Greater exposure reduced the odds of current cigarette use and smokeless use by 30% and 45%, respectively. Anti-smoking media campaigns help to shape social norms and institutional policies around smoking, which in turn change smoking behavior at the population level,including adult quit attempts.Several studies have found that youth are equally likely to report favorable responses to adult-targeted ads as to youth targeted ads,Studies from California,Massachusetts,and Australia demonstrate that exposure to adult-targeted mass media campaigns is associated with reduced smoking initiation and smoking behavior among youth. Even in countries where comprehensive tobacco control policies have been in effect for decades , intensive mass media campaigns have a positive additional influence on smoking behavior outcomes.Tobacco taxes are used to provide an annual revenue stream to support implementation of government media campaigns that consist of paid radio, television, billboard, internet and social media, and print advertising. Media campaigns with greater impact also include public relations campaigns for general market and population-specific communities, including various ethnic populations, young adult, and lesbian, gay, bisexual, transgender, and queer communities.Social norm change has been one of the most effective tobacco control strategies in the United States. The most successful application of the social norm change strategy took place in California, where in 1989 a statewide tobacco control program was implemented to transform the social environment where tobacco use is not socially desirable or acceptable.The key to the success of the California Tobacco Control Program has been its design as a broad-based campaign focused on reinforcing the nonsmoking norm aimed at the population as a whole – not just smokers or youth,for each element of the program, including the statewide hard hitting, evidence-based media campaign. Indeed,greenhouse growing racks by focusing on adults through its comprehensive tobacco control program, California has achieved one of the lowest youth smoking rates in the United States.Advertising bans are another important policy to denormalize tobacco use.
Like large graphic warning labels and plain packaging, they are inexpensive for governments to implement, and generally apply to all products Point of sale tobacco display bans in Ireland and Australia were both followed by reduction in perceived smoking prevalence among youth and young adults, which reflects lower normalization of tobacco use. In contrast to media campaigns, which require regular appropriations and create ongoing opportunities for the tobacco industry to weaken, block, or eliminate funding, advertising bans, once enacted, are legally binding.Promoting understanding of the industry’s predatory behavior has been a central theme of the California Tobacco Control Program since it started in 1989 and the Truth Initiative “truth” campaign. The messaging frame on industry behavior is an important reason for these campaigns’ success at preventing smoking initiation and promoting quit attempts, likely because they reduce the attractiveness of affiliating with the tobacco companies’ brand images. In contrast, programs that focus solely on individual, peer and family influences on youth smoking prevention and understate or ignore the effects of tobacco industry advertising are less effective than campaigns that highlight the role of the tobacco industry. Indeed, when Florida – where the “truth” campaign first originated in 1999– shifted its media messaging away from confronting the tobacco industry to a softer “kids shouldn’t smoke” message, it lost its effectiveness.Tobacco companies use product engineering to maximize consumption and profits.Large corporations have the scientific and technical capacity to undertake research and development programs that aim to identify which characteristics of a product to manipulate, and use sophisticated manufacturing processes to accentuate product features that maximize addictive potential. The cigarette companies invested heavily in their secret internal R&D departments to understand the addiction process, and modified their products to increase their addictiveness.Reviews of internal industry documents show that cigarette companies manipulate nicotine levels, cigarette length, chemical additives to alter nicotine absorption, improve the flavour of the smoke, reduce harshness,and increase puff intensity.
They also use ventilated filters, manipulation of nicotine levels,and other product modifications to attract novice smokers and to increase addictive potential by optimizing nicotine delivery and dosing.Cigarette companies also designed their brands to meet psychological and psychosocial needs of consumers.In addition to attracting youth,product design technology was used to recruit and socially normalize smoking among women,African Americans,Latinos,Asians,LGBTQ,low income groups, and veterans. Cigarette companies have also taken advantage of weak cigarette testing protocols around the world to conceal the actual toxicity of their products to consumers and regulators.In the process of manufacturing cigarettes to enhance nicotine delivery, and so the addictiveness and sales of cigarettes, tobacco companies have reduced particle size and made many other design changes which , while good for the cigarette business, resulted in a more dangerous cigarette in 2014 than in 50 years earlier in 1964. Changes in tobacco blends and curing of tobacco has caused US cigarettes to have higher levels of tobacco specific nitrosamines , a group of carcinogens found in tobacco and nicotine products. Surgeon General Report observed that “[f]or Kentucky reference cigarettes, mutagenicity per mg of total particulate matter was 30–40% lower for unfiltered cigarettes than for the same cigarette with a filter added.”These design changes have not only made cigarettes become more dangerous in terms of rising lung cancer rates,but also contributed to an increase in overall mortality, chronic obstructive pulmonary disease and heart disease. The rising risks correspond to changes in cigarette design – unfiltered to filtered, higher tar to lower tar, introduction of filter vents, among other changes to cigarette design. Deeper inhalation of more dilute smoke increases exposure of the lung parenchyma. These and other design changes in cigarettes may also have contributed to the shift, beginning in the 1970s, in the histologic and topographic features of lung cancers in male smokers, with an increase in the incidence of peripheral adenocarcinomas that largely offset the decrease in squamous-cell and small cell cancers of the central airways.The tobacco companies use menthol and other flavour additives including fruit and candy flavouring as marketing tools to attract young smokers.National survey findings from the United States and Japan confirm that menthol cigarette use is disproportionately common among younger and newer adolescent smokers.
Tobacco products that disguise the taste of tobacco through flavouring agents and palatability enhancers create products that largely appeal to youth and young adults.Menthol is the most popular characterizing flavour of cigarettes in the US, with more than 90% of all cigarettes containing menthol.Tobacco companies use menthol’s analgesic effects to mask acute effects of smoking . Such harsh effects, if experienced by the smoker, could encourage quit attempts and cessation among menthol users.Women perceive the minty aroma of menthol cigarettes to be more socially acceptable than non-menthol cigarettes, which complicates public health efforts to denormalize tobacco use. In the US, the tobacco companies intensely market menthol cigarettes in predominately black communities through price discounts, signage, and through associations of menthol use with hip hop lifestyle and culture.Family and social factors that prevented smoking among African American teens do not seem to carry over into young adulthood likely due to tobacco company targeted marketing.In 2012, teenage smoking prevalence among whites was twice as high as black smoking prevalence .While use rates among young adults remains higher for whites than blacks ,compared to white smokers, menthol cigarettes are disproportionately used among black smokers. National data from the United States show that around 80% of African American smokers use menthol cigarettes compared to around 30% of whites. Tobacco-caused morbidity and mortality rates are disproportionately higher among African Americans compared to whites,and menthol cigarette smoking is disproportionately high among African Americans, which may help to partly explain the disproportionate tobacco-related disease burdens.These rapid changes in medical costs are due to the fact that risks of cardiac events,non-cancer lung disease, complications of pregnancy,and effects on children begin to appear almost immediately when people stop smoking or being exposed to secondhand smoke. Cancer is also affected, albeit more slowly over time. Hospitalizations for heart attacks, other cardiovascular conditions, stroke, and pulmonary conditions drop immediately following implementation of smoke free laws, as do need for treatment of respiratory conditions,plant bench indoor and complications of pregnancy and hospitalizations for childhood illnesses. The fact that marijuana smoke exposure has similar – indeed larger – effects on vascular function73 suggests that there may be similar adverse consequences and medical costs if marijuana use increases following legalization and expansion of the market. Tobacco control policy change in Australia between 2001 and 2011 played a substantial role in reducing smoking prevalence among Australian adults between 2001 and 2011. During that time, the Australian government increased tobacco taxes, adopted more comprehensive smoke free laws, and increased investment in mass media campaigns, which can explain 76% of the decrease in smoking prevalence from 23.6% to 17.3% . Comprehensive tobacco control policies may have an even greater impact on cigarette consumption and demand reduction in low and middle income countries compared to high income countries.For example, there has been a 50% reduction in male and female smoking prevalence in Brazil between 1989 and 2010, which represents a 46% relative reduction compared to the 2010 prevalence under the counterfactual scenario of policies held to 1989 levels.Combined these policies had averted 420,000 deaths by 2010, with estimates of an almost 7 million deaths averted projected by 2050.
Uruguay, an international leader in tobacco control, became one of the first countries to fully implement the Framework Convention on Tobacco Control. In 2006, Uruguay implemented its national smoke free law, and in 2009 the government implemented the largest graphic warning label, covering 80% of the package. In that same year Uruguay prohibited use of false or misleading statements on tobacco packages . There were three tobacco tax increases in June 2007, June 2009, and February 2010, which made tobacco products in Uruguay the highest in the region. In 2012, the Ministry of Health launched an aggressive mass media campaign308 and in 2014 the government prohibited all forms of tobacco marketing including advertising, promotion and sponsorship, product promotion, and point-of sale displays. Since implementation of its comprehensive tobacco control program, tobacco consumption, risk perceptions, and social acceptability of use and the tobacco industry have shifted dramatically. From 2003 to 2011, adult smoking dropped by 3.3 percent each year while youth smoking dropped by 8 percent, from 39% to 31% for males and from 28% to 20% for females. 308 In 2012, 75% of Uruguayans favored a total ban on all tobacco products within 10 years and 60% of the population believed the tobacco companies were unethical. Support for comprehensive smoke free laws among smokers increased from 54% in 2006 to 90% in 2012.After Uruguay implemented its smoke free law, hospital admissions for heart attacks dropped 20%309 and non-hospital emergency visits for bronchospasm dropped by 15%. 303A 2000 study on marketing restrictions in OECD countries found that the effects of marketing bans are cumulative and that partial bans were not associated with reductions in tobacco use. Overall, comprehensive bans on advertising and promotions were associated with a significant reduction in tobacco consumption since implementation, with larger effects for more comprehensive bans. Tobacco companies use market research to understand smoking behaviour among different segments of the population,and, in turn, use such research in future marketing campaign messages.This information can be used to design advertising campaigns that circumvent partial advertising restrictions by shifting expenditures toward other media outlets .For example, after the 1998 Master Settlement Agreement in the United States, in which the tobacco companies agreed to some limitations on their advertising and promotional activities, the tobacco industry shifted marketing expenditures to direct mailings and online marketing.Partial advertising restrictions permit cigarette companies to target young adults through lifestyle magazines created by the industry,event sponsor ships,and low income and less educated women through distribution of coupons with food stamps, direct mail, and bundle offers at the point-of-sale.Following implementation of a 2012 law that prohibited point-of-sale tobacco displays in New Zealand the odds dropped significantly for experimentation with smoking , smoking initiation , and smoking prevalence , among adolescents, consistent with similar studies from Ireland,Norway,and Australia.There was a marginal decrease in perceived peer smoking among New Zealand smokers, which may have been greater if all forms of tobacco marketing had been prohibited simultaneously.Because the tobacco industry continuously seeks to evade any advertising restrictions, the World Health Organization recommends that governments license tobacco manufacturers and retailers, with penalties and sanctions for noncompliance, including license suspension and revocation for repeat violations commensurate on the nature and seriousness of the offence, to assist with enforcement efforts to control tobacco advertising.