Exposing the hydra of Big Tobacco

FROM the early 1980s, Australian governments of all persuasions pursued the tobacco control agenda with vigour and determination. “Quit” campaigns established around the country from 1983 used mass media to educate the community about the dangers of smoking. Government funding was secured to place advertisements during prime-time television and elsewhere. Innovative public relations approaches led to supportive coverage in all forms of media, helping to popularise the “Quit” message. Large reductions in smoking prevalence and public support for “Quit” campaigns further encouraged governments to enact recommendations from the World Health Organization and other international health agencies.

This included banning all forms of promotion of tobacco products and raising taxes on tobacco products, with the objectives of making smoking less affordable and generating additional funds for public education campaigns and replacement of tobacco sponsorship of sport and the arts, all complemented by a cascade of further evidence about the harms of both smoking and passive smoking.

By contrast, even in the face of irrefutable evidence of the lethal nature of smoking published since 1950 (and here), in Australia, as elsewhere, the tobacco industry has sought to deny and undermine the evidence, and to oppose, delay or minimise the impact of any action by governments and health authorities to reduce smoking. Among many examples, curbs on tobacco advertising were countered by the development of sports and other forms of sponsorship, concerns about the dangers of smoking were mitigated by promotion of low tar cigarettes as alternatives to quitting, moves to protect non-smokers from the harms of passive smoking were resisted with the support of industry-funded research that sought to create doubt about the evidence, and lobbying against health warnings on packs resulted in delays and a watering down of strong wording.

The tobacco industry has described Australia as the world’s “darkest market”. Advertising of tobacco has been banned in the broadcast and print media, outdoors and inside retail outlets. Tobacco products may not be displayed in shops other than specialist tobacconists, and all products must be plainly packaged with graphic health warnings covering three quarters of the front and 90% of the back of packs. Since 2010, the government has enacted five substantial increases in taxes on tobacco products, and (with bipartisan support) four more are scheduled for each September from 2017 to 2020.

But Big Tobacco — the global tobacco industry — remains powerful and massively resourced, with budgets for strategising and countering health measures that dwarf the resources available even to governments seeking to reduce smoking. Once it became clear that there was bipartisan support for measures such as regular tax increases and plain packaging, it would have been remarkable if the global tobacco companies that dominate the Australian market had not from the outset been determined to develop and implement strategies to undermine these approaches.

The history of tobacco control in Australia and internationally also shows that there is never room for complacency. While new approaches may have immediate impact, these must be complemented by continuing action and further evolving measures over time, otherwise the momentum will be lost. Experience shows that when complacency sets in, encouraging trends can be interrupted unless existing approaches are further invigorated and new approaches implemented. When tobacco advertising was banned in the late 1980s and early 1990s, there was a sense that the task had been done, and some momentum was lost — until this was recognised by the federal government of the day, which introduced the first National Tobacco Campaign, and restored encouraging trends in smoking prevalence. Similarly, in the late 1990s Australia’s pioneering tobacco control leader, Dr Nigel Gray, drew attention to ways in which “the resilient and resourceful tobacco industry has responded to tobacco control”, expressing concern about complacency and the need for further action in an MJA editorial entitled: Smoking — time to ring the alarm bells again.

The global international tobacco industry is like the ancient Greek Hydra, the monster that is a nest of nine snake-heads. Cut one off and the others spring into action while the first one regrows itself. Despite tax increases, graphic health warnings and plain packaging, tobacco companies in Australia are still managing to find ways to reassure smokers and keep tobacco products affordable and attractive to young people. Here are some of the ways they are achieving their aims — all cause to ring the alarm bells once more.

Strategy 1: produce and promote multiple new low price products

Since major tax rises starting in April 2010, tobacco companies have greatly increased the number of products available for sale in the budget range.

Box 1 Number of tobacco products (brand and brand extension-pack size combinations) — Australia 2010 to 2016, value, mainstream and premium segments

Source: NSW Retail Tobacco Traders Association Australian Retail Tobacconist price lists 2010 to 2016

Many of these feature concepts of value in the product name, for instance Just Smokes, JPS Eternal Red, Endless Blue and Abundant Gold. Such products have been increasingly promoted on retail price boards in favour of other more traditionally popular brands (Bayly M, Scollo M, Lindorff K, et al. Tobacco price boards as a promotional strategy — a longitudinal observational study in Australian retailers. Submitted for publication.). While no data are collected by governments about product type, tobacco company reports to shareholders suggest that the sales of value brands now make up more than 50% of the market.

Strategy 2: confuse price signals to consumers with bulk deals to keep heavy smokers continuing to smoke as much as possible and by producing odd-numbered cigarette pack sizes

Australia is the only country in the world where cigarettes are sold in large packs containing 30, 35, 40 and 50 cigarettes. While smoking fewer cigarettes does not significantly reduce the risk of dying from smoking — the risk of smoking is determined more by duration of smoking over the lifetime — heavier smokers tend to find it harder to quit (here, and here).

Cigarettes in Australia are now available not just in packs of multiples of five or ten (ie, 20, 30, 40 and 50 sticks). Brands are now selling in packs of 21, 22, 23, 26 and even recently, 43 and 44. After the most recent tax increase, for instance, British American Tobacco repackaged its popular Dunhill brand from 25 to 23 cigarettes, ensuring that the up-front purchase price remained the same, despite the 12.5% tax increase. These odd pack sizes make it very difficult for the consumer to calculate the price per stick, providing effective interference to what would otherwise be clear price signals after every tax increase.

Strategy 3: produce and promote roll-your-own products as a “natural”, cheaper alternative with increasingly lower up-front purchase costs

Many smokers believe that roll-your-own (RYO) tobacco contains fewer additives than factory-made cigarettes and is somehow more “natural” (here and here). In fact, it is primarily the by-products of burning tobacco that are responsible for the harm caused by smoking, but in any case RYO contains a larger weight of additives per gram of tobacco (here).

Until 2010, most RYO tobacco pouches in Australia were sold in packs of 50 g. Since then, manufacturers have experimented with increasingly smaller pouch sizes of 40, 30 and then 25 g. Most recently, they have produced even smaller, attractively sized packs containing only 20 g of tobacco and retailing for substantially less than the most popular brand of cigarettes. There is no minimum size required for RYO products sold in Australia, and “sample packs” of 10 g have recently been noted for sale on Australian tobacco retailing websites.

Even when smokers buy large cigarette packs that are cheaper per stick, the price of a single cigarette made with RYO tobacco has risen much less steeply over time than the price of the cheapest factory-made cigarette.

Box 2 Cheapest factory-made cigarette (FMC) and cheapest roll-your-own (RYO) cigarette (assuming 0.7 g of tobacco used per cigarette) available for sale in Australia

Source: NSW Retail Tobacco Traders Association price lists 2001 to 2016

To make matters worse, an extended range of filters is now sold in a variety of widths to enable RYO smokers to use less tobacco per rolled stick and hence pay substantially less tax per cigarette, without corresponding health benefits, given consumers draw harder to maintain nicotine intake.

Not surprisingly, use of RYO tobacco is becoming popular among teenagers, with over 60% of past-month smokers aged 12–17 years reporting having used RYO at least once, and 24% having used it 20 times or more.

Strategy 4: use and encourage price boards at point of sale to promote attractive prices, new products and novel brand names

Price boards at point of sale enable direct advertising of brand names in locations where all consumers will be exposed, and have become an important promotional opportunity for tobacco companies and retailers. They enable the companies to headline new products, and to draw attention to “value” and “budget” brands and novel brand names that entail reassurance-based marketing, with terms such as “natural”, flavours such as menthol and new RYO products.

There is also currently no regulation in Australia that prevents companies from providing retailers with perks, including “professional education” in exotic beachside locations or tobacco stock on attractive terms, or to encourage prominent positions on tobacco price boards at point of sale. In a study of retailer attitudes to sale of tobacco products, one retailer commented, “You know, ‘you buy 50 packs, I’ll give you 10 packets free’. Well, then it’s worth buying from them, yeah”.

Strategy 5: promote the myth of varying levels of harm

One of the objectives of plain packaging legislation in Australia was to reduce the ability of tobacco companies to mislead consumers about the relative harms of different products. While use of colours on packs is no longer permitted, the legislation does not extend to the brand name or variant names of the product itself. The use of colour naming (e.g. Winfield White) and sensory naming (e.g. Peter Jackson Smooth Blue) sustain the notion that lighter colours and less harsh cigarettes indicate lower tar and, thereby, falsely imply lower levels of harm. Consumer misperceptions of reduced harm are reinforced by the tiny holes in cigarette filters, which mix air with inhaled tobacco smoke to provide the sensation of lighter and less harmful smoke. But it’s all a smokescreen: all cigarettes are deadly.

Strategy 6: incorporate technological gimmicks that misleadingly imply less harm

Manufacturers are increasingly focusing on the cigarette itself which, apart from the colour of the paper and filter, is currently completely unregulated in Australia. Cigarette filters do not protect from the serious harms of smoking because the toxic products of combustion continue to be inhaled deep into the lungs. Brands with “taste flow” or “firm feel” filters nonetheless imply less harm and are now standard in the brands used by most Australian smokers.

Strategy 7: use terms such as “natural” and “organic” in promoting tobacco products, implying lower levels of harm

Cigarette brand and variant names that play into consumer beliefs about the safety of all things “natural” and “organic” are another form of reassurance-based marketing. Products listed in late 2016 in tobacco product catalogues include Nat Sherman Naturals; Natural American Spirit, produced by the Santa Fe Natural Tobacco Company; Manitou No additives Pink and Organic Gold; and Maya No additives Red and Natural Menthol.

RYO tobacco products on the market in Australia similarly include Manitou Organic and names that highlight the features of the tobacco plant itself; for instance, Winfield Kingleaf and Bond Street Kingleaf. Industry positioning of RYO tobacco as “organic” is reinforced by brand names of rolling paper, such as Venti Earth and Raw Organic papers, OCB “100% natural, 100% vegetarian – Natural Arabic Gum” papers and brand names of filter tips such as RAW 100% SLIM Cotton Filters.

Strategy 8: market products that distract from harms with “fresh” menthol and other flavours and scents

The most popular brands of cigarettes in Australia have introduced novelty products that provide a new twist on the menthol variant. Capsules containing menthol have been placed in the filter, providing smokers with a “hit” of menthol when the filter is squeezed. Products such as JPS Ice, Peter Jackson Hybrid Blue Regular to Fresh and Winfield Optimum Sky Blue Crush compete for the attention of potential new smokers.

Box 3 Capsules containing menthol are placed in the filter and provide smokers with a “hit” of menthol when the filter is squeezed

Source: Quit Victoria, pack collection

These products are quickly gaining popularity internationally. In a recent survey of Australian teenagers, over 50% of past-month smokers reported that they had used these types of cigarettes. In recognition of their role in increasing the palatability and addictiveness of cigarettes, all menthol products are shortly to be banned in several countries and the European Union. Australia, however, lacks national legislation that would enable such a measure.

Tobacco companies also appear to be experimenting with flavour infusions and scents. The recently introduced Winfield Optimum Crush Summer Rush not only continues the competition for the number of superlative connotations in a single product name but also smells like lime. The Philip Morris cigarette brand variants introduced onto the market in 2016 – Longbeach Moments North Coast, West Coast and East Coast – reinforce the idea of “taking a moment for yourself” with “woody” and other aromas suggestive of appealing locations. Moreover, recently introduced RYO products sold in 10 g sample packs and retailing for half the cost of a typical pack of cigarettes are flavoured with banana, apple, caramel and chocolate.

There is currently no national legislation that allows the Australian Government to ban tobacco products blatantly attractive to young people.

Strategy 9: engage in aggressive lobbying, public relations activity and litigation to oppose and undermine evidence-based measures and distract from actions that may reduce sales

Tobacco companies are still free to make political donations. There are also no constraints on their public relations and lobbying activities — the Australian Government Register of Lobbyists (which reflects only the activity of third-party lobbyists, not individuals working directly for the companies) includes at least 25 entries for companies lobbying either for tobacco companies or for those with a substantial interest in tobacco sales.

The Australian Government and others internationally have now been dragged through no fewer than seven courts or international tribunals to defend tobacco plain packaging legislation. The tobacco industry has lost on all occasions to date, with the ruling on the final current case (a complaint against Australia to the World Trade Organization by countries receiving legal support from international tobacco companies) scheduled for release in 2017. While the industry keeps losing, litigation such as this is time-consuming, a distraction, and may well have discouraged less determined governments. Following a similar incident in the UK, in Australia a tobacco company has even taken legal action against a cancer charity to obtain data that would have provided invaluable insights into children’s attitudes to tobacco: it lost, but again, a time-consuming distraction for those involved.

The tobacco industry in Australia, as it does all over the world, repeatedly “cries wolf” about the problem of illicit tobacco. However, independent monitoring suggests that levels of use in Australia of illicit tobacco are low and vastly outweighed by use of cheap products marketed by tobacco companies themselves. It is appropriate for the government to take actions that prevent tax fraud and to pursue those who sell tobacco that has not been taxed, but this should not be used as a distraction from the evidence-based measures that will reduce smoking and its harms.

Meanwhile …

While the tobacco industry has been stepping up its efforts in Australia, federal investment in antismoking campaigns has declined from a frequency of 3666 target audience rating points (TARPs) in 2011, and 2500 on average for 2010–2012, to an average of just 441 TARPs per year in the past 3 years. Strong, sustained, mass media campaigns that achieve over 4800 TARPs per year are a critical complement to tax increases as an evidence-based approach to reducing smoking prevalence,(here, here, here and here), including among people in vulnerable and lower socio-economic groups where smokers are concentrated. The absence of sufficient strong public education over the past 3 years has deprived the nation of the momentum needed to ensure continuing impact for tax increases and plain packaging, and to counter the tobacco industry’s price-based, reassurance-based and other distraction marketing strategies. Governments need to restore spending on public education campaigns, which is now worryingly below the levels required.

What next?

Tobacco is a product that causes or contributes to a vast range of disabling and debilitating diseases. Apart from the costs to the health care system, in Australia it causes the premature death of two out of every three long term users. Unlike the 1950s, anybody who in 2017 works for a tobacco company or serves on its board must be acutely aware of the devastating effects of tobacco products on their consumers. It is encouraging that the new Minister for Health has expressed his determination to act further on smoking. Key measures the government should now progressively implement to counter tobacco industry strategies, such as price and reassurance-based marketing of tobacco products, include:

1. Run effective, sustained, adequately funded mass media campaigns, while also providing extra support for vulnerable populations.
2. Introduce new legislation to enable regulation of the product itself, to require comprehensive and easily comprehended warnings about the product to consumers and to outlaw all features, names and implicit claims likely to falsely reassure smokers or make products more attractive to children.
3. Amend plain packaging legislation to standardise the number of cigarettes in a pack and the amount of RYO tobacco in pouches and establish a minimum RYO pack size no smaller than 30 g.
4. Encourage all governments to ban the promotion of tobacco products on price boards at point of sale, and end perks to retailers.
5. Amend excise and customs legislation to equalise the tax on RYO tobacco with that on cigarettes.
6. Ensure compliance across all areas of government of Article 5.3 of the World Health Organization Framework Convention on Tobacco Control, which requires comprehensive effort to protect tobacco control measures from commercial and other vested interests of the tobacco industry.
7. Assess the feasibility of requiring manufacturers and importers to affix Government-issued “tax paid” stamps with covert security markings (enabling tax agencies to determine if these were faked) to all tobacco products dutied for sale in Australia. Improve surveillance of retailers to ensure that no untaxed products are being sold.
8. Require tobacco wholesalers to report in detail on sales of each category of tobacco product sold in each primary health care network in the country so that progress can be monitored and appropriate corrective action taken quickly if new problems emerge.
9. Ban political donations from tobacco companies and require tobacco companies to publish details of their lobbying, marketing and public relations activities.

Professor Mike Daube, AO, is professor of Health Policy at Curtin University. Todd Harper is the chief executive officer of Cancer Council Victoria.

The authors thank Dr. Michelle Scollo of the Cancer Council Victoria and Professor Melanie Wakefield of the Centre for Behavioural Research in Cancer at the Cancer Council Victoria for their technical support.

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