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Objective: To investigate the tobacco-attributable burden on disease, medical costs, productivity losses and informal caregiving; and to estimate the health and economic gains that can be achieved if the main tobacco control measures (raising taxes on tobacco, plain packaging, advertising bans and smoke-free environments) are fully implemented in eight countries that encompass 80% of the Latin American population., Design: Markov probabilistic microsimulation economic model of the natural history, costs and quality of life associated with the main tobacco-related diseases. Model inputs and data on labour productivity, informal caregivers' burden and interventions' effectiveness were obtained through literature review, surveys, civil registrations, vital statistics and hospital databases. Epidemiological and economic data from January to October 2020 were used to populate the model., Findings: In these eight countries, smoking is responsible each year for 351 000 deaths, 2.25 million disease events, 12.2 million healthy years of life lost, US$22.8 billion in direct medical costs, US$16.2 billion in lost productivity and US$10.8 billion in caregiver costs. These economic losses represent 1.4% of countries' aggregated gross domestic products. The full implementation and enforcement of the four strategies: taxes, plain packaging, advertising bans and smoke-free environments would avert 271 000, 78 000, 71 000 and 39 000 deaths, respectively, in the next 10 years, and result in US$63.8, US$12.3, US$11.4 and US$5.7 billions in economic gains, respectively, on top of the benefits being achieved today by the current level of implementation of these measures., Conclusions: Smoking represents a substantial burden in Latin America. The full implementation of tobacco control measures could successfully avert deaths and disability, reduce healthcare spending and caregiver and productivity losses, likely resulting in large net economic benefits., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: TD is an Associate Editor of Tobacco Control with respect to Product Marketing and Promotion. He has served as an expert witness in tobacco and vaping litigation on behalf of governments whose policies have undergone constitutional challenges.

Introduction: Reducing tobacco retailer density is suggested to be a key component of tobacco endgames. Where tobacco retail reduction policies exist, 'grandfathering' is typically used, where existing retailers are exempt from restrictions aimed at reducing outlet density. We examined the possible impact on tobacco outlet density in New Zealand of a policy preventing new retail outlets from selling tobacco, but allowing existing retail outlets to continue selling tobacco until they ceased trading or relocated., Methods: We obtained data on numbers of tobacco outlets and the number of outlet closures recorded annually from 2006 to 2016. We calculated the mean and the lowest and highest 3-year rolling average closure rates for each type of tobacco outlet. We projected decreases in the number of tobacco outlets that would hypothetically be permitted to sell tobacco from 2020 onwards and estimated when the combined number of tobacco outlets would decline by 50% and 95%., Results: Based on mean annual closure rates, the total number of tobacco outlets would decrease by 50% by 2032 and a 95% reduction could be achieved by 2072. By 2025, the number of tobacco outlets would decrease by 27%; by 2050, this reduction would reach 84%., Conclusion: A tobacco retail reduction policy that prevented new retail outlets from selling tobacco and grandfathered existing retailers would be unlikely to achieve New Zealand's target of a 95% reduction in tobacco outlet density within several decades of being enacted. Nonetheless, this policy could achieve a 50% reduction in tobacco retail availability in the first decade of implementation., Competing Interests: Competing interests: Although we do not consider it a competing interest, for the sake of full transparency we note that authors have undertaken work for health-sector agencies working in tobacco control., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Despite the internet's broad reach and potential to influence consumer behaviour, there has been little examination of the volume, characteristics, and target audience of online tobacco and e-cigarette advertisements., Methods: A full-service advertising firm was used to collect all online banner/video advertisements occurring in the USA and Canada between 1 April 2012 and 1 April 2013. The advertisement and associated meta-data on brand, date range observed, first market, and spend were downloaded and summarised. Characteristics and themes of advertisements, as well as topic area and target demographics of websites on which advertisements appeared, were also examined., Results: Over a 1-year period, almost $2 million were spent by the e-cigarette and tobacco industries on the placement of their online product advertisements in the USA and Canada. Most was spent promoting two brands: NJOY e-cigarettes and Swedish Snus. There was almost no advertising of cigarettes. About 30% of all advertisements mentioned a price promotion, discount coupon or price break. e-Cigarette advertisements were most likely to feature messages of harm reduction (38%) or use for cessation (21%). Certain brands advertised on websites that contained up to 35% of youth (<18 years) as their audience., Conclusions: Online banner/video advertising is a tactic used mainly to advertise e-cigarettes and cigars rather than cigarettes, some with unproven claims about benefits to health. Given the reach and accessibility of online advertising to vulnerable populations such as youth and the potential for health claims to be misinterpreted, online advertisements need to be closely monitored., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Context: The European Union (EU) Tobacco Products Directive that bans sales of snus (a form of oral tobacco) in EU countries other than Sweden is currently under review. Major tobacco companies favour the ban being overturned. This study aims to explore compliance with the current ban on snus sales and examines the conduct of online snus vendors, including their compliance with two other EU Directives on excise and tobacco advertising and Swedish legislation banning sales of snus outside Sweden., Methods: To determine who is currently distributing snus via the internet in the EU, searches were carried out in Google, followed by searches in the WHOIS and Amadeus databases. Five online test purchases of snus were made in each of 10 EU Member States using a standardised protocol. Feedback from the test purchases and further analysis of the websites accessed for test purchases were used to critically examine snus retailers' conduct., Results: The majority of online vendors operate from Sweden and target non-Swedish EU citizens. Test purchases were successfully made in all 10 EU Member States; of 43 orders placed, only two failed. Age verification relied only on self-report. The majority of sales applied Swedish taxes, contrary to EU requirements. Copious sales promotion activities, many price based, are incorporated in these websites contravening the EU regulation, and three test purchases were delivered with gifts., Conclusions: Snus is currently being sold on the single market via the internet in contravention of Swedish legislation and three EU Directives. The apparent willingness of the tobacco industry to contravene EU and Swedish legislation and profit from unlawful sales raises questions about their status as stakeholders in consultations on future policy developments. The findings highlight how national and regional tobacco control legislation can be undermined in an increasingly globalised world.

Background: Sponsorship of Formula One (F1) motor racing, which has been used as an indirect medium of tobacco advertising for several decades, was prohibited by the 2005 European Union Tobacco Advertising Directive. Most F1 tobacco sponsorship of motor racing in the EU has since ceased, with the exception of the Scuderia Ferrari team, which continues to be funded by Philip Morris. In 2007, the Marlboro logo on Ferrari cars and other race regalia was replaced by an evolving 'barcode' design, which Ferrari later claimed was part of the livery of the car, and not a Marlboro advertisement., Objective: To determine whether the 'barcode' graphics used by Ferrari represent 'alibi' Marlboro advertising., Methods: Academic and grey literature, and online tobacco industry document archives, were searched using terms relevant to tobacco marketing and motorsport., Results: Tobacco sponsorship of F1 motor racing began in 1968, and Philip Morris has sponsored F1 teams since 1972. Phillip Morris first used a 'barcode' design, comprising red vertical parallel lines below the word Marlboro on the British Racing Motors F1 car in 1972. Vertical or horizontal 'barcode' designs have been used in this way, latterly without the word Marlboro, ever since. The modern 'barcode' logos occupied the same position on cars and drivers' clothing as conventional Marlboro logos in the past. The shared use of red colour by Marlboro and Ferrari is also recognised by Philip Morris as a means of promoting brand association between Marlboro and Ferrari., Conclusion: The Ferrari 'barcode' designs are alibi Marlboro logos and hence constitute advertising prohibited by the 2005 EU Tobacco Advertising Directive.

Introduction: Australia has introduced legislation to force all cigarette packaging to be generic from 2012 onwards. The tobacco retail industry estimates this will result in transaction times increasing by 15-45 s per pack and is spending at least $A10 million of tobacco industry funds on an advertising campaigns claiming that the increased time and errors associated with plain packaging will ultimately cost small businesses $A 461 million per annum and endanger 15,000 jobs. We undertook an objective experiment to test these claims., Methodology: Participants (n=52) were randomly assigned to stand in front of a display of either 50 plain or coloured cigarette packets and then were read a randomly ordered list of cigarette brands. The time participants took to locate each packet was recorded and all selection errors were noted. After 50 'transactions', participants repeated the entire experiment with the alternative plain/coloured packs. Afterwards, participants were asked in an open-ended manner whether plain or coloured packaging was easier to locate and why., Results: The average transaction was significantly quicker for plain compared with coloured packs (2.92 vs 3.17 s; p=0.040). One or more mistakes were made by 40.4% of participants when selecting coloured packaging compared with only 17.3% for plain packaging (p=0.011). Qualitative results suggested that the colours and inconsistent location of brand names often served to distract when participants scanned for brands., Conclusion: Rather than plain packaging requiring an additional 45 s per transaction, our results suggest that it will, if anything, modestly decrease transaction times and selection errors.

Aim: To evaluate the short-term economic impact of legislation removing point of sale tobacco promotional displays (ie, tobacco displays and other point of sale tobacco advertising) in Ireland, implemented July 2009, on cigarette sales across a range of categories of retail outlets., Methods: Cigarette sales were evaluated using scanning (weekly data since January 2006) and audit data (bimonthly since November 2007) within different retail categories using data sourced from AC Nielsen, Ireland. Visual inspection and time-series regression techniques were used where appropriate to assess changes in sales over time and in relation to the legislation., Results: No change was observed in sales data in any retail category over and above seasonal patterns and an underlying downward trend over time. Similarly, where available data enabled statistical analysis, there was no significant effect in the short term (up to 12 months after implementation) on retail sales of tobacco products, over and above seasonal and long-term trends. CONCLUSIONS Recent claims of substantial revenue losses and closures of small retailers as a direct result of the removal of point of sale tobacco promotional displays in Ireland are not borne out by these data. The removal of point of sale displays is aimed at reducing the pernicious effects of tobacco advertising on children and is therefore likely to have an impact on sales over a much more protracted time period. This should enable retailers to adapt over time, perhaps using such regulations as an opportunity to play a role in promoting healthier products in the local community.

Background: Tobacco displays at the point of sale (PoS) are an important means for the tobacco industry to communicate with consumers. With regulations prohibiting PoS displays recently having come into force in Ireland, passed into law in England, Wales and Northern Ireland and some Australian states, and being considered in New Zealand, Finland and Brazil, this is an increasingly important issue. This study explores the nature of displays, the extent to which they are tobacco industry funded, and the relation between the tobacco companies and retailers., Methods: Three areas were chosen to gain a snapshot of PoS displays in England. Over 100 retailers were visited, with interviews taking place on site. Information was gathered on the type and size of tobacco display, who was paying for the display, requirements and incentives, and visits by industry representatives., Results: The majority of retailers had gantries provided by tobacco companies. A minority of these were fitted with automated dispensers called retail vending machines. Attractive lighting and colour were often used to highlight particular products. Most retailers were being visited by industry representatives who checked displays. Some retailers also reported incentives offered to them for displaying products., Conclusions: The results suggest that the tobacco industry presence and control in the retail environment is significant. Tobacco companies overwhelmingly provided tobacco gantries in the shops surveyed and influenced displays through a combination of requirements and incentives. The extensive involvement of tobacco companies in providing and monitoring retail displays suggests the importance of implementing policies to end this form of advertising.

Background: The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) bans all forms of tobacco advertising, promotion and sponsorship. The comprehensiveness of this ban has yet to be tested by online social networking media such as Facebook. In this paper, the activities of employees of the transnational tobacco company, British American Tobacco, (BAT) on Facebook and the type of content associated with two globally popular BAT brands (Dunhill and Lucky Strike) are mapped., Methods: BAT employees on Facebook were identified and then the term 'British American Tobacco' was searched for in the Facebook search engine and results recorded, including titles, descriptions, names and the number of Facebook participants involved for each search result. To further detail any potential promotional activities, a search for two of BAT's global brands, 'Dunhill' and 'Lucky Strike', was conducted., Results: Each of the 3 search terms generated more than 500 items across a variety of Facebook subsections., Discussion: Some BAT employees are energetically promoting BAT and BAT brands on Facebook through joining and administrating groups, joining pages as fans and posting photographs of BAT events, products and promotional items. BAT employees undertaking these actions are from countries that have ratified the WHO FCTC, which requires signatories to ban all forms of tobacco advertising, including online and crossborder exposure from countries that are not enforcing advertising restrictions. The results of the present research could be used to test the comprehensiveness of the advertising ban by requesting that governments mandate the removal of this promotional material from Facebook.

Background: African countries are a major potential market for the tobacco industry, and the smoking epidemic is at various stages of evolution across the continent. Ghana is an African country with a low prevalence of smoking despite an active tobacco industry presence for over 50 years. This study explores potential reasons for this apparent lack of industry success., Objective: To explore the history of tobacco industry activity in Ghana and to identify potential reasons for the current low prevalence of smoking., Methods: A search was made of tobacco industry archives and other local sources to obtain data relevant to marketing and consumption of tobacco in Ghana., Findings: British American Tobacco, and latterly the International Tobacco Company and its successor the Meridian Tobacco Company, have been manufacturing cigarettes in Ghana since 1954. After an initial sales boom in the two decades after independence in 1957, the sustained further increases in consumption typical of the tobacco epidemic in most countries did not occur. Possible key reasons include the taking of tobacco companies into state ownership and a lack of foreign exchange to fund tobacco leaf importation in the 1970s, both of which may have inhibited growth at a key stage of development, and the introduction of an advertising ban in 1982. BAT ceased manufacturing cigarettes in Ghana in 2006., Conclusion: The tobacco industry has been active in Ghana for over 50 years but with variable success. The combination of an early advertising ban and periods of unfavourable economic conditions, which may have restricted industry growth, are likely to have contributed to the sustained low levels of tobacco consumption in Ghana to date.

Background: The international trend towards comprehensive bans on tobacco advertising has seen the tobacco industry become increasingly innovative in its approach to marketing. Further fuelling this innovation is the rapid evolution and accessibility of web-based technology. The internet, as a relatively unregulated marketing environment, provides many opportunities for tobacco companies to pursue their promotional ambitions., Methods: In this paper, "open source marketing" is considered as a vehicle that has been appropriated by the tobacco industry, through a case study of efforts to design the packaging for the Camel Signature Blends range of cigarettes. Four sources are used to explore this case study including a marketing literature search, a web-based content search via the Google search engine, interviews with advertising trade informants and an analysis of the Camel brand website., Results: RJ Reynolds (RJR) has proven to be particularly innovative in designing cigarette packaging. RJR engaged with thousands of consumers through their Camel brand website to design four new cigarette flavours and packages. While the Camel Signature Blends packaging designs were subsequently modified for the retail market due to problems arising with their cartoon-like imagery, important lessons arise on how the internet blurs the line between marketing and market research., Conclusions: Open source marketing has the potential to exploit advertising ban loopholes and stretch legal definitions in order to generate positive word of mouth about tobacco products. There are also lessons in the open source marketing movement for more effective tobacco control measures including interactive social marketing campaigns and requiring plain packaging of tobacco products.

Background: From 2000 to 2006, moist snuff sales have increased and now account for 71% of the smokeless tobacco market. Previous research has shown that major manufacturers of smokeless tobacco products manipulated free nicotine, the form most readily absorbed, to promote tolerance and addiction., Aim: This study examines the possibility that company-specific and brand-specific strategies of the major moist snuff manufacturers involve controlling free nicotine content and ease of dosing with products that are designed and targeted to specific groups. This study looks at the current total US moist snuff market with product design data from the Massachusetts Department of Public Health; moist snuff use from the National Survey on Drug Use and Health; market data from ACNielsen; and magazine advertising expenditures from TNS Media Intelligence., Results: (1) The levels of free nicotine of moist snuff products have increased over time for several major manufacturers; (2) the number and variety of sub-brands have increased over time; (3) changes in design, as reflected by variation in free nicotine associated with pH or tobacco leaf, or both, have enhanced the ease and uniformity of dosing; (4) marketing through price and advertising has increased; and (5) youth use has increased., Conclusion: A combination of factors including brand proliferation, control of free nicotine and product design has most likely resulted in the expanded consumption of moist snuff, particularly among young people.

Objective: This study assessed the cost effectiveness of different types of television and radio advertisements and the time of day in which advertisements were placed in generating calls to the Oregon tobacco quitline., Design: Cost effectiveness was measured by cost per call, calculated as the cost of advertising divided by the number of quitline calls generated by that advertising. Advertising was bought in one-week or two-week blocks and included 27 daytime television buys, 22 evening television buys and 31 radio buys., Results: Cost effectiveness varied widely by medium, time of day and advertisement used. Daytime television was seven times more cost effective than evening television and also more cost effective than radio. The most effective advertisements at generating quitline calls were real life testimonials by people who lost family members to tobacco and advertisements that deal practically with how to quit., Conclusions: Placement of television advertisements during the day versus the evening can increase an advertisement's effectiveness in generating calls to a quitline. Some advertising messages were more effective than others in generating calls to a quitline. Quitline providers can apply findings from previous research when planning media campaigns. In addition, call volume should be monitored in order to assess the cost effectiveness of different strategies to promote use of the quitline.

Objectives: This study assessed the relative effectiveness and cost effectiveness of television, radio and print advertisements to generate calls to the New York smokers' quitline., Methods: Regression analysis was used to link total county level monthly quitline calls to television, radio and print advertising expenditures. Based on regression results, standardised measures of the relative effectiveness and cost effectiveness of expenditures were computed., Results: There was a positive and statistically significant relation between call volume and expenditures for television (p<0.01) and radio (p<0.001) advertisements and a marginally significant effect for expenditures on newspaper advertisements (p<0.065). The largest effect was for television advertising. However, because of differences in advertising costs, for every $1000 increase in television, radio and newspaper expenditures, call volume increased by 0.1%, 5.7% and 2.8%, respectively., Conclusions: Television, radio and print media all effectively increased calls to the New York smokers' quitline. Although increases in expenditures for television were the most effective, their relatively high costs suggest they are not currently the most cost effective means to promote a quitline. This implies that a more efficient mix of media would place greater emphasis on radio than television. However, because the current study does not adequately assess the extent to which radio expenditures would sustain their effectiveness with substantial expenditure increases, it is not feasible to determine a more optimal mix of expenditures.

Objective: We estimated the cost effectiveness of the Oregon tobacco quitline's "free patch initiative" compared to the pre-initiative programme., Methods: Using quitline utilisation and cost data from the state, intervention providers and patients, we estimated annual programme use and costs for media promotions and intervention services. We also estimated annual quitline registration calls and the number of quitters and life years saved for the pre-initiative and free patch initiative programmes. Service utilisation and 30-day abstinence at six months were obtained from 959 quitline callers. We compared the cost effectiveness of the free patch initiative (media and intervention costs) to the pre-initiative service offered to insured and uninsured callers. We conducted sensitivity analyses on key programme costs and outcomes by estimating a best case and worst case scenario for each intervention strategy., Results: Compared to the pre-intervention programme, the free patch initiative doubled registered calls, increased quitting fourfold and reduced total costs per quit by $2688. We estimated annual paid media costs were $215 per registered tobacco user for the pre-initiative programme and less than $4 per caller during the free patch initiative. Compared to the pre-initiative programme, incremental quitline promotion and intervention costs for the free patch initiative were $86 (range $22-$353) per life year saved., Conclusions: Compared to the pre-initiative programme, the free patch initiative was a highly cost effective strategy for increasing quitting in the population.

Objectives: To identify key themes related to tobacco advertising and promotion in testimony provided by tobacco industry-affiliated witnesses in tobacco litigation, and to present countervailing evidence and arguments., Methods: Themes in industry testimony were identified by review of transcripts of testimony in the Tobacco Deposition and Trial Testimony Archive (http://tobaccodocuments.org/datta) from a sample of defence witnesses, including three academic expert witnesses, six senior executives of tobacco companies, and one industry advertising consultant. Counterarguments to the themes embodied in defence testimony were based on information from peer-reviewed literature, advertising trade publications, government reports, tobacco industry documents, and testimony provided by expert witnesses testifying for plaintiffs., Results: Five major themes employed by defence witnesses were identified: (1) tobacco advertising has a relatively weak "share of voice" in the marketing environment and is a weak force in affecting smoking behaviour; (2) tobacco advertising and promotion do not create new smokers, expand markets, or increase total tobacco consumption; (3) the tobacco industry does not target, study, or track youth smoking; (4) tobacco advertising and promotion do not cause smoking initiation by youth; and (5) tobacco companies and the industry adhere closely to relevant laws, regulations, and industry voluntary codes. Substantial evidence exists in rebuttal to these arguments., Conclusions: Tobacco industry-affiliated witnesses have marshalled many arguments to deny the adverse effects of tobacco marketing activities and to portray tobacco companies as responsible corporate citizens. Effective rebuttals to these arguments exist, and plaintiffs' attorneys have, with varying degrees of success, presented them to judges and juries.

Background: Retail stores are the primary medium for marketing cigarettes to smokers in the US. The prevalence and characteristics of cigarette retail advertising and promotions have been described by several investigators. Less is known about the proportion of cigarette sales occurring as part of a retail promotion and about the effects of tobacco control policies on cigarette promotions., Objective: To estimate the effect of the Master Settlement Agreement (MSA), state tobacco control programme funding and cigarette taxes on retail promotions for cigarettes in supermarkets in the US., Outcome Measures: Proportion of cigarette sales occurring under a retail promotion and the value of multipack promotions (eg, buy one pack, get one pack free) and cents-off promotions, measured using scanner data in supermarkets from 50 retail market areas from 1994 to 2004., Results: Promoted cigarette sales have increased significantly since the MSA (p<0.01), and are higher in market areas with high tobacco control programme funding (p<0.01) and high cigarette tax (p<0.01). The value of a multipack promotion is higher since the MSA (p<0.01) and in market areas with high cigarette tax (p<0.01). The value of a cents-off promotion is negatively related to the MSA (p<0.01), with mixed results for tobacco control programme funding (p<0.05), and is unassociated with tax., Conclusions: Higher promoted cigarette sales and increased promotional values in market areas with strong tobacco control policies, compared with market areas with weaker tobacco control policies, may partially offset the decline in smoking achieved in those areas.

Background: Direct to consumer advertising is increasingly used by the pharmaceutical industry, but its benefits and harms have yet to be summarised in a comprehensive and rigorous manner., Methods: A systematic review was conducted of robust evaluations of the impact (positive and negative) of direct to consumer advertising. A broad range of databases and data sources (including Cinahl, Embase, HMIC, HSRProj, Medline, PsycInfo, and the internet) were searched from inception to 2004., Results: From 2853 citations only four reports were found that met the strict inclusion criteria and provided usable results. Direct to consumer advertising is associated with increased prescription of advertised products and there is substantial impact on patients' request for specific drugs and physicians' confidence in prescribing. No additional benefits in terms of health outcomes were demonstrated., Discussion: Direct to consumer advertising is banned in most countries, and the research evidence tends to support the negative impact that is feared by those who support a legislative ban. Further research is needed into the clinical and economic impact of direct to consumer advertising in healthcare systems.

Objective: To assess effects of the Master Settlement Agreement (MSA) and the four individual state settlements on tobacco company decisions and performance., Design: 10-K reports filed with the US Securities and Exchange Commission, firm and daily data from the Center for Research in Security Prices, stock price indices, market share and advertising data, cigarette export and domestic consumption data, and newspaper articles were used to assess changes before (1990-98) and after (1999-2002) the MSA was implemented., Subjects: Five major tobacco manufacturers in the USA., Main Outcome Measures: Stockholder returns, operating performance of defendant companies, exports, market share of the original participants in the MSA, and advertising/promotion expenditures., Results: Returns to investments in the tobacco industry exceeded returns from investments in securities of other companies, using each of four indexes as comparators. Domestic tobacco revenues increased during 1999-2002 from pre-MSA levels. Profits from domestic sales rose from levels prevailing immediately before the MSA. There is no indication that the MSA caused an increase in tobacco exports. Total market share of the original participating manufacturers in the MSA decreased. Total advertising expenditures by the tobacco companies increased at a higher rate than the 1990-98 trend during 1999-2002, but total advertising expenditures net of spending on coupons and promotions decreased., Conclusion: The experience during the post-MSA period demonstrates that the MSA did no major harm to the companies. Some features of the MSA appear to have increased company value and profitability.

Objectives: To quantify the contribution the tobacco industry has made to foreign direct investment (FDI) in the former Soviet Union (FSU) as an indicator of its political and economic leverage; to explore the impact this has had on production capacity and tobacco control in the region., Design: Data on industry investment and its impact on cigarette production capacity were collated from industry journals, reports, and websites. Data on total FDI were obtained from the European Bank of Reconstruction and Development., Results: By the end of 2000, transnational tobacco companies (TTCs) had invested over 2.7 billion US dollars in 10 countries of the FSU. Tobacco money as a proportion of FDI varies from 1% to over 30% in Uzbekistan. Cigarette production capacity in the factories receiving investments tripled from 146 to 416 billion cigarettes per annum and the TTCs' market share has increased from nothing to between 50-100% in the markets in which they invested. Findings suggest that the effectiveness of national tobacco control measures corresponds broadly to the nature of the political and economic transition in each country and the size of industry investment, which is determined in part by the political context. Thus more effective measures tend to be seen in democratic states with smaller or no industry investments while the least effective measures are seen in highly centralised, one party states with high levels of industry investment or those with limited governmental capacity., Conclusions: The entry of the TTCs at a time of major political and economic change left the FSU particularly vulnerable to industry influence. This influence was enhanced by the industry's significant contribution to FDI, their ability to take over existing state monopolies in all but the largest countries, and the lack of democratic opposition.

Objective: To investigate the role of the retail environment in cigarette marketing in Australia, one of the "darkest" markets in the world., Design: Analysis of 172 tobacco industry documents; and articles and advertisements found by hand searching Australia's three leading retail trade journals., Results: As Australian cigarette marketing was increasingly restricted, the retail environment became the primary communication vehicle for building cigarette brands. When retail marketing was restricted, the industry conceded only incrementally and under duress, and at times continues to break the law. The tobacco industry targets retailers via trade promotional expenditure, financial and practical assistance with point of sale marketing, alliance building, brand advertising, and distribution. Cigarette brand advertising in retail magazines are designed to build brand identities. Philip Morris and British American Tobacco are now competing to control distribution of all products to retailers, placing themselves at the heart of retail business., Conclusions: Cigarette companies prize retail marketing in Australia's dark market. Stringent point of sale marketing restrictions should be included in any comprehensive tobacco control measures. Relationships between retailers and the industry will be more difficult to regulate. Retail press advertising and trade promotional expenditure could be banned. In-store marketing assistance, retail-tobacco industry alliance building, and new electronic retail distribution systems may be less amenable to regulation. Alliances between the health and retail sectors and financial support for a move away from retail dependence on tobacco may be necessary to effect cultural change.

Background: About 81% of cigarette manufacturers' marketing expenditures in the USA is spent to promote cigarette sales in stores. Relatively little is known about how these expenditures help the manufacturers achieve their marketing goals in stores. A better understanding of how tobacco companies influence the retail environment would help researchers and tobacco control activists to monitor industry presence in stores., Objective: To describe the types of tobacco company incentive programmes offered to retailers, how these programmes impact the store environments, and possible visual indicators of retailer participation in incentive programmes., Study Design: In-depth qualitative interviews with a convenience sample of 29 tobacco retailers were conducted in 2001., Setting: USA., Main Outcome Measures: The types and requirements of retailer incentive programmes provided by tobacco companies, and how participation in a programme alters their stores., Results: The retailers provided insights into how tobacco companies convey promotional allowances and special offers to them and how these incentives shape the retail environment. Retailers noted that tobacco companies exert substantial control over their stores by requiring placement of products in the most visible locations, and of specific amounts and types of advertising in prime locations in the store. Retailers also described how tobacco companies reduce prices by offering them volume based discounts, "buy two, get one free" specials, and "buying down" the price of existing product., Conclusions: Tobacco companies are concentrating their marketing dollars at the point-of-sale to the extent that the store is their primary communication channel with customers. As a result, all shoppers regardless of age or smoking status are exposed to pro-smoking messages. Given the financial resources spent by tobacco companies in stores, this venue warrants closer scrutiny by researchers and tobacco control advocates.

Objective: The Master Settlement Agreement (MSA) of November 1998 prohibited participating tobacco companies from directly or indirectly targeting youth in marketing. Widely publicised information in May 2000 showed increased cigarette advertising in magazines with substantial youth readership and companies were pressed to change their practices. The responses of the tobacco industry to the MSA and to the public pressure are examined., Design: Expenditures on cigarette advertisements in national magazines in the USA are compared for three periods: January to November 1998, December 1998 to June 2000, and July 2000 to November 2001. Magazines in which at least 15% of readers are youth under age 18 are focused upon. Regression models test for the significance of period differences after controlling for seasonal and long term patterns., Data Sources: Commercially maintained data on advertising in US magazines and on magazine readership by age., Key Measures: Monthly cigarette ad expenditures in magazines with 15%+ youth readership, and monthly proportion of ad expenditures in 15%+ youth magazines., Results: Cigarette advertising expenditures in magazines with 15%+ youth readership increased dramatically after MSA implementation and fell dramatically after public pressure. The percentage allocation of expenditures to 15%+ magazines fell significantly in both periods. Results differ somewhat by company., Conclusions: The tobacco industry response to the MSA was at best modest, reducing proportional allocations of advertising to youth magazines but increasing the absolute amount of such advertising. The value of public pressure was seen in substantial reductions in both absolute and proportional spending on youth magazines, although not by all companies.

Objective: To assess the prevalence and characteristics of tobacco sales and point-of-sale promotions and advertising in predominantly Latino business districts, and in comparison districts; and the economic importance of tobacco sales and marketing to Latino owned small businesses., Design: Observational surveys of retail establishments and interviews with store managers., Setting: Demographically contrasting business districts of eastern Massachusetts., Main Outcome Measures: Percentage of businesses selling tobacco, numbers and characteristics of exterior and interior tobacco advertisements per store, merchant reports of promotional allowances received from tobacco distributors., Results: The proportion of businesses selling tobacco, and hence having storefront tobacco advertising, is strongly negatively correlated with per capita income in the census tracts where businesses are located (Spearman's rho = -0.794, p = 0.006). Mentholated brands are marketed disproportionately in low income, urban communities. Latino merchants are highly dependent on tobacco sales, but would require relatively modest compensation to forego tobacco promotional allowances., Conclusions: Storefront tobacco advertising is far more prevalent in predominantly minority, low income communities than in non-minority, higher income communities, principally because of the differing mix of kinds of businesses in the two types of communities, and the greater prevalence of tobacco vendors in lower income neighbourhoods. Tobacco companies obtain this advertising at little cost.

Objectives: To examine the tobacco industry's use of bar promotions, including their target groups, objectives, strategies, techniques, and results., Design: Over 2000 tobacco industry documents available as a result of the Master Settlement Agreement were reviewed on the internet at several key web sites using keyword searches that included "bar", "night", "pub", "party", and "club". The majority of the documents deal with the US market, with a minor emphasis on Canadian and overseas markets., Results: The documents indicate that bar promotions are important for creating and maintaining brand image, and are generally targeted at a young adult audience. Several measures of the success of these promotions are used, including number of individuals exposed to the promotion, number of promotional items given away, and increased sales of a particular brand during and after the promotion., Conclusion: Bar promotions position cigarettes as being part of a glamorous lifestyle that includes attendance at nightclubs and bars, and appear to be highly successful in increasing sales of particular brands.

Objective: To understand the development, intent, and consequences of US tobacco industry advertising for low machine yield cigarettes., Methods: Analysis of trade sources and internal US tobacco company documents now available on various web sites created by corporations, litigation, or public health bodies., Results: When introducing low yield products, cigarette manufacturers were concerned about maintaining products with acceptable taste/flavour and feared consumers might become weaned from smoking. Several tactics were employed by cigarette manufacturers, leading consumers to perceive filtered and low machine yield brands as safer relative to other brands. Tactics include using cosmetic (that is, ineffective) filters, loosening filters over time, using medicinal menthol, using high tech imagery, using virtuous brand names and descriptors, adding a virtuous variant to a brand's product line, and generating misleading data on tar and nicotine yields., Conclusions: Advertisements of filtered and low tar cigarettes were intended to reassure smokers concerned about the health risks of smoking, and to present the respective products as an alternative to quitting. Promotional efforts were successful in getting smokers to adopt filtered and low yield cigarette brands. Corporate documents demonstrate that cigarette manufacturers recognised the inherent deceptiveness of cigarette brands described as "Light"or "Ultra-Light" because of low machine measured yields.

The American Stop Smoking Intervention Study (ASSIST) is a programme to implement proven interventions in 17 states across the United States. ASSIST applies all that we have learned in 10 years of research on tobacco use prevention and control. The goal of this seven-year project is to reduce the prevalence of smoking and cigarette consumption in the ASSIST states. The scientific basis for ASSIST is described, followed by a general description of the project and its current status in the 17 targeted states.