Tobacco Documents Online

Wu ri;shops Discussion in the;worlshop~considbredopporwnities to regulate these pradiicrsatibbth the Federal and~State levefs. Aederal • The Executive Branch should make the regulation of tobacco products-regttlntion ~of their manufacture, distribution, sale; labeling, advendsfng;,and promotion=apriotnry in federal heaith, care reform and other tiealth policy initiatives. • FDA should use its existing authorities to regulkteall "bW,yield" tobacco products as drnigs under Sec. 201 of the Federal!Food, Drug and Cosmetic Act. • Congress sh ould enact specific statutory authorities whieh mith. out question give the Food and Drug Adntinistradon the authority, and tJie resouv+oes to, regulate the tnaaufmre, distribtttion; sate, hbeling, adl'erfisiag, and promotion of tobacco prodttcts. swe • 11he nation's govenorsshould make the regulation of tobacco- produas a priority in health policy initiatiroes.. • States should use their existing,drug authorities to regulate "low y'eld" tobacco products as!drugs. • States should consider enacting,speci8c statuwryprovisions which would,regulate the manttfactune, distributlon,,sale, label• ing, advertising, and promotion of~ tobxcco products as a c.lass of drug. These new requirements should include full disclosures of ingrnedients and of information known to the tnattufactutets about . the toarictity of'the products as well as requirements that the manu- facturers assist customers who wantAo quiG • States should ban billboards which advertise tobaeco produds. . • States shoufd use existing consumer protection authorities to regulate the tnattufacture, distribution, sale;,labelittg, advertising and promotion of tobacco products. ' Pub/kJfadtb Community • The public heaftti cotnmunity should develnp, support, an& maintain a-resource library which would serse as a repository, for informatiott about the tobacco problem needed by, policy makers and regulators. ' Atnesican Brattds; the maker of'NR,STY cigarettes calls its direct mailoperatiowa,"Smoicers fnforrmtion Certter."'Since each, tobaaoo eofnpany maintains extensive mailing lists of its custmm- ers and potentialcuswmers, information on harms fnom smoking and advice on how to quit could easily be sent to these indiNiduals directly as part of public information campaigns.

Wurkshops Tobacco Use: An American Crisu The Role of Federal and Sta.te Excise Taxes The Effect of Taxation It is a basic rule ofeconomics that, as the price of a commodity rises; demand for that commodity,falls. There is aisubs'tantiali body of evidence, frotn the United States and other, ccountries, that demonstrates that acigarette price increase leads to a fall-but a less than proportionate fall-in cigarette eonsttmptioni Much of' the evidence was summarized in the'1992 report'of the Surgeon General, Smok'ingand tdealtb in theAmaricas (pages 127-1'36). That evidence is based on econometric studies. Empirical experi- ence in countries whichihave seen substantial'priee ihcreases tells a sirnilar tale., The relationship between the real ('ie: inflation adjusted) price of tobacco and per capita consumption for Canada showsthisclearfy (figure 1). The'Canadian experience also suggests that price has been associ- ated with~a particularly rapid!fall in consumption among teenag- ers (figure'2), fiut Canada, i's not speciaL It is typical. Exacttv the same phenom- enon can be seen in the United States (figure 3). As shown, in figure 4, taxes in the U:S: have fallen in real ternrs since the time Figure 1 ARfIGL rEREAfdTA' COMSOMt1'IOROF (1GARflT6 UIDRULH00['or7D64C110 0e 7 veu.1 CANADA t5S1 - MIS'. l1A' u:N aN I sus/ uN I SI,N ~ S3s1 N IZ ~ SIN, IfM IIM 1155. 1964 a1f1 1571 17T71 IMt 1511IH1 -~ Asd i Ier ~ e.~lt1 ~ na~}W ~ - G.wnam...n ie, MIYe, nuw~e s,~I,q ~~ s r.,l«d Y a qd>d !ne 0 ToOu» ~.IMI l.Ibnl David'Sweanor, JD Kenneth' E. Warner, PhD of the landmark 1964' report of the United States Surggon Gen- eraL In nominal terms; tbtal taxes rose from 14 cents per pack that year to 44! 5' cents in 1991 ~ Adjusted for inIlktion, however, the tax would have needed to be 61.6 cents simply to maintain its real value. As such, , real taxes are 28% lower in 1991 than they were in 1964. Both state and federal taxes fell during this time. Adjusted for inflation, federal'''taxes fell bv'more than40%. Taxes on ~a pack of'cigarettes have fallen from 50% of ihe',selling price tb only 25%,,a.s shown in figure 5. One result of this is thatt the United States now has the lowest taxes on tobacco of anv' major industrial country, and is much lower than Canada and northern European countries, as shown in appendix A. lhrough most of the 198Ws total taxes have remained rather constant in real tetmts. While manygovernments balked'atithe idea of raising'taxes, the tobacco industry showed no such qualms: the industry raised wholosale prices frequently and substantially: The resulti cigarette prices rose by 60% more thann the general'rate oflinflation: As the economic analyse,s would predict, consumption felll (figure 3). Eig!ure 2 UAL C1GAR.ETSE.rRICTS'~.ANO L7GARETiE.SMOK]MG AMONG U'NADIAI6AGE ~,S TO If' 501 .ri 41S 41% ?Is 1pi M US 2l'S 111 IK tl s1 1 110 co 0 uf7' HN If9TI •"Nn,Smatngl -Reel ToDattp Pewe InOe. ('96'.100{: ~ ~ i - - ~ - ~ T,-,haccn l-se .a+:--lmw*ic::in Cr:sts `i

Yti'orhshup, Precise estimates of the relationship between price and demand vary. A reasonable estimate,is that a ll0% increase in price leads to. about a 4% fall in consumption. For children, the effect of'price increases on smoking is believed to be at least as substantial. In recent years, the tobacco industry has introduced discount, brands of cigarettes and offt'red significant percentage discounts through in-store promotions and the use of coupons. This means that price-sensitive people have been able to move to less expen- sive cigarettes as an alternative to leaving the market altogether, or not entering it'in the first place. Reseanch on price-sensitivity does not address the implications of the fact that~'average' price is no lbnger indicative of what price-sensitive people are paying for their cigarettes. Arguments for Increasing Tobacco Taxes Raising tobacco taxes to the levei Ieurrently exiating in places such as'Sdandlitavia„the British Isles, and Canadk could result in millionsfewer tobacco-caused deaths among Americans currently, alive. In termts of health impact, there has probably never been aa sing'fe intervention in American historytharhas accomplished what could be achieved through reform of federal and state to- bacco tax laws. Indeeda,flarris (1'987) estimated that the 8-cent- per-pack federal tax increase in 1983 would mean thaL54,000 additional then-teens would live to 65 years of age: Eataminingthe same tax increase; Warner ( 1986) noted that if the real value of the tax could be maintainedi some 450,000 premature deathss caused by smoking would ultimately be avoided. Note that this extraordinary'health achievement was estimated to nesult from a small tax increase.. Besvnd4he health impact, there are tnany otherpowerful argtt- ments thatsupport sustained increases in tobacco taxes: • Increased tobacco taxes can raise considerable revenue. US tobacco taxes in 1'99'1i amotmted to $13 billion: By companison,. Canada, with one tenth the population of the States, raised over E66 billion, and the UIC with less than a quarter of the US populatim raised 1E 10 billion.llhere is little doubt that the United States could be raising at least $30 billionimore annually, even taking into account the substantial drop in smoking tliatwould be ex- pected to foilowthe tax increases,. • lttoseadditional billions of'tax dolL4rs cottld itmd better health care provision, school programs, nutritlon1progruns--or simply be used to reduce the deficit or reduce other taxes (higher ttr bacco taxes do not ~ have to mean higher, overall taxes) .: • Smokers'do not derive the entire economic benefit from keepingg taxes down. The tobacco companies are given greater freedom to increase their owniprices, thus increasutg,their profits and their economic andipolitical power. As anexample, PhilipMorris reports that it, sold 191.2 billion cigarettes in the United States in 1980 and had operating,ineome of $786 million fnom1 those sales, By 1991 sales hadincreased by 15% but'operating ineome had increased by'over 500% to f 4.8 billion. This income level repre- sents, in:1991i alone, three and one half billionldollars more than would be required to have simply kept pace with infiation. In the absence of tax increases,,tobaceo companies show no pLans to. restrain their own price increases., If prices are, instead, raisedd through tax increases, the health impact is realized whik providg ing revenue for important national and local programs. • People are prepared to vote for higher cigarette taxes, as, the necent ~ experiences in California and Massachusetts make clear. In fact polling from around the country shows stnongsupportlor tobacco tax increases, particulardywhen introduced as part of a comprehensive program. If we use the intensity of'the industry's opposition to any given measure as the true indication ofits prohablo impact on consump• tion; the tobacco industry has clearly acknowledged the impact Figttre 46 ANNIIAy /E0. CAfRA CONfUMld7OM OIC7GAl[TTt7 ANOR[AL InUO[ O• TOLWCO . (rr M~yney UXtiYL rCANflD 11l1 .IM 3404 1 sus• ua¢ $1.20 :.Ir s lso 26" $1.40 12.0 $120 ® a tol hlu' f1L0 GP~ d LMn lY% mlLn 23N 5010 $1.50 IIILC SsM N SOb 1S 5030 70110 lsN . , , $1.0 054 1959 lsu 1964 leTl Nn 1903 1966 ' usl. - Ina i.p. upu caw..0/e. - Itca f"ce~.e( TeMC<a~IIMI EdMru~ TplACCO /RlCF! A ' TA7[l7 UNl7E4'. lTNTEi ~. 1YJ7'. . 1AI RGL T[tYf ~~. 0 szA7t'E smm1AL toaACCO Ty12t ®.InOrt I•/CL n(1

that taA increases can lhm We need only iook at tbe recent mulel+ million idollar (but unsttccesdull) effortimounted by the industry to oppose a 25 cent per pack tax increase in Massachusetts. Tobacco Industry Argttments against Tax Increases The industry uses numerous arguments to defend!its profits. To accept them means to accept a huge continuing death toll from smoking. These arguments are either bogus or can be met in a way that is less dangerous to public health than perpetuating the sale of'low, priced tobacco: • Inl tobacco-growing states, the industry,will atguerthat l increased taxation will devastate tobacco fanners: In fact in-state consump- tion, even in the largest tobacco growing!states, is insignificant compared to out of state consumption: Governments would ordi- narily have to forgo over $ 1100 in potential revenue for euery' dollar of ~ retained sales by its tobacco'growers. The key point is thatJarmers, as opposed to the tobacco tnanufacturets; make so Gtt1e out of the sale of each cigarette that they could easily be compensated for the adverse income effects of any fall in sales- and encouraged out of tobacco growing. • in states with 1 tobacco manufacturing facilities, the industry will argue'that jobs could'be lost Again, since little of what is pro- duced in-state is actually consumed there, the impact'is quite small. When these jobs are then measured in terms of taxes forgone per job saved, or lives lost per job saved, the industrl?s argumentiiecomes absurd. •'In states with no serious tobacco industry presence-the vast majority of US'statesl arguments will be made about the impact on local retailers. in such states a substantial proportion of expenditures on tobacco products are immediately'.exported" to tobacco companies and tobacco states: Increased taxes will increase'state revenues, and spending,neallocated to other good.k and services will produce more jobs, as allarger fraction~of such expenditure will remain in-state: • The industry will also attack tobacco tax' inct eases with the argument that all tases are bad and!must!be avoided. The fact is Figure 5 TpEACCO.TAXATIOM M THEUNrtEOSTATES AVEAAOE.tl6ARERE TAX AS A 1l OF~NETAIL PRICE 50% .oz 30% 2as 20% that golverrtments need money. While an income tax can discour- age work'ing; land investutent taxes can discourage savings and ittvestment, tobacco'taxes discourage the use of'otu leading cause of'preventable death. If any taxes are to be increased, it makes sense to increase the'ones which discourage behavior society seeks to discourage. • The'industry presents itself as the defenderl of the poor.lt will argue that higher tobacco taxes are a regressive form of taxation, that they hit the less weU-0ff far more than the better-ofL' That 1 is due in part to the fact ttiat the better-off and better-eduoated have responded to health information, while the poor have been tar= geted by an industry anxious to hang on to customers: The indus- tryne9er points out that • for all its concerns about the poor it hasbeeniraising tobacco prices over the pasi decade, at rates well1in excess of tax in- creases, to boost its own profits; • that'the money raised from higher taxes coukf be'used to fund projects, tax or welfare changes that would improve the lives of the poor. • that the real "regressivit}+, is the higher rates of~death andd dis'ease'among the poor resulting from their continued addiction to tobacco, fostered by targeted'industry ad campaigns. Developing a Strategy Drawing on these facts and arguments, the key is to start influcnc= ing leatlirtg,opinion,formers, legislators, healfli and medical organiparions and the public at large about the role tobacco taxescan play in both health and fiscal policy~ This means directing, information andllobbying efforts both at those interested in health and those responsible for finance, at the state and federal level. It means tailoring the argument to local circumstances. It means beginning to understand the budget ptoess and getting the riglu information to the right people at the right time. Recent experience at the state level suggests this can be done. This should 'be replicated in states that'have not raised taxes recettdy, and progress should be maintained'm states which have- since the effect of a one-time nominal tax increase is underminedd every year due to infiktion. lttdividual states can start following their neighbors"'lead That;,in tnm, reduces the risk that some of the impact of higher taxes could be diminished by 9nctea5ed i cross-border shopping for cigarettes. By far the most dramatic impact would come'from a substantial hike in the federal tax. In 1951 the federal tax was set at 8 cents a pack. It stayed'there foroxer 30 years. If'the federal tax was adjustedimerely to eover inflation since 19511 it would be about 43 cents in 1993'rather than 24 cents. Th at would do no more than return the tax level to thatiprewailing before the risks of smoking were known. But it would be a start. Far more significantt would be an increase that reflects the fact that taxes, to comple- ment health goals, should be significantly higher ihan they were before we knew the'magnitude of the health problem.lfiis has been achieved in our neighbor to the north. Canada, :utd inim:uiv other industriali¢ed'nations around the world. TohQcco L'se An american Crisis o?~~, ~~,' 9~'~{~Q, G1 I I tg5S 1901 1967 ' 1973 ,. 197~9 INea ,'Y.9n

..4VttrE;.shitps. Can it be Done? The simple answer is: yes: In fact some states have alreydj+atovad and many others are in the process. Other countries have tobacco industries, tobacco lobbies; tobacco farmers and large numbers oftobacco users, and have anainedJsubstantial increases in to- bacco taxes: Canada is a ptnme example: In the early 198n's, Canada's tobacco taxes were lower than rthe rates presently found in the United States: Despite vigorous opposition from a pow!ertul tobacco tobby, a eoncerted effort by Canadiatt health groups has led to taxes which now amount to about $3 1 (US) 1 perpaelt Cana- dian per capita consumption since 1983 has fallen by over 40%, half again as fast as that of the United'States. N(any other places, inciudittg Ireland; the United IGngdbm, France;,Sweden, New Zeaiand; Australia and Hong Kong have t ecentiy brought forward substantialltobacco tax increases. The challenge;to the American health commtmity is to learn from previous eEforts,,ereate the infrastructure within health organi;2- tions necessary todirectthis campaign, and to see if we can create a bigger and more decisive public health success,storl+than has ever been achieved in this country: The prize will be millions of premature deaths avoided! and a bankroll of'biilions of addi- tional dollars to assist financially strapped govetmments.to serve the nation's people. Recommendations The participants of the workshop examined various optiotu, including the position paper recently put together by the Coalition on Smoking or Health. That document calls for a federal tax increase of'at least $2.00 per pack. Such an iitcrease, if main- tained in,real value, is estimated.to reduce cigarette use by roughly 25%, eventually preventing,about two million tobacco- caused deadu while simultaneously raising $35 billion per year in additional revenue. The Coalition ~has also reeommendbd ;itr creases of about $ 1.00 per pack ia,state excise taxes. There was very strong support for these goals. As such the;workslwp has made the following two recommendatiotts: 1. The federal government should'intx+ease the clgarette exciserout by at loast $2:00 per pack with an equivalent amount assessed on alffother tobacco products. The reai'(in9ation-adjusted),vafue;of this tax should be at least maintained thereafter. 2. We encourage the individual states to inctease state excise taxes by approximately $1.00 per pack with an eqltivalent amount assessed on all other tobaccoproducts: The real ~(ihflntion-ad= justed): value of this tax should be maintained thereafter. Implrmentation Itm7s reoognized!thatirecommettdatioas of this magnitude will have little tfiance of stxcess, without a serious effort!on the pata off the heaNti cotnmunity. It was agt eed that a well-fiutdbd; profes- sionxl ieampaign will be aecessary and'that it will need to be given operational independence while being siinultaneousty'suppotted by a broad coalition of grassroots organizations. iztfrunucture will haNe to be buik to assist these effortsaad significant!sums of money will need to be misedlWhileour task is a big~one, there was gen- eraf agreement that the oppottuttityto save two million lives makes this not only an unprecedented opportunity but a potentiall y ex• tremely cost-effectiwe oae. There was a recognized need to tnove. qaiatdy aed decisively if we ane to achieve these gqals. Appendix A Average totalitazes and tax incidtxtce of a pack of ' 20 cigarettes in various countries as of+October 1'5„ 1992 Countrv Avg. Total'Tattes (American Dollars) Tax Incidence Denmark $4.18 85% Nortwiy, $3:93 68% Sweden $3•77' 73% Canada (British Columbia): $3.26 -69% Ireland $3.13 75% Finland $2.86 74% UK~ $2.86 76% Canada (Otttario) r2:85 69% NetherUnds $2:63 , 70% Germany $2.35' 72% Belgium $1.94' 73% NewZeaLhnd Frattce M92 , $1.56 6'8% 7't % Attstralia (Y~ctoria) $1.46 60% Italy $1I.32 72% Japan $1.09 60% US'(Hawaii)-Highest $0.75 37% US (Michigan)-AWerage $0.52, 29% US, (hirginia)-Lowest$o:3p~ I9%

Workshctips Tobacco Marketing and P7romotion. Introdiictioa In 1964 ; the Surgeon General's first report on smoking and health proved bevoand any reasonable doubt that cigarette smoking is the single most preventable cause of premature death andAisease in the United States. Vonetheless;,despite repeated reports by gov- erttmental and private sector orgattirations which focus on the nature and impact of'tobacco-advertising;andJmarketing;,such, promotion continues unregulated!and unrestricted, and tobacco, industry efforts to recruit new users, maintain current users, andi silence its opponents continue unabated. !n providing an analysis of public policy options, this paper will brieflv review the current d'ata and literature about the si cance of 'advertising and promotion of tobacco products in the United States. It will discuss the infiuence oftigarette and spitting tobacco advertising on yroung people, adults, and the media; how tobacco and'health issues are covered in the mass media, how societyv'iews tobacco and tobacco advertising;,and'how the gov- ernment responds totobacco and health issues. tiatntre and extent of tabacco advertising and promotion. How Much is Spent? While the tobacco industry contends thatobacco advertising andd marketing is not intended to and,does not help to attraa new. smokers, in 1990 the tobacco inditstty spent over E3:9 billion- or more than1]0.6 million a dity-promoting its products. These figures represent an increase ofover E!370 ihillion since 1989 and another increase of $342 million since 1988. Even when these expenditures are adjusted for inllation, the 11990 figures represent an increase of more than one hundred percent in advertising and promotion expenditures by, the tobacco industty during the 1980s. Today, annual!expenditures on cigarette advertising promotion total more than $4 billion-or $'14 for every man, woman and child in this country. The advertising promotional expenditure per carton is in excess of $1.35. In contrast, in 1980, after adjusting for inflation to constant 1'989 dollars, the tobacco industry only. spent $.58 per carton on advertising and promotion. Tobacco Advertising and Promotion Expenditures while tobacco industry advertising;spending in magazittes ($380 million in 1989), newspapers ($7? million in 1'989')S and bill- To~hacco U;ce an An:ecican Crisis Alan Bhun, MD Matt Myers, JLl boards ($39 million in 1989), continue to be large enough to have a major impact on each of these media„such traditional advertising has been suppiemented by other forms of promotion. For example, point-of-sale advertising;in ruetail establishmenvi, totaled'E24Tmillion in 1989; an increase of 99% from the previ- ous year. Simitariy, the amount spent on give-awaynon-cigarette utility items, such as calendars, Iighters, and T-shirts, increased by oNer $72 million~ftiom 1988uo reach a totallof $262 million in 1989. tf this figure were to~include retail value added~give-aways, such as key chains andllighters, which ane given as a bonus when a consumer purchases a pack of ciganettes, the expenditure would be far higher. (Incidentally, point-of-sale advertising and advertising on utilitarian ~ items are exempted from the health warning requirements.) Expenditures on the promotion of sports and sporting events also i's growing. In 1989, the tobacco inditstry spent $97:7 million on sports and sporting events, an increase of'more than 8% in one year from the S84 million spent in 1988. Such activities includo golfi tennis; and various froms of motor racing., Tobacco bill'+ boards also continued to be the dominate advertisements in manv . major professional stadiums in which non-tobacco sponsored events are pLayed,and televised. A number of promotional themes and campaigns that began in Europe have found their way to the United States. For example, in 1992,Pliilip Morris,announced a•new campaign en6tted.the: "Marlboro Adventure Team ...Tprt guys who wilUhike and bikc, a.s well as ride the rapids of the SouthwesL" According to Philip Morris, as ,of March , 1993, more than 300;000 people had applied, to participate in the events. Doubtless the most significant trend in tobacco advertising expen- ditures-and the least addressed by,tobaccm control advocates-- is that'of ptromotionallallowattces, such as the amount paid by cigarette companies to retailers for shelf space; cooperative advertising with retailers, trade promotions to wholesalers- Pro- motional allowances,,which constitute the single fkr" advenis- ing categPry„totalled $999:8 million in11989. Discounaeoupons and retail value added!promotions, such as multiple pack promo- ~ tions and offers of a free key chain or lighter (blister-packed to cigarette pack), comprise the secondUrgesuadvertising and, promotional expenditure by the tobacco industry. in 1'989, $959.9 million was spent~on this type of advertising and prorno, tion, N[ealth advocates liave devoted scant attention to atticxamina~ 2024~.,969'~p

1r ttrhSlutylts tion of the role stwli promotions have had litreotuuer'xcting;die intended cigarette consumption-mducing effect of'ezcise taxes. The amotmuof moneybeing,spentonAiscottntcouppns, give- aways, and cut-rate cigarettes illustrates the etnphasis plaeed by the tobacco industry on those consumers who have fewer dollus to spend on tobacco: While such emphasis may, inpart,,be a reaction to the .recent ~ recession, it also appears to represent a strategy designed to offset any reduction in cigarette consumption as result of increasediexcise tazes;,as well as knowledge by the, tobacco industry that the prevalence of smoking is inversely proportional to income. Targeted marlceting Tobar.co Marketing and Youth cigarette manufacturers say theydo not market to young people (to not want chifdten~to smoke.lndeed, Philip Morras and R.J. Reynolds have created national advertising campaigns built upon prevalence theme. However, the tobacco industry's claints are contradicted by its heavy use of image-based advertising in~eon- texts where the ads will be observedby yamg,people:. Fach yea.r, more than three million Americanwuttg'people under the age of 18 'consume 947 million packs of ctganettes. Almost 900 percent of all new smokers start by the age of'21. The age of initiation of'smoking has declincd over the last 40 years by 2.4 years overall and 5.4 years for white females: it is no coincidence that teena$ers smoke precisely those brands with advertising messages which appear to be targeted!at adoles- cents. A 1989 ~GDC study, confftming,an earlierstndy, conducted by D0G (Doctors Ought to C.ane) regarding agarette brand ptmf-, erences among adolescents, found that 71 pereent of white teen- agers who buy tlieir own cigarettes smoke Marlboro; while 61 percent, of black teenagers buy Newport, a menthol brand. Camel represents the second most popular brattd among white ywtdi, while for blacks; the ttext most ptreferred!brands are Kool and Salem, two other menthol brands. In two recent stu+veys, at least 84 percent ofthe adolescent aurreat'smokers saho usually bought their own cigarettes purchased one of three most highly a&w- tised targeted'brands-Martboro, Newport or Camef--each of which empliasizes image-based advertising. The same sttrveqs found that brand preference is muchimore aooeentrated among adolescents who smoke than among adults whostnoke. For years, Marlboro has beenthe predominantbrand used by adolescents, who appear to be attracted to the brand's image of'f strength and independence promotediin the long-nunt»ng . Marlboro Man"'adxertising campaign. The longstanding success of Marlboro has been partly explkiited by William J1 MoCartliy and Ellen Gritz, who examined the pa}cltological and social factors that influence teenagers to smoke. Aeeording,to testimony pro- vided by Dr. McCarthy before the Subcommittee on Health and the Envi ronment of the Committee on 1 Energy and Commerce, "To the degree thati adolescents consciously try to reduce the distance between their ideallse{f-'image and their owniself:images, and the scientific literature supports thatthey do; there is reason to conchxie thRt~tfie personality traits poptilarfy'imputed to ciga, rette smokers and cigarette advertisements are sufficiently allur, ing to induce adolescents to s:aoke.... For the typical teenagerr seeking to make his/her real!self'corrx:spond more closely to his/ her ideal selfa' the portrayal in cigarette ads of;valuedaspect.~c of identity such as independence, social and physical lattractiveness andleonfidence cannot fail to make cigarettes appear more attrac- tive to teeflagers thani they would be without such associated imagetN." The Joe Camellcartoon caricature introduced in the US in the mid-1980's contains none of~the subtlety of'the Marlboro cowtiov;, but few advertising campaigns have been more effective in such a short period of time with young people: In 1'986, Camel ranked seventh among the youngest age group of people who smoke. in 1'989, one year after the advertising'catnpaigtt began, the brand' ranked third among teenagers surveyed. Three studies pubfished in the December 11, 1991 issue of the JourrtaGof tbeAmers'can :Me.fical ASsociatdon OIAM) confiemed' what every expert (and anyone with commonsense) had alreadv concluded. Whatever the intent, the "Old Joe" cartoon camel advertising campaign had'its greatest influence on children andd adolescents: Two of these studies specifically examined the influ- ence of the "Old Joe" campaign on teenagers. Both studies of teenagers found: (11) thai teenagers are far more likely to have seen and remember these advertisements than adults; (2) that teenagers associated!these advertisements withithe product being advertised far more than adults; and (3) most impotnanttyn a stunning,and'dramatic rise in the use of Camel cigarefles directly paralleled the introduction and pursuit of this advertising,campaign. The same two studies documented an explosive growth in the sale of Camel cigarettes in pre-teens andiadolescents: While surveys conducted on seven different occasions between 1976 and 19M among seventh to twelfth graders revealed that only 0.5 percent of those surveyed used Camel lcigarettes, the study released in ithe . December 1991 issue of;4M of'the same age group in 1990 found that 32.8 percent reported using Camel cigarettes.lfie . second study fotmd that among teens and pre-teens surveyed the use of Camel cigarettes rose 230 percent between 1986 and t.. .990: As shocking as are the results of these two studies, a shird studv published in the same issue ofAW, which examined the infiu- ence of this campaign on three to sitt year old lchlldren; is,even more disturbing. Among six year olds surveyed, nearly as manyof the childrett could identify an illustration of the "Old J oe" camel cartoon logo as could'identify; a commonly used logo of Mickey Motise: fie "Oldloe" campaign has combined every m$rfceting,tool avaiiable to the tobacco industry to reach out, to children. Nbtonly do the print, advertisements using "Old Joe" stress themes that uniquely'appeal to young people, but the overall campaign has also included ifree T=shicts, baseball caps, posters, inflatabM air mattresses, and other items of clothing far more likely to be worn or used by adolescents than by adults. Furrther, the campaigtt hus 64

made heavy use of discount aoupons. At least one adverti.sement went so far as to explaia to individuals who do not like to redeem i coupons (that is, children too ytxmg to legalty do so), tiow to ask a ftnend'or a stranger to do so for thetn. While the "Old Joe" camfraign'.s appeal to youth is so blatant that Adir?rtdsdngAge has editoriati¢ed'thatttiis catnpaign,..erossed the divider between [a company's] legal right to advertise and its unique social responsibility to the general public", the advertising campaign has continued'unabated. Howevers those concerned about the influence of adierti5ing on ytxtt>g,people also should not lose sight of the fact that while "Old Joe"'has prompted a public outcry for reform, countless other image-based ubiquitous cigarette advertising campaigna,,exempli6ed!by the "Marlboro" cowboy and Vitgirtia Sllms models, pose every bit as serious a problemi Tobacco Marketing and Women Over the last 25' years, tobacco marketing targeted at women has become evertnotre pervasive. It was less than 30 years ago that'the first cigarette introdueed solely for women was brought~on thee market. It is no coincidence that advertising campaigns targeted at women preceded land then accompanied the rapid spread of smoking among teenage girls in the United States in the late 1960s and the early, 1970s. Taking advantage of major changes in social' attitudes about1 the role of women in our, societv, the tobacco industry'in the late 1960s began a massive campaign to associate smoking with independence and social progness -ttte type of values portrayed by Yirginia Slims advertising campaigns. Wttile the tobacco industry has long marketed tobacco products to women implying that smoking provides a mechanism for stay- ing thin, the 19805 witnessedlan explosion of~ advertising using false images that link smoking with tall, thin, elegant, attractive women using ad0ertising slogans which associate tobacco use with good health through thinness and weight reduction: Recent . advertisements for Sttper Slims from Virginia Slims feature photo- graphs of taUL ultra thin young women dressed in tight, revealutg, dottiing wftose images have been elongated andibodies made too appGar'even more slendr:r through trick photography. The ads make use of words with double meanings, all oPwhich have weight or thinness-related meanings, sttdt as "Ultra 11ght", and tag lines, such as "We can't make ypur calls shorter, just slim- mer." Ads for Qapri Super Slime carry the bold slogan„'"Itfe Slimmest Slim." The 1'989 Teenage Attitudes an0ractices (TAPS) Survey of ado• lescents fbund that while non-smoking adblescent girl.s strongly disagree with the statement that smoking helps keep weight down, the survey found tharamong current teenage girls who smoke, over 66 percent of those surveyed agreed with the statement that smoking helps keep one's weight down. The 1986 Adult Use of Tobacco Survey found that'52.7 percent of all women age 21 through 49 strongly or somewhat agreed with the statement'that smoking helps control weight These ads are successful. Inithe 1960s, far more teenage boys smoked thaniteenage girls. In the 197tis;,teenage girls were the only i.on cohort where smoking'actually'increased Today, mon teenage boys and!teenage girls smoke in almost equal numbers. Tobacco Marketing and'Ethnic MinoRities The tobacco industry has been especially adeptiatlezploiting raci:d identity in defining aprofitable market'among ethnic minorities. The result is an increase in smokfng-related disease andldeath among targeted ethnic groups in the US: Seeking new markets through advertising and promotional cam- paigns in certain minorfty,commtmities has been a,nece,caity for tobacco companies as the smoking white male population has decreasedlihthe US during the past two decades. While major daily newspapers have experienced a decrease in irevenue from cigarette advertising accounts, the African American-owned and Hispanic-owned newspapers continue to be a major context for cigarette advertisingtargeted to these specific ethnic communities. Tobacco companies and the minority press have become allies in the effort to pramote cigarettes iniethnic communities and inner, city neighborhoods. IniNovetnber 1985, Philip Morris hosted 93 publishers of the African American newspapers at its corporate headquarters in New York for a forum on preserving freedoms in American life. Early in 1986, these publishers voted to condemnn attempts to restriction on tobacco advertising. In 199d:,the wa- tional Association of'Hispanic Publications made a similar state- ment. The 350 Hispanic newspapers that belong to tlie association receive about 20% of their advertising revenue from alcohol and tobacco companies. Perhaps the greatest concentration of tobacco company advertis- ing is in Afriean American publications such asJet; Essence, and Ebony, which reach 47 percent of African American women and 38% of Afritan American men: Despite frequent health topics head-linedion the front covers of 6bon}^ andiEssence, 6bonv'h;L; never published'almajor article on the leading cause of death among African Americans: tobacco; in its 40-year history. Es- sence, which positions itself as a Black lifestyle magazine; h:cKs never published anartide on smoking;,much les.s on cigarette advertising. Billboard;and transit:advertising„whilemotA'fcican AmerRcan-orHi.spattic-owned, represent an importanrmedia within these communities. Studies conducted by Scenic America and other organizations have xhown disproportionate advertising of tobacco and alcohol products in,inner-city neighborhoods: In many Afri- canAmericart and Hispanic neighborhoods, virtually 80% to 90% of all billboard advertising is for btand+ of tobacco and acohol. Ini African American communities especially;,cigarette advertifiing is the single common theme in a variery of retail outlets from food stores and supermarkets to beauty paribrs and barber shops (;v; well as dry cleaners; laundromats, gas stations, and!bars and . grills). Ironically, money saving offers are perhaps the major appeal'th:u the tobacco industry makes to the people with the lbtvest dispos- able income.lfiere has been aldramatic increase in the number 55 Tobacco G'se; An Anterican Chsas 2?lJh+4,,ZV.771r.

Wctrkshops of rebate coupons in magazines and!newspaFers and in-store discounta good for up to ~5U'% oH~oncigarette parks, In a subur• ban, predon»nently white neighborhood, promotions indude a~ free t-shirt or other item for the purchase of three packages of cigarettes. The same promotional offer in an;-(rican American or Hispanic neighborhood is available for alone-pack purcha5e: The free distributionof sample packs is also common in inner-city communities. Tobacco companies have also linked cigarette promotions to African American and Hispanic music andcultural events. R.J, Reynolds and United States Tobacco (UST) sponsor Hispanic street fairs and festivals, such as Qutco de Maw eelebrations, and, Brown and Williamson foots the bill for numerous Spanish and jazz musicals in Hispanic communities. BroAVtrand Williamson also presents annual "Koof Achiever" awards (named for Kool cigarettes) to people who want to improve the °quality of life in inner-city communities." The tobacco compatn• has even enlisted the National Urban League, the National Newspaper Publishers Association, and the NAACP in the nominating pt•ocess: Johnso n Publications, publishers ofiELiony andJet, adds another insidious twist by permitting itself to be the apparent sponsor of a national' traveling fashionfairthat is in large pant paidfor by R.J. Reynolds to promote its More brand of cigarettes. Sitnilnrly, Philip Morris has sponsoredcultural events such as the Alvin ,liley American Dance Theatre: jazz and blues concerts, and a photographic display of the late Dr. Martiit Luther King, Jr In 1990, R.J. Reynolds announced plans to Launch anew menthol' cigarette brand called Uptown (more,than65% of blacks who smoke buy menthol brrartds);. Ptiiladelphia, Pennsylvania was selected as the test market for a promotional blitz aimed'at wung urbanafrican Americans. However, before the tobacco company could get its marketing off the ground, a local group callingitself the Uptown G,oalition was fotmed, by IDr: Robert Robinson, then with~Eox Chase Cancer Centen With the help from other health advocacy groups and' a blast at R.J. Reynolds by Secretary of ' Health and Human Services Louis Sullivan: the Uptown Coalition was successful in preventingthe test market of the brand. Despite .the Goalition's success, R.J. Reynolds began anaggt•essive national' campaign for Salem cigarettes (`"t'tte Box") i in inner-city African American neighborhoods for, which Uptown had. been intendedl Similarly, other cigarette brands popular among African Ameri- cans, such as Newport and!Bettsott and Hedges, continue to be: agressively marketed in much the same way. Tobacco advertising and promotion: Market expansion or brand switching The tobacco industry, claims that the $4 billion it spends each year on cigarette advertising is intended onlyto maitttain "brand lovaltv" and that it does not seek to attract new smokers, (or,, conversly; that cigarette advertising is only designed to persuade smokers to switch brands). The tobacco industry has further argued that unless those who are concerned about the impactof tobacco can~proHe that advertising and marketing actually causes people to startor not to stop, cigarette advertising and marketing should remain unrestricted. In support obits position, thetobacco industry often quotes ouvof context a single sentence in the 11989 Report of the Surgeon General that states P'There ,is no scientificallj+ rigorous study avail- able to ttie public that~provides a definiti.ve answer to the basic question of whether advertising and promotion increase the level of! tobacco consumption." However, thetobacico indltstry, conseiously and!deceitfully fails to put the sentence in context by omitting the followingsentences from the Surgeort General's Repoat which appear iinmediately after the quotedlsetttence: "Givenrthe complexity ofthe iasue, none is likely to be forthcom, inginthe foreseeable future. The most comprehensive review of both the direct and!indirect mechanisms (whereby advertising may affeeueonsumption) concluded thatithe collective empirical, experiential, and logical evidence makes it more.hkely than not that advertising and promotional activities do stimulate cigarette constanption." Aside from; its dishonesty;thetobacco indostt3's position lacks merirfor three distinet; independet-t reasons. Frst;,tlie point of; the Surgeon General, as statediin testimony before the Subcom- mittee onTranspotnationand Hazardous Substances of the Energy and Commerce Committee of the United States House of Repne- sentatives oniSeptember 13, 11989, is that a perfectly, ddesigned study to prove that cigarette advertising increases cigarette con- sumption will probably never be accomplished because proof of that type in a single study, is virtually never available "when study- ing human behavior."The overwhelming evidence demonstrates that tobacco advertising and marketing'practices do have an impacton the use of tobacco in a variety of complex, interrelated' ways that are not capable of beingproven or disproven in a sinrJe study, but are no less significant Second, the tobaeco industry tiaF attempted to manipulate the debate into a focus on the availability of a single scientific study precisely to avoid public policy action in much the same way that the tobacco industry established the Q,ounsel on Tobacco Re- search to avoid public policy action on the health effects of to- baceo long after more than enough evidence was available to act. Third, in*ht of the available dka, the tuKttruroverted'health eEfectsof tobacco use, andiihe st$ted1goal ofour government to discourage tobacco use, especially among children, the burden ~ shoul8 be on the tobacco industry to demonstrate that its $3.9 billion marketing effort does not play any role, direct or indirecti in the uptake of tobacco use rather than on those responsible officials concerned about the health ofour nation to prove to the contrary. The data demonstrating that marketingand advertising of tobacco products does play a role in tobacco use comes from many ili.ci- plines and from many sources: Combined, it can lead to only one conclusion. Briefly;these data fall iinto six categories. 1. The tobacco industry annually loses more of its customers than do the manufacturers of any other producL An average of 1.5 milllon Americans quitsmoking each ycar and an additional 434,()00 die from smoking-related causes: Since over 90 ~per-

cent of all'new smokers are under the age of 20, this means that thousandsof children have to begin srnoking ,each day in order for the tobaccw industry to maintain the status quo. The tobacco industry,knows that if one hasn't,startedismoking by their 18th birthday, they only have a one in ten chanee of ever doing,so: 2: only a small percentage of a!l smokers switch brands each year. Three manufacturers cutTently sell over 80,percent of'all' cigarettes sold in the Utrited'Stgtes. Thus, too few smokers switch to justify, a $3.9 billion expenditure each year. Also, many of tliose who do switch simpiyswitch to a different brand of the same manufacturer. if the sole purpose of advertising was brand switching, the three major tobacco manufacturers would make fir more money if they agreed to discontinue tobacco advertising and marketing because they spend far more each year on advertising and!marketing than they make by acquiring new smokers from their competitors. 3. Tobacco advertising has been shown rto work. Advertising campaigns targeted at women preceded and then accompaniedd the rapid,spread of smoking among women. Advertising cattt- paigns on behalf'of smokeless tobacco products precedediand then accompanied the rapid rise of the use,of~smokeless to- bacco products by teenagers. The recent "Old Joe" advertising campaign has documented the dramatic influence over a shoru period of time a single advertising campaign,can have onn tobacco use among adolescents. None of these changes in smoking rates can be pritttarily explained by any, factor other than the impact of advertising and marketing for specific, brands. 4. Advertising experts agree that market expansion is a signi6cant objective of advertising for virtually all products: There is no evidence that advertising operates differently for tobacco prod- ucts. Tobacco is not the type of matttre.market where nevv consumers do not need to be attracted. The matttre market argument applies in situations where a society becomes fully educated as to the need for and benefits of a product,andiwill' continue to purehase that product without further education or persuasion. Nfattyhouseliold prodttar, such as soap, tissue paper, or latmdrydetergent f911 into this category. However, tobacco-is differenu Given the educational efforts to discourage people from using tobaeco producxs and'given the known health hazards of.tobaccoproducts, each new generation of children must be convinced and persuaded of1 a1 reason to buy the product Thus, by depicting tobacco products as an integSal part of'a highly desirable lifestyle and personal,image„tobacco advertisersattraet~individuals who do notcurretttly use that, product, but who want to emulate that lifestyle and project a depicted image. Advertisements that effectively assoeiate,smok- ing w,ith the latest trends or ideas or with independence, so- phistication, sexual, social, or athletic success and happiness attract smokers and non-smokers alike who wantito be like the people in the ads. 5. If adventising does not increase consumption for tobacco products, why do state monopolies advertise in.countries where there is no competition? Auone time or another, several countries which,thenhad state monopolies, inclucing;Au.stri,, Japaa,,South Korea,lMiland; and thtrkey, have engaged in widespread cigarette advertising. 6. The tobacco indusuy, has generated considerable debate over what can~be teatned:about the role of advertising from the international experience of countries that banned advertising after preriously permitting it: While several countries with free market economies have enacted statutory bans on the advertis, ing attd/or promotion of tobacco, only, a few have instituted effectiue bans: Even fewer countries have combined those bans or restrictions with a comprehensivesmoking-educ:uion pro- gram or counteradvertising campaign. While the tobacco industry has funded a study which manipulates the data in an effort to tnake it appear as if restrictions or bans.on tobacco advertising have had no impact, an increasing number of impartial govetmmentaliyfunded studies provide substantial evidence to the contrary: A 1989'swd j' by the Government of vew 2,ealand~providedlpersuasive evidence that in,those countries which enacted!serious bans, there was a measurable overall decrease ia tobacco use from what would,have existed had there been no ~ban and/or restriction. In 1993 the Chief'Eeonomic Advisor of the Department oCHeaith of the Government of Great Britain issued a report whiclifound that advertising ten& to increase consumption of tobacco prod1 ucts and that bans on tobacco advertising,tend to result in a decrease of tobacco use from wtiat'would have occurred in the absence of such a ban. The reporteottsidered 19 keystudiesfnom the United tCutgdom, United States attd'elsewttere. Focusingon the four countries with the most sufficient data-Notway, Finland. Canada,and'~tiiew7.ealand--the report's author found'that in all four countries, bans or restrictions on advertising resulted in an overall decrease in consumption. The limitations of'these data must be understood. Multiple anti- tobacco actions accompanied the advertisi,ng ban. It is impossible to know the effect of the advertising ban alone. Nonetheless, the data ftom these couturies show a positive correlation between elirninsarttg advertising and promotion and a declining percentage of'yvung'people whosmoke: Despite any argument the tobaaao,industry decides to proulgate during the debate on cigarette advertiaing;,everyone can agree that an advertisement for cigarettes, regardless of brand, is an advertise.menrto smoke. Currentgove7rnrnenta[ restrictions on tobacco advert9si ng ; an d~ promotion At, the federal!level, there has been remarkably little done to restrict the influence of tobacco advertising,and promotion: In, 1965, 'Congress rejected a proposal by the Federal Trade Commission to requinedetaited health warnings on all cigarene advertisements and packages and, instead, required'only that all cigarette packages carrv the following message: "Caution: Ciga- rette SinokingiMay Be Hazardous To Your Health." No warning 6- To6acco C"se.•.-inAmerican Crisis 2024196974