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Controlling the Tobacco Epidemic:
Selected Evidence in Support of Banning All Tobacco
Advertising and Promotion, and Requiring Large, Picture-Based Health Warnings on Tobacco Packages
Canadian Cancer SocietyInternational Union Against Cancer
April 2001
Suggested citation:
Canadian Cancer Society, Controlling the Tobacco Epidemic: Selected Evidence in Support of Banning All Tobacco Advertising and Promotion, and Requiring Large, Picture-Based Health Warnings on Tobacco Packages (Ottawa: Canadian Cancer Society, International Union Against Cancer, 2001).
For more information contact:
Ken Kyle
Director of Public Issues
Canadian Cancer Society
116 Albert St., Suite 1010
Ottawa, Ontario K1P 5G3 Canada
Tel: 613-565-2522, ext. 301
Fax: 613-565-2278
Email:
The Canadian Cancer Society is a national, community-based organization of volunteers, whose mission is the eradication of cancer and the enhancement of the quality of life of people living with cancer.
Founded in 1933, the International Union Against Cancer (UICC) is an independent, international, non-governmental association of more than 290 member cancer fighting organisations in 86 countries. Based in Geneva, Switzerland, UICC's purpose is to promote awareness and responsibility for the growing global cancer burden; to take effective action to prevent and reduce cancer incidence and mortality; to improve the quality of life of cancer patients and their families, and to build the capacity of our members and partners to meet local cancer control needs.
Table of Contents
Page
Foreword5
Part I – Advertising and Promotion7
Introduction8
Reports8
Conference Proceedings 22
Canadian Statistics 24
Studies and Other Literature 25
Part II – Package Labelling 80
Introduction 81
Knowledge of health effects of smoking 82
General Canadian Statistical Information 87
Tobacco Industry Statements/Documents 88
Legal Cases and Opinions 97
Studies, Reports and Other Literature – Warnings 99
Promotional Impact of Packaging 143
Education Initiatives Generally 151
International Reaction to New Canadian Warnings 155
Toxic Constituent Labelling 156
Part III – Expert Opinions – Health Warnings 165
Introduction 166
Expert Opinions 166
Part IV – Expert Opinions – Plain Packaging 202
Introduction 203
Expert Opinions 203
Bibliographical List 210
Foreword
Two of the critically important tobacco control measures recommended by the World Health Organization are (1) banning all tobacco advertising and promotion and (2) requiring prominent health warnings on tobacco packages. Tobacco companies have long fiercely resisted implementation of these measures.
In Canada, on April 25, 1997, Parliament adopted the Tobacco Act, a national law containing significant restrictions on tobacco advertising and promotion. On December 10, 1998, Parliament adopted An Act to amend the Tobacco Act, strengthening the Tobacco Act by including a total ban on sponsorship advertising as of October 1, 2003. On June 26, 2000, the Tobacco Products Information Regulations were adopted, following approval by the federal Cabinet, by the House of Commons Standing Committee on Health, and by the House of Commons as a whole. These Regulations require that one of 16 rotated picture-based warnings appear on the top 50% of the front and back of cigarette packages. One of 16 additional rotated messages are required inside the package, either on an insert or on the “slide” of slide and shell packages. Further, the Regulations require that toxic emission yields printed on the side of the package be reported as a range. The range would include the yield resulting from the International Organization for Standardization (ISO) test method, as well as from an intensive smoking test method.
During the parliamentary process, the Canadian Cancer Society tabled with parliamentary committees two extensive compilations of evidence:
Canadian Cancer Society, “Compilation of Selected Evidence Regarding the Impact of Tobacco Advertising and Promotion: A Submission to Parliamentarians for Use During Consideration of Bill C-42, An Act to amend the Tobacco Act”, December 1998 (4 volumes, 165 tabs).
Canadian Cancer Society, “Compilation of Selected Evidence Regarding the Impact of Tobacco Package Warnings and Labelling: A Submission to Members of Parliament for Use During Consideration of Regulations Under the Tobacco Act” May 2000 (6 volumes, 208 tabs).
Each of these parliamentary submissions contained a summary highlighting – through quotations – key aspects of the studies, reports and other literature included in the compilations. This report reproduces the summaries, updated with additional evidence. The same format is used: a quotation followed by the source. Where text appears in square brackets – “[“ “]” – the text is a description rather than a quotation. Where a source document includes footnotes or references, these have been omitted from quotations.
The parliamentary submissions had been prepared by the Canadian Cancer Society to respond to tobacco industry claims that there was no credible evidence that tobacco advertising and promotion increases consumption, and that there was no credible evidence that the new larger, picture-based Canadian health warnings would be any-more effective than the previous, smaller, text-only warnings.
A number of items included in French only in the original parliamentary submissions have been translated into English for this report.
The release of this report has been prepared to coincide with the second meeting of the International Negotiating Body for the Framework Convention on Tobacco Control. This meeting is to take place April 30 – May 5, 2001 in Geneva, Switzerland. Two of the issues being considered are a total ban on advertising and promotion, and requiring large, picture-based warnings on tobacco packages. A further issue on the agenda deals with the banning of terms such as “light” and “mild”.
The Canadian Cancer Society supports provisions in the FCTC that would ban all tobacco advertising and promotion, that would require Canadian-style picture-based package warnings or other messages covering at least 50% of the exterior of the package, and that would prohibit labelling terms such as “light” and “mild”. It is hoped that this report will be of use to delegates during their deliberations.
The research assistance of the National Clearinghouse on Tobacco and Health, in Ottawa, Canada, is gratefully acknowledged, as is the assistance of many others.
April 2001
Part I
Advertising and Promotion
Part I
Advertising and Promotion
Introduction
As documented in this report, there is overwhelming evidence to conclude (1) that tobacco advertising and promotion (including informational advertising, sponsorships and brand stretching) increase tobacco consumption, and (2) that there is sufficient justification for a legislated ban on all forms of direct and indirect tobacco advertising and promotion.
The evidence includes conclusions of the World Health Organization, the World Bank, the United Nations Children’s Fund (UNICEF), the U.S. Surgeon General, the U.S. Federal Trade Commission, the U.S. Food and Drug Administration, parliamentary committees from Australia, Canada, Ireland and the United Kingdom, a Royal Commission in British Columbia, and numerous other authoritative reports from various committees, task forces and institutions. The evidence also includes the conclusions of national and international conferences; recommendations of international, national, and subnational health organizations; examples of countries which have curbed tobacco advertising and promotion; statistical trends in Canada showing reduced smoking rates following implementation of the Tobacco Products Control Act in 1988 and the Tobacco Act in 1997; documented violations and inadequacies of industry self-regulating codes; the voluntary acceptance by tobacco manufacturers of significant marketing restrictions contained in out-of-court litigation settlements; tobacco industry documents; a vast array of studies and other literature; and logic and reason.
The body of evidence is substantial and growing quickly. As noted, this report contains a selected compilation, not a comprehensive compilation, and has been prepared in part to respond to the tobacco industry’s stated position (1) that there is no credible evidence that tobacco advertising and promotion affects overall consumption, as opposed to only influencing market share, and (2) that there is no justification for a total ban on tobacco advertising and promotion.
Reports
1. While the federal ban on tobacco advertising is a positive step, further measures are needed. The ARF supports a ban on use of tobacco names, trademarks, colors and logos in all advertising of events, products or organizations sponsored by tobacco companies. (p.5)
Addiction Research Foundation [Canada], “Preventing Smoking: Tobacco Control Policies. Best Advice From the Addiction Research Foundation.” July 1995.
2. The Committee believes that, on the basis of the evidence received from a wide range of groups and of studies that show sponsorship by tobacco manufacturers acts as cigarette advertising to children, there should be no special exemption permitting tobacco advertising at sporting and cultural events of international significance. The Committee further believes this recommendation should be phased in by the year 2000. (p.38)
Australia, Senate Community Affairs References Committee, “The Tobacco Industry and the Costs of Tobacco-Related Illness: Report of the Senate Community Affairs Reference Committee” December 1995.
3. The commission is of the view that banning tobacco advertising is very important. Many young British Columbians start smoking each year and will die from it. We think it is important that nothing be permitted that would encourage people to smoke.
Therefore, the commission recommends that:
16.a. the provincial government pass legislation similar to the Tobacco Products Control Act.; and
b. if the legislation is found to be contrary to the Canadian Charter of Rights and Freedoms,
the province resort to Section 33(1) of the Charter to ensure that the prohibition against tobacco advertising is maintained. (p.C-70)
British Columbia Royal Commission on Health Care and Costs, “Closer to Home: The Report of the British Columbia Royal Commission on Health Care and Costs” 1991.
4. It is clearly contrary to the public interest for the use of a harmful product to be actively promoted even though a ban on production and sales would be unacceptable.(p.30)
...
[Y]oung people can hardly be expected to believe that governments really consider cigarette smoking to be hazardous if they allow unlimited cigarette promotion. Further, large numbers of smokers wish to stop smoking or stay stopped and anything that could be done to support their resolve and reduce the pressures to smoke, which are part of our society, would be desirable.(p.31)
...
Your Committee recommends that cigarette advertising and all other promotion of cigarette sales be progressively eliminated.(p.32)
...
[A]ny type of cigarette promotion implies that the use of cigarettes is desirable and presumably harmless, and a priori, adds to the cultural acceptability of smoking.(p.33)
Canadian House of Commons, Standing Committee on Health, Welfare and Social Affairs, “Report of the Standing Committee on Health, Welfare and Social Affairs on tobacco and cigarette smoking” 1969.
5. The promotion of tobacco products takes on many forms: advertising, sponsorship, attractive packaging, massive point-of-sale product exposure, etc. All these promotional activities foster the “normalness” of tobacco use, among others. Thus, an anti-tobacco strategy cannot ignore this important aspect of the tobacco industry’s marketing strategies (p. 72).
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Anti-tobacco measures at the national level
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That the Quebec Government adopt the appropriate initiatives in order to eliminate or minimize tobacco product promotional activities, this not excluding collaboration with the federal government in this area (p. 73).
Comité consultative sur le cancer [Cancer Advisory Committee] [Quebec], «Programme québécois de lutte contre le cancer; Pour lutter efficacement contre le cancer, formons équipe» [«Quebec Cancer Control Program; Let’s Get Together to Effectively Fight Cancer»] October 1997, [Report to Minister of Health and Social Services].
6. Partial bans are not recommended because of the likelihood that permissible promotional activities would be enhanced. In Britain, the elimination of cigarette advertising on television was followed by increases in overall promotional budgets and in coupon gift schemes. (p.148)
Department of National Health and Welfare (Canada), “Cigarette Smoking and Health” Prepared for the Health, Welfare and Social Affairs Committee, House of Commons, December 19, 1968, In: House of Commons Standing Committee on Health, Welfare and Social Affairs, Minutes of Proceedings and Evidence No. 9, December 19, 1968, Appendix B, pp.143-155.
7. 5.1 Ban on advertising
Advertising restrictions are essential to any comprehensive program to reduce consumption of tobacco products, particularly among youth. . . . [T]he imagery portrayed through such activities plays an important role in shaping young persons’ attitude toward, and willingness to experiment with, tobacco products.
Comprehensive restrictions on advertising are intended to prevent messages and images that attract young people, therefore helping to prevent inducements to use tobacco products and the consequent dependence on them. These restrictions are intended to reduce the appeal of tobacco products to Canadians, particularly youth, and to prevent the positive imagery about tobacco products.
With respect to advertising, a comprehensive prohibition is considered the most effective measure to achieve the government’s policy objectives. It would appear that all forms of advertising contribute to making tobacco products socially acceptable and desirable as consumer goods and therefore represent an inducement to use tobacco products. Consequently, alternative measures, such as a partial ban, a ban on lifestyle advertising or a ban on advertising aimed at youth, would not appear to be as effective. (p.27)
. . .
5.2 Restrictions on promotion (p.27)
. . .
The linkage of cigarette brands to non-tobacco goods such as clothing or, alternatively, the use of non-tobacco trade marks with positive associations (e.g. a fashion designer’s name used as a cigarette brand name) on tobacco products, appeals to youth and dilutes health concerns by associating tobacco products with desirable products and activities. These forms of promotional activities are considered indirect advertising. These forms of promotional activities are considered indirect advertising. Some items, when used or worn by people, particularly youth, create a new advertising medium which can enter schools or other locations where advertising is usually prohibited. (p.28)
. . .
5.3 Restrictions on sponsorship
Sponsorship or event marketing is a form of promotion that is a key component of the marketing strategies of tobacco companies. The sponsorship of sports and cultural events is a relatively cost-effective form of advertising and promotion which capitalizes on the other elements of the marketing mix such as packaging, brand image and point-of-sale promotion. Sponsorship offers several advantages over traditional advertising by heightening the visibility of tobacco brand names, shaping consumer attitudes and communicating commitment to a particular lifestyle.
. . . The events and activities are often designed to appeal to a youth market segment, to create good will for the tobacco industry through association with sports and the arts, and to link tobacco use with exciting, glamorous and fun events.
Brand name sponsorship activities have an influence on youth and use “lifestyle” approaches in their market research and creative materials. They provide opportunities to create a familiarity between tobacco and sports and arts enthusiasts. Those participating or watching a sponsored event, including youth, repeatedly see a tobacco product brand name linked with an event they enjoy. This form of indirect advertising contributes to shaping attitudes, particularly young persons’ attitude, toward smoking. (p.29)
. . .
Since promotional activities related to sponsorship are considered a form of indirect advertising, the rationale put forward for restricting advertising applies as well to sponsorship. (p.30)
Health Canada, “Tobacco Control: A Blueprint to Protect the Health of Canadians” (Ottawa: Minister of Supply and Services, 1995).
8. The Committee considers that what is required is a National Anti-Smoking Strategy which includes the following:
. . .
A ban on all tobacco advertising, sponsorship and patronage (chapter 8, p.2 of internet print out)
. . .
It is the view of the Committee that the continued sponsorship of events such as Formula One racing by tobacco companies and the worldwide glamorization of cigarettes which results from both press reporting and the televising of such events, encourages children and adolescents to smoke cigarettes and actively colludes with the tobacco companies in ensuring that young people become nicotine addicted. (chapter 8, p.8)
Ireland Oireachtas [Parliament], Joint Committee on Health and Children, “A National Anti-Smoking Strategy: A Report on Health and Smoking” November 1999. Accessed March 27, 2001.
9. Policy Recommendations
The images typically associated with advertising and promotion convey the message that tobacco use is a desirable, socially approved, safe and healthful, and widely practiced behaviour among young adults, whom children and youths want to emulate. As a result, tobacco advertising and promotion undoubtedly contribute to the multiple and convergent psychosocial influences that lead children and youths to begin using these products and to become addicted to them.
... The message should be unequivocal -- tobacco use is unhealthy and socially disapproved. In the context of this emergent social norm, the contradictory messages now conveyed by the tobacco industry can no longer be tolerated. The Committee therefore recommends a step-by-step plan to eliminate these commercial messages from the various media of mass communication. Realizing that implementation of this recommendation will require careful planning and a period of transition, the Committee proposes a sequential process for phasing in the necessary restrictions. (p.131)
Lynch, B.S., Bonnie, R.J., eds., Committee on Preventing Nicotine Addiction in Children and Youths, Institute of Medicine [U.S.], Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and Youths (Washington, D.C.: National Academy Press, 1994).
10. Conclusions
1. Cigar use began to increase in the United States after promotional activities for cigars increased beginning in 1992.
2. Promotional activities for cigars have increased the visibility of cigar consumption, normalized cigar use, and broken down barriers to cigar use. (p.217)
National Cancer Institute [U.S.], Cigars: Health Effects and Trends, Smoking and Tobacco Control Monograph 9, 1998.
11. There is substantial evidence that young people are aware of, and respond to, cigarette advertising. (p.9)
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Advertisements present images that appeal to youth and are seen and remembered by them.(p.9)
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In sum, both qualitative and quantitative studies examining the effects of advertising on adolescents suggest that the content of advertisements influence attitudes, beliefs and values related to tobacco. They do so by portraying benefits of smoking that resonate with the issues and concerns of adolescents; namely, peer bonding, social approval, independence/autonomy, self-image, body image, adventure-seeking and normative behaviour.(p.13)