Lessons learned on the road to a smoke-free Italy.

In the face of strong and protracted opposition by the Tobacco Industry (TI) and its allies, Italy's national smoke-free legislation came into force in 2005 prohibiting smoking in all indoor public places and workplaces including offices, bars, and restaurants. Using internal TI documents made public through US litigation, we reveal the industry's nearly 40-year effort to influence health policy related to secondhand smoke, including attempts to block Italy's national smoke-free legislation. Strategies included manipulating hospitality groups and establishing front organizations, manipulating journalists and media, and manipulating the science and direct lobbying against smoking restrictions. The TI's extensive plan to thwart smoke-free efforts in Italy can be used to inform other countries about the industry's tactics and Italy's experience in overcoming them by ultimately implementing a comprehensive workplace smoke-free law.

British American Tobacco and the "insidious impact of illicit trade" in cigarettes across Africa.

OBJECTIVES: To provide an overview of the complicity of British American Tobacco (BAT) in the illicit trade of cigarettes across the African continent in terms of rationale, supply routes and scale. METHODS: Analysis of internal BAT documents and industry publications. RESULTS: BAT has relied on illegal channels to supply markets across Africa since the 1980s. Available documents suggest smuggling has been an important component of BAT's market entry strategy in order to gain leverage in negotiating with governments for tax concessions, compete with other transnational tobacco companies, circumvent local import restrictions and unstable political and economic conditions and gain a market presence. BAT worked through distributors and local agents to exploit weak government capacity to gain substantial market share in major countries. CONCLUSIONS: Documents demonstrate that the complicity of BAT in cigarette smuggling extends to Africa, which includes many of the poorest countries in the world. This is in direct conflict with offers by the company to contribute to stronger international cooperation to tackle the illicit tobacco trade.

Eliminating child labour in Malawi: a British American Tobacco corporate responsibility project to sidestep tobacco labour exploitation.

OBJECTIVES: To examine British American Tobacco and other tobacco industry support of the Eliminating Child Labour in Tobacco Growing Foundation. DESIGN: Analyses of internal tobacco industry documents and ethnographic data. RESULTS: British American Tobacco co-founded the Eliminating Child Labour in Tobacco Growing Foundation (ECLT) in October 2000 and launched its pilot project in Malawi. ECLT's initial projects were budgeted at US2.3 million dollars over four years. Labour unions and leaf dealers, through ECLT funds, have undertook modest efforts such as building schools, planting trees, and constructing shallow wells to address the use of child labour in tobacco farming. In stark contrast, the tobacco companies receive nearly US40 million dollars over four years in economic benefit through the use of unpaid child labour in Malawi during the same time. BAT's efforts to combat child labour in Malawi through ECLT was developed to support the company's "corporate social responsibility agenda" rather than accepting responsibility for taking meaningful steps to eradicate child labour in the Malawi tobacco sector. CONCLUSION: In Malawi, transnational tobacco companies are using child labour projects to enhance corporate reputations and distract public attention from how they profit from low wages and cheap tobacco.

"If we can just 'stall' new unfriendly legislations, the scoreboard is already in our favour": transnational tobacco companies and ingredients disclosure in Thailand.

OBJECTIVES: To review the strategies employed by overseas cigarette manufacturers operating in Thailand to obstruct the passage and subsequent enforcement of national public health legislation, specifically the ingredients disclosure provision of the 1992 Tobacco Products Control Act. METHODS: Analysis of previously confidential tobacco industry documents relevant to non-compliance with the ingredients disclosure legislation. RESULTS: Requirement for disclosure of ingredients contained in cigarettes contained in the Tobacco Products Control Act was identified by transnational tobacco companies (TTCs) not only as a significant threat to their operations in Thailand, but as a dangerous global precedent. Industry documents reveal a determined campaign to block, stall, or amend the proposed regulation during the legislative process. Industry representatives petitioned the Ministry of Health to revise the requirement from by brand disclosure to a more palatable by company submission. Strategies were adapted in the wake of the passage of the Act. Most significantly, the industry in concert with embassies in Bangkok threatened the Thai government with appeals to international trade bodies on the grounds of violation of international agreements. Industry documents also reveal that as submission of ingredient lists appeared unavoidable, leading companies operating in Thailand endeavoured to confound the disclosure requirement by disguising ingredients and reformulating brand recipes. CONCLUSIONS: The evidence presented highlights the importance of ingredients regulation and demonstrates how health policy can be transformed during its implementation. A greater understanding of trade agreements emerges as a priority for global tobacco control.

Tobacco industry strategies to undermine the 8th World Conference on Tobacco or Health.

OBJECTIVE: To demonstrate that Philip Morris and British American Tobacco Company attempted to initiate a wide ranging campaign to undermine the success of the 8th World Conference on Tobacco or Health held in Buenos Aires, Argentina, in 1992. DATA SOURCES: Publicly available tobacco industry documents housed in Minneapolis, Minnesota, USA; Guilford, UK; on-line document websites; and telephone interviews with informed parties. STUDY SELECTION: Those documents determined to be relevant to the companies' campaigns against the 8th World Conference on Tobacco or Health. DATA EXTRACTION: Revision of chapter VIII of the July 2000 WHO report by a committee of experts, entitled: Tobacco company strategies to undermine tobacco control activities at the World Health Organization: report of the committee of experts on tobacco industry documents. DATA SYNTHESIS: Internal documents describe proposed media and science orientated campaigns developed by BAT, Philip Morris, and their consultants to divert attention away from the conference. RESULTS AND CONCLUSION: This work shows that the tobacco industry has the resources and vested interest to combat perceived threats in its regional operating markets, in this case its Latin American market. It is important for the worldwide public heath community to become aware of the numerous ways in which the tobacco industry and its front groups can work against international tobacco control meetings, even including the manipulation of or working with other public health groups to oppose tobacco control efforts. Future world conference planners and participants should be aware that the tobacco industry is likely to continue to employ such methodology. There is no reason to think that the industry is paying less attention to such conferences in the present or future. Rather, it is likely the industry will adopt and expand strategies that were successful while abandoning those that were not effective. Required disclosure of financial support by all participants at all tobacco scientific conferences is recommended. For the tobacco control community, we also recommend careful coalition building and networking with other public health groups on the ways tobacco is implicated in other public health issues.

Targeting of Asian Americans and Pacific Islanders by the tobacco industry: results from the Minnesota Tobacco Document Depository.

OBJECTIVE: The study objective was to review internal tobacco industry documents written between 1985 and 1995 regarding the Asian American and Pacific Islander (AAPI) population in the USA. These documents detail opportunities and barriers to promotion of tobacco products, as viewed by the tobacco industry and its market research firms. DATA SOURCES: /methods: Researchers reviewed tobacco industry documents from the document depository in Minneapolis, Minnesota and the tobacco industry's website, The Tobacco Archive, in a systematic fashion. A combined technique was employed using title keywords, dates, and names to search the 4(b) index. FINDINGS: A review of internal tobacco company documents reveal that during the late 1980s, the industry and its market research firms recognised the importance of the AAPI community as a potential business market. Documents describe the population growth in this community, the high prevalence of smoking in countries of origin, high purchasing power of AAPI immigrants, cultural predisposition to smoking, opportunities afforded by the high proportion of retail businesses under AAPI ownership, barriers to developing the AAPI market, comprehensive campaigns, and political and lobbying efforts. Comprehensive campaigns were designed to integrate promotion efforts in AAPI consumer, retail, and business communities. CONCLUSIONS: The documents show that the tobacco industry developed specific promotion strategies to target the AAPI population. Tobacco control initiatives in the AAPI group have been slower to develop than in other targeted ethnic groups, and may benefit by increased awareness of industry methods to promote tobacco use.

The smoke you don't see: uncovering tobacco industry scientific strategies aimed against environmental tobacco smoke policies.

OBJECTIVES: This review details the tobacco industry's scientific campaign aimed against policies addressing environmental tobacco smoke (ETS) and efforts to undermine US regulatory agencies from approximately 1988 to 1993. METHODS: The public availability of more than 40 million internal, once-secret tobacco company documents allowed an unedited and historical look at tobacco industry strategies. RESULTS: The analysis showed that the tobacco industry went to great lengths to battle the ETS issue worldwide by camouflaging its involvement and creating an impression of legitimate, unbiased scientific research. CONCLUSIONS: There is a need for further international monitoring of industry-produced science and for significant improvements in tobacco document accessibility.

Cardiac rehabilitation: participating in an exercise program in a quest to survive.

Cardiovascular diseases are the major cause of death in the United States. The American Heart Association reports that approximately 500,000 persons die each year from heart attacks. Cardiac rehabilitation programs are based on objectives that would, when adhered to, extend and improve an individual's quality of life after experiencing a cardiac event. The purpose of this qualitative study was to explore and describe strategies that individuals who experienced a cardiac event used to overcome barriers associated with an exercise program. The sample consisted of six subjects (four females and two males) who were enrolled in a cardiac exercise program for 1 year or longer, and who continued to actively participate in at least two cardiac exercise classes per year. This study revealed that individuals who consistently participated in a cardiac exercise program did not use strategies to overcome barriers; rather, in their quest to survive, they used strategies to ensure their participation in the program.

Ovarian steroid manipulation of the antidipsogenic and thermogenic responses of rats to central administration of prostaglandin E1.

Intracerebroventricular (icv) injection of prostaglandin E1 (PGE1) increases arterial pressure, suppresses water intake, and elevates core temperature of rats. Treatment of ovariectomized rats with estradiol or progesterone results in an attenuation of the pressor response to PGE1. This work addressed the effects of daily subcutaneous injection of estradiol (1 microgram), progesterone (5 mg), or oil vehicle on the antidipsogenic and thermogenic response to icv PGE1 of ovariectomized rats. The change of core temperature induced by the PGE treatment was significantly correlated with antidipsogenesis for ovariectomized rats receiving daily oil injections. Although neither the suppression of water intake nor the increase of core temperature in response to icv PGE1 was affected significantly by ovarian steroid treatment, the linear relation between the thermogenic and antidisogenic actions of the icv PGE1 was abolished by either estradiol or progesterone administration. Thus, although the pressor, antidipsogenic, and thermogenic effects of icv PGE1 tend to occur in concert, they may be differentially affected by ovarian steroid administration, which suggests that the mechanisms underlying these varied effects of icv PGE1 may be independent.