The taste of smoke: tobacco industry strategies to prevent the prohibition of additives in tobacco products in Brazil

BackgroundThe tobacco industry (TI) uses several strategies to attract new consumers, including using additives in tobacco products, which makes tobacco especially attractive to youth. Based on scientific evidence and the principles of the WHO Framework Convention on Tobacco Control, the Brazilian Health Regulatory Agency (ANVISA, for the name in Portuguese), published the Collegiate Board Resolution (RDC, for the name in Portuguese) 14/2012 in 2012, prohibiting the addition of substances that enhance the flavour and taste of tobacco products in order to make them more attractive. In response, the TI used various strategies to prevent RDC 14/2012 from entering into force. At the time, the Brazilian additive ban was the most comprehensive in the world as it included a ban on menthol.ObjectivesThis paper analyses the arguments and strategies used by the TI to prevent the implementation of the additives ban.MethodsReview of published articles, reports, legislation and legislative activity, internal TI documents, media stories and other documents to describe TI’s reaction to the ban.ResultsThe results show that the TI used some well-known strategies to delay or cancel the entering into force of the resolution. For example, the TI attempted political interference, used litigation and commissioned studies with findings that questioned the resolution’s rationale. The TI strategies used in Brazil are similar to those used at the global level to oppose other tobacco control measures.ConclusionsTI successfully delayed the most comprehensive additive ban in the world using its usual tactics, despite the fact that none of the arguments presented by the TI had an acceptable scientific basis or evidence.

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Perception of Tobacco in Young Adults of Urban India: A Qualitative Exploration and Health Policy Analysis

Journal of Global Oncology ◽

10.1200/jgo.18.80100 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 198s-198s

Author(s):

S. Ghose ◽

S.S. Datta

Keyword(s):

Policy Analysis ◽

Tobacco Control ◽

Tobacco Use ◽

Urban Youth ◽

Control Measures ◽

Control Law ◽

Theory Approach ◽

Major Theme ◽

Tobacco Products ◽

The World

Background: Tobacco is the single largest cause of preventable death globally. An emerging body of evidence shows that tobacco is 1 of the identified causes of cancer contributing to 50% of cancers in men and 20% in women and the same is estimated to kill 10 million people by 2030. The epicenter of this epidemic is the low and middle income countries with 80% of the 1 billion smokers in the world coming from there. India is home to 275 million tobacco users and is the second largest producer and user of tobacco products after China. Many of the users demonstrate a very early smoking debut and a significant proportion of India's population falls in this group. Prevention of early tobacco debut and use of tobacco in youth is 1 of the critical ways of reducing the burden of noncommunicable diseases in the world. There is very limited information on how today's youth perceive using tobacco products, and what they think of the anti-tobacco campaigns and legislative measures. Aim: The qualitative arm aims to bridge some of the knowledge gaps related to tobacco use in today's urban youth; to understand the perceptions of the youth about tobacco. The policy piece evaluates relevant tobacco control legislations in India using a prevalidated policy analysis framework. It critically analyses the gaps of the national tobacco control mechanisms responsible for impacting the tobacco use in the youth. Methods: A qualitative grounded theory approach was followed. In a university in India, 30 young undergraduate students were recruited. Data were collected through in-depth interviews, focus groups and participant observations. The policy section critically analyzed relevant parts of the India's tobacco control law taking its lead from the qualitative data, compared it with the WHO Framework Convention of Tobacco Control (FCTC), and identifies barriers and gaps to understand how its impacting the use of tobacco in youth. Results: Peer influence and social desirability emerged as major influencers for tobacco debut. Stress, exams, depression, family problems and symptoms of stress for example headache, sleeplessness etc. were other influencers for debut. The other major theme was the perceptions and concepts on tobacco addiction and quitting. Knowledge among youth on available quitting or cessation support was very little. Most of the study participants believed that the current tobacco control measures are not effective. The policy analysis of national tobacco control measures revealed significant gaps that are currently being exploited by the tobacco industry as they continue to promote tobacco products and increase production capacity. Conclusion: This study recommends amending the Indian tobacco control law to address the gaps and implement a more stringent legislation commensurate to the tobacco use patterns and existing barriers.

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FDA’s reduced exposure marketing order for IQOS: why it is not a reliable global model

Tobacco Control ◽

10.1136/tobaccocontrol-2020-056316 ◽

2021 ◽

pp. tobaccocontrol-2020-056316

Author(s):

Lauren Kass Lempert ◽

Stella Bialous ◽

Stanton Glantz

Keyword(s):

Public Relations ◽

Tobacco Control ◽

Scientific Evidence ◽

Tobacco Product ◽

Tobacco Products ◽

Sales And Marketing ◽

Philip Morris ◽

The Us ◽

The Usa ◽

The Difference

The US Food and Drug Administration (FDA) issued orders in July 2020 authorising Philip Morris Products S.A. to market its heated tobacco product (HTP) IQOS inside the USA with claims that it reduces exposure to some dangerous substances. FDA’s ‘reduced-exposure’ orders explicitly prohibit the marketing of IQOS with claims that IQOS will reduce harm or the risk of tobacco-related diseases. Under US law, FDA’s IQOS orders are problematic because FDA disregarded valid scientific evidence that IQOS increases exposure to other dangerous toxins and that Philip Morris Products S.A. failed to demonstrate that consumers understand the difference between reduced-exposure and reduced-harm claims. Unfortunately, both ‘reduced-exposure’ and ‘reduced-harm’ are classified as ‘modified risk tobacco products’ under US law. Exploiting this confusion, Philip Morris International used the FDA decision as the basis for marketing and public relations campaigns outside the USA to press governments to reverse policies that ban or regulate the sales and marketing of HTPs, including IQOS. Parties to the WHO Framework Convention on Tobacco Control should reject tobacco companies’ unsubstantiated explicit or implied claims of reduced harm associated with HTPs and resist Philip Morris International’s and other companies’ calls to relax HTP regulations based on the FDA’s actions. Instead, parties should adopt policies aligned with the Framework Convention on Tobacco Control when dealing with HTPs and other novel tobacco products.

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Analysis of the tobacco industry’s interference in the enforcement of health warnings on tobacco products in Brazil

Cadernos de Saúde Pública ◽

10.1590/0102-311x00120715 ◽

2017 ◽

Vol 33 (suppl 3) ◽

Cited By ~ 1

Author(s):

Cristina de Abreu Perez ◽

Vera Luiza da Costa e Silva ◽

Stella Aguinaga Bialous

Keyword(s):

Interest Groups ◽

Tobacco Control ◽

Tobacco Industry ◽

Strong Impact ◽

Health Warnings ◽

Tobacco Products ◽

Tobacco Control Policies ◽

The Relationship ◽

Original Information ◽

Regulatory Measure

Abstract: This article aims to analyze the relationship between the Brazilian government’s adoption of a regulatory measure with a strong impact on the population and the opposition by invested interest groups. The methodology involves the analysis of official documents on the enforcement of health warnings on tobacco products sold in Brazil. In parallel, a search was conducted for publicly available tobacco industry documents resulting from lawsuits, with the aim of identifying the industry’s reactions to this process. The findings suggest that various government acts were affected by direct interference from the tobacco industry. In some cases the interventions were explicit and in others they were indirect or difficult to identify. In light of the study’s theoretical framework, the article provides original information on the Brazilian process that can be useful for government policymakers in the strategic identification of tobacco control policies.

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Country Participation in the WHO Framework Convention on Tobacco Control Health Warnings Database

Tobacco Use Insights ◽

10.1177/1179173x211064214 ◽

2021 ◽

Vol 14 ◽

pp. 1179173X2110642

Author(s):

Christopher M. Seitz ◽

Kenneth D. Ward ◽

Zubair Kabir

Keyword(s):

Tobacco Control ◽

World Health ◽

Warning Labels ◽

Health Warnings ◽

Tobacco Products ◽

Health Warning ◽

Pictorial Warnings ◽

The World ◽

Alternative Tobacco Products ◽

Tobacco Packaging

Background The World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) Health Warnings Database is an online, publicly available resource created for countries to upload and share pictorial health warnings for tobacco packaging. The purpose of this study was to evaluate the extent to which the database is used by countries for the sharing of pictorial warnings. Methods The study’s sample included parties to the FCTC who required graphic health warning labels on cigarette packaging from. Those countries were categorized as having a low, middle, and high Socio-Demographic Index (SDI). The Health Warnings Database was then analyzed for those countries’ unique pictorial images, as well as the number of pictorials that were shared between countries. Results Of the 110 countries that required pictorial warnings on cigarette packaging, only 53 (48%) voluntarily contributed pictorials to the database, with most of those (53%) being high SDI-level countries. There were 342 unique pictorials on the database, with 62 images posted by seven countries that were used by 13 other countries. Conclusion While sharing was evident from the database, there remains a need for more countries to upload the pictorials to the database. There is also a need to expand the database to include alternative tobacco products, such as waterpipe tobacco and e-cigarettes.

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Overview on Cigarettes and Other Tobacco Products Act and its implementation: current update

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20205737 ◽

2020 ◽

Vol 8 (1) ◽

pp. 463

Author(s):

Dhwanit Thakore ◽

Mahesh Chavda ◽

Girish Parmar ◽

Tejal Sheth

Keyword(s):

Public Health ◽

Tobacco Control ◽

Tobacco Use ◽

Control Measures ◽

Public Health Issue ◽

Tobacco Products ◽

Health Goal ◽

The Status ◽

Public Health Goal ◽

Almost All

Tobacco use- a major public health issue in India has an enormous effect on the lower SES population. . There is an evident link between tobacco use or consumption and poverty. The widespread use of almost all forms of tobacco among the Indian population can be attributed to the social and cultural acceptance in the country. Cigarette and Other Tobacco Products Act, 2003 (COTPA) is the legislation that regulates tobacco in India. The prime objective of this review is to compile the literature with information about the laws regulating tobacco use and the status of implementation of tobacco control provisions covered under COTPA. Since effective tobacco control measures involve multi-stakeholders i.e public health, law, trade and commerce, industry, consumer, human rights and child development, coordinated efforts are required to successful enforcement. The outcome of the current literature is bridging the gaps to make the tobacco control a very important public health goal and thereby protect the population from the consequent morbidity and mortality due to tobacco use.

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Heated debates on regulations of heated tobacco products in South Korea: the news valence, source and framing of relative risk/benefit

Tobacco Control ◽

10.1136/tobaccocontrol-2020-056131 ◽

2021 ◽

pp. tobaccocontrol-2020-056131

Author(s):

Jungmi Jun ◽

Sei-Hill Kim ◽

James Thrasher ◽

Yoo Jin Cho ◽

Yu-Jin Heo

Keyword(s):

South Korea ◽

Tobacco Control ◽

Tobacco Industry ◽

Warning Labels ◽

Tobacco Products ◽

News Stories ◽

Time Period ◽

Significant Difference ◽

Tv News ◽

The Government

BackgroundWe analyse news representations of the regulation of heated tobacco products (HTPs) in South Korea, the country where HTP use is among the highest in the world despite conflicts between the government and the HTP manufacturers.MethodsWe analysed a total of 571 print and TV news covering HTP regulations, published between 2017 and 2018, the time period when HTPs were introduced to the country and various regulations of HTPs were proposed and implemented. We assessed the prevalence and associations among specific types of HTP regulations that were discussed, valence towards regulation, sources, framing of the relative health risks/benefits of HTPs compared with conventional cigarettes.ResultsTaxation (55.2%) and warning labels (25.7%) were two regulation topics covered the most. Almost equal proportions of pro-regulation (2.5%) and anti-regulation valence (2.2%) were found in taxation-related news, while pro-regulation valence appeared more frequently for other restrictions, including warning labels (pro=9.5% vs anti=1.4%), marketing restrictions (pro=6.9% vs anti=0%) and integration of HTPs into smoke-free policies for cigarettes (pro=8.7% vs anti=0%). The government (59%), followed by the tobacco industry (39.4%), was the source cited most often across news stories while the presence of tobacco control advocates was low (4.9%). As for framing, there was no significant difference in the prevalence of stories mentioning reduced harm (31.7%) and equal or more harm (33.6%) of HTPs compared with cigarettes.ConclusionsWe provide implications for governments and tobacco control advocates on building consensus for applying cigarette equivalent taxes and pictorial warning labels to HTPs.

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The Chilling Effect: Investor-State Dispute Settlement, Graphic Health Warnings, the Plain Packaging of Tobacco Products, and the Trans-Pacific Partnership

10.31219/osf.io/pr28w ◽

2018 ◽

Author(s):

Matthew Rimmer

Keyword(s):

Public Health ◽

Tobacco Control ◽

Dispute Settlement ◽

Trade Agreement ◽

Control Measures ◽

The European Union ◽

Health Warnings ◽

Tobacco Products ◽

Plain Packaging ◽

Philip Morris

Investor-State Dispute Settlement (ISDS) poses significant challenges in respect of tobacco control, public health, human rights, and sustainable development. Two landmark ISDS rulings provide procedural and substantive guidance on the interaction between ISDS and tobacco control. The ISDS action by Philip Morris against Uruguay in respect to graphic health warnings raised important procedural and substantive issues. The ISDS matter between Philip Morris and Australia over the plain packaging of tobacco products highlighted matters in respect of abuse of process. In the Trans-Pacific Partnership (TPP), there was a special exclusion for tobacco control measures in respect of ISDS. There was also a larger discussion about the role of general public health exceptions. In the Comprehensive Economic and Trade Agreement (CETA), there was a debate about the application of ISDS to intellectual property rights. In the European Union, there has been discussion of the creation of an international investment court. In the renegotiation of the North American Free Trade Agreement (NAFTA), there has even been calls to abolish ISDS clauses altogether from both Republicans and Democrats. This article concludes there is a need to protect tobacco control measures implementing the WHO Framework Convention on Tobacco Control 2003 from further investor and trade challenges.

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Contribution and Influence of the Civil Society for the New Health Warning Label of Tobacco Products in Brazil

Journal of Global Oncology ◽

10.1200/jgo.18.55300 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 134s-134s

Author(s):

M. Coutinho Marques de Pinho ◽

C. Abreu Perez ◽

C. Galhardo Ferreira Vianna

Keyword(s):

Civil Society ◽

Tobacco Control ◽

Public Consultation ◽

World Health ◽

Warning Label ◽

Health Warnings ◽

National Agency ◽

Tobacco Products ◽

Health Warning ◽

The World

Background and context: In April 2017, National Agency for Health Surveillance (Anvisa) launched a public consultation for the revision of Resolution Number 335/2003, on health warning labels. Aim: A group of representatives from civil society and tobacco control advocates in Brazil met in person and virtually to make contributions to the Anvisa´s proposal for new health warning label for tobacco products packages, considering the civil rights for participation and collaboration to Brazilian policies provided by public consultation. Strategy/Tactics: The advocates and researches consulted the Framework Convention on Tobacco Control of the World Health Organization and its Guideline for Article 11 (Packaging and Labeling of Tobacco Products) implementation adopted in 2008 based on scientific studies and successful experiences in other countries. In addition, international researchers and representatives of international institutions were also consulted to collect successful examples of health warnings in the world. Program/Policy process: In October 2017, the Anvisa Board of Directors at a public ordinary meeting approved the new health warnings and in December of the same year, published the new resolution about it. Outcomes: In a comparative analysis, even if all the recommendations made in the CP have not been complied with, the influence of the contributions of the group of tobacco control advocates to the final version of the warnings is evident. The main contributions considered by Anvisa were: 1) to increase the effectiveness of the health warnings using colored images instead of black and white images, 2) the use of yellow in the upper and lower tiers was also one of the points suggested by the group, and 3) the concept proposed by the group for side warnings was fully complied. What was learned: Civil society participation for the agency´s public policy implementation process is essential and has been possible through the regulatory agenda, public consultations and regular public meetings. However, as is expected, the regulated sector has been quite active. The group recognizes the importance of the Anvisa measure in proposing new health warnings, however, significant recommendations have not been adopted and it may interfere with the goals of the measure. Anvisa´s strategy of allowing the social participation is essential, in accordance with Universal Health System principles and must be maintained. Regarding to the next health warnings and messages on packages of tobacco products, it would be greater to consider higher frequency of updating the images and recover the scientific process of development of the 3rd round of health warnings labels coordinated by the National Institute of Cancer in 2007/2008.

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Impact of the WHO FCTC on tobacco control: perspectives from stakeholders in 12 countries

Tobacco Control ◽

10.1136/tobaccocontrol-2019-054940 ◽

2019 ◽

Vol 28 (Suppl 2) ◽

pp. s129-s135 ◽

Cited By ~ 2

Author(s):

Lorraine Craig ◽

Geoffrey T Fong ◽

Janet Chung-Hall ◽

Pekka Puska

Keyword(s):

Tobacco Control ◽

World Bank ◽

Tobacco Industry ◽

Primary Objective ◽

Political Support ◽

Control Measures ◽

Stakeholder Perspectives ◽

Independent Expert ◽

Development Levels ◽

The Impact

BackgroundThe WHO Framework Convention on Tobacco Control (WHO FCTC), the first WHO treaty, entered into force in 2005. In April 2015, a seven-member independent expert group (EG) was established by a decision of the FCTC Conference of the Parties to assess the impact of the Treaty in its first decade.One component of the EG’s methodology was to gather evidence on WHO FCTC impact from Parties themselves. This paper presents findings from 12 country missions on how the FCTC impacted progress on tobacco control.MethodsBetween November 2015 and May 2016, EG members conducted missions in 12 countries representing each of the six WHO regions and the four World Bank economic development levels. In each country, the EG interviewed a broad range of stakeholders to assess the extent to which the FCTC had contributed to tobacco control. The primary objective was to assess whether tobacco control measures would have been developed or passed, or implemented at all, or as quickly, if there had been no FCTC. Through this counterfactual inquiry, the EG sought to determine the FCTC’s causal role.ConclusionThe FCTC was reported to have made contributions along the entire policy/regulation process: the development of a measure, building legislative and political support for a measure and its implementation. These stakeholder perspectives support the conclusion that the FCTC has played a pivotal role in accelerating and strengthening the implementation of tobacco control measures, although tobacco industry interference continues to be a significant obstacle to further advancement.

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The World Trade Organization

10.1093/oso/9780190672676.003.0018 ◽

2018 ◽

Author(s):

Suerie Moon ◽

Thirukumaran Balasubramaniam

Keyword(s):

Human Rights ◽

World Trade Organization ◽

Tobacco Control ◽

World Trade ◽

Access To Medicines ◽

Control Measures ◽

Public Health Services ◽

Major Power ◽

The World ◽

Health Related

The ability of governments to protect and promote health-related human rights can be constrained by international trade rules, including those of the World Trade Organization (WTO). The WTO rules can increase medicine prices, challenge tobacco control measures, restrict national food safety policies, and facilitate brain drain from public health services. This chapter offers a brief history of the WTO’s origins, a high-level overview of the health implications of various WTO agreements, and a closer look at how two key issues—access to medicines and tobacco control—have created greater policy space for health within the WTO. It then identifies the institutional factors that promote or hinder human rights protection and offers conclusions on the prospects for institutionalization of health-related human rights. This chapter concludes that protecting health within the WTO and broader global trade regime is possible, but remains a significant challenge due to major power asymmetries.

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