Tobacco Control Playbook

KEY MESSAGE: Smoking is not an adult behaviour. Most smokers start as children, and around the world millions of children are smokers. Tobacco companies have a long history of targeting children and young people, exposing them to a wide range of advertising and other forms of marketing, and seeking to prevent measures that will reduce smoking in children and young people.

What is the issue?

Tobacco companies claim that smoking is an adult behaviour, and that they market and sell their products responsibly, and only to informed adult smokers ^[1].

What is the evidence for concern?

• For decades tobacco industry publications, statements, media comments, websites and other materials have maintained the same mantra – that tobacco is a product for adults (whose “choice should be respected” ^[2]) and that the industry does not market to children, non-smokers ^[3] and “unintended audiences” ^[4]. Companies support these positions with claims such as “We market and sell to adult smokers. Adults are capable of making an informed decision to smoke. Our products and marketing and sales activities are not meant for minors or nonsmokers. We have a responsibility as a leading tobacco company to do our part in preventing youth smoking. We warn consumers about the health effects of our products. All advertising and packaging for consumers must have health warnings, even if the law does not require these warnings” ^[5].
• Further, the industry claims that it does not want children to smoke ^[6][7] and that it is active in promoting prevention, for example through supporting “youth smoking prevention” activities ^[6], while also providing information to the public about the harms of smoking ^[8].
• The companies also claim that smokers are aware of the risks of smoking, which therefore is an informed choice for adults ^[9].
• They argue that smokers are “informed”, that “informed adults have rights to consume them and to choose the brands they prefer”, which also serves as a rationale for maintaining tobacco advertising and promotion and to pursue the argument that “We have a role in helping to preserve our consumers' rights” ^[10].
• The companies further draw attention to governmental and health agency education or cessation activities ^[11], implying that as they currently stand these are adequate to inform smokers about the harms of smoking. As well as asserting that their marketing is specifically targeted only to adults, they claim that children and other non-smokers are not influenced by their advertising and promotion ^[12].
• The argument that smokers can be made aware of the risks is used as part of the rationale and further basis for arguing against tobacco control measures, on the basis that further measures opposed by the industry are not required ^[13].
• Some tobacco companies provide information on their websites about some aspects of the harms of smoking ^[14] and refer to carefully selected governmental and other reports as demonstration of their purportedly responsible approach ^[15].
• The companies claim to be active in promoting processes to ensure that retailers do not sell to children ^[6], and even to run their own education and support programs for children and schools ^[7].
• Simply put, tobacco industry approaches on this issue are clear: they do not want children to smoke, smoking is an adult behaviour, they do everything they can to protect children and to ensure an informed community, and everybody knows that smoking is harmful.

What is the reality?

• Smoking is not solely an adult behaviour. Around the world millions of children are smokers, in LMICs as well as in more affluent countries, and they are targets for tobacco marketing ^[16].
• The vast majority of smokers started as children or adolescents ^[17], long before they might have been aware of the harms of smoking or be able to understand issues ranging from cancer and heart disease to addiction.
• It is in the tobacco industry’s interests to ensure that as many children and young people as possible start smoking. It is also in the industry’s interests to portray smoking as an adult behaviour to which children and young people can aspire.
• It is misleading to present smoking as solely an adult behaviour with products marketed and sold to children. Despite legislation on sales to minors, in most if not all countries, children are fairly readily able to access cigarettes. Even in countries where tobacco control policies are advanced, many children smoke. In LMICs it is commonplace to see children purchasing and smoking single cigarettes as part of the process towards becoming a regular smoker.
• There is massive and incontrovertible evidence from tobacco industry documents and the broader literature (including many papers and reports) demonstrating that tobacco companies are aware that children are a crucial market for them, and have specifically targeted children and young people ^[16].
• Similarly, there is incontrovertible evidence that children, young people and adult smokers are heavily exposed to tobacco promotion (including that claimed to be directed only to adult smokers) and influenced by it ^[16]. It is indeed impossible to market a product such as cigarettes to adult consumers only.
• Far from supporting education about smoking, the industry has from the outset sought to cast doubt on evidence about the harms, denied much of the evidence, and attacked and undermined governments, health authorities (including WHO) and research institutions seeking to make smokers aware of the evidence.
• Further, tobacco companies have fiercely opposed both measures that would be effective in preventing the onset of smoking in children, and in making children, other non-smokers and smokers adequately aware of the harms of smoking, and also measures to ensure that adults and children are better informed, such as strong, well-funded, sustained and hard-hitting evidence-based media campaigns, evidence-based pack health warnings and plain packaging.
• Activities presented by the tobacco industry as evidence of responsible behaviour are both ineffective and counter-productive. Their so-called “education” programs for children and others are ineffective and counter-productive, designed only to support claims of responsible behaviour and to pre-empt stronger, more effective educational activities ^[18][19].
• Smokers are not aware of the harms of smoking. While some governments and health authorities have run public education programs (through mass media, etc.) about the harms of smoking, these are typically very modest, with budgets minimal in comparison with tobacco promotion budgets, short-term, and often for various reasons not hard-hitting. There is overwhelming evidence that many smokers are not aware of the extent of the problem, its magnitude, the vast range of diseases and other harmful consequences of smoking, the suffering that results from diseases caused by smoking, its impacts on families and communities, the economic costs of smoking, all the likelihood that they themselves will suffer and ultimately died because they smoked, some are not aware at all, and even when they are aware of some of the risks, they may not believe these apply to them ^[20].

Key messages

• Smoking is not an adult behaviour. Most smokers start as children, and around the world millions of children are smokers.
• Tobacco companies have a long history of targeting children and young people, exposing them to a wide range of advertising and other forms of marketing, and seeking to prevent measures that will reduce smoking in children and young people.
• Smokers are not aware of the risks of smoking, and even when they are aware that smoking is harmful, often believe that the risks do not apply to them.
• The tobacco industry has fiercely opposed evidence-based measures that will prevent the onset of smoking in children and make both children and adult smokers aware of the risks of smoking.