Premature Death in the New Independent States (1997) / Chapter Skim
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Tobacco Control Policy Strategies: Lessons from Western Developed Countries
Tobacco Control Policy Strategies: Lessons from Western Developed Countries
Pages 287-313
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From page 287... ...
Worse still, this negative health impact is not restricted to the consumer, but extends to others who are exposed to environmental tobacco smoke (U.S. Environmental Protection Agency, 1992~.
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From page 288... ...
This is followed by a look at the context for a tobacco control program, including the natural history of smoking behavior and the role of advertising in increasing tobacco consumption. The chapter then examines the various components of a tobacco control program.
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From page 289... ...
The entry of the transnational tobacco industry giants into the economy and politics of the region has changed expectations for consumption over the next decade. In 1988, per capita consumption projections for the Soviet Union foresaw a negligible increase through 1998, with some projected brand switching toward filtered cigarettes (60 percent of market in 1988 to 80 percent in 1998)
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From page 290... ...
The entrance of the transnational tobacco companies significantly changed that scenario. In purchasing tobacco plants in Central and Eastern Europe, the transnational tobacco companies have significantly increased their manufacturing capabilities.2 It is expected that the long-term goals of the companies are to expand cigarette production within the region, to expand per capita consumption levels toward those seen in the United States, and to increase the level of profitability for each cigarette sold.3 To promote higher consumption levels, the industry might be expected to follow the prescription that has been so successful in other countries: large marketing expenditures and the use of their economic might to create pressure.
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Accordingly, this discussion of the context for tobacco control starts with a review of the natural history of smoking behavior. One of the peculiarities of tobacco control is the existence of a major industrial group that seeks to influence behavior in a way that is directly contradictory to the goals of tobacco control programs.
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37 42 47 52 57 62 FIGURE 11-2 Different measures of smoking behavior for Californian females, 1992. SOURCE: Pierce et al.
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COMPONENTS OF A TOBACCO CONTROL PROGRAM A viable tobacco control movement requires widespread acceptance of and concern about the health consequences of smoking (U.S. Department of Agriculture, 1985, 1989~.
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This section examines the various components of a tobacco control program, including the implementation of policies to restrict advertising, efforts to influence beliefs about the health consequences of smoking and environmental tobacco smoke, the role of health professionals, school-based smoking prevention programs, the use of cigarette pricing for tobacco control, efforts to control access by minors, use of mass media for counteradvertising, and the role of restrictions on smoking behavior. The Implementation of Policies to Restrict Advertising Advertising Bans and Their Impact on Tobacco Consumption and Smoking Uptake A number of approaches to restricting tobacco marketing have been tried.
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From page 295... ...
Reaction of the Tobacco Industry to Restrictions on Advertising To investigate the reaction of the industry to the 1971 broadcast media advertising ban, we look at trends in marketing expenditures before and after the introduction of the ban. During the 1960s, tobacco marketing expenditures were relatively stable, exhibiting a 26 percent increase over the decade.
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From page 296... ...
The Importance of Beliefs About Health Consequences of Smoking and Environmental Tobacco Smoke Shifts in Beliefs About the Health Consequences of Smoking In the 1920s, the health consequences of smoking were not well known. An example of this is given by a dean of medicine at a university who recounted the story of being awakened in the middle of the night so that he could see "a case that you will never see again in your career." It turned out to be a patient with lung cancer.
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From page 297... ...
Trends in Initiation and Cessation Prior to the official start of the public health campaign against smoking in 1964, the dissemination of information about the health consequences of smoking was the only anti-smoking intervention. Accordingly, we are able to assess its importance for smoking behavior by studying trends in initiation and cessation of smoking over the period.
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. The tobacco industry recognized the importance of physicians in the 1930s when it advertised that more doctors smoked Camels, and later advertised that dentists advised the public to smoke Viceroys.
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bEnvironmental tobacco smoke. SOURCE: Pierce et al.
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From page 300... ...
In addition, General Pershing became an ardent advocate for the provision of free cigarettes to the troops. The tobacco industry was fond of quoting him: "I'll tell you what we need to win the war: we need cigarettes just as much as bullets." As a result, the Red Cross became one of many associations raising money to dispatch free cigarettes to allied soldiers.
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From page 301... ...
There was a marked increase in the incidence of initiation among young men (Kennett, 1987~. With demobilization, the incidence level declined to what it had been previously; again, however, there was no similar return to prewar levels in per capita consumption.
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There was no public discussion of the tax or price increase and no identifiable effect on consumption. From the mid-1980s through 1993 in the United States, the tobacco industry introduced generic "no-name" cigarettes at a lower price while it systematically increased the price of its premium brand products.
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From page 303... ...
Nevertheless, this period was the first during which there was a sustained decline in per capita consumption (see Figure 11-5~. The requirement for anti-smoking messages is widely believed to have provided the disincentive for the tobacco industry to conduct a vigorous fight against the broadcast media advertising ban.
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From page 304... ...
The tobacco industry typically outspends these campaigns by orders of magnitude as high as 25 to 30 times. Furthermore, the industry, in conjunction with advertisers, has carefully honed its messages and their presentation so that it is virtually impossible for tobacco control programs to win the image war with adolescents.
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From page 305... ...
However, this industry message may be vulnerable in the area of "lack of control." Many adolescent smokers report considerable difficulty in trying to quit, and for this age group in particular, such a loss of control could serve as an effective disincentive to start smoking. The Role of Restrictions on Smoking Behavior One of the major goals of tobacco control is to protect nonsmokers from the harmful effects of environmental tobacco smoke.
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From page 306... ...
However, the willingness of legislators to promote tobacco control goals must be expected to change with the entry of the transnational tobacco companies into the economy. There is considerable evidence in the United States that the distribution of tobacco industry largesse is sufficient to weaken the enthusiasm and resolve of most legislators (Moore et al., 1994; Glantz and Begay, 1994~.
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Given that Eastern European government authorities have shown a willingness to try to ban cigarette advertising (although not to enforce such a ban) , they may be willing to allow public service announcements presenting the health side of the issue.
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Johnson, and D Bal 1992 Protection from environmental tobacco smoke in California: The case for a smoke-free workplace.
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Begay 1994 Tobacco industry campaign contributions are affecting tobacco control policymaking in California. Journal of the American Medical Association 272:1176-1182.
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Waranch 1990 Ending smoking at the Johns Hopkins Medical Institutions: An evaluation of smoking prevalence and indoor air pollution. Journal of the American Medical Association 264: 1565- 1569.
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1984 A Smoking Gun: How the Tobacco Industry Gets Away with Murder. Philadelphia, PA: George F
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The fourth unique period in tobacco advertising started with the launch of women's brands of cigarettes in 1967 (Albright, 1988; Ernster, 1985) ; this campaign occurred at the same time as a major counteradvertising campaign on the health consequences of smoking (U.S.
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1ndus~ undertook in me eddy yews. T-upb me 1870s Id 1880s, ~ picture of ~ scantly mad Coma was Encoded w1~ each pack of cigars.
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