.

• Clean indoor air efforts throughout the state were also a strength.

• Partners were concerned about the security of funding due to the large state and city budget deficits.

• The highly politicized DOH environment and slow grant process were viewed as barriers to the program.

• Little support from state policymakers and the influence of the tobacco industry made implementing a comprehensive program challenging.

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Tobacco Control Policy Making: International (13)

The Tobacco Industry's Successful Efforts to Control Tobacco Policy Making in Switzerland

Cigarette consumption among people 15 years or older peaked in Switzerland in the early 1970’s with 3,700 cigarettes per capita and per year, followed by a decline to 2,800 cigarettes per capita and per year in 1994. After a decline of the proportion of smokers from 37% in 1980 to 31% in 1992, this proportion has increased again to 33% in 1997. Women, particularly the young, and children and adolescents, have shown a continued increase in smoking prevalence, despite the focus of tobacco prevention efforts on children and adolescents.

Every year, over 10,000 people die from tobacco use in Switzerland, about a sixth of all annual deaths in Switzerland, making smoking the leading preventable cause of death in Switzerland. This number is more than 20 times higher than the number of deaths caused by illegal drugs.

The tobacco excise tax in Switzerland is the lowest in Western Europe. The laws governing tobacco products, their marketing and sales, are weak and have little practical effect on the tobacco industry.

There is no meaningful protection of nonsmokers from the toxic chemicals in secondhand tobacco smoke, in public places or work places.

A ten-country survey on people’s experiences and attitudes concerning tobacco and smoking in 1989, commissioned by Philip Morris International, showed that Swiss people were aware of secondhand smoke’s adverse effects on health, but only a minority favored government regulations for smoking in restaurants and workplaces.

A first comprehensive 5-year tobacco prevention program, 1996 to 1999, issued by the Swiss Federal Office of Public Health lacked adequate financial resources, focus on specific interventions, cooperation between partners for tobacco prevention, and program coordination and management. It ignored the role of the tobacco industry.

As a result of recent events in the US and WHO’s active engagement of the tobacco industry, the draft five-year plan for tobacco prevention in Switzerland for 2001 to 2005 identifies the tobacco industry as a major obstacle to tobacco prevention.

Until the recent merger of British American Tobacco (BAT) with Burrus-Rothmans in 1999, the single most important tobacco company in Switzerland was Philip Morris (PM), with a market share of close to 50% (and close to 25% for Marlboro alone). Since the merger, the tobacco market is dominated by PM and BAT, each with a market share of cigarette sales between 45% and 50%.

As was the case in the US, in the early 1960’s, the scientists in Swiss tobacco industry research laboratories (in this case, FTR (Fabriques de Tabac Réunies) / Philip Morris) accepted and discussed the dangerous effects of smoking on health in internal company communications. At that time, these scientists earnestly tried to find ways to reduce the carcinogenic effects of cigarettes through elimination of carcinogenic components.

Contrary to privately expressed views, tobacco industry’s public position in Switzerland was that there was ongoing controversy in the issue whether smoking caused diseases or not.

The “controversy” was nurtured through regular media briefings and scientific meetings with carefully chosen scientists who would publicly support the industry’s position, but without declaring their liaisons with the tobacco industry. Relationships with these industry “consultants” or “witnesses” were maintained through direct payments and indirectly through funding of their research.

By late 1980’s the tobacco industry had identified the decline of social acceptability of smoking in Europe as a major threat to its viability. This recognition led to the development of a comprehensive strategy to fight the secondhand smoke issue. “Courtesy and tolerance” and economic arguments were used to divert the public’s and policy makers’ attention from the health issue. The resulting strategies were often devised in consultation with executives of other Philip Morris subsidiaries and Philip Morris International headquarters in New York. Well aware of its low credibility with the public, journalists were given interviews and told not to mention the tobacco company’s name in the newspaper article.

Official publications, such as “Smoking and Mortality in Switzerland” by the Federal Office of Public Health, the report on the respiratory effects of secondhand smoke by the US Environmental Protection Agency, as well as original scientific publications, such as an article in the American Journal of Respiratory and Critical Care Medicine, dealing with secondhand smoke and respiratory symptoms in Switzerland (SAPALDIA study) written by a group of Swiss scientists, were massively attacked by the tobacco industry. The tobacco industry employed “consultants” and politicians with industry ties, who used standard industry arguments.

One of the most active industry consultants in Switzerland was Peter Atteslander, a Swiss citizen and professor at the University of Augsburg in Germany. He wrote white papers for the tobacco industry and reported from meetings worldwide. Atteslander appeared to be the essence only member of the Switzerland-based “Arbeitsgruppe für Gesundheitsforschung (AGEF) (“Working Group on Health Research”), which published his work without disclosing the ties to the tobacco industry.

To fight smoking restrictions in restaurants and hotels, the tobacco industry developed a strong ally in the hospitality association, the International HoReCa. The secretary general of International HoReCa at the time was Dr. Xavier Frei, also president of the SCRA (most likely the Swiss Café and Restaurant Association). The hospitality association made extensive use of tobacco industry resources and repeatedly printed tobacco industry positions in hospitality industry newsletters, without the members of International HoReCa or SCRA being informed about the close ties between their organization and the tobacco industry.

The “accommodation program,” a well-known tobacco industry strategy to preempt regulatory measures against smoking in restaurants and workplaces first developed in the United States, was used in Switzerland. The fact that even the logo was the same as the one used in the US is another illustration of tobacco industry’s recycling of strategies and tactics worldwide.

The shift of focus from the problem of secondhand smoke to one of indoor air quality in general was (and remains) a major strategy used by the tobacco industry worldwide to dilute the problem of secondhand smoke with other indoor air pollutants and ventilation of buildings. To this end, an indoor air quality control company with close ties to the tobacco industry, ACVA Atlantic Inc., USA, later renamed Healthy Buildings International, HBI, collected data which was used extensively by the tobacco industry to further their goal of downplaying the role of secondhand smoke as a major component of indoor air pollutant. Employees of HBI were sent to Switzerland to collect data on Swiss office buildings, and the data were used in the newsletters of HoReCa to support the accommodation program and against non-smoking regulations. HBI has been discredited in the US.

The tobacco industry tried to influence smoking policy in airplanes through partial funding of IFAA’s (International Flight Attendants Association) world congresses. This influence was established through close relationship with the president of the association, a common industry strategy in influencing organizations. When, in the wake of smoke-free flights in the US and other countries, Swissair finally introduced smoke-free flights, it was heavily criticized in newspaper articles by the Swiss “Smokers Club,” and later the Swiss “Club of Tobacco Friends,” whose president and founder is a former public relations official for the tobacco industry.

The Swiss Cigarette Manufacturers Association successfully influenced smoking policy in railway trains through letters to the publishers of newspapers and direct lobbying toward cantonal authorities and the head of the national railways.

Two referendums on tobacco and alcohol advertising bans in 1979 and 1993 were rejected by Swiss voters despite pre-referendum polls favoring advertising bans through a strong and lasting alliance of the tobacco industry with the advertising agencies and the print media. The tobacco industry successfully kept itself behind the scenes in order to avoid negative publicity while financing the anti-advertising ban campaigns and supplying the alliance against advertising bans with well-crafted arguments by tobacco industry public relations and law firms through the International Tobacco Information Center, INFOTAB. The tobacco industry and its allies used economic and political arguments, such as purported effects on employment, state tax revenues, and individual and corporate freedom to fight the advertising bans.

Close relationships with officials and politicians were emphasized and maintained through regular meetings with the head of the political parties and briefings of the “tobacco caucus” in the parliament. This caucus gave the tobacco industry the means to stay well informed about the political agenda and to easily influence the political process in their favor.

While Switzerland has some of the most progressive and innovative public health promotion programs, most public health advocates underestimate the power of, and driving forces behind, a tobacco industry, and only few of them have confronted the industry directly.

Attempts to undermine tobacco control: tobacco industry "youth smoking prevention" programs to undermine meaningful tobacco control in Latin America

We sought to understand how the tobacco industry uses "youth smoking prevention" programs in Latin America. We analyzed tobacco industry documents, so-called "social reports," media reports, and material provided by Latin American public health advocates. Since the early 1990s, multinational tobacco companies have promoted "youth smoking prevention" programs as part of their "Corporate Social Responsibility" campaigns. The companies also partnered with third-party allies in Latin America, most notably nonprofit educational organizations and education and health ministries. Even though there is no evidence that these programs reduce smoking among youths, they have met the industry's goal of portraying the companies as concerned corporate citizens and undermining effective tobacco control interventions that are required by the World Health Organization Framework Convention on Tobacco Control.

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Tobacco Control Policy Making: United States (82)

Tobacco Industry Political Activity and Tobacco Control Policy Making in Washington: 1983-1996

The tobacco industry is a major political and legal force in the state of Washington through campaign contributions, lobbying, and filing lawsuits.

The tobacco industry has become a major source of campaign contributions to legislative candidates. In the 1985-86 legislative session, the tobacco industry contributed $31,100 to legislative candidates. Contributions reached a peak during the 1989-90 legislative session when the tobacco industry contributed $119,059 to legislative candidates. During the current 1995-1996 election cycle, the tobacco industry has contributed $69,573 to legislative candidates between January 1, 1995 to September 30, 1996. Tobacco industry contributions to legislative candidates is expected to exceed the 1993-1994 amount of $70,524.

During the 1993-1994 legislative session, the combined contributions of Philip Morris, RJ Reynolds, and the Tobacco Institute ranked eighth among top contributors to legislative campaigns in Washington.

In the past few election cycles, there has been a significant shift in tobacco industry contributions away from the Democratic party and towards the Republican party in Washington. During the 1989-90 election cycle, 47 percent of tobacco industry contributions to legislators, legislative candidates, political parties and party controlled committees went to the Republican party. Contributions to Republicans increased to 60 percent in the 1991-1992 election cycle and 66 percent in the 1993-1994 election cycle. Between January 1, 1995 and September 30, 1996, the tobacco industry contributions to the Republican party has increased to 83 percent.

The tobacco industry makes significant contributions to legislative leaders. House Speaker Clyde Ballard has received $11,880 in tobacco industry contributions since 1986, more than any other current legislator. All Republican House Leaders have received tobacco industry contributions and generally had more pro-tobacco industry policy scores. In the Senate, where the Democrats held a one vote majority during the 1995-1996 session, Majority Leader Sid Snyder received $3,600 from the tobacco industry throughout his career. Valoria Loveland, the Democratic Caucus Chair, received $1,600 in tobacco industry contributions during the 1995-1996 electoral cycle.

In addition to providing campaign contributions, the tobacco industry is active in lobbying members of the legislature and the administration. In 1993 and 1994, the tobacco industry spent $643,188. The trend suggests that the tobacco industry will exceed that amount during the 1995-1996 session. In 1995, the tobacco industry spent $368,660 in lobbying expenditures, an increase in the rate of lobbying expenditures over the previous election cycle. The tobacco industry became an especially active lobby in 1991 and 1992, after a number of local smoke free and youth access ordinances were passed in Washington cities and counties.

A statistical relationship exists between tobacco industry campaign contributions and state legislative behavior. The more money a legislator receives, the less likely he or she is to support tobacco control efforts. The tobacco industry also tends to contribute more money to legislators that have supported the industry in the past.

Besides campaign contributions and lobbying, the tobacco industry has used legal tactics to slow down tobacco control activity in the state of Washington. Legal action by the tobacco industry has 1) lead the city of Puyallup to rescind a smoke-free restaurant ordinance, 2) forced the Department of Labor and Industries to defend their clean indoor air regulations in Superior court, and 3) has created an atmosphere of intimidation among organizations associated with Project ASSIST.

Despite the highest tobacco tax in the nation, none of the money raised from tobacco taxes has been earmarked for tobacco prevention or cessation programs.

The state of Washington is among 19 states and counties that is suing the tobacco industry in order to recover health and medical costs associated with tobacco related illnesses.

Tobacco Policy Making in California 2001-2003: No Longer Finishing First

* Tobacco control efforts in California during the 2001-2002 legislative session were hampered by the resurgence of the tobacco industry and a lack of commitment from the Davis Administration.

* During the 2001-2002 legislative session, the tobacco industry spent a total of $5.95 million in political expenditures, which is an increase of $1.3 million over the previous legislative session.

* Campaign contributions from the tobacco industry to legislators, legislative candidates, political parties and constitutional officers totaled $1.66 million, a 13% increase over the previous election cycle.

* Tobacco industry to campaign contributions continue to favor Republicans over Democrats, although the divide is not as great as in previous years. Thus, of the $1,153,466 that was contributed to an identifiable party (including candidates, constitutional officers, legislators and political parties) during the 2001-2002 legislative session, $706,150 went to Republicans (61%) compared to $447,316 to Democrats (39%). This is an increase from the previous election cycle, when Republicans received 58% ($857,023) of the tobacco industry’s contributions in California and Democrats received 42% ($613,587).

* An additional $513,000 was contributed to non-partisan committees in 2001-2002.

* The largest recipients of tobacco industry funds during the 2001-2002 legislative session were Assemblyman Tony Strickland (R-Dist.37), who received $63,000 and Senator James Brulte (R-Dist.31) who received $67,500.

* On average, for every one point increase in a legislator's tobacco policy score, tobacco industry campaign contributions decreased by $3,270. This is a slight decrease from the 1997-1998 legislative session when a one point increase in the policy score resulted in a $3,690 decrease in tobacco industry campaign contributions

*During the 2001-2002 legislative session, 74 candidates and elected officials did not accept contributions from the tobacco industry; 16 Republicans (23% of 69 Republicans) and 59 Democrats (59% of 100 Democrats).

* Among the committees that review tobacco control policy, members of the Assembly Governmental Organizations Committee received the highest average tobacco industry campaign contribution among those recipients who accepted tobacco industry funding: $16,988 per member accepting tobacco funds. The Assembly Revenue and Taxation Committee ranked a close second ($16,750 per accepting member), followed by the Senate Governmental Organizations Committee ($14,694 per accepting member) and the Assembly Health Committee ($12,778 per accepting member). With the exception of the Assembly Budget and Appropriations Committees, all of the Republican members of these committees accepted tobacco industry campaign contributions.

* The tobacco industry spent $4.29 million on lobbying expenditures during the 2001-2002 legislative session, including $3.64 million paid directly to lobbying firms and an additional $649,076 on activities and other expenditures to influence policy making in California. Excluding activity and other expenditures, the tobacco industry increased its lobbying expenditures by $1.05 million (a 41% increase) between the 1999-2000 and 2001-2002 legislative sessions.

* The tobacco industry has adopted a new strategy of using independent expenditure committees, which are not required to report political expenditures, to attack and discredit policy makers sympathetic to tobacco control in California.

* Of the 10 tobacco-related bills that were enacted during the 2001-2002 legislative session, the tobacco lobbying firms reported lobbying against seven of them. The three bills not lobbied on included: a) AB2205 which increases the penalty for knowingly holding or selling tobacco products without having paid the appropriate tobacco tax, b) AB 1867 which expands the area around totlots in which smoking is prohibited and c) SB 322 which prohibits the sale of bidis.

* Of the 17 tobacco-related bills that were not enacted during the 2001-2002 legislative session, the tobacco lobbying firms reported lobbying against 12.

* The tobacco industry has also made efforts to gain legitimacy in the public’s eye through youth prevention programs and image changes, such as Philip Morris changing its name to Altria and renewing its efforts to donate funds to community projects. The result is that policy makers, such as Carole Migden, are starting to state that the tobacco industry has changed as a justification for accepting tobacco industry campaign contributions.

* The effectiveness of California’s tobacco control efforts were recognized by the tobacco industry in September 2002 when R.J. Reynolds filed suit against the California Tobacco Education Media Campaign, claiming that the media campaign made it impossible for the tobacco companies to receive a fair trial with an unbiased jury. Judge Michael T. Garcia ruled against the tobacco company.

* R.J. Reynolds made a second attempt at legitimacy in the court of public opinion, this time in conjunction with Lorillard, by returning to the California Courts in April 2003, filing allegations of vilification by the Media Campaign.

* The tobacco industry spends more than $1.2 billion annually on advertising and promotions in California alone. At the same time, California’s Tobacco Control Program was funded at only about 12% of the tobacco industry’s expenditures on advertising and promotions.

* The Tobacco Control Program’s budget has continued to erode at the hands of the Davis Administration. The Governor’s Proposal for the 2003-2004 Budget appropriates approximately $86 million for the program, which is a decrease from $108 million in 2002-2003 and $154 million in 2001-2002. The decline in revenues is due to a decrease in Proposition 99 revenues as a result of decreased tobacco consumption and a lack of new funds dedicated to the Tobacco Control Program. At the same time, inflation has reduced the purchasing power of the funds that are available.

* In 2001, Governor Davis increased funding for the Media Campaign $19 million in FY1999-2000 to $45 million for FY2000-2001 and FY2001-2002. In 2001, Governor Davis also allocated $20 million from the state’s share of MSA revenues for a youth anti-smoking campaign. However, this commitment to the Tobacco Control Program was short-lived, as Governor Davis withdrew the additional funds in 2002.

* While rates of tobacco use in California have remained stable at about 17% between 2000 and 2001, the prevalence decreased to 16.6% in 2002. This drop may be a reflection of the additional funds provided in 2000 and 2001.

* In 2002, there were three proposals introduced to increase the cigarette excise tax. Governor Davis introduced a 50 cent increase which was changed to a 63 cent increase in the Senate’s revision of the budget, Senator Deborah Ortiz introduced a 65 cent increase, and Speaker Herb Wesson proposed a $2.13 increase. While Senator Ortiz intended the revenues from a tax increase to go to tobacco control and access to health care programs, neither the Governor nor Speaker Wesson earmarked any portion of the tax for tobacco control efforts. None of these proposals were enacted.

* In January 2003, Governor Davis included a $1.10 cigarette tax increase in his 2003-2004 Budget proposal, but these funds were intended to bridge the $34.6 billion budget deficit and as of April 2003, none of the revenues were earmarked for tobacco control efforts.

* In his May 2003 budget revision, Governor Davis proposed only a 23 cent tax increase in 2003-2004 and an additional 40 cent tax increase in 2004-2005. This decision was made despite a 61% public approval for a cigarette tax increase of $2.00 and a 68% approval for a cigarette tax increase of 75 cents.

* While state officials decided to securitize $2.5 billion in Master Settlement Agreement revenues in January 2003, the Governor's May 2003 budget revision indicated that the state would not securitize its remaining share of funds. Instead, the $173 million expected for the next fiscal year would be used to cover General Fund expenditures for the Healthy Families Program.

*. While the Governor's May revision of the 2003-2004 Budget did not reflect the Tobacco Education and Research Oversight Committee’s funding recommendations, funding for the Tobacco Control Program was increased by 6% as opposed to a decrease or a diversion of funds as a result of a one time increase in the Proposition 10 backfill.

* While the Davis Administration has not exhibited the hostility to the Tobacco Control Program evidenced during the Wilson years, it has also failed to give an effective program a priority. Progress only took place when the administration was faced with external pressures, either mounted by health advocates or, in one case, a legal challenge by the tobacco industry.

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Reports on Industry Activity from Outside UCSF (82)

The Tobacco Industry in New Zealand: A Case Study of the Behaviour of Multinational Companies

This report takes a preliminary look at the behaviour of the tobacco industry in New Zealand. It is based on a series of literature searches, interviews with key informants, and on the examination of internal tobacco industry documents, many of which have been released by court orders in the United States. The report considers the tobacco industry activities in the context of a suggested framework for a responsible industry. The framework assumes that where the available evidence indicates that a consumer product poses a significant health hazard, then there are a number of appropriate responses that a business should undertake. These include warning the public, ceasing to promote the product and modifying the product to reduce harm.

We found internal tobacco industry documents that appeared to show that advisers to the industry in New Zealand believed that smoking caused cancer, at a period when the industry was denying this link in statements to Parliament. Other documents showed that the industry took some credit for the decision in 1994 to end the Public Health Commission. The industry believed that they had slowed the adoption of new health warnings about tobacco during the 1990s. The documents show that the industry was assisted in their opposition to tobacco control activity by major New Zealand law firms, and by lawyers that included Sir Geoffrey Palmer, an ex-Prime Minister of New Zealand.

The behaviour of the tobacco industry in particular areas is summarised below. The industry and the direct health effects of smoking: The available evidence suggests that the tobacco industry in New Zealand has been irresponsible in its prolonged delay in admitting the health risks posed by its products. Instead, it has attempted to falsely reassure the public and has been obstructive regarding the placement of health warnings on its products. When the industry has started to admit to the health risks from smoking, it has done so in a vague and disingenuous way. It has failed to substantively and appropriately communicate the health risk of its products to its customers and the public.

The industry and the addictiveness of nicotine: The tobacco industry in New Zealand has been irresponsible in not informing its customers that its products are addictive. It has tried to provide reassurance to the public by defining smoking as merely a “habit”. Furthermore, the industry has been obstructive about the placement of health warnings with the word “addiction” on its products. Even though internal industry documents have showed that British American Tobacco and Philip Morris have known for several decades that nicotine is addictive, the companies have still not actively and explicitly acknowledged the severity of the dependence created.

The industry and second-hand smoke: The tobacco industry in New Zealand has consistently failed to warn the New Zealand public or the consumers of its products about the health risks from second-hand smoke. Furthermore, it has attempted to reassure the public and smokers that these risks are not real. These industry activities have been undertaken while the parent companies of some of the New Zealand companies knew of the risks posed by second-hand smoke (as shown by their internal documents). The irresponsible actions of the industry in New Zealand are similar to the approach taken by the industry elsewhere.

Industry misuse of product design and opposition to harm reduction: The tobacco industry in New Zealand appears to have misused the design of tobacco products, particularly its use of additives. Many of the design changes may have been for marketing purposes rather than for harm reduction. The industry has also opposed the removal of fire accelerants from cigarettes. The apparent focus on marketing issues and lack of concern about significantly reducing harm to consumers is consistent with the policies of the industry’s parent companies and of other overseas tobacco companies.

Industry opposition to tobacco control initiatives: The available evidence suggests that the tobacco industry in New Zealand has opposed all substantive measures to help reduce tobacco consumption, to prevent the uptake of smoking by youth, and to protect the population from second-hand smoke. In particular, they have opposed restrictions on tobacco promotion (advertising and sponsorship) and smokefree environment regulations. They have also opposed the organisations involved in tobacco control and the compensation of those harmed by tobacco use. This irresponsible pattern of behaviour is highly consistent with that of the parent companies overseas and of other international tobacco companies.

A responsible industry? It appears that the tobacco industry in New Zealand has behaved in a highly irresponsible manner over the last four decades. The industry’s activities would appear to conflict with the societal values embodied in consumer protection legislation such as New Zealand’s Fair Trading Act. Controlling the industry: We argue that given the extensive harm to New Zealanders from tobacco use, and the chronically irresponsible behaviour of the tobacco industry, there is a need for the New Zealand Government to more intensely regulate this particular industry. We suggest that the desired end point for Government policy is a smoking prevalence and exposure to second-hand smoke as near as possible to zero, while still permitting smoking to be legal. A wide range of tobacco control interventions should be used to achieve these end points.

We consider that essential elements of a more effective tobacco control programme would include regular tobacco taxation increases and a much tighter regulatory environment. In particular, there is a need to severely constrain the way tobacco is sold and to control the composition of cigarettes. Publicising irresponsible tobacco industry activities and facilitating legal action against the industry appear to be valuable aspects that could be introduced to New Zealand Government tobacco control activities.

An effective long-term programme for a virtually smokefree New Zealand would need to be carefully planned. It may need to be conducted by a focused, independent agency with secure funding. Without such measures the irresponsible behaviour of the tobacco industry in New Zealand will continue to impose a major burden on the health and welfare of its customers and on the public of New Zealand.

Golden Leaf, Barren Harvest: The Costs of Tobacco Farming

While a few large-scale tobacco growers have prospered, the vast majority of tobacco growers in the Global South barely eke out a living toiling for the companies. Many tobacco farmers are now stuck producing a crop that is labor and input intensive and brings with it a host of health and environmental dangers. Meanwhile, the cigarette companies continue to downplay or ignore the many serious economic and environmental costs associated with tobacco. Recent research conducted by the World Bank has shown that, contrary to tobacco industry claims, global tobacco control efforts are not a threat to developing countries or tobacco farmers. As this report shows, even with global demand for tobacco leaf rising, the inescapable problems with tobacco farming make it a losing investment for most countries and farmers.

The National Social Climate of Tobacco Control, 2000-2001

This survey is an attempt to contribute to the understanding of tobacco control through the introduction of an institutional-based perspective that stresses not simply individual variations in behaviors and attitudes, but rather attempts to use cross-sectional survey data to monitor trends for societal norms, practices, and beliefs surrounding tobacco. This technique is primarily one of a shift in focus and interpretation rather than basic survey methodology.

The design of the survey instrument was based on an extensive review of extant instruments such as the Behavior Risk Factor Surveillance System, the Current Population Survey - Tobacco Supplement, and the California Adult Tobacco Survey, and supplemented by additional items needed to flesh out the social climate concept. The reliance on existing measurements was greatly enhanced by the review and excellent advice from the Office of Smoking and Health of the Centers for Disease Control and Prevention (CDC).

The origins of this study can be traced to research associated with the tobacco settlement in Mississippi. We developed the social climate approach to help the Mississippi Tobacco Control Foundation – The Partnership for a Healthy Mississippi and the Mississippi State Department of Health - monitor the degree to which their efforts were impacting the social fabric of Mississippi.

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Surveys and Program Evaluations from Outside UCSF (62)

American Legacy Foundation. Legacy First Look Report 1. Cigarette Smoking Among Youth: Results from the 1999 National Youth Tobacco Survey

The purpose of this report is to provide detailed information on cigarette smoking among youth, including the prevalence and intensity of smoking behavior as well as the characteristics of the cigarettes smoked by middle and high school students. It is the first in a series of reports from the American Lagacy Foundation (Legacy) that will summarize findings from the NYTs and other surveys and studies conducted by Legacy

The California Tobacco Control Program: A Decade of Progress, Results from the California Tobacco Survey, 1990-1999

Executive Summary:

During the 1990s in California, smoking behavior and attiudes about smoking have changed, as measured from the California Tobacco Surveys (CTS) and other data sources. Some of the most important findings from the CTS are highlighted below. For a more complete summary, see the Key Findings from each chapter of this report, which appear both in this Executive Summary and at the end of each chapter. Throughout this report, results are given with the margin of error (±95% confidence limits)

Adult Smoking Behavior

Over the decade, per capita cigarette consumption fell by a factor of 57% in California compared to only 27% in the rest of the United States. By the end of 1999, Californians consumed only 4.1 packs of cigarettes per person per month, compared to 9.1 in the rest of the United States.

While adult (18+ years) smoking prevalence decreased in the first few years of the decade, after 1994 changes in the prevalence were not statistically significant. The most recent CTS indicated that adult smoking prevalence was 18.3±0.3% in 1999.

Despite relatively stable smoking prevalence since 1993, fewer California smokers are heavy daily smokers, and between 1990 and 1999, the prevalence of daily smoking declined by a factor of 18.6%. These findings explain the decline in per capita cigarettes consumption. In 1999, only 13.0±0.3% of Californians were daily smokers. Only 6.4±0.4% of California college graduates were daily smokers.

Over the decade, the percent of California smokers making a quit attempt lasting a day or longer in the last year increased by a factor of 25.9% to 60.1±1.5% in 1999. Quitters in 1999 appeared to be as successful as those earlier in the decade.

In California, the cigar fad appears to be dissipating, mostly among adults who have never smoked cigarettes. In 1999, most current California cigar smokers only a few cigars a month 83.2Executive Summary:

Durig the 1990s in California, smoking behavior and attiudes about smoking have changed, as measured form the California Tobacco Surveys (CTS) and other data sources. Some of the most important findings from the CTS are highlighted below. For a more complete summary, see the Key Findings from each chapter of this report, which appear both in this Executive Summary and at the end of each chapter. Throughout this report, results are given with the margin of error (±95% confidence limits)

Adult Smoking Behavior

Over the decade, per capita cigarette consumption fell by a factor of 57% in California compared to only 27% in the rest of the United States. By the end of 1999, Californians consumed only 4.1 packs of cigarettes per person per month, compared to 9.1 in the rest of the United States.

While adult (18+ years) smoking prevalence decreased in the first few years of the decade, after 1994 changes in the prevalence were not statistically significant. The most recent CTS indicated that adult smoking prevalence was 18.3±0.3% in 1999.

Despite relatively stable smoking prevalence since 1993, fewer California smokers are heavy daily smokers, and between 1990 and 1999, the prevalence of daily smoking declined by a factor of 18.6%. These findings explain the decline in per capita cigarettes consumption. In 1999, only 13.0±0.3% of Californians were daily smokers. Only 6.4±0.4% of California college graduates were daily smokers.

Over the decade, the percent of California smokers making a quit attempt lasting a day or longer in the last year increased by a factor of 25.9% to 60.1±1.5% in 1999. Quitters in 1999 appeared to be as successful as those earlier in the decade.

In California, the cigar fad appears to be dissipating, mostly among adults who have never smoked cigarettes. In 1999, most current California cigar smokers only a few cigars a month (83.2±3.7% smoked <5/month). Cigar smokers who were former cigarette smokers showed the highest level of monthly cigar consumption.

Adolescent Smoking Behavior

Although California adolescents showed an alarming increase in smoking prevalence (any smoking in the past 30 days) between 1993 and 1996, by 1999 current smoking prevalence had fallen to 7.7±0.8%, significantly lower than prevalence in 1990.

Among young adolescents 12-13 years of age, the percentage of committed never smokers rose by a factor of 17.7% between 1996 and 1999 to 65.7±1.9%.

In 1999, 79.8±6.4 of current adolescent established smokers reported they had tried to quit sometime in the past.

Adolescent use of other tobacco products is highly related to cigarette smoking. In 1999, rates of adolescent ever experimentation with cigars (15.0±1.2%) and bidis (7.0±0.8) were much higher than for chewing tobacco or snuff (3.1±0.5%).

Protection of Nonsmokers form Secondhand Tobacco Smoke

In 1999, 93.4±0.8% of California indoor workers reported that smoking was not allowed in their workplace, up from 35.0±1.3% in 1990.

In 1999, the percentage of nonsmokers exposed to someone smoking in their work area in the past two weeks increased significantly from 11.8±1.5% in 1996 to 15.6±1.4% in 1999. Over the decade, however, exposure to secondhand smoke in the workplace decreased by a factor of 46.2%

In 1999, 73.3±1.1% of Californians lived in smokefree homes, up by a factor of 30% since 1993. Further, nearly half (47.2±1.8%) of current California smokers live in smokefree homes, a factor increase of 135% since 1993.

Accordingly, the percentage of California children and adolescents protected from secondhand smoke at home increased by a factor of 15.1% since 1993, to 88.6±1.1% in 1999.

Other Important Findings

While adult California smokers were more concerned about the price of cigarettes after the $0.50/pack excise tax increase in January 1999, about 70% buy their cigarettes at the most expensive outlets, only a few (5.47±0.8%) bothered to seek out untaxed sources, and 58.2±1.139% supported a further tax increase of $0.50 or more.

In 1999, less than half (48.0±1.5%) of California’s adolescent never smokers believed that it is easy to get cigarettes, down by a factor of 16% since 1996.

Perceived compliance with smokefree school policies increased by a factor of 64% from 1996 to 1999, when 66.6±1.5% of adolescents reported that most of the students who smoke obey the no-smoking rule on school property.

In 1999, 9.0±0.9% of adolescents had a tobacco promotional item, a factor decrease of 34.5% since 1996. However, 14.9±1.1% of adolescents said they would be willing to use a promotional item. Few adults (1.2±0.2%) reported ever giving such an item to a child or adolescent, but 7.6±0.6% said they were willing to do so.

The Effect of the New York State Cigarette Fire Safety Standard on Ignition Propensity, Smoke Toxicity and the Consumer market

This report examines New York's initial experience implementing fire safety standards for cigarettes. This study provided the first assessment of the ability of manufacturers to produce cigarettes that reduce ignition propensity, while maintaining price and consumer acceptability. The study also measures a number known toxic compound s commonly found in cigarettes to determine if there are substantial differences in their levels compared to Mssachussetts cigarettes. The study compares laboratory testing of RIP and the level of nineteen known toxic compounds for the same four cigarette brands sold in New York and Massachussetts. The study further examines measures of tax revenue, pricing, and brand availability to assess the effects of fire safety standards on the consumer market.

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WHO Tobacco Control Papers (117)

SACTob Recommendation on Tobacco Product Ingredients and Emissions

Historically, cigarettes and other tobacco products have been exempt from health and safety standards for ingredients and emissions that are typically applied to other consumed products including foods, beverages and drugs (1, 2, 3). Although some countries have begun to develop and apply standards for allowable ingredients, there are no globally accepted standards or guidelines (2). Presently limits on emissions from tobacco products have not been implemented with the exception of estimates of tar, nicotine and carbon monoxide (2). An important consideration in the regulation of ingredients is that when the cigarette is used as intended, the ingredients can be modified and emission profiles altered during the processes of combustion (“burning”) and pyrolysis (“modification by heat”). Therefore, the focus of this document is on the importance of evaluating tobacco product emissions as well as their ingredients under the conditions in which these products are actually used. The purpose of the document is to provide recommendations to support the development of protocols for assessing tobacco product ingredients and associated emissions with the intent to reduce tobacco caused disease.

The central premise is that tobacco product ingredients and emissions thereof, including nicotine, should be regulated. Ingredients include all product components, materials used to manufacture those components, residual substances from agricultural practices, storage and processing, and substances that can migrate from packaging into the product. [The term ingredients is preferred to terms such as “additives” and “processing aids”]. Emissions comprise what is actually delivered to the user and are the product responsible for most tobacco-attributable death and disease. Emissions are substances that are produced when the product is used and this is distinguished from "exposure", a term that in this context refers to the fraction of emissions that is actually absorbed by the user.

Effectiveness of Tax and Price Policies for Tobacco Control

This new volume of the IARC Handbooks of Cancer Prevention in Tobacco Control presents a critical review and evaluation of the evidence by 25 international experts from twelve countries on the economics, epidemiology, public policy and tobacco control aspects of tax and price policies. The working group draws conclusions about the effectiveness of tax and price measures to control tobacco use in the population. The Handbook covers an overview of tobacco taxation; industry pricing strategies and other industry initiatives diluting the effects of taxes on consumption; tax, price and aggregated demand for tobacco, as well as demand at the individual level in adults, young people and the economically disadvantaged; tax avoidance and tax evasion and the economic and health impacts of tobacco taxation. This body of evidence and the consensus evaluation of 18 concluding statements on the impact of interventions to increase the price of tobacco products, can assist policy makers, government officials, evaluators and researchers working in tobacco control and disease prevention, to base their decisions on the latest scientific evidence.

The Scientific Basis of Tobacco Product Regulation

The Tobacco Free Initiative is proud to announce the release of the second volume of the WHO Study Group on Tobacco Product Regulation (TobReg) Technical Report Series on the Scientific Basis of Tobacco Product Regulation. This WHO Technical Report Series makes available the findings of an international group of experts that provide WHO with the latest scientific and technical advice in the area of product regulation. The second report presents policy recommendations on the topics of: smokeless tobacco products and their health effects, and implications for harm reduction and research needs; 'fire safer' cigarettes and approaches to reduced ignition propensity; mandated lowering of toxicants in cigarette smoke, such as tobacco specific nitrosamines and other constituents; and, cigarette machine smoking regimens. The Study Group intends this new set of recommendations to be useful to WHO Member States, and national policymakers and regulators in shaping tobacco control policy.

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