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      Tobacco industry strategies to prevent a ban on the display of tobacco products and changes to health warning labels on the packaging in Brazil

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          Abstract

          INTRODUCTION

          Through packaging and marketing, the tobacco industry (TI) is able to increase the appeal of its products and reduce the effectiveness of health warning labels (HWLs). Based on scientific evidence and the principles of the WHO Framework Convention on Tobacco Control (FCTC), ANVISA, the Brazilian surveillance and regulatory agency, conducted a process to implement new regulations at the point-of-sale (POS), including a display ban, and new parameters to HWLs. In order to prevent the regulation from entering into force, the TI strategically used several approaches. The objective of this study was to analyze the approaches used by the TI to prevent the implementation of a tobacco display ban and new requirements to HWLs.

          METHODS

          In order to identify and describe TI’s approaches, we reviewed several sources of documentation, including published articles, reports, legislation, TI documents, and media stories.

          RESULTS

          Well-known, reported approaches were used by the TI in order to prevent the implementation of new regulations. These approaches included political interference, litigation, and funding studies to question tobacco control measures as previously reported in Brazil and other countries.

          CONCLUSIONS

          Using established approaches, the TI successfully stopped the implementation of a tobacco display ban and new parameters to HWLs in Brazil.

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          Most cited references51

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          Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the International Tobacco Control (ITC) Four Country Survey.

          D. Hammond (2006)
          Health warnings on cigarette packages are among the most common means of communicating the health risks of smoking. However, few studies have evaluated the impact of package warnings on consumer knowledge about tobacco risks. The aim of the current study was to use nationally representative samples of adult smokers from the United States (USA), the United Kingdom (UK), Canada (CAN), and Australia (AUS) from the International Tobacco Control Four Country Survey (ITC-4) to examine variations in smokers' knowledge about tobacco risks and the impact of package warnings. A telephone survey was conducted with 9058 adult smokers from the following countries: USA (n = 2138), UK (n = 2401), CAN (n = 2214) and AUS (n = 2305). Respondents were asked to state whether they believed smoking caused heart disease, stroke, impotence, lung cancer in smokers, and lung cancer in non-smokers. Respondents were also asked whether the following chemicals are found in cigarette smoke: cyanide, arsenic and carbon monoxide. Smokers in the four countries exhibited significant gaps in their knowledge of the risks of smoking. Smokers who noticed the warnings were significantly more likely to endorse health risks, including lung cancer and heart disease. In each instance where labelling policies differed between countries, smokers living in countries with government mandated warnings reported greater health knowledge. For example, in Canada, where package warnings include information about the risks of impotence, smokers were 2.68 (2.41-2.97) times more likely to agree that smoking causes impotence compared to smokers from the other three countries. Smokers are not fully informed about the risks of smoking. Warnings that are graphic, larger, and more comprehensive in content are more effective in communicating the health risks of smoking.
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            Health warning messages on tobacco products: a review.

            To review evidence on the impact of health warning messages on tobacco packages. Articles were identified through electronic databases of published articles, as well as relevant 'grey' literature using the following keywords: health warning, health message, health communication, label and labelling in conjunction with at least one of the following terms: smoking, tobacco, cigarette, product, package and pack. Relevant articles available prior to January 2011 were screened for six methodological criteria. A total of 94 original original articles met inclusion criteria, including 72 quantitative studies, 16 qualitative studies, 5 studies with both qualitative and qualitative components, and 1 review paper: Canada (n=35), USA (n=29) Australia (n=16), UK (n=13), The Netherlands (n=3), France (n=3), New Zealand (n=3), Mexico (n=3), Brazil (n=2), Belgium (n=1), other European countries (n=10), Norway (n=1), Malaysia (n=1) and China (n=1). The evidence indicates that the impact of health warnings depends upon their size and whereas obscure text-only warnings appear to have little impact, prominent health warnings on the face of packages serve as a prominent source of health information for smokers and non-smokers, can increase health knowledge and perceptions of risk and can promote smoking cessation. The evidence also indicates that comprehensive warnings are effective among youth and may help to prevent smoking initiation. Pictorial health warnings that elicit strong emotional reactions are significantly more effective. Health warnings on packages are among the most direct and prominent means of communicating with smokers. Larger warnings with pictures are significantly more effective than smaller, text-only messages.
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              The Policy Dystopia Model: An Interpretive Analysis of Tobacco Industry Political Activity

              Background Tobacco industry interference has been identified as the greatest obstacle to the implementation of evidence-based measures to reduce tobacco use. Understanding and addressing industry interference in public health policy-making is therefore crucial. Existing conceptualisations of corporate political activity (CPA) are embedded in a business perspective and do not attend to CPA’s social and public health costs; most have not drawn on the unique resource represented by internal tobacco industry documents. Building on this literature, including systematic reviews, we develop a critically informed conceptual model of tobacco industry political activity. Methods and Findings We thematically analysed published papers included in two systematic reviews examining tobacco industry influence on taxation and marketing of tobacco; we included 45 of 46 papers in the former category and 20 of 48 papers in the latter (n = 65). We used a grounded theory approach to build taxonomies of “discursive” (argument-based) and “instrumental” (action-based) industry strategies and from these devised the Policy Dystopia Model, which shows that the industry, working through different constituencies, constructs a metanarrative to argue that proposed policies will lead to a dysfunctional future of policy failure and widely dispersed adverse social and economic consequences. Simultaneously, it uses diverse, interlocking insider and outsider instrumental strategies to disseminate this narrative and enhance its persuasiveness in order to secure its preferred policy outcomes. Limitations are that many papers were historical (some dating back to the 1970s) and focused on high-income regions. Conclusions The model provides an evidence-based, accessible way of understanding diverse corporate political strategies. It should enable public health actors and officials to preempt these strategies and develop realistic assessments of the industry’s claims.
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                Author and article information

                Journal
                Tob Prev Cessat
                Tob Prev Cessat
                TPC
                Tobacco Prevention & Cessation
                European Publishing on behalf of the European Network for Smoking and Tobacco Prevention (ENSP)
                2459-3087
                01 December 2020
                2020
                : 6
                : 66
                Affiliations
                [1 ]Agência Nacional de Vigilância, Sanitária, Brasilia, Brazil
                [2 ]Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
                [3 ]Johns Hopkins Bloomberg School of Public Health, Institute for Global Tobacco Control, Johns Hopkins University, Baltimore, United States
                Author notes
                CORRESPONDENCE TO Andre L. Oliveira da Silva. Laboratório de Toxicologia do CESTEH/ENSP/FIOCRUZ. R. Leopoldo Bulhões, 1480 - Manguinhos, Rio de Janeiro - RJ, CEP 21041-210. E-mail: andre.sp.ensp@ 123456gmail.com ORCID ID: https://orcid.org/0000-0003-4768-959X
                Article
                66
                10.18332/tpc/128321
                7737563
                33069530
                5290c347-416f-4542-91ff-5eb85a7a0427
                © 2020 Oliveira da Silva A. L. et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial 4.0 International License.

                History
                : 03 June 2020
                : 19 August 2020
                : 09 October 2020
                Categories
                Policy Case Studies

                tobacco industry,smoking prevention,tobacco display ban,health warnings,tobacco industry strategies,brazil

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