Received: 15 February 2023
Accepted: 13 July 2023
DOI: 10.1111/add.16332
RESEARCH REPORT
US tobacco companies selectively disseminated
hyper-palatable foods into the US food system: Empirical
evidence and current implications
Tera L. Fazzino 1,2
|
Daiil Jun 1,2
1
Department of Psychology, University of
Kansas, Lawrence, Kansas, USA
2
Cofrin Logan Center for Addiction Research
and Treatment, University of Kansas,
Lawrence, Kansas, USA
|
Lynn Chollet-Hinton 3 |
Kayla Bjorlie 1,2
Abstract
Background and aims: US tobacco companies owned leading US food companies from
1980 to 2001. We measured whether hyper-palatable foods (HPF) were disproportionately developed in tobacco-owned food companies, resulting in substantial tobacco-
3
Department of Biostatistics and Data
Science, University of Kansas Medical Center,
Kansas City, Kansas, USA
Correspondence
Tera Fazzino, Department of Psychology,
University of Kansas, 1415 Jayhawk
Boulevard, 4th Floor, Lawrence, KS 66046,
USA.
Email: tfazzino@ku.edu
Funding information
There was no funding for this study.
related influence on the US food system.
Design: The study involved a review of primary industry documents to identify food
brands that were tobacco company-owned. Data sets from the US Department of Agriculture were integrated to facilitate longitudinal analyses estimating the degree to which
foods were formulated to be hyper-palatable, based on tobacco ownership.
Setting and cases: United States Department of Agriculture data sets were used to identify HPF foods that were (n = 105) and were not (n = 587) owned by US tobacco companies from 1988 to 2001.
Measurements: A standardized definition from Fazzino et al. (2019) was used to identify
HPF. HPF items were identified overall and by HPF group: fat and sodium HPF, fat and
sugar HPF and carbohydrates and sodium HPF.
Findings: Tobacco-owned foods were 29% more likely to be classified as fat and sodium
HPF and 80% more likely to be classified as carbohydrate and sodium HPF than foods
that were not tobacco-owned between 1988 and 2001 (P-values = 0.005–0.009). The
availability of fat and sodium HPF (> 57%) and carbohydrate and sodium HPF (> 17%)
was high in 2018 regardless of prior tobacco-ownership status, suggesting widespread
saturation into the food system.
Conclusions: Tobacco companies appear to have selectively disseminated hyperpalatable foods into the US food system between 1988 and 2001.
KEYWORDS
Addictive food, fat, food environment, formulation, policy regulation, sodium
I N T R O D U CT I O N
which may come at great expense to public health [3]. Federal regulation can serve as a powerful counterweight to protect population
Product formulation is an important public health issue. Food
health.
and drug products sold to consumers may contain chemicals
During the US tobacco epidemic of the 1950s, tobacco compa-
and ingredients that may negatively impact consumer health [1, 2].
nies formulated cigarette products to maximize their addictiveness at
Furthermore, products such as tobacco and highly palatable foods
the expense of public health, and incurred federal regulation as a
may be designed to maximize public consumption and industry profits,
result [4, 5]. Tobacco companies maximized the addictiveness of their
Addiction. 2023;1–10.
wileyonlinelibrary.com/journal/add
© 2023 Society for the Study of Addiction.
1
FAZZINO ET AL.
cigarettes by using a specific nicotine content delivery threshold
out and consume HPF [24, 25]. These consequences are similar to
(≥ 0.7 mg) and manipulating the form of nicotine to maximize its deliv-
other substances of abuse, including nicotine [19]. Our previous work
ery upon inhalation [4, 6]. They also added ingredients to increase the
revealed that the prevalence of HPF, particularly HPF with elevated
palatability and acceptability of cigarettes, such as menthol and
fat and sodium, increased substantially in the US food system
sugar [7]. Thus, tobacco companies used product formulation as a key
during the past 30 years, with the steepest increase during 1988–
tool in maximizing the addictiveness of their cigarettes. In addition to
2001 [26], the primary period of tobacco company ownership in the
product formulation, tobacco companies also used aggressive and
food system.
targeted marketing strategies to promote wide use of their products
The purpose of the study was to determine the degree to which
[4, 7]. Tobacco companies advertised heavily to children to expressly
tobacco companies formulated their food products to be hyper-
preserve the viability of the tobacco market for future generations,
palatable, relative to food companies that were not tobacco-owned.
and promoted menthol cigarettes to minoritized racial and ethnic
We hypothesized that HPF may be an addictive agent disproportion-
communities [4, 7]. Following revelations of these practices in the
ately developed in tobacco-owned food products, resulting in sub-
1990s, the US federal government responded by regulating the avail-
stantial tobacco-related influence on the US food system.
ability and marketing of tobacco products [4].
In part as a response to tobacco industry regulation, the largest
US tobacco companies, Phillip Morris (PM) and RJ Reynolds
METHODS
(RJR), diversified their investments by buying into the US food
industry [8, 9]. In the early 1980s PM bought major US food compa-
The study was conducted in 2022 at the University of Kansas. The
nies including Kraft and General Foods. By 1989, PM’s combined
study involved a two-part process in which (1) tobacco industry docu-
Kraft–General Foods was the largest food company in the world
ments were searched to identify a comprehensive list of food brands
[8, 10]. RJR had a slower trajectory of entry to the food industry
that were owned by PM and RJR; and (2) food system data sets from
and bought into the US beverage market in the 1960s, and
the United States Department of Agriculture (USDA) were used to
acquiring a limited number of specialty convenience food brands
identify foods that were and were not tobacco-owned from 1988
(e.g. puddings and maple syrup brands) throughout the 1970s
to 2018. Databases were integrated to facilitate longitudinal analyses
[11, 12]. However, in 1985 RJR purchased major cookie and cracker
estimating the likelihood that food products were formulated to be
brand Nabisco, which doubled company food profits in a single year
hyper-palatable based on tobacco-ownership status.
and solidified their status as a leader in the US food industry [13].
Years selected for the study corresponded to tobacco company
Collectively, PM- and RJR-owned companies dominated the US food
leadership in the US food system and the availability of data sets from
system between the late 1980s to the early 2000s [14–17]; thus,
the USDA. The years 1988 and 2001 were selected to represent a
companies that specialized in creating addictive tobacco products
period in time during which US tobacco companies dominated the US
led the development of the US food system for > 20 years (see
food market [14–17]. The anchor year of 1988 was selected based on
Fazzino [18] for a detailed review of industry activities). In this
data availability from the USDA, and aligned with the 1989 merger of
regard, evidence has revealed that RJR and PM directly applied their
Kraft–General Foods by PM, which facilitated PM’s leadership in the
tobacco product formulation strategies to their food company prac-
food system [8]. The year 2001 represented the final period that both
tices [8, 9]. Tobacco-owned food subsidiaries learned product for-
companies led industry sales [16]. The date of 2018 represented the
mulation strategies from company tobacco scientists, which included
most recently available data set from the USDA on branded foods in
adding a variety of appealing colors to their sugar-sweetened bever-
the food system at the time of the study.
ages, and adding sugar and caffeine to maximize consumption [8].
However, no further research has examined the ways in which the
application of tobacco product formulation techniques may have
Classification of tobacco-owned food brands
influenced the US food system.
Prior studies have described how certain foods may have addic-
To identify food brands and products that were owned by PM and
tive qualities similar to those of tobacco products and other sub-
RJR, internal industry documents were reviewed through the Univer-
stances of abuse [18, 19]. Such foods, termed hyper-palatable foods
sity of California San Francisco’s Industry Documents Library (IDL), a
(HPF), may be an addictive agent that tobacco companies developed
repository of primary source industry documents that is freely avail-
in their food products. HPF are designed with combinations of
able to researchers and the general public [27]. A systematic, iterative
palatability-inducing ingredients (fat, sugar, sodium and/or carbohy-
search process was conducted to identify documents that reported all
drates) that create an artificially rewarding eating experience [20].
brands and food products owned by PM and RJR to facilitate their
These combinations of nutrients do not occur in nature; as a result,
subsequent identification in the USDA food data sets (detailed below).
these foods can excessively activate brain reward neurocircuitry
The search process is summarized herein and reported in detail in the
[21, 22] and facilitate excess caloric intake [23]. Repeated
Supporting information section. Searches were conducted in the Truth
consumption of HPF over time may result in dysregulation of food
Tobacco Industry Documents Collection and the Food Industry Docu-
reinforcement processes, leaving individuals highly motivated to seek
ments Collection. Initial searches were conducted broadly to identify
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2
the types of industry documents that most comprehensively reported
comparison of the HPF status of foods that were tobacco-owned in
all tobacco-owned brands and food products (see Supporting informa-
1988, relative to the same food items that were not tobacco-owned
tion section for more details). A second refined search focused on col-
(e.g. saltine cracker). Secondly, a longitudinal file was created with
lecting
reports,
tobacco-owned food items that were present in 1988 and 2001. This
shareholder reports), which typically contained comprehensive food
summary-style
company
reports
(e.g.
annual
facilitated an analysis of the HPF status of tobacco-owned food items
brand listings. A third search was conducted to identify any remaining
between 1988 and 2001, relative to the same types of food that were
summary-style tobacco company reports available in the IDL not cap-
not tobacco-owned. Finally, the HPF status of food items with versus
tured in the first two search rounds. Twenty-five documents were col-
without a history of tobacco ownership as of 2018 were compared
lected and reviewed in detail, and a total of 373 tobacco-owned
cross-sectionally to test whether previous tobacco ownership may be
brands were identified (Supporting information, Table S1). In addition,
associated with the HPF items available in the current food environ-
most reports also provided performance comparisons with competitor
ment. Prevalence rates of HPF throughout branded foods previously
products/companies, which were used to identify brands that were
tobacco-owned and foods not previously tobacco-owned were also
not tobacco-owned at the same period.
quantified.
Data sources on food hyper-palatability
Measure of hyper-palatability
Following the search of industry documents, tobacco-owned foods
Foods were identified as HPF using the standardized definition from
were identified in publicly available data sets from the USDA, which
Fazzino et al. [20]. The definition was informed by evidence indicating
are considered representative of the US food system. Figure 1 depicts
a combination of palatability-inducing ingredients (fat, sugar, carbohy-
the data sets used in the study. Data sets were compiled to represent
drates and/or sodium) at specific thresholds may induce hyper-
three periods of time: 1988, 2001 and 2018. The NHANES-III
palatability. The definition specifies quantitative combinations of
24-hour dietary recall assessment (conducted from 1988 to 1994)
nutrients at thresholds that may yield hyper-palatability: (1) fat and
was used to identify tobacco-owned foods as of 1988 [28]. The USDA
sodium (FSOD), (2) fat and simple sugars (FS) and (3) carbohydrate
Standard Reference Databases for 1997, 1998 and 1999 and the
and sodium (CSDO) (detailed in the Data analysis section, below) [20].
2001 Food and Nutrient Database for Dietary Studies were used to
The HPF definition has excellent convergent validity for identifying
identify tobacco-owned food items between 1997 and 2001 [29–32].
foods hypothesized to be hyper-palatable [20], strong discriminant
The 2018 Branded Foods Database was used to characterize previ-
validity for foods hypothesized to not be hyper-palatable (e.g. raw
ously tobacco-owned foods for 2018 [33]. A parallel process was con-
fruit) [20] and is distinct from constructs such as energy density and
ducted to identify food items not tobacco-owned for respective time-
ultra-processed foods [20, 34]. Furthermore, evidence indicates HPF
periods, informed by competitor products identified in tobacco indus-
may be the target of clinically defined binge-eating episodes [35] and
try documents.
that highly processed HPF may be the target of food addiction [36],
Several data files were compiled for analysis (see Figure 1).
First, a matched-cases file was created to facilitate a cross-sectional
FIGURE 1
Data-sets and corresponding analyses.
supporting the premise that HPF may have strong addictive
properties.
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3
TOBACCO COMPANIES AND HPF
FAZZINO ET AL.
Identification of hyper-palatable foods
previously tobacco-owned in 2018. Modified Poisson regression
models with robust standard errors (fixed effects only) were used to
The HPF definition was applied to all food data in accordance with
characterize the magnitude of the differences via prevalence ratios
the published measure (detailed in the Supporting information
(PR). The study analyses were not pre-registered.
section) [20]. The percentage of kilocalories (kcal) from fat, sugar and
carbohydrates (following subtraction of fiber and sugar) and percentage of sodium by weight in grams were calculated. Items that met
RE SU LT S
criteria for at least one of the following were classified as HPF:
(1) FSOD (> 25% kcal from fat, ≥ 0.30% sodium), (2) FS (> 20% kcal
fat, > 20% kcal sugar) and (3) CSOD) (> 40% kcal carbohydrates,
Tobacco company food brand ownership and
representation in the study data-sets
≥ 0.20% sodium) [20].
A total of 105 tobacco-owned food items and 587 nontobacco-owned food items were present in both data sets used in the
Data analysis
longitudinal analyses (1988 and 2001), yielding a total sample size of
692. The 105 foods identified as tobacco-owned were representative
Figure 1 depicts analyses conducted with corresponding data sets.
of the brands and food items sold by PM and RJR, owners of the larg-
First, a McNemar’s χ2 test was conducted with the matched pairs of
est food companies in the US market [17, 37]. RJR’s largest food
foods to determine whether there were differences in the HPF status
brands were Nabisco and Planters Lifesavers [17] and the following
of foods that were tobacco-owned relative to matched food items
products led sales as of 1989: cookies and crackers from sub-brands
that were not tobacco-owned in 1988. Three additional McNemar’s
Oreo, Grams (Nabisco/Teddy), Ritz and Premium [17], all of which
χ2 tests were conducted to determine whether there were differences
were represented in the data set. PM-owned Kraft–General Foods
in the status of foods that were tobacco-owned for each HPF group
comprised the following categories: cereals/baked goods, grocery
(FSOD, FS and CSOD) [20] relative to the same foods that were not
products (e.g. Miracle Whip, side dishes), processed meats (e.g. Oscar
tobacco-owned.
Mayer hot dogs/sausages) and frozen/convenience meals [16, 37].
To examine whether tobacco company ownership of food items
These food categories comprised 75% of PM’s total food sales
was associated with change in the likelihood that foods were classified
between 1989 and 1993 [37], and all types of foods were represented
as HPF in 2001 relative to 1988, a modified Poisson regression model
in the data set. RJR and PM largely retained these principal brand lines
with mixed effects and robust standard errors using sandwich variance
throughout their ownership in the food system [to 2001 (RJR) or
estimation was used to estimate risk ratios (RRs) accounting for
2007 (PM)] [15, 16]. Thus, the identified tobacco-owned foods were
repeated measures, with a random intercept for food item to account
highly representative of the overall product lines and highest volume
for correlated HPF status among repeated food items and fixed
sales products from RJR and PM in 1988–2001.
effects for database year and tobacco-ownership status. Three parallel
models were also constructed with each HPF group (FSOD, FS and
CSOD) as dichotomous outcomes to determine if tobacco company
ownership was differentially associated with type of HPF. In addition,
Matched-pairs analysis of food item hyper-palatability
and tobacco ownership in 1988
an interaction effect of year by tobacco ownership was added
and tested as a fixed effect for all primary models to determine if
An examination of 145 matched pairs of food items indicated that in
change in HPF status depended upon tobacco company ownership.
1988, there were no significant differences in the likelihood that
Tobacco-owned foods represented the following categories: cook-
tobacco-owned food items were hyper-palatable, relative to their
ies, crackers, meats and cheeses, frozen foods, salad dressings, cereals
matched food items that were not tobacco-owned (HPF: McNemar’s
and bakery items. Therefore, foods that were from the same food cate-
χ2 = 0.100, P = 0.752; FSOD HPF: McNemar’s χ2 = 0.063, P = 0.803;
gories but owned by a non-tobacco food company were included as
FS HPF: McNemar’s χ2 = 0.0001, P = 0.999; and CSOD HPF:
comparator foods in the primary longitudinal analyses. To examine the
McNemar’s χ2 = 0.450, P = 0.502). Findings from this analysis suggest
impact of tobacco ownership on HPF availability within the broader US
that during the time that tobacco companies purchased and devel-
food environment, a second set of modified Poisson regression models
oped food companies, they did not selectively acquire food products
with robust standard errors for RR estimation included all food items
that were hyper-palatable.
that were not tobacco-owned from any food category (3371 items),
together with the tobacco-owned items, and included HPF, FSOD HPF,
FS or CSOD HPF as the outcome in four separate models.
Finally, to understand the current status of the food system in the
Food item formulation by year and tobacco company
ownership: 1988–2001
context of prior tobacco ownership, we calculated the proportion of
HPF overall and each group (FSOD, FS and CSOD) among foods that
Findings from the repeated-measures Poisson models are reported in
were ever tobacco-owned, relative to food items that were not
Table 1. Results indicated that tobacco company ownership was
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4
TABLE 1
Food item hyper-palatability by year and tobacco company ownership.
Year
β (SE)
P-value
Risk Ratio (95% CI)
HPF overall
1988
(ref )
–
–
2001
−0.005 (0.015)
0.746
0.995 (0.966, 1.025)
Tobacco-owned
0.010 (0.050)
0.849
1.010 (0.916, 1.113)
1988
(ref)
–
–
2001
−0.006 (0.024)
0.793
0.994 (0.949, 1.041)
Tobacco-owned
0.257 (0.099)
0.009
1.293 (1.065, 1.569)
1988
(ref)
–
–
2001
−0.066 (0.040)
0.097
0.936 (0.865, 1.012)
Tobacco-owned
−0.796 (0.220)
< 0.001
0.451 (0.293, 0.694)
Fat and sodium HPF
Fat and sugar HPF
Carbohydrate and sodium HPF
1988
(ref)
–
–
2001
0.075 (0.063)
0.232
1.078 (0.953, 1.218)
Tobacco-owned
0.593 (0.213)
0.005
1.810 (1.193, 2.745)
Note: Model specified random intercept for food item and fixed-effect for database year.
Abbreviations: CI = confidence interval; HPF = hyper-palatable foods; SE = standard error.
significantly associated with the likelihood that food items were
contrast to primary model findings, tobacco ownership was not sig-
FSOD HPF and CSOD HPF, showing that tobacco ownership was
nificantly associated with fat and sugar HPF items (RR = 0.867,
consistently associated with food item hyper-palatability for FSOD
P = 0.550; Table 2).
and CSOD over time (P-values = 0.005–0.009; Table 1). Tobaccoowned foods were 29% more likely to be classified as fat and sodium
HPF (RR = 1.293) and 80% more likely to be classified as carbohy-
Differences in food item hyper-palatability in 2018
drate and sodium HPF (RR = 1.809) between 1988 and 2001, relative
to the same types of foods that were not tobacco-owned (Table 1).
Differences in the hyper-palatability of foods that were ever tobacco-
Figure 2 displays the predicted probabilities that food items were
owned (n= 5031) in 2018 relative to food items that were not previ-
FSOD HPF and CSOD HPF for tobacco-owned items and non-
ously tobacco-owned (n= 112105) were examined. As of 2018, the
tobacco-owned items. There was no significant association between
proportions of HPF among foods that were and were not previously
tobacco company ownership and the likelihood that food items were
tobacco-owned were consistently very high (75.2 versus 76.9%),
HPF overall (Table 1). In addition, tobacco company ownership was
regardless of ownership status (PR = 0.977; P = 0.165; Table 3). There
associated with a lower likelihood that food items were fat and sugar
were, however, statistically significant differences in the proportion of
HPF (RR = 0.451, P = 0.0003; Table 1), suggesting that tobacco
foods that were classified as FSOD HPF, FS HPF or CSOD HPF based
companies consistently avoided fat and sugar HPF in their products.
on prior tobacco ownership (Table 3). The prevalence of FSOD HPF
No significant interaction effects between tobacco ownership and
was high overall (60.6 versus 57.9%), and there was a small but
year were observed for HPF overall (FSOD HPF, FS HPF or CSOD
statistically significant 4% greater prevalence of FSOD HPF among
HPF; P-values = 0.088–0.825), suggesting that the likelihood that
previously tobacco-owned items (PR = 1.046, P = 0.014; Table 3).
food items became HPF across years did not vary according to
tobacco ownership (see Supporting information, Table S2 for full
model results).
DI SCU SSION
Similar to the primary findings, models that included all food
system data indicated that tobacco company ownership was signifi-
Products sold to US consumers, such as tobacco and hyper-palatable
cantly associated with an increased likelihood that foods were
foods, may be designed to maximize public consumption at great risk
FSOD HPF (RR = 1.485, P = 0.0001) and CSOD HPF (RR = 1.725,
to public health [3]. In this regard, commonalities between the prac-
P = 0.005) over time (Table 2). Furthermore, tobacco company own-
tices of US tobacco and food companies have been highlighted for
ership was significantly associated with a higher likelihood that food
the past 20 years [3, 38, 39]. This paper underscores the fact that
items were HPF overall (RR = 1.320, P = 0.0001; Table 2). In
these commonalities are the direct result of shared ownership: US
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5
TOBACCO COMPANIES AND HPF
FAZZINO ET AL.
FIGURE 2
ownership.
Predicted likelihood of food item classification as fat and sodium HPF and carbohydrate and sodium HPF by tobacco company
tobacco giants Phillip Morris and RJ Reynolds owned leading US food
between 1988 and 2001, a time during which tobacco-owned food
companies between the 1980s and early 2000s and dominated the
companies led the US food industry [15–18, 37]. The three types of
US food system in sales per year [15–18, 37]. Our prior work docu-
HPF have distinct formulations (fat and sodium HPF; fat and sugar
ments the dramatic rise in HPF prevalence in the US food system dur-
HPF; carbohydrates and sodium HPF), and our evidence suggests that
ing the past 30 years [26]. Our current study findings indicate that
tobacco companies may have selectively targeted the promotion and
one reason for this rise may be that tobacco companies were more
dissemination of two types of HPF, specifically fat and sodium HPF
likely to disseminate foods that were hyper-palatable into the food
and carbohydrate and sodium HPF. The tobacco companies’ food
system between 1988 and 2001, relative to food companies that
product portfolios were heavily represented by meal-based items such
were not tobacco-owned. Foods that were tobacco-owned were 29%
as meats, cheeses and frozen dinners, which typically meet criteria as
more likely to be fat and sodium HPF and 80% more likely to be car-
fat and sodium HPF [20, 26]. Thus, the development of fat and
bohydrate and sodium HPF during 1988 and 2001 relative to foods
sodium HPF align with their food company portfolios. Additionally,
that were not tobacco-owned. Finally, analyses of the most recent
tobacco companies owned leading cookie and cracker brands
data (2018) revealed that the prevalence of HPF overall, and fat and
(e.g. Nabisco) [20], which produced foods that may be carbohydrate
sodium HPF specifically, was extremely high among branded foods
and sodium HPF, which is also consistent with our findings. However,
that were previously tobacco-owned, as well as those that were not,
using the same rationale, cookie products often align with fat and
suggesting widespread saturation of HPF in the US food system.
sugar HPF, and thus it is curious that tobacco companies did not
Our findings indicate that tobacco companies were consistently
selectively disseminate these products into the food system. In fact,
involved in the dissemination of HPF into the US food system
our evidence indicated that tobacco-owned food companies were less
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6
TABLE 2
Food item hyper-palatability by year and tobacco company ownership-full food system.
β (SE)
Year
P-value
Risk Ratio (95% CI)
HPF overall
1988
(ref)
–
–
2001
0.021 (0.011)
0.049
1.021(1.000, 1.043)
Tobacco-owned
0.278 (0.048)
<0.001
1.321 (1.203, 1.450)
Fat and sodium HPF
1988
(ref)
–
–
2001
0.003 (0.015)
0.830
1.003 (0.974, 1.034)
Tobacco-owned
0.396 (0.091)
<0.001
1.486 (1.244, 1.775)
Fat and sugar HPF
1988
(ref)
–
–
2001
0.018 (0.026)
0.489
1.018 (0.967, 1.072)
Tobacco-owned
−0.142 (0.238)
0.550
0.868 (0.545, 1.382)
Carbohydrate and sodium HPF
1988
(ref)
—
2001
0.054 (0.029)
0.063
1.056 (0.997, 1.118)
Tobacco-owned
0.546 (0.194)
0.005
1.725 (1.180, 2.522)
Note: Model specified random intercept for food item and fixed-effect for database year.
Abbreviations: CI = confidence interval; HPF = hyper-palatable foods; SE = standard error.
TABLE 3
Differences in food item hyper-palatability in 2018 based on history of tobacco company o ownership.
Percentage tobacco-owned
(n/N)
Percentage not tobacco-owned
(n/N)
HPF
75.2%
(3784/5031)
FSOD HPF
Prevalence Ratio (95% CI)
P-value
76.9%
(86284/112105)
0.977 (0.946, 1.009)
0.165
60.6%
(3047/5031)
57.9%
(64879/112105)
1.046 (1.009, 1.085)
0.014
FS HPF
35.8%
(1801/5031)
25.6%
(28375/112105)
1.414 (1.348, 1.483)
< 0.001
CSOD HPF
17.2%
(865/5031)
22.4%
(25156/112105)
0.766 (0.715, 0.819)
< 0.001
Abbreviations: CI = confidence interval; CSOD = carbohydrate and sodium HPF; HPF = hyper-palatable foods; FS = fat and sugar HPF; FSOD = fat and
sodium HPF.
likely to promote fat and sugar HPF relative to food companies that
HPF availability in our current food environment. Foods that were
were not tobacco-owned. Considered within the context of the
ever tobacco-owned showed slightly higher relative prevalence (4%)
broader food system, in the 1990s to the early 2000s there was a
of fat and sodium HPF classification in 2018 relative to foods that
growing concern regarding sugar contributing to obesity risk [40], and
were never tobacco-owned, suggesting that history of tobacco com-
US dietary recommendations included reducing/moderating sugar
pany ownership may still distinguish foods that are fat and sodium
consumption, particularly from sweets and snacks [41]. To induce
HPF. However, the prevalence of fat and sodium HPF was high overall
hyper-palatability, food companies have limited nutrients to modify
(> 57%) and the percentage difference was small (2.7%). Thus, it may
(fat, sugar/carbohydrates and sodium) [42]; thus, tobacco companies
be that companies that were not tobacco-owned observed the suc-
may have avoided promoting HPF with elevated fat and sugar, and
cess and market competitiveness of tobacco-owned food companies,
instead focused on foods that could be enhanced with sodium,
and began producing HPF to remain competitive in the market. Similar
thereby remaining under the detection of most nutritional advice and
instances in which tobacco companies observed competitor successes
public scrutiny.
with cigarettes, and subsequently changed product formulations to
Our analyses indicate that the proliferation of HPF in prior
remain market-competitive, occurred during the tobacco epidemic [4].
decades during tobacco company-ownership may have influenced
The same process may explain the small differences observed in the
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7
TOBACCO COMPANIES AND HPF
FAZZINO ET AL.
proportion of carbohydrate and sodium HPF that were and were not
previously tobacco-owned in 2018. Overall, findings of the current
C O N C LU S I O N S A N D P U B L I C H E A LT H
IMPLICATIONS
study suggest that tobacco company involvement in the US food system may have had long-standing consequences for the availability of
This study found that US tobacco companies appear to have selec-
HPF, which currently saturate the US food environment [26].
tively disseminated fat and sodium HPF and carbohydrate and sodium
Our study found strong evidence indicating that tobacco compa-
HPF products into the US food system between 1988 and 2001, and
nies were consistently involved with HPF products over time; how-
that these products have become highly prevalent in the US food
ever, we did not find direct evidence of product reformulation, and
environment today. Despite growing scientific evidence regarding the
further work is needed to understand and characterize tobacco com-
addictive properties of HPF [19], there are no federal regulations
pany involvement in this area. In this regard, our matched-pairs analy-
addressing HPF accessibility. The state of the food environment for
sis determined no observed difference in the proportion of HPF by
US consumers bears a striking resemblance to the US environment in
tobacco ownership in 1988, suggesting that tobacco companies did
the 1950s during the tobacco epidemic, before the US federal gov-
not acquire products that were already HPF in 1988. However, our
ernment regulated the availability of tobacco products [4]. Similar
longitudinal analyses did not yield significant interaction effects
efforts are needed to regulate the availability of HPF, in light of our
between tobacco ownership and year, which may have indicated
evidence indicating that the same tobacco companies may have been
product reformulation. The discrepancy may be due to differences in
influential in shifting the profile of US foods towards greater hyper-
food items that (1) directly matched based on tobacco ownership sta-
palatability.
tus in 1988; and (2) matched longitudinally in 1988 and 2001. Further
work involving historical analysis of tobacco documents in the UCSF
AUTHOR CONTRIBU TIONS
Industry Documents Library may identify ways in which tobacco com-
Tera L. Fazzino: Conceptualization (lead); formal analysis (lead); inves-
panies considered product formulation and the degree of company
tigation (lead); methodology (equal); supervision (lead); writing—origi-
intent in potential reformulations. Given that the Industry Documents
nal draft (lead). Daiil Jun: Data curation (equal); investigation (equal);
Library contains millions of documents with varied content, format
methodology (equal); validation (supporting); visualization (support-
and text form (e.g. meeting notes, e-mail exchanges, hand-written
ing); writing—review and editing (equal). Lynn Chollet-Hinton: Formal
notes in the margins of report documents), machine-learning models
analysis (supporting); investigation (supporting); methodology (equal);
with natural language processing methods may facilitate document
supervision (supporting); validation (supporting); visualization (sup-
review and novel discovery of tobacco industry activities that may
porting); writing—review and editing (equal). Kayla Bjorlie: Validation
have directly impacted the US food environment. Addressing tobacco
(equal); visualization (equal); writing—review and editing (equal).
industry involvement in the food system also relates to broader commercial determinants of health, providing an example of ways in which
AC KNOW LEDG EME NT S
one industry may have substantial involvement in seemingly unrelated
None.
public health risk. In this regard, researchers have recently called for
expanding considerations of commercial determinants of health
DECLARATION OF INTERESTS
beyond the examination of single industries or single products [43],
None.
and the work reported in this study presents an example of ways to
engage with the complexity of cross-industry activities. Future work
DATA AVAILABILITY STAT EMEN T
in this and other areas should embrace the interconnections among
Data are available upon request from the lead author.
industries to more clearly understand the collective drivers of public
health harms.
The study had several limitations. First, the primary analyses were
conducted on a longitudinal data set that was constructed among sev-
ET HICS S TAT E MENT
No data from human subjects were used in the study; all data are publicly available from the USDA/CDC.
eral USDA data sets that were not explicitly designed for integration.
As a result, our study includes a subset of items that were tobacco-
ORCID
owned and suitable for matching. However, the foods were highly
Tera L. Fazzino
https://orcid.org/0000-0002-2896-9791
representative of the overall product lines and highest volume sales
from PM and RJR from 1988 to 2001 [17, 37], thus yielding confidence in the representativeness of the data. In addition, our study
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databases. Our cross-sectional analyses provide a current picture of
the US food system and association with previous tobacco ownership,
although causality cannot be inferred from our cross-sectional nor
broader longitudinal analyses.
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SUPPORTING INF ORMATION
Additional supporting information can be found online in the Supporting Information section at the end of this article.
How to cite this article: Fazzino TL, Jun D, Chollet-Hinton L,
Bjorlie K. US tobacco companies selectively disseminated
hyper-palatable foods into the US food system: Empirical
evidence and current implications. Addiction. 2023. https://
doi.org/10.1111/add.16332
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10