Smoking out Australia's growing illicit tobacco market: Current trends and future challenges.

Data from the Australian Taxation Office and Australian Border Force show notable recent increases in illicit tobacco seizures across Australia. The illicit tobacco market results in substantial losses in tax revenue, funds organised crime, and perpetuates tobacco use, threatening to undermine Australia's ability to achieve its national commercial tobacco endgame goal of 5 % or less smoking prevalence by 2030. This commentary discusses recent trends in Australia's illicit tobacco trade, reasons why this is of concern, potential drivers of Australians' illicit tobacco use, and policy measures that could be implemented to mitigate increasing illicit tobacco trade such as implementing a track and trace system, increased investment in the Australian Border Force to enhance detection of illicit tobacco shipments at Australia's borders, and encouraging public tip-offs of illicit tobacco sales.

Genetic predispositions moderate the effectiveness of tobacco excise taxes.

BACKGROUND: Tobacco consumption is one of the leading causes of preventable death. In this study, we analyze whether someone's genetic predisposition to smoking moderates the response to tobacco excise taxes. METHODS: We interact polygenic scores for smoking behavior with state-level tobacco excise taxes in longitudinal data (1992-2016) from the US Health and Retirement Study (N = 12,058). RESULTS: Someone's genetic propensity to smoking moderates the effect of tobacco excise taxes on smoking behavior along the extensive margin (smoking vs. not smoking) and the intensive margin (the amount of tobacco consumed). In our analysis sample, we do not find a significant gene-environment interaction effect on smoking cessation. CONCLUSIONS: When tobacco excise taxes are relatively high, those with a high genetic predisposition to smoking are less likely (i) to smoke, and (ii) to smoke heavily. While tobacco excise taxes have been effective in reducing smoking, the gene-environment interaction effects we observe in our sample suggest that policy makers could benefit from taking into account the moderating role of genes in the design of future tobacco control policies.

Smoking, Vaping, and Tobacco Industry During COVID-19 Pandemic: Twitter Data Analysis.

The reports suggesting a beneficial effect of nicotine on coronavirus disease 2019 (COVID-19) severity may encourage smoking. We aimed to analyze tweets on COVID-19 and smoking coming from casual Twitter users and Twitter accounts representing the tobacco industry. We collected tweets on COVID-19 and smoking from January 1 to May 1, 2020, using Twitter application programming interface. We analyzed sentiment, likes, or retweet to followers ratios, and the posts coming from the casual users to find pieces of news that could affect the discourse. Tweets coming from industry were analyzed manually. We analyzed n = 33,890 tweets on COVID-19 and smoking. The sentiment of tweets was negative, hitting a nadir in mid-March, but became less negative in April when preprints suggesting benefits from smoking on COVID-19 were released. Similar trends were observed for the ratios of likes or retweets to followers. We found 58 messages from the tobacco industry concerning COVID-19. Twenty-two (37.9 percent) mentioned the efforts of tobacco companies to support the development of a COVID-19 vaccine. Two tweets included Food and Drug Administration statements that there is no evidence that vaping increases the risk of COVID-19. The occurrence of preprints suggesting benefits of smoking in COVID-19 might increase sentiment and reactions to tweets on tobacco products and the virus. The authors of potentially controversial articles should restrain from the promotion of their results before the completion of the peer-review process. Twitter presents a convenient tool to monitor e-discourse during a health crisis. The research community should monitor the tobacco industry's social media.

Shifting from tobacco growing to alternatives in Malawi? A qualitative analysis of policy and perspectives.

Tobacco is the primary export commodity in Malawi and an important contributor to foreign earnings. The entrenchment of tobacco interests within government has partly explained why Malawi has lagged in its efforts to address the health consequences of tobacco and has been a vocal opponent of global tobacco control. Despite the extensive historical and entrenched relationship between the economy of Malawi and tobacco production, there have been important shifts at the highest policy levels towards the need to explore diversification in the agricultural sector. There is explicit recognition that alternatives to tobacco production must be pursued. This study provides an analysis of the policies and perspectives that characterize contemporary government approaches to tobacco and alternatives in Malawi by interviewing key government officials working on tobacco policy and reviewing recent policy documents. This research finds that there is openness and movement towards reducing tobacco growing in Malaw, including efforts to reduce tobacco dependency. Rather than a singular tobacco policy discourse in the country, there is a somewhat conflictual set of policies and perspectives on the future of tobacco in Malawi. Informing these policies and perspectives is the interplay between the economics of agricultural production (tobacco vs other crops), global markets (ranging from the ability to generate export earnings to the inability to compete with wealthier countries' non-tobacco crop subsidies) and the lack of developed supply and value chains other than those created by the transnational tobacco industry. The implications for government policy supporting a move away from tobacco dependence are not straightforward: there is a need to fill the supply chain gap for alternative crops, which requires not only strong intersectoral support within the country (and some challenge to the residual pro-tobacco narratives) but also international support.

Transnational tobacco companies and the mechanism of externalization: A realist synthesis.

Externalization theory assumes that risks and costs are systematically displaced from high-income countries (HICs) to low- and middle-income countries (LMICs). We review how and why transnational tobacco companies (TTCs) influence the local circumstances of LMICs that trigger externalization mechanisms, leading to tobacco-attributable risk outcomes. Our realist synthesis of scientific evidence and gray literature identifies externalization mechanisms with risk outcomes at the level of health policy, smoking trends, and tobacco production. The results reveal the mediating role of local and global third parties and intermediaries. Externalization mechanisms produce systematic tobacco-attributable inequalities between places located in HICs and those located in LMICs.

Looking Back and Ahead: The Food and Drug Administration's Regulation of the Tobacco Industry and Next-Generation Products.

Regulatory policy toward tobacco significantly affects oral health because tobacco use is a driver of diseases that manifest themselves in or near the oral cavity. Tobacco use in the United States has been associated with millions of cases of periodontal disease. Researchers have identified the role of combusted and noncombusted tobacco products in promoting cancers of the head and neck, leading to disease and premature death. Tobacco companies have moved increasingly toward so-called next-generation products (NGPs)-products that may emit fewer toxins than combustible forms of tobacco. Although NGPs may negatively affect the lungs and other bodily systems, they shift the injection site of nicotine from the lungs to the oral cavity and oral tissues. Because the long-term effects of NGPs are unknown, this tobacco marketing development has profound implications for oral disease. The US Food and Drug Administration exercises regulatory authority over tobacco products. The tobacco industry has avoided meaningful regulation of its products, especially smokeless forms. By publishing new research, oral health scientists can meaningfully shape the climate in which the administration's policy making occurs.

Exploiting the "video game craze": A case study of the tobacco industry's use of video games as a marketing tool.

BACKGROUND: Video games have grown in popularity since the 1970s, and tobacco imagery is present in a substantial subset of games, including those oriented to youth. Much like exposure to tobacco content in films, exposure to tobacco content in video games may influence smoking uptake and use; however, the tobacco industry's role in facilitating or promoting the use of tobacco imagery in video games is unclear. We explored the industry's interest in and use of video games to market their products to youth and young adults. METHODS: We retrieved and analyzed archival tobacco industry documents. We supplemented information from the documents with current and archived versions of several brand and corporate websites and one website containing user-supplied information on video games. RESULTS: Tobacco companies recognized the youth appeal and marketing potential of video games as early as 1980. Initial marketing ideas included incorporating video game themes into product packaging and design. More fully realized plans focused on incorporating video games into product promotions in bars, as a high visibility way to attract younger patrons and increase long-term marketing opportunities by generating names for tobacco company direct-marketing databases. Tobacco companies also incorporated video games into in-home product promotions, primarily as components of brand websites, in order to enhance brand image and generate repeat website traffic. A similar desire to attract and keep visitors led to discussions about the inclusion of video games on corporate youth smoking prevention websites, although only one company, Lorillard, followed through. CONCLUSIONS: Video game players are an attractive target market for tobacco companies. Video games, as used by these companies, facilitate consumer engagement with particular tobacco brands or particular corporate messages. Eliminating the use of video games as a promotional vehicle may require limiting tobacco marketing in both physical and online environments.

Characteristics of storefront tobacco advertisements and differences by product type: A content analysis of retailers in New York City, USA.

Tobacco companies in the U.S. spend billions of dollars advertising at the point-of-sale. Using photographs of storefront tobacco ads in New York City (NYC), we conducted a content analysis to describe the prevalence of common features across four product categories and illuminate ways in which they may influence behavior. In 2017, data collectors photographed exterior ads from a representative sample of tobacco retailers in NYC (n = 796). We coded each ad (n = 976) for the presence of various characteristics (e.g., brand, price displays, warning labels, menthol/flavors, size, location). Chi-square tests examined differences by product type. Most ads were for cigarettes (40%), followed by electronic nicotine delivery systems (ENDS, 27.9%), cigars (26.9%), and smokeless tobacco (5.2%). Over half of cigarette and smokeless tobacco ads promoted a menthol or flavored style (61% each), compared to about a quarter of cigar (25.9%) and ENDS ads (30.3%, p < .0001). Cigar and ENDS ads, however, were more frequently placed directly on the door of entry (49.4% and 46.7%, respectively, p < .001). Only 5% of ENDS ads displayed a standard warning label. Notably, a quarter of all tobacco ads (23.4%) were for the brand Newport. Cigarette ads still dominate at the point-of-sale with regard to volume and size. Across all products, ad features did not always align with local and federal policies (e.g., flavor bans, warning label mandates). Continued surveillance of advertising strategies and policy compliance can help provide the evidence base needed to inform marketing regulations that reduce the deadly burden of tobacco use.

Tobacco Industry Denormalization Beliefs in Hong Kong Adolescents.

BACKGROUND: Tobacco industry denormalization (TID) seeks to expose the industry's misconducts. Research on TID beliefs, meaning negative attitudes toward the tobacco industry (TI), may inform TID programs, but was limited to western populations. We investigated TID beliefs and their association with smoking and sociodemographic characteristics in Hong Kong adolescents. METHODS: In a school-based cross-sectional survey of 14214 students (mean age 15.0 years, 51.5% boys), TID beliefs were assessed by two questions: (1) whether the TI was respectable and (2) whether the TI tried to get youth to smoke, each with four options from "definitely no" to "definitely yes." Smoking susceptibility and behaviors were also assessed. Sociodemographic characteristics included age, sex, perceived family affluence, highest parental education, numbers of co-residing smokers, and school-level smoking prevalence. RESULTS: Of all students, 77.6% considered the TI not respectable and 56.6% believed that the TI tried to get youth to smoke. Stronger TID beliefs were inversely associated with smoking susceptibility and behaviors. For example, students considering the TI definitely not respectable (vs. definitely yes) were 56% (95% confidence intervals [CI] = 45% to 66%), 49% (95% CI = 41% to 56%), and 53% (95% CI = 36% to 65%) less likely to be susceptible to smoking (among never-smokers) and be ever- and current smokers, respectively. Of all correlates examined, only younger age and having no co-residing smoker were associated with TID beliefs. CONCLUSIONS: Substantial proportions of Hong Kong adolescents did not hold TID beliefs, but those who did were less likely to smoke. Our results suggest that TID programs may help reduce adolescent smoking. IMPLICATIONS: The TI's misconducts and responsibility for the tobacco epidemic were not well known by Hong Kong adolescents. TID beliefs in this population were inversely associated with smoking. These findings suggest that TID programs in local adolescents may be of value. The investigation into the correlates of TID beliefs found that socioeconomic status and school-level smoking prevalence were not associated with TID beliefs. This suggests that local TID programs targeting adolescents in general, for example, mass-media campaigns, may be more appropriate than those targeting particular schools or selected groups of adolescents.

Marketing with tobacco pack onserts: a qualitative analysis of tobacco industry documents.

BACKGROUND: Cigarette packs are a form of advertising that distributes brand information wherever smokers go. In the 21st century, tobacco companies began using onserts on cigarette packs to communicate new advertising messages to smokers. METHODS: We reviewed tobacco industry documents dated 1926 to 2017 to identify how the tobacco industry developed and used onserts in marketing and to serve the industry's political and legal objectives. RESULTS: Onserts added to cigarette packs became a more cost-effective way for brands to market in the year 2000. Manufacturers then began studying them, finding that new messages were appealing, while repeated messages were ignored. By 2005, tobacco companies were using onserts to effectively communicate about new tobacco products and packaging changes. They also used repeated 'corporate responsibility' messages that were, according to the industry's own research, likely to be ignored. CONCLUSIONS: Tobacco companies have expanded on cigarette pack-based advertising. Twenty-first century onserts simultaneously seek to increase sales using materials that are novel, attractive and provide independent value, while undercutting public health messages about the risks of tobacco use using materials that repeat over time and are comparatively unattractive. Health authorities can use this industry research to mandate onserts to communicate effective health messages.

Lesbian, Gay, Bisexual, and Transgender (LGBT) View it Differently Than Non-LGBT: Exposure to Tobacco-related Couponing, E-cigarette Advertisements, and Anti-tobacco Messages on Social and Traditional Media.

BACKGROUND: LGBT populations use tobacco at disparately higher rates nationwide, compared to national averages. The tobacco industry has a history targeting LGBT with marketing efforts, likely contributing to this disparity. This study explores whether exposure to tobacco content on traditional and social media is associated with tobacco use among LGBT and non-LGBT. METHODS: This study reports results from LGBT (N = 1092) and non-LGBT (N = 16430) respondents to a 2013 nationally representative cross-sectional online survey of US adults (N = 17522). Frequency and weighted prevalence were estimated and adjusted logistic regression analyses were conducted. RESULTS: LGBT reported significantly higher rates of past 30-day tobacco media exposure compared to non-LGBT, this effect was strongest among LGBT who were smokers (p < .05). LGBT more frequently reported exposure to, searching for, or sharing messages related to tobacco couponing, e-cigarettes, and anti-tobacco on new or social media (eg, Twitter, Facebook, etc.) than did non-LGBT (p < .05). Non-LGBT reported more exposure from traditional media sources such as television, most notably anti-tobacco messages (p = .0088). LGBT had higher odds of past 30-day use of cigarettes, e-cigarettes, and cigars compared to non-LGBT, adjusting for past 30-day media exposure and covariates (p ≤ .0001). CONCLUSIONS: LGBT (particularly LGBT smokers) are more likely to be exposed to and interact with tobacco-related messages on new and social media than their non-LGBT counterparts. Higher levels of tobacco media exposure were significantly associated with higher likelihood of tobacco use. This suggests tobacco control must work toward reaching LGBT across a variety of media platforms, particularly new and social media outlets. IMPLICATIONS: This study provides important information about LGBT communities tobacco-related disparities in increased exposure to pro-tobacco messages via social media, where the tobacco industry has moved since the MSA. Further, LGBT when assessed as a single population appear to identify having decreased exposure to anti-tobacco messages via traditional media, where we know a large portion of tobacco control and prevention messages are placed. The study points to the need for targeted and tailored approaches by tobacco control to market to LGBT using on-line resources and tools in order to help reduce LGBT tobacco-related health disparities. Although there have been localized campaigns, only just recently have such LGBT-tailored national campaigns been developed by the CDC, FDA, and Legacy, assessment of the content, effectiveness, and reach of both local and national campaigns will be important next steps.

How Menthol Is Key to the Tobacco Industry's Strategy of Recruiting and Retaining Young Smokers in Singapore.

INTRODUCTION: Singapore has a strong and well-established tobacco control policy, but smoking rates among young Singaporeans remain relatively high. In other countries, tobacco companies have used menthol to encourage smoking among young people. Singapore still permits the sale of menthol tobacco products and little is known about the tobacco industry's internal strategy and motivation for marketing menthol tobacco in Singapore. METHODS: Tobacco industry documents analysis using the Truth Tobacco Industry Documents Library. Findings were triangulated with Euromonitor market data on menthol tobacco in Singapore, and trend data on smoking prevalence in Singapore from the First National Morbidity Survey, Labour Force Survey, National Health Survey, and National Health Surveillance Survey. RESULTS: Menthol tobacco products became popular among young Singaporeans in the early 1980s, largely due to a health-consciousness trend among young people and the misperception that menthol tobacco products were "safer." Philip Morris, in an attempt to compete with R.J. Reynolds for starter smokers, developed and launched several menthol brands designed to appeal to youth. While many brands initially failed, as of February 2018, menthol tobacco products comprise 48% of Singapore's total tobacco market. CONCLUSIONS: Menthol is key to the tobacco industry's strategy of recruiting and retaining young smokers in Singapore. Banning the sale of menthol tobacco products will be an important part of preventing smoking in Singapore's younger generation.

Philip Morris International-funded 'Foundation for a Smoke-Free World': analysing its claims of independence.

The Foundation for a Smoke-Free World was launched in September 2017 with an announced 12-year funding commitment of $1 billion from Philip Morris International (PMI). The Foundation claims that its governing documents (certificate of incorporation, bylaws and a pledge agreement) ensure that it has an independent research agenda and stringent protections from conflicts of interest. We analysed the text of these governing documents. Their provisions have multiple loopholes, particularly regarding conflicts of interest. Further, these documents cannot substitute for other important documentation such as information about PMI's internal business case for investing $1 billion in the Foundation, an unwaivable conflict of interest policy, annual disclosure statements, copies of pre-Foundation establishment correspondence between key individuals, all signed contracts or salary information, none of which, as of July 2018, the Foundation has made publicly available. Even if these were released, however, it is problematic that the Foundation's fundamental purpose was decided on and its leader selected following a tobacco company-paid, privately negotiated arrangement with the Foundation's president. It cannot be regarded as independent.

The Response of Retailers in Scotland to the Standardised Packaging of Tobacco Products Regulations and Tobacco Products Directive.

INTRODUCTION: With most marketing channels prohibited, the retail environment has assumed greater importance for tobacco companies, even in markets with a ban on the open display of tobacco products. Research has yet to qualitatively explore how retailers respond to standardized packaging in a country where this has been introduced. METHODS: As part of the DISPLAY study, face-to-face interviews were conducted with 24 small retailers in Scotland between May 23 and June 26, 2017; the interviews were conducted after The Standardised Packaging of Tobacco Products Regulations and the Tobacco Products Directive were fully implemented. RESULTS: We found high retailer compliance with the legislation. With price-marked packs and packs containing less than 20 cigarettes and 30 g of rolling tobacco banned, retailers stated that this helped simplify ordering and stock management. The removal of price-marked packs also allowed them some flexibility to set their own prices, but many chose to stick closely to recommended retail price in order to remain competitive and avoid complaints from customers. In contrast to one of the tobacco industry's arguments against standardized packaging, most retailers suggested that transaction times had not increased, even though the changes had only recently come into force. CONCLUSIONS: This study challenges some of the arguments used against standardized packaging and provides an insight into the storage and pricing strategies adopted by retailers following the removal of price-marked packs. IMPLICATIONS: This study explores the response of the retailers to the introduction of standardized tobacco packaging and provides an insight into the storage and pricing strategies adopted by retailers following the removal of price-marked packs. It explores the importance of the retailer in tobacco companies' desire to maintain tobacco sales and challenges some of the arguments used against standardized packaging, such as an increase in transaction times. Countries seeking to introduce standardized packaging should monitor the experiences of retailers, preferably from preimplementation through to post implementation, to help understand how retailers respond to this policy and to inform compliance.