Tobacco Control Playbook

KEY MESSAGE: There is overwhelming evidence that tobacco companies continue to make massive efforts to mislead the public about the harms of smoking, deny and undermine the evidence, and to oppose strong public education programs that would present the evidence effectively.

What is the issue?

Tobacco companies present themselves as being responsible organisations that provide appropriate information about the health consequences of smoking, and have played a valuable role in education of children, young people and the community.

What is the evidence for concern?

• Tobacco companies have historically sought to give the impression that they are interested in ensuring that the public is accurately informed about health aspects of smoking, accepting "an interest in people's health as a basic responsibility, paramount to every other consideration in our business" ^[1].

• They have funded research programs purportedly designed to elicit more information about smoking and health ^[1].

• The companies claim that they do not want children to smoke, and that this is a behaviour only "adults who fully understand the risks" should engage in ^[2][3][4].

• The companies have developed many "education" programs, some specifically designated as "youth smoking prevention", including through schools and youth development programs ^{[2][3][5][6][7][8]}. They also provide support for activities for parent education programs and organisations that "positively influence kids and their decision not to engage in risky behaviours like tobacco use" ^[3].

• The companies provide information about smoking and health on their websites and elsewhere, often citing authoritative reports and with links to reputable government and health agencies ^[9][10]. Some have developed their own programs such as "QuitAssist" purportedly to support smokers who want to quit ^[3][11]. Some also even have websites dedicated to disseminating tobacco industry-funded research on products that reduce the impact of "cigarette smoking on public health" ^[12].

• The industry presents smoking as an adult behaviour or "adult choice", with the implication that this will discourage children from smoking ^[5][6][13].

• Tobacco industry approaches to education have also focused heavily on themes such as peer pressure, parental role modelling, emphasis on "the law", and penalising children and adolescents for purchasing and possessing cigarettes ^[6].

• There have been partnerships between tobacco companies, retailers and others, including health and education ministries and non-government organizations, purportedly aimed at preventing smoking by children ^{[2][3][8][14]}.

• The companies depict provision of information on smoking and health, "product transparency" and industry education programs as examples of social responsibility ^[3][15].

• The companies claim to support legislation setting a minimum age to purchase tobacco products, and assert that they work with governments to introduce the legislation where none exists ^[13].

• The companies take credit for complying with mandated health warnings and product information, along with claims that their marketing is responsible ^[3].

What is the reality?

• There is overwhelming and incontrovertible evidence that tobacco companies have made massive efforts to mislead the public about the harms of smoking, deny and undermine the evidence, attack scientists and others presenting evidence about the dangers of smoking, and to oppose strong public education programs that would present the evidence effectively ^[16].

• There is similarly overwhelming evidence that tobacco industry "research" programs were a smokescreen from the earliest years. They were used to present an impression that tobacco companies were concerned about possible harms – but in reality aimed at confusing both public and policymakers, and giving the impression that more research was needed to determine whether smoking was indeed harmful ^[16].

• While the companies have consistently claimed that they do not want children to smoke, there is evidence of their interest in smoking among children and early commencement of smoking. They have targeted young people through advertising and use of themes widely accepted as being appealing to children (e.g. Joe Camel) ^[7]. They have also strongly opposed the measures that would be most effective in preventing the onset of smoking among children and young people ^[6]. Further, youth-focused programs have served to justify tobacco industry market research on young people ^[5].

• Information provided about smoking and health on company websites and elsewhere is minimalist and misleading. It uses phrases and terminology that, while in recent years accepting that there may be some harms, presents them in a very low-key manner, does not cover all the harms, still denies some of the evidence (e.g. on passive smoking) ^[1], and fails dismally to present the magnitude and urgency of the problem – or indeed the companies' responsibilities in promoting further death and disease from tobacco use and opposing measures recommended by health authorities. Evidence from industry documents further shows that in various contexts tobacco companies have worked assiduously to avoid mentioning the harms of smoking in the documentation ^[5][17]. Even the "QuitAssist" program starts by stressing the difficulties of quitting, and fails dismally to present the massive health risks of smoking as the primary cause for quitting ^[11].

• Presentation of smoking as an "adult choice" is widely perceived as encouraging smoking by children through presenting smoking as a behaviour to which children should aspire ^[5][7]. Youth education programs by the tobacco industry are complemented by tobacco advertising, which has over the years further presented smoking as "forbidden fruit" and an act of rebellion ^[5].

• The approaches to education adopted by tobacco companies have in sum focused almost entirely on themes least likely to be effective, and have avoided those that would have most impact. Research shows clearly that tobacco industry education programs for young people have been at best ineffective, and at worst likely to encourage smoking ^[18]. Industry documents indicate that such evaluations as have been carried out by the companies are more concerned about public relations impact than actually preventing or reducing smoking. There is further evidence that such programs have been presented by the industry primarily in the hope that they will serve as an alternative to effective action by governments ^[5][17].

• Use of third parties has been an important strategy for tobacco companies in ensuring further support for their activities and presenting ineffective programs as a worthwhile approach ^[14].

• "Big Tobacco" is the world's least reputable and most irresponsible industry. Tobacco companies have used terms such as "air cover" to describe activities claimed to display social responsibility ^[19]. In recent years, the companies have placed an increasing focus on "corporate social responsibility", providing information through a range of media about their activities supporting communities, charitable organisations and other apparently socially desirable objectives ^[20]. This is manifestly all part of a public relations program designed to present the industry as being socially responsible and acceptable, rather than responsible for more than seven million deaths each year around the world ^[21], targeting vulnerable communities and ruthlessly opposing any action that might reduce its sales.

• Any claims for support of a minimum purchase age should again be seen as a public relations mechanism. The companies are well aware that children and young people are often freely able to breach such legislation – in both developed and low and middle income countries, and have indeed frequently opposed proposals to raise the legal purchase age.

• The tobacco industry has fiercely opposed effective health warnings and product information as recommended by health authorities. There is no more irresponsible advertising and marketing than that for tobacco, yet the industry has fought tooth and nail to prevent curbs on its promotional activities, and has sought to delay and circumvent these wherever possible despite strong recommendations over decades from the World Health Organization ^[22].

Key messages

• Tobacco companies have been remain defiantly irresponsible.
• Their "corporate social responsibility" activities are no more than (in their own words) "air cover".
• Their "education" programs have been either ineffective or counter-productive.
• The tobacco industry is the last group that should be considered as appropriate to provide any form of education on matters relating to smoking and health.