Tobacco Control Playbook

KEY MESSAGE: Tobacco smoking is highly addictive and, in most cases, starts in childhood. The tobacco industry's marketing, research and public relations activities are a source of misinformation. These issues make it difficult for people to make free and informed choices about tobacco smoking.

What is the issue?

It is sometimes claimed that smoking is a free and informed choice.

What is the evidence for concern?

The tobacco industry and its allies argue that:

• Smoking is a free and informed choice, made by adult consumers who are well-informed about the risks of smoking;
• There is no certainty about various aspects of the harms of smoking, including addiction;
• The tobacco industry has made significant contributions to educating the public about the negative health effects of smoking, and long supported research and products designed to make smoking less harmful;
• Tobacco control interventions are part of an authoritarian "nanny state" which imposes unnecessary regulations, restricts free choice, and treats smokers as victims who cannot act responsibly for themselves ^[1]; and
• The tobacco industry should be permitted to sell and market its products freely to consumers without curbs and regulations.

What is the reality?

• Smoking is highly addictive, due particularly to the role of nicotine ^[2]. Cigarettes are also highly engineered: many varieties contain added chemicals such as ammonia and bronchodilators such as liquorice to amplify the effects of nicotine ^[3].
• Although many smokers have quit without assistance ^[4], quitting smoking can be difficult for some. The vast majority of smokers want to quit, but an estimated 3–7% unaided quit attempts are successful ^[5]. Around 90% of smokers regret that they ever started smoking ^[6], and in any given year approximately 40–50% attempt to quit ^[7].
• Most smokers start as children or adolescents, long before they can appreciate the risks and addictiveness of smoking. Many young people also overestimate their ability to quit later in life ^[8], and tend to focus on short-term reasons for smoking, such as acquiring a socially desired identity ^[9].
• Many smokers are not fully aware of all the harms of smoking, the magnitude of the problem, the extent of the risks that apply to them personally, or the suffering likely to result for them and their families ^[10].
• Tobacco companies have denied the evidence, while supporting and promoting research and other activities to undermine the advice of health authorities and, in the industry's own words, to "spread doubt over strong scientific evidence [so] the public won't know what to believe" ^[11].
• The tobacco industry has a long history of marketing cigarettes to children and young people ^[12]. Tobacco companies do this using cleverly targeted marketing campaigns and diverse media such as television, billboards and displays at the point of sale, as well as more indirect strategies such as tobacco product placements in movies and video games, event sponsorships, and tobacco promotions on websites and social media.
• Tobacco industry marketing entails a wide range of deliberately misleading practices which make it difficult for people to make informed choices about smoking ^[13]. Also, education programs run by tobacco companies have been shown to have no positive impact and in all likelihood to be counter-productive ^[14].
• Tobacco industry marketing and public relations have placed a strong focus on implying a lower health risks for some brands. For example, tobacco companies market some tobacco brands using descriptors such as light or mild, using light- or pastel-coloured packaging. These brand variations are intended to convey a lower health risk and are essentially a strategy to have more health-conscious smokers "kept in the market" longer ^[15], even though these cigarette varieties provide no health benefits over other brands.
• Tobacco companies also use additives such as menthol in many cigarette brands to mask the harshness of tobacco and to create the illusion of a reduced health risk which, in particular, encourages smoking initiation and sustained smoking among children and young people ^[16].
• Tobacco companies have forcefully opposed measures that might increase public awareness of the harms of smoking, encourage smokers to quit, and prevent the onset of smoking among children.
• An important role for government is to inform the public about possible harms to health, and act to protect the community, as it has done in relation to both communicable and noncommunicable diseases in areas such as safe food, safe water, road safety, and many others.

Key messages

• Smoking is not a free choice – it is addictive; most smokers start as children, long before they can understand either the harms or the concept of addiction; and quitting smoking can be very difficult.
• Smokers are not well informed about the harms of smoking, the risks to themselves, and the suffering likely to result in them and their families.
• Tobacco companies have a long history of denying and undermining the evidence, marketing to children, promoting products as though they conferred health benefits, and opposing measures that would inform smokers properly and reduce smoking.
• Governments have a responsibility to inform the community about harmful products and behaviours and take action that will protect public health.