Selling Death nicely packaged

1. Selling Death nicely packaged Rima Nakkash, DrPH Faculty of Health Sciences American University of Beirut

2. Spread of the epidemic In the 20th century, the tobacco epidemic killed 100 million people worldwide. During the 21st century, it could kill one billion. WHO, MPOWER 2008

3. …Tobacco use is unlike other threats to global health. Infectious diseases do not employ multinational public relations firms. There are no front groups to promote the spread of cholera. Mosquitoes have no lobbyists. —Thomas Zeltner, MD, David A. Kessler, MD, Anke Martiny,PhD, Fazel Randera, MD1

4. The Dwarves-video

5. “Nicotine is addictive. We are, then, in the business of selling nicotine…” (Addison Yeaman from Brown & Williamson, 17 July 1963) Tobacco company CEOs declare, under oath, that nicotine is not addictive (1994)

7. Lots of toxic chemicals!

8. Carbon Monoxide-auto exhaust, gas chambersCarbon Dioxide Carbonyl Sulfide Benzene (1) Toluene-industrial solvent, in explosivesFormaldehyde (2)- body tissue preserverAcrolein-aquatic herbicide=burned glycerol Acetone-poisonous solvent, nail polish removerPyridine-poisonous solventMethylpyridine-insecticide solvent Vinylpyridine Hyrogen Cyanide-rat poison, gas chambersHydrazine-rocket fuel chemical Ammonia-poisonous, cleaning agent for toilets and floorsMethylamine-tanning agentDimethylamine-tanning acceleratorNitrogen Oxides Nitrosodimethylamine Nitrosodiethylamine Nitrosopyrrolidine Formic Acid-caustic solventAcetic Acid-caustic solventMethyl Chloride-poisonous refrigerantButadiene Particulate Matter-animal carcinogenNicotine-insecticide, cockroach killerAnatabine Phenol-toilet bowl disinfectant What is in tobacco and cigarettes?

9. Catechol-tanning, dyeing agentHydroquinone-photographic developing agentAniline-industrial solventToluidine-agent in dye manufactureNapthalamine-mothballsAminobiphenyl Benz(a)anthracene Benzo(a)pyrene Cholesterol Butyrolactone Quinoline-specimen preservativeHarman Nitrosonornicotine NNH Nitrodiethanolamine Cadmium Nickel Zinc-anti-corrosion coating for metalsAluminum-metalTitanium-metalCopper-metalMercury-metal Silicon-metalSilver-metalGold-metalPolonium-210-radioactive elementBenzoic Acid-tobacco curing agentLactic Acid-caustic solvent Glycolic Acid-metal cleaning agentSuccinic Acid-agent in Lacquer manufacturePCDDs and PCDFs –dioxins, dibenzofurans Hexamine-barbecue lighterStearic Acid-candle waxCadmium-rechargeable batteriesArsenic-poisonButane-cigarette lighter fluidPropylene Glycol-antifreeze

10. What’s in a cigarette • Video

14. SPIKE MY CIGARETTE • VIDEO, Is big tobacco evil ?

15. Tobacco Industry uses a variety of tactics • They target youth and special populations such as women, different cultural groups and low income people. • They reassure concerned smokers by linking tobacco with healthy images. • They use advertising and promotion to publicize their product. • They launch “prevention” campaigns that have been shown to actually encourage youth to smoke. • They pretend to be concerned “corporate citizens” by donating money to various causes. • They challenge the decisions of governments to control tobacco. • They use their networks to influence politicians. • They create “front groups” to express their opinions. • They create controversy about the health effects of smoking. • They deny scientific evidence. • They deny that second-hand smoke is dangerous, even though it has been proven to be harmful.

16. Other tactics • Flavored products:  Cigarettes, smokeless tobacco, and so-called “little cigars” have been introduced in many candy, fruit, and alcohol flavors that mask the harshness of the products and make them appealing to children. • Novel smokeless products:  New smokeless tobacco products, some in teabag-like pouches and even in dissolvable, candy-like tablets, have been marketed as ways to help smokers sustain their addiction where they cannot smoke. • Targeted products and marketing: New products and marketing, such as R.J. Reynolds’ Camel No. 9, are aimed at women, girls and other populations. • Unproven health claims:  To discourage smokers from quitting, and possibly entice new or former smokers, increasing numbers of products have been marketed with unproven and misleading claims that they are less harmful than traditional cigarettes. • Undisclosed product designs: The report also details how tobacco manufacturers control nicotine delivery to maximize addiction, while using flavorings and other additives to make their products milder,

19. Are you really more of a man if you smoke? What girl is going to kiss you with that stinky breath?

20. The tobacco industry as disease vector • The tobacco industry plays a key role in the tobacco epidemic. • Industry voluntary or self-regulatory measures have not been proven to be effective. • Release of internal tobacco industry documents (TIDs).

21. Framework Convention on Tobacco Control • Adopted in May 2003 by the World Health Assembly (WHA). • Ninety days after the 40th country ratified the treaty, the FCTC became legally binding in February 2005 .

22. Anti smoking media campaigns

23. Non price measures Ban tobacco advertising in all its forms

24. Advertising to women ……

26. ….and youth Faraya Skiing Event Mika concert downtown Beirut

27. Tobacco advertising increases consumption: • Encourages children to experiment • Encourages smokers to smoke more • Reduces motivation to quit • Encourages former smokers to resume • Discourages full and open discussion of the hazards of smoking as a result of media dependence on advertising revenues … dependence of organisations receiving sponsorship from tobacco companies • Creates through in which tobacco use is seen as familiar and acceptable .

29. Tobacco Industry Resistance • Voluntary codes in existence for decades, but consumption is growing • A 1989 Philip Morris International Memorandum states that: “The general argumentation used by the industry is beginning to look extremely weak… This is best illustrated in the advertising bans and consumption argument, where the industry argues that ‘advertising does not increase total market size’, yet we are presented with a dilemma in developing markets where the total market is growing and advertising expenditure is rising accordingly. How can we reconcile this?...”

30. Branding • Marlboro Classics clothing, camel boots and accessories, Gauloise cars

31. Sports Sponsorship

32. Music Sponsorship

33. Health Warning Labels Iran Brazil

34. Jordan: Courtesy of Dr. Hiba Ayoub

36. التحذيرات الصحية على علب السجائرفي جمهورية مصر العربية

37. Graphic labels on tobacco products

38. Graphic Warnings • “Large, graphic warnings on cigarette packages are an effective means of increasing health knowledge among smokers [and] may also help to reduce the disparities in health knowledge by providing low-income smokers with regular access to health information.” • Hammond and colleagues also found that smokers in countries where a warning depicts a particular health hazard of smoking are much more likely to know about that hazard and smokers who reported noticing warnings were 1.5 to 3 times more likely to believe in each health hazard. Hammond et al.,2001

39. 73 percent of smokers approved of them • 54 percent had changed their opinion on the health consequences of smoking • 67 percent said the new warnings made them want to quit. • The impact was particularly strong among less educated, lower income people.

40. Industry Arguments and Rebuttals • Expensive and technically difficult • Larger warnings or the use of pictures will not be more effective than existing warnings. • Smokers already know the health effects of smoking. • Mandatory health warnings constitute an expropriation of the tobacco industry's • Packages and trademarks spoiled • The warnings ‘demonize’ smokers and make them feel like outcasts. • If the government wants to put out those messages, it should use billboards or TV commercials.

41. Dangers of second hand smoke

42. The debate is over! • The Surgeon General’s 2006 Report on The Health Consequences of Involuntary Exposure to Tobacco Smoke • secondhand smoke causes cancer, heart disease and serious lung ailments. • Former Surgeon General Richard Carmona stated when releasing the report, "The debate is over. The science is clear. Secondhand smoke is not a mere annoyance but a serious health hazard."

43. Secondhand smoke contains over 4,000 chemicals, including at least 69 that cause cancer, including arsenic, ammonia, formaldehyde, and polonium 210. • Studies show that children, the elderly, and people with respiratory illnesses are especially vulnerable to secondhand smoke. • For example, children exposed to secondhand smoke are more susceptible to bronchitis, asthma, eye and ear problems, and other ailments.

44. Bans on Smoking in the Workplace and Public Places Previously “SECRET” Tobacco Industry Documents: • “Total prohibition of smoking in the workplace strongly affects industry volume. Smokers facing these restrictions consume 11%-15% less than average and quit at a rate that is 84% higher than average…If smoking were banned in all workplaces, the industry’s average consumption would decline 8.7%-10.1% from 1991 levels and the quitting rate would increase 74% (e.g. from 2.5% to 4.4%).” • Such measures need to be strictly enforced in order to be effective.