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Controlling the Tobacco Epidemic:
Selected Evidence in Support of Banning All Tobacco
Advertising and Promotion, and Requiring Large, PictureBased Health Warnings on Tobacco Packages
Canadian Cancer Society
International Union Against Cancer
April 2001
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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: kkyle@ottawa.cancer.ca
www.cancer.ca
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.
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Table of Contents
Page
Foreword
5
Part I – Advertising and Promotion
7
Introduction
8
Reports
8
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
Introduction
165
166
-4 Expert Opinions
Part IV – Expert Opinions – Plain Packaging
166
202
Introduction
203
Expert Opinions
203
Bibliographical List
210
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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.
-6 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
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Part I
Advertising and Promotion
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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)
-10 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).
...
Anti-tobacco measures at the national level
...
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).
-11 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 AntiSmoking Strategy: A Report on Health and Smoking” November 1999.
http://www.irlgov.ie/committees-99/c-health/reports.htm 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-bystep 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)
...
Advertisements present images that appeal to youth and are seen and remembered by them.(p.9)
...
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)
...
Evidence for the effects of marketing on youth smoking behaviour can be found across numerous
research studies representing a wide range of methods, including survey research, longitudinal
studies, historical and econometric analyses.(p.25)
...
Although no one study or method in this body of research provides definitive conclusions, the
cumulative evidence across these varied methods and research questions support strongly the
conclusion that marketing plays a significant role in youth smoking behaviour, both in terms of
initial experimentation and brand preference. (p.26)
...
It is the conclusion of the National Cancer Institute of Canada’s project team that tobacco
marketing in Canada does influence tobacco initiation in youth under the age of sixteen, and
older. The weight of evidence supports three general conclusions:
- a total ban on tobacco marketing would significantly reduce messages targeted at youth which
promote initiation of tobacco youth.
- a total ban on tobacco marketing would significantly contribute to a reduction in the prevalence
of tobacco use among youth.
- a total ban is the only reasonable policy from a population health perspective, given the
complex, contextual nature of marketing influence, and the likelihood that partial bans will
simply result in a shift of emphasis to alternative methods of marketing.(p.34)
National Cancer Institute of Canada, Centre for Behavioural Research and Program
Evaluation, “Tobacco Marketing and Youth: Examination of Youth Attitudes and
Behaviour to Tobacco Industry Advertising and Sponsorship” March 31, 1996. Prepared
for Health Canada.
12.
The need for congressional action regarding FDA's efforts to restrict tobacco advertising,
promotion, and marketing is particularly urgent. ... Advertising and promotion constraints may
not have dramatic short-term effects, but they are integral parts of all successful tobacco control
efforts in states and foreign countries and must be part of any long-term U.S. national tobacco
control program. (p.8)
National Cancer Policy Board [U.S.], Taking Action to Reduce Tobacco Use
(Washington, D.C.: National Academy Press, 1998).
13.
The Task Force calls for the provincial government to ban the use of tobacco product names,
trademarks, colours and logos in all tobacco sponsorship advertising. (p.1)
Ontario Task Force on the Primary Prevention of Cancer, “Recommendations for the
Primary Prevention of Cancer; Report of the Ontario Task Force on the Primary
Prevention of Cancer” March 1995. [Report to Ontario Minister of Health]
14.
Smoking in young people is reinforced and maintained by a number of factors in the immediate
and wider social environment, particularly the availability of cigarettes to young people and
tobacco advertising. A ban on tobacco advertising would have a significant impact on the uptake
of tobacco by young people in the UK. (p.74)
Royal College of Physicians of London, Smoking and the Young: A report of a working
party of the Royal College of Physicians (London: Lavenham Press Ltd., 1992).
15.
Implement the federal Tobacco Control Blueprint.
In December 1995, Health Canada produced a comprehensive plan - the Tobacco Control
Blueprint. It includes many significant proposals: a ban on advertising; restrictions on tobacco
sponsorship and promotion; packaging and labelling requirements; limits on access for young
people; product regulation; and others. So far, these are just words. It’s time to make them
actions! (p.14)
Schabas, R. “Tobacco. Sounding the Alarm. Report of the Chief Medical Officer of
Health” Ontario Ministry of Health, 1996.
16.
Conclusions
3.9 Price, advertising and promotion influence cigarette consumption.
...
Recommendations
3.12 All forms of tobacco advertising, promotion and identifiable sponsorship should be banned.
(p.31)
Scientific Committee on Tobacco and Health [U.K.] Report of the Scientific Committee
on Tobacco and Health. (London: H.M.S.O., February 1998).
17.
It is recommended that the Ontario Government initiate discussions to encourage the federal
government to take action prohibiting promotion of tobacco.
It is further recommended that, within areas over which it has jurisdiction, the Ontario
government should prohibit all forms of tobacco promotion ...
There is a significant likelihood that advertising and other tobacco promotion serve to increase
the overall consumption of tobacco in Ontario. (pp.13-14)
Task Force on Smoking [Ontario], “Smoking and Health in Ontario: A Need for Balance.
Report of the Task Force on Smoking Submitted to the Ontario Council of Health” May,
- 15 1982 [The Ontario Council of Health is the senior advisory body to the Minister of
Health].
18.
Smokers have not been properly informed by the industry of the nature of the risk they are taking and
the marketing practices of the industry put children at risk. (p.23)
...
A complete ban on all forms of advertising of tobacco products is necessary if we are to reduce
children's exposure to inducements to tobacco products. (p.48)
Tobacco Free Policy Review Group [Ireland], “Towards a Tobacco Free Society: Report
of the Tobacco Free Policy Review Group” [Report to the Minister] 2000.
19.
Ending tobacco advertising
Why action is needed
6.3 Previous Governments have operated voluntary agreements with the tobacco industry on
advertising. But there is little evidence that they have worked. Surveys show that 96 per cent of
children say they have seen cigarette advertising in the last six months. ... (p.47)
6.4 The cigarette brands smoked most by children are also those most heavily advertised. Survey
evidence shows that half of all young people believe they have seen a cigarette advert on TV in the
last six months despite the fact that it was banned 33 years ago. That suggests that tobacco
sponsorship of televised events has a similar impact to direct advertising. (pp.47-48)
United Kingdom Department of Health, “Smoking Kills: A White Paper on Tobacco”
December, 1998.
20.
[W]e must conclude that, in the face of the evidence that has now been accumulated, the
Government can no longer maintain its position that a further tightening of tobacco advertising
controls is unlikely to contribute to a reduction of the prevalence of smoking in the UK.(p.xvii)
...
We recommend that the Government support the Directive [of the European Union].(p.xviii)
United Kingdom, House of Commons Health Committee, “Second Report: The European
Commission’s Proposed Directive on the Advertising of Tobacco Products” (London:
H.M.S.O., 1992).
21.
Summary of Conclusions and Recommendations
...
(p) The evidence we have reviewed from the advertising agencies leads us to conclude that,
once more, voluntary agreements have served the industry well and the public badly.
Regulations have been seen as hurdles to be overcome or side-stepped; legislation
banning advertising as a challenge, a policy to be systemically undermined by whatever
means possible. ... (paragraph 88).
(q) Most of the tobacco companies have sought to challenge the Government's commitment
to introduce an advertising ban in advance of the date for implementation set by the EU
directive. The argument they have repeatedly advanced is that tobacco advertising does
not increase consumption, it merely persuades smokers to switch brands. However,
looking through the documents that the agencies themselves produced, this view is
completely discredited (paragraph 89).
- 16 (r) Our review of the copious evidence from the advertising agencies, which includes
substantial quantities of market research, leads us to conclude that the advertising
agencies have connived in promoting tobacco consumption, have shamelessly exploited
smoking as an aspirational pursuit in ways which inevitably make it attractive to
children, and have attempted to use their creative talents to undermine Government
policy and evade regulation. We welcome the Government's commitment to end all
forms of tobacco advertising and sponsorship (paragraph 99).
United Kingdom, House of Commons Health Select Committee, “Second report:
The tobacco industry and the health risks of smoking” Volumes I-II, London:
Stationery Office, 2000, June 14, 2000.
22.
There is no scientifically rigorous study available to the public that provides a definitive answer
to the basic question of whether advertising and promotion increase the level of tobacco
consumption. Given the complexity of the issue, none is likely to be forthcoming in the
foreseeable future. The most comprehensive review of both the direct and indirect mechanisms
concluded that the collective empirical, experiential and logical evidence makes it more likely
than not that advertising and promotional activities do stimulate cigarette consumption. (pp.512513).
U.S. Department of Health and Human Services, Reducing the Health Consequences of
Smoking: 25 Years of Progress. A Report of the Surgeon General, U.S. Department of
Health and Human Services, Public Health Service, Centers for Disease Control, Center
for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health,
DHHS Publication No. (CDC) 89-8411, 1989.
23.
Advertising tends to increase consumption of cigarettes, although the relationship is difficult to
quantify precisely. Advertising restrictions are generally associated with declines in consumption
and, hence, are an important component of tobacco-control programs. (p.136)
U.S. Department of Health and Human Services, Smoking and Health in the Americas.
Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service,
Centers for Disease Control, National Center for Chronic Disease Prevention and Health
Promotion, Office on Smoking and Health, DHHS Publication No. (CDC) 92-8419,
1992.
24.
Even though the tobacco industry asserts that the sole purpose of advertising and promotional
activities is to maintain and potentially increase market shares of adult consumers, it appears that
some young people are recruited to smoking by brand advertising.(p.194)
...
Conclusions
1. Young people continue to be a strategically important market for the tobacco industry.
2. Young people are currently exposed to cigarette messages through print media (including
outdoor billboards) and through promotional activities, such as sponsorship of sporting events
and public entertainment, point-of-sale displays, and distribution of specialty items.
3. Cigarette advertising uses images rather than information to portray the attractiveness and
function of smoking. Human models and cartoon characters in cigarette advertising convey
independence, healthfulness, adventure-seeking, and youthful activities -- themes correlated with
psychosocial factors that appeal to young people.
- 17 4. Cigarette advertisements capitalize on the disparity between an ideal and actual self-image and
imply that smoking may close the gap.
5. Cigarette advertising appears to affect young people’s perceptions of the pervasiveness, image,
and function of smoking. Since misperceptions in these areas constitute psychosocial risk factors
for the initiation of smoking, cigarette advertising appears to increase young people’s risk of
smoking. (p.195)
U.S. Department of Health and Human Services, Preventing Tobacco Use Among Young
People: A Report of the Surgeon General, Atlanta: Georgia: U.S. Department of Health
and Human Services, Public Health Service, Centers for Disease Control and Prevention,
National Center for Chronic Disease Prevention and Health Promotion, Office on
Smoking and Health, 1994.
25.
Advertising is an important influence on tobacco use initiation and maintenance, as documented in
Preventing Tobacco Use Among Young People. Cigarette advertising and promotion may stimulate
cigarette consumption by (1) encouraging children and adolescents to experiment with and initiate
regular use of cigarettes, (2) deterring current smokers from quitting, (3) prompting former smokers
to begin smoking again, and (4) increasing smokers' daily cigarette consumption by serving as an
external cue to smoke. In addition, cigarette advertising appears to influence the perceptions of
youths and adults about the pervasiveness of cigarette smoking and the images they hold of smokers.
Cigarette advertising also may contribute to the perception that smoking is a socially acceptable, safe
behavior and may produce new perceptions about the functions of cigarette smoking in social
situations. All of these perceptions have been shown to be risk factors for the initiation of cigarette
smoking.
...Available data indicate that young people smoke the brands that are most heavily
advertised. In 1993, the three most heavily advertised brands of cigarettes, Marlboro, Camel, and
Newport, were the three most commonly purchased brands among adolescent smokers. ... Although
combined sales of these brands represented only 35 percent of the adult market share, they
represented only 86 percent of the adolescent market share. These data suggest tobacco advertising
influences brand preference among youths ... (p.220)
U.S. Department of Health and Human Services, Tobacco Use Among U.S. Racial/Ethnic
Minority Groups – African Americans, American Indians and Alaska Natives, Asian
Americans and Pacific Islanders, Hispanics: A Report of the Surgeon General, Atlanta:
Georgia: U.S. Department of Health and Human Services, Centers for Disease Control
and Prevention, National Center for Chronic Disease Prevention and Health Promotion,
Office on Smoking and Health, 1998.
26.
The tobacco industry has argued that its main purpose in advertising is to maintain brand loyalty and
to capture a greater market share of current smokers. Intensive review of the available data,
however, suggests a positive correlation between level of advertising and overall tobacco
consumption -- that is, as advertising funds increase, the amount of tobacco products purchased by
consumers also increases. Furthermore, several judicial opinions ... have questioned whether the
enormous investment in advertising serves only brand loyalty. (p.162)
U.S. Department of Health and Human Services, Reducing Tobacco Use: A Report of the
Surgeon General, Atlanta, Georgia: U.S. Department of Health and Human Services,
Centers for Disease Control and Prevention, National Center for Chronic Disease
Prevention and Health Promotion, Office on Smoking and Health, 2000.
- 18 27.
Advertising is also used to reduce fear of the health risks from smoking by presenting facts and
figures (e.g., information on nicotine and tar content) or by using positive imagery (e.g. clear blue
skies and white-capped mountain peaks). (p.491)
...
Specialty items that contain brand names or logos, such as clothing and accessories, often serve as
walking ads and enhance the perception that tobacco use is the norm. For cigarettes, these items do
not carry the health warning required for other forms of advertising and promotion. (p.492)
...
[S]ponsorship is economical because it allows a company to reach a niche market without wasting
resources and provides "embedded advertising," which links product attributes or lifestyle images to
an active event. ...
Recognition of Power of Advertising
...Tobacco industry sponsorship may also lend an aura of social legitimacy to smoking (p.492)
...
The trade presses of both the advertising and tobacco industries were unequivocal in giving credit to
advertising for the growth of cigarette sales, especially among women. (p.497)
...
As in the United States, tobacco advertising in other countries portrays a variety of attractive images
and themes that have been used to promote the social acceptability of smoking among women and to
highlight attributes of particular brands. Smoking has been promoted as being glamorous,
sophisticated, fun, romantic, sexually attractive, healthy, sporty, sociable, relaxing, calming,
emancipating, feminine, and rebellious and as an aid to weight loss. (p.521)
...
Conclusions
...
4.
Women have been extensively targeted in tobacco marketing, and tobacco companies have
produced brands specifically for women, both in the United States and overseas. Myriad
examples of tobacco ads and promotions targeted to women indicate that such marketing is
dominated by themes of both social desirability and independence, which are conveyed
through ads featuring slim, attractive, athletic models. ...
5.
Tobacco industry marketing, including product design, advertising, and promotional
activities, is a factor influencing susceptibility to and initiation of smoking.
6.
The dependence of the media on revenues from tobacco advertising oriented to women,
coupled with tobacco company sponsorship of women's fashions and of artistic, athletic,
political, and other events, has tended to stifle media coverage of the health consequences of
smoking among women and to mute criticism of the tobacco industry by women public
figures. (chapter 4, p.527)
U.S. Department of Health and Human Services, Women and Smoking: A Report
of the Surgeon Genera, Atlanta, Georgia: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Center for
Chronic Disease Prevention and Health Promotion, Office on Smoking and
Health, 2001, prepublication version, accessed March 27, 2001,
http://www.cdc.gov/tobacco/sgr_forwomen.htm.
28.
[T]he purpose of the Joe Camel campaign was to reposition the Camel brand to make it attractive
to younger smokers. At least one of the targets of the campaign was “first usual brand” smokers.
...
- 19 The Joe Camel campaign induced many of these children and adolescents under the age of 18 to
smoke Camel cigarettes or increased the risk that they would do so. For many of these children
and adolescents, the decision to smoke Camel cigarettes was a decision to begin smoking; for
others, the decision to smoke Camel cigarettes was a decision to continue smoking. As a result,
the Joe Camel campaign caused or was likely to have caused these children and adolescents to
initiate or continue smoking cigarettes. (p.2)
...
R.J. Reynolds actions . . . have caused or were likely to cause substantial and ongoing injury to
the health and safety of children and adolescents under the age of 18 that is not offset by any
countervailing benefits and is not reasonably avoidable by these consumers. (p.3)
U.S. Federal Trade Commission, “In the Matter of R.J. Reynolds Tobacco Company, a
corporation: Complaint.” Docket No. 9285, May 28, 1997.
29.
We believe that limiting the advertising, marketing and promotion of tobacco products directed to
children can be an appropriate and necessary part of a comprehensive approach to reducing youth
tobacco use. Such limitations can serve as an important complement to other strategies, such as
access restrictions and public education, to reduce underage tobacco use.
The FTC further believes that any effort to restrict tobacco advertising to young people must be
sufficiently broad to be effective. The FTC each year issues a report on the advertising and
promotional expenditures of U.S. cigarette manufacturers. Those reports show that after cigarette
manufacturers were prohibited from advertising on television and radio in 1969 (a prohibition
that was intended, in part, to protect children), they put tens of millions of dollars into print
advertising to sell their products. In more recent years, the cigarette manufacturers have shifted
an increasing amount of money away from traditional advertising and into sponsorships and socalled “trinkets and trash” -- T-shirts, caps, and other logo-adorned merchandise -- that some
believe are very attractive to young people. To prevent simply another such shift in marketing
strategy, a set of advertising and marketing restrictions that addresses the many different ways in
which tobacco may be marketed and advertised to minors is necessary. (pp.3-4 of internet print
out)
U.S. Federal Trade Commission, “Prepared Statement of the Federal Trade Commission
on Advertising, Marketing and Antitrust Issues in the Global Tobacco Settlement
Presented By Robert Pitofsky, Chairman, Before the Committee on Commerce, Science
and Transportation, United States Senate” March 3, 1998, accessed November 25, 1998,
www.ftc.gov/os/1998/9803/tobacc98.tes.htm
30.
... [T]he apparent focus on the possible causal role of cigarette and smokeless tobacco advertising
in young people’s initial decision to smoke or to use smokeless tobacco is overly narrow.
Human behavior cannot be modeled so simplistically. In point of fact, tobacco advertising has an
effect on young people’s tobacco use behaviour if it affects initiation, maintenance, or attempts at
quitting.
The evidence that FDA has gathered in this proceeding establishes that cigarette and
smokeless tobacco advertising does have such an effect. While not all the evidence in the record
supports this conclusion, there is more than adequate evidence, that when considered together,
supports a conclusion that advertising, with knowledge of the industry, does affect the smoking
behavior and tobacco use of people under the age of 18. This behavior includes the decision
whether to start using cigarette or smokeless tobacco, whether to continue or to increase ones
- 20 consumption, when and where it is proper to use tobacco, and whether to quit. This evidence
includes:
Expert opinion - The American Psychological Association provided expert opinion, with
specific citation to numerous studies to show that tobacco advertising plays directly to the factors
that are central to children and adolescents and thus plays an important role in their decision to
use tobacco. ...
Advertising theory - Basic advertising and consumer psychology theory, statements from
advertising experts, and general consumer testing show that advertising that is multi-media, that
uses color, and that employs more pictures, characters, or cartoons as opposed to text is more
robust and can be better processed, understood and remembered by children and adolescents, who
have less information processing ability than adults. ...
Studies and Surveys - Studies show that children are exposed to substantial and
unavoidable advertising, that exposure to tobacco advertising leads to favourable beliefs about
tobacco use, that advertising plays a role in leading young people to overestimate the prevalence
of tobacco use, and that these factors are related to young people’s tobacco initiation and use. ...
Empirical Studies - Studies conducted on sales data have shown that advertising did
increase one segment of the tobacco market (low tar cigarettes), that advertising in New Zealand
had the effect of increasing tobacco sales to young people, and that a large multi-country survey
showed that advertising tends to increase consumption of tobacco products. ...
Anecdotal Evidence and Various Advertising Campaigns Successful With Young People Studies show that the buying behavior of young people is influenced by advertising, that they
smoke the most advertised brands, that children ages 3 to 6 can recognize a cartoon character
associated with smoking at the same rate as the recognize Ronald McDonald, that various ad
campaigns (Camel cigarettes, Reg cigarettes, products designed for women and smokeless
tobacco advertising aimed at new users) that appeared to be targeted to young people did have an
effect upon young people’s purchases and use of tobacco, and that young people report that they
got their information about a tobacco brand from billboards, magazines, in store advertising and
on teeshirts. ...
Industry Statements - Statements in documents created by R.J. Reynolds’ researchers, by
Philip Morris advertising people, by executives of US Tobacco and by people in and doing work
for various Canadian tobacco companies indicate that young people are an important and often
crucial segment of the tobacco market.
Consensus Reports - The IOM and 1994 Surgeon General Report concluded on the basis
of an exhaustive review of the evidence that advertising affects young people’s perceptions of the
pervasiveness, image, and function of smoking, that misperceptions in these areas constitute
psychosocial risk factors for the initiation of tobacco use and thus advertising appears to influence
young people’s risk of tobacco use. ...
Thus the evidence in this proceeding demonstrates that cigarette and smokeless tobacco
advertising plays a material role in the decision of children and adolescents under the age of 18 to
engage in tobacco use behavior. It therefore establishes that the harm from this advertising is
real.(pp.44488-44489)
...
Some items, when used or worn by young people, also create a new advertising medium -- the
“walking billboard” -- which can come into schools or other locations where advertising is
usually prohibited. (p.44521)
...
[T]he agency recognizes that the tobacco industry has exploited loopholes in partial bans of
advertising to move its imagery to different media. When advertising has been banned or
severely restricted, the attractive imagery can be and has been replicated on nontobacco items that
- 21 go anywhere, are seen everywhere, and are permanent, durable, and unavoidable. By transferring
the imagery to nontobacco items, the companies have “thwarted” the attempts to reduce the
appeal of tobacco products to children.(p.44524)
...
Because they penetrate the young persons’ world, they are very effective in creating the sense that
tobacco use is widely accepted, which ... is extremely important to children and adolescents.
(p.44525)
...
FDA finds that all nontobacco items that bear cigarette or smokeless tobacco brand logos are
capable of playing a significant role in a young person’s decision to engage in tobacco use.
(p.44526)
...
FDA has concluded that nontobacco items (identified with a tobacco brand), either sold, given
away, or provided for proof of purchase are an instrumental form of advertising in affecting
young people’s attitudes towards and use of tobacco. Moreover, banning this form of advertising
is essential to reduce tobacco consumption by young people. (p. 44527)
...
The effect of sponsored events on the young people who attend or see these events is
enormous. Advertising affects young people’s opinion of tobacco products, first, by creating
attractive and exciting images that can serve as a “badge” or identification, second, by utilizing
multiple and prolonged exposure in a variety of media, thereby creating an impression of
prevalence and normalcy about tobacco use, and finally by associating the product with varied
positive events and images. The sponsorship of events by tobacco companies uniquely achieves
all three objectives. Sponsorship creates an association between the exciting, glamorous or fun
event with the sponsoring entity. Whether at the live gate, or on television, young people will
repeatedly see and begin to associate the event, which they are enjoying, with the imagery and
appeal of the product. All of the attendant concerns of hero worship of the sports figures and
glamorization of the product by identification with the event are present, whether there are
thousands or hundreds of thousands of young people in attendance. Race car drivers are
extremely popular with young people and often are looked up to as heros. According to one
promoter of NASCAR properties, “We’ve found that boys look to NASCAR drivers the same
way they do heros, such as firemen, policemen, professional fighters, or astronauts.”
Furthermore, sponsorship events present a prolonged period of time in which to expose
the audience, including young people, to the imagery. Sponsorship events do not provide people
with a momentary glimpse at the imagery, but from 1 to 2 or 3 hours of constant attractive
imagery. The audience has more than enough time to associate the images of the sporting event
or the concert with the product. (p.44528-29)
...
The agency finds that the evidence regarding the effect of advertising and sponsorship on
children’s smoking behavior is persuasive and more than sufficient to justify this regulation. ...
The evidence demonstrates that sponsorship of sporting events by tobacco companies can lead
young people to associate brand names with certain life styles or activities and can affect their
purchasing decisions. (p.44530)
U.S. Food and Drug Administration, “21 CFR Part 801 et al., Regulations Restricting the
Sale and Distribution of Cigarettes and Smokeless Tobacco to Protect Children and
Adolescents; Final Rule”, Federal Register Vol. 61, No.168, August 28, 1996.
31.
The report has two recommendations:
- 22 1. Where governments decide to take strong action to curb the tobacco epidemic, a multi-pronged
strategy should be adopted. Its aims should be to deter children from smoking, to protect
nonsmokers, and to provide all smokers with information about the health effects of tobacco. The
strategy, tailored to individual country needs, would include: ... (2) publishing and disseminating
research results on the health effects of tobacco, adding prominent warning labels to cigarettes,
adopting comprehensive bans on advertising and promotion ... (p.10)
...
Cigarette advertising and promotion
Policymakers who are interested in controlling tobacco need to know whether cigarette advertising
and promotion affect consumption. The answer is that they almost certainly do, although the data are
not straightforward. The key conclusion is that bans on advertising and promotion prove effective,
but only if they are comprehensive, covering all media and all uses of brand names and logos. (p.49)
World Bank, Curbing the Epidemic: Governments and the Economics of Tobacco
Control (Washington, D.C.: World Bank, 1999).
32.
Successful complete or almost complete bans on tobacco advertising are characterized by:
- general prohibition (with limited exceptions mentioned below) of all use of names of tobacco
products, trademarks, and logos in all advertising, whether for tobacco products or non-tobacco
goods and services, or for sporting or cultural events, institutions, organizations or participants;
- general prohibition of the use of tobacco product trade names, trademarks, and logos, except on
tobacco products themselves;
- prohibition of the use of games, contests and prizes and the free distribution of cigarettes by
tobacco importers, manufacturers, wholesalers, and retailers or their agents;
- exemption from the general prohibitions of only specific and limited forms of advertising, e.g.
signs of specifically limited size, number, and content at points of purchase for tobacco products.
(pp.54-55)
World Health Organization, Tobacco or health: A global status report, (Geneva: World
Health Organization, 1997).
33.
All advertising and promotion of tobacco products should be prohibited; this should apply to
sponsorship of sporting events and other indirect means of promotion, as well as to the more
obvious forms of advertising. (p.69)
World Health Organization Expert Committee, “Smoking control strategies in developing
countries; Report of a WHO Expert Committee” World Health Organization Technical
Report Series 695 (Geneva: World Health Organization, 1983).
34.
The international tobacco industry’s irresponsible behaviour and its massive advertising and
promotional campaigns are, in the opinion of the Committee, direct causes of a substantial
number of unnecessary deaths. The Committee expressed particular concern at the tobacco
industry’s expansionary approach to the developing countries. (p.9)
...
Recommendations addressed to all countries
...
2. There should be a total prohibition on all forms of tobacco promotion. (p.72)
World Health Organization Expert Committee on Smoking Control, “Controlling the
Smoking Epidemic: Report of the WHO Expert Committee on Smoking Control” World
- 23 Health Organization Technical Report Series 636 (Geneva: World Health Organization,
1979).
Conference Proceedings
35.
All African countries should review their tobacco control legislation with the goal of banning all
advertising and sponsorship by the tobacco industry. (p.177)
All-Africa Conference on Tobacco or Health, “Final Conference Recommendations for
Tobacco Control in Africa” In: Yach, D., Harrison, S., eds., Proceedings of the All-Africa
Conference on Tobacco or Health, Harare, Zimbabwe, 14-17 November 1993.
36.
The participants therefore urge that:
...
 all countries and areas become free of tobacco advertising
Fifth Asia Pacific Association for the Control of Tobacco (APACT) Conference, “The
1998 Subic Bay international declaration of support for action to control tobacco” Subic
Bay, The Philippines, 23-26 November 1998, Tobacco Control, 1999;8(1):81.
37.
To make it possible for every person in Europe to enjoy the rights set out in the charter, the
Conference participants recommended ten strategies to be followed.
...
3. Outlaw the advertising and promotion of tobacco products and sponsorship by the tobacco
industry. (p.14)
First European Conference on Tobacco Policy, “It Can Be Done: A Smoke-free Europe;
Report of the First European Conference on Tobacco Policy” Madrid, Spain, 7-11
November 1988. WHO Regional Publications, European Series, No. 30.
38.
Banning sports sponsorships and other promotions and the tobacco industry’s use of healthy,
sexy, athletic models and cartoon figures in advertising should result in a decrease in tobacco use,
especially among youth.(p.iv)
...
The data demonstrating that marketing and advertising of tobacco products does play a role in
tobacco use comes from many disciplines and from many sources.(p.66)
...
The group restates its long-term commitment to eliminate exploitation by the tobacco industry
through advertising and marketing.
a. It is in America’s best interest to take into account the dynamic nature of the industry and for
any ban to be broad enough to cover traditional forms of advertising and more recent trends like
sponsorship, product placement, utilitarian items, etc. and learn from other countries where the
industry has circumvented a ban.(p.71)
Houston, T., ed., “Tobacco Use: An American Crisis. Final Conference Report and
Recommendations From America’s Health Community” Washington, D.C., 9-12
January 1993 (Chicago: American Medical Association, 1993).
- 24 39.
Policy Recommendations
...
1. End tobacco advertising, promotion, sponsorship and other tobacco marketing activities out of
concern for children. (p.12)
International Policy Conference on Children and Tobacco, “Policy Recommendations”
Washington, D.C., U.S.A., 17-19 March 1999, In: INGCAT Update 10, 1999, 2nd quarter.
40.
The workshop asks the ICCA to endorse the objectives and recommendations set out in the World
Health Organization 1979 Expert Committee report Controlling the Smoking Epidemic - which
calls for, among other things, an end to all forms of tobacco promotion. (p.3)
International Workshop on Smoking and Health; Edwards, P., Skirrow, J., eds.,
“Strategies for a Smoke-free World: Recommendations of the International Workshop on
Smoking and Health to the International Council on Alcohol and Addictions, Calgary,
Alberta, Canada, 1985” (Edmonton: Alberta Alcohol and Drug Abuse Commission,
1986).
41.
Lung cancer is the leading cause of cancer death in the world. The incidence is rising at an alarming
rate in both men and women. Ninety percent of cases are caused by active or passive smoking and
therefore could be avoided or prevented. . . . In order to achieve its goal of eliminating lung cancer,
the IASLC . . . 4. Requests all industrial sectors and media organs to eliminate tobacco advertising
and marketing.
Ninth World Conference on Lung Cancer, “IASLC 2000 Tokyo Declaration on
Tobacco”, [International Association for the Study of Lung Cancer] Tokyo, Japan, 2000.
42.
This conference resolves that:
1. All nations implement the International Strategy for Tobacco Control.(p.1017)
...
AN INTERNATIONAL STRATEGY FOR TOBACCO CONTROL
Since measures to deal with the tobacco problem must be comprehensive and long term, the
following individual actions should form the basis of such a strategy.
1. Legislation to ban all direct and indirect advertising and promotion of tobacco products.
2. Legislation to protect young people from tobacco promotion and sales.(p.1018)
Ninth World Conference on Tobacco and Health, “Resolutions of the Ninth World
Conference on Tobacco and Health”, Paris, France, 1994, In: Slama, K., ed., Tobacco
and Health: Proceedings from the 9th World Conference on Tobacco and Health. (New
York: Plenum Press, 1995).
43.
The European Union, the European region, Latin America and other countries represented at this
conference call for governments, international organizations, and NGOs to:
1) Support the highest level policies on advertising and information; for example, ban all advertising,
sponsorship and promotion as in the European Union . . .
Second European Conference on Tobacco or Health and First Iberoamerican Conference
on Tobacco or Health, “Canarias Declaration” Las Palmas de Gran Canaria, Spain, 23-27
February 1999.
- 25 -
44.
Finally, the Conference recognises that the key issues are: (p.239)
...
 legislating to ban all direct and indirect advertising and promotion of tobacco products
(p.240)
Smokefree Europe: Conference on Tobacco or Health, “Smokefree Europe Conference
Resolution on the European Tobacco Strategy” In: Waller, M., Lipponen, S., eds.,
Smokefree Europe: A Forum for Networks, Smokefree Europe: Conference on Tobacco
or Health, Helsinki, Finland, 2-4 October 1996, pp.238-240.
45.
The conference recommends:
The WHO and governments to formulate an International Framework Convention to include
protocols for comprehensive tobacco control programmes and the recommendations from
previous World Conferences, and with the capability to be made broader and more restrictive
over time. (p.117)
Tenth World Conference on Tobacco or Health, “Resolutions of the 10th World
Conference on Tobacco or Health” In: Slama, K. Tobacco Control and Prevention: A
Guide for Low Income Countries (Paris: International Union Against Tuberculosis and
Lung Disease, 1998), pp.117-120.
46.
Conference Resolutions (p.1)
...
That the Government of Canada amend the Tobacco Products Control Act to prohibit tobacco
sponsorship advertising (p.3)
Tobacco-Free Canada: First National Conference on Tobacco or Health, Ottawa, Ontario,
20-22 October 1993, Conference Resolutions.
Canadian Statistics
47.
[This item indicates that, according to internal RJR-Macdonald data for the years 1988-1996, the
prevalence of adult (age 19+) smoking in Canada was 31.0% in 1988 (prior to the Tobacco
Products Control Act, and 26.9% in 1993, representing a decline of 13.2%. Prevalence increased
following the 1994 tobacco tax rollback. Among 19-24 year olds, the youngest age group
measured, prevalence decreased from 33.4% in 1988 to 28.3% in 1993, a decline of 15.3%.]
Newman, L., Wilson, S. (RJR-Macdonald Inc.), memorandum to Kauffeld, R. (RJRMacdonald Inc.), June 4, 1997, “Subject: Market Incidence and Usage”.
48.
[Imperial Tobacco internal data indicate that the prevalence among adults (age 15+) in Canada
fell from 34.8% in 1988 (prior to the Tobacco Products Control Act) to 29.0% in 1993, the last
year prior to the 1994 tobacco tax rollback. This represents a decline of 16.7%.]
Imperial Tobacco Ltd. “The Canadian Tobacco Market at a Glance” 1989; Imasco Ltd.,
“Annual Report 1992” 1993; Imasco Ltd., “Annual Report 1993” 1994.
- 26 49.
[Although the industry claims that smoking levels were unchanged during the period that the
Tobacco Products Control Act (TPCA) was in force, this claim is disproved by their own internal
prevalence data, cited above, and by annual sales and import data from Statistics Canada. Per
capita consumption (age 15+) based on domestic sales of cigarettes and roll-your-own (1g = one
cigarette) fell from 2784 in 1988 to 2114 in 1995, a decline of 24.1%. During the first four years
of the Tobacco Act, per capita consumption fell from 2161 in 1996 (pre-Act) to 1904 in 2000, a
decline of 13.5%. Per capita consumption was 31.6% lower in 2000 as compared to 1988. And
although the industry claimed that imports would increase as a result of the TPCA, manufactured
cigarette imports actually fell from 31 per capita in 1988 to 16 per capita in 1995, a decrease of
48%. In 2000, per capita cigarette imports were at 17, and imported cigarettes represented less
than 1% of the cigarette market in Canada.]
Statistics Canada, “Production and disposition of tobacco products” Catalogue 32-022,
December issues, 1988-2000. Statistics Canada, Demography Division “Total Population
and Population Aged 15+, Canada, Provinces and Territories, July 1, 1971 to 1996”
custom printout, 2001; Statistics Canada, Demography Division “Total Population and
Population Aged 15+, Canada, Provinces and Territories, July 1, 1997 to 2000” custom
printout, 2001; Statistics Canada, “Imports by Commodity” Catalogue 65-007, December
issues, 1988-2000.
50.
[This item indicates that 10-17 year olds comprise 11% of the population. This suggests that a
requirement that advertising be permitted only in publications having 15% or less youth
readership is more than reasonable, and indeed overly cautious. As it stands under the Tobacco
Act, tobacco advertising, including sponsorship advertising, can be placed in publications read by
a higher percentage of teenagers than of adults. (Children aged 0-9 years cannot be expected to
read publications in any great numbers.)]
Statistics Canada, 1996 Census, table showing segmented population for males, females,
and total for persons aged 1-30.
Studies and Other Literature
51.
Sports sponsorships can offer cost-effective exposure for a product, associate a company or
product name with a specific event, and provide companies with high visibility activities,
particularly if the events are national or international in scope. All of this contributes to the
bottom-line performance. (pp.352-353)
Abratt, R., Grobler, P.S. “The Evaluation of Sports Sponsorships” International Journal
of Advertising 1989;8:351-362.
52.
[S]ponsorship of sport by tobacco companies is a method of advertising cigarettes and other
tobacco products. It provides them, at very low cost (about £9 mn) substantial television and
other publicity which they could not otherwise obtain either at all (because of the ban on tobacco
advertising on television) or for anything like that price. (p.10)
Action on Smoking and Health [U.K.], “Tobacco Sponsorship of Sport” March 1994.
- 27 53.
This brief summarises the arguments in favour of a ban on all tobacco promotion and advertising
and answers the most common counter-arguments. ... A ban is justified on health grounds...
...
No-one claims that advertising is the only determinant of tobacco consumption or smoking
prevalence: to do so would be absurd. It is equally absurd, however, to claim (as the industry
does) that advertising does not expand (or slow the contraction of) the market and that it does not
in fact assist in the recruitment of new smokers. (p.1)
Action on Smoking and Health [U.K.], “Tobacco Advertising: The case for a ban”, 5th
ed., January 1996.
54.
Brand-stretching, that is, the use of tobacco brand names on non-tobacco merchandise or services,
has been used by the tobacco industry for many years as a means of promoting cigarettes when
faced with a ban on direct tobacco advertising. The examples which follow show the extent to
which the tobacco industry will go in order to circumvent restrictions on tobacco promotion. (p.1)
Action on Smoking and Health [U.K.], “ASH Briefing on ‘Brand-stretching’” February
1998.
55.
Marketing to Children. The companies deny that they target the young. The documents reveal the
obvious - that the market of young smokers is of central importance to the industry. Many
documents reveals the companies’ pre-occupation with teenagers and younger children - and the
lengths they have gone to in order to influence smoking behaviour in this age group.
...Advertising. The industry maintains that advertising is used only to fight for brand share and
that it does not increase total consumption - academic research shows otherwise. The documents
show that advertising is crucial in nurturing the motivation to smoke by creating or projecting the
positive values, such as independence, machismo, glamour or intelligence, erroneously associated
with the product. (p.i)
Action on Smoking and Health [U.K.], “Tobacco Explained: The truth about the tobacco
industry...in its own words” 25 June 1998.
56.
Cigarette advertising and promotion contribute to a social environment that supports smoking and
convinces many to start.(p.166)
...
Ad messages reduce the effectiveness of health warnings. ... By portraying smoking as a
common, harmless practice, advertising masks tobacco’s addictive nature as well as the lethal
effects of its use.(p.167)
...
Cigarette advertising exploits the fears and frustrations of disadvantaged people. Ads targeted at
women associate smoking with romance, social acceptability, sexual attractiveness, and
independence; ads targeted at the poor and oppressed associate smoking with prosperity, success,
social liberation, and independence.(p.168)
...
Sponsorship of sporting and cultural events gives the tobacco industry a legitimacy it does not
deserve. Sports promotions deceptively link smoking with health and athletic ability.(p.170)
Advocacy Institute [U.S.], “Truth and the Consequences of Cigarette Advertising: An
Advocate’s Guide to Arguments in Support of Banning Cigarette Advertising and
Promotions; Developed by the Advocacy Institute for the American Cancer Society and
- 28 the UICC” In: Building a Tobacco-Free World: 8th World Conference on Tobacco and
Health, 30 March - 3 April 1992, Buenos Aires, Argentina, American Cancer Society.
57.
Interviews were conducted with 848 Glasgow children aged between 11 and 14 years. There
were consistent differences between smokers and non-smokers. Smokers tended to be more adept
at recalling, recognizing and identifying cigarette advertisements. This suggests they tend to pay
more attention to cigarette advertising. Smokers also tended to be generally more appreciative of
cigarette advertising. Moreover, this greater awareness and appreciation of cigarette advertising
was independent of other important predictors of under-age smoking, such as smoking by peers,
siblings and parents. These findings, taken in conjunction with previous research, indicate that
cigarette advertising is reinforcing under-age smoking. (p.399)
Aitken, P.P., Eadie, D.R. “Reinforcing effects of cigarette advertising on under-age
smoking” British Journal of Addiction, 1990;85(3):399-412.
58.
Six hundred and forty Glasgow children, initially aged between 11 and 14 years, were
interviewed twice, with approximately one year between interviews. Children whose intentions
to smoke when older became more positive between the two interviews tended to be more aware
of cigarette advertising at the time of the first interview (compared with children whose intentions
to smoke were negative at both interviews). Children whose intentions to smoke became more
negative between the interviews tended to be less appreciative of cigarette advertisements at the
time of the first interview (compared with children whose intentions to smoke were positive at
both interviews). Since both groups differed from their respective contrast groups before their
declared intentions changed, these findings support the view that cigarette advertising has
predisposing as well as reinforcing effects on children’s attitudes and behaviour with respect to
smoking. (p.383)
Aitken, P.P., Eadie, D.R., Hastings, G.B., Haywood, A.J. “Predisposing effects of
cigarette advertising on children's intentions to smoke when older” British Journal of
Addiction, 1991;86(4):383-390.
59.
It seems that some 12-year olds and most 14- and 16-year olds perceive cigarette advertisements
much in the way that young adults do; therefore advertising campaigns targeted at older teenagers
and young adults are likely to present qualities which younger teenagers find attractive. (p.785)
Aitken, P.P., Leathar, D.S., O'Hagan, F.J. “Children's Perceptions of Advertisements for
Cigarettes” Social Science and Medicine, 1985;21(7):785-797.
60.
Cigarette brand imagery is often presented in advertisements for other products or services.
Recent research sponsored by the Cancer Research Campaign suggests that many primary school
children may identify such advertisements as advertising cigarettes, and perceive exciting and
attractive imagery in this kind of advertising material. (p.201)
Aitken, P.P., Leathar, D.S., O’Hagan, F.J. “Brand Stretching Advertisements for
Cigarettes: Impact on Children” Health Education Journal 1985;44(4):201-202.
61.
First, more than half the secondary school children and about a third of the 10 and 11-year olds
were able to name cigarette brands and sponsored sports. This shows the power of sports
- 29 sponsorship in putting cigarette brand names and associated sports imagery into children’s
memories.
... [I]t seems that television sports sponsorship by cigarette manufacturers acts as advertising and
therefore circumvents the law banning cigarette advertising on television.
Thirdly, and perhaps even more important, the research described here indicates that associations
between cigarette brand names (or their visual cues) and exciting sponsored sports can be elicited
or triggered by simple advertisements. That such associations can be elicited even in young
primary school children indicates the insidious nature of cigarette brand sponsorship of sports.
(pp.210-211)
Aitken, P.P., Leathar, D.S., Squair, S.I. “Children’s awareness of cigarette brand
sponsorship of sports and games in the UK” Health Education Research, 1986;1(3):203211.
62.
Prohibition on Youth Targeting. No Participating Manufacturer may take any action, directly or
indirectly, to target Youth within any Settling State in the advertising, promotion or marketing of
Tobacco Products, or take any action the primary purpose of which is to initiate, maintain or increase
the incidence of Youth smoking within any Settling State.
. . . Ban on Use of Cartoons. Beginning 180 days after the MSA Execution Date, no Participating
Manufacturer may use or cause to be used any Cartoon in the advertising, promoting, packaging or
labeling of Tobacco Products. (p.3.229)
...
No Participating Manufacturer may engage in more than one Brand Name Sponsorship in the States
in any twelve-month period . . . [There is a transition period ending not later than three years from
the Execution Date. Also, Brown and Williamson may also sponsor GPC country music festival or
Kool jazz festival, in addition to one other sponsorship.] (p.3.230)
...
. . . [E]ach Participating Manufacturer shall remove from within the Settling States within 150 days
after the MSA Execution Date all of its (A) billboards (to the extent that such billboards constitute
Outdoor Advertising) advertising Tobacco Products; (B) signs and placards (to the extent that such
signs and placards constitute Outdoor Advertising) advertising Tobacco Products in arenas, stadiums,
shopping malls and Video Game Arcades; and (C) Transit Advertisements advertising Tobacco
Products. (p.3.231)
...
To the extent that any advertisement advertising Tobacco Products located within an Adult-Only
Facility constitutes Outdoor Advertising or a Transit Advertisement, this subsection (d) shall not
apply to such advertisement, provided such advertisement is not visible to persons outside such
Adult-Only Facility.
. . .Prohibition on Payments Related to Tobacco Products and Media. No Participating Manufacturer
may, beginning 30 days after the MSA Execution Date, make, or cause to be made, any payment or
other consideration to any other person or entity to use, display, make reference to or use as a prop
any Tobacco Product, Tobacco Product package, advertisement for a Tobacco Product, or any other
item bearing a Brand Name in any motion picture, television show, theatrical production or other live
performance, live or recorded performance of music, commercial film or video, or video game
(“Media”); provided, however, that the foregoing prohibition shall not apply to (1) Media where the
audience or viewers are within an Adult-Only Facility (provided such Media are not visible to
persons outside such Adult-Only Facility); (2) Media not intended for distribution or display to the
public; or (3) instructional Media concerning non-conventional cigarettes viewed only by or
provided only to smokers who are Adults.
- 30 . . . Ban on Tobacco Brand Name Merchandise. Beginning July 1, 1999, no Participating
Manufacturer may, within any Settling State, market, distribute, offer, sell, license or cause to be
marketed, distributed, offered, sold or licensed (including, without limitation, by catalogue or direct
mail), any apparel or other merchandise (other than Tobacco Products, items the sole function of
which is to advertise Tobacco Products, or written or electronic publications) which bears a Brand
Name. Provided, however, that nothing in this subsection shall (1) require any Participating
Manufacturer to breach or terminate any licensing agreement or other contract in existence as of June
20, 1997 (this exception shall not apply beyond the current term of any existing contract, without
regard to any renewal or option term that may be exercised by such Participating Manufacturer);
prohibit the distribution to any Participating Manufacturer’s employee who is not Underage of any
item described above that is intended for the personal use of such an employee; (3) require any
Participating Manufacturer to retrieve, collect or otherwise recover any item that prior to the MSA
Execution Date was marketed, distributed, offered, sold, licensed, or caused to be marketed,
distributed, offered, sold or licensed by such Participating Manufacturer; (4) apply to coupons or
other items used by Adults solely in connection with the purchase of Tobacco Products; or (5) apply
to apparel or other merchandise used within an Adult-Only Facility that is not distributed (by sale or
otherwise) to any member of the general public. (p.3.232)
...
Ban on Gifts to Underage Persons Based on Proofs of Purchase. Beginning one year after the MSA
Execution Date, no Participating Manufacturer may provide or cause to be provided to any person
without sufficient proof that such person is an Adult any item in exchange for the purchase of
Tobacco Products, or the furnishing of credits, proofs-of-purchase, or coupons with respect to such a
purchase. (p.3.232-3.233)
...
Ban on Non-Tobacco Names. No Participating Manufacturer may, pursuant to any agreement
requiring the payment of money or other valuable consideration, use or cause to be used as a brand
name of any Tobacco Product any nationally recognized or nationally established brand name or
trade name of any non-tobacco item or service or any nationally recognized or nationally established
sports team, entertainment group or individual celebrity. Provided, however, that the preceding
sentence shall not apply to any Tobacco Product brand name in existence as of July 1, 1998.
(p.3.233)
Alabama, et al. [46 U.S. states and American Samoa, District of Columbia, Guam, Puerto
Rico, Northern Mariana Islands], Philip Morris Inc., R.J. Reynolds Tobacco Company,
Brown & Williamson Tobacco Corporation, Lorillard Tobacco Company, “Master
Settlement Agreement” November 23, 1998. In: Tobacco Products Litigation Reporter,
1998;13(6):3.223-3.327[out-of-court settlement of state government medicare cost recovery
lawsuits against tobacco manufacturers]
63.
Children who approved of cigarette advertising were twice as likely to become smokers as
children who disapproved . . .
...
Children who disapproved of cigarette advertising were more likely to quit than those who
approved of it.(p.61)
...
Predisposing factors are those which are anteceded to smoking behaviour and which provide the
initial motivation for it. ... [A]pproval of advertising was an important predisposing factor.
Furthermore, children who held favourable attitudes to smoking and cigarette advertising were at
- 31 greater risk of adopting or maintaining smoking behaviour than those whose attitudes were more
disapproving.
Reinforcing factors are related to the maintenance of the behaviour. Most of the predisposing
factors we identified also have a role in reinforcement. We found that attitudes to cigarette
advertising and smoking changed over the study period so that they remained congruent with
smoking behaviour. This suggests to us that these attitudes form part of the reinforcement
process.(p.64)
...
In summary, well-enforced legislation is needed to ban the sale of cigarettes to children as well as
banning all advertising of cigarettes. These strategies should be supplemented by carefully
tailored health education programmes. These three measures should lead to a reduction in
childhood smoking because they would provide a broad attack on the predisposing, reinforcing
and enabling aspects of this unhealthy behaviour.(p.65)
Alexander, H.M., Calcott, R., Dobson, A.J., Hardes, G.R., Lloyd, D.M., O’Connell, D.L.,
Leeder, S.R. “Cigarette Smoking and Drug Use in Schoolchildren: IV. Factors
Associated with Changes in Smoking Behaviour” International Journal of Epidemiology,
1983;12(1):59-66.
64.
There is a strong association between an awareness of and involvement with tobacco promotions
and being susceptible to tobacco use or a user of tobacco products. (p.1590)
Altman, D.G., Levine, D.W., Coeytaux, R., Slade, J., Jaffe, R. “Tobacco Promotion and
Susceptibility to Tobacco Use among Adolescents Aged 12 through 17 Years in a
Nationally Representative Sample” American Journal of Public Health,
1996;86(11):1590-1593.
65.
There should be a ban on all tobacco and alcohol advertising in all media. This ban should
include all “passive” advertising in sponsored sports events (ie, banners, logos, etc). (p.296)
American Academy of Pediatrics, Committee on Communications “Children,
Adolescents, and Advertising” Pediatrics, 1995;95(2):295-297.
66.
[M]easures that reduce youths’ overall exposure to tobacco advertisements (and to the positive
imagery presented in the remaining ads) would be expected to contribute to reductions in
underage smoking rates. (p.12)
American Psychological Association, American Psychological Association Submission to
the U.S. Food and Drug Administration on the proposed rule to restrict the sale and
distribution of cigarettes and smokeless tobacco, December 28, 1995.
67.
Faced with increasing public awareness in many countries of the serious health effects of
smoking, and increasing government action directed at reducing smoking, the tobacco industry
has responded by developing new strategies aimed at sustaining current markets and developing
new markets around the world. (p.3)
Amos, A., “Cigarette advertising and marketing strategies” Tobacco Control,1992;1(1):34.
- 32 68.
In Germany in the 1990s young women have become a prime target for cigarette ads, many of
which have promoted smoking as synonymous with western images of modern emancipated
womanhood. It is therefore particularly worrying that between 1993 and 1997, rates of smoking
among 12 to 25 year old women in former East Germany nearly doubled from 27% to 47%. In
contrast rates among young men showed a less steep increase from 38% to 45%, and there was
little change in smoking rates among the same age group in former West Germany. In addition
the desire to quit among 12-25 year old smokers declined from 62% to 42% over this period.
(p.6)
...
Conclusion
At the beginning of the 20th century few people could ever have imagined how such a stigmatised
behaviour as female smoking would be transformed, with the aid of judicious marketing, into a
socially acceptable and desirable practice. (p.8)
Amos, A., Haglund, M. “From social taboo to “torch of freedom”: the marketing of
cigarettes to women” Tobacco Control, 2000;9(1):3-8.
69.
[T]he children’s perceived responses to cigarette advertising showed the strongest and most
consistent evidence of an effect on the uptake of smoking by children who initially were nonsmokers. Moreover, in contrast to the effect of the educational programme, this association
became stronger over time.(p.121)
...
Taken together with the results of other research, we believe that there now is no room for doubt,
if there ever really was, that cigarette advertising has an important effect on uptake of smoking by
children.(p.123)
Armstrong, B.K., de Klerk, N.H., Shean, R.E., Dunn, D.A., Dolin, P.J. “Influences of
education and advertising on the uptake of smoking by children.” Medical Journal of
Australia, 1990;152(3):117-124.
70.
Conclusions. The "No Additives" slogan was perceived by a majority of adolescents and about a
quarter of adults as implying one or more health claims. (p.522)
...
[S]ubstantial proportions of the adolescents in the present study, especially the smokers, liked each of
the four ads from the “No Additives” campaign, and for three of the four ads, 20% or more said the
ad made smoking more appealing. (p.526)
...
More generally, the findings provide further support, from a public health perspective, for banning
tobacco advertising or at minimum restricting it to adults-only venues. (p.527)
Arnett, J.J., “Winston’s “No Additives” Campaign: “Straight Up”? “No Bull”?” Public
Health Reports, 1999;114:522-527.
71.
Nearly half believed that the Joe Camel advertisement makes smoking more appealing, and 40%
believed that the Marlboro Man advertisement makes smoking more appealing. Adolescent
smokers were more likely than non-smokers to believe that the advertisements for Camel and
Marlboro make smoking more appealing.
Conclusions - The advertisements most popular among adolescents are for two of the brands they
are most likely to smoke - Marlboro and Camel. The results of the study are consistent with the
- 33 view that certain cigarette advertisements enhance the appeal of smoking to many
adolescents.(p.129)
...[I]n the interest of reducing smoking among adolescents, cigarette advertising and promotion
should be banned or restricted to adult-only venues. (p.133)
Arnett, J.J., Terhanian, G. “Adolescents’ responses to cigarette advertisements: links
between exposure, liking and the appeal of smoking” Tobacco Control,1998;7(2):129133.
72.
In the land of indirect advertising, Benson & Hedges bistro advertisements, originally designed to
circumvent the European Union directive to ban cigarette advertising, are being fine tuned. Malaysia
was selected as the testing ground for the bistro ads, because of its tolerance of indirect advertising,
despite a law banning direct cigarette ads. ...
The B&H bistro is advertised regularly on national television and even on billboards. The
advert shows outdoor activities not usually found in a bistro, such as fishing and parachuting. The
script uses pairs of words joined by an ampersand, such as sweet & bitter and sky & earth. (p.243)
Assunta, M. “Malaysia: & another way round ad restrictions” Tobacco Control,
1999;8(3):243-244.
73.
Common sense tells us that the billions of dollars spent to make smoking romantic, mature,
successful, [and] the thing that “beautiful” and healthy people do will attract some people,
especially young people, to take up smoking who might not otherwise have done so and will
influence some smokers who might have quit to keep on smoking.
Shouldn’t the industry that promotes this lethal product be responsible for proving that
cigarette advertising does not induce anyone to smoke or keep anyone from quitting?(p.35)
...
It is common sense that any advertising or promotion that makes the smoking of a
particular brand attractive makes smoking attractive.(p.36)
Ashton, L.P. “Countering Tobacco Marketing, Advertising and Promotion” In: Building a
Tobacco-Free World: 8th World Conference on Tobacco and Health, 30 March - 3 April
1992, Buenos Aires, Argentina, American Cancer Society, pp.34-37.
74.
Results. Across the four ads [Camel, Marlboro, Newport, Virginia Slims], between 37% and 84% of
the students [aged 10-15] reported that the ads communicated to them that smoking will make people
popular, cool, successful in life, sexy, attractive, and healthy. Sizeable percentages of students
reported that the ads show people using the product in an "exaggerated" way, and that what people in
the ads are doing requires "exercise and physical energy." The median estimated age of the models
in the ads was under age 25 for four out of the six models.
Conclusions. As perceived by adolescents, current cigarette print advertising violates basic tenets of
the Voluntary Code, thus bringing into question the tobacco industry's ability to self-regulate image
advertising. These findings suggest that the FDA ruling to prohibit image advertising for tobacco in
publications with significant youth readership deserves serious consideration. (p.488)
Barbeau, E.M., DeJong, W., Brugge, D.M., Rand, W.M. “Does Cigarette Print
Advertising Adhere to the Tobacco Institute’s Voluntary Advertising and Promotion
Code? An Assessment” Journal of Public Health Policy, 1998;19(4):473-488.
- 34 75.
One process through which tobacco advertising may work is by reducing rates of quitting. Theories
of addiction support the notion that relapse can be prompted by environmental cues. Further,
because withdrawal symptoms occur over a predictable time frame, and because the most popular
time to quit smoking is the beginning of the year, as a New Year's resolution, tobacco companies can
make use of advertising to remind quitters of their need to smoke. Study 1 examined advertising in
10 popular magazines. It found a higher number of ads in January and February than the rest of the
year after 1984. Study 2 examined cigarette advertising on the back cover of 10 other popular
magazines. This study also found a higher rate of cigarette advertisements in January and February
than for the rest of the year. The results suggest that cigarette marketers may be attempting to
preempt quitting by cuing smoking behavior. (p.161)
Basil, M.D., Basil, D.Z., Schooler, C. “Cigarette Advertising to Counter New Year’s
Resolutions” Journal of Health Communication, 2000;5:161-174.
76.
[A survey of Massachusetts teens aged 12-17 found that 54% know someone under 18 who owns a
tobacco promotional item, 52% have seen a tobacco company catalog, 11% have a tobacco company
catalogue, and 23% have a promotional item. (p.11)]
Biener, L., Fowler, F.J., Roman, A.M., “1993 Massachusetts Tobacco Survey: Tobacco
Use and Attitudes at the Start of the Massachusetts Tobacco Control Program” A report
to the Massachusetts Department of Health. Boston: Center for Survey Research,
University of Massachusetts, 1994.
77.
Results. Adolescents who, at baseline, owned a tobacco promotional item and named a brand whose
advertisements attracted their attention were more than twice as likely to become established
smokers (odds ratio = 2.70) than adolescents who did neither.
Conclusions. Participation in tobacco marketing often precedes, and is likely to facilitate,
progression to established smoking. Hence, restrictions on tobacco marketing and promotion could
reduce addiction to tobacco. (p.407)
Biener, L., Siegel, M. “Tobacco Marketing and Adolescent Smoking: More Support for a
Causal Inference” American Journal of Public Health, 2000;90(3):407-411.
78.
A cautious conclusion would be that the advertising ban as from 1975, with the concomitant
publicity throughout the legislative process, has had an impact on consumption and young
people’s smoking, and in combination with the continued educational efforts was a causal factor
in the new trend.
. . . In June 1997 the former Health Minister Professor Gudmund Hernes, Ph D, made the
following statement: ...
“there is no doubt that the Norwegian advertising ban has had a clear and substantial influence on
total consumption in general, and smoking rates among school children in particular.” (p.12)
Bjartveit, K., Lund, K.E. “The Norwegian ban on advertising of tobacco products: has it
worked?” (Oslo: Norwegian Cancer Society, Norwegian Health Association, June 1998).
79.
Exposure of the Marlboro Logotype during the 1989 Marlboro Grand Prix Telecast
...
Total no. of times Marlboro seen or mentioned 5933
Total length of broadcast (min)
93.62
- 35 Total time Marlboro seen (min)
46.17
Percent of time Marlboro seen
49.32 (p.915)
Blum, A. “The Marlboro Grand Prix: Circumvention of the Television Ban on Tobacco
Advertising” New England Journal of Medicine, 1991;324(13):913-917.
80.
[W]e found significant associations between perceived influence of cigarette advertisements and
exposure to social and information (cigarette advertising) prosmoking environments as well as
smoking susceptibility. (p.105)
Borzekowski, D.L.G., Flora, J.A., Feighery, E., Schooler, C. “The Perceived Influence of
Cigarette Advertisements and Smoking Susceptibility Among Seventh Graders” Journal
of Health Communication, 1999;4(2):105-118.
81.
Adolescents with high exposure to cigarette advertising were significantly more likely to be
smokers, according to several measures of smoking behaviour, that were those with low exposure
to cigarette advertising. (p.217)
Botvin, G.J., Goldberg, C.J., Botvin, E.M., Dusenbury, L. “Smoking Behaviour of
Adolescents Exposed to Cigarette Advertising” Public Health Reports,
1993;108(2):217-224.
82.
Another more sophisticated strategy is to give the name of a well-known brand of cigarettes to
another product, such as coffee, and to design the coffee package exactly like the cigarette pack; that
brand of coffee is then used to promote the music programme on the radio that is most popular
among young people, 'The 40's principals' which is 'casually' sponsored by 'Coffee Coronas'. (p.347)
Calvo, J.R., Calvo-Rosales, J., Lopez-Cabañas, A., Lopez, M., Torres, M., Navarro,
M.C., Segurs, J.M., Marrero, M., Orengo, J.C. “Strategies used by the tobacco industry to
target young consumers: The Canary Islands experience” In: Lu, R., Mackay, J., Niu, S.,
Peto, R., eds., The Growing Epidemic: Proceedings of the Tenth World Conference on
Tobacco or Health, (London: Springer-Verlag London Limited, 2000) 24-28 August
1997, Beijing, China, pp.347-348.
83.
Since at least the 1960’s, Philip Morris has repeatedly made similar claims that it does not market
cigarettes to kids. But internal company documents revealed in the tobacco lawsuits show that
Philip Morris has regularly done just that. (p.1)
Campaign for Tobacco-Free Kids [U.S.], “Philip Morris – A History of Double Talk”
February 16, 2000 [fact sheet].
84.
Only a third of all adults recalled seeing a tobacco ad in the past two weeks but more than 70
percent of kids aged 12 to 17 reported seeing those ads. Cigarette companies continue to
advertise heavily in magazines with large youth readerships, such as Sports Illustrated – which 51
percent of the polled teens but only 16 percent of adults read regularly – and People magazine –
which 35 percent of teens but only 20 percent of adults read regularly. (p.2)
Campaign for Tobacco-Free Kids [U.S.], “Research Findings on Tobacco Industry
Marketing to Kids in Magazines” 20 May 2000 [fact sheet].
- 36 85.
“Our profile taken locally shows this brand being purchased by black people (all ages), young
adults (usually college age), but the base of our business is the high school student.” 1978
Lorillard memo from Achey to CEO Curtis Judge about the “fantastic success” of Newport, No.
TINY0003062. (p.4)
Campaign for Tobacco-Free Kids [U.S.], “Tobacco Company Quotes on Marketing to
Kids” June 23, 2000 [fact sheet].
86.
Internal company documents show that Brown & Williamson has had a longstanding interest in
capturing a larger share of the youth market for cigarettes. (p.2)
...
“The younger smoker is of pre-eminent importance: significance in numbers, ‘lead in’ to prime
market, starts brand preference patterning” . . .[B&W New Ventures Project/The New Smoker 1974]
(p.2)
Campaign for Tobacco-Free Kids [U.S.], “Is Brown and Williamson a Good Corporate
Citizen? Their Own Words and Deeds Say No” October 18, 2000 [fact sheet].
87.
The complete ban of tobacco advertising is a necessary component of an effective and
comprehensive tobacco control policy. There is ample evidence that advertising can increase
tobacco consumption in a variety of ways. . . .
. . . Sponsorship promotions are akin to lifestyle advertising, and their elimination is easily
justifiable from a constitutional point of view given the Supreme Court of Canada’s decision in
RJR-MacDonald v. Canada (Attorney General). (p.2)
...
The ban on the use of tobacco trademarks on non-tobacco goods and services, contained in the
Blueprint, is a crucial component of a comprehensive tobacco control policy. Failure to include
such a provision would open up massive promotional opportunities for tobacco companies. (p.3)
Canadian Cancer Society, “Taking Action on Tobacco: A Submission to the Office of
Tobacco Control, Health Canada, Respecting Tobacco Control: A Blueprint to Protect
the Health of Canadians” January, 1996.
88.
There is ample evidence that tobacco advertising increases consumption, including important
evidence that has arisen since the trial respecting the Tobacco Products Control Act. The
evidence includes academic studies, logic, anecdotal reports, corporate documents, industry
admissions, expert opinion, conference materials, and international materials. Much of this
evidence has been documented elsewhere. (p.10)
Canadian Cancer Society, “Response to Tobacco Industry Arguments Against Bill C-71,
the Tobacco Act” February 1997.
89.
[This report documents many Canadian tobacco company violations of the industry’s own
voluntary marketing code. On a number of occasions, after having been found in violation, the
industry weakened the code to allow the offending marketing practice(s) to continue.]
Canadian Cancer Society, “Compilation of Complaints made under the Tobacco Industry
Voluntary Packaging and Advertising Code, and Responses to Complaints” 1997.
- 37 90.
The CMA supports a total ban on the promotion of tobacco; this includes advertising in all forms
and the sale of non-tobacco products displaying tobacco brand names, logos or colours. It also
supports a ban on all tobacco-brand marketing associated with the sponsorship of sports, cultural
and other events. (p.240A)
Canadian Medical Association, “CMA Policy Summary: Tobacco and Health” Canadian
Medical Association Journal, 1997;156(2):240A-240C.
91.
In Chapter Six, I report on the extent of information provided in a sample of Australian print
media cigarette ads. The results show that cigarette ads are almost devoid of information, and at
times arguably misleading. (p.33)
...
Advertising for smoking accessories carrying cigarette brand names is also a form of indirect
advertising, a notion recognized by the Australian Broadcasting Tribunal in its December 1983
Policy Statement on “incidental” and “indirect” advertising. In France, tobacco advertising may
not contain any graphic or photographic image other than that of the product itself, its packaging
and trade symbols. Marlboro effectively circumvented this proscription by placing its cowboy on
the pack, thereby allowing the Marlboro man back into French advertising. (pp.46-47)
...
[C]igarette advertising promotes smoking by associating it with a wide range of carefully
selected, motivating themes. To maintain otherwise would suggest that the tobacco industry
spends billions of dollars worldwide on advertising to no effect. In every brand campaign
considered in Chapters Six and Seven [in this book], appeals were found that held out promises
that touch ordinary, human desires: prestige, gender identification, belonging to a group, and so
on. Many of these are emotions and needs which are at their most acute in the developmental
phases of adolescence. The continued denial by the industry that its advertising holds [no]
behavioural consequences for children should therefore be soundly rejected. (p.116)
...
Malaysian television, where cigarette advertising is banned, has a nightly cavalcade of ads for
Kent and Salem holidays, Camel camping equipment, Benson and Hedges exhibitions and a
Winston sports magazine. (p.126)
Chapman, S. Great Expectorations: Advertising and the Tobacco Industry (London:
Comedia Publishing Group, 1986).
92.
The logic of banning tobacco billboards adjacent to schools is even more absurd. Here, it is being
suggested that a child sighting such a billboard 195 metres from a school might be influenced by
its message, but the same child sighting the same advertisement 205 metres from a school would
somehow be immune from its persuasions. (p.130)
Chapman, S. “The ethics of tobacco advertising and advertising bans” British Medical
Bulletin, 1996;52(1):121-131.
93.
Smokers were nearly twice as likely to correctly identify edited cigarette advertisements and
slogans than were non-smokers. (p.491)
Chapman, S., Fitzgerald, B., “Brand Preference and Advertising Recall in Adolescent
Smokers: Some Implications for Health Promotion” American Journal of Public Health,
1982;72(5):491-494.
- 38 -
94.
All major health, medical and consumer groups have identified a ban on all forms of tobacco
advertising as an essential component of a comprehensive smoking control programme.
- Tobacco advertising promotes the idea that smoking is acceptable, desirable and glamorous.
- It undermines the credibility of government health education campaigns against smoking.
- It stops the flow of full information about the health risks of smoking because many magazines
and newspapers do not wish to offend their tobacco advertisers. (p.3)
Chapman, S., White, P., Aitken, P.P. Pushing Smoke: Tobacco advertising and
promotion, (Copenhagen: World Health Organization Regional Office for Europe and the
Commission for the European Communities, 1988).
95.
It is suggested that children are receiving the positive messages from cigarette advertisements
even as young as the impressionable age of nine years when they are most likely to try their first
cigarette, although the advertisements are supposedly not intended for them. They may see these
messages as generic to smoking and the positive impressions they gain from them could be one of
the important influences in their decision to smoke. (p.75)
Charlton, A. “Children's advertisement-awareness related to their views on smoking”
Health Education Journal, 1986;45(2):75-78.
96.
Any ban on tobacco advertising must include all sponsored sport. [This study found that boys
whose favourite sport to watch on television was car racing are almost twice as likely to smoke,
and are also twice as likely to remember the names of leading car racing sponsors, Marlboro and
Camel, than boys who do not follow car racing.]
Charlton, A., While, D., Kelly, S. “Boys’ smoking and cigarette-brand-sponsored motor
racing” The Lancet 1997;350(9089):1474.
97.
[P]eer approval and exposure to tobacco advertising were also both significant predictors for use
and susceptibility. Extending the ban of tobacco marketing practices to all mass media may be
necessary if smokeless tobacco use is to be reduced. (p.S57)
Choi, W.S., Farkas, A.J., Rosbrook, B., Elder, J.P., Pierce, J.P. “Does advertising
promote smokeless tobacco use among adolescent boys? Evidence from California”
Tobacco Control, 1995;4(suppl 1):S57-S63.
98.
Despite claims by the tobacco industry that promotional items are intended solely for smokers at
least 21 years of age, millions of young people, both smokers and non-smokers, possess and use
such items. This popular form of advertising lacks warning labels and familiarises minors with
tobacco products. (p.253)
Coeytaux, R.R., Altman, D.G., Slade, J. “Tobacco promotions in the hands of youth”
Tobacco Control, 1995;4(3):253-257.
99.
Reynolds’s research identified important psychological needs in a period of cultural change that were
being met less well by other cigarette brands. A successful implementation of such a campaign
- 39 would give the brand the ability to bring people who might not have become regular smokers into the
product category. (pp.159-160)
...
A series of documents focus on peer acceptance . . . : “The objective of Camel advertising worldwide
will be to convince prime prospect smokers that by choosing Camel as their usual brand they will
enhance their acceptance among their peer groups” (p.160)
Cohen, J. “Playing to Win: Marketing and Public Policy at Odds over Joe Camel”
Journal of Public Policy and Marketing, 2000;19(2):155-167.
100.
[T]he titles of some of the known earlier reports make it clear that selling to youth and market
segmentation were of great interest to Imperial Tobacco in the 1950s and 1960s:
 1955: University student brand switching
 1964-5: Smoking habits of teenagers;
 1965: The youth market (Toronto) (p.1)
...
"When we talk about a switcher we are talking about someone who has been smoking his usual
brand for less than 12 months. This definition includes starters (did not smoke before) and smokers
that had no regular or particular previous brand.” Imperial Tobacco Switching Study, 1991. (p.9)
Collishaw, N. “Selling Smokes to Starters” Paper presented at the World No-Tobacco
Day Forum on Tobacco Industry Documents, Ottawa, Canada, May 31, 2000, accessed
March, 2001, http://www.tobaccopapers.org/WNTD/WNTDWeb/default1.htm
101.
Another key was to make and sell the brand that teenagers would begin to smoke, the brand for
starters. Theory held that if you hooked them early, they would continue to smoke your brand
throughout their lives. The theory worked like a charm. (p.19)
Collishaw, N. “The Story of Player’s Lights” Paper presented at the World No-Tobacco
Day Forum on Tobacco Industry Documents, Ottawa, Canada, May 31, 2000, accessed
March, 2001, http://www.tobaccopapers.org/WNTD/WNTDWeb/default1.htm
102.
Between 1970 and 1985, the use of the moist snuff increased by 30% among all Americans, but
eightfold in the 17- to 19-year-old group. Such an increase did not occur by accident, but rather as
the result of a carefully crafted marketing strategy by tobacco companies, which uses extensive
point-of-purchase displays, wide distribution on free samples, and sponsorship of touring sports
and cultural events.(pp.351-352)
...
Tobacco companies also recognize the powerful influence sport has on shaping youthful
behavior. They have exploited sport to pass the nation’s tobacco epidemic on to each new
generation, recruiting young people to replace those who have quit or died from tobacco use. The
harmful effects of tobacco are camouflaged against the backdrop and thrill of athletic victory. All
of this must end.(p.353)
Connolly, G.N. “Snuffing Tobacco Out of Sport” American Journal of Public Health,
1992;82(3):351-353.
- 40 103.
There are several reasons why allowing sponsorships by tobacco companies (especially
sponsorship of sports) undermine attempts to curb tobacco consumption: (1) sponsorships
function like advertising, (2) sports sponsorship reach the youth market very effectively, (3)
sponsorships associate smoking with healthy, popular activities and images, and (4) the
international nature of sponsored events may allow exemption from national sponsorship bans.
(p.243)
Cornwell, T.B., “The Use of Sponsorship-Linked Marketing by Tobacco Firms:
International Public Policy Issues” Journal of Consumer Affairs, 1997;31(2):238-254.
104.
The government should introduce a total ban on all forms of tobacco advertising and promotion,
including sponsorships. Also prohibited would be the free distribution of tobacco; the use of
tobacco brand names and logos on nontobacco goods like lighters and T-shirts; and the use of
games, contests, and other incentives to promote sales. (p.248)
Cunningham, R. Smoke & Mirrors: The Canadian Tobacco War (Ottawa: International
Development Research Centre, 1996).
105.
To what extent do youth recognize sponsored event advertising as advertising for tobacco
products? To what extent to they recognize it as advertising for an event or activity?(p.6)
...
Less than one percent of young people mentioned the event being advertised by these posters. A
significant proportion, however, interpreted the posters as advertisements for cigarettes. Fiftythree said the Player’s Ltd. Racing ad was about cigarettes and 12% said the du Maurier Jazz
Festival ad was about cigarettes. The brand name was mentioned equally as frequently. In fact, it
was common for students to mention the brand name and cigarettes in the same line (e.g. Player’s
cigarettes, du Maurier cigarettes).(p.9)
...
Even with the restrictions on direct advertising of tobacco products in Canada that were in place
over the time of this study, youth perceived that tobacco product advertising was occurring,
through the advertising of events sponsored by tobacco companies, notably Player’s Ltd. Racing
and the du Maurier Jazz Festival. This is particularly true for Player’s, with colours, font and
even shapes making fairly blatant connections to the cigarette package itself. That over one half
of students associated the Player’s Ltd. Racing ad with cigarettes, despite the fact that the poster
did not have the word “Player’s” on it indicates the high degree of success that Player’s has had
in maintaining a profile for their company and their product, despite the ban on advertising
cigarettes. Given that the purpose of the advertising ban was to eliminate cigarette advertising,
these results indicate the Player’s, and to a lesser extent, du Maurier, have successfully
circumvented the spirit of the law.(p.16)
d’Avernas, J.R., Northup, D., Foster, M.K., Burton, D., Ferrence, R., Pollard, J.,
Rootman, I., Flay, B.R., “Cigarette Packaging and Event Marketing Increases the
Attractiveness of Smoking: A Study of Youth”. Ontario Tobacco Research Unit,
Working Paper Series #28, Toronto, 1997.
106.
[E]vidence indicating that cigarette advertising and promotion increase total consumption,
especially among youth, has accumulated steadily.(p.2)
...
- 41 The reason for the industry’s failure to support a federal ban on tobacco advertising must be that
the underlying premise is wrong - that is, the companies must indeed perceive an industry-wide
benefit to advertising and promotion. The benefit - the maintenance or expansion of the cigarette
market - serves a vital need for an industry that is losing more than 400,000 of its consumers each
year to smoking-attributable deaths.
...
. . . the common-sense notion that advertising must have effects beyond loyalty and brand
switching.(p.3)
Davis, R.M. “The effects of tobacco advertising: Brand loyalty, brand switching, or
market expansion?” American Journal of Preventive Medicine, 1996;12(1):2-3.
107.
In light of the conclusive evidence identifying smoking as a major health hazard with no
redeeming health aspect, the federal government has developed a policy designed to discourage,
in the strongest possible terms, the sponsorship of amateur sport by the tobacco industry.
Therefore, effective immediately, all national amateur sport bodies funded in part by the
federal government will be required to desist from associating in any new or renewed sponsorship
arrangements with the tobacco products industry. The federal government will withhold all funds
from national amateur sport organizations associating in any sponsorship, promotional or other
financial support arrangements (e.g. advertising) with the tobacco products industry for events or
programs predominantly involving amateur athletes. (p.2)
Department of Canadian Heritage, Sport Canada “Federal Government Policy on
Tobacco Sponsorship of National Sport Organizations” Originally issued March 1985.
108.
Canadian tobacco companies have evaded the intent of advertising provisions in the past through the
sponsorship of cultural and sports events. The provisions of Bill C-42 aim to close some of the
loopholes that were previously exploited by the tobacco companies. (p.84)
Dewhirst, T. “Tobacco sponsorship is no laughing matter” Tobacco Control,
1999;8(1):82-84.
109.
Sponsorship has enabled tobacco manufacturers to extend the brand identities they developed
using traditional product advertising. Through commissioned research on youth consumer
culture, the industry has endeavoured to isolate those groups that are most likely to start smoking
and then has sought to reach and influence these groups through sponsored activities that link the
sponsoring cigarette brands to desirable, peer-defined attributes, identities and personalities. . . .
[M]anufacturers have utilized sponsorship to communicate meanings of masculinity, maturity,
independence, rebelliousness, excitement, and adventure. (p.1)
Dewhirst, T. "Tobacco Sponsorship Appealing to Male Youths in Canada: Positioning
Cigarettes as Symbols of Masculinity, Independence, Rebelliousness, Excitement and
Adventure" History of Advertising Archives, Faculty of Commerce, University of British
Columbia, Vancouver, January 2000.
110.
[This document annotates various exhibits in the Minnesota medicare cost recovery lawsuit, e.g.
"RJR document dated July 22, 1980 – subject is "MDD Report on Teenage Smokers (14 to 17)".
Document is from G.H. Long (head of marketing and later president of RJR) to Mr. E.A. Horrigan,
Jr. (president of RJR).”] (p.6)
- 42 Dewhirst, T., Pollay, R.W., "Exhibited and Exposed: Annotations to Documents discussed
in Minnesota et al. Plaintiffs v. Philip Morris, et al., Defendants", History of Advertising
Archives, Faculty of Commerce, University of British Columbia, Working Paper 98.4, July
1998.
111.
[This document includes various quotations from internal tobacco company documents, as indicated
by the excerpts quoted.]
"The market share of health cigarettes increases rapidly for a brief period during each health scare
and quickly stabilizes at a new and higher level of market penetration" (p.2)
"The illusion of filtration is as important as the fact of filtration" (p.2)
"Psychologically, most smokers feel trapped. They are concerned about health and addiction.
Smokers care about what commercials say about them. Advertising may help to reduce anxiety and
guilt (p.3)
People who smoke filter cigarettes "may be receptive to advertising which helps them escape from
their inner conflicts about smoking" (p.3)
"smokers have to face the fact that they are illogical, irrational and stupid" (p.7)
"while an ad that depicts an exciting, invigorating situation could be interesting to the smoke-viewer,
the very thin line separating positive excitement from negative-creating situation should never be
crossed" (p.7)
"The marketing perspective should be broadened so as to include within its planned competitive
activities, programmes which are directed specifically towards maintaining the smoking habit at
current levels, and if possible to increase those levels. We should not simply rest content with the
traditional role of marketing, which aims to increase market share at a profit within increasing
constraints and prohibitions" (p.9)
"In point of fact, smoking an ultra low tar cigarette seems to relieve some of the guilt of smoking and
provide an excuse not to quit" (p.15)
"it was Philip Morris scientists who perfected the instrument that was used for many years by the
Federal Trade Commission and other groups around the world for the measurement of 'tar' and
nicotine yielded by cigarettes" (p.20)
"and at best only a steady, inexorable grind downwards in deliveries. It is a moot point whether
actual deliveries to humans have ever really dropped across the vast majority of the smoking
population." (p.21)
“Let us provide the exquisitness [sic], and hope that they, our consumers, continue to remain
unsastisfied. All we would want then is a larger bag to carry the money to the bank” (p.21)
Dewhirst, T., Pollay, R.W. "Quotes and Notes Re: Marketing of Light Cigarettes" History of
Advertising Archives, Faculty of Commerce, University of British Columbia, Working
Paper 99.2, July 1999.
112.
Children are influenced by tobacco promotions even before they understand the purpose of
advertising. Adolescence is a time of vulnerability when youths must struggle to form an
identity, to become independent of their parents, and to establish themselves with their peers.
Tobacco advertising exploits the vulnerabilities of youths by offering tobacco as the key to the
desired self-image, as a badge of independence, and as the key to acceptance by their peers.
Research demonstrates that children’s attitudes and behavior regarding tobacco are influenced by
advertising. In addition to promoting brand switching, tobacco advertising increases the number
of youths who smoke or use spitting tobacco.(p.87)
...
- 43 A complete ban on all advertising and promotion of tobacco is warranted to protect children from
exploitation at the hands of tobacco advertisers.(p.90)
DiFranza, J. “The Effects of Tobacco Advertising on Children” In: Slama, K., ed.,
Tobacco and Health: Proceedings from the 9th World Conference on Tobacco and
Health (New York: Plenum Press, 1995), pp.87-90.
113.
Tobacco products are very heavily advertised at the point of sale with an average of 48
advertisements per outlet. (p.324)
DiFranza, J.R., Coleman, M., St. Cyr, D. “A Comparison of the Advertising and
Accessibility of Cigars, Cigarettes, Chewing Tobacco, and Loose Tobacco” Preventive
Medicine, 1999;29(5):321-326.
114.
Old Joe Camel cartoon advertisements are far more successful at marketing Camel cigarettes to
children than to adults. This finding is consistent with tobacco industry documents that indicate
that a major function of tobacco advertising is to promote and maintain tobacco addiction among
children.(p.3149)
...
Our study provides further evidence that tobacco advertising promotes and maintains nicotine
addiction among children and adolescents. A total ban of tobacco advertising and promotions, as
part of an effort to protect children from the dangers of tobacco, can be based on sound scientific
reasoning.(p.3152)
DiFranza, J.R., Richards, J.W., Jr., Paulman, P.M., Wolf-Gillespie, N., Fletcher, C., Jaffe,
R.D., Murray, D. “RJR Nabisco's Cartoon Camel Promotes Camel Cigarettes to
Children” Journal of the American Medical Association, 1991;266(22):3149-3153.
115.
Conclusions. This study provides preliminary evidence that stars who smoke on and off screen
may encourage youth to smoke. (p.1)
...
We conclude that there is a relationship between adolescents' choice of favorite movie actors and
actresses and their smoking status. Favourite movie stars may provide normative behavior models
that are emulated or used to justify subsequent smoking. Alternatively, adolescent smokers may
gravitate to media and activities that include more smoking. (p.8)
Distefan, J.M., Gilpin, E.A., Sargent, J.D., Pierce, J.P. “Do Movie Stars Encourage
Adolescents to Start Smoking? Evidence from California” Preventive Medicine,
1999;28(1):1-11.
116.
[S]uch programmes were clearly instrumental in discouraging existing smokers from stopping and in
disrupting attempts to give up: "I was trying to cut down, and the coupons were encouraging me to
smoke. So when I got the gifts I wanted, I stopped smoking that brand." "I suppose it's easier just to
save the coupons than not to smoke. After all it's a drug – that's all it is at the end of the day." These
behavioural effects were more often observed in smokers living in low-income communities. (p.352)
Eadie, D.R., MacKintosh, A.M., Hastings, G.B. “Effect of tobacco loyalty programmes
on low-income smokers” In: Lu, R., Mackay, J., Niu, S., Peto, R., eds. The Growing
Epidemic: Proceedings of the Tenth World Conference on Tobacco or Health, (London:
Springer-Verlag London Limited, 2000) 24-28 August 1997, Beijing, China, pp.351-353.
- 44 -
117.
The pack by itself was expected to play a key role in conveying the images and associations of the
brand. As one of BAT's marketing training documents puts it: "The modern cigarette pack is not just
a container, it has to have a personality!" (p.8)
...
"[A]s one moves down the delivery sector then the closer to white a pack tends to become. This is
because white is generally held to convey a clean, healthy association." Principles of Measurement
of Visual Standout in Pack Design, 1986 (p.10)
Edwards, K. “Getting the Pack to Speak for Itself: Cigarette Packaging in the Face of
Restrictions on Advertising” Paper presented at the World No-Tobacco Day Forum on
Tobacco Industry Documents, Ottawa, Canada, May 31, 2000.
118.
The intention to expand the market is clearly evident from the introduction of brands aimed at
young women and children. (p.2)
European Bureau for Action on Smoking Prevention, “Report on Tobacco Advertising:
‘Give Children a Chance’”, Brussels, March 1991.
119.
Whereas this Directive must therefore take due account of the health protection of individuals, in
particular in relation to young people, for whom advertising plays an important role in tobacco
promotion; (p.L 213/9)
...
[A]ll forms of indirect advertising and sponsorship, and likewise free distribution, have the same
effects as direct advertising (p.L 213/10)
[This European Union law, which banned tobacco advertising and sponsorship, was subsequently
invalidated in court on the grounds that it was not authorized by the article under which it was
adopted.]
European Union, Directive 98/43/EC of the European Parliament and of the Council of 6
July 1998 on the approximation of the laws, regulations and administrative provisions of
the Member States relating to the advertising and sponsorship of tobacco products.
120.
Our results support the hypothesis that tobacco marketing may be a stronger current influence in
encouraging adolescents to initiate the smoking uptake process than exposure to peer or family
smokers or sociodemographic variables including perceived school performance. (p.1538)
Evans, N., Farkas, A., Gilpin, E., Berry, C., Pierce, J.P. “Influence of Tobacco
Marketing and Exposure to Smokers on Adolescent Susceptibiliy to Smoking” Journal of
the National Cancer Institute, 1995;87(20):1538-1545.
121.
Tobacco companies conduct marketing campaigns that effectively capture teenage attention and
stimulate desire for their promotional items. These marketing strategies may function to move
young teenagers from non-smoking status toward regular use of tobacco. Our results demonstrate
that there is a clear association between tobacco marketing practices and youngsters’
susceptibility to smoke. The findings, along with other research, provide compelling support for
regulating the manner in which tobacco products are marketed, to protect young people from the
tobacco industry’s strategies to reach them. (p.123)
- 45 Feighery, E., Borzekowski, D.L.G., Schooler, C., Flora, J. “Seeing, wanting, owning: the
relationship between receptivity to tobacco marketing and smoking susceptibility in
young people” Tobacco Control, 1998;7(2):123-128.
122.
The recognition rates of The Disney Channel logo and Old Joe (the cartoon character promoting
Camel cigarettes) were highest in their respective product categories. Recognition rates increased
with age. Approximately 30% of 3-year-old children correctly matched Old Joe with a picture of
a cigarette compared to 91.3% of 6-year-old children.
Conclusion. - Very young children see, understand, and remember advertising. (p.3145)
Fischer, P.M., Schwartz, M.P., Richards, J.W., Goldstein, A.O., Rojas, T.H. “Brand Logo
Recognition by Children Aged 3 to 6 Years. Mickey Mouse and Old Joe the Camel”
Journal of the American Medical Association, 1991;266(22):3145-3148.
123.
Prior to 1988, Canadian cigarette advertising approaches consisted primarily of motivation and
symbolic association. Attractive, healthy-looking people of indeterminate age were featured in
desirable settings, or occasionally the desirable settings stood on their own. (p.40)
...
While tobacco companies were not legally allowed to place their brand logos on merchandise in
Canada from 1988 until September 1995, they were permitted to use their sponsorship logos,
which are essentially the same as the brand image that appears in advertising or on packaging.
Currently, Rothman’s Racing and Craven ‘A’ Country are offering branded merchandise (T-shirts
and jackets) as contest prizes on their internet sites. (p.44)
...
In the years since 1988, when the industry was unable to legally advertise in traditional media,
they didn’t miss a step. They increased their commitment to event marketing – a category of
activity in which they were and continue to be leaders. Through this avenue they were able to
associate their products with activities that presumably fit their niche marketing strategies and/or
public relations objectives. (E.g. Player’s affiliation with Jacques Villeneuve, Belvedere’s
association with rock music, Matinée’s tie-in with fashion – these choices speak volumes about
the audiences the brands are targeting). (p.70)
Froese, B., Héon, D., Lavack, A.M., Vernon, L., Madill, J.J. “Marketing of Tobacco
Products” Prepared for Health Canada, May 15, 1996.
124.
After reviewing the mountain of evidence developed by independent researchers and reinforced
by internal industry documents, one can not help but conclude that the time for policymakers to
take action is now. (p.18)
Giglio, J. “How tobacco company advertising influences minors to use tobacco: A
summary of independent research and internal industry documents” Washington, D.C.:
American Cancer Society, 1996.
125.
Although other influences cannot be ruled out, we suspect that the expanded tobacco marketing
budget, with its increased emphasis on tactics that may be particularly pertinent to young people,
affected adolescent initiation rates. (p.122)
Gilpin, E.A., Pierce, J.P. “Trends in adolescent smoking initiation in the United States: is
tobacco marketing an influence?” Tobacco Control, 1997;6(2):122-127.
- 46 -
126.
In 1994, young adults (18-24 years) were the most likely to possess a promotional item (27.5 +
4.1, + 95% confidence limit). However, willingness to use an item was highest among those ages
15-17 years (35.4 + 3.4%) and was also high among those ages 12-14 years (24.4 + 2.7%).
Among youth, ownership or willingness to use promotional items was more likely for boys,
whites, those reporting below average school performance, and those smoking or susceptible to
smoking. Youth ownership of promotional items increased from 1993 to 1994, as did the
frequency of their obtaining items from coupons.
Conclusions. Promotional marketing undertaken by the tobacco industry was effective in
capturing the interest of adolescents, although actual acquisition was highest among young adults.
(p.14)
Gilpin, E.A., Pierce, J.P., Rosbrook, B. “Are Adolescents Receptive to Current Sales
Promotion Practices of the Tobacco Industry?” Preventive Medicine, 1997;26(1):14-21.
127.
A dose-response relationship was found between smoking level and cigarette advertisement
recognition, with regular smokers recognizing 61.6% of advertisements, compared with only
33.2% for non-smokers. (p.488)
Goldstein, A.O., Fischer, P.M., Richards, J.W., Creten, D., “Relationship Between High
School Student Smoking and Recognition of Cigarette Advertisements” Journal of
Pediatrics, 1987;110(3):488-491.
128.
Promotional activities make it difficult for recent quitters. As an example of the
interdependencies among wide-ranging determinants of the smoking career, consider the response
of a recent quitter coming across a cigarette advertisement in a magazine. He or she may find
within the ad a number of symbols closely associated with his or her own recent smoking habits.
The symbols and the conditioned responses to them may serve as a strong cues for smoking,
enhanced by biologic potency of nicotine as an unconditioned stimulus. (p.714)
Haire-Joshu, D., Morgan, G., Fisher, E.B., “Determinants of Cigarette Smoking” Clinics
in Chest Medicine, 1991;12(4):711-725.
129.
[This item describes legislative restrictions on tobacco advertising in European countries.]
Harkin, A.M., Anderson, P., Goos, C. Smoking, drinking and drug taking in the
European Region (Copenhagen: World Health Organization Regional Office for Europe,
1997).
130.
An extensive range of evidence now points to the conclusion that advertising does encourage
smoking, especially among the young. (p.14)
Hastings, G.B., Aitken, P.P. “Tobacco advertising and children’s smoking: a review of
the evidence” European Journal of Marketing 1995;29(11):6-17.
131.
In summary, the evidence shows:
- tobacco advertising is getting through to children
- 47 - by the industry’s own logic, tobacco advertising is making children more effective consumers of
tobacco
- tobacco advertising is reinforcing the habit amongst children who already smoke
- tobacco advertising is encouraging children to start smoking
- ‘indirect’ promotions such as ‘brand stretching’ and sponsorship also get through to children
It should be recognized that a ban will significantly reduce the pressure on children to smoke. ...
[I]t is clear that without cigarette advertising fewer children would become, and remain, smokers
and fewer would ultimately die of smoking related diseases. (p.9)
Hastings, G.B., Aitken, P.P., MacKintosh, A.M., “From the Billboard to the Playground.
A résumé of the academic research on the influence of advertising on children’s
smoking” Centre for Social Marketing, Department of Marketing, University of
Strathclyde, Glasgow, United Kingdom, August 1991.
132.
Children were familiar with cigarette advertising and in particular the Reg campaign. Although
younger children struggled to understand the creative content of the adverts, older and smoking
children could understand and appreciate the humour. They considered Reg to be amusing and
could relate to the type of joke used in the advert. In addition Reg’s flippant attitude towards
serious issues appealed to the children. While adults aged 18-24 understood the campaign they
did not identify with it, and 35-55 year olds (the campaign’s supposed target) were unappreciative
of the campaign.
Conclusions - The Reg campaign was getting through to children more effectively than it was to
adults and held most appeal for teenagers, particularly 14-15 year old smokers. (p.933)
Hastings, G.B., Ryan, H., Teer, P., MacKintosh, A.M. “Cigarette Advertising and
Children's Smoking: Why Reg was Withdrawn” British Medical Journal,
1994;309:933-937.
133.
Summary points
Tobacco advertising is intended to increase consumption as well as brand share and has a powerful
effect on young people.
Sponsorship and advertising work in exactly the same way and are only a small part of tobacco
marketing.
Tobacco advertisers are driven by a commercial imperative to increase sales, and they show no
concern for the ethical or public health consequences of their actions.
Voluntary agreements simply do not work and must be replaced by statutory measures. (p.366)
Hastings, G.B., MacFadyen, L. “A Day in the life of an advertising man: review of
internal documents from the UK tobacco industry’s principal advertising agencies”
British Medical Journal, 2000;321:366-371.
134.
Summary
The House of Commons Health Committee obtained a range of documents from five of the
advertising agencies which have accounts with the UK tobacco industry. These provide a unique
glimpse into the mindset and tactics of both tobacco advertisers and their clients.
...
The documents establish the following key points:
1. The aim is to increase consumption as well as brand share. ... The documents show how branding
and consumption are inextricably linked; that individual brands will gain from market expansion --
- 48 and therefore deliberate plans are made to encourage it; that efforts are made to enhance the social
acceptability of smoking per se, not just particular brands; and that the industry is actively involved
in increasing per capita consumption, recruiting new smokers and discouraging existing ones from
quitting.
...
3. The young are a key target, and imagery is the way to reach them. In many instances, care is taken
to refer to young adult smokers, but there is also an overwhelming recognition that young people and
the "youth market" are vital to commercial success. Their lifestyles, motivations and aspirations are
all the subject of detailed and continuous market research and everything possible is done to attract
and retain them. Specifically, again and again, the conclusion is drawn that young people smoke for
emotional reasons and that branding can meet these needs by adding aspiration, coolness and "street
cred" to the product. (p.4)
...
Sponsorship and advertising have become one. Sponsorship and advertising perform the same key
task of promoting the all important brand images that appeal to young smokers. (p.5)
Hastings, G., MacFadyen, L. “Keep Smiling: No One’s Going to Die; An Analysis of
Internal Documents from the Tobacco Industry’s Main UK Advertising Agencies”
London: Centre for Tobacco Control Research and Tobacco Control Resource Centre,
British Medical Association, 2000. [Prepared for the U.K. House of Commons Select
Committee on Health].
135.
Forty-nine percent of all youth aged 10-14 and 51% of those aged 15-19 report seeing
advertisements for events sponsored by tobacco corporations.(p.1)
...
Eighty-five percent of smokers and 83% of non-smokers agree that these “billboards and signs
are a way of advertising particular brands of cigarettes”. Finally, 43% of smokers and 58% of
non-smokers agree that these “billboards and signs are a way of encouraging people to smoke.”
(pp.1-2, Fact Sheet No.10)
Health Canada, “Youth Smoking Survey 1994”, Fact Sheet No. 10. See also Health
Canada, “Youth Smoking Survey 1994, Technical Report”, 1996.
136.
Tobacco-sponsored sports events on BBC TV are undermining the work of the Health Education
Authority, and the BBC itself, in trying to prepare young people to evaluate the risks that
smoking presents to them. When tobacco-sponsored sport says in the most seductive way that
smoking is a route to success, glamour and the most attractive values of life, how can health
education compete? (p.17)
Health Education Authority [U.K.], “Tobacco and the BBC: A review of how BBC TV
promotes cigarettes through tobacco-sponsored sport” 1992.
137.
This study examined the effects of a tobacco sponsorship advertisement on young males and
found that a single exposure to the advertisement reinforced existing behaviour among smokers,
created more favourable attitudes to smoking among non-smokers, increased non-smokers’ brand
awareness and influenced their brand preference. (p.25)
Hoek, J., Gendall, P., Stockdale, M. “Some Effects of Tobacco Sponsorship
Advertisements on Young Males” International Journal of Advertising, 1993;12:25-35.
- 49 138.
Results – Advertisements featuring the cartoon character Joe Camel were significantly more
appealing to both black and white students than were advertisements with human models and with
text only . . . Text only advertisements were significantly less appealing than other types of
advertisements among both black and white students…
Conclusion – This study provides further support for the year 2000 national objective to “eliminate
or severely restrict all forms of tobacco product advertising and promotion to which youth younger
than age 18 are likely to be exposed.” (p.249)
Huang, P.P., Burton, D., Howe, H.L., Sosin, D.M. “Black-white differences in appeal of
cigarette advertisement among adolescents” Tobacco Control, 1992;1:249-255.
139.
The wide exposure events enjoy in both electronic and print media provides sponsors with vast
publicity opportunities. For many companies, the cost of purchasing the TV and print exposure
their sponsorships garner would be unaffordable.
For example, for the cost of a 30-second spot on the Super Bowl telecast, a company can sponsor
a team on the NASCAR Winston Cup circuit, which delivers more than 30 hours of TV coverage.
...Brands with huge ad budgets and high unaided recall do not need sponsorship to generate
visibility. Instead, they often sponsor for the lifestyle association the sponsored property
represents.
They are looking to the event to have a rub-off effect on their image and ultimately their sales.
(p.10)
IEG, Inc. “IEG’s Complete Guide to Sponsorship: Everything you need to know about
sports, arts, event, entertainment and cause marketing” 1996.
140.
Regulations and Restrictions Affecting the Tobacco Industry
General
The advertising, sale and consumption of cigarettes and other tobacco products in many countries
including the UK has been subject to regulatory pressure from governments, health officials and
anti-smoking groups, principally due to claims that cigarette smoking and tobacco products are
harmful to health.
These actions have resulted in a number of substantial restrictions on the marketing, advertising
and consumption of cigarettes, which have been introduced by regulation or voluntary
agreements. In addition, activities by anti-smoking groups have been designed to curtail cigarette
sales and to diminish the social acceptability of smoking. Legislation imposing restrictions on
smoking in public places has also been enacted in a number of countries and some employers
have initiated restrictions or bans on smoking in the workplace.(pp.18-19)
...
Effect on volumes
The Directors believe that the various restrictions and regulations, together with the substantial
increases in excise taxes on smoking tobacco products, have had, and are likely to continue to
have, a detrimental effect on market size. Future profitability will depend on Imperial Tobacco’s
continuing ability to maintain brand margins, adapt production capability, increase efficiencies,
launch new products and expand internationally.
There can be no assurance that the governments in countries where Imperial Tobacco operates or
plans to operate will not adopt additional or more restrictive legislation or regulations that further
limit the ability of tobacco companies, including Imperial Tobacco, to develop, market or sell
- 50 their products. In particular, the UK Labour Party has indicated that, if it were elected, it would
intend to initiate a ban on tobacco advertising.(p.20)
Imperial Tobacco Group p.l.c. [U.K.] “Introduction to the Official List” 1996.
141.
[These ads show that similar lifestyle images have been used both in direct tobacco advertising
and in tobacco sponsorship advertising.]
Info-tabac, 1998, [examples of tobacco advertising and tobacco sponsorship advertising].
142.
Direct or indirect tobacco advertising, sponsorship and promotion help to create an environment that
lures non-users into trying tobacco, and subtly undermines users' decisions to try to stop. INGCAT
and other NGOs encourage all governments to enact and enforce complete bans on all forms of direct
or indirect tobacco advertising, sponsorship and promotions.
International Non Governmental Coalition Against Tobacco, “Position Statement About
Tobacco Advertising” 1998. [endorsed by organizations from 26 countries].
143.
[T]he IOC refuses to give its patronage to any advertising activity by the tobacco or alcohol
industry. Since the Olympic Winter Games in Calgary (Canada) in 1988, every edition of the
Olympic Games, including the XVIII Olympic Winter Games in Nagano, have been declared
“Smoke-free” in collaboration with the organizing committees.
International Olympic Committee, “Health and sport” Olympic Review, XXVI-20, AprilMay 1998, 52.
144.
The International Union Against Cancer in common with the World Health Organization and
leading health authorities throughout the world urge all countries to ban all forms of advertising
and promotion including sponsorship and other forms of indirect advertising. (p.3)
International Union Against Cancer (UICC); “The Case for Banning Advertising and
Promotion” UICC Tobacco Control Fact Sheet, March 1993.
145.
By the time they finish high school, nearly two-thirds (65.2%) of American young people who are
current smokers say they usually smoke Marlboro. Two other brands account for most of the
remainder – Newport (13.3%) and Camel (9.6%). These three brands account for 88.1% of the
current smokers in twelfth grade (another 4.1% say they have “no usual brand”). . . .
Among younger smokers . . . these three brands also predominated: They are the usual brand for
81.6% of the current smokers in eighth grade (another 9.7% have no usual brand), and 86.1% of
current smokers in tenth grade (where 6.4% say they have no usual brand). (p.3)
...
SUMMARY
In sum, the very high rates of cigarette smoking found among American teenagers in the late 1990s
are associated with the popularity of just three brands: Marlboro (a Philip Morris product), Newport
(a Lorillard product), and Camel (an RJR/Nabisco product). Perhaps not coincidentally, these have
been among the most heavily advertised and promoted cigarette brands, in particular Marlboro; and
also perhaps not coincidentally, two of them (Newport and Camel) have aggressively pursued youthoriented themes in their advertising – the “Alive with pleasure” theme and the Joe Camel theme,
respectively.
- 51 The clearly dominant brand, however, is Marlboro, which has successfully identified itself
with the American icon of the Western cowboy, as well as with certain competitive sports, like
Formula One racing.
...
Finally, the fact that so few of the current smokers in their teens do not already have a brand that they
usually smoke (10% of eighth graders, 6% of tenth graders, and 4% of twelfth-grade current
smokers) helps to illustrate why tobacco companies might have a compelling interest in having their
advertising and promotion reach underage children. (p.7)
Johnston, L.D., O'Malley, P.M., Bachman, J.G., Schulenberg, J.E. “Cigarette Brand
Preferences Among Adolescents” Monitoring the Future Occasional Paper 45, Ann
Arbor, MI, U.S.A, Institute for Social Research, University of Michigan, 1999.
146.
When legislation exists, the tobacco industry will do all it can to get round it. (p.552)
Joosens, L., “Strategy of the Tobacco Industry Concerning Legislation on Tobacco
Advertising in Some Western European Countries” In: Forbes, W.F., Frecker, R.C.,
Nostbakken, D., eds., Proceedings of the Fifth World Conference on Smoking and
Health, Winnipeg, Canada, 10-15 July 1983 (Ottawa: Canadian Council on Smoking and
Health, 1985), vol.1, pp.549-554.
147.
The purpose of this legislation was to avoid the Marlboro cowboy or the Camel traveller images
and to break the link tobacco products have acquired with attractive values such as friendship,
love, adventure, success, etc. However, the cowboy and the traveller reappeared in
advertisements for matches, lighters, etc. In some cases the tobacco industry used the same
picture before and after the legislation: what has been an advertisement for cigarettes, became an
advertisement for lighters ...
Nearly all Belgians (95%) are considering the advertisement for Marlboro lighters as
advertisement for Marlboro cigarettes, according to industry surveys. (p.469)
Joosens, L. “Success and Failure of the Legislative Action Against Smoking in Belgium”
In: Aoki, M., et al., eds. Smoking and Health 1987: Proceedings of the 6th World
Conference on Smoking and Health, Tokyo, Japan, 9-12 November 1987 (Amsterdam:
Elsevier Science Publishers, B.V. (Biomedical Division), 1987), pp.467-470.
148.
Many confidential marketing plans of the tobacco industry, which were revealed in court cases, have
shown that the industry was targeting young people. R.J. Reynolds internal documents, released in
January 1998, revealed for instance that the tobacco company sought to reverse its declining sales by
targeting 14-24 year olds. Memos described the success of the Joe Camel cartoon in France and
stated that the campaign was “about as young as you can get, and aims right at the young adult
smoker Camel needs to attract.” (p.5)
Joossens, L. “Why ban tobacco advertising in the European Union?” Brussels:
International Union Against Cancer, February 1998.
149.
Summary
The aim of indirect tobacco advertising is to promote or to reinforce the impact of the brand name
and its theme. Indirect tobacco advertising includes those advertisements for non-tobacco products
- 52 and services bearing the same name as well known tobacco brands and using the same advertising
techniques and "lifestyle" content as tobacco brands.
...
...It seems to be more logical that indirect advertising affects the promotion of tobacco products than
not at all. This is in line with the view of the Belgian Court (Cour d'Arbitrage) in 1999: "Whatever
may be the purpose to market products with the same brand name as known tobacco products, the
advertising for these products has the consequence to promote the brand also and can be considered
as an indirect way of advertising tobacco products." (p.15)
Joossens, L. “How to circumvent tobacco advertising restrictions: The irrelevance of the
distinction between direct and indirect advertising” Brussels: International Union Against
Cancer, March 2001.
150.
Because the FDA also seeks to reduce demand for tobacco products by young people, the
rule includes a comprehensive set of restrictions on tobacco advertising and promotion. The reason
is simple: tobacco products are among the most heavily advertised products in this country and
studies show that young people are particularly susceptible to the messages. (p.885)
...
In addition to traditional advertising media, evidence has shown that nontraditional forms of
advertising and promotion are instrumental in affecting young people's attitudes towards and use of
tobacco. ... Therefore, the agency determined that hats, tee shirts, and other specialty items bearing
brand names or logos must be prohibited.
… The sponsorship of an event in a brand name associates adventure, risk-taking, and hero worship
with the brand and contributes to a perception that tobacco use is acceptable and commonplace.
(p.886)
Kessler, D.A., Wilkenfeld, J.P., Thompson, L.J. “The Food and Drug Administration’s
Rule on Tobacco: Blending Science and Law” Pediatrics, 1997;99(6):884-887.
151.
It was concluded that, over nearly a decade, cigarette brands popular among youths were more likely
than adult brands to advertise in magazines with high youth readerships. (p.331)
King, C., Siegel, M. “Brand-specific cigarette advertising in magazines in relation to
youth and young adult readership, 1986-1994” Nicotine and Tobacco Research,
1999;1(4):331-340.
152.
Cigarette brands popular among young adolescents are more likely than adult brands to advertise
in magazines with high youth readerships.(p.516)
...
Based on the documentation in this and other studies of widespread and heavy exposure of youths
to cigarette advertising in magazines, public health considerations argue that cigarette advertising
in all magazines should be eliminated.(p.520)
King, C., Siegel, M., Celebucki, C., Connolly, G.N. “Adolescent Exposure to Cigarette
Advertising in Magazines: An Evaluation of Brand-Specific Advertising in Relation to
Youth Readership” Journal of the American Medical Association, 1998;279(7):516-520.
153.
[O]ur findings provide new evidence that black adolescents are preferentially exposed to advertising
by those cigarette brands that are most popular among black adolescent smokers. This finding, when
- 53 combined with the results of studies on the effect of cigarette marketing on smoking initiation, has
important implications for public health policy. It suggests that cigarette advertising may influence
smoking initiation among black youths. To counteract rising rates of smoking among black youths,
public health interventions that reduce or eliminate exposure of these youths to cigarette advertising
in magazines and other media may be beneficial. (p.70)
King, C., Siegel, M., Pucci, L.G. “Exposure of black youths to cigarette advertising in
magazines” Tobacco Control, 2000;9(1):64-70.
154.
All considered, we have found that the advertisements appearing in A-Magasinet for “Camel
Boots” constituted an infringement of the advertising ban of the Tobacco Act. A-Magasinet has
been informed accordingly by the Ministry of Social Affairs and the advertising of Camel Boots
has ceased. (p.570)
Kjonstad, A. “The Tobacco Industry and the Ban on Advertising” In: Forbes, W.F.,
Frecker, R.C., Nostbakken, D., eds., “Proceedings of the Fifth World Conference on
Smoking and Health” Winnipeg, Canada, 10-15 July 1983, (Ottawa: Canadian Council
on Smoking and Health, 1985), vol. 1, pp.567-573.
155.
This study examined relationships between cigarette advertising and smoking experimentation.
Using environmental and psychological measures of advertising exposure, it was demonstrated
that adolescents who experimented with cigarettes were better able to recognize advertised
products than those who had not, a selective exposure effect. Conversely, subjects who were
better at recognizing advertised brands were more likely to have experimented with cigarettes, an
effect due to their exposure to cigarette advertising.(p.287)
...
[I]t appears that exposure to smoking advertisements does affect the likelihood that young people
will smoke.(p.296)
Klitzner, M., Gruenewald, P.J., Bamberger, E. “Cigarette advertising and adolescent
experimentation with smoking” British Journal of Addiction, 1991;86(3):287-298.
156.
On several occasions during my tenure as Surgeon General, I endorsed proposals that would ban
all tobacco advertising and promotion. I certainly support the proposal to restrict tobacco
advertising as a reasonable compromise, although I would continue to endorse a total advertising
ban as a long-term goal. (p.2894)
Koop, C.E. “A Parting Shot at Tobacco” Journal of the American Medical Association,
1989;262(20):2894-2895.
157.
Smoking among young people is an important public health problem. Although the causes are
multifactorial, in Hong Kong environmental tobacco advertising is an important risk factor that
can be removed by banning all forms of tobacco promotion to young people. (p.217)
Lam, T.H., Chung, S.F., Betson, C.L., Wong, C.M., Hedley, A.J. “Tobacco
Advertisements: One of the Strongest Risk Factors for Smoking in Hong Kong Students”
American Journal of Preventive Medicine, 1998;14(3):217-223.
- 54 158.
TV sports sponsorship by tobacco manufactures acts as cigarette advertising to children and
therefore circumvents the law banning cigarette advertisements on TV. (p.85)
Ledwith, F. “Does Tobacco Sports Sponsorship on Television Act as Advertising to
Children?” Health Education Journal, 1984;43(4):85-88.
159.
Conclusions
The preceding analysis shows that exposure to promotion is a significant predictor for susceptibility
to smoking among non-smokers, even after removal of variance explained by school level,
rebelliousness, parental, peer and reference group norms, perceived benefits and positive social
images of smoking. The analysis suggests that while exposure to tobacco promotion is correlated to
other risk factors for smoking uptake, tobacco promotion has an independent influence on
susceptibility to smoking. The findings support concerns about the effect of tobacco promotion on
youth. Regardless of whether the promotions are intended for adults or minors, they reach youth and
clearly serve as additional risk factors for smoking uptake. (p.356)
Lee, H., Buller, D., Chassin, L., Kronenfeld, J., MacKinnon, D. “Influence of cigarette
promotion on mediators of smoking” In: Lu, R., Mackay, J., Niu, S., Peto, R., eds., The
Growing Epidemic: Proceedings of the Tenth World Conference on Tobacco or Health,
(London: Springer-Verlag London Limited, 2000) 24-28 August 1997, Beijing, China,
pp.353-357.
160.
Results -- Almost 20% of the billboards contained tobacco advertising. Four of the top five and nine
of the top 22 brands displayed on billboards were tobacco products. Billboards were located in all
areas of St Louis except for the communities with the highest average incomes. Tobacco billboards
were more likely to be found in low income areas and areas with a higher percentage of African
Americans. Images of African American figures on tobacco billboards were concentrated in the
most heavily African American populated regions of the city. Approximately 74% of all billboards
in the city of St Louis were within 2000 feet (700 metres) of public school property.
Conclusions -- Tobacco products were the single most heavily advertised type of product on
billboards in St Louis. The geographic distribution of tobacco billboards, as well as the types of
images found on these billboards, is consistent with the hypothesis that tobacco companies are
targeting poor and minority communities with their advertising. (p.16)
Luke, D., Esmundo, E., Bloom, Y. “Smoke signs: Patterns of tobacco billboard
advertising in a metropolitan region” Tobacco Control, 2000;9(1):16-23.
161.
Results: There was a high level of awareness of and involvement in tobacco marketing among 15-16
year olds sampled in the study: around 95% were aware of advertising and all were aware of some
method of point of sale marketing. Awareness of and involvement with tobacco marketing were
both significantly associated with being a smoker: for example, 30% (55/185) of smokers had
received free gifts through coupons in cigarette packs, compared with 11% (21/199) of non-smokers
(P<0.001). When other factors known to be linked with teenage smoking were held constant,
awareness of coupon schemes, brand stretching, and tobacco marketing in general were all
independently associated with current smoking status.
Conclusions: Teenagers are aware of, and are participating in, many forms of tobacco marketing, and
both awareness and participation are associated with current smoking status. This suggests that the
current voluntary regulations designed to protect young people from smoking are not working, and
that statutory regulations are required. (p.513)
- 55 MacFadyen, L. Hastings, G. and MacKintosh, A.M. “Cross sectional study of young
people’s awareness of and involvement with tobacco marketing” British Medical Journal
2001;322:513-517.
162.
As there is ample evidence of the harmful effects of cigarette advertising on children’s attitudes
and behaviour, the first step is to ban all forms of tobacco advertising and sponsorship. (p.236)
Mélihan-Cheinin, P., Hirsch, A. “Effects of Smoke-Free Environments, Advertising Bans
and Price Increases” In: Bolliger, C.T., Fagerström, K.-O., eds., The Tobacco Epidemic,
Progress in Respiratory Research, 1997;28:230-246.
163.
Cigarette advertising is a major factor in influencing children, it is readily available to them and
some advertisements seem positively to be directed towards the young. The image which
children perceive from the advertisement is very strong and affects non-smoking children equally
as it does smokers. More attention clearly needs to be paid to the overwhelming evidence of the
effect of advertising and pressure put on governments to ban, or at least limit, the advertising of
cigarettes where children are likely to be influenced by them. (p.275)
Mindell, J. “Review: Direct Tobacco Advertising and its Impact on Children” Journal of
Smoking-Related Diseases, 1992:3(3):275-284.
164.
[A]ll tobacco sponsorship for international sporting events held in Australia will be phased out by
2006. (p.1)
Minister for Health and Family Services (Australia), “All Tobacco Sponsorship To Go by
2006”, The Hon. Dr. Michael Wooldridge -- Minister for Health and Family Services,
September 22, 1998 [media release].
165.
Settling Defendants agree to discontinue all Billboards and Transit Advertisements of Tobacco
Products in the State. . . .
Settling Defendants shall not make, in the connection with any motion picture made in the United
States, or cause to be made any payment, direct or indirect, to any person to use, display, make
reference to, or use as a prop any cigarette, cigarette package, advertisement for cigarettes, or any
other item bearing the brand name, logo, symbol, motto, selling message, recognizable color or
pattern of colors, or any other indicia of product identification identical or similar to, or identifiable
with, those used for any brand of domestic tobacco products. (p.14 of internet print out)
On and after December 31, 1998, Settling Defendants shall permanently cease marketing, licensing,
distributing, selling or offering, directly or indirectly, including by catalogue or direct mail, in the
State of Minnesota, any service or item (other than tobacco products or any item of which the sole
function is to advertise tobacco products) which bears the brand name (alone or in conjunction with
any other word), logo, symbol, motto, selling message, recognizable color or pattern of colors, or any
other indicia of product identification identical or similar to, or identifiable with, those used for any
brand of domestic tobacco products. (pp.14-15)
Minnesota [State of], Philip Morris Inc., R.J. Reynolds Tobacco Company, Brown &
Williamson Tobacco Corporation, Lorillard Tobacco Company, “Settlement Agreement and
Stipulation for Entry of Consent Judgement” May 8, 1998, accessed March 29, 2001,
http://stic.neu.edu/MN/settlement.htm
- 56 166.
Experience with tobacco industry self-regulation of tobacco product advertising and promotion,
whether through voluntary codes or voluntary agreements, has proved to be less restrictive then
legislative approaches. While the threat of more stringent legislation has often moved the
industry to voluntarily become more restrictive, the industry proposals seek the minimum
restrictions it deems would be acceptable in the current context.(p.25)
...
The case that voluntary codes or agreements are appropriate for tobacco product advertising and
promotion cannot be made. It therefore must be concluded that governments should use carefully
drafted and comprehensive legislation, which is then enforced, if they wish to seriously restrict
advertising and promotion to achieve their health objectives.(p.26)
Mitchell, B. “Restricting Advertising and Promotion of Tobacco Products: An Overview
of Voluntary Agreements as an Alternative to Legislation” Ontario Tobacco Research
Unit, Working Papers Series # 34, Toronto, 1998.
167.
Former Surgeon General Joycelyn Elders has said that tobacco advertising aims to convince
children “that they’re slim, they’re sexy, they’re sociable, they’re sophisticated, and they’re
successful. The teenager gets an image, and the tobacco companies get an addict.” (p.1)
...
David Goerlitz, a model who became known as the “Winston Man”, reported during a photo
session that he was surprised when he found out that none of the R.J. Reynolds executives
attending were smokers. “Are you kidding?” one of the executives said. “We reserve that right
for the poor, the young, the black and the stupid.” (p.26)
Moyer, D., “The Tobacco Reference Guide” 2000, published on UICC Globalink July 7,
2000, chapter 28, “Advertising”, available http://www.globalink.org/tobacco/trg/
168.
Let us take an example. I may make dynamite. There are people who wish to use my product
and thus I have it available for sale. Yet I know it is very dangerous, especially in the wrong
hands, like those of young people. So I do not go on T.V. and radio, and take ads in all
newspapers and magazines, to encourage everyone I the viewing and reading public to buy
dynamite, and moreover buy as much of it as they can.
Yet almost every minute of every day, we are urged, coaxed, and cajoled to buy a variety
of different brands of a potentially dangerous product – namely cigarettes. We know that the
consumption of this product contributes to cancer, heart disease, emphysema and other serious
diseases. Yet to the contrary, on the ads we are told that cigarettes increase pleasure,
attractiveness, sophistication, and sexual potency.
While I believe that cigarettes should be available, I do not agree that we should
deliberately and enthusiastically encourage their use – especially without a counter-voice to
present the other side of the picture. Advertising, however, does in fact encourage smoking and
makes it appear desirable. For that reason I feel that this Committee should look at all the
possible ways that cigarette advertising can be strongly controlled. (p.130)
Munro, J. (Canadian Minister of National Health and Welfare), House of Commons
Standing Committee on Health, Welfare and Social Affairs, Minutes of Proceedings and
Evidence No. 9, December 19, 1968, pp.127-142.
- 57 169.
[This document cites internal industry documents discussing advertising targeted to youth, and
advertising countering health concerns. One example is Document A901268 – May 26, 1975
“What Have We Learned From People? A Conceptual Summarization of 18 Focus Group
Interviews on the Subject of Smoking”, which states in part “In the young smoker’s mind a
cigarette falls into the same category with wine, beer, shaving, wearing a bra (or purposely not
wearing one), declaration of independence and striving for self-identity. For the young starter, a
cigarette is associated with introduction to sex life, with courtship, with smoking ‘pot’ and
keeping late studying hours.” (pp.8.60-8.61)]
Myers, M.L., Iscoe, C., Jennings, C., Lenox, W., Minsky, E., Sacks, A. “Federal Trade
Commission Staff Report on the Cigarette Advertising Investigation” May 1981, excerpt
published 1988, Tobacco Products Litigation Reporter 1988;3(6):8.59 - 8.67.
170.
The results indicate that a very high percentage of children read, or look at, most newspapers and
magazines belonging to their parents or other adult members of the family. The majority of these
children were aware of the cigarette advertisements contained in them and could correctly recall the
brands most frequently advertised. Awareness was highest among children who smoked, but 60 per
cent of all children who had never smoked had also seen and remembered cigarette advertisements.
. . . The four brand names most frequently identified by all children, whatever their smoking habits,
were those most frequently advertised in colour. The children were less likely to remember
advertisements printed in black and white and those with a ‘tombstone’ format. The need for a total
ban on cigarette advertisements in the national press, or legislation to limit their content and format,
is indicated. (p.12)
Nelson, E., Charlton, A. “Children and advertising: does the Voluntary Agreement work?”
Health Education Journal 1991;50(1):12-15.
171.
The purpose of A Catalogue of Deception is to show conclusively that the tobacco industry has never
taken its advertising code seriously. The code has simply provided the industry with a public
relations exercise aimed at delaying any effective regulation of the promotion of tobacco. It is absurd
that a government could have expected honesty from an industry whose very existence is predicated
on the suffering and death of thousands of those who use its products. (p.2)
Non-Smokers’ Rights Association [Canada], “A Catalogue of Deception: The use and
abuse of voluntary regulation of tobacco advertising in Canada; A report for submission
to The Honourable Jake Epp, Minister of Health and Welfare Canada” January 1986.
172.
Sponsorships create a comfort level for the decision to smoke, implicitly suggesting that
significant organizations and influential role models are comfortable with their association with
tobacco products and with the risks they entail. (p.7)
Non-Smokers’ Rights Association [Canada], “What the Tobacco Manufacturers Do Not
Want You to Know About Tobacco Sponsorship of the Arts... Corporate Philanthropy?
Or selling addiction?” 1996.
173.
Our data suggest to us that intervention in the field of cigarette advertising may be the most direct
and effective means of reducing the prevalence of smoking in children. After the smoking
behaviour of the child’s friends, approval of cigarette advertising was the strongest correlate of
childhood smoking. (p.230)
- 58 O’Connell, D.L., Alexander, H.M., Dobson, A.J., Lloyd, D.M., Hardes, G.R.,
Springthorpe, H.J., Leeder, S.R. “Cigarette Smoking and Drug Use in Schoolchildren. II
Factors Associated With Smoking,” International Journal of Epidemiology,
1981;10(3):223-231.
174.
The history of tobacco marketing portrays a strong relationship between cigarette advertising
targeted to women and the rise in the prevalence of women smoking. ... [T]he tobacco industry
understood and capitalized on the women’s liberation movement to sell cigarettes as symbols of
freedom and emancipation... (p.67)
O'Keefe, A.M., Pollay, R.W. “Deadly Targeting of Women in Promoting Cigarettes”
Journal of the American Medical Women's Association, 1996;51(1-2):67-69.
175.
Conclusions: Underage youths are viewed by the tobacco industry as critical to its future. Underage
youth smoking patterns were examined for decades. Reductions in youth smoking rates were seen
by tobacco companies as a negative trend for the companies. Specific marketing campaigns were
directed at underage youth and were successful with this age group.
...
As an expert witness for the State of Minnesota, I examined hundreds of industry documents related
to youth smoking. These documents, along with published literature, formed the basis of my
testimony on youths and smoking. The major opinion of this testimony was that the actions of
tobacco companies were a substantial factor in causing underage youths (<18 years old) to
smoke.(p.935)
...
[A]s an RJR document points out, most smokers begin smoking regularly and select a usual brand at
18 years or younger. (p.940)
Perry, C.L. “The Tobacco Industry and Underage Youth Smoking: Tobacco Industry
Documents from the Minnesota Litigation” Archives of Pediatric and Adolescent
Medicine, 1999;153:935-941.
176.
[This study examined primary school children, mean age 10.3.] Brand recognition ranged from
53% (Salem name) to 95% (Marlboro name and Salem logo). [E]ver smokers ... were more
successful than never smokers in identifying cigarette brands. ... Smoking is a paediatric health
problem in Hong Kong; tobacco advertisements are widely recognised by young children and
associated with smoking experience. A total ban on environmental advertising is needed as part
of a comprehensive policy for the prevention of smoking-related disease in Hong Kong. (p.150)
Peters, J., Betson, C.L., Hedley, A.J., Lam, T.-H., Ong, S.-G., Wong, C.-M., Fielding, R.
“Recognition of cigarette brand names and logos by young children in Hong Kong”
Tobacco Control, 1995;4(2):150-155.
177.
The following rules would apply to all tobacco products sold in the U.S. (including all its
territories and possessions, as well as duty-free shops within U.S. borders).
...
As in the FDA rule, the new regime would:
 Prohibit the use of non-tobacco brand names of tobacco products except for tobacco products
in existence as of January 1, 1995 . . .
- 59 

Restrict tobacco product advertising to FDA specified media . . .
Restrict permissible tobacco product advertising to black text on a white background except
for advertising in adult-only facilities and in adult publications . . .
...
 Ban all non-tobacco merchandise, including caps, jackets or bags bearing the name, logo or
selling message of a tobacco brand . . .
 Ban offers of non-tobacco items or gifts based on proof of purchase of tobacco products . . .
(p.8)
 Ban sponsorships, including concerts and sporting events, in the name, logo or selling
message of a tobacco brand . . .
Further, building on and going beyond the FDA rule, the new regime would:
 Ban the use of human images and cartoon characters – thereby eliminating Joe Camel and the
Marlboro Man – in all tobacco advertising and on tobacco product packages
 Ban all outdoor tobacco product advertising, including in enclosed stadia as well as brand
advertising directed outside from a retail establishment . . .
 Prohibit tobacco product advertising on the Internet unless designed to be inaccessible in or
from the United States
 Establish nationwide restrictions in non adult-only facilities on point of sale advertising with
a view toward minimizing the impact of such advertising on minors. These provisions, which
are detailed in Appendix VII . . .
 Ban direct and indirect payments for tobacco product placement in movies, television
programs and video games.
 Prohibit direct and indirect payments to “glamorise” tobacco use in media appealing to
minors, including recorded and live performances of music (p.9)
...
Appendix VII – Restrictions on Point of Sale Advertising (p.63)
...
1. There shall be no Point of Sale Advertising of tobacco products, excluding adults-only stores
and tobacco outlets, except as provided herein:
A. Each manufacturer of tobacco products may have not more than two separate point of sale
advertisements in or at each location at which tobacco products are offered for sale, except any
manufacturer with 25 percent of market share may have one additional point of sale
advertisement. A retailer may have one sign for its own or its wholesaler’s contracted house
retailer or private label brand. . . .
B. Point of Sale advertisements permitted herein each shall be of a display area not larger than
576 square inches (either individually or in the aggregate) and shall consist of black letters on
white background or recognized typographical marks.
Point of Sale advertisements shall not be attached to nor located within two feet of any fixture on
which candy is displayed for sale. Display fixtures are permitted signs consisting of brand name
and price, not larger than 2 inches in height.
2. Except as provided herein, Point of Sale Advertising shall mean all printed or graphical
materials bearing the brand name (alone or in conjunction with any other word), logo, symbol,
motto, selling message, or any other indicia of product identification identical or similar to, or
identifiable with, those used for any brand of cigarettes or smokeless tobacco, which, when used
for its intended purpose, can reasonably be anticipated to be seen by customers at a location at
which tobacco products are offered for sale.
- 60 3. Audio and video formats otherwise permitted under the FDA Rule may be distributed to adult
consumers at point of sale but may not be played or shown at point of sale (i.e., no “static video
displays”). (p.63)
Philip Morris Incorporated, R.J. Reynolds Tobacco Company, Brown and Williamson
Tobacco Corporation, Lorillard Tobacco Corporation, Attorneys General from 40 U.S.
states, et al. “Proposed Resolution”, June 20, 1997 [Proposed out-of-court settlement
agreed to by tobacco manufacturers and state Attorneys General. The agreement required
congressional approval to be implemented, something that did not occur.].
178.
“[W]e are willing to accept these restrictions in order to find the common ground. We are willing
to accept these restrictions so something can be done now,” Parrish said.
The plan also would ban tobacco product brand names, logos, characters and selling messages on
non-tobacco-related items such as hats or T-shirts; ban tobacco product sponsorship of events
with significant youth audiences; create tobacco-free ad zones by banning all outdoor tobacco
product advertising within 1,000 feet of any playground or elementary or secondary school,
including outward-facing window display advertising; ban tobacco product advertising in or on
trains, buses, subways and taxis, and in terminals, stations, platforms or stops for these vehicles;
and guarantee that there would be no tobacco product advertising in youth-oriented publications.
(p.2)
Philip Morris U.S.A., “Philip Morris U.S.A. Calls for Federal Legislation to Stop
Underage Smoking; Company Outlines Comprehensive Blueprint for Immediate Action”,
15 May 1996 [news release]. See also accompanying documents: “Remarks by Steve
Parrish Philip Morris/UST Press Conference, May 15, 1996”; “Elements of Philip Morris
U.S.A.’s and United States Tobacco Company’s Comprehensive Plan to Combat
Underage Tobacco Use”; “Side-By-Side Comparison of Philip Morris U.S.A. and United
States Tobacco Company Plan with FDA’s Proposed Rule”.
179.
It was found that children who had viewed the Master’s Snooker Tournament sponsored by Benson
and Hedges were more likely to recall the brand than non-viewers. This replication of previous
findings was extended to include the effects of sponsored sport on smoking, after allowing for
personality and social factors known to influence the frequency of smoking, after allowing for
personality and social factors known to influence the frequency of smoking. Association between
recall, other advertising variables and smoking were positive in all but one instance after allowing for
the effects of controls. (p.145)
Piepe, A., Charlton, P., Morey, J., Yerrell, P., Ledwith, F. “Does sponsored sport lead to
smoking among children?” Health Education Journal 1986;45(3):145-148.
180.
[T]his longitudinal study adds a crucial piece of evidence to the contention that tobacco industry
advertising and promotional activities are causally associated with young people starting to
smoke. The 5 criteria for assessing causality of a suspected agent from epidemiological studies
are that (1) it must clearly precede the hypothesized effect; (2) the association should be strong;
(3) consistent, and (4) specific; and (5) it should be expected from theory. From this study it is
clear that the effect of advertising precedes the development of susceptibility to smoking. The
effect is strong and specific, with at least 34% of experimentation with cigarettes attributed to
- 61 these activities. The association is consistent with other studies. Finally, such a causal effect is
expected from theoretical consideration of how persuasive communications work. (p.515)
Pierce, J.P., Choi, W.S., Gilpin, E.A., Farkas, A.J., Berry, C.C., “Tobacco Industry
Promotion of Cigarettes and Adolescent Smoking” Journal of the American Medical
Association, 1998;279(7):511-515.
181.
[This article validates susceptibility to smoking as a predictor of adolescents taking up smoking.]
Pierce, J.P., Choi, W.S., Gilpin E.A., Farkas, A.J., Merritt, R.K. “Validation of
Susceptibility as a Predictor of Which Adolescents Take Up Smoking in the United
States” Health Pscychology, 1996;15(5):355-61.
182.
3. Adolescents who are receptive to tobacco advertising are more likely than adolescents who are
not receptive to be susceptible to smoke in the future.
4. Tobacco advertising and marketing practices are an important and independent predictor of
smoking uptake. The effect of tobacco marketing on susceptibility is at least as large as the effect
of exposure to peers or family members who smoke. (p.101)
Pierce, J.P., Evans, N., Farkas, A.J., Cavin, S.W., Berry, C., Kramer, M., Kealey, S.,
Rosbrook, B., Choi, W., Kaplan, R.M. Tobacco Use in California. An Evaluation of the
Tobacco Control Program, 1989-1993 (La Jolla, California: University of California, San
Diego, 1994).
183.
Summary of Findings
1. Tobacco advertising reaches the very young. Audience awareness of cigarette advertising for
the most popular brands is already well established in young adolescence. More that 90% of 12to 13-year-old children could nominate a brand that was advertised. The cigarette brands most
frequently recalled were Camel and Marlboro.(p.119)
...
4. Evidence suggests that tobacco advertising may encourage teenagers to smoke by associating
smoking with benefits that they want. Adolescents across age groups were overwhelmingly in
agreement that tobacco advertising promotes specific benefits of smoking. The more cigarette
advertisements adolescents recalled, the more likely adolescents were to believe that advertising
promotes the benefits suggested in the survey.
5. Cigarette advertising appears to be a powerful independent source of information about the
benefits of smoking for adolescents, beyond the information they receive from smokers they
know. Cigarette advertising was especially associated with attributions that smoking was
beneficial for increasing confidence in social settings and in weight control. Having a smoker in
the social environment was especially associated with the attribution that relaxation was a benefit
of smoking.(p.120)
Pierce, J.P., Farkas, A., Evans, N., Berry, C., Choi, W., Rosbrook, B., Johnson, M., Bal,
D.G. Tobacco Use in California 1992. A Focus on Preventing Uptake in Adolescents.
(Sacramento, California: California Department of Health Services, 1993).
184.
This article presents evidence for sex-specific temporal associations between major cigarette
marketing campaigns and increases in youth smoking initiation using national survey data for
1910-1977.(p.500)
- 62 ...
Tobacco marketing builds adolescent demand, and, hence, urgent public policy action is needed
to extend the broadcast advertising ban to all tobacco marketing practices, including print and
billboard advertising, sponsorships, sale or give-away of promotional merchandise, and point-ofsale advertising displays. (p.507)
Pierce, J.P., Gilpin, E.A. “A Historical Analysis of Tobacco Marketing and the Uptake
of Smoking by Youth in the United States: 1890-1977” Health Psychology,
1995;14(6):500-508.
185.
Results -- Although Camel advertisements were favoured more than Marlboro and other brands in
1993 and 1996, the "market share" for promotional items shifted markedly during this period from
Camel and other brands towards Marlboro. We estimated that between 1988 and 1998, there will be
7.9 million new experimenters because of tobacco advertising and promotions. This will result in 4.7
million new established smokers: 2.1, 1.2 and 1.4 million due to Camel, Marlboro, and other brands'
advertising and promotions, respectively. Of these, 1.2 million will eventually die from smokingattributable diseases: 520 000 from Camel, 300 000 from Marlboro, and the remainder from other
brands. (p.37)
Pierce, J.P., Gilpin, E.A., Choi, W.S. “Sharing the blame: smoking experimentation and
future smoking-attributable mortality due to Joe Camel and Marlboro advertising and
promotions” Tobacco Control, 1999;8(1):37-44.
186.
Perception of advertising is higher among young smokers; market-share patterns across age and
sex groups follow the perceived advertising patterns; and changes in market share resulting from
advertising occur mainly in younger smokers. Cigarette advertising encourages youth to smoke
and should be banned. (p.3154)
Pierce, J.P., Gilpin, E., Burns, D.M., Whalen, E., Rosbrook, B., Shopland, D., Johnson,
M. (1991). “Does Tobacco Advertising Target Young People to Start Smoking? Evidence
from California” Journal of the American Medical Association, 1991;266(22):3154-3158.
187.
34% of adolescent experimentation with cigarettes in California can be attributed to tobacco
industry advertising and promotional activities. In 1996, over 200,000 California adolescents
experimented with smoking; 68,000 did so because of tobacco industry advertising and
promotions. (p.I-v)
Pierce, J.P., Gilpin, E.A., Emery, S.L., Farkas, A.J., Zhu, S.H., Choi, W.S., Berry, C.C.,
Distefan, J.M., White, M.M., Soroko, S.; Navarro, A. Tobacco Control in California:
Who’s Winning the War? An Evaluation of the Tobacco Control Program, 1989-1996
(La Jolla, CA.: University of California, San Diego, 1998).
188.
In girls younger than 18 years, smoking initiation increased abruptly around 1967, when tobacco
advertising aimed at selling specific brands to women was introduced. (p.608)
Pierce, J.P., Lee L., Gilpin, E.A. “Smoking Initiation by Adolescent Girls, 1944 Through
1988. An Association with Targeted Advertising” Journal of the American Medical
Association, 1994;271(8):608-611.
- 63 189.
Content analysis of 394 Canadian cigarette ads from 1987 finds that, despite full legislation
freedom to be informative, there is very little information manifest in ads. The healthiness of the
product and the associated life styles of its consumers is displayed in several ways, typically
visuals of bold and lively behaviour in pure and pristine environments, sometimes with
descriptors like “light” or “ultra-mild.” More than two thirds of the ads manifest healthfulness in
one or more of these ways.(p.74)
...
Canadian cigarette advertising in 1987 contained absolutely no information about the price or
special deals, nor any information about research or surveys on cigarette qualities and
performance, nor any information about the tobacco ingredients, nor any information about the
filter attributes or performance, nor any information about the additives used, nor any voluntary
information about the health consequences of smoking.(p.78)
Pollay, R.W., “Information and Imagery in Contemporary Canadian Cigarette Ads” In:
Stout, P., ed., Proceedings of the American Academy of Advertising, (Austin, Texas:
University of Texas, 1990), pp.74-79.
190.
Publicity has long played a key role in promoting the public acceptance of cigarettes. Its role
changed in response to the ‘health scare’ of the 1950s, from the recruitment of new (women)
smokers to the retention of existing (concerned) smokers and supporting legal and political
battles. (p.39)
Pollay, R.W. “Propaganda, Puffing and the Public Interest” Public Relations Review,
1990;16:(3):39-54.
191.
Content analysis shows that the bulk of cigarette advertising in both the US and Canada displays
healthfulness through a variety of symbolic means. (p.160)
Pollay, R.W. “Signs and Symbols in American Cigarette Advertising: A Historical
Analysis of the Use of ‘Pictures of Health’ ” In: Hartvig-Larsen, H., Mick, D.G., Alsted,
C., eds., Marketing & Semiotics: Selected Papers from the Copenhagen Symposium
(Copenhagen: Handelshojskolens Forlag, 1991), pp.160-176.
192.
The amount of cigarette sponsorship in prime time slots [on U.S. television in 1963] was
significantly correlated with the delivered proportions of teenagers, not adults. (p.130)
Pollay, R.W. “Exposure of US youth to cigarette television advertising in the 1960s”
Tobacco Control, 1994;3(2):130-133.
193.
A descriptive history reveals the strategic interest in the young manifested by the cigarette
industry from 1920 to the present. The tobacco and advertising trade presses, FTC records and
recently disclosed corporate documents display and discuss the targeting of adolescents and
collegians. They also document the rationale and results of media choices, the use of cartoons,
and especially the use of images of independence to appeal to the psychological need of
adolescents. (p.1)
Pollay, R.W. “Targeting Tactics in Selling Smoke: Youthful Aspects of 20th Century
Cigarette Advertising” Journal of Marketing Theory and Practice, 1995;3(1):1-22.
- 64 194.
[This article reports on an ad for BUZ cigarettes featuring two mostly naked, semi-covered
women.]
Pollay, R.W. “The BUZ in Canada without an ad ban” Tobacco Control, 1995;4(4):397398.
195.
Conclusions:
1. Cigarette marketing targeting women has a history spanning more than seven decades,
beginning in the 1920s.
2. Cigarette marketing targeting women over the years has been consistently predominated by a
durable theme in associating cigarettes with fashion, status and stylishness.
3. Cigarette marketing targeting women over the years has been consistently predominated by a
durable theme in associating cigarettes with slimness and weight control. More recently, this has
been extended to associating cigarette brands with the concept of “superslim”.
4. Cigarette marketing targeting women has often appealed to a consumer attitude of
rebelliousness, as displayed by the flappers of the 1920s, the “rebellious, but unliberated”
Virginia Slim, the “Slim ‘n Sassy” Misty smoker, and the “fun-loving rebel” in Dakota’s brand
image.
5. Cigarette marketing targeting women now focuses on increasingly precise narrow segments of
women, defined by lifestyle patterns, values and attitudes, and labelled with key traits or
predispositions, e.g. “virile females” and “the vulnerables”.
6. Cigarette marketing targeting women is now shaped by extensive consumer research
influencing many aspects of the marketing mix: product forms, packaging design and colours,
advertising imagery, and lifestyle research to choose promotional events.
7. Some cigarette marketing targeting women now relies on promotional events, not just media
advertising, because these are “tightly targeted, extremely impactful.”
8. Women have proven to be responsive to cigarette marketing. While not all brands seeking
their trade can succeed simultaneously, substantial success was realized by associating cigarettes
with slimness beginning in the 1920s, and by the Virginia Slims campaign of the late 1960s. In
addition, women were the first to embrace product innovations such as king-size cigarettes,
menthol, charcoal, and recessed filters. (pp.20-21)
Pollay, R.W. “You’ve Come the Wrong Way, Baby! Chapters in the Continuing Saga of
Cigarette Advertising Targeting Women” Working Paper 95.5, History of Advertising
Archives, October 1995.
196.
The tobacco industry is all too interested in corralling the young, and everywhere that's the case.
... And that's almost unavoidable. One key reason for that is the phenomenal brand loyalty in this
product category. There is very little brand switching. Brand patterns get established among the
young and, once you've got a customer as a youth, you tend to hold onto the customer. Of thirtyeight products studied by the J. Walter Thompson ad agency, cigarettes have the highest brand
loyalty. Less than ten percent of smokers will switch in any given year. And even those people
who do switch are not only few in number, but they are fickle in character and frail. They are not
a very attractive segment. They are nowhere near as attractive as the adolescent who will
continue to smoke for years. (p.261)
Pollay, R., "Tricks of the Tobacco Trade" Journal of Business Administration and Policy
Analysis, 1996/98;24-26:229-266.
- 65 197.
The cigarette industry has not voluntarily employed its advertising to inform consumers in a
consistent and meaningful way about any of the following (1) the technologies employed in
fabricating the products, (2) the constituents added in the manufacturing processes, (3) the
residues and contaminants that may be present in the combustible column, (4) the constituents of
smoke that may be hazardous, (5) the addictiveness of nicotine, or (6) the health risks to which its
regular consumers are inevitably exposed. Their advertising for reduced yield products, instead,
has relied on pictures of health and unnecessarily vague images of intelligence, and has misled
consumers into believing filtered products in general, and low tar products in specific, to be
safe(r) than other forms without knowing exactly why. (p.7)
Pollay, R.W. “Advertising/Marketing of Low Yield Cigarettes: Themes, Messages and
Miscommunication” Testimony to Commonwealth of Massachusetts, Department of
Public Health Hearing (Jan. 30, 31, 1997) Re: 105 CMR 660.000 Cigarette and
Smokeless Tobacco Products: Reports of Added Constituents and Nicotine Ratings,
Working Paper 97.2, History of Advertising Archives.
198.
The tobacco industry promotes friendly “experts” and uses public relations tactics to produce
uncertainty around research results that threaten it. This inhibits public policies responsive to
these research findings. These tactics, long used against medical science, are now being used to
counter the studies challenging to the myth that cigarette advertising is of no import. ... The vast
preponderance of evidence indicates that cigarette advertising plays a meaningful role in
influencing the perceptions, attitudes, and smoking behavior of youth. Denials of these effects,
without brand new and compelling evidence, are highly suspect. (p.53)
Pollay, R.W., “Hacks, Flacks, and Counter-attacks: Cigarette Advertising, Sponsored
Research, and Controversies” Journal of Social Issues, 1997;53(1):53-74.
199.
The Export “A” striking images attract attention and associate positive lifestyles images with the
brand names, logos and other trade mark or graphic signifiers. These associations, particularly
with repetition, serve to influence the opinions, attitudes, perceptions and beliefs of viewers,
whether young or old, smokers or not. It is these factors that bias consumers’ judgements and
increase the likelihood of smoking ... (pp.73-74)
. . . These sponsorship ads establish these brand images no less effectively than traditional
merchandise advertising. (p.74)
Pollay, R.W. “Export “A” ads are extremely expert, eh?” Tobacco Control,
2001;10(1):71-74.
200.
Cigarette advertising had much impact on how many people smoke (aggregate demand), "growing"
the market for fifty years from WWI until the Surgeon General's first report (1964). (p.1)
...
Much cigarette advertising targets potential starters because this segment is key to long term
success.
Much cigarette advertising targets "pre-quitters," because most smokers are "concerned." (p.2)
...
Some cigarette advertising design and imagery seeks to influence the social acceptability of smoking,
e.g. perceptions and judgments of peers, parents, and other non-smokers. (p.3)
...
Cigarette advertising's existence implies relative product safety to many consumers.
- 66 Bans of cigarette advertising are likely to affect starting, quitting or consumption rates in the long
run.
Bans of cigarette advertising will advance public health and welfare as new generations emerge.
Bans of cigarette advertising are proposed and endorsed by virtually all health authorities. (p.4)
Pollay, R.W., “Myth Conceptions and the Stark Reality about Cigarette Advertising and
Promotion” History of Advertising Archives, Faculty of Commerce, University of British
Columbia, Vancouver, July 1999.
201.
Results—Careful and extensive research has been employed in all stages of the process of
conceiving, developing, refining, and deploying cigarette advertising. Two segments commanding
much management attention are “starters” and “concerned smokers”. To recruit starters, brand
images communicate independence, freedom and (sometimes) peer acceptance. These advertising
images portray smokers as attractive and autonomous, accepted and admired, athletic and at home in
nature. For “lighter” brands reassuring health concerned smokers, lest they quit, advertisements
provide imagery conveying a sense of well being, harmony with nature, and a consumer’s self image
as intelligent.
Conclusions—The industry’s steadfast assertions that its advertising influences only brand loyalty
and switching in both its intent and effect is directly contradicted by their internal documents and
proven false. So too is the justification of cigarette advertising as a medium creating better informed
consumers, since visual imagery, not information, is the means of advertising influence. (p.136)
...
Cigarette advertising has shown remarkable power to create a demand for cigarettes, greatly
promoting its popularity, and inducing far more people than would otherwise be the case to become
smokers. (p.145)
...
Advertising and promotional activities and communication serve to induce many changes in the
public’s perceptions creating: more positive attitudes toward smoking and smokes; less
consciousness and fear of any unhealthy consequences of smoking; a stronger self image among
smokers; more confidence of some social support for smoking; and perceptions that smoking is a
cultural commonplace to be taken for granted. To smokers it is a reminder and reinforcer, while to
non-smokers it is a temptation and a teacher of tolerance. (p.146)
Pollay, R.W. “Targeting youth and concerned smokers: evidence from Canadian tobacco
industry documents” Tobacco Control, 2000;9(2):136-147.
202.
Contrary to vehement industry denials, the targeting of youth is amply evidenced in corporate
documents produced during the trial about Canada’s cigarette advertising ban. Extensive and
sophisticated research identified target segments, starting at age 15, and guided the advertising
aimed at them, while recognizing addiction among adolescents. Images of independence and
freedom from authority were used by competing firms to appeal to the psychological needs of
young starters. Careful crafting ensured that images were not too immature, lest the brand
consequently be rejected, and the activities not too aerobic, lest this precipitate cognitive counterarguing. “Positive lifestyle imagery” was used as a matter of policy to enhance the social
acceptability of smoking. The importance of images of independence to attract Canadian youths
is compared to the American experience with brands like Marlboro. (p.266)
Pollay, R.W., Lavack, A.M. “The Targeting of Youths by Cigarette Marketers: Archival
Evidence on Trial” In: McAlister, L., Rothschild, M.L., eds., Advances in Consumer
Research, 1993;20:66-271.
- 67 -
203.
Cigarette brand shares of advertising voice are found to be significantly related to realized market
shares, with advertising sensitivity being about three times larger among teenagers than among
adults. This result is robust to various analytic assumptions and converges with strategic analysis,
consumer behaviour theory and research, econometric metanalyses, historical research, and
corporate documents. The authors argue that cigarette competition between firms is
predominated by the battle of brands for market share among the young, and assertions to the
contrary, without supporting evidence, should be treated with scholarly skepticism. (p.1)
Pollay, R.W., Siddarth, S., Siegel, M., Haddix, A., Merritt, R.K., Giovino, G.A., Eriksen,
M.P. “The Last Straw? Cigarette Advertising and Realized Market Shares Among Youths
and Adults, 1979-1993” Journal of Marketing, 1996;60:1-16.
204.
[A] sizeable percentage of adolescents unexposed to smokers in their social environment
nonetheless believe that cigarette smoking has benefits. Tobacco advertising is a likely source of
such beliefs. (p.284)
Prokhorov, A.V., Farkas, A., Gilpin, E., Johnson, M., Bal, D., Pierce, J.P. “Perception of
benefits to smoking cigarettes in adolescents unexposed to smokers in their social
environment” European Journal of Public Health 1995;5(4):281-285.
205.
[T]he FDA has compiled substantial evidence showing the direct correlation between colorful,
image-laden ads and underage smoking ... and studies in the record show that advertising has a
profound influence on a minor's decision to experiment with tobacco. ... Additional studies confirm
that each of the advertising and promotional techniques addressed by the FDA, such as outdoor
advertising and promotional give-aways, has a direct and substantial impact on minors. ... This
evidence ... establishes that the FDA's rules will dramatically lessen tobacco use by minors ... Indeed,
Kentucky, North Carolina and Virginia concur in the FDA's assessment. They condemn the FDA
rule because it will result in revenue losses occasioned by a decline in tobacco use. (pp.3.11123.1113)
...
Over the past decade, tobacco companies have shifted a substantial portion of their advertising
budgets to the sponsorship of sporting, musical, artistic, and other events. They do so to heighten
their product’s visibility, mold consumer attitudes, link their product with a particular lifestyle, and
thereby increase sales. . . .
... The events are fun, exciting, and glamorous. Tennis tournaments, sports car, motorcycle and
powerboat racing, and rodeos all are aimed at sports enthusiasts – many of whom are children or
teenagers. Rock concerts and country music festivals are also magnets for adolescents. When
minors view these events, either in-person or on television, they are inundated with images of the
brand-name or product logo (on uniforms, vehicles, signs, and virtually every surface imaginable),
creating a direct and compelling association between the product and an enjoyable experience.
(p.3.1118)
Public Citizen, National Center for Tobacco-Free Kids, American Academy of Pediatrics,
American Cancer Society, American College of Preventative Medicine, American Heart
Association, American Lung Association, American Medical Association, American
Medical Women's Association, American Public Health Association, American Society of
Addiction Medicine, The HMO Group, National Association of African Americans for
Positive Imagery, National Association of Elementary School Principals, National
- 68 Association of Secondary School Principals, and National PTA, "Memorandum Amici
Curiae" in Coyne Beahm, Inc., Brown and Williamson Tobacco Corporation, Liggett Group,
Inc., Lorillard Tobacco Company, Philip Morris, Inc., and R.J. Reynolds Tobacco Company
v. U.S. Food and Drug Administration and David A. Kessler, M.D., Commissioner of Food
and Drugs U.S. District Court for the Middle District of North Carolina, Greensboro
Division, November 27, 1996, Tobacco Products Litigation Reporter, 1996;11(8):3.11003.1119.
206.
Conclusion
We have documented that youth are heavily exposed to stationary, outdoor cigarette advertising, that
this exposure is intense in areas close to public schools, that it is more intense in neighborhoods with
more children, that the ethnicity of models in the tobacco advertising matches the demographic
characteristics of the neighborhoods, and that tobacco advertising strategies are in line with accepted
professional marketing practices that target adolescents for other products. Given the pervasive
nature of outdoor tobacco advertising we observed in this study, it appears that the only way to
protect youth from this exposure is to eliminate it. (p.158)
Pucci, L.G., Joseph, H.M., Siegel, M., “Outdoor Tobacco Advertising in Six Boston
Neighborhoods: Evaluating Youth Exposure” American Journal of Preventive Medicine,
1998;15(2):155-159.
207.
Simply put, our findings demonstrate that young people are being preferentially exposed to cigarette
promotional advertising in magazines, and that this exposure is particularly high for precisely those
cigarette brands that are most popular among young people.
Perhaps our most striking finding was that between 1986 and 1992, all promotional cigarette
advertising in the magazines in our sample appeared in youth magazines with predominantly white,
male readership.
This work adds to previous evidence that cigarette companies target young people in their
magazine advertising by demonstrating a specific relationship between promotional cigarette
advertisements for youth cigarette brands in magazines with high youth readership. (p.35)
Pucci, L.G., Siegel, M. “Features of sales promotions in cigarette magazine
advertisements, 1980-1993: an analysis of youth exposure in the United States” Tobacco
Control, 1999;8(1):29-36.
208.
Conclusions. By documenting a relationship between brand-specific magazine advertising exposure
and brand of smoking initiation among new smokers, this study provides strong new evidence that
cigarette advertising influences youth smoking. (p.313)
...
We found that the brand of initiation among Massachusetts youths who started smoking between
1993 and 1997 was highly correlated with their exposure to brand-specific advertising in magazines
in 1993. (p.317)
...
…[W]e believe that this study adds to the accumulating evidence that cigarette advertising influences
youth smoking behavior. Based on this evidence, efforts to eliminate or restrict cigarette advertising
to prevent youth tobacco use are justified. (p.319)
Pucci, L.G., Siegel, M., “Exposure to Brand-Specific Cigarette Advertising in Magazines
and Its Impact on Youth Smoking” Preventive Medicine, 1999;29(5):313-320.
- 69 -
209.
[This item identifies 712 organizations in Quebec which have endorsed a tobacco control position
statement including to “prohibit all types of tobacco promotions, including sponsorship.” These
organizations include medical associations and institutions, members of the public health
network, hospitals, clinics, medical centres, foundations, health and anti-tobacco organizations,
education and youth groups, municipalities, and others.]
Quebec Coalition for Tobacco Control, “Position” and “Organizations Who Have
Endorsed the Position of the Coalition” October 29, 1998.
210.
Results—241 [high school] students (39.1%) had heard of Camel Cash, and 53 (8.6%) had collected
Camel Cash. The proportions who had heard of Camel Cash and who had collected Camel Cash
were highest among current smokers [24.8%], followed by experimenters [8.0%] and then students
who had never smoked [1.5%] (p<0.001). 32 students [5.2%] aged 17 or younger stated that they
purchased Camel cigarettes specifically to get Camel Cash. (p.258)
...
Introduced in 1991, Camel Cash, or “C-notes”, were designed to parody US currency and are
attached to packs of Camel cigarettes. The C-notes can be redeemed for items that are, in
themselves, Camel cigarette promotions. (p.258)
...
The need to collect the substantial number of Camel Cash dollars required to redeem prizes creates
an incentive for young people to smoke more. This probably increases the likelihood that
experimental smokers will progress to regular smokers, and regular smokers to addicted smokers.
The popularity of promotional items among non-smoking children and teenagers raises the
possibility that non-smokers might buy their first pack of cigarettes solely to obtain a promotional
item. (p.259)
...
In the absence of a total ban on tobacco promotion in all forms and in all media, new federal laws are
needed to outlaw the distribution of tobacco promotional items and all tobacco advertising to
children through the mail. (p.260)
Richards, J.W., DiFranza, J.R., Fletcher, C., Fischer, P.M. “R.J. Reynolds’ “Camel
Cash”: Another way to reach kids” Tobacco Control, 1995;4:258-60.
211.
The code has served as the basis of the industry’s efforts to avoid further local, state, and federal
regulatory oversight of its marketing activities. A historical review of cigarette advertising since
1964 indicates that the voluntary code’s major provisions have been regularly violated in the
spirit and the letter. ... The historical evidence indicates that self-regulation of cigarette
advertising and promotion by the tobacco industry has been repeatedly given trials and has not
worked. (p.295)
Richards, J.W., Tye, J.B., Fischer, P.M. “The tobacco industry’s code of advertising in
the United States: myth and reality” Tobacco Control, 1996;5(4):295-311.
212.
Tobacco sales promotion seems both to promote and to reinforce smoking among young people.
(p.5)
- 70 Rimpelä, M.K., Aaro, L.E., Rimpelä, A.H. “The effects of tobacco sales promotion on
initiation of smoking - experiences from Finland and Norway” Scandinavian Journal of
Social Medicine, 1993;49(suppl):5-23.
- 71 213.
Just as providing a safe water supply eliminates the need for each family to boil its water,
so laws banning the advertising and promotion of tobacco alter the environment in which
young people grow up and free them from the pressure to smoke. (p.3)
Roemer, R. Legislative Strategies for a Smoke-free Europe, (Copenhagen: World
Health Organization Regional Office for Europe and the Commission for the
European Communities, 1988).
214.
Experience with different types of legislation restricting tobacco advertising and
promotion leads to several conclusions:
1. Legislation is essential. Voluntary agreements with the industry fail to restrict the
promotion of tobacco products. ...
2. Partial bans on tobacco advertising are not effective in controlling tobacco
consumption. ... (p.42)
3. A total ban on both advertising and sponsorship is essential if tobacco consumption is
to be reduced significantly and quickly. (p.43)
Roemer, R. Legislative Action to Combat the World Tobacco Epidemic, 2d ed.
(Geneva: World Health Organization, 1993).
215.
All these data indicate that tobacco advertising primarily reaches young people.
Adolescents seem to be more familiar with such advertising and are also more likely to
appreciate its brand-stretching messages.
...
It seems that the Belgian legislation, which was intended to protect adolescents from
image-oriented advertising, has had little effect, since brand-stretching products have
adequately replaced cigarettes. Almost all the young people perceive the advertising
messages for the Marlboro lighter and the Belga metal box as cigarette advertising.
Many of them also associate specific profiles with the different brands, which suggests
that image-oriented publicity has continued to be effective. Even Barclay, a brand that
was launched on the Belgian market only after the restrictive legislation was in effect,
could be assigned a brand image by the majority of the adolescents (compared with 48
percent of the adults). (p.319)
Rombouts, K., Fauconnier, G. "What is Learnt Early is Learnt Well? A Study of
the Influence of Tobacco Advertising on Adolescents" European Journal of
Communication, 1988;3:303-322.
216.
Do youth misinterpret advertising of tobacco-company sponsored events as advertising
for tobacco products? YES
Do youth associate the sponsorship activities with images, activities and events that are
appealing and desirable? YES (p.5)
Rootman, I., Flay, B.R., Northup, D., Foster, M.K., Burton, D., Ferrence, R.,
Raphael, D., Single, E., Donovan, R., d’Avernas, J. “A study on Youth Smoking,
Plain Packaging, Health Warnings, Event Marketing and Price Reductions” Key
Findings. Figures. 1995. University of Toronto, University of Illinois at Chicago,
York University, Ontario Tobacco Research Unit, Addiction Research
Foundation.
- 72 217.
These results, coupled with previous research, indicate that although withdrawal induces
general cognitive deficits, abstinent smokers selectively attend to, and remember,
smoking stimuli. Such a bias may have ramifications for cessation efforts.(p.447)
...
Reductions of exposure to smoking cues during withdrawal ought to decrease the
influences of smoking stimuli that might lead to relapse.(p.450)
Rosenblatt, M.R., Jarvik, M.E., Olmstead, R.E., Iwamoto-Schaap, P.N. “Memory
for Cigarette Advertisements Enhanced by Smoking Abstinence” Experimental
and Clinical Psychopharmacology, 1996;4(4):447-450.
218.
[T]here is ample evidence that tobacco advertising affects children. (p.518)
...
Tobacco advertising has to be banned. There is no question. (p.519)
Roussos, C. “Banning tobacco advertisements: is there a question?” European
Respiratory Journal, 1998;11:517-519.
219.
Conclusions--This study offers evidence of a dose-response relation between the number of
CPIs [cigarette promotional items] owned by adolescents and higher likelihood of
experimental and established smoking. The dose-response relation persists after controlling
for confounding influences. These data provide further support of a causal relation between
tobacco promotional campaigns and smoking behaviour among adolescents.(p.163)
Sargent, J.D., Dalton, M., Beach, M. “Exposure to cigarette promotions and
smoking uptake in adolescents: evidence of a dose-response relation” Tobacco
Control, 2000;9:163-168.
220.
Conclusions. This study supports a close linkage between tobacco promotional activities
and uptake of smoking among adolescents beyond baseline descriptions of receptivity to
cigarette promotions. Over time, the likelihood of smoking uptake is increased when an
adolescent acquires a CPI [cigarette promotional item] or becomes willing to use one and is
decreased when an adolescent who owns a CPI loses it or becomes unwilling to use it. This
provides strong evidence that elimination of cigarette promotional campaigns could reduce
adolescent smoking. (p.320)
...
...Moreover, the evidence from a number of cross-sectional and longitudinal studies of
independent samples of children is consistent in showing that tobacco marketing, however
measured, is implicated in adolescents' decisions to smoke and in their continued
experimentation with cigarettes. This convergence of findings from multiple studies
provides strong support for causality and justification for further tobacco marketing
restrictions. (p.326)
Sargent, J.D., Dalton, M., Beach, M., Bernhardt, A., Heatherton, T., Stevens, M.
“Effect of Cigarette Promotions on Smoking Uptake Among Adolescents”
Preventive Medicine, 2000;30:320-327.
221.
Cigarette promotional items are owned by one third of students in these rural northern
New England schools. These items are highly visible in the public school setting, and
their ownership is strongly associated with initiation and maintenance of smoking
- 73 behavior. These data lend support to a ban on CPIs to be included in US Food and Drug
Administration regulations to prevent tobacco use among US youth. (p.1189)
Sargent, J.D., Dalton, M.A., Beach, M., Bernhardt, A., Pullin, D., Stevens, M.
“Cigarette Promotional Items in Public Schools” Archives of Pediatric and
Adolescent Medicine, 1997;151:1189-1196.
222.
Eighty-eight percent of these 13-year-olds reported exposure to cigarette marketing: the
majority often saw ads in magazines, on billboards, and at stores and events, and one
quarter owned cigarette promotional items. After social influences to smoke were
controlled for, exposure to cigarette marketing was related to self-reported smoking
behaviour. Likelihood of experimenting with smoking was 2.2 times greater among
those who owned promotional items and 2.8 times greater among those who had received
mail from a tobacco company. Seeing cigarette advertisements in magazines increased
this likelihood by 21%, and seeing tobacco marketing in stores increased it by 38%.
(p.1216)
Schooler, C., Feighery, E., Flora, J.A. “Seventh Graders’ Self-Reported Exposure
to Cigarette Marketing and Its Relationship to Their Smoking Behavior”
American Journal of Public Health, 1996;86(9):1216-1221.
223.
[A survey of 300 advertising executives found that 63% agreed that a goal of tobacco
advertising was to market to adult nonsmokers; 59% agreed that a goal was to market to
teenage nonsmokers; 82% agreed that tobacco advertising reaches children and teenagers
in significant numbers; 78% agreed that tobacco advertising makes smoking more
appealing or socially acceptable to children and teenagers; 71% agreed that tobacco
advertising changes behavior and increases smoking among children and teenagers.]
Shepardson Stern & Kaminsky, "Advertising Agency Survey" 1996; Campaign
for Tobacco-Free Kids [U.S.], "New Survey Finds Majority in Advertising
Industry Say Cigarette Ads Affect Kids, Favor Restrictions", [news release]
December 18, 1996.
224.
[T]he total profit derived from the 3.1 million company switchers in 1986 was on the
order of $362 million. Clearly, brand switching alone does not justify the $2.4 billion
spent on cigarette advertising and promotion in 1986.(p.15)
...
This analysis suggests that brand switching alone cannot be the sole effect of cigarette
advertising.(p.16)
Siegel, M., Nelson, D. E., Peddicord, J.P., Merritt, R.K., Giovino, G.A., Eriksen,
M.P. “The Extent of Cigarette Brand and Company Switching: Results from the
Adult Use-of-Tobacco Survey” American Journal of Preventive Medicine,
1996;12(1):14-16.
225.
The abuses and avoidances of federal regulation by the three spit tobacco makers reported
here underscore the need for constant vigilance by public health workers and the continued
closing of loopholes in countries which have not yet banned tobacco product advertising.
(p.74).
Slade, J. "Spit tobacco makers evade U.S. warning label requirement" Tobacco
Control, 1994;3(1):73-74.
- 74 -
226.
Despite a ban on advertising cigarettes and moist snuff products in electronic media in
the US, advertising for these products regularly occurs through signage, uniforms, decals,
and other sources at sporting events which are covered by broadcast and cable television.
(p.925)
Slade, J. “Tobacco Product Advertising During Motorsports Broadcasts: A
Quantitative Assessment”, In: Slama, K., ed., Tobacco and Health: Proceedings
from the 9th World Conference on Tobacco and Health (New York: Plenum
Press, 1995), pp.925-927.
227.
An international network of clothing stores promotes the Marlboro cowboy/Marlboro
country fantasy by selling expensive, Old West-styled casualwear for men in a chain of
stores called “Marlboro Classics”. The chain’s motto is “Fits the Man”. (p.340)
...
The atmosphere and ethos that the catalogue evokes are identical to those of advertising for
the Marlboro brand of cigarettes. Freedom, independence, disdain for authority, autonomy,
making one’s own decisions, personal fulfilment. These are the ideals embodied in the
fantasy created by the catalogue and by advertising for the cigarette. (p.340)
Slade, J. “Marlboro Classics: sheep’s clothing” Tobacco Control, 1996;5(4):340341.
228.
EXECUTIVE SUMMARY
1. Bans or restrictions on tobacco advertising have been legislated in many countries
based upon research which shows a strong correlation between advertising and
susceptibility to smoking, especially among young people.
2. In response, Transnational Tobacco Companies (TTCs) have sought other methods of
marketing their products. The most popular has been the sponsorship of sport and
cultural events. The main benefit for TTCs is the ability to leverage significant
media exposure through event-associated promotion and media coverage, much of
which bypasses the intent of advertising restrictions by appearing to be accidental or
incidental. (p.iii)
Susan Spoke & Associates, “Literature Review on Sponsorship” Produced for
Health Canada, April 10, 1996.
229.
A sample of cigarette advertisements was taken from Time and Life magazines, two of the
most widely circulated magazines throughout the fifties. ...
...[A]bout half of the [cigarette] ads focused mainly on health claims in 1952 and 1953. ...
Industry documents show that tobacco companies are concerned with helping
smokers "maintain faith and confidence in the smoking habit" and that "advertising ... should
be constructed in ways so as not to provoke anxiety about health, but to alleviate it." (p.111)
Swedrock, T.L., Hyland, A., Hastrup, J.L. “Changes in the focus of cigarette
advertisements in the 1950s” Tobacco Control, 1999;8(1):111-112.
230.
Advertising is a vital link in the Smoke Ring, because advertising conditions the way
cigarettes are perceived. Every year the tobacco industry spends around $2 billion
globally to ensure that cigarettes are associated with glamour, success and sophistication,
- 75 instead of lung cancer, bronchitis and heart disease. The industry needs to make this
huge and ever-increasing investment to perpetuate this false image in order to counter the
evidence that cigarettes are not desirable but dangerous. After addiction, advertising is
the industry’s most powerful ally in its battle for the hearts and minds of the smoker and
in its drive to seduce more recruits into the Smoke Ring. (p.44)
...
Sponsorship is a particularly attractive form of promotion: it enables the companies to
associate cigarettes with healthy, glamorous and life-enhancing activities; it polishes their
corporate image; it creates goodwill among the public; it gives them access to prestigious
and powerful people and institutions involved in sport and the arts; it makes financially
hard-pressed governments and governing bodies even more dependent upon them; and,
above all, it enables them to get round the ban on advertising cigarettes on television.
Tobacco sponsorship is designed to change the public perception of cigarettes and the
companies who make them. (p.99).
Taylor, P. Smoke Ring: The Politics of Tobacco (London: The Bodley Head,
1984).
231.
This research shows a clear relation between on-screen tobacco use by movie stars and
higher levels of smoking uptake in the adolescents who admire them. This association
appears to be independent of other factors known to predict adolescent smoking, such as
smoking by family and peers. It is unlikely that this effect is due to smokers simply paying
more attention to on-screen smoking. Instead, the association between star smoking and
attitudes that predict smoking (susceptibility) was even stronger among never smokers,
suggesting that the influence of movie star smoking begins before experimentation with
cigarettes. We believe that this evidence strongly suggests that media portrayals of tobacco
use by popular movie stars contribute to adolescent smoking. (p.20)
Tickle, J.J., Sargent, J.D., Dalton, M.A., Beach, M.L., Heatherton, T.F.
“Favourite movie stars, their tobacco use in contemporary movies, and its
association with adolescent smoking” Tobacco Control, 2001;10(1):16-22.
232.
Outdoor advertising expenditures plummeted after the MSA took effect – an expected result,
since the MSA banned most forms of outdoor advertising. From a level of $118.6 million in
the first nine months of 1998, expenditures fell to just $8.1 million in the corresponding
period of 1999.
Magazine advertising increased correspondingly. Cigarette advertising expenditures in
magazines climbed from $225.8 million to $315.1 million. Advertising in newspapers and
Sunday magazines also increased dramatically, from $8.8 million to $28.8 million. The net
result was to maintain cigarette advertising expenditures at the pre-MSA level. (p.6)
Turner-Bowker, D., Hamilton, W.L. “Cigarette Advertising Expenditures Before
and After the Master Settlement Agreement: Preliminary Findings”
Massachusetts Department of Health, Abt Associates Inc., May 15, 2000.
233.
If advertising and promotion increase cigarette consumption, then less than two million
new or retained smokers - 5.5 percent of smokers who start each year or try to quit (most
failing) - alone would justify the annual promotional expenditure of $2 billion. A
preponderance of quantitative studies of cigarette advertising suggest a causal
relationship with consumption. Other studies show that children are influenced by
cigarette advertising. Additionally, there are many individual examples of targeted
- 76 marketing campaigns being followed by increased consumption within the target market.
The evidence supports the hypothesis that cigarette advertising and promotion increase
and sustain cigarette consumption. If brand share were the only function of advertising
and promotion, as the cigarette manufactures insist, the industry would lobby vigorously
for an ad ban. (pp.507-508)
Tye, J.B., Warner, K., Glantz, S.A. “Tobacco Advertising and Consumption:
Evidence of a Causal Relationship” Journal of Public Health Policy,
1987;492-508.
234.
Age of smoking initiation was earlier ... among those adolescents who had a favourite
tobacco advertisement, had received tobacco promotional items, or would be willing to use
tobacco promotional items. Results suggest that the smoking behavior of social network
members and pro-tobacco media influences are important determinants of age of smoking
initiation. Because early smoking initiation is associated with higher levels of addiction in
adulthood, tobacco control programs should attempt to counter these influences. (p.371)
Unger, J.B., Chen, X. "The role of social networks and media receptivity in
predicting age of smoking initiation: a proportional hazards model of risk and
protective factors" Addictive Behaviors, 1999;24(3):371-381.
235.
A directive banning all direct and indirect tobacco advertising in the 15 nations of the
European Union (EU) would constitute a major advance in the protection of child rights
to health and development, UNICEF Executive Director Carol Bellamy said today.
...
“[W]e view broad restrictions on advertising as a significant step in protecting children
from the ravages of tobacco,” Ms. Bellamy said. “Not only would such a ban help save
countless lives in the region -- it could lend momentum to the broader campaign for
worldwide restrictions on the promotion and sale of tobacco products, particularly to
children in developing countries”.
United Nations Children’s Fund (UNICEF), “UNICEF backs European plan to
ban tobacco ads”, November 7, 1997 [news release].
236.
Despite a high level of knowledge about the adverse effects of tobacco, cricket
sponsorship by tobacco companies increased children’s likelihood of experimentation
with tobacco by creating false associations between smoking and sport. Many of the
children believed that the cricketers smoked.
Vaidya, S.G., Naik, U.D., Vaidya, J.S. “Effect of sports sponsorship by tobacco
companies on children’s experimentation with tobacco” British Medical Journal,
1996;313(7054):400.
237.
Merchandise (clothes etc.) is very cost effective, because the smoker pays for the clothes
and advertises the product. (p.3)
Vickers, A. (Abbott Mead Vickers BBDO) “How the tobacco industry will
exploit loopholes in an advertising ban” Action on Smoking and Health Paper 1,
October 1997. www.ash.org.uk/papers/ashpap1.html accessed 24 November
1999.
- 77 238.
There is a strong association between having a brand preference and smoking among
primary and secondary school students. Although not all adolescent cigarette smokers
have a preferred brand, preference tends to increase with use in a dose-response fashion.
This study provides descriptive evidence of the association of brand preference and use,
and suggests that brand preference may represent an important “within-drug” stage and
may play an important role in cigarette use initiation and maintenance. (p.358)
Volk, R.J., Edwards, D.W., Lewis, R.A., Schulenberg, J. “Smoking and
Preference for Brand of Cigarette Among Adolescents” Journal of Substance
Abuse, 1996;8(3):347-359.
239.
Advertisements were considered “youthful” if they were judged by community surveyors
to include models who appeared to be in their early twenties or younger. (p.139)
...
The finding that the more that youthful advertisements were displayed outside stores, the
more that young people [under 18] tried to buy cigarettes, is not surprising, but it is not
one that has been previously examined empirically. (p.140)
...
Rigorous policy-oriented approaches are clearly also needed to reduce youth access to
cigarettes and include, as the Clinton Administration recently announced, “far-reaching
restrictions on tobacco advertising and sales to adolescents.” (p.141)
Voorhees, C.C., Yanek, L.R., Stillman, F.A., Becker, D.M. "Reducing cigarette
sales to minors in an urban setting: issues and opportunities for merchant
intervention" American Journal of Preventive Medicine, 1998;14(2):138-142.
240.
Conclusions – The observed increase in point-of-purchase marketing in the period following
the billboard advertising ban suggests that the tobacco industry may be shifting at least some
of the expenditures once spent on billboard advertising to the advertising and promotion at
the point-of-purchase. To the extent that this is so, the intended effects of the MSA billboard
ban may not be fully realized. (p.3)
...
High levels of exposure to tobacco advertising and promotions are likely to influence
adolescent tobacco-related perceptions and behaviors. ... [R]esearch studies suggest that the
point-of-purchase environment may have important influences on youth in terms of making
tobacco use seem normative and, ultimately, increasing the likelihood of taking up smoking.
(p.12)
Wakefield, M.A., Terry, Y.A., Chaloupka, F.J., Barker, D.C., Slater, S.J., Clark,
P.I., Giovino, G.A. “Changes at the Point-of-Sale for Tobacco Following the
1999 Tobacco Billboard Ban” July 2000, ImpacTeen Research Paper Series,
No.4.
241.
The evidence suggests that attributing a singular or exclusive role to advertising and
promotion is inappropriate. The brand share function is undoubtedly a major one. Yet the
logical and empirical case for concluding that advertising and promotion encourage
cigarette consumption, including initiation of the habit, substantially dominates the case
against this proposition. The formal analytical evidence on the direct effects of
advertising leaves room for uncertainty, but the preponderance of evidence of all types
supports the existence of a relationship between promotion and cigarette consumption.
- 78 The evidence on the indirect effects - the suppression and distortion of media coverage of
tobacco, and the consequent impact on the public’s knowledge and smoking behavior leaves little room for doubt. (p.84)
Warner, K.E. Selling Smoke: Cigarette Advertising and Public Health
(Washington, D.C.: American Public Health Association, 1986).
242.
Our findings provide strong statistical support for the belief that magazines in the United
States have restricted their coverage of the dangers of smoking out of fear of economic
reprisals by cigarette manufacturers. The degree of restriction appears to be a function of
the magazine’s degree of dependence on revenues from cigarette advertising. Our results
are also consistent with the widespread perception that the restriction of coverage
associated with the acceptance of cigarette advertising is particularly important in the
case of women’s magazines. (pp.307-308)
Warner, K.E., Goldenhar, L.M., McLaughlin, C.G. “Cigarette Advertising and
Magazine Coverage of the Hazards of Smoking: A Statistical Analysis” New
England Journal of Medicine, 1992;326(5):305-309.
243.
In increasing numbers, Americans will seek to satisfy nicotine addictions through the use
of novel nicotine-delivery products devoid of several of the poisons that make cigarettes
so deadly. ... However, a series of technological, economic, political, regulatory, and
social developments augurs a strange-bedfellows competition in which these industries
will vie for shares of a new multibillion dollar long-term nicotine-maintenance market.
Regulatory options range from encouraging competition to banning all nicotine-delivery
devices. A more realistic approach discourages use of the most dangerous products,
while making less hazardous products readily available to adults. (p.1087)
Warner, K.E., Slade, J., Sweanor, D.T. “The Emerging Market for Long-Term
Nicotine Maintenance” Journal of the American Medical Association,
1997;278(13):1087-1092.
244.
Awareness of certain brands of cigarette was linked to an increased risk of onset of
smoking in 11 to 13 year olds, especially girls. Awareness of the most advertised brands
was a strong predictor of smoking, while awareness of other brands, probably known
from other sources, was a less likely predictor. Children appear to take in the messages
of cigarette advertising and interpret them as generic to smoking rather than brand
specific. (p.399)
While, D., Kelly, S., Huang, W., Charlton, A. “Cigarette advertising and onset of
smoking in children: questionnaire survey” British Medical Journal,
1996;313:398-399.
245.
On balance, there is no doubt that advertising has some effect on influencing uptake of
smoking among children, and on this basis, should be discontinued. The most
compelling industry defence of advertising – that to deny them the ‘right’ of advertising
denies the consumer important product information – is fatuous, given the dearth of
useful product information typically provided by tobacco advertising, particularly
sponsorship. (p.299)
- 79 Winstanley, M., Woodward, S., Walker, N. Tobacco in Australia: Facts and
Issues, 1995. (Carlton South, Victoria, Australia: Victorian Smoking and Health
Program, 1995).
246.
In the limited area encompassed by the cities of Ottawa and Hull, point-of-sale
advertising for Player’s Ltd. Racing and the Matinée Ltd. Fashion Foundation generated
about 280 million exposures – the equivalent of more than 2 exposures per resident each
day – for just over $100,000. In the larger Ottawa/Hull region (including Nepean,
Gloucester, Kanata, etc.), other forms of advertising generated more than 16 million
exposures at a cost exceeding $2.5 million. (p.iii)
Woods, R. “Tobacco Sponsorship Advertising in the Ottawa/Hull Region”
Prepared on behalf of the Canadian Council on Smoking and Health, December,
1993.
247.
The Forty-third World Health Assembly,
...
Encouraged by:
...
(c) recent information demonstrating the effectiveness of tobacco control strategies, and
in particular:
...
- comprehensive bans and other legislative restrictive measures to control effectively
direct and indirect advertising, promotion and sponsorship concerning tobacco (p.263)
...
1. URGES all Member States:
...
(2) to consider including in their tobacco control strategies plans for legislation or other
effective measures at the appropriate government level providing for:
...
(c) progressive restrictions and concerted action to eliminate eventually all direct and
indirect advertising, promotion and sponsorship concerning tobacco (p.264)
World Health Assembly, Resolution WHA43.16, May 1990, In: Roemer, R.
Legislative Action to Combat the World Tobacco Epidemic, 2d ed. (Geneva:
World Health Organization, 1993), pp.263-264.
248.
[In this resolution, the World Health Assembly, the parent body of the World Health
Organization, called for the development of an international framework convention for
tobacco control. The WHA also urged member states to implement comprehensive
tobacco control strategies, including a ban on all forms of tobacco promotion, reiterating
previous WHA resolutions.]
World Health Assembly, “An international framework convention for tobacco
control” Resolution WHA49.17, May 25, 1996.
249.
WHO and its co-sponsors of World No-Tobacco Day, the United Nations Educational,
Scientific and Cultural Organization (UNESCO) and the International Olympic
Committee (IOC) join forces in calling for all nations to end sponsorships which in any
- 80 way associate tobacco products with sporting and cultural activities. (quotation from
news release)
World Health Organization, “Sport and the Arts Without Tobacco: Play It
Tobacco Free!” World No-Tobacco Day Advisory Kit, 1996, and accompanying
documents; World Health Organization, “World No-Tobacco Day: Play It
Tobacco-Free!” press release WHO/41, May 31, 1996.
250.
The tobacco industry, in advance of a total ban, will try to lobby for voluntary
agreements and encourage health warnings rather than total bans. The former has been
shown internationally and locally not to work. The only solution, and a sensible one
from a public health perspective, is to act more assertively and ban all tobacco
advertising as a matter of urgency. (p.841)
Yach, D., Paterson, G. "Tobacco advertising in South Africa with specific reference
to magazines" South African Medical Journal 1994;84(12):838-841.
- 81 -
Part II
Package Labelling
- 82 -
- 83 -
Part II
Package Labelling
Introduction
The Canadian Tobacco Products Information Regulations require that one of 16 rotated picturebased health warnings appear on the top 50% of the front and back of cigarette packages. The
Tobacco Products Information Regulations will (1) increase the knowledge and depth of
appreciation of the health effects of tobacco and the characteristics of tobacco products, (2)
reduce the promotional impact of tobacco packaging, and (3) advance public health by reducing
tobacco use.
There is overwhelming evidence to justify the warnings required by the Regulations as being
more effective than the smaller, text-based warnings previously appearing on Canadian
packaging. The evidence includes: tobacco industry statements and documents; court
judgements; expert opinions; a vast array of studies, reports and other literature; international
reaction to the Canadian proposals; and logic and reason. The data on the number of people who
are illiterate, or who are immigrants who speak neither English nor French, is evidence
supporting the use of pictures in warnings. Evidence regarding the current insufficient public
awareness and appreciation of the health effects of tobacco use highlights the need for improved
package warnings. Evidence indicating that educational initiatives can successfully reduce
smoking and increase public awareness is evidence that an educational initiative using packaging
as the medium can also succeed. Evidence regarding the important promotional impact of
packaging and supporting implementation of plain packaging demonstrates the importance of the
package as a communications medium. As well, given that plain packaging – using 100% of the
package – is justified, using only 50% of the package for warnings is also justified.
There is also ample evidence to justify a ban on labelling terms such as “light” and “mild”.
“Light” and “mild” cigarettes are not significantly safer for health than regular cigarettes, despite
the fact that many smokers perceive this to be the case. Tobacco companies have helped create
this incorrect perception through labelling and marketing practices. The existing International
Organisation for Standardization (ISO) and U.S. Federal Trade Commission (FTC) test methods
result in toxic emission yields that greatly understate the levels actually inhaled by smokers.
Smokers may smoke much more intensely than would be expected through the ISO and FTC test
methods.
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 position that there is no credible evidence to justify picture-based
warnings covering 50% of the front and back of cigarette packages.
In this Part, items are separated into general categories. However, it may be that an item cited in
one category is also relevant to (but not repeated in) another category. For example, an item in
“Studies, Reports and Other Literature – Warnings” may refer to both warnings and plain
packaging, but the reference is not repeated in the category “Promotional Impact of Packaging”.
- 84 -
Knowledge of health effects of smoking
251.
[This study found that, on an unprompted recall basis, smokers underestimated the health
risks of smoking.]
Angus Reid Group, Inc., Ontario Campaign for Action on Tobacco, “Eight in Ten
(78%) Ontarians Would Vote “Yes” in Referendum for Support [$0.25] Per Pack
Tax Hike on Cigarettes to be Spent on Tobacco Control Programs” December 8,
1998.
252.
[In this study, Ontario respondents were asked whether smoking or exposure to ETS is a
cause, may be a cause, or is not a cause of specific health effects. The indicated proportion
of smokers/non-smokers agreed that smoking caused lung cancer (67%, 87%), chronic
bronchitis (66%, 75%), pregnancy complications (51%, 67%), heart attacks (45%, 60%). As
for ETS, the results were: chest problems in children (36%, 58%), lung cancer (33%, 54%),
heart attacks (18%, 30%), ear problems in children (11%, 14%).] The findings imply that
while effective educational programs aimed at the entire population are needed, specific
efforts must be directed at smokers. Appropriately designed health warnings on cigarette
packages and package inserts are potential vehicles. The latter measure was supported by a
majority of smokers in this survey.(p.9)
Ashley, M.J., Cohen, J., Bull, S., Ferrence, R., Poland, B., Pederson, L., Gao, J.
“Knowledge about Tobacco and Attitudes Toward Tobacco Control: How Different
Are Smokers and Nonsmokers?” Ontario Tobacco Research Unit, Working Paper
Series No. 43, February 1999.
253.
Among both adolescents [29% vs. 12%] and adults [22% vs. 7%], smokers were more than
twice as likely as nonsmokers to doubt they would die from smoking even if they smoked 30
or 40 years. (p.629)
...
60% of adolescent smokers nevertheless believed that "I could smoke for a few years and
then quit if I wanted to." (p.630)
...
Summary and conclusions
The results of the present study indicate that the optimistic bias contributes to
smoking behavior, especially with respect to addiction and especially among adolescents. It
appears to be easy for many adolescents to believe that they are exempt from the risk of
addiction that applies to others. (p.631)
Arnett, J.J. "Optimistic bias in adolescent and adult smokers and nonsmokers"
Addictive Behaviors, 2000;25(4):625-632.
254.
Results. Only 29% and 40% of current smokers believed they have a higher-than-average
risk of MI [myocardial infarction] or cancer, respectively, and only 39% and 49% of heavy
smokers (>=40 cigarettes per day) acknowledged these risks. Even among smokers with
hypertension, angina, or a family history of MI, 48%, 49%, and 39%, respectively, perceived
their risk of MI as higher than average. In multivariate analyses, older (>=65 years), less
educated (< high school graduate), and light smokers (1-19 cigarettes per day) were less
likely than younger, more educated, and heavy smokers to perceive an increased personal
risk of MI or cancer.
- 85 Conclusions. Most smokers do not view themselves at increased risk of heart disease or
cancer. As part of multifaceted approaches to smoking cessation, physicians and public
health professionals should identify and educate smokers who are not aware of smokingrelated health risks. (p.1019)
Ayanian, J.Z., Cleary, P.D. “Perceived Risks of Heart Disease and Cancer Among
Cigarette Smokers” Journal of the American Medical Association 1999;
281(11):1019-1021.
255.
[This study found that smokers underestimated the health effects of smoking.]
Creative Research Group, The, “Project Viking Volume I: A Behavioural Model of
Smoking” Prepared for Imperial Tobacco Ltd., February-March 1986, Exhibit 21A,
RJR-Macdonald v. Attorney General of Canada.
256.
21% of daily smokers and 11% of non-smokers disagreed that "Quitting smoking reduces
health damage even after many years of smoking." (Q.85E(f))
37% of daily smokers and 31% of non-smokers agreed that "People have to smoke for many
years before it will hurt their health." (Q.85E(e))
65% of daily smokers and 74% of non-smokers agreed that "People who are taking up
smoking today don't understand the true health risks associated with smoking." (Q.85E(d))
77% of daily smokers and 45% of non-smokers agreed that "Smoking is no worse than a
lot of other things around us, like chemicals in food and car exhaust fumes." (Q.85E(c))
25% of daily smokers and 5% of non-smokers disagreed that "The health of non-smokers
is put in serious jeopardy when they are exposed to second-hand smoke." (Q.85E(b))
16% of daily smokers and 3% of non-smokers disagreed that "People who smoke put
their health in serious jeopardy." (Q.85E(a))
Environics Research Group Ltd., “Statistical Tables on Toxic Constituents in
Tobacco – Adults” Prepared for Health Canada, 1996; see also Derek Leebosh
(Environics Research), memorandum to Jerry King (Office of Tobacco Control,
Health Canada) April 25, 1996.
257.
[This study found that smokers underestimate the health effects caused by smoking, and that
smokers were less aware of the health effects than nonsmokers. In an unprompted question
34% recalled that smoking caused heart attack/disease, 32% emphysema, 17% addiction and
6% second-hand smoke. When prompted with specific health conditions, notable
proportions of smokers said that smoking played no role at all in increasing a smoker’s risk,
or did not know whether it played a role: emphysema (13%), mouth cancer (12%), harm to
babies during pregnancy (12%), stroke (20%), clogged blood vessels (25%), tooth loss and
gum disease (38%), impotence (66%), ear infections in children from ETS (59%), Sudden
Infant Death Syndrome from ETS (65%), for example. 15% of smokers agreed that a packa-day smoker is just as likely to get lung cancer as a never smoker. 81% of smokers
incorrectly named breast cancer (instead of lung cancer) as the type of cancer causing the
most cancer deaths in Canada. 23% of smokers rated the addictiveness of smoking
cigarettes as being “like a favourite food, e.g. chocolate”. Overall, non-smokers were much
more aware of the health effects than smokers.]
Environics Research Group, “Assessment of Perceived Health Risks due to
Smoking” Prepared for Health Canada, Office of Tobacco Control, November 1999.
- 86 258.
[This study found that, on an unprompted recall basis, smokers underestimated the health
risks of smoking.]
Gallup Canada Inc. “Gallup National Omnibus Attitudes Toward Smoking
Restrictions” Conducted for the Canadian Cancer Society, October, 1987.
259.
Students ages 10 to 18 were given the task of estimating the probability of four possible
consequences of cigarette smoking: heart trouble, cancer, carbon monoxide in alveolar
air, and breathlessness during strenuous exercise. Subjects made estimates for
generalized others who smoke, for themselves as hypothetical lifelong smokers, and for
their actual selves. Comparisons of generalized others with hypothetical self and of
hypothetical self with actual self suggest that the subjects engage in significant denial.
Smokers denied their susceptibility more than nonsmokers for generalized others and for
themselves as hypothetical lifelong smokers. (p.363)
Hansen, W.B., Malotte, K. “Perceived Personal Immunity: The Development of
Beliefs about Susceptibility to the Consequences of Smoking” Preventive
Medicine 1986;15:363-372.
260.
[In a survey in Erie County, New York, 58% of smokers answered "yes" in response to the
question "Do you think a filter makes a cigarette safer than the same cigarette without a
filter?"]
Hastrup, J.L., Cummings, K.M., Swedrock, T., Hyland, A., Pauly, J.L.
“Consumers’ knowledge and beliefs about the safety of cigarette filters” Tobacco
Control, 2001;10(1):84-86.
261.
Results: Less than 10% of smokers in the national sample and only 14% of smokers in the
state sample knew that one Light cigarette could give the same amount of tar as one Regular
cigarette. Less than 10% of smokers knew that one Ultra-light cigarette could give the same
amount of tar as one Regular cigarette. Thirty-two percent of the Light and 26% of the Ultralight smokers in the national sample, and 27% of Light and 25% of Ultra-light smokers in
the state sample, said they would be likely to quit smoking if they learned one Light/Ultra
light equaled one Regular.
Conclusion: Many Light and Ultra-light smokers are smoking these cigarettes to reduce the
risks of smoking and/or as a step toward quitting. However, these smokers are unaware that
one Ultra-light/Light cigarette can give them the same amount of tar and nicotine as one
Regular cigarette. Many of the Ultra-light/Light smokers sampled in this study stated that
they would be likely to quit if they knew this information. Mistaken beliefs about low-yield
brands are reducing intentions to quit smoking. (p.9)
Kozlowski, L.T., Goldberg, M.E., Yost, B.A., White, E.L., Sweeney, C.T.,
Pillitteri, J.L. “Smokers’ Misperceptions of Light and Ultra-Light Cigarettes May
Keep Them Smoking” American Journal of Preventive Medicine, 1998;15(1):916.
262.
These results suggest that, compared to nonsmokers, smokers underestimate the risk of a
smoker developing each of the diseases rated. Further, they minimize their own risk even
more than they do that of the “average smoker.” This effect seems to be more
pronounced among younger adult smokers than it is among older smokers. (pp.274-275)
- 87 Lee, C. “Perceptions of Immunity to Disease in Adult Smokers” Journal of
Behavioral Medicine 1989;12(3):267-277.
263.
The argument that people freely choose to smoke assumes that individuals at the point of
initiation of smoking (often in adolescence) hold accurate beliefs about smoking. Smoking
beliefs and the presence of known smoking risk factors were assessed in interviews with a
sample of 895 urban young people. The respondents greatly overestimated the prevalence of
adult and peer smoking, negative attitudes of their peers were greatly underestimated, a large
proportion believed that they would be less likely than other people to contract a smokingrelated illness if they became smokers, and there was a general lack of understanding of the
adverse consequences experienced upon smoking cessation. These misperceptions were
more common among youngsters who were smokers, who intended to smoke, or who had
friends of family members who smoked. Because misinformation among young people is
widespread and those at greatest risk for smoking are the most misinformed, the tobacco
industry’s argument that the decision to smoke reflects an “informed choice” is without
merit. (p.3373)
Leventhal, H., Glynn, K., Fleming, R. “Is the Smoking Decision and ‘Informed
Choice’? Effect of Smoking Risk Factors on Smoking Beliefs” Journal of the
American Medical Association, 1987;257(24):3373-3376.
264.
Conclusion
Although perceptions of risk associated with smoking appear to have increased in the last 10
years, and are now more accurately associated with certain diseases, it is still the case that
people who currently smoke have lower perceptions of smoking risk than do nonsmokers,
those who smoke but have made the decision to quit, or those who have already quit. In
addition, there is evidence that smokers are “guilty” of an optimistic bias when it comes to
those risk perceptions; in contrast, there was no evidence of such a bias among any other
group. Thus, risk and benefit perception do appear to be closely linked to the decision to
continue vs. stop risky behaviors, such as smoking (p.487).
McCoy, S.B., Gibbons, F.X., Reis, T.J., Gerrard, M., Luus, C.A.E., Sufka, A.V.W.
"Perceptions of smoking risk as a function of smoking status" Journal of Behavioral
Medicine, 1992;15(5):469-488.
265.
Conclusions. These findings suggest that at least heavy smokers significantly underestimate
their risk of premature mortality. (p.755)
Schoenbaum, M. “Do Smokers Understand the Mortality Effects of Smoking?
Evidence from the Health and Retirement Survey” American Journal of Public
Health 1997;87(5):755-759.
266.
[This survey found that, on an unprompted basis, many smokers were unable to recall health
effects of second-hand smoke.]
Statistics Canada, “General Social Survey 1995” Tables 8, 9A, 9B (excerpt,
Canada).
267.
Although public knowledge about the health effects of tobacco use has improved over the
last 15 years, evidence persists in gaps of understanding. ...
- 88 [T]he public continues to underestimate the magnitude of the risks arising from
tobacco use. The resulting inability of consumers to make fully informed decisions about
tobacco use could be interpreted as a failure on the part of the manufacturer to achieve
informed consent from users of the product.(p.187)
U.S. Department of Health and Human Services, Reducing Tobacco Use: A
Report of the Surgeon General, Atlanta, Georgia: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Center
for Chronic Disease Prevention and Health Promotion, Office on Smoking and
Health, 2000.
268.
Conclusions
1. Girls who initiate smoking are more likely than those who do not smoke to ... have less
knowledge of the adverse consequences of smoking and the addictiveness of nicotine
(p.527)
U.S. Department of Health and Human Services, Women and Smoking: A Report
of the Surgeon General, Atlanta, Georgia: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Center for
Chronic Disease Prevention and Health Promotion, Office on Smoking and
Health, 2000), prepublication version, accessed March 27, 2001
http://www.cdc.gov/tobacco/sgr_forwomen.htm
269.
Many children and adolescents do not adequately comprehend the nature of the risk or
the seriousness of nicotine addiction, or the other dangerous health effects of smoking
cigarettes. (p.3)
U.S. Federal Trade Commission, “In the Matter of R.J. Reynolds, a corporation:
Complaint.” Docket No. 9285, May 28, 1997.
270.
CONCLUSION
. . . Clearly, there is some acknowledgement of risk by smokers. Nevertheless, they
minimize that risk and show a clear tendency to believe that the risk applies more to other
smokers than to themselves. (p. 139)
Weinstein, N. D. “Accuracy of Smokers’ Risk Perceptions” Annals of Behavioral
Medicine 1998;20 (2):135-140.
271.
First, there is evidence that many smokers are not fully aware of the high probability of
disease and premature death that their choice entails. (p.29)
 Second, there is evidence that children and teenagers may not have the capacity to
properly assess any information that they possess about the health effects of smoking.
Equally important, there is evidence that new recruits to smoking may seriously
underestimate the future costs associated with addiction to nicotine.
...
People’s knowledge of the health risks of smoking appears to be partial at best, especially in
low- and middle-income countries where information about these hazards is limited. In
China, for example, 61 percent of adult smokers surveyed in 1996 believed that cigarettes
did them “little or no harm.”
- 89 . . . [E]ven where individuals have a reasonably accurate perception of the health risks faced
by smokers as a group, they minimize the personal relevance of this information, believing
other smokers’ risks to be greater than their own.
Finally, there is evidence from various countries that some smokers may have a
distorted perception of the health risks of smoking compared with other health risks. For
example, in Poland in 1995 researchers asked adults to rate “the most important factors
influencing human health.” The factor most frequently chosen was “the environment,”
followed by “dietary habits” and “stress or hectic lifestyles”. Smoking trailed in fourth
place, and was mentioned by only 27 percent of adults questioned. In fact, smoking
accounts for more than one-third of the risk of premature death in middle-aged men in
Poland, far more than any other risk factor. (pp.30-31)
...
. . . Even in the United States, where young people might be expected to have received more
information, almost half of 13-year-olds today think that smoking a pack of cigarettes a day
will not cause them great harm. . . .
. . . Among final-year high school students in the United States who smoke but believe they
will quit within five years, fewer than two out of five actually do quit. (p.31)
World Bank, Curbing the Epidemic: Governments and the Economics of
Tobacco Control (Washington, D.C.: World Bank, 1999).
General Canadian Statistical Information
272.
[In the five year period 1994-98, there were 1,053,411 new immigrants in Canada. Of
these in 1998, 44% spoke neither English nor French, including 39% of those aged 10+.
A large proportion come from developing countries (where smoking and health education
may be poor or non-existent).]
Citizenship and Immigration Canada, “Facts and Figures 1998; Immigration
Overview” (Ottawa: Minister of Public Works and Government Services, 1999).
273.
The reading skills of 16% of Canada’s adults are too limited to allow them to deal with
the majority of written material encountered in everyday life (p.9).
Statistics Canada, “Adult literacy in Canada: Results of a National Study”
Catalogue 89-525E, 1991.
274.
[This study of literacy found that, for prose literacy, the proportion of Canadians age 16+
in lowest literacy category was 22% overall, 25% in the Atlantic provinces, 28% in
Quebec, 89% among those with less than Grade 8 education, 59% for those completing
primary school, 25% for those with some secondary school, 28% among francophones,
33% among francophones outside Quebec, 48% among those whose first language is
neither English nor French, and 36% for those not born in Canada.]
Statistics Canada, Human Resources Development Canada, National Literacy
Secretariat, “Reading the Future: A Portrait of Literacy in Canada” Catalogue
no.89-551-XPE (Ottawa: Minister of Industry, 1996).
- 90 -
Tobacco Industry Statements/Documents
275.
The Question of Warnings and Cautionary Labels
Several proposals involve public cautions concerning cigarette smoking. All apparently
involve the dubious assumption that such warnings are scientifically justified. All are open
to the following objections:
A) Any warning which goes beyond present scientific knowledge will create disbelief
on the part of the consumer.
B) Such warnings are unnecessary to inform the public; Canadians are already highly
aware of the smoking and health issue.
C) An overstated warning might actually attract attention to smoking, particularly
among the young.
D) Warnings applied to products which may be potential, long-term hazards if abused
tend to degrade warnings on products which are immediately and acutely
dangerous. (p.1673-1674)
...
Serious consideration needs to be given to the possible boomerang or back-lash effect of
overstated warning notices. Warnings are partly intended to discourage young people
from taking up smoking, but just the reverse may result. (p.1675)
[These arguments were used by the industry in 1969 to oppose any warnings on
cigarette packages. At least two of these arguments, rebelliousness and that the public is
fully aware of the health consequences, were again used by manufacturers to oppose the
warnings required by the Tobacco Products Information Regulations.]
Ad Hoc Committee of the Canadian Tobacco Industry “A Canadian Tobacco
Industry Presentation on Smoking and Health: A Presentation to the House of
Commons Standing Committee on Health, Welfare and Social Affairs” In: House of
Commons Standing Committee on Health, Welfare and Social Affairs, Minutes of
Proceedings and Evidence, June 5, 1969, pp.1579-1689.
276.
Industry response – international
Plain pack group
- Terms of reference
 Review attacks on designs and trademarks
 Identify opportunities for action
- Membership
 BAT, PMI, RJR, Rothmans, Reemstma, Imperial UK, Gallaher
 Strong legal accent (p.5)
...
Examining
- Treaties & conventions
- Industry bodies . . .
- GATT/TRIPS (p.7)
Findings
- Current conventions & treaties afford little protection
- GATT/TRIPS little joy (p.8)
BAT, “Cigarette Pack Labelling” 1994, Bates No.502648266-273.
- 91 277.
POLICY
It is BATCo. Policy to comply with any national requirement to place health warnings on
cigarette packaging and in advertising.
...
Pictorial warnings, and those occupying a major pack face or faces (front and back) or a
disproportionately large area of advertising space, should be resisted, as should moves to
plain or generic packs. Every effort should be made to protect the integrity of the
company’s packs and trade marks.
OBJECTIVES
To minimize the damage to the Group’s most valuable assets, trade marks, pack designs.
To neutralize the controversy over pack warning labels.
To minimize the disruption to advertising communications. (p.503864424)
BAT, “1995 Key Area Paper: Corporate Affairs” Bates No.503864417-451.
278.
“We did some mock-up boards and, frankly, find it very unacceptable to put an
advertisement for our product out in that manner,” said Don Brown, Imperial Tobacco’s
Marketing Vice-President. “The first thing you see is a big warning that says ‘Smoking
causes cancer,” Mr. Brown said. “You’ve got to see it to understand. It’s just a feeling.” (pp.
B1-B2) [Tobacco companies said they would voluntarily stop placing billboard ads in new
locations as of July 1, 1998, due to a requirement that a warning “Smoking causes lung
cancer, emphysema and heart disease” would appear in the top 20% of the ad. The
companies had been permitted to advertise on billboards during a two-year transition period
after the Tobacco Products Control Act came into force, that is until January 1, 1991.]
Brown, D. as quoted in Strauss, M. “Two tobacco companies to end ads” Globe and
Mail, March 29, 1989, pp.B1-B2.
279.
CIGARETTES – ASK ALL 15 YEARS AND OVER
...
[1(d)]Three of the reasons many people quit smoking cigarettes are for health, to save money
and social pressure from family, friends or co-workers. (SHOW YELLOW CARD I) In your
case, how important was cost in your decision to quit smoking cigarettes (RECORD
BELOW).
And how important was health in your decision to quit smoking? (RECORD BELOW)
And how important was social pressure in your decision to quit smoking cigarettes?
(RECORD BELOW) (p.465258171) [This demonstrates that people quit smoking for health
reasons, and that this is actively monitored by Imperial Tobacco.]
Canadian Facts, Study JD648(MS988) questionnaire, conducted for Imperial
Tobacco, Bates No. 465258170-173.
280.
The declining consumption pattern also reflects undeniably the fact that the popularity of
cigarettes has diminished among Canadian consumers. In 1970, some 41 percent of
Canadians over the age of 15 said they smoked cigarettes regularly; in 1985 the
comparable figure was 30 percent.
That trend, in turn, would seem to reflect to some degree the impact of campaigns
sponsored by the Government of Canada and others to persuade people to stop or reduce
smoking. (pp.4-5.)
...
- 92 Canadian tobacco manufacturers believe that the public interest is best served when
consumers have the fullest and freest flow of information about all points of view on a
subject or a product. Thus, we cannot object, in law or in principle, to the proposition
that Canadians, in deciding whether to purchase cigarettes, are entitled to receive from
their government appropriately worded messages on the subject of smoking and health.
(p.30)
...
The Minister’s Departmental representative has suggested 15 rotating warnings compared
with four in the U.S.A. That is impractical.
Legislation requiring special warnings covering tobacco products must take into account
the practical difficulties facing the tobacco industry in arranging for package redesign and
reprinting. These changes cannot be done instantaneously, particularly where the entire
industry is being required to change all its packaging at once. The industry is prepared to
commence compliance as soon as the law is confirmed, starting with the packaging of
major brands, but it will take at least two years to complete packaging of all existing
brands. The Canadian printing industry could not meet demands of the industry for
earlier compliance. (p.32) [Nonetheless, in 1989, the industry states that it changed all its
brands within 10 months, as required by the Tobacco Products Control Regulations. In
1994, the industry says that it changed all brands in six months, following the March 3,
1994 rejection by the Supreme Court of Canada of the industry’s stay application and
prior to the September 12, 1994 deadline.]
Canadian Tobacco Manufacturers’ Council, “A brief to the Legislative
Committee of the House of Commons on Bill C-51” December 11, 1987.
281.
Speaking on behalf of Imperial, Chairman and CEO Don Brown said: “. . . We do not
take this action because we object to Health Canada warnings appearing on our packages,
or to the content of those warnings. We do not object because Health Canada’s new
warnings contain pictures. We object to the excessive expropriation of our packages and
trademarks. . . .”
Imperial Tobacco Canada Limited, “Imperial Tobacco Asks Quebec Superior
Court to Annul Tobacco Regulations and to Stay the Implementation of New
Labeling Regulations Until After Its Constitutional Challenge Has Been Heard”
July 6, 2000 [news release].
282.
[Warnings first appeared on Canadian cigarette packages in 1972. Following the
implementation of these warnings, the percentage of smokers who agreed that smoking is
dangerous for anyone increased from 48% in 1971 to 59% in 1972.]
Imperial Tobacco Ltd., “The Canadian Tobacco Market at a Glance”, 1989, RJRMacdonald v. Attorney General of Canada, Exhibit AG-31.
283.
Mme. Justice L’Heureux-Dubé: I mean, it is evident if you make it more prominent and
more people can see it more clearly on the top of the package, to me if those studies
decided that it was in the public interest to put those notices, or course, if you make them
more visible it is clear it is in the public interest to do that too. What kind of studies do
you need for that?
Mr. Colin K. Irving: Well, My Lady, what you need is this.
The law authorizes regulations for a purpose. The purpose is to convey information to
the public. If the warnings in the form which the Government of Canada only three years
- 93 ago thought was adequate are conveying the information to the public, and if there is
nothing to show that a new format is going to convey that information any better and that
is the case there is nothing.
Mme. Justice L’Heureux-Dubé : To show except some common sense perhaps. (pp.3233)
...
Mr. Colin K. Irving: The statute authorizes the government to convey information. It
does not authorize the government to expropriate the company’s packaging. That is what
they are doing it without any supporting evidence at all. That is the point. (p.34)
...
So that if the Court wishes that could be a condition of the stay, that the new warnings
themselves will come out. If it is as important as Doctor Graham thought it was in his
affidavit, then the new warnings could be out in three months not twelve. Because all of
the time, the trouble and the expense is in doing a complete repackaging. (pp.38-39)
. . . We are perfectly prepared to put out the new ones, if that is what the government
really wants. It could be done in one quarter of the time that will be taken to get those
warnings before the public in the new formats and at a fraction of the expense. (p.39)
...
Mr. Simon V. Potter: As Mr. Irving finished his argument a few minutes ago, it became
clear that a regulatory change which required simply a change of text would not have us
here before you. And Canadians would have the eight new texts in a period of three
months rather than a period of twelve. (p.43)
Irving, C.K. (lawyer for RJR-Macdonald Inc.), Potter, S.V. (lawyer for Imperial
Tobacco Ltd.), Transcript of audio tapes of proceedings, Supreme Court of
Canada, RJR-Macdonald Inc. v. Attorney General of Canada, October 4, 1993.
284.
It is important to know as much as possible about teenage smoking patterns and attitudes.
Today’s teenager is tomorrow’s potential regular customer, and the overwhelming majority
of smokers first begin to smoke while still in their teens. . . .
Furthermore, it is during the teenage years that the initial brand choice is made: At least a
part of the success of Marlboro Red during its most rapid growth period was because it
became the brand of choice among teenagers who then stuck with it as they grew older – this
combined with the rapid growth in the absolute number of teenagers. (p.1; p.1000390808)
...
Reasons for the Decline in Teenage Smoking
There is no question but that peer pressure is important in influencing the young not to begin
smoking. A decade and more ago it was a major reason why teenagers began to smoke.
Now it is a major reason for their not beginning to smoke . . .
The decline in teenage smoking is also attributable in large part to the anti-smoking
propaganda: The high school seniors were asked “How much do you think people risk
harming themselves (physically or in other ways) if they . . . Smoke one or more packs of
cigarettes per day.” The percent answering “great risk” increased from 51 percent in 1975 to
65 percent in 1980, with the sharpest increases in 1976 and 1979. (p.20; p. 1000390827.)
Johnston, M., “Young Smokers – Prevalence, Trends, Implications and Related
Demographic Trends” Memorandum to Dr. Robert B. Seligman, Philip Morris
Research Center Special Report, Philip Morris U.S.A. Inter-Office Correspondence,
March 31, 1981, Bates No. 100390803-829.
- 94 285.
The authors conclude that the anti-smoking commercials represented a shock to the
underlying upward trend in teenage smoking in the mid-1960’s and early 1970’s,
particularly in the first year in which they were aired, but that the trend reasserted itself the
following year, although teenage smoking remained at a lower level than would have been
the case in the absence of commercials. This is consistent with my findings that random
shocks, such as the report of the Royal College of Physicians and Surgeons, the Readers
Digest articles, and the reports of the Surgeon General have brief effects and then sales
subsequently resume the upward trend, but more slowly and from a lower base. (p.2)
...
It is worth noting that government actions designed to reduce smoking in the late 1960’s and
early 1970’s served to moderate an underlying upward trend in teenage smoking, while any
government action taken now will accelerate its present downward trend. (p.4)
Johnston, M., “Teenage Smoking and the Federal Excise Tax on Cigarettes” Philip
Morris U.S.A. Inter-office correspondence, Memorandum to Harry G. Daniel,
September 17, 1981, Bates No. 200125524-527.
286.
Canadians who choose to smoke are convinced that there are health risks associated with
smoking, in part because there have been health warnings on Canadian cigarette packages
for almost three decades. (p.5)
Levitt, B. (President and Chief Executive Officer, Imasco Ltd.), statement dated
January 29, 1998 “Imasco 1997 Annual Report”, 1998.
287.
The Lorillard Tobacco Company today announced the launch of a nationwide youth
smoking prevention program.
...
The new program, which the company said would be ongoing, is comprised of a series of
national broadcast and print advertisements directed at both kids and parents, and includes
websites, education materials, and a multi-city tour to encourage parents to talk to their kids
about not smoking.
Lorillard Tobacco Company, “The Lorillard Tobacco Company Unveils Youth
Smoking Prevention Program; Cutting-Edge Ads to Be Broadcast” October 11,
1999 [news release].
288.
In development of the ad creative, extensive research was conducted to determine the
effectiveness with target audiences and the potential impact these ads would have on kids
perceiving smoking as “uncool”. The research demonstrated that:
 Both television spots clearly communicated the “Don’t Smoke” message.
 The ads had a measurable effect on shifting attitudes regarding smoking.
 Smoking was perceived as less cool and decreased other favorable smoking perceptions.
 The ads were seen as different from other advertising and different from other antismoking advertising.
 The ads were relevant, believable and interesting; they had stopping power. (p. 3 of
internet print out)
Lorillard Tobacco Company, “Youth Smoking Prevention Program” accessed
January 7, 2000, http://208.184.33.80/demo/2take10/webcast.htm
- 95 289.
But if this whole process winds up costing the industry, pick a number, $100 million, $200
million, all of those are deductible expenses. So taxpayers, first of all, share 50 per cent of
the cost. Then the industry will raise its prices in order to recover those costs because that
happens for all costs in all industries. Who pays? As I said at the outset, taxpayers pay.
Retailers pay. The environment pays. Printers pay. But tobacco companies will not end up
paying because the smoking rate is very unlikely to decline. (p.2)
...
Leaving aside the question of how big the warning panel is, what’s in it as long as it’s
attributed to government is basically up to government. (p.3)
Parker, R. (President, Canadian Tobacco Manufacturers’ Council) Transcript of
news conference, Ottawa, January 18, 1999.
290.
Perhaps I should start by just stating some of the things on which we’re in full agreement
with the government of Canada and with Minister Rock. The first and most obvious is the
significant health risks that are associated with tobacco and which smokers are exposed.
The second thing, because of those risks, is that children should not smoke. A third thing is
that there should be warnings on the package – clear, permanent, memorable and credible –
about what those health risks are. And the final point is that those warnings should be
periodically refreshed because they do get stale from being exposed constantly to the same
messages.
Parker, R. (President, Canadian Tobacco Manufacturers’ Council) Transcript of
news conference, Ottawa, January 19, 2000.
291.
Mr. Parker: . . .
The second question was what can be done to eliminate or reduce youth smoking. I think
much can be done in terms of advertising. Obviously, there is information on the health
risks. There are peer activity groups; the kind of things the young people who appeared
before that committee participated in. There are advertising campaigns, although I have
less faith in their efficacy than Senator Kenny may have.(p. 52:45)
...
Senator Kenny: Mr. Parker, you may not agree, but a study done by the University of
Berkeley in 1994 indicated that tax and education combined would have an impact on
reducing smoking.
Mr. Parker: In general, I would not disagree with that proposition. As I said earlier, there
is a connection between price and consumption, particularly for young people. … I would
not disagree that education and price together have a role to play in this. (p. 52:55)
Parker, R. (Chairman and Chief Executive Officer, Canadian Tobacco
Manufacturers’ Council), Proceedings of the Standing Senate Committee
on Legal and Constitutional Affairs during hearings on Bill C-71, the
Tobacco Act, April 1, 1997, pp.52:45, 52:55.
292.
In October 1997, at the request of the United States Senate Judiciary Committee, the
Company provided the Committee with a document setting forth the Company’s position
on a number of issues. On the issues of the role played by cigarette smoking in the
development of lung cancer and other diseases in smokers, and whether nicotine, as
found in cigarette smoke, is addictive, the Company stated that despite the differences
that may exist between its views and those of the public health community, it would, in
order to ensure that there will be a single, consistent public health message on these
- 96 issues, refrain from debating the issues other than as necessary to defend itself and its
opinions in the courts and other forums in which it is required to do so. The Company
also stated that in relation to these issues, and the health effects of ETS, the Company is
prepared to defer to the judgement of public health authorities as to what health warning
messages will best serve the public interest. (p.23) [See also: “We are also prepared to
defer to the judgement of public health authorities as to what health warning messages
will best serve the public interest . . . ” Bible, G.C. (Chief Executive Officer, Philip
Morris Companies Inc.), “Prepared Statement of Geoffrey C. Bible Inc. Before the U.S.
Senate Commerce Committee” February 24, 1998.]
Philip Morris Companies Inc., “1999 Annual Report”, 2000.
293.
The federally-mandated warning labels on cigarettes were last changed in 1984. Since
then a number of countries, including Canada and members of the European Union, have
imposed new warning labels. Further, the Federal Trade Commission’s methodology to
measure the “tar” and nicotine yields of cigarettes has been criticized as producing
misleading information.
1.The legislation, through amendments to the Federal Cigarette Labeling and
Advertising Act and the Comprehensive Smokeless Tobacco Health Education Act,
would mandate new rotating warnings, to be introduced concurrently into the
distribution chain on all tobacco product packages and cartons, and to be rotated
quarterly in all advertisements. For cigarettes, the warnings would be:
 “WARNING: Cigarettes are addictive”
 “WARNING: Tobacco smoke can harm your children”
 “WARNING: Cigarettes cause fatal lung disease”
 “WARNING: Cigarettes cause cancer”
 “WARNING: Cigarettes cause strokes and heart disease”
 “WARNING: Smoking during pregnancy can harm your baby”
 “WARNING: Smoking can kill you”
 “WARNING: Tobacco smoke causes fatal lung disease in non-smokers”
 “WARNING: Quitting smoking now greatly reduces serious risks to your health”
For smokeless tobacco products, the warnings would be:
 “WARNING: This product can cause mouth cancer”
 “WARNING: This product can cause gum disease and tooth loss”
 “WARNING: This product is not a safe alternative to cigarettes”
 “WARNING: Smokeless tobacco is addictive”
For cigarettes, the warnings would occupy 25% of the front panel of the package
(including packs and cartons) and would appear on the upper portion thereof. The
legislation would contain a grandfather provision for existing brands with flip-top
boxes comprising less than 25% of the front panel. For smokeless tobacco products,
the warnings would appear on the principal display panel (e.g. a band around the can
for moist smokeless tobacco products) and would occupy 25% of the display panel.
The warnings would be printed in line with current Canadian standards (e.g. 17 point
type with appropriate adjustments depending on length of required text) and in an
alternating black on white and white on black format. (pp.9-11)
...
Effective Dates on Final Passage
...
Package Labeling 1/3 in 90 days, 1/3 in 120 days, 1/3 in 180 days (p.23)
- 97 Philip Morris Incorporated, R.J. Reynolds Tobacco Company, Brown and
Williamson Tobacco Corporation, Lorillard Tobacco Corporation, Attorneys
General from 40 U.S. states, et al. “Proposed Resolution”, June 20, 1997
[Proposed out-of-court settlement agreed to by tobacco manufacturers and state
Attorneys General. The agreement required congressional approval to be
implemented, something that did not occur.].
294.
Five specific measures have been identified to fulfil Philip Morris International’s
commitment to addressing the issue of youth smoking around the world. We have
pledged to:
...
Support youth anti-smoking programs, organized in concert with education and
health officials in every country (p.1 of internet print out)
...
Youth NO-SMOKING EDUCATION PROGRAMS
We believe that education programs are important parts of any effort to reduce
youth smoking, and we advocate that such programs be made available to and
directed at youth, parents, teachers and other appropriate groups.
We will help develop concepts, programs and messages and we will seek partners
including governments, schools, and parent and community groups. We will
sponsor such programs on our own or with the industry, as appropriate.
HEATH WARNING NOTICES
In order to ensure that there will be a single, consistent public health message on the issues
of whether cigarette smoking causes disease and whether it is addictive, we will defer to the
judgement of public health authorities as to what health warning messages relating to these
matters will best serve the public interest.
It is the policy of our company that every cigarette package shall contain a health warning
whether required by law or not. Similarly, we shall comply strictly with laws requiring
health warnings in advertising and in those markets where there are no such laws we will
develop guidelines for voluntarily placing health warnings in our advertising. (p.2)
Philip Morris International, “Our Global Commitment in Support of Youth
Smoking Prevention: Where We Stand” accessed March 17, 2001,
http://www.pmintl.com/corp_resp/global.html
295.
“Our company believes the settlement provides an unprecedented opportunity to design and
implement programs that can have a positive impact on reducing the incidence of youth
smoking,” said Merlo [Ellen Merlo, Senior Vice President, Corporate Affairs, Philip Morris
USA].
Most experts agree that a comprehensive effort should include advertising campaigns,
educational programs in schools, community-based programs that promote positive youth
development, and enhanced access prevention and enforcement efforts.
Philip Morris USA, “Philip Morris USA Notes Final Approval of Master Settlement
Agreement; Encourages states to devote released funds to youth smoking prevention
initiatives . . .” November 12, 1999 [news release].
296.
Four Integrated Strategies
- 98 We are applying a comprehensive approach that integrates the following four strategies to
help reduce youth smoking. [Communication; Education; Community Action; Access
Prevention]
Communication
We are creating TV and print messages for youth and parents, as well as exploring radio,
direct mail, outdoor and Internet messages. The message to youth is that smoking is not
“cool” or necessary for them to define themselves. (p. 2 of tab)
Philip Morris U.S.A., “Youth Smoking Prevention”
www.philipmorrisusa.com/DisplayPageWithTopic.asp?ID=75, accessed May 7,
2000.
297.
Mr. Potter: As a matter of constitutional and Charter law, senator, it is clear also
that lawyers who may complain about an attack on freedom of expression cannot
complain about the government putting out more information rather that making
less information available to people.
Potter, S. (Imperial Tobacco lawyer), Proceedings of the Standing Senate
Committee on Legal and Constitutional Affairs during hearings on Bill C-71, the
Tobacco Act, April 1, 1997, p.52:55.
298.
The drop in total industry sales for the year is a direct result of the adverse publicity
emanating from the report of the U.S. Surgeon General’s Committee on Smoking and
Health which was released in January, 1964. (p.4)
Rothmans of Pall Mall Canada Limited, “Annual Report 1964”, 1964.
299.
Mr. Paul Szabo [Member of Parliament]: Okay. With regard to the broader tobacco
question, the strategy the government is bringing forward here in the regulations about
changing the messages, putting on some graphics, etc., have you thought of the impact
that may have on the possible first-time smoker? In terms of a strategy, do you think it
might work?
Mr. Joe Spriet [Small Canadian Tobacco Manufacturers Association, which represents
three manufacturers]: I think initially it will have a really big impact, but going down the
road. . . . In restrospect, having looked at the last 20 years of regulations and health
warnings, worldwide consumption and all of those things, I would imagine five years
down the road you’re going to have to triple the old warnings again to have the same
impact. (p.8 of internet print out)
Spriet, J., Evidence, House of Commons Standing Committee on Health,
Meeting no.25, June 1, 2000, during hearings on the Tobacco Products
Information Regulations and the Tobacco Reporting Regulations, accessed July
23, 2000,
www.parl.gc.ca/InfoComDoc/36/2/HEAL/Meetings/Evidence/healev25-e.htm
- 99 -
Legal Cases and Opinions
300.
[A]ccepting the assumptions you have given to me [that failure to adequately
warn caused a person to die or be harmed] and taking it as a given that those
assumptions could be supported by the evidence, it is my opinion that in law a
charge of criminal negligence either causing death or bodily harm could be made
out. (p. 13)
Doherty, D. (McCarthy & McCarthy), “Opinion as to the availability of criminal
sanctions against manufacturers of cigarettes” Letter to C. Garfield Mahood
(Executive Director, Non-Smokers’ Rights Association) April 13, 1987, p.13.
301.
Once a duty to warn is recognized, it is manifest that the warning be adequate. It should
be communicated clearly and understandably in a manner calculated to inform the user of
the nature of the risk and the extent of the danger; it should be in terms commensurate
with the gravity of the potential hazard, and it should not be neutralized or negated by
collateral efforts on the part of the manufacturer. The nature and extent of any given
warning will depend on what is reasonable having regard to all the facts and
circumstances relevant to the product in question. (p.101)
...
Whether a particular warning is adequate will depend on what is reasonable in the
circumstances. But the fact that a drug is ordinarily safe and effective and the danger
may be rare or involve only a small percentage of users does not necessarily relieve the
manufacturer of the duty to warn. While a low probability of injury or a small class of
endangered users are factors to be taken into account in determining what is reasonable,
these factors must be balanced against such considerations as the nature of the drug, the
necessity for taking it, and the magnitude of the increased danger to the individual
consumer. Similarly, where medical evidence exists which tends to show a serious
danger inherent in the use of a drug, the manufacturer is not entitled to ignore or discount
that information in its warning solely because it finds it to be unconvincing. The
manufacturer is obliged to be forthright and to tell the whole story. The extent of the
warning and the steps to be taken to bring the warning home to physicians should be
commensurate with the potential danger -- the graver the danger, the higher the duty.
(p.112-113)
Ontario Court of Appeal (per Mr. Justice Robins), Buchan v. Ortho
Pharmaceutical (Canada) Ltd. (1986), 54 Ontario Reports (2d) 92, writing for a
unanimous court (5:0).
302.
Conclusion
...
Under the 1979 GATT Agreement on Technical Barriers to trade, as well as, NAFTA
Chapter 9, GATT, Article XX (b), and NAFTA Article 2101, Canada would be justified
in adopting plain packaging legislation developed to protect life and health of its citizens
and would not violate her international obligations in doing so.
Furthermore, my interpretation of the relevant GATT and NAFTA provisions dealing
with intellectual property rights and investment leads me to the conclusion that the
proposed legislation would not violate Canada’s international trade obligations in these
specific areas. (p.11, Castel)
- 100 Robinson, M.J. “Proposed Canadian Legislation requiring “Plain Packaging” for
Cigarettes and Tobacco Products” Letter to Garfield Mahood (Executive
Director, Non-Smokers’ Rights Association), May 11, 1994; Castel, J.-G.
“Would Plain Packaging for Cigarettes Violate Canada’s International Trade
Obligations?” Letter to J. Michael Robinson (Fasken Campbell Godfrey) May
11, 1994.
303.
. . . All warnings must be reasonably communicated, and must clearly describe any
specific dangers that arise from the ordinary use of the product . . . (p.653)
...
The nature and scope of the manufacturer’s duty to warn varies with the level of danger
entailed by the ordinary use of the product. Where significant dangers are entailed by the
ordinary use of the product, it will rarely be sufficient for manufacturers to give general
warnings concerning those dangers; the warnings must be sufficiently detailed to give the
consumer a full indication of each of the specific dangers arising from the use of the
product. . . . (p.653-654)
...
The courts in this country have long recognized that manufacturers of products that are
ingested, consumed or otherwise placed in the body, and thereby have a great capacity to
cause injury to consumers, are subject to a correspondingly high standard of care under
the law of negligence . . . (p.655)
Supreme Court of Canada (per Mr. Justice La Forest) in Hollis v. Dow Corning
Corp. [1995] 4 Supreme Court Reports 634.
304.
Where manufactured products are put on the market for ultimate purchase and use by the
general public and carry danger (in this case, by reason of high inflammability), although
put to the use for which they are intended, the manufacturer, knowing of their hazardous
nature, has a duty to specify the attendant dangers, which it must be taken to appreciate in
a detail not known to the ordinary consumer or user. . . . The required explicitness of the
warning will, of course, vary with the danger likely to be encountered in the ordinary use
of the product. (pp.574-575)
Supreme Court of Canada (per Mr. Justice Laskin) in Lambert v. Lastoplex
Chemicals Co. Limited [1972] Supreme Court Reports 569, writing for a
unanimous court (5:0).
305.
Further, both parties agree that past studies have shown that health warnings on tobacco
product packages do have some effects in terms of increasing public awareness of the
dangers of smoking and in reducing the overall incidence of smoking in our society . . .
(p. 353)
[A]ny public interest in maintaining the current price of tobacco products cannot carry
much weight. This is particularly so when it is balanced against the undeniable
importance of the public interest in health and in the prevention of the widespread and
serious medical problems directly attributable to smoking. . . .
The public interest in health is of such compelling importance that the applications for a
stay must be dismissed . . . (pp.353-354) [In this case, the Court rejected a tobacco
industry attempt to obtain an injunction to block implementation of new warnings on the
grounds that there would be too much cost to the industry.]
- 101 Supreme Court of Canada (per Mr. Justice Sopinka and Mr. Justice Cory) in
RJR-Macdonald Inc. v. Canada (Attorney General), [1994] 1 Supreme Court
Reports 311, writing for a unanimous Court (9:0).
Studies, Reports and Other Literature – Warnings
306.
ASH and BMA believe that the low level of awareness [of impotence] among smokers
makes a compelling case for new warnings on packets of cigarettes and other tobacco
products. (p.6)
...
ASH and BMA call for the British Government and the European Union to add the
following warnings to labels on cigarettes and tobacco products sold in the UK and EU:
WARNING: Smoking causes male sexual impotence
WARNING: Smoking damages sperm
WARNING: Smoking may damage your sex-life (p.8)
Action on Smoking and Health [U.K.], British Medical Association, "Warning:
Smoking Causes Male Sexual Impotence" 1999, downloaded from Internet
September 13, 1999. www.ash.org.uk/papers/impotent.html
307.
The ARF believes tobacco should be included in the Canadian Hazardous Products Act.
Not only would this send a message to Canadians about the harmfulness of this
substance, but it would also facilitate additional preventive measures such as plain
packaging, larger warnings on packages . . . (p.2)
Addiction Research Foundation [Canada], “Preventing Smoking: Tobacco
Control Policies. Best Advice from the Addiction Research Foundation” July
1995.
308.
Overall, the front position was voted the most effective position for conveying a health
message; inside the lid was the next most supported position. ...
When the packs tested were ranked for effectiveness, Pack A (front and back) was
considered the most powerful in persuading cessation of smoking or in persuading someone
not to take up smoking.
...
Health warnings with an outline (as against "unboxed warnings") were preferred (p.13) [by
a margin of 85% to 13% (p.25)].
AGB Spectrum Research Ltd., “Testing the Positions of Health Warnings on
Cigarette Packs” Prepared for Health Promotion Programme, Department of Health,
New Zealand, November 1987.
309.
Text messages
 word the message simply so that people with a minimal reading level can understand it
 use prohibitive wording to discourage unsafe acts, and use permissive wording to
encourage safe behavior
 state the consequences of the prohibited action
 speak directly to the reader by using the word "you"
- 102 
use a left justified, right ragged edge format and a headline style to allow maximum
reading speed
 avoid extraneous text which does not directly contribute to comprehension of the hazard
Pictorial
 show consequences of the prohibited action (in process)
 use bold, silhouette of human for best clarity from a distance
 indicate injury to the human
 keep pictorial simple to avoid multiple interpretations and visual clutter
 design pictorial to convey the warning with minimum reliance on the text message so
that people who do not read the text (including illiterates and foreigners) will still get the
message
 avoid the universal (red circle with a slash) prohibitive symbol because it tends to
obscure the pictorial
 avoid graphics which do not directly contribute to comprehension of the hazard (p.3)
American Institutes for Research, "Project Overview and Summary of Findings"
from “Final Report: Effectiveness of Swimming Pool Warning Signs and Labels"
(CPSC-C-86-1163, Task Order 16), March 3, 1988, Prepared for the U.S. Consumer
Product Safety Commission, Human Factors Division.
310.
The first step in the battle against tobacco usage is always to inform, and convince, the
population that tobacco is harmful. Warning labels can be a useful educational tool in
heightening this awareness.
Bang, K. “Warning Labels in Developing Countries” World Smoking and Health,
1993;18(2):10.
311.
The presentation of health warnings in the context of plain packs achieved a significantly
greater recall rate as opposed to brand packs. When less brand image cues were presented,
respondents were able to perceive and recall with more accuracy a greater proportion of
'non-image' information. (p.315)
...
When asked what suggestions they had for health warnings on cigarette packets, students'
most common response ... was to change the words to 'smoking kills'. ... Other common
suggestions that came forward were to: (a) increase the size of the warning; (b) display the
warning in a boxed area to separate it from other information; (c) use the hinged opening
part at the top of the packet for the warning to bring it to attention every time a cigarette was
taken from the packet; (d) put an additional warning on an insert in the packet, which would
have to be removed to access the cigarettes; and (e) print the warning on the cigarette itself.
(p.321)
Beede, P. Lawson, R. “The Effect of Plain Packages on the Perception of Cigarette
Health Warnings” Public Health 1992;106:315-322.
312.
The use of an illustration supporting the conventional health warning text on tobacco packs
is a key advance toward more effective health education. (p.406)
Blondal, T., Magnusson, G. “Innovation in Iceland: Graphic Health Warnings on
Tobacco Products”, New York State Journal of Medicine 1985;85(7):405-406.
- 103 313.
Findings.
In the cross-sectional sample at follow-up, 66% of smokers reported at least sometimes
noticing the health warnings when taking out a cigarette (compared with 37% at baseline),
and 14% reported they had refrained from smoking on at least one occasion as a result
(compared with 7% at baseline). (p.1427) [This study was conducted before and after the
implementation of new, strengthened Australian health warnings.]
Borland, R. “Tobacco health warnings and smoking-related cognitions and
behaviours” Addiction, 1997;92(11):1427-1435.
314.
The new warning system goes further than the previous warnings towards providing the
moral imperative of adequate information, and thus should contribute to tobacco control
efforts. ... While the new warnings may have some impact on the image of cigarette packs,
the producers' trade marks and packaging style remain the most salient features of the
packets. Consideration still needs to be given to some form of generic or standardized
packaging. (p. 1156)
Borland, R, Hill, D. “The path to Australia’s tobacco health warnings” Addiction
1997;92(9):1151-1157.
315.
Results - There was high awareness of the new warnings, particularly among smokers, with
the increased size of the new warnings the most salient feature. More than a third of
smokers reported being affected by the warnings, with reductions in consumption and
talking about warnings being the most common effects. Among smokers, there was an
increase in knowledge about the main constituents of tobacco smoke. The number of types
of health effects mentioned also increased as did the number of warnings correctly recalled.
Overall beliefs about the six warning statements became stronger. Few changes were found
for non-smokers. ...
Conclusions - These results suggest the new health warnings are resulting in better informed
smokers and thus suggest that informative health warnings can play an important role in
better informing consumers. (p.317)
Borland, R., Hill, D. “Initial impact of the new Australian tobacco health warnings
on knowledge and beliefs” Tobacco Control 1997; 6:317-325.
316.
Package health messages lead to reduced smoking thus protecting the health of
Canadians. Package health messages reduce the alluring, attractive nature of packages
that is an inducement to young persons and others to use tobacco products. Package
health messages communicate information thus enhancing public awareness of the health
hazards of using tobacco products. The more prominent and the more extensive these
messages, the better these objectives are met. (p.53)
...
Pictures should be used on at least some rotated messages. As the saying goes, “a picture
says a thousand words”. Those with lower levels of education are much more likely to
smoke, and may be more likely to benefit from pictures on packages. Pictures can assist
smokers visualize the nature of a tobacco-caused disease or affliction. Pictures also help
to convey a message [to those] who have a low literacy level. As well, some newer
Canadians lack proficiency in both English and French. (p.59)
...
At least 75% of the package front and back should be allocated for health messages.
Health messages are far more important than the pro-tobacco messages sought to be
- 104 conveyed by tobacco companies. Allocating 25% of the front and back of the package
for manufacturers is sufficient to enable manufacturers to communicate information that
currently appears on the package front and back. (p.61)
Canadian Cancer Society, “Confronting the Tobacco Epidemic: Recommendations
for Regulations under the Tobacco Act; A Report Submitted to the Honourable
Allan Rock, Minister of Health” March 1998.
317.
Summary List of Recommendations
Part I – Labelling
 regulations should specify that the content of warnings should be able to be changed
administratively, without the need for regulatory amendment
 the proposal to increase the warning space on the package front/back to 60% is to be
commended, although 75%, 80% or 100% would be even more effective
 warnings should include pictures and other graphics (e.g. healthy lung, lung with
cancer)
 some images in warnings should link with commercials placed on television . . .
 the use of slides to convey additional health messages is strongly supported
 the number of rotated messages on the front/back of the package should be at least 16.
The number of slides should be at least 25
...
 the use of a colour marker word, such as “WARNING” is desirable
 the placing of a toll-free “Quit” Line number, as well as a world wide web address, are
desirable items that should go on a package.
...
 at least 60% of all six sides of a carton should be used to convey a health message, a
message(s) that might benefit by being different than the messages found on packages.
100% of some sides might be used. French and English messages could appear on
opposite carton sides. (p.2)
Canadian Cancer Society, “Advancing Tobacco Control: A Submission to the
Director, Office of Tobacco Control, Health Canada on the Consultation Papers
Options for Tobacco Promotion Regulations and Proposed New Labelling
Requirements for Tobacco Products” March 12, 1999.
318.
The Canadian Cancer Society today released six research studies it commissioned showing
that larger cigarette package warnings with photos would be effective (1) at increasing
public awareness of the health effects of smoking and (2) at discouraging smoking. The
photos examined in research include black lungs, lungs with emphysema, a person with a
damaged throat, and a mouth with a cancer tumor. (p.1)
...
“These results are dramatic and compelling,” says Ken Kyle, Director of Public Issues for
the Canadian Cancer Society. “We reiterate our recommendation to Health Canada to
increase the size of cigarette warnings to at least 60% of the package exterior, to require
colour photos as part of the warnings, and to increase the number of different messages to be
included as part of a rotated series.” (p.2)
Canadian Cancer Society, “Larger Cigarette Warnings with Photos of Health Effects
Would be Effective at Discouraging Smoking, Concludes Canadian Cancer Society
Research” January 18, 2000 [news release].
- 105 -
319.
“The new warnings are historic,” said Patti Pacholek, Chair of the National Public Issues
Committee of the Canadian Cancer Society. “The full set of rotated warnings represents an
outstanding, well-targeted educational campaign. There is no more cost-effective way to
reach smokers than through the 2 billion cigarette packages sold each year in Canada.”
Minister Allan Rock and Health Canada officials are to be commended for the vision and
extensive work that have led to today’s announcement,” said Pacholek. “The colour photos
on packages will make a particular impact: a picture says a thousand words. Overall, these
warnings will increase the depth of public understanding of the health effects of cigarettes,
and will lead to a reduction in smoking. That is why we can expect vigorous opposition
from tobacco companies. During the consultation period, we intend to urge the government
to increase the size of the exterior warning to at least 60% of the package front and back.”
Canadian Cancer Society, “Canadian Cancer Society Endorses New Cigarette
Warnings Announced Today by Health Minister Allan Rock” January 19, 2000
[news release].
320.
Warnings lead to increased awareness of risks AND increased desire to quit.
Canadian Cancer Society, Canadian Medical Association, Coalition québécoise
pour le contrôle du tabac, Non-Smokers’ Rights Association, Ontario Campaign
for Action on Tobacco, Physicians for a Smoke-free Canada, “Better Warnings
for Better Health” April 2000 [poster].
321.
[This item contains examples of inserts from packages of Aspirin, Sominex (a sleep aid),
and an oral contraceptive manufactured by Searle.]
Canadian Cancer Society, “Examples of Package Inserts”, May 2000.
322.
[This document lists 102 organizations and 372 individuals known to have written to Health
Canada in support of the new package health warning proposals announced January 19,
2000.]
Canadian Cancer Society, “List of Organizations and Individuals Known to Have
Written to Health Canada in Support of New Tobacco Warning Regulations
Announced January 19, 2000” May 29, 2000.
323.
[This item contains examples of tobacco manufacturers using colour pictures of people on
cigarette cartons, on cigarette packages and on matchbooks. Previously in Canada on
Matinee cartons Imperial Tobacco has printed a colour picture of a woman playing tennis.]
Canadian Cancer Society, “Examples of Cigarette Packages, Cigarette Cartons
and Matchbooks with Colour Pictures of People” May 29, 2000.
324.
[Y]our Committee has considered the Proposed Tobacco Products Information
Regulations (SOR/JUS – 60143) and the Proposed Tobacco (Reporting) Regulations
(SOR/JUS – 601036) referred to the Committee on Friday, May 12, 2000, pursuant to the
Tobacco Act, S.C. 1997, c.13, s.42.1.
Your Committee recommends that the Government enact the proposed regulations
without amendment.
- 106 Canadian House of Commons, Standing Committee on Health, “Third Report”
June 7, 2000.
325.
[O]nly 8% of physicians are regular smokers. (p.240C) [Doctors are particularly
knowledgeable about the health effects of smoking, and have a rate of smoking much lower
than the general population in Canada. This demonstrates that increased awareness and
depth of understanding of the health effects can lead to reduced smoking. In 1969, the
Canadian Medical Association told the House of Commons Standing Committee on Health,
Welfare and Social Affairs that the proportion of doctors who smoked had fallen from 65%
to 35% in the previous 15 years.]
Canadian Medical Association, “CMA Policy Summary; Tobacco and Health”
Canadian Medical Association Journal, 1997;156(2):240A-240C.
326.
Conclusion
To be effective, health warnings need to be noticed, persuasive and provide guidance for
appropriate action. To be noticed, health warnings need to stand out from the surrounding
pack design and they need to be large enough to be read easily. To be persuasive, the
warnings need to be understood, believed, and judged to be personally relevant by the
reader. It follows that warnings about a range of ill-effects of smoking that is
comprehensive increases the chance that people reading warnings will find at least one illeffect with which they relate. Finally, the effectiveness of any call to action is enhanced by
specific instructions about the first step to take. (p.7)
...
Recommendations
G2. The adverse health effects of tobacco smoking should be effectively conveyed on the
packaging of all tobacco products. Children handling cigarettes with a view to trying
smoking should be provided with understandable information about the health consequences
of smoking. Consumers have a right to be informed about the hazardous consequences of
use. Information is most likely to affect behaviour if it is available at the time behaviour
takes place. . . . There is general evidence that the availability of information affects
decision making. (p.9)
...
G4. Information to encourage and assist addicted smokers wishing to quit should be
provided on the packaging of all tobacco products. Carrying out the intention to change
health behaviour can be enhanced if instructions about an appropriate response are available
at critical moments of decision (i.e. smokers need to have available the first step in a chain of
behaviours that will lead them to quitting at the moment they decide to make a quit attempt.
(p.10)
...
G7. Tobacco products should be sold in “standard packages” . . . Packaging creates brand
images, which are inimical to rational appraisal of the dangers of smoking. This undermines
the impact of health warnings and may promote tobacco use, particularly among adolescents
in whom the habit may not yet be entrenched.
G8. Provision should be made with respect to all aspects of labeling for: a) changes to be
made in the light of new discoveries b) ongoing monitoring and evaluation to ensure
continued effectiveness. Relevant new knowledge on both consequences of smoking and on
effectiveness of health messages may become available in the future. Over-exposure may
ultimately lead to reduced message effectiveness. (p.11)
...
- 107 B1. That a panel be set aside covering not less than 25% of the surface area of the front of
the pack for inclusion of a health warning and that this boxed area have a clear border. . . .
Enlargement increases legibility. . . . The larger the area occupied by the warning, the better
it communicates . . . and the stronger its impact.
B2. That regulations specify the contents and other design features of this boxed area. To
effectively communicate health messages health authorities need control over the design and
content of the message-in-context.
B3. That the boxed area contain one of a comprehensive set of health warnings which shall
be rotated with equal frequency . . . A larger set of warnings will allow a greater variety of
dangers to be made salient and will provide a degree of novelty that will reduce habituation
and thus enhance noticeability.
B4. That the position of the boxed area on the pack be specified in the regulations as being at
the top of the front of the pack. . . . Top of the front of the pack is the most noticeable
position . . . and people believe that the top is the optimal position. (p.14)
...
B6. That there be a minimum font size for the warnings. . . . Large font can be more easily
read and at a greater distance. (p.15)
...
B11. That the back of the pack should be given over entirely to the provision of more
detailed health information about the harmful consequences of smoking. The public wants
more information. Smokers who have limited recall of key health information should have
information available when needed. Extra detail and repetition makes the warnings more
persuasive. Since some smokers self-exempt themselves from the risks of smoking, more
detailed information stressing the personal relevance of the harm will make it more difficult
to deny risk. Many products (and most drugs) have large amounts of the surface area of
packaging given over to product information. (p.16)
Centre for Behavioural Research in Cancer [Australia], Health Warnings and
Contents Labelling on Tobacco Products (Carlton South, Victoria, Australia: AntiCancer Council of Victoria, 1992) Prepared for Ministerial Council on Drug
Strategy Tobacco Task Force.
327.
Contents labelling: Ninety-one per cent of respondents thought the proposed contents
labelling to be more informative, and 85% said that it should be on packs in preference to the
current labelling. This later figure rose to 94% in the context of the proposed label
discouraging smoking uptake.
Front of pack warning: Ninety-one per cent of respondents believed the proposed changes to
be more effective than the current system, and 85% considered it the preferred option to
print on packs. The latter figure rose to 96% in the context of the change discouraging
smoking uptake.
Back-of-pack information: Seventy-eight per cent of respondents approved of using the
back-of-packs for extra information, and approval rose further to 94% in the context of
discouraging smoking uptake.
Standardised packaging: Forty-nine per cent of respondents approved of laws requiring
packets to be standardised in the manner depicted, and only 39% disapproved, the remainder
did not offer opinions. In the context of discouraging smoking uptake, approval rose to
87%.
Centre for Behavioural Research in Cancer [Australia], "Public Approval of
Proposed Tobacco Pack Labelling and Other Modifications. Supplement to: Health
Warnings and Contents Labelling of Tobacco Products", (Carlton South, Victoria,
Australia: Anti-Cancer Council of Victoria, 1992).
- 108 -
328.
It is imperative that the specific risks of smoking to women should always be included in
health warnings on cigarette packets and advertisements, as is the case now in numerous
countries, such as Canada, Iceland and Sweden. Since 1970, WHO has recommended that
cigarette packets should carry health warnings about the dangers of smoking; these warnings
must be accurate and comprehensible to the public, they should be changed regularly to
ensure that smokers do not become accustomed to the same message and they should be
clearly visible. (p.81).
Chollat-Troquet, C. Women and Tobacco (Geneva: World Health Organization,
1992).
329.
Summary and Conclusions
1. The impact of the new cigarette pack warnings exposed in this research is likely to be
marginal whatever the nature of the message, because of their comparatively small size.
At 4% of the pack face, they are difficult for many to read, and comparatively easy to
ignore.
2. There is a tendency to interpret the smallness of the warnings as evidence of government
duplicity. More worringly, there also seems to be a tendency to equate the size of the
warning with the magnitude of the risk.
3. To maximise the impact of the new back-of-pack warnings, the optimum strategy would
be to increase their size, position them near the top of the pack, rotate them frequently,
and ensure maximum colour clash with brand livery. Consideration might also be given
to moving the warnings to the front of the pack.
4. The impact and relevance of particular warnings seems to depend to some extent upon
the lifestage of the smoker. Differential impact of this kind is a further important reason
for message rotation. (p.34)
Cragg, Ross and Dawson Limited, “Health Warnings on Cigarette and Tobacco
Packs: Report on Research to Inform European Standardization” Prepared for
Health Education Authority and the Department of Health [U.K.] December 1990.
330.
Following a lengthy regulatory process, Canada’s new cigarette package warnings are the
first with photographs, and the first covering 50% of the package front and back.
...
The regulations require that one of 16 rotated picture based warnings, in full colour,
cover 50% of the top of the front and back of the package, with English on one side and
French on the other.
Inside the package, one of 16 additional messages is required, either on an insert,
or on the “slide” portion of slide and shell packages. (p.362).
Cunningham, R. “Canada: warnings with colour pictures required” Tobacco
Control, 2000;9(4):362-363.
331.
No single health warning or system of warnings can be ideal for all countries. It is obvious,
however, that the best system devised thus far entails a series of clear, well-presented,
sizeable, personalized, rotating health warnings which stress the harmful health
consequences of smoking and the benefits of giving up. My own view is that as the next
step, the warning label could include advice on methods of stopping smoking.(p.46)
- 109 Daube, M. “In Support of Health Warnings” World Smoking and Health,
1982;7(3):2,42-46.
332.
Although most Canadians (70% of adults and 72% of young people, aged 12 to 17) feel
at least somewhat informed about what is in cigarettes, almost three-quarters (73% and
83%) feel there should be more information available about the contents of cigarettes.
Canadians express almost unanimous support (89% and 91%) for requiring cigarette
companies to display a list of toxic constituents on cigarette packages. Most Canadians
(88% and 92%) also support the idea of requiring cigarette companies to display an
informational statement about the effects of chemical constituents along with this list.
A majority of Canadians believe a list of toxic constituents along with an informational
statement would be at least somewhat effective in the following ways: providing information
about the chemicals and toxins in cigarettes (78% and 79%); discouraging young people not
currently smoking from starting (73% and 80%); discouraging themselves from smoking
57% and 77%; and discouraging smoking among young people who currently smoke (53%
and 55%). Just under half (48% and 45%) think this will be effective in discouraging adults
who smoke.(p.6)
Environics Research Group Ltd., “Public Attitudes Toward the Listing of Toxic
Ingredients on Cigarette Packages: A Survey Report” Prepared for Health Canada,
June 1996.
333.
[In an in-home survey of 2000 Canadians aged 18+, respondents were shown a card with
three possible cigarette package formats. When asked which best provides health
information, 34% chose a plain package with a cancer warning and a picture of black lungs
(format A), 46% chose a plain package with a cancer warning and detailed poisonous
contents information (format B), and 8% chose a current package with a cancer warning.
3% said none. When asked which format would most discourage you from smoking, 57%
chose format A, 23% format B, 4% the current package, and 8% none.]
Environics Research Group Ltd., “Reactions to Cigarette Packaging Formats”
Prepared for the Canadian Cancer Society / Physicians for a Smoke-free Canada,
Focus Canada 1998-4, 1999.
334.
Many smokers spontaneously mention the warning labels on cigarette packages as being a
source of information about the health risks from smoking.
...
There was also a consensus that the warning messages had been the same for so many
years that they had stopped noticing them, whereas in the beginning when the warning
labels were new, they had definitely taken notice.(p.5)
...
[S]mokers report that they do in fact look at the inside of the flap over the cigarettes (i.e.
"the flip"). They also often look at the slide of the package. They reported that they
would also look at the back of the slide if there were a calendar there or any other
interesting information.[p.6]
...
The most frequent type of information that smokers mentioned wanting to see on the slide
was information about toxic ingredients of cigarettes and more fact-based information about
the risks of smoking. There were also spontaneous mentions of wanting statistics about
- 110 death rates and disease rates, or statements ending in a question mark regarding possible
symptoms of smoking related illnesses. ...
The idea of a 1-800 number on the slide with information on how to quit smoking was also
very popular. [It] would offer smokers a way out, rather than always giving them a gloomy,
negative message.
There was also quite a bit of support for putting pictures or graphic on the slide, such as a
picture of a person with mouth cancer or a women with a hole in her neck due to a
tracheotomy. These were seen as ways of shocking people and also as a way of
penetrating people who do not respond to written types of information.
It was also suggested that the flip at the top of the slide could be a place to put a small
amount of information with a directive to look at the back of the slide for more detailed
information. The back of the slide could then be the place to have a longer article on
some specific health related topic.(p.7)
...
The consensus was that the back of the slide could be a good place to run truly detailed
information of this kind that requires more space. The smoker would have the option of
reading it "at some point". Others suggested putting this same information on a little
fold-out piece of paper that could also be useful as something to include in cigarette
packages that use the flip-top format."(p.10)
Environics Research Group Ltd., “Focus Group Report Regarding Messages On
Cigarette Package Slides and Flip-Tops” Prepared for Health Canada, February
1999.
335.
[In an in-home survey of 2049 Canadians aged 18+, respondents were shown a card with
four possible cigarette package formats with different sized cancer warnings. When asked
which format would most discourage people from smoking, 12% chose a 36% size cancer
text warning, 5% chose a 45% size cancer text warning with headline and detailed
information, 6% chose a 60% size cancer text warning with headline and detailed
information, 40% chose an 80% size cancer text warning with headline and detailed
information, and 28% said none.]
Environics Research Group Ltd., “Reactions to Cigarette Packaging Formats”
Prepared for the Canadian Cancer Society, Focus Canada 1999-1, March 1999.
336.
In all of the groups, participants were extremely positive and impressed with visual
images of the cancerous mouth, lungs and brain. ... Many participants said that if these
images were on cigarette packages, they would be afraid to let anyone see their packs and
they would be more motivated to try to quit.(p.5)
...
 Most thought that putting these pictures directly on cigarette packages was a very good
idea. Participants thought these pictures would capture a whole new segment of people
who are currently ignoring the text warning messages.
...
 Pictures: All pictures of lungs and mouths must be placed on the front of the packages.
Some images might be placed on the back of the slide or on the lip as well, but the front
is seen as the most effective.
...
 Health warning messages: These were very good on the front -- longer more detailed
messages could go on the back of the slide as well. (p.6)
...
- 111 
The flat slides received much praise. People liked the colours, and the yellow
highlighting and underlining was also seen to be very effective. Many people
commented on the good quality of the information.
...
 Most participants in all groups favoured 60 percent of the package being devoted to
health information. They felt this made the message legible and still left some room for
the manufacturer to identify the brand.(p.7)
Environics Research Group, “Qualitative (Focus Group) Report Regarding Health
Warning Labels and Images on Cigarette Packages” Prepared for the Office of
Tobacco Control, March 29, 1999.
337.
Package Testing - Initial Impressions of the New Health Warnings
 There were strong positive reactions to new [picture-based] designs in all groups. Even
though a number of participants stated that some of the warnings are "disgusting to look
at," there was a strong consensus that the proposed health warnings would be more
effective than the current warnings.
 There was a much higher acceptance of the more graphic warnings by younger
participants than by older people.
 There was a strong consensus among the focus group participants that the new messages
definitely have the ability to get attention. The addition of pictures was seen as the most
significant change from the current warnings.
 In general, those designs that emphasized the use of text were seen as less effective than
those where the picture could deliver the message. The majority of smokers fall into the
lower income and education groups, where functional illiteracy tends to be higher than
among other socio-economic groups. Clear visuals, where the picture actually does say
a thousand words, will have the greatest "across the board" impact on the smoking
population.
 When participants were asked about the size of the warning, there was overall
agreement that 60 percent of the package was an acceptable size for the health warning
labels. It was also felt that there would be enough remaining room on the package for
brand trademarks, text and other visual product identifiers.
 Both staunch smokers and potential quitters stated that the new messages will lead to
even greater social pressure to quit smoking. These proposed warnings, especially those
that are graphic in nature, are seen to significantly increase social pressure on smokers.
Quantitative Ratings of Individual Warnings
 Non-smokers and potential quitters provide higher ratings than staunch smokers do for
each of the health warnings tested in these sessions. As well, younger participants and
women tend to provide higher ratings than do older participants and men. (p.6)
...
Slide Designs
[P]articipants appreciated the inclusion of the Internet site address and the toll-free
telephone number on the slide. There was a strong recommendation that these features
should be positioned closer to the top of the slide. (p.24)
...
[A] majority of participants, smokers and non-smokers alike, thought that the slide could
be used to provide information. (p.24)
Environics Research Group, “Health Warning Testing” Prepared for Health Canada,
June 24, 1999.
- 112 -
338.
[An in-home survey of 2018 Canadians aged 18+ was conducted. When shown three
different warning sizes for an emphysema text warning, 3% chose the 36% size, 8%
chose the 45% size, 68% chose the 60% size, and 16% chose none. For an emphysema
warning including a photo of a lung with emphysema, 3% chose the 36% size, 6% chose
the 45% size, 74% chose the 60% size, and 13% chose none. When shown an
emphysema warning with text, and one with a photo, 11% chose the text-only warning,
72% chose the text and photo, and 12% said neither.]
Environics Research Group, “Reactions to Cigarette Packaging Formats” Prepared
for the Canadian Cancer Society, Focus Canada 1999-2, 1999.
339.
[In a national survey of 2,018 Canadians, 74% of respondents supported "Health Canada
regulations requiring cigarette pack health warnings to include pictures and to occupy
60% of the front and back of each pack", with just 20% opposed. Among daily smokers,
59% were supportive versus 35% opposed.]
Environics Research Group Limited, Focus Canada Report 1999-2, Prepared for
Action on Smoking and Health, 1999; Leebosh, D. (Environics), “Results of Focus
Canada omnibus Questions (FC 82)” memorandum, August 18, 1999; Action on
Smoking and Health [Canada], “Majority of Canadians want larger warnings on
cigarette packages” January 10, 2000, [news release].
340.
[A survey of 746 Canadian youth aged 12-18 was conducted. When shown three
emphysema text warning mockups and asked which size format would most discourage
people from smoking, 2% chose the 36% size, 5% chose a 45% size warning, 86% chose
the 60% size, and 5% said none. In a different comparison of two mockups with a 60%
size emphysema warning, 88% chose the warning with text and photo of an emphysema
lung, 7% chose the text only warning, and 4% said neither.]
Environics Research Group, “Youth Reactions to Cigarette Packaging Formats”
Prepared for the Canadian Cancer Society, September 1999.
341.
[An in-home survey of 2061 Canadians age 18+ was conducted. Respondents were asked
which packaging format would most increase awareness of the health hazards of
cigarettes. For a throat damage warning with text and photo, 6% chose the 36% size, 5%
chose the 45% size, 9% chose the 60% size, 63% chose the 80% size, and 15% said none.
Almost identical results were found for a mouth cancer warning with text and photo.]
Environics Research Group, “Reactions to Cigarette Packaging Warning Message
Sizes” Prepared for the Canadian Cancer Society, Focus Canada 1999-3, 1999.
342.

Eight in ten adult smokers say they are more conscious of the risks of smoking than
they used to be; three quarters of young smokers also report this.
...
 Almost half of smokers of all ages look at the health warning messages on tobacco
products at least once a day; two in ten adult smokers and one in ten young smokers
never look at these messages. (p.5)
...
- 113 
Large majorities of Canadians of all ages, both smokers and non-smokers, agree that
current health warning messages on cigarette packages provide important information
for smokers to be reminded of and are worth re-reading. However, majorities also
feel that the messages are worn out and have lost their effectiveness; this sentiment is
particularly strong among smokers.
...
 One-half of smokers of all ages say health warning messages on cigarette packages
have had at least some impact on making them more conscious of the health risks of
smoking than they used to be.
 Around four in ten adult smokers say that these messages have had at least some impact
on getting them to smoke less around others than they used to; less than one-quarter of
young smokers agree with this statement.
 About one-third of smokers of all ages report at least some impact on increasing their
desire to quit smoking.
 About one-quarter of smokers of all ages say the messages have had at least some
impact on getting them to smoke less or to try quitting.
...
 Majorities of smokers of all ages believe that using pictures and using colour are
effective ways to make these messages more noticeable.(p.6)
 Two-thirds of adults, and over eight in ten youth, both smokers and non-smokers, feel
that a cigarette package bearing this image of a blackened lung and the new text
message is more effective than one bearing only the current health warning message,
both in informing Canadians of the health effects of smoking and in encouraging
Canadians to reduce tobacco use. (p.7)
 [When shown different sized warnings, 25%, 40%, 50%, and 60%, smokers and nonsmokers, adults and youth, chose by a dominant margin the 60% size as being most
effective in informing about health effects of tobacco and in encouraging reduction of
tobacco use. Reasons given for this choice included bigger warning,
noticeable/attracting, biggest/easiest to read, more prominent lettering, more
information, and diminishes brand name.] (pp.56-65)
Environics Research Group, “Canadian Adult and Youth Opinions on the Sizing of
Health Warning Messages” Prepared for Health Canada, Office of Tobacco Control,
October 1999.
343.
[An in-home survey of 2049 Canadians age 18+ was conducted. Fully 78% of Canadians
supported including information on how to quit smoking as part of new health warning
messages on cigarette packages, with only 20% opposed. Among daily smokers, 68%
were supportive and 28% were opposed. Among occasional smokers, 75% were
supportive and 24% were opposed.]
Environics Research Group, “Focus Canada Report 1999-4” Prepared for
Canadian Cancer Society, 2000; Leebosh, D. (Environics Research), “Results of
Focus Canada Omnibus Questions (FC94)” January 21, 2000 [Memorandum].
344.
When asked if this was a good way or not to provide information to smokers, a majority of
56 percent say messages describing the health hazards of smoking or messages offering help
about quitting smoking placed on the flip/slide of cigarette packages would be a good way to
provide information to smokers. Thirty-six percent think this would not be a good way to
provide this information.
- 114 ...
Among those who think this is a good way to provide information to smokers, 47 percent
say this format may convince/help smokers to quit. Another 33 percent say people will read
the message. (p.6)
Environics Research Group Limited, “Health Warning Messages on the
Flip/Slide and Inserts of Cigarette Packaging: A Survey of Smokers” Prepared
for Health Canada. Final Report. May 2000.
345.
Most participants felt that the new larger health warning messages, featuring colour
photographs, were a definite improvement over the current warning messages. Teenagers
were particularly impressed with the use of pictures and the larger size of the messages
that allow for the dissemination of more information. Most participants were moved by
the dramatic and scary pictures and messages, such as the woman smoking through a hole
in her throat, the sick baby, the cemetery with grieving loved ones, and warnings that
depicted the physical and health consequences of smoking such as the diseased mouth.
The consensus was that the approach was good and was an improvement over the status
quo.
Some participants were sceptical as to how much of a difference such messages
would make in reducing the smoking rate. However, most participants felt that the
messages showed valuable information and that they could have an impact on
certain populations, such as pregnant women smokers, teens thinking of starting to
smoke, those thinking of quitting and other groups of smokers. (pp.5-6)
Environics Research Group Limited, “Testing New Health Warning
Messages for Cigarette Packages: A Summary of Three Phases of Focus
Group Research; Final Report” Prepared for Health Canada, May 2000.
346.
Overall, two-thirds of Canadians (67%) in the 2000 survey say they look at or read health
warning messages on tobacco products. This includes 41 percent who say they do this at
least once a week. Nineteen percent say they look at or read messages several times a day
(11%) or about once a day (8%). Another 26 percent do this less than once a week. Onethird (34%) say they never look at or read health warning messages on tobacco products.
(p.4)
...
An overwhelming majority of 90 percent of Canadians in the 2000 survey say they have
seen health warning messages on cigarette packages themselves. (p.5)
...
A very large majority of Canadians (88%) in the 2000 survey support placing health warning
messages on tobacco products. (p.5)
...
Almost six in ten Canadians (59%) in the 2000 survey think that increasing the size of the
health warnings on cigarette packages would be much more effective (11%), somewhat
more effective (26%) or a little bit more effective (22%) in informing Canadians about the
health effects of tobacco. Four in ten (38%) think that increasing label size would be no
more effective in doing this. (p.6)
A similar proportion (56%) in 2000 think that increasing the size of health warnings would
be much more effective (10%), somewhat more effective (22%) or a little more effective
(24%) in encouraging Canadians to reduce their tobacco use. Four in ten (40%) think this
would be no more effective in this regard. (p.6)
...
- 115 A significant majority of Canadians (68%) in the 2000 survey think package B (with a new
health warning message covering 50 percent of the package) would be more effective in
informing Canadians about the health effects of tobacco. Only 15 percent think package A
(with a status quo health warning message covering 25 percent of the package) would be
more effective. Nine percent say the two versions would be equally effective and seven
percent think neither of the two versions is more effective in informing Canadians about the
health effects of tobacco. Two percent have no opinion. (p.7)
Similarly, a significant majority (69%) in the 2000 survey think package B (with a new
health warning message covering 50 percent of the package) would be more effective in
encouraging Canadians to reduce their tobacco use. Only 12 percent think package A . . .
would be more effective. (p.8)
Environics Research Group Limited, “Canadian Opinion on the Size of Health
Warning Messages: A Validation Survey” Final Report, Prepared for Health
Canada, May 5, 2000.
347.
[A]dding illustrations to the warnings, rather than using text alone, has substantial effects,
regardless of warning area. These effects are especially strong for smoker image and
warning credibility. (p.30)
CONCLUSIONS
All of the results point to the conclusion that simply increasing the warning area on
cigarette packages to 40% from the current 30% causes two major changes in the
perceptions of members of the four target groups:
 it makes them see the warnings as more likely to discourage smoking among people in
general, as well as among specific social types;
 it increases the perceived credibility of the warning messages.
. . . [T]he larger warning area [to 40% from 30%]:
 increases the perceived dangerousness of tobacco;
 reduces the perceived intelligence, healthiness, and physical attractiveness of smokers
To achieve a negative impact on general attractiveness of cigarette packages, the warning
area must be increased to at least 50%, because at 40%, the effects are too limited to be
significant.
When the area occupied by warnings is increased to 50% from the current 30%, the effects
observed at 40% are amplified, and all categories of effects become significant.
When the warning area is increased to 60% from 50%, the effects continue to increase,
but the general attractiveness of the package is the main variable affected.(p.31)
...
These results confirm the hypothesis that the warnings play a role when people do not use
tobacco or when they are thinking about quitting.(p.46)
...
Though this impact may vary for other warnings and depending on the illustrations used,
these results do indicate that the illustrations are important for more effectively
convincing the most sceptical target groups: people who already have a smoking
habit.(p.67)
Études de marché Créatec+, Les, “Effects of Increasing the Area Occupied by
Health Warnings on Cigarette Packages” Prepared for Health Canada, September
1999.
348.
Conclusion
- 116 

349.
All the results obtained come together to conclude that the modified warnings do not
change the results of the August 1999 study regarding the effects of an increased surface
area. In fact, overall, we can for all practical purposes conclude that the effects would
have been at worst the same. A detailed analysis, by criteria, indicates that on just some
of the aspects the effects would even have been amplified.
Beyond this validation, this study shows once again that a 50% increased surface area
reveals significant effects for all criteria surveyed (p. 26).
Études de marché Créatec+, Les « Validation des effets d’une surface accrue
suite à des modifications aux avis utilisés dans l’étude de 1999 » [« Validation
of the effect of increasing the surface area following modifications to the
warnings used in the 1999 study »] Prepared for Health Canada, Bureau of
Tobacco Control, March 2000 [translation].
The general warning required pursuant to the first subparagraph of paragraph 2 and the
warning for smokeless and oral tobacco products referred to in the third subparagraph of
paragraph 2 shall cover not less than 40% of the external area of the corresponding surface
of the unit packet of tobacco on which it is printed. This percentage shall be increased to
45% for countries with two official languages and 50% for countries with three official
languages.
...
7.
The additional warning referred to in the second paragraph of paragraph 2 shall
cover not less than 50% of the external area of the corresponding surface of the unit packet
on which it is printed. This percentage shall be increased to 55% for countries with two
official languages and 60% for countries with three official languages.
Justification:
Recent Canadian research, designed to test an increase in warning size from 30% to 60%
proved that the larger the message, the more effective it is at encouraging smokers to stop
smoking. So: 'the bigger, the better'. (p.22)
...
7b.
Member States may require that all, or a proportion, of the space allocated to the
additional warning referred to in the second subparagraph of paragraph 2 be allocated to the
printing of colour photographs or other illustrations depicting the health consequences of
smoking.
Justification:
Illustrations are likely to strengthen the impact of the health warnings. Until forbidden by
law, tobacco manufacturers used graphic advertising to suggest that their products were
healthy. It may be assumed that its use to promote the opposite will discourage smoking.
(p.23)
...
Clearly, the larger the warning the more effectively the message is conveyed and texts must
be geared to the perception smokers have of their environment. To date, in this respect,
warnings have proved to be entirely inadequate. A warning covering a large area also makes
it possible to give consumers reliable and specific information instead of superficial and
simplistic buzzwords. Half of all smokers in all age groups say that, in terms of being
alerted to health risks, warnings on tobacco product packaging have some influence at least.
(p.36)
European Parliament, Committee on the Environment, Public Health and
Consumer Policy, “Report on the proposal for a European Parliament and
Council directive on the approximation of the laws, regulations and
administrative provisions of the Member States concerning the manufacture,
- 117 presentation and sale of tobacco products (COM(1999) 594 – C5-0016/2000 –
1999/0244(COD))”, A5-0156/2000, May 30, 2000.
350.
These texts should cover at least 30% of the front of the cigarette packet, and they should be
rotated in such a way as to guarantee their regular appearance. In addition to the warning
text on the front, the back of the cigarette package shall also carry a warning text covering at
least 40% of the surface... (p.2 of internet print out)
...
In Member States with more than one official language, these percentages are
correspondingly higher.
The Commission shall, as soon as practicable and in any event not later than 31 December
2002, adopt rules for the use of colour photographs or other illustrations to depict and
explain the health consequences of smoking ... Where Member States require such
additional warnings, these shall be in accordance with these rules.
...
Trade marks with suggestive terms
With effect 30 September 2003, texts, names, trade marks and figurative or other signs, such
as "low tar", "light," "ultra light", "mild" or any other similar terms as well as any
information concerning yields – without prejudice to the provisions concerning the printing
of yields on one side of the packet –, suggesting that a particular tobacco product is less
harmful than others shall not be used on the packaging of tobacco products. (p.3)
European Union, Parliament-Council Conciliation Committee, "Agreement on
manufacture, sale and presentation of tobacco products" February 28, 2001 [news
release], accessed March 17, 2001, http://ue.eu.int/Newsroom/treebrowse.cfm?BID=77&LANG=1.
351.
Recommendations
7. Plain (generic) packaging should be required in a manner that has minimal impact
on the printing and packaging industry.
8. Additional health warnings and ingredient information should be required on
tobacco packaging.
9. Package health warning inserts should be required.
10. Deceptive labelling such as, “light” and “mild”, should be eliminated. (p.18)
Expert Panel on the Renewal of the Ontario Tobacco Strategy, “Actions will
speak louder than words: Getting serious about tobacco control in Ontario; A
Report to the Minister of Health from her Expert Panel on the Renewal of the
Ontario Tobacco Strategy” February 1999.
352.
Warnings which are novel, targeted, and developed through a creative process function
more effectively as communication devices. (p.279)
...
It should be obvious that huge warnings that dominate an advertisement would be noted by
subjects. (p.280)
...
To be effective, warnings must be managed using the same strategies that are employed
to develop the cigarette ads with which they must compete. (p.284)
- 118 Fischer, P.M., Krugman, D.M., Fletcher, J.E., Fox, R.J., Rojas, T.H. “An evaluation
of health warnings in cigarette advertisements using standard market research
methods: what does it mean to warn?” Tobacco Control 1993;2:279-285.
353.
Both the "Skull and Crossbones" and the "Lungs" symbols were believed likely to give
cause for concern if they appeared on a cigarette package. In contrast, the "No Smoking"
sign was too familiar to be thought provoking.
 The "Skull" symbol would appear to offer most potential against younger, more recent
smokers and against males. It was instantly linked with death and widely acknowledged
as a sign for other poisonous and life threatening substances.
 The "Lungs" symbol clearly connoted cancer, a definitive statement of the causal
relationship between smoking and cancer. (p.vi)
Gillian Tuffin Research Ltd, “Cigarette Package Design Research” GTR#1217,
Prepared for Canadian Cancer Society, April 1990.
354.
All respondents welcomed the concept of an insert inside a cigarette package providing
them with information on the risks associated with smoking as a very good idea. The
majority were already concerned about smoking and knew that they should quit: they
were anxious for help. It would appear that they need to be scared more strongly to
persuade them that it was time to stop, and to be offered a source of help in quitting at the
same time.
 No one queried the credibility of the various insert materials... Respondents stressed the
importance of presenting information in a factual, detailed and direct manner. The
question and answer format was the preferred vehicle for attracting and maintaining
smokers' interest in the insert materials. (p.viii)
Gillian Tuffin Research Ltd., “Cigarette Package Insert Research” GTR#1226,
Prepared for Canadian Cancer Society, April 1990.
355.
The increased number and revised format for the health messages reflect the strong
consensus of the public health community that the serious health hazards of using these
products be more fully and effectively communicated to consumers. Support for these
changes has been manifested by hundreds of letters and a number of submissions by
public health groups highly critical of the initial regulatory requirements under this
legislation as well as a number of Departmental studies indicating their need. (p.3285)
...
These messages will improve consumer awareness of the hazards associated with tobacco
use. This enhanced awareness is expected to reduce tobacco consumption and thus
improve the health of Canadians. (p.3286)
Health Canada, “Regulatory Impact Analysis Statement” Canada Gazette, Part
II, vol. 127, no.16, August 11, 1993, pp.3277-3294.
356.
A key component of the government’s tobacco control strategy is to warn Canadians of
the hazards associated with smoking. . . . Strong health messages and information on
the toxic constituents of tobacco smoke which appear on packages are a crucial
component of this strategy. (p.33)
Health Canada, “Tobacco Control: A Blueprint to Protect the Health of Canadians”
(Ottawa: Minister of Supply and Services, 1995).
- 119 -
357.
Labels offer a direct way of communicating information to users and potential users of
tobacco products. Warnings on labels have proven to be very effective in conveying health
information related to tobacco, rating second only to television as a source of information.
Recent studies show that smokers read the information contained on tobacco product labels
1.7 times per day, and that most find the messages believable. With approximately 6.5
million smokers in Canada, this means messages are read more than 11 million times per
day." (p.9)
...
Over the years, the public has become increasingly aware of the health hazards associated
with using tobacco products. For instance, two surveys were conducted where
respondents were asked to identify these hazards: in 1990, 44% of respondents identified
lung cancer, 34% identified cancer in general and 1% identified addiction; in 1996, 64%
identified lung cancer, 51% identified cancer in general and 26% identified addiction.
Health labels almost certainly played a role in increasing the awareness of these hazards,
given that these messages were so visible. (p.10)
Health Canada, “Proposed New Labelling Requirement for Tobacco Products;
Consultation Paper” January 1999.
358.
“Canadians who use tobacco products need to fully understand the serious health hazards
inherent in this lethal product, which has been scientifically linked to more than 20 specific
cancers and diseases,” Mr. Rock [Health Minister Allan Rock] said. “Tobacco is the only
product on the market that will result in premature death for one out of every two users.
With these hard-hitting health messages and compelling graphics, we will reach smokers
directly and effectively. (p.1)
...
“The ground-breaking regulations reflect the Government of Canada’s commitment to
protecting the health of Canadians through integrated and effective tobacco control
strategies,” Mr. Rock said. “Smokers themselves have told us that our current health
messages are outdated, and that they want strong messaging and information to support their
efforts to quit. We have worked with them to develop highly effective messages and
packaging.” (p.2)
Health Canada, “Health Minister Reveals New Cigarette Labelling Measures”
January 19, 2000 [news release and accompanying materials, including visuals of
the proposed new warnings].
359.
[Canadians were asked to rate the importance of various government tobacco control
interventions on a scale of 1 to 10. 65% gave health warning messages on packages a
rating of 10 out 10, including 45% of smokers and 72% of nonsmokers.]
Health Canada, Canadian Tobacco Use Monitoring Survey, Wave 1, Fact Sheet
9, February-June 1999 “Government Tobacco Control Interventions” 2000.
360.
Currently, health warnings and toxic emission information are displayed on tobacco
packages on a voluntary basis. Research has indicated that the impact of the current
health warning messages seen on packages of tobacco products is wearing out. They are
no longer as effective as before since they have been in place for some years. In addition,
they do not address a number of knowledge gaps on the part of users, nor do they reflect
- 120 the true level of hazard associated with the product. Additionally, as current labelling
practices are done on a voluntary basis, not all tobacco products sold in Canada are
labelled.
Research has demonstrated that the segment of the public that uses, or is most
likely to use, tobacco products regards the package as an important source of information.
It has also been found that the display of important facts on the package directly assists
users in their decision not to smoke. Research has also shown that to be effective, the
display of information on packages must be noticeable, believable, relevant and
memorable. Moreover, it must address the concerns of smokers and potential smokers
alike. To do this, messages should:
 employ colour and graphics;
 be increased in size from the current practices;
 contain concrete facts and statistics; and
 address issues of concern to product users. (p.1750)
...
Research has indicated that enlarging the area occupied by the health warning (when
compared to the area currently utilized by tobacco manufacturers on a voluntary basis),
using colourful graphic images for health warnings and adding facts and statistics,
increases the effectiveness of the displayed health warning. (p.1752)
Health Canada, “Regulatory Impact Analysis Statement” Canada Gazette Part II,
vol. 134, no. 15, July 19, 2000, pp.1748-1760.
361.
The research conducted by Centre for Behavioural Research in Cancer both demonstrated
the need for more effective labeling and provided some evidence that this package of
measures is likely to act as a deterrent to young people taking up smoking and may assist
intending quitters. (p.94)
Hill, D., “Australia’s new health warnings on cigarette packaging” Tobacco Control
1992;1(2):92-94.
362.
Existing warnings have lost their initial impact (p.2)
...
Pictures should be used when appropriate because they are the rapidest way to
communicate. The images should be tight-focused and readily understandable. Colour is
critical, unless the content dictates otherwise. (p.9)
...
Larger is better, depending on location. Up to 60% for pack facings and 100% for sliders
is effective and acceptable. (p.9)
...
Typefaces should be large and easy to read by the most casual observer (p.9)
...
Messages should address a variety of themes in order to have impact on the wide variety
of target audiences (p.9)
[Different messages have an impact on different people. Of the 12 exterior pack
warnings rated for effectiveness, 11 of the 12 were chosen as most effective by at least
one participant. Among the 15 sliders, each was chosen as most effective by at least one
participant. (pp.41,60)]
...
Message content must be rotated and refreshed frequently in order to keep smokers’
- 121 attention (p.10).
...
[Among the warnings tested, the most effective included:
- Tobacco Industry’s Poster Child, with a picture of a young woman and identified health
effects superimposed on her body
- Smoker dying of cancer, with text and a picture of a naked, extremely thin man
- Protect your children’s health, with text and a picture of an infant
- Cigarettes cause emphysema with text and a picture of a lung with emphysema
- A pack a day costs $1400 per year!, with a table showing the money spent for 1, 5, 10,
20 and 40 years
- Warning - Throat damage, with text and a picture of a man who breathes through a metal
tube in his neck
- Cigarettes cause mouth cancer, with text and a picture of a diseased mouth]
- [The overwhelming majority of participants felt that the messages would be useful in
encouraging quitting (p.80).]
Informa Market Research, “Focus Group Research on New Health Warnings on
Tobacco Packages.” Prepared for the Canadian Cancer Society, May 1999.
363.
[In a survey of 820 Quebec adults, 66% agreed that governments should further explain
health warnings through inserts and media advertising (p.22)]
Info-tabac [Canada], « Explication des huit nouveaux avertissements de santé des
paquets de cigarettes: Rapport final » [“Explanation of eight new cigarette package
health warnings”] March 9, 1995.
364.
[83% of Canadians supported requiring manufacturers to place more detailed warnings
about the risks of tobacco use inside cigarette packages. (p.5)]
Insight Canada Research, “Smoking in Canada: Warnings; Report on the Findings of
a Nation-Wide Survey Conducted on Behalf of the Canadian Cancer Society, the
Heart and Stroke Foundation of Canada, and the Canadian Council on Smoking and
Health” November 1992.
365.
Policy Recommendations
...
2. Establish and enforce policies to stop the sale of tobacco products to minors and require
strong, prominent health warnings on all tobacco products. (p.12)
International Policy Conference on Children and Tobacco, “Policy
Recommendations” Washington, D.C., U.S.A., 17-19 March 1999, In: INGCAT
Update 10, 1999, 2nd quarter.
366.
The UICC (International Union Against Cancer) believes that every country should
implement an effective system of health warnings and labelling that recognizes the
unique threat tobacco poses to its consumers. This is a crucial part of informed consent.
It also offers a cost-effective health education program.
... To be effective, warnings should
 Contain a clear and unequivocal message about the dangers of tobacco use, in simple
and stark terms. They should warn not only of the risk but of the degree of risk ...
- 122 Where any significant proportion of the user population cannot read, use should be made
of graphic symbols to illustrate the dangers.
 Be undiluted by any attribution...
 Be prominent. Warnings should:
- Be on the front and back of the pack, not on the side panels.
- Be at the top of the pack, not at the bottom.
- Cover a minimum of 25% of the package face. Legislation should also specify the size of
the print.
- Be in starkly contrasting colors. It is no good to design an effective message, only for it to
be lost as part of the pack design.
...
 Apply to all tobacco products and all forms of packaging. (p.3)
...
Package Inserts
The requirement on manufacturers to place longer health messages inside the packet
offers an innovative health promotion campaign targeted directly at tobacco users. Such
inserts allow not only longer warnings but also the use of graphics to bring home the
danger of tobacco use more clearly. The UICC believes that this approach should be
widely adopted. (p.4)
International Union Against Cancer, “International Union Against Cancer
Recommendations on Health Warnings and Labels” World Smoking and Health
1993;18(2):3-4.
367.
Health warnings are an important part of any comprehensive strategy to reduce tobacco
use, providing both the first and last lines of defence in the struggle against smoking and
death. Ideally health warnings should be the first thing smokers see before buying their
cigarettes and the last thing they see before lighting up their cigarettes.
...
What we are really trying to do is to market health, and in so doing we have to think and
act like a real company, using all available marketing tools. (p.267)
Kaiserman, M. J. “The effectiveness of health warning messages” Tobacco Control
1993;2(4):267-69.
368.
There is a genuine difference between information provision and information impact.
Current studies using a variety of social-science research methods indicate that the [U.S.]
mandated warnings are very limited in terms of communicating the dangers of
smoking.(p.98)
...
Cognitive goals are realistic, because warnings are informational by nature. If done
properly, cigarette warnings can communicate meaningful risk information at reasonably
high levels of cognition – knowledge and comprehension. Mandated cigarette warnings
should attract the attention of a target audience, hold attention long enough to be
considered, and then be remembered well enough to have a chance to influence behavior.
(p.100)
...
Warning messages should be part of future interventions. ...
Providing information is not enough. Rotated black-and-white warnings, either on the
package or in the ads, are not an effective long term solution. The focus should change
from "mandated warnings" to "mandated warning programs," which means ongoing
- 123 research, development, and monitoring. ... It is important to employ the appropriate
message and graphic design tools necessary to capture, guide, and hold the reader's
attention to the warning. This means treating the warning like an ad campaign that is
tested and monitored.
...
Warnings are only a piece of the puzzle. Advertisers understand that messages that are
integrated with larger communications programs are more effective than isolated messages.
A synergy takes place between encountering messages in the media, on packages, in stores,
on promotional items, at sponsored events, and on other promotional material disseminated
by an organization." (p.101)
Krugman, D.M., Fox, R.J., Fischer, P.M. “Do Cigarette Warnings Warn?
Understanding What it Will Take to Develop More Effective Warnings” Journal of
Health Communication, 1999;4:95-104.
369.
Results indicated that within the competitive reading environment of a cigarette ad, new
warnings attract greater readership, with quicker attention to warnings than mandated
warnings. New warnings were noticed in 1 to 2 ½ seconds less time. [The new warnings
were of the same size, but with different text, with colour, and with one having a graphic.]
(p.39)
...
[A]ttention is a critical process prior to comprehension, attitude development, or changes in
behavior. Warnings are competing in an environment where many other elements in the
advertising vie for readers’ attention. . . .
In the context of obtaining attention, the new warnings tested in this study possess two clear
advantages over the existing mandated warnings: (1) new warnings are able to attract the
attention of more individuals, and (2) new warnings gain attention in a shorter period of
time. Both of these advantages are important issues with respect to the efficacy of warnings.
(p.49)
...
[I]t is likely the current system of warnings suffers from “wearout.” (p.50)
Krugman, D.M., Fox, R.J., Fletcher, J.E., Fischer, P.M., Rojas, T.H. “Do
Adolescents Attend to Warnings in Cigarette Advertising? An Eye-tracking
Approach” Journal of Advertising Research 1994;34(6):39-52.
370.
The average cigarette smoker uses a new pack every day, making pack warnings the
commonest health education messages of any kind. . . (p.750)
...
It is concluded that:
(1) The front main face of the cigarette packet is by far the most effective position for a
warning.
(2) Specific disease warnings are superior to health advice.
(3) A boxed outline improves the warning’s effectiveness.
(4) The most effective warning was ‘Smoking is addictive and kills.’ This warning was the
most unacceptable to industry representatives.(p.752)
Laugesen, M. “Optimal Wordings and Pack Position for Strong Varied Disease
Warnings on Cigarette Packs in New Zealand” In: Durston, B., Jamrozik, K., eds.,
The Global War: Proceedings of the 7th World Conference on Tobacco and Health”
Perth, Western Australia, Australia, 1990, pp.750-752.
- 124 -
371.
The authors replicate and extend previous research on the effects of pictures, consumer
information-processing level, ad meaning, and ad exposure on brand name recall by using
consumers in a different culture. The findings indicate the robustness of the effects of those
factors on recall. Specifically, better recall was obtained with ads containing pictures and
words than with words-only ads . . . (p.66)
Leong, S.M., Ang, S.H., Tham, L.L. “Increasing Brand Name Recall in Print
Advertising Among Asian Consumers” Journal of Advertising 1996;25(2):65-81.
372.
Summary of Findings:
...
1. Pictures with warning messages were, on average, approximately 60 times more
encouraging to stop/not start smoking than messages without pictures. (p.ii)
...
2. For 95% of smokers and 80% of non-smokers, the time taken to correctly recognize
their 'regular brand' on store shelves, will not likely be affected by increasing the size of
warning messages to 60% of the principal display surface of cigarette packages. For only
@5% of smokers will increasing the size of warning messages from 35% to 60% of the
principal display surface of cigarette packages, initially increase the error rate of
recognizing their 'regular brand'. But this effect will likely disappear with learning.
3. Overall, the effects of increasing the size and emotional content of warning messages
on cigarette packages and including message enhancing pictures, has the potential,
compared to the current warning messages, to encourage more smokers to stop smoking
and deter more non-smokers from starting to smoke. (p.iii)
Liefeld, J.P. “The Relative Importance of the Size, Content & Pictures on Cigarette
Package Warning Messages” Department of Consumer Studies, University of
Guelph, September 15, 1999.
373.
The observed pattern of the relative importancies of the attributes and their levels was the
same as reported in the August 1999 study. (p.2)
Liefeld, J.P., “Partial Replication: The Relative Importance of the Size, Content &
Pictures on Cigarette Package Warning Messages” Prepared for Health Canada.
Department of Consumer Studies, University of Guelph, April 14, 2000.
374.
The overall finding was that health warnings on advertisements and cigarette packs do
have the potential to influence smokers' attitudes to smoking. But the present British
warning appears not to be effective, partly because of the governmental attribution, and
partly because the equivocal 'can' enables smokers to direct the message away from
themselves.
‘Smoking kills’ was clearly the warning which respondents thought would have the most
deterrent effect. (p.218)
...
Both rotation and positioning of warnings were said to be important factors. ... Warnings
placed on the front of the pack were believed by all to have more force. (p.219)
Linthwaite, P. “Health Warnings” Health Education Journal 1985;44(4):218-219.
- 125 375.
Results indicated that specific warnings on ads can act as a counterinfluence to an ads’
appeal by making it appear less attractive and less persuasive than if the ad contained only a
general warning. This effect was especially true for smokers. Subjects also rated an ad as
more attractive, more persuasive, and less credible when it showed an attractive model than
when it did not. Being pretested on their beliefs about the hazards of smoking resulted in
high attractiveness and persuasion ratings and in smokers’ recalling and recognizing more of
the specific warnings that appeared on ads. (p.378)
Loken, B., Howard-Pitney, B. “Effectiveness of Cigarette Advertisements on
Women: An Experimental Study” Journal of Applied Psychology 1988;73(3):378382.
376.
[T]obacco health warnings should also aim to discourage tobacco use, not only by providing
information regarding the harmful consequences of tobacco, but also by vitiating the appeal
of advertising and promotion and by sending an unequivocal anti-tobacco message. In the
Committee’s view, strong health warnings, and accompanying package regulation, are an
important component of a coordinated plan to reduce and prevent tobacco use by children
and youths. (p.239)
...
Warnings are likely to become less effective with time as they become “worn out.” An
unchanging shape, size, and heading in the warning may discourage further exploration of
the message. . . . Periodically altering the format of the warnings may help to refresh their
impact. (p.242)
...
Using a larger number of rotating warnings is also more likely to provide a reader with one
or several messages that will be perceived as personally relevant. . . . Using a larger number
of rotating messages may also help to prevent the messages from becoming “worn-out” over
time. (p.243)
...
In sum, studies on communication of health messages demonstrate that consumer response
to warning labels depends on the format and presentation of the message, as well as its
content. . . . For greater impact, the format and content of the warnings must be designed
with the same communication techniques used to craft the pro-tobacco messages with which
they must compete. (p.244)
...
“Plain packaging” should be considered. (p.245)
Lynch, B.S., Bonnie, R.J., eds., Committee on Preventing Nicotine Addiction in
Children and Youths, Institute of Medicine, Growing Up Tobacco Free: Preventing
Nicotine Addiction in Children and Youths (Washington, D.C.: National Academy
Press, 1994), ch. 8.
377.
More detailed messages, if well done, could be a valuable addition to any warning
system. Inserts could expand on exterior package warnings, address new risk messages
or target specific groups. (p.11)
...
Precedents for package warning inserts are common for many drugs which are far less
harmful than tobacco that are sold over the counter. It is both ironic and tragic, for
example, that a nicotine gum product used for smoking cessation is sold with an insert
warning of the transfer of nicotine dependence whereas the cigarette that created the
original problem is sold with no such warning.(p.12)
- 126 Mahood, G., “Canadian tobacco package warning system” Tobacco Control
1995;4(1):10-14.
378.
Smokers want larger warnings with pictures, colour, and graphics. And they want tough,
frank messages outside and inside the package. Most smokers seem to be saying "Give
us the truth, however uncomfortable. We want anything that will help us get off
cigarettes." If the government listens, the recommended warnings could prevent tens of
thousands of deaths over time. (p.356)
...
The existing Canadian warnings influenced the development of warnings in Australia,
Poland, Singapore, South Africa, and Thailand. Warnings based on the Canadian model
were also written into the draft American settlement agreement in 1997 and into other
subsequent bills, including the McCain Bill, that were debated in the United States Congress.
(p.357)
...
The warnings being considered would take Canada a giant step toward plain packaging.
At a minimum, they would denormalise the industry's sophisticated packaging. Equally
important, the fact that the government would require the product to be sold with such
messages, thereby separating this product from other legitimate products in the
marketplace, could be the most important warning message of all.(p.359)
Mahood, G., “Warnings that tell the truth: breaking new ground in Canada”
Tobacco Control 1999;8:356-362.
379.
“The tough new warnings - which will be effective and easy for young people to
understand - will be another step in the National Campaign Against Drug Abuse," Mrs
Lyster [Minister for Health] said.
“It is imperative that we do all we can to deter young people from taking up smoking, and
to help people who already smoke kick the habit," Mrs. Lyster said. (p.1)
Minister for Health, Victoria [Australia] “Boost for Warnings on Tobacco
Labelling” April 15, 1992 [news release].
380.
I think it only fair that everyone who inhales cigarettes smoke should be totally aware of
the risks he is taking. That is why I would like to see a health warning on each and every
package and carton. By a warning, I do not mean a timid statement. If we are going to
get the truth across, we have to tell it like it is. Thus the warning should be strong and
crystal clear. (p.131)
Munro, J. (Canadian Minister of National Health and Welfare), House of
Commons Standing Committee on Health, Welfare and Social Affairs, Minutes
of Proceedings and Evidence No. 9, December 19, 1968, pp.127-142.
381.
Summary of Findings
The past efforts of the Commission plus the efforts of Congress and other governmental
agencies and private organizations to increase the amount of health information available to
consumers had had an important impact. Many more consumers now are aware that
smoking is hazardous to their health than in 1964. (p.8)
. . . [E]ven if it is assumed that every consumer is aware that smoking is hazardous, the
evidence indicates that many consumers do not have enough information about the health
- 127 risks of smoking in order to know how dangerous smoking is, i.e., what is the nature and
extent of the health risk of smoking. Many consumers also do not know whether the general
health risks of smoking have any personal relevance to themselves or whether they are
among those groups of people who may be uniquely vulnerable to these health hazards.
Finally, without more specific, concrete information, consumers have a more difficult time
remembering and are less likely to consider health information at all in making their
smoking decision.
More specifically, the data discussed in Chapter III suggest that many consumers do not
know enough about the health effects of smoking to know how dangerous smoking is and
indeed desire more information about the specific hazards of smoking. (p.9)
SUMMARY OF RECOMMENDATIONS
...
Of the options explored, staff at this preliminary stage believes the following are likely to be
most effective: (a) additional funding for expanded educational efforts, such as public
service announcements; (b) changing the shape and increasing the size of the current
warning; and (c) replacing the current warning with a system of short rotational warnings.
(p.21)
. . . Rotating the various health warnings would also assist in maintaining their noticeability
over an extended period, and would more effectively communicate a substantial amount of
specific health information about which millions of consumers are uninformed. (p.22)
...
In sum, the circle and arrow shape was superior to all other shapes tested. (p.5-19)
...
Part of the reason very few people notice the current warning is its small size. The other
shapes tested by Burke, which were 50% larger than the existing rectangle, were all found to
be more noticeable. (p.5-20)
Myers, M., Iscoe, C., Jennings, C., Lenox, W., Minsky, E., Sacks, A. “Federal
Trade Commission Staff Report on the Cigarette Advertising Investigation” May
1981.
382.
[H]ealth warnings reply to the basic right of the consumer to be informed of the dangers
of a consumer product. They also represent, in a growing number of countries, an
important element of smoking prevention policies. Well conceived warnings, printed
clearly on the pack, discourage people from smoking and contribute to the reduction of
smoking prevalence. Behavioural studies and opinion polls confirm this opinion but add
that the impact of health warnings could be increased by improvements in their quality.
The quality of health warnings is based on three main criteria: their visibility, their
legibility and their power of persuasion on the general public.
...
The size of health warnings is one of the principal factors determining their visibility (and
their legibility).
...
The space reserved for health warnings should be defined by a clearly drawn frame. (p.4)
...
A complete series of warnings drawing attention to the different health consequences of
tobacco use should appear in rotation on all cigarette packs.
In addition to ensuring
the communication of more complete information (a greater number of warnings), the
rotation avoids the effects of habituation and makes it possible to reach different target
groups. (p.5)
...
- 128 Plain packs for cigarettes are justifiable, popular, and would make an important
contribution to the effectiveness of health warnings and the credibility of public health
education campaigns.
In fact, plain packs would act as highly effective health warnings in themselves. The very
fact that the product was subjected to this kind of restriction would highlight its essential
difference from other consumer products. (p.24)
Naett, C., Howie, C. “The Labelling of Tobacco Products in the European Union”
European Bureau for Action on Smoking Prevention, December 1993.
383.
Warning leaflets appear in packages of many drugs and hazardous products sold. Such
warnings are inserted because manufacturers have a duty in law to warn their customers of
any risk involved in the use of their products.
...
Will the smoker read this warning? [an insert]
Many smokers won’t. But that is also a truism for warnings for other products. The
message will still get through to many. The smoker’s husband or wife will read it, or the
children. The concern they express will encourage the smoker to rethink tobacco. If only a
small percentage of smokers respond to the warning, the savings in lives will number in the
tens of thousands over time.
National Campaign for Action on Tobacco [Canada], “WARNING: Treat the
Epidemic Like an Epidemic” 1989 [brochure].
384.
What are the features of an effective warning system? Any effective warning system for
tobacco must tell youth and adults about the nature of the risks (e.g. lung cancer, heart
disease) and the magnitude of the danger (e.g. lung cancer is almost always fatal). An
effective warning system will also explain how tobacco risks compare to other risks and
offer assistance with respect to avoiding those risks (i.e. offering help to quit smoking).
...
[B]y itself, the warning system that we recommend has the potential to prevent tens of
thousands of unnecessary deaths, over time. (p.4)
National “Tobacco OR Kids” Campaign [Canada], “What would be a fair warning
for a lethal product that addicts children and causes more preventable death than
murder, traffic accidents, alcohol and AIDS combined? At a minimum, a warning
that tells the truth . . . ” 1999.
385.
Recommendations
...
1. Use the largest letters possible. Letter size was more important than size of the warning
area, though bigger letters of course require more space.
2. Place the words on a uniform background instead of on top of pictorial details.
...
4. When other aspects of the warning design lead to a background color that is neither black
or white, a letter color that is neither white nor black may maximize legibility. ...
5. The legibility of warnings can be improved by the use of letter/background colours other
than black and white. Color is also widely noted for its ability to attract attention in
graphics. ...
- 129 6. Avoid glossy surface coatings and metallic inks. Under certain common lighting
conditions, these produce glare which can severely degrade legibility (Nilsson, 1991). A flat
or matte finish would make the warnings legible under a wider range of lighting conditions.
7. Use color pictures to improve visual effectiveness.
8. Use the biggest pictures possible to improve visual effectiveness.(p.13)
Nilsson, T. "Legibility and visual effectiveness of some proposed and current health
warnings on cigarette packages" Report of research done under contract to the
Bureau of Tobacco Control, Health Protection Branch, Environmental Health
Division, Health Canada, September, 1999.
386.
This conference further resolves that:
...
(e) National governments should be encouraged to take measures leading to the adoption
of generic packaging as a means of reducing inducements to tobacco consumption.
...
AN INTERNATIONAL STRATEGY FOR TOBACCO CONTROL
Since measures to deal with the tobacco problem must be comprehensive and long term, the
following individual actions should form the basis of such a strategy.
...
1. Effective health warnings and regulation of tobacco product packaging and such
promotional material still permitted.” (p.1018)
Ninth World Conference on Tobacco or Health, “Resolutions of the Ninth World
Conference on Tobacco and Health”, In: Slama, K., ed., Tobacco and Health
Proceedings from the 9th World Conference on Tobacco and Health (New York:
Plenum Press, 1995), pp.1017-1018.
387.
[This memorandum describes the content of new health warnings approved by the
Swedish National Board of Health and Welfare. Cigarettes were to carry 16 rotated
warnings with pictograms. Cartons were to contain 4 detailed text messages. Smokeless
tobacco was to contain 4 rotated text messages, apart from nasal snuff which had one text
warning. The warnings were not ultimately confirmed by the Swedish Cabinet on the
grounds that Sweden needed to harmonize its warnings in preparation to enter the
European Union.]
Nordgren, P., “News from Sweden: New Health Warnings on Tobacco Products”
1991.
388.
The first set of warnings, issued in 1977, contained primarily basic information about the
risks of contracting lung cancer, cardiovascular diseases, etc. ... (p.12)
The effect of health warnings was evaluated through surveys carried out by the National
Smoking and Health Association, NTS, about smoking habits and attitudes between
1976-1977. The results showed that people's knowledge about the health effects of
smoking had increased, especially among smokers, concerning facts mentioned in the
warnings. Respondents were in favor of warnings; attitudes concerning, for example,
smoking during pregnancy had become more unfavorable. Most important smoking
prevalence had decreased. (pp.12-13) [citing Ramstrom, L. Maerkrning av tobaksvaror
foercndrar uppfattningen och beteenden (the labeling of tobacco products changes
opinions and behavior)./ In Tobaken och vi (Tobacco and Us), Journal of the National
Smoking and Health Association NTS, 4, 1979 (Swedish).]
- 130 The later [post-1977] texts have not been evaluated, except for a small unpublished study
where about 30 smokers were interviewed. Results showed that these smokers reacted
more in favor of texts clearly directed toward specific target groups and that facts about
the effect of smoking on others (passive smoking, risks during pregnancy) had a major
impact. Messages with clear, "scaring" facts were regarded as most effective.(p.13)
...
The fact that a big international company took the trouble and expense to complain about
the health warnings might demonstrate, we thought, that the company suspects, or from
its own surveys knows, that the warnings have a greater than expected impact on
consumers. (p.13)
Nordgren, P., “Renewal of Health Warnings: Lessons Learned in Sweden” World
Smoking and Health, 1993;18(2):12-14.
389.
Provincial Tobacco Package Warnings Make Good Health Policy for Many Reasons:
1. Requiring a provincial warning would help show that Ontario understands the magnitude
of the health problem underway and is prepared to take additional health steps to meet that
problem. ...
...
3. "Informed consent" must be present when customers buy tobacco industry products. ...
4. Federal tobacco control legislation invites the province to improve upon existing tobacco
warnings. ...
5. A provincial warning can be required at no cost to the taxpayer and minimal cost to the
industry. ...
6. A provincial warning would help us to "de-market" tobacco products. (p.2 in tab)
Ontario Campaign for Action on Tobacco, "Give Kids a Chance. Critical reasons
why a provincial warning on cigarette packages must become law under Ontario’s
Tobacco Control Act" 1995.
390.
There appears to be a positive relationship between the recall of pack warning labels and the
recall of health problems for lung cancer, heart problems, strokes, and cancer, as those who
have seen these warning labels are more likely to recall the corresponding health problem,
relative to those who have not seen such labels.
...
Warning messages on cigarette packages and other displays appear to have an impact and
should be retained in their current, prominent form. (p.122) [For example, among 15-19
year olds, of those that recalled the heart disease warning on the package, 70% named heart
diseases/heart attack as a smoking and health problem. Among those that did not recall the
heart disease package warning, only 32% named heart diseases/heart attack as a smoking
and health problem. For stroke, the comparable figures were 56% and 5%. (p.130)]
Paglia, A., de Groh, M., Rehm, J., Ferrence, R. “Knowledge of Health Risks” In:
Stephens, T., Morin, M. (Health Canada), eds., Youth Smoking Survey 1994
Technical Report (Ottawa: Minister of Supply and Services, 1996) (Catalogue No.
H49-98/1-1994E).
391.
READABILITY. If a warning sign or placard is printed only in the English language,
can it effectively transmit or communicate the necessary safety information to a worker
who cannot read the English language? Today there are millions of workers who can
read and write only in a foreign language. . . .
- 131 It would seem obvious that the ability to read a message is a prerequisite to understanding
that message. In some states, certain workplace warning and instruction signs are
required to be in two languages. This may solve the readability problem for those who
can read those languages, but what about those who can read only in other foreign
languages? Perhaps more importantly, what about the millions of functionally illiterate
native-born workers? There are many unskilled or semi-skilled machine operators who
cannot read the warnings that they see every day . . . (p.76)
...
REINFORCEMENT. The abbreviated warnings posted in the workplace should be
supplemented by more explanatory detail . . .
This is particularly true when workers grow accustomed to obvious hazards or begin to
forget about certain hidden hazards that they routinely encounter. They may be
superficially aware of the hazard, but are they fully informed as to the true nature and
magnitude of the risk involved? . . .
...
DANGER SIGNAL. Is the warning sufficiently attention-getting and recognizable as a
warning? . . .
The warning must command attention and be perceived as a warning. It should alert a
reasonable person to possible danger. Signal words such as “danger,” “warning,”
“caution” or “safety alert” are used to denote the degree of risk and to convey a relative
sense of urgency. Colors such as red, amber and yellow are used to suggest degree of
risk or relative danger.
Warnings in the text of operator’s manuals and maintenance instructions may be boxed,
underlined or highlighted to emphasize the importance of the warning. (p.79)
Peters, G.A. “15 Cardinal Principles to Ensure Effectiveness of Warning System”
Occupational Health and Safety, May 1984, pp.76-79.
392.
[I]n theory, health professionals have ample epidemiological evidence by which to
convince women of the dangers of smoking during pregnancy. Perhaps these statistics
are too abstract to convince economically disadvantaged women of the dangers of
smoking.
Further research is needed to develop more effective methods of
communicating the dangers of smoking during pregnancy. A visual approach might be
effective, showing how the placenta attempts to preserve oxygen transfer to the
developing fetus, using pictures such as these.
Pfarrer, C., Macara, L., Leiser, R., Kingdom, J., “Adaptive angionesis in
placentas of heavy smokers” The Lancet, 1999;354(9175):303.
393.
[This document provides a history of cigarette package warnings/labelling in Canada.]
Physicians for a Smoke-free Canada, “Background; Chronology of Cigarette
Labelling in Canada” January 2000.
394.
[Citing internal industry documents, this report provides a historical chronology of
tobacco industry efforts to minimize warnings, toxic constituent and additive disclosure,
and advertising restrictions.]
Physicians for a Smoke-free Canada, “Selected Documents from Guildford
Depository, Philip Morris Web-site, RJR Tobacco Web-site, Brown &
Williamson Web-site, and other sources regarding: CTMC-government relations;
- 132 Restraints on the packaging, labelling and advertising of tobacco” February 1,
2000.
395.
64 subjects were presented pictures and later asked to draw them or provide one-word
descriptions. Other subjects were presented words and asked to recall them or draw
representational pictures. Recall was tested immediately and 48 hr. later. Regardless of
recall mode, subjects viewing pictures showed significantly greater recall than subjects
viewing words, and for all subjects immediate recall was better. (p.1079)
Purdy, J.E., Luepnitz, R.R. "Immediate and long-term retention for pictorial and
verbal stimuli” Perceptual and Motor Skills 1982;55:1079-1082.
396.
[This document provides a response to ten different arguments raised by the tobacco
industry against improved tobacco package warnings .]
Quebec Coalition for Tobacco Control, Non-Smokers’ Rights Association,
Physicians for a Smoke-free Canada, Canadian Cancer Society, “Cigarette
Packaging: More Information = More Protection” January 25, 2000.
397.
There are now 16 warning notices. ...
Using a multitude of warning notices is expected to achieve two benefits. First, it may help
to avoid having the notice ignored by smokers. Repeating a single notice ad infinitum tends
to erode its effect. Too, a greater range of information can obviously be included in 16
notices than in a single one. It is intended that the notices be changed in the future so that
they will not lose their freshness and effectiveness. By renewing texts, the contents can be
kept current and reflect progress of future research. This first set of texts is intended to cover
a broad spectrum of areas and to be combined with messages to encourage smokers to stop
smoking. (p.30)
Ramstrom, L.M., “New Ideas in Sweden’s Tobacco Labeling Act” World Smoking
and Health, 1976;(1):28-31.
398.
[A South African study examined the impact of larger, more detailed package warnings.
Among smokers, 7% agreed that the messages “Made you stop smoking”, 41% agreed
the messages “Made you think about giving up”, and 15% agreed that the messages
“Made you smoke less”. Among non-smokers, 39% agreed that the messages “Made you
glad that you never started”.]
Reddy, P., Meyer-Weitz, A., Levin, J. “South Africans’ response to Tobacco
Control Health Warnings” 1996 published by Medical Research Council and
Human Sciences Research Council.
399.
The good intentions of safety personnel can be subverted when the label design function
is subordinated to the interests of sales, advertising, legal, materials, and finance
managers. (p.44)
...
Test the warning label for effectiveness to insure that the message intended penetrates the
consciousness of all possible users, some of whom may speak a different language. (p.46)
Riley, M.W., Cochran, D.J., Deacy, J.E. “Warning label design” Professional
Safety, October 1981, pp.44-46.
- 133 -
400.
Regulation is one of the most powerful tools in the fight against smoking in Canada. And
that’s why today I’m announcing that we intend to file two proposed regulations that will
make a real difference in this fight. The first has to do with changes in cigarette
packaging. Under these proposals, every package of cigarettes will have to bear one of
16 messages that will take up fully one half of the front and one half of the back of every
package. And every one of these messages is going to be accompanied by a hard hitting
message by colour graphics and it’s going to include important information about the
poisonous ingredients in cigarette smoke. We believe this will make a difference.
The cigarette package is one of the most important marketing and communication tools
available to the industry. Do you know that over two billion cigarette packages are
purchased every year in this country? That 10 or 20 or sometimes 30 times a day, the
smoker takes the package out and uses it, puts in on the table, puts it in a pocket – has it
available in the house for kids to see. This is an enormously important tool for
communicating and the tobacco companies know it. And they spend a lot of money
using the package to get their message out. Well, the people of Canada are going to use
the package to get their message out. (pp.2-3 in tab)
Rock, A. “Announcement on new tobacco regulation proposals” Speaking Notes
for Allan Rock, Minister of Health; University of Ottawa, January 19, 2000.
401.
As of 1991, 77 countries in the world required health warnings, but most of them (48)
merely require a statement that smoking is injurious to health – a traditional warning so
familiar and hackneyed that it hardly attracts the attention of the smoker any more.
Following the example pioneered by Sweden, however, increasing numbers of countries
are adopting strong, rotating warnings that capture the attention of the smoker. (p.45)
...
Basic reasons for health warnings
The rationale for health warnings and indications of tar and nicotine content is closely
related to health education. The reasons for this type of legislation are as follows:
- to alert the public to the health hazards of tobacco use;
- to serve as the basis or starting point for a health education programme;
- to put the weight of the government and the health authorities behind a smoking-control
policy and thus to assist the movement towards a smoke-free society. (p.46)
...
General experience
The most significant development concerning health warnings has been the imaginative
innovation of strong, rotating warnings made even more effective by pictures. The recent
requirement for adding package inserts is a promising strategy. The original, traditional
warning, “Smoking is hazardous to health”, is obsolete and no longer effective.
Experience indicates that introduction of strong, rotating warnings in conjunction with a
media campaign on television and in newspapers increases public awareness of the new
warnings. (p.54)
Roemer, R. Legislative Action to Combat the World Tobacco Epidemic, 2nd
ed., (Geneva: World Health Organization, 1993).
402.
Students were asked to list everything they could remember about a cigarette package
after they had viewed it for about one minute. In Ontario, 83% mentioned the health
- 134 warning. It was recalled more frequently than even the brand name, which was
mentioned by 77% of students.
 There are marked differences between Ontario and Chicago. Among those in the
Chicago sample, the health warning was mentioned by only 6% of the time compared to
83% of the time in the Ontario sample (Figure 2). The warnings on Canadian cigarette
packages are much more prominent than those on American packages. These data show
that while Canadian warnings have been effective at getting the attention of young
smokers, the American warnings have not.
 In Ontario, twice as many students reported that it was easier to see the health warning
on the plain package (51%) than on the regular package (29%). The remainder (20%)
said it made no difference.
 In Ontario, actual recall of the health warning was improved by plain packaging, but
only for regular smokers. More daily smokers (82%) remembered the health warning
when it was shown on a plain package than when it was shown on a regular package
(62%). For the Chicago sample, memory of the warning was no different when it was
presented on a plain package or on a regular package.
 Believability of the health warning is enhanced by plain packaging. While 53% of
Grade 7 and 9 students in Ontario said the plain package makes the health warning look
more serious, only 19% said the regular package makes it look more serious.(p.6)
...
Plain cigarette packaging would render ineffective one of the few remaining tools that
tobacco companies in Canada use to build an image for their products....
The evidence is strong that plain packaging of cigarettes would reduce the positive imagery
associated with smoking particular brands for many young people. ...(p.9)
One quarter of Grade 7 and 9 students in our survey said that young smokers would smoke
less, and one third said that young nonsmokers would be less likely to start, if all cigarettes
were sold in plain packages. (p.10)
Rootman, I., Flay, B.R., Northup, D., Foster, Mary K., Burton, D., Ferrence, R.,
Raphael, D., Single, E., Donovan, R., d’Avernas, J. “A Study on Youth Smoking:
Plain Packaging, Health Warnings, Event Marketing and Price Reductions. Key
Findings. Figures. University of Toronto, University of Illinois at Chicago, York
University, Ontario Tobacco Research Unit, Addiction Research Foundation, 1995.
403.
The European Union, the European region, Latin America and other countries represented at
this conference call for governments, international organizations, and NGOs to:
. . . adopt strong health warning labels covering at least thirty percent of tobacco packaging
as in Poland, and implement strong mass-media campaigns to discourage tobacco use as in
Venezuela.
Second European Conference on Tobacco or Health and First Iberoamerican
Conference on Tobacco or Health, “Canarias Declaration” Las Palmas de Gran
Canaria, Spain, 23-27 February 1999.
404.
[T]here is clear evidence that package messages and other elements of package design
have the potential to significantly reduce tobacco use. (p.i)
...
Congress needs to delegate regulatory authority to an administrative body such as the
FDA, while giving that authority broad powers to efficiently change messages and other
- 135 package requirements on a regular basis, in order to communicate new knowledge about
tobacco use risks, and to respond to loopholes; (p.i)
...
One value of conspicuous package warnings is to reduce the impact of huge retail
package displays, a necessary part of reducing demand for tobacco by minors. If a
warning is required on only one side of the package, manufacturers will urge or pay
retailers to display packages with the warnings hidden. (p.9)
...
It is important that the option of providing messages in visual rather than text format be
left open. ... Providing visual information would also allow messages to reach the many
Americans who are illiterate or who do not read English. (p.11)
...
The concept behind plain packaging includes the ability to remove much of the image of
tobacco products, thus severing the impact of past and present promotional efforts and
making the product less attractive. (p.20)
...
Package inserts
There are additional ways of using the package to convey information to the consumer.
An ideal way to supplement warnings on the outside of packages is to provide detailed
information on inserts inside the packages. ... Inserts are cost-effective and are already
used by manufacturers on a regular basis. They offer a way to provide a greater variety
of messages and more information than is practical on the outside of the package. (p.20)
...
There should be as little discretion as possible given to tobacco companies with respect to
the presentation of messages. (p.21)
...
Package health messages should be considered to be only part of a broader package warning
system that includes ingredient information, removal of misleading labeling, package inserts
and, eventually, plain packaging. (p.22)"
Selin, H., Sweanor, D. “Tobacco Product Packaging and Labelling” Health Science
Analysis Project, Policy Analysis No. 12 (Washington, D.C.: Advocacy Institute,
1998), pre-release copy.
405.
Stengthening the warning label on cigarette packages could be one way of raising public
awareness. (p.11)
Shaman, D. “Getting Out the Antismoking Message” American Lung Association
Bulletin 1981; 67(7):11-15.
406.
The scale of the industry's efforts to defeat or at least weaken the new measures is itself
instructive, indicating the potential effectiveness of this sometimes underrated aspect of
tobacco control policy. Unfortunately, some concessions were surrendered, the most
important being to change the instructions for the colour of the warnings, originally
specified as "black and white", to "contrasting colours". One glance at the pack
reproduced here is enough to show who decides how to interpret this: the use of gold or
silver on white is a monument to the industry's contempt for health policy.
Simpson, D. “Poland’s world-leading health warnings” Tobacco Control
1998;7(3):229-230.
- 136 407.
The provision of clear, understandable information in visual or message form printed on
packaging is a fundamental concept of public health education. This particular applies to
tobacco where because of the health risks, the dangers of use need to be clearly outlined as
the basic starting point of health education programs. (p.1)
...
Health warnings are a valuable part of any comprehensive strategy on tobacco control.
Health warnings are a low-cost action, with proven benefit in attitude change, that is
borne by the industry. Tobacco health warnings enable the dissemination of the real
impact of smoking. (p.6)
Stanton, H. “Health Warnings: Are They Effective as Consumer Education” Paper
presented at the Asia Pacific Association for the Control of Tobacco, Chiang Mai,
Thailand, November 1995.
408.
Priorities for Action Under Each Strategic Direction (p.14)
...
Continue to introduce measures to make tobacco packaging more informative. (p.16)
Steering Committee of the National Strategy to Reduce Tobacco Use [Canada],
Federal/Provincial/Territorial Advisory Committee on Population Health [Canada],
“New Directions for Tobacco Control in Canada: A National Strategy” (Ottawa:
Health Canada, 1999).
409.
One approach would be to increase the amount of space on the package allocated to the
message. More space would allow for larger print so that any message would be more likely
to attract notice and would be easier to read. This would also allow room to develop more
sophisticated messages (which could trigger increased elaboration and hence greater
impact).(p.5)
...
We have seven recommendations:
1) Tobacco package labels should be integrated into a broader anti-tobacco campaign that
included television commercials, point of sale ads and school based programs.(p.7)
2) Labels could be more effective if they focused on the benefits (e.g., health and financial)
of cessation.
3) The effectiveness of labels could be increased by including information relevant to the
negative social consequences of tobacco use.
4) Labels could be made more effective by reinforcing tobacco users' beliefs that they are
capable of quitting.
5) The effectiveness of package labels could be increased by including features which would
serve multiple roles (e.g., attracting attention, symbolizing danger).
6) To counteract the loss of message effectiveness due to overexposure, messages should be
rotated or changed regularly.
7) If the tobacco industry were required to use different package designs in different
provinces, this would create conditions for powerful field research that could help refine
message design on an ongoing basis. (p.8)
Strahan, E.J., Fabriger, L.R., Fong, G.T., Zanna, M.P., Cameron, A.J.R.,
“Enhancing the Effectiveness of Message Labels on Tobacco Packaging” Prepared
for the Centre for Behavioural Research and Program Evaluation, National Cancer
Institute of Canada, March 1999.
- 137 410.
The proposed format was overwhelmingly preferred (80%) over existing (20%) and old
(4%) formats. This is consistent with smokers stated importance of cigarette package
messages. Respondents like the proposed format for its position on the package, and
more predominant (black & white) print. (p.19) [proposed format was 25% plus border,
black and white, top of package; existing format was 20%, bottom of pack, package
colours; old format was small print, side of package, package colours].
...
Overall, inserts were seen to offer a significant amount of news value, particularly
through statistics. As with messages, the inserts were thought to be clear, believable,
important and relevant. (p.20)
...
Cigarette packages are an important and desired resource for health information on
smoking, with current messages frequently referenced by the majority of smokers. (p.21)
Tandemar Research Inc., “Tobacco Health Warning Messages, Inserts and Toxic
Constituents Information Study: Final Report” Prepared for Tobacco Products
Section, Environmental Health Directorate, Health and Welfare Canada, 1992.
411.
Information sources
 A sizeable proportion of smokers mention cigarette packaging as a source of
information about the hazards of smoking. Four in ten smokers volunteer “cigarette
packaging” when asked where they had recently seen or heard information regarding
these hazards. This places cigarette packaging only second to television (60%) as a
source of information.
 A higher proportion of teens (49%, 15 to 19 year olds) than the general smoking
population cite cigarette packaging as a source of information. In addition, a higher
proportion of English speaking smokers (43%) than French smokers (31%) cite this
source. French smokers are more likely to indicate TV as an information source.
Awareness and frequency of reading messages
 Not surprisingly, virtually all smokers have seen cigarette package health warnings
(99%). On average, these messages are read 1.7 times per day.
 The average frequency of reading these messages is slightly lower in French
speaking smokers at 1.4 times per day. There are no differences among age groups in
the frequency with which these messages are read.
Degree of influence of messages
 Cigarette packaging health messages have contributed a great deal towards impacting
the short-term objective of raising public awareness of the health hazards of smoking.
Of those smokers who agree that they have become more conscious of the risks of
smoking, 70% agree that the messages on cigarette packages have contributed “a
little/a lot compared to other things” in becoming more aware of the risks associated
with smoking. (This translates to 53% of the total smoking population).
 Regarding the longer term goal of decreasing tobacco consumption, cigarette pack
messages have also made inroads. Of those smokers who expressed an increased
interest in wanting to quit smoking, the majority (60%) agree that the cigarette pack
messages have contributed “a little/a lot compared to other things” in this desire.
(36% of the total smoking population)
 Furthermore, about half of smokers who have made an attempt to quit recently or are
smoking less than they used to cite cigarette pack messages as contributing to these
behaviours (51% and 49%, respectively). (19% and 20%, respectively of the total
smoking population). (p.6)
- 138 ...
General opinion of health warning messages
 Although one might suspect that smokers do not want to continue seeing the negative
consequences of smoking on their cigarette packages, their responses to several
statements regarding their opinion of health messages on cigarette packs does not
support this view. In fact, when asked how much they agreed or disagreed with the
statement “it is important for smokers to be reminded of”, about three-quarters (72%)
of smokers agreed with this statement.
 In addition about half (53%) agreed that “the messages are worth reading again, even
after seeing them several times.” (p.8)
...
Conclusions
1. The location and colour of health messages does influence smokers ability to
remember them. The message is more likely to be remembered when shown on the top
of the package, and when presented in Black and White.
2. Messages located on the top of the package, occupying 35% of the space and in
contrasting black and white type were clearly indicated as ‘most likely to be read by
smokers’. (p.13)
Tandemar Research Inc. “Cigarette Packaging Study: The Evaluation of New
Health Warning Messages” Prepared for Health Canada, March 1996.
412.
413.
[W]arnings are an integral part of [a] comprehensive approach. [They work]
synergistically with other elements of [a] comprehensive approach to increase awareness
and decrease consumption. (p.15)
Tilson, M.L., “Tobacco Package Warnings: Towards Informed Consent” Paper
presented to Tobacco-Free Canada: First National Conference on Tobacco or
Health, Ottawa, 21-22 October 1993, Ottawa, Ontario.


Pictorials can enhance warnings by serving to enhance noticeability. The primary
requirement of an effective warning is that it be noticed.
Incorporating "novelty features" into the warning design can serve as a powerful
reinforcement of the warning message. Pictorials are one such means of strengthening
the impact of the message.
...
 Recognition and recall of pictures is superior to that of words.
 Pictographs that include a limited amount of text are better understood than those with
no accompanying verbal information.
...
 Using graphics with text to convey health information improves comprehension and
recall. (p.2)
Tilson Consulting, "The Value of Pictures/Pictograms in Warning Messages:
Summary of Findings" Prepared for Health Canada, 2000.
414.
The tobacco giants of the world will begin including health warnings on all products,
whether bound for domestic or export markets.
- 139 Tobacco International, “Major makers put warnings on all cigarettes – domestic and
export” Tobacco International, February 15, 1992.
415.
[Various municipalities in Canada require the posting of signs warning of the dangers to
health of environmental tobacco smoke, with the signs having a graphic (e.g. lungs, heart,
fetus overlayed on silhouette depictions of people). The signs are required to be posted in
specified places where smoking is permitted. Examples of municipalities requiring such
signs are: Toronto (Ont.), Hamilton (Ont.), Ancaster (Ont.), Stoney Creek (Ont.), Windsor
(Ont.), Lethbridge (Alta.), Pincher Creek (Alta.)]
Toronto Public Health, “A Guide to Toronto’s New No Smoking By-law for Public
Places and Workplaces” 1999; Toronto, City of, By-law No.441-1999, “A by-law to
regulate smoking in public places and workplaces in the City of Toronto and to
repeal smoking by-laws in the former municipalities”; Hamilton, City of, “By-law
No. 98-140 Respecting: Smoking in Public Places and the Workplace”; Lethbridge,
City of, “Consolidation of a By-law of the City of Lethbridge to Regulate Smoking
Within the City of Lethbridge”.
416.
At the conclusion of the Council of Health Ministers meeting on 4 December 1997, the
European Commission was asked to bring forward new proposals for tobacco products in
the areas of tar, nicotine and labelling. We welcome the fact that the Commission are
working on proposals, and believe that the Commission review should take account of
developments outside the EU. For example, Canada and Australia have introduced larger,
more prominent health warnings on cigarette packets. (p.77)
United Kingdom Department of Health, “Smoking kills: A White Paper on
Tobacco” December 1998.
417.
Messages should appear on all packs, stating the addictiveness of, and damage to health
caused by smoking. In addition, a variety of health messages – such as that relating to male
potency which we recommend above – should be used on certain packets. These messages
should be harder hitting and more relevant to consumers than those currently used
(Paragraph 174).
United Kingdom, House of Commons Health Select Committee, “Second report:
The tobacco industry and the health risks of smoking” Volumes I-II, London:
Stationery Office, 2000, June 14, 2000.
418.
The potential public education value of package-based health messages is inherent in their
exceptionally large rate of exposure to consumer view. In the United States, about 478
billion cigarettes were consumed in 1997. Each of these cigarettes will be removed from a
package that could be viewed by many cigarette users at exactly the time they are preparing
to engage in the activity such messages are intended to prevent. These messages can be seen
not only immediately before use but also at the point of sale or at any time the package is in
the possession of the user. The messages do not have to be directed only at tobacco users;
any exposed package can be viewed by, and can provide information equally germane to,
users and nonusers alike. (p.186)
U.S. Department of Health and Human Services, Reducing Tobacco Use: A
Report of the Surgeon General, Atlanta, Georgia: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Center
- 140 for Chronic Disease Prevention and Health Promotion, Office on Smoking and
Health, 2000.
419.
The more noticeable a warning is, the more effective it will be. (p.609)
...
The appropriate use of color, size, and a pictorial can increase the impact of the message.
In addition to attracting attention, the ideal warning clearly and concisely describes the
hazard and gives instructions for avoiding it. (p.611)
Wogalter, W.S., Godfrey, S.S., Fontenelle, G.A., Desaulniers, D.R., Rothstein, P.R.,
Laughery, K.R. “Effectiveness of Warnings” Human Factors 1987;29(5):599-612.
420.
Recommendations: (p.82)
...
. . . Where governments decide to take strong action to curb the tobacco epidemic, a
multipronged strategy should be adopted. Its aims should be to deter children from
smoking, to protect nonsmokers, and to provide all smokers with information about the
health effects of tobacco. The strategy, tailored to individual country needs, would
include: . . . (2) publishing and disseminating research results on the health effects of
tobacco, adding prominent warning labels to cigarettes . . . (pp.82-83).
World Bank, Curbing the Epidemic: Governments and the Economics of Tobacco
Control (Washington, D.C.: World Bank, 1999).
421.
The Thirty-ninth World Health Assembly, (p.259)
...
4. URGES those Member States which have not yet done so to implement smoking
control strategies; these, as a minimum, should contain the following:
...
(5) prominent health warnings, which might include the statement that tobacco is
addictive, on cigarette packets, and containers of all types of tobacco products; (p.260)
World Health Assembly Resolution WHA39.14, May 1986, In: Roemer, R.
Legislative Action to Combat the World Tobacco Epidemic, 2d ed. (Geneva:
World Health Organization, 1993), pp.259-261.
422.
By the mid-1990s, however, a number of countries had introduced health warnings with
much greater impact, including direct statements of health hazards and multiple messages,
that were larger and more prominently displayed. Such warnings are now required in a
number of countries including Australia, Canada, Iceland, Norway, Singapore, South Africa,
and Thailand. Greatly enhanced effectiveness has been found with legally required health
warning schemes that include the following:
- multiple warnings, each of which appears in approximately equal proportions on packages
of tobacco products;
- warnings on all kinds of tobacco products, with the text appropriate to the product
concerned;
- strong, uncompromising messages in the text of each warning . . . (p.53)
...
WHO has recommended that all Member States should implement comprehensive tobacco
control policies and programmes that include at least the following components:
- 141 ...
- effective health promotion, health education, and smoking-cessation programmes
- prominent health warnings on tobacco product packaging (p.63)
World Health Organization, “Tobacco or health: A global status report (Geneva:
World Health Organization, 1992).
423.
E. Packaging and labelling
...
1. Because the regulation of tobacco packaging and labelling is an essential component of
control efforts with respect to tobacco products sold or distributed in the domestic market
and in international trade, each Party shall adopt appropriate measures to ensure that:
...
(b) the use of tobacco packets of the terms "low tar", "light", "ultra light", "mild" or any
other similar terms that have the aim or the direct or indirect effect of conveying the
impression that a particular tobacco product is less harmful than others shall be prohibited;
(c) tobacco packaging and labelling shall not otherwise promote a tobacco product by any
means that are false, misleading or deceptive or that are likely to create an erroneous
impression about its characteristics, health effects, hazards or emissions;
...
(e) Option 1: all units of tobacco products shall carry the warnings [and a picture or
pictogram] elaborated in Annex [INSERT].(p.10)
or
Option 2: all units of tobacco products shall carry a picture or pictogram illustrating the
harmful consequences of tobacco consumption and general health warnings in the principal
language or languages of the country where the product is placed on the market. The
Conference of the Parties [shall initiate the preparation of a Protocol setting out appropriate
rules and procedures in the area of tobacco packaging and labelling] [may adopt standards to
harmonize tobacco packaging and labelling in a technical Annex to this Convention]. (p.11)
...
Annex 2
TOBACCO PRODUCT PACKAGING AND LABELLING
...
Option 1:
(Explanatory note: It should be noted that this option is given only as a possible example and
may have to be further adopted to be appropriate for a global standard.)
1. Each unit packet of tobacco products shall carry two different health warnings.
2. The warnings required by this Annex shall be printed on the two [most visible] surfaces of
the unit packet, and on any outside packaging used in the retail sale of the product.
3. The text of warnings and yield indications required under this Annex, shall be:
(a) printed in easily legible black type on a white background. In order to accommodate
language requirements, each Party may determine the point size of the font, provided that the
font size specified in its legislation is such as to occupy the greatest possible proportion of
the area set aside for the text required;
(b) centred in the area in which the text is required to be printed, parallel to the top edge of
the packet;
(c) Surrounded by a black border of not less than [INSERT] millimetres, which does not in
any way interfere with the text of the warning given or information given;
(d) in the principal language or languages of the country in which the product is placed on
the market.
- 142 4. Texts as required by this Annex and by Article [II.D.2] shall not be printed on the
underside or on the tax stamps of unit packets. The texts shall be irremovably fixed and
indelible, and shall not in any way be hidden, obscured or interrupted by other written or
pictorial matter, nor by the opening of the packet.
5. The health warning required by this Annex shall cover not less than 25% of the external
area of the corresponding surface of the unit packet on which it is printed. This percentage
shall be increased to 27% for countries with two principal languages and 30% for countries
with three principal languages.(p.32)
or
Option 2:
General:
1. Any written information that is required by this Annex shall be printed:
(a) in the principal language or languages of the country where the product is placed on the
market;
(b) in a manner that ensures that the information is legible and prominently displayed.
Health warnings
2. For the purposes of this section a health warning consists of a written statement and a
[colour picture] that illustrates the harmful effects of tobacco consumption or the benefits of
cessation.
3. The Parties shall adopt appropriate measures to ensure that health warnings are displayed
on every package or wrapper in accordance with the terms of this Annex.
4. The health warnings required by this Annex shall be displayed on the two largest display
surfaces on each unit package.
5. They shall occupy 50% of those surfaces and be positioned parallel to the top edge of the
package or the top part of the package and in the same direction as the other information that
is on the package.
Health information
6. The Parties shall adopt appropriate measures to ensure that every package of tobacco
products displays health information in accordance with the terms of this Annex.
7. The health information required by this Annex shall be displayed in the following manner:
(a) on [each side of] a leaflet, the message being centred and occupying at least 50% to 70%
of the page; or
(b) in the case of a slide package,
(i) on a leaflet in accordance with paragraph 7(a) above; or
(ii) on the surface of the slide that is opposite to the slide that is next to the tobacco
products, in such a manner that the health information is centred and occupies 60%
to 70% of the surface.
8. In the case of a leaflet, the leaflet shall measure approximately [INSERT] by [INSERT]
millimetres and be readily visible to a person who opens a package in which it has been
inserted.(p.33)
World Health Organization, "Provisional texts of proposed draft elements for a
WHO framework convention on tobacco control" A/FCTC/WG2/3, February 29,
2000.
424.
G. Non-price measures to reduce the demand for tobacco
1. Each Party shall, to the extent possible within the means at its disposal and its capabilities,
adopt legislative, executive and administrative measures, and cooperate with other Parties in
harmonizing appropriate non-price policies, in order to reduce tobacco consumption and
exposure to tobacco smoke. Such measures and policies shall include the following: (p.3)
...
- 143 (d) adoption of appropriate measures to ensure that:
(i) the terms “low tar”, “light”, “ultra light”, “mild” or any other similar term that has the aim
or the direct or indirect effect of conveying the impression that a particular tobacco product
is less harmful than others are not used on any unit packet or package of tobacco products;
(ii) tobacco packaging and labelling does not otherwise promote a tobacco product by any
means that are false, misleading or deceptive or that are likely to create an erroneous
impression about its characteristics, health effects, hazards or emissions;
...
(iii) each unit packet or package of tobacco products carries a general health warning,
including a picture or pictogram illustrating the harmful consequences of tobacco
consumption, in accordance with Annex . . . (p.4)
World Health Organization, “Chair’s text of a framework convention on tobacco
control” International Negotiating Body on the WHO Framework Convention on
Tobacco Control, Second session, A/FCTC/INB2/2, January 9, 2001.
425.
For pre-literate populations, consideration might be given to the use of appropriate
warning symbols rather than text. In all warnings the information given should be clear,
and the position and size of the warning must be such as to command attention. (p.47)
World Health Organization Expert Committee, “Smoking control strategies in
developing countries; Report of a WHO Expert Committee” World Health
Organization Technical Report Series 695 (Geneva: World Health Organization,
1983).
426.
[T]obacco manufacturers will not, in general, voluntarily agree to warnings that reflect
accurately the views of health authorities and . . . they will make every effort to minimize
the impact of such warnings. (p.56)
...
Introduction of a mandatory system of warnings provides yet further evidence of
government concern about smoking and health. It is vital to ensure that exact
specifications for the warning are carefully set out so that its effect is not minimized by
careful pack design or any other device. Care should be taken that any warnings used are
both accurate and comprehensible to the public at large, and the government should retain
the right to vary the warning at will. (p.57)
World Health Organization Expert Committee on Smoking Control, “Controlling
the smoking epidemic: Report of the WHO Expert Committee on Smoking
Control” World Health Organization Technical Report Series 636 (Geneva:
World Health Organization, 1979).
427.
[This article contains warning texts from Norway, European Community, United
Kingdom, Chile, Costa Rica, Ireland, Thailand, USA, New Zealand, Singapore, South
Africa, India, Iceland.]
World Smoking and Health, “Texts of health warnings” World Smoking and Health
1993;18(2):14-17.
428.
As the world’s leading smoking cessation company, SmithKline Beecham welcomes the
opportunity to respond to the recently proposed Tobacco Products Information Regulations
...
- 144 ...
We believe that these proposed regulations will have immediate and long-term positive
health effects on Canadians. In addition, they will also initiate changes in legislation and
reduction in tobacco use around the world. This new initiative will clearly position Canada
in a leadership role.
We endorse our government’s aggressive initiative to inform consumers about the risks
associated with smoking via the pack warnings. Cigarette packages with clear, colourful
graphics are more intrusive and persuasive than the smaller word-only warnings currently in
use. Package warnings, in combination with advertising, counter existing incorrect
information regarding tobacco products. Smokers need information on the risks of smoking
as well as information regarding clinically proven ways to quit. . . .
In addition, these changes to packaging will work well in concert with the other tobacco
control initiatives underway by Health Canada. “When tobacco control initiatives are
planned that are likely to have an impact on quitting activity, there is an opportunity to
inform smokers about effective quitting methods.” (p.1)
...
With this legislation, Canada will lead the world in reducing tobacco consumption in the
short and long term. This will have tremendous positive impact on millions of people
worldwide. (p.4)
Wright, T. (Vice President & General Manager, SmithKline Beecham Consumer
Healthcare), McCullogh, J. (Regulatory Affairs Project Manager, SmithKline
Beecham Consumer Healthcare), Letter to Katrina Edwards (Acting Director
General, Bureau of Tobacco Control, Health Canada), February 22, 2000.
429.
[T]he 30% labels have had considerable influence on smoking habits and attitudes.
Among male smokers, 3% stated that they had quit smoking, another 16% attempt to stop
or to control their habit, and further 14% said they better understood the harmful
consequences of smoking as a result of the new labels. The corresponding figures among
women were 4%, 16% and 19%. . . .
CONCLUSION:
The enlargement of health warnings on cigarette packs has favorably affected the health
status of Poles by leading to direct declines in smoking prevalence and increased
awareness of the effects of smoking. (p.2)
Zatonski, W., Przewozniak, K., Porebski, M., “The positive health impact of
enlarged cigarette pack warning labels in Poland” Paper presented at the 2nd
European Conference on Tobacco or Health, Las Palmas de Gran Canaria, Spain,
23-27 February 1999.
430.
In announcing the new [1993] regulations put forward under Canada's Tobacco Products
Control Act, Mrs. Collins [Minister of Health] said, "Although the current warnings have
been effective, larger and more visible messages will make smokers even more aware of
the risks they are taking.” (p.5)
...
Canadian Cancer Society president Dr. Jacques Cantin hailed the new warnings, saying
"The Canadian Cancer Society is extremely pleased with (Minister of Health) Collins'
leadership. There are a large number of teenagers in Canada who have the potential to
start smoking. If the warnings encourage even a small percentage of these potential
cancer patients to reject tobacco, a great deal of misery and death will be prevented."
(p.6).
- 145 Zoller, H. “Canada Leads Way with World’s Toughest Tobacco Warnings” World
Smoking and Health, 1993;18(2):5-6.
Promotional Impact of Packaging
431.
Through discussion, respondents revealed that cigarette packaging plays a substantial role in
promoting distinct images associated with specific cigarette brands. In direct response to a
proposal requiring cigarette brands to be marketed in ‘plain’ packs, participants predicted a
decrease in the rate of smoking initiation among children due to the “dull and boring”
appearance of the packs. (p.175)
...
In order to increase the effectiveness of health and tobacco campaigns, efforts should be
undertaken to reduce the influence of brand image appeal.
While steps have been taken to diminish the impact of cigarette advertising, equal attention
should now be directed towards regulating the promotional role of cigarette packaging. The
results of this study indicate that cigarette packaging functions in the same promotional role
as advertising messages. Therefore, efforts to limit cigarette promotions should include
regulation of cigarette packaging. One method of reducing promotion effects through
packaging may be the implementation of cigarette plain packs. (p.177)
Beede, P.C., Lawson, R.W., “Brand image attraction: the promotional impact of
cigarettes packaging” The New Zealand Family Physician 1991:175-177.
432.
The practical implications of this finding suggest that as adolescents develop and are
exposed to cigarettes and advertising, their attention will first be drawn towards brand image
cues. Perception, retention, and recall of health warning information will be less likely than
impressions about the brand. Presentation of cigarettes in plain-packs would increase the
probable impact and retention of the health warning message. (p.16)
...
When presented in plain-pack form, however, respondents’ abilities to recall health warnings
was significantly improved over the brand packs.
...
[I]n the case of young inexperienced non-smokers, plain-packs would serve as a substantial
deterrent to the initiation of smoking behaviour. (p.17)
Beede, P., Lawson, R., Shepherd, M., “The promotional impact of cigarette
packaging : a study of adolescent responses to cigarette plain-packs” University of
Otago, Dunedin, New Zealand, 1992.
433.
Attractive packaging can enhance tobacco sales. Marketing experts point out that this is
particularly important for self-selected impulse purchases or when the imagery is an
important aspect of the product. These factors are important with first-time teen smokers.
. . . With little cost to government, plain packaging can make a major contribution to
reducing tobacco consumption and the prevalence of tobacco use. (p.ii)
...
- 146 Summary List of Reasons Which Support Plain Packaging
1. Eliminates Package as Advertising;
2. Reduces Effect of Past Advertising;
3. Decreases Impact of Foreign Advertising;
4. Decreases Impact of Sponsorships;
5. Will Decrease Shelf Displays;
6. Reduces Positive Brand Imagery;
7. Creates Negative Brand Imagery;
8. Sends a Strong Public Education Message;
9. Influences Consumer Perception of Quality and Taste;
10. Reduces Smuggling;
11. Improves Effectiveness of Warnings;
12. Improves Effectiveness of Public Education;
13. Will Result in Fewer Products on the Market;
14. Eliminates Extraneous Writing;
15. Costs Government Almost Nothing to Implement;
16. Facilitates Further Regulatory Measures;
17. Improves the Indoor and Outdoor Environment;
18. Reduces Tobacco Consumption and Prevalence (p.3)
...
Given the importance of branded packaging to the promotion of tobacco products, and given
the enormous risk of cancer from tobacco use, our conclusion is that plain packaging both
would be necessary and desirable public policy. (p.59)
Canadian Cancer Society, “Putting Health First: the Case for Plain Packaging of
Tobacco Products” Submitted to the House of Commons Standing Committee on
Health, April 1994.
434.
Twenty-three professors of marketing across Canada are of the view that it is likely that
plain packaging would reduce tobacco use. (p.1)
Canadian Cancer Society, “Marketing Professors Endorse Plain Packaging of
Tobacco Products” May 23, 1994 [news release].
435.
This document outlines a number of arguments which have been put forward in opposition
to plain packaging of tobacco products. A response follows each argument. (p.1)
Canadian Cancer Society, “Responses to Arguments Against Plain Packaging of
Tobacco Products; Submitted to Members of the Standing Committee on Health”
May 24, 1994.
436.
[P]lain or generic packaging is a reasonable component of the evolving national strategy to
reduce tobacco consumption. (p.28)
...
The Committee, therefore, recommends:
1. That the federal government establish the legislative framework required to proceed
with plain or generic packaging of tobacco products;
2. That the legislation be introduced when Health Canada concludes its current study on
the effects of plain packaging on tobacco consumption, if the results of that study
support the available evidence that such packaging will reduce consumption;
- 147 3. That the federal government require that plain or generic packages be produced in a
manner that minimizes the possibility of contraband products, and that the design
incorporate printing and packaging technologies that will make duplication as difficult
as possible. (p.29)
Canadian House of Commons, Standing Committee on Health, “Towards zero
consumption: Generic packaging of tobacco products. Report of the Standing
Committee on Health” June 1994.
437.
Simmons [Committee Chair Roger Simmons] pointed out that “Generic or plain
packaging will ensure that tobacco products sold to consumers appear in identical
containers that are without any distinguishing feature. Studies presented to the
Committee suggested that plain packaging will make the tobacco products less attractive
and appealing and that such packaging would reduce consumption.” [news release]
Canadian House of Commons, Standing Committee on Health, “Health Committee
Reports on Plain Packaging of Tobacco Products” June 21, 1994 [news release].
438.
Your Committee further recommends the following:
That Health Canada examine and report to Parliament, within 18 months, on the need for
further regulatory action with respect to:
...
 the movement toward plain packaging.
Canadian House of Commons, Standing Committee on Health, “Third Report”
June 7, 2000.
439.
CMA stated in 1986 that plain packaging of tobacco products should be a critical part of any
comprehensive plan to reduce tobacco consumption in Canada, particularly among young
people. (p.4)
...
it would strengthen and give credibility to public health warnings against tobacco use (p.7)
...
CMA recommends that, as one component of a multi-faceted strategy to control the smoking
epidemic, the Government of Canada enact legislation to make plain packaging of all
tobacco products mandatory. (p.10)
Canadian Medical Association, “Plain Packaging of Tobacco Products; Presentation
to the House of Commons Standing Committee on Health” May 3, 1994; see also
Canadian Medical Association, “Plain Packaging Will Help Stem Smoking
Epidemic, Say Doctors” May 3, 1994 [news release].
440.
There is ample evidence that, in the past, advertising has created a very strong association
between the appearance of the packaging and the image created by the advertising. This has
produced what could be called a “store of value” in the package design. In itself, the
package design is a form of advertising. (p.11)
...
A further advantage of generic packaging would be that government health warnings would
be more visible; there would be significantly less “clutter” and less scope for the tobacco
industry to disguise the health message by package design and color schemes, as has been
attempted by the tobacco industry in Canada. (p.12)
- 148 Carr-Gregg, M.R.C., Gray, A.J., “‘Generic’ Packaging – A Possible Solution to the
Marketing of Tobacco to Young People” World Smoking & Health 1993;18(2):1113.
441.
Discussion and Conclusions
...
Plain packaging can effectively break the link to other advertising and promotions. (p.23)
...
Plain packaging makes the package, and therefore the product, less interesting in its own
right. (p.24)
...
Packaging has a greater influence on youth as compared to adults. (p.25)
...
In conclusion, the results of this study provide strong support for public policy to legislate
plain packaging, as part of a comprehensive plan to reduce tobacco use. By excluding plain
packaging from such a plan, an important opportunity would be missed to effectively break a
critical and powerful link that transfers the images portrayed via other promotional
strategies, to the user of cigarettes. (p.27)
Centre for Health Promotion [Canada], “Effects of Plain Packaging on the Image of
Tobacco Products Among Youth” November 30, 1993; Canadian Cancer Society,
“Plain Cigarette Packaging – A Turn-Off for Teens!” [news release] “Highlights”
and “Fact Sheet” January 6, 1993.
442.
Conclusions
The weight of evidence on numerous fronts clearly indicates that plain packaging can be
expected to result in a decrease in tobacco consumption. The package is a form of
advertising, an increasingly important form in jurisdictions, such as Canada, where media
advertising has been banned but sponsorships continue. Plain packaging would eliminate
the positive imagery associated with the brand and would break the link between the
package and the sponsorship promotions. Plain packaging would also enhance education
efforts and itself would send the message that tobacco is a unique consumer product,
meriting distinct legislative and regulatory control. (p.86)
Cunningham, R., Kyle, K. “The case for plain packaging” Tobacco Control 4(1):8086.
443.
. . . [Youth] are, nevertheless, susceptible to the image associated with regular packages,
saying cool kids smoke cigarettes in regular packages, regular packages are more likely to
make their peers begin smoking, and they prefer to be seen with regular packages. In
contrast, plain packages are seen as boring and ugly, and the health warnings appears both
more prominent and more serious on them. [T]here seem to be two distinct negative factors
about plain packages that reduce the appeal of smoking to youth: their lack of brand
identification, and their lack of flair.
Youth believe that the negative (or neutral) imagery projected by plain packages will
translate to fewer people their age smoking. . . .
. . . Restrictions on advertising and promotion, including plain packaging, form one plank in
a comprehensive platform of strategies to protect youth from starting to smoke. (p.17)
d’Avernas, J.R., Northrup, D., Foster, M.K., Burton, D., Ferrence, R., Pollard, J.,
Rootman, I., Flay, B.R. “Cigarette Packaging and Event Marketing Increases the
- 149 Attractiveness of Smoking: A Study of Youth”. Ontario Tobacco Research Unit,
Working Papers Series No. 28, October 1997.
444.
[A]ny regulation issued by the FDA should recognize that the package is a form of point-ofpurchase advertising, and generic packaging for all tobacco products should be considered if
the goal is to protect children from point-of-purchase advertising. (p.325)
DiFranza, J.R., Coleman, M., St. Cyr, D. “A Comparison of the Advertising and
Accessibility of Cigars, Cigarettes, Chewing Tobacco, and Loose Tobacco”
Preventive Medicine, 1999;29(5):321-326.
445.
Conclusions
9.1 Standard Packaging Effects
 ... Whereas the current packs tend to be seen as “stylish”, “colourful”, “for young
people” etc, the standard packs are seen to be “old fashioned”, “dull”, “for old people”
etc.
...
 Almost 40% of 11-17 year old smokers and approximately one in four adult smokers
‘thought’ they would smoke less if all brands were in standard packaging. . . .
 Overall, the data suggest that standard packaging could lead to a lessening in
consumption amongst current smokers, and a lessening in uptake amongst non-smokers.
The main factor appears to be a lessening or negation of the positive images associated
with smoking and cigarette brands through a lessening or negation of the positive
images associated with cigarette packaging. (p.21)
Donovan, R.J. “Smokers’ and Non-Smokers’ Reactions to Standard Packaging of
Cigarettes” University of Western Australia, 1993.
446.
Every package that we see on the shelves of the supermarket, drug store, the liquor store, or
any retail outlet is a visual communication, a complex set of symbols that has an impact on
the customer. The purpose of this communication is to make the potential customer desire
the product. It is a deliberate effort to win customers . . . (p.232)
Gardner, B.B. “The Package as Communication” In Walter Stern, ed., Handbook of
Package Design Research John Wiley & Sons, 1981, pp.232-237.
447.
Plain and generic packaging of tobacco products (all other things being equal), through its
impact on image formation and retention, recall and recognition, knowledge, and consumer
attitudes and perceived utilities, would likely depress the incidence of smoking uptake by
non-smoking teens, and increase the incidence of smoking cessation by teen and adult
smokers. (pp.14-15)
...
[In a pilot study, 152 Toronto teenagers were shown five versions of plain packages, with
one depicting black lungs, and none of the others depicting images. 86% of the respondents
identified the “lungs” package as the one that would most discourage them from smoking.
(p.90)]
...
Conjoint Experiment
1. Current packages have the least perceived utility for helping smokers stop smoking, while
lungs packages have the highest perceived utility.
- 150 2. The lungs package has the least perceived utility to encourage non-smokers to start
smoking, while the current package has the highest perceived utility. (p.152)
...
Of the various versions of plain packages, the lungs version generated the most negative
images about smoking and smokers. (p.156)
Goldberg, M.E., Kindra, G., Lefebvre, J., Liefeld, J., Madill-Marshall, J.
Marohardjono, N. Vredenburg, H., When Packages Can’t Speak: Possible impacts
of plain and generic packaging of tobacco products. Expert Panel Report Prepared
at the Request of Health Canada, March 1995.
448.
Studies of youth, tobacco company spokespersons, and marketing experts confirm the
importance of packaging to the appeal of tobacco. The tobacco control community agrees
that plain packaging is a necessary, (although insufficient) measure in addressing the
tobacco epidemic, and would be particularly effective in reducing smoking uptake among
youth. Plain packaging is crucial in contributing to the informed consent of tobacco users.
Countries should consider plain packaging as an essential component of an effective tobacco
control strategy. (p.3)
International Union Against Cancer, “UICC Tobacco Control Fact Sheet: Generic
Packaging” February, 1996.
449.
The package is the visual identity of the brand. The package represents the product at the
point of sale; the representation must be effective, motivating. The package is the visual
brand image and silent salesman. (p.191)
...
. . . In other words, lines (words) are not as effective as forms and images. Forms and
images have much greater motivating power than words.
...
It is in the psychological realm where color plays a major role. Color, like imagery, is a vital
factor in package design. (p.192)
...
First, the package must attract attention. Then it must have a favorable psychological effect
– favorable associations that are transferred to the product it contains.
...
Consumer attitude tests have proven that effective use of color will heighten the appeal and
effectiveness of packaging. (p.197)
Lynn, B. “Color Research in Package Design” In Walter Stern, ed., Handbook of
Package Design Research John Wiley & Sons, 1981, pp.191-197.
450.
Attractive packages offer children and adolescents an enticing symbol which represents
critical passage from adolescence into the world of “adult” behaviour. Beautiful
packages send an inconsistent message to children about the danger of the product.
Mixed messages undermine the work of governments and health agencies to reduce
tobacco consumption. (p.5)
Mahood, G. “Generic or “Plain Pack” Tobacco Packages: Moving Toward Real
Bans on Tobacco Advertising” Paper presented to the 8th World Conference on
Tobacco or Health, Buenos Aires, Argentina, April 1992.
- 151 451.
The Ministry of Health has reviewed research into Plain Packs that is available to us. We
believe there is good prima facie and some empirical evidence that plain packaging
would be:
 less attractive to children
 better to communicate health warnings and other information to consumers
 dissociate the packages from sponsorship advertising
 be easily recognized and perhaps help deter smuggling (p.7)
...
We believe that the brightly coloured cigarette packages displayed behind cashiers
suggest to people, and young people in particular, that it is not really much different from
the brightly packaged candy bars in front of the cashier. Tobacco is unique in its place in
our society and should be treated differently, in a visible manner. This can be
accomplished with plain packaging. (p.8)
Ontario Ministry of Health, “Presentation to the House of Commons Standing
Committee on Health Hearings on Plain Packaging” May 10, 1994.
452.
Conclusions
Cigarettes are a “badge product,” with the package graphics and branding constituting the
“badge.” In the purchase, possession and use of a brand, the consumer acquires both the
physical product and these associated meanings. The nature of the specific badge
determines how consumers perceive themselves as its users, how they perceive the product
experience, how others perceive them as users, and how they assume that others will
perceive them.
...
Packaging, and its design, is an integral part of the promotional communications mix of a
firm. Advertising, publicity and promotions seek to make a brand symbolic and rich in
meaning, meanings that are recalled, reinforced and delivered by the package itself. (p.12)
...
Legislation mandating the plain packaging of cigarettes is highly likely to reduce tobacco
consumption and prevalence through several intermediary effects: by eliminating the
package as a form of advertising unto itself, by reducing the effects of previous advertising,
reducing the effect of sponsorship and associated communications, by reducing the size and
impact of retail displays, by reducing the positive imagery now attached to cigarette brands,
by reducing in time the number of brands offered in retail displays, by enhancing the
visibility of smuggled cigarettes, and by enhancing the impact of package warnings. (p.13)
Pollay, R.W., “As Anyone Can Plainly See: Brand Imagery in Cigarette Packaging
and Promotion; A Submission to Hearings on Plain Packaging of Tobacco Products,
House of Commons, Standing Committee on Health” May 3, 1994.
453.
Additionally, plain packaging is likely to increase the prominence, as well as the
believability, of the health warnings. (p.29)
...
In conclusion, given current restrictions on advertising, imposing restrictions on package
design has significant potential to alter the marketing mix in such a way so as to weaken
other components of the overall marketing strategy for tobacco products. . . .
Public policy to legislate plain packaging is encouraged as part of a comprehensive plan to
reduce tobacco use. By excluding plain packaging from such a plan, it appears that
government is missing an opportunity to:
- 152 

make health warning messages on cigarette packages more noticeable and believable;
and
effectively break a critical and powerful link that transfers the images portrayed via
promotional strategies, to the user of the product. (p.30)
RBJ Health Management Associates, “Impact of Plain Packaging of Tobacco on
Youth Perceptions and Behaviour; Report of Study 1” June 1993.
454.
The Company is very aware that every customer carries the Rothmans logo, on the
package, with him or her all the time. That package comes out many times a day, and
every time it is seen makes a personal comment about the person who carries and shows
it. Trust in its quality must never be compromised through any lapse of attention to the
smallest detail. (p.7)
Rothmans of Pall Mall Canada Limited, “Rothmans of Pall Mall Canada Limited
1957-1982” 1982.
455.
As advertising restrictions loom or become reality, the surfaces of the pack itself remain
available for communication to customers and potential customers. The increased interest
these companies are showing in novel pack designs and in novel brands is likely to be a way
of exploring how to market cigarettes in a limited advertising environment. The adaptation
of advertising to the pack itself in this manner is but another reason that a requirement for
plain packaging is sound public policy. (pp.169-170)
Slade, J. “The pack as advertisement” Tobacco Control, 1997;6(3):169-170.
456.
The cigarette pack: an important message carrier
. . . In this struggle to win over smokers, the pack and its message have become increasingly
important weapons.
...
advertising will be restricted or even prohibited . . . This will make the pack itself an
important advertising medium. The role of the cigarette pack as the creator and bearer of an
image will be more significant than ever.
The pack carries the message.
During the 90’s, the traditional cigarette pack will not be good enough for the selling job it
will have to do. If it cannot be shown and marketed in advertising as before, it must carry
the whole message itself. And when more and more popular brands vie for space on the
tobacconist’s shelves, the demand for a design that sells will be greater than ever before.
(p.14)
Tobacco International, “Rethinking Cigarette Packs for a New Age” Tobacco
International March 1, 1991, pp. 14-17.
457.
“The proof is that when we offered them Marlboro at half price – in generic brown boxes –
only 21% were interested, even though we assured them that each package was fresh, had
been sealed at the factory, and was identical (except for the different packaging) to what they
normally bought at their local tobacconist or cigarette machine.” (p.109)
Trachtenberg, J.A., “Here’s one tough cowboy” Forbes, February 9, 1987, pp.108110.
- 153 458.
We believe that the extraordinarily dangerous nature of the product being marketed means
that tobacco companies cannot expect to operate in the same commercial environment as
most other industries. We are concerned that tobacco manufacturers continue to think of
cigarette packs as being a way either of exploiting the aspirational nature of their products or
conveying implied health messages. Notwithstanding the potential restrictions caused by
EU single market legislation we believe that the advantages and disadvantages of
introducing generic or plain packaging for all tobacco products should be carefully assessed
by the Tobacco Regulatory Authority we propose below (paragraph 189). Such packaging
would be of a standard colour with the brand name in a standard type face. Beyond this, the
only other permitted information would be health warnings and consumer information about
product contents (paragraph 112).
United Kingdom, House of Commons Health Select Committee, “Second report:
The tobacco industry and the health risks of smoking” Volumes I-II, London:
Stationery Office, 2000, June 14, 2000.
Education Initiatives Generally
459.
Total per-capita cigarette purchases in Massachusetts fell 30 percent from Fiscal Year 1992
to Fiscal Year 1998. Purchases declined faster after 1992 than in the years leading up to
1992, and faster in Massachusetts than in the rest of the country. Purchases in the rest of the
U.S. (excluding California, which has had a similar tobacco control program since 1989)
declined just 9 percent from 1992 to 1998.
Smoking during pregnancy dropped sharply in Massachusetts, from a prevalence of 25
percent in 1990 to 13 percent in 1996. Most of the decline occurred after 1992. The
nationwide prevalence of smoking during pregnancy declined much more slowly during the
same period.
Massachusetts youth smoking rates resisted the national trend. The smoking prevalence
among Massachusetts high school students declined slightly from 1995 to 1997, while
national rates rose. The Massachusetts decline was strongest among 9th graders, the
youngest group examined, which bodes well for the future. (p.v)
...
Massachusetts residents who recalled the television spots showed the greatest understanding
that smoking causes lung cancer, heart disease, and blocked arteries – the points emphasized
in the campaign. The number of respondents who “strongly agreed” that smoking has these
consequences was 7-12 percentage points higher for those aware of the campaign than for
the Massachusetts residents unaware of the campaign or for the non-Massachusetts
residents.
A second set of television spots addressed “light” and “ultra-light” cigarettes, debunking the
idea that these cigarettes reduce the health risks associated with smoking. This media
campaign had even more pronounced effects than the Australia campaign. Only about 10
percent of Massachusetts survey respondents who remembered the television spots believed
that light cigarettes would reduce the smoker’s risk of lung cancer, heart disease, or general
health problems. Among non-Massachusetts residents who had never seen the television
spots, three times as many (over 30 percent) believed that smoking light cigarettes would
“somewhat” or “greatly” decrease those risks. (p.32)
Abt Associates Inc. “Independent Evaluation of the Massachusetts tobacco
Control Program. Fifth Annual Report” January 1994 to June 1998, Prepared for
the Massachusetts Department of Public Health.
- 154 -
460.
The Massachusetts anti-tobacco campaign achieved high levels of penetration into the
population and was well received by both smokers and non-smokers. The results suggest
that advertisements depicting suffering as a result of tobacco use may be instrumental in
promoting cessation or reinforcing the decision to quit. (p.401)
Biener, L., McCallum-Keeler, G., Nyman, A.L. “Adults’ response to
Massachusetts anti-tobacco television advertisements: impact of viewer
and advertisement characteristics” Tobacco Control, 2000;9(4):401-407.
461.
Evaluations of 40 mass media programs/campaigns designed to influence cigarette
smoking were reviewed. Information/motivation programs/campaigns generally
produced changes in awareness, knowledge, and attitudes. Extensive national campaigns
also produced meaningful behaviroral change. Programs/campaigns designed to promote
some specific smoking-related action produced mixed results, depending in large part on
the type of promotion involved. Mass media cessation clinics were found to be effective,
with media plus social support being more effective than viewing plus printed material,
and either combination being more effective than viewing alone. (p.153)
...
Several policy implications are also clear:
 consider maximizing the availability of counter information by extending the scope
of the Fairness Doctrine, or something like it, to cover all forms and forums of the
advertising and promotion of cigarettes, and preventing or maximizing “corporate
censorship” of the content of print media;
 any ban of tobacco advertising and promotion would have to be comprehensively
applied to all forms of media, and accompanied by educational programming to
counter the myth of social acceptability of smoking created by years of advertising
and promotion (p.158)
Flay, B.R. “Mass Media and Smoking Cessation: A Critical Review” American
Journal of Public Health 1987;77(2):153-160.
462.
Whilst advertisements were designed to elicit a visceral response in viewers, new
information as well as graphic images [of health effects] was conveyed, and so cognitive
as well as affective changes might be expected. It was pleasing to note improvement
between the pre and post campaign surveys on knowledge items that related to campaign
messages, whereas non-campaign-specific knowledge did not change. This is evidence
for specific informational effects of the campaign.
Both the tracking and the post campaign surveys indicated that the campaign stimulated
more frequent and intense thoughts about quitting . . . (p.3)
...
After the campaign, more smokers intended to be not smoking a year hence, than
smokers interviewed before the campaign, but more important was the evidence that the
campaign helped move more smokers through the ‘stages-of-change’ towards
quitting.(p.4)
Hill, D., Hassard, K. “Overview” In: Research and Evaluation Committee of the
National Expert Advisory Committee on Tobacco “Australia’s National Tobacco
Campaign: Evaluation Report Volume One” Prepared for the Commonwealth
Department of Health and Aged Care, May 1999.
- 155 -
463.
Conclusions: Amidst extensive anti-smoking efforts, the [Massachusetts] campaign to
counter-market light cigarettes appears to promote smoking cessation and to inform smokers
of the risks of light cigarettes. Further counter-marketing efforts should be encouraged.
(p.339)
Kozlowski, L.T., Yost, B.A., Stine, M.M., Celebucki, C., “Massachusetts’
Advertising Against Light Cigarettes Appears to Change Beliefs and Behavior”
American Journal of Preventive Medicine, 2000;18(4):339-341.
464.
Gasp is one of the Ministry’s newest tools to keep young British Columbians smoke free.
It was created with a great deal of input from B.C. teens, and has been tested with them at
each stage of development. The magazine has tested very well with students.
...
Gasp is designed to get the attention of young people and give them compelling reasons
not to start smoking. Teens have told us clearly that our communications must be real,
truthful, graphic and powerful in order to break through the clutter and make an impact
on them. In its final form, Gasp will be in full, vivid colour for even greater impact. (p.1)
...
There are some strong images in Gasp, but we know from testing the magazine with
teenagers that these images will have the desired impact. To quote one Grade 8 girl who
participated in testing Gasp, “Disgusting – quite convincing not to smoke. It talks about
the truth behind smoking and what effect it has on your life, and how some smokers
suffer.” (p.2)
Little, J. (Director, Corporate Communications, B.C. Ministry of Health and
Ministry Responsible for Seniors), Letter to Callard, C. (Executive Director,
Physicians for a Smoke Free Canada), January 7, 2000; B.C. Ministry of Health,
Gasp Magazine, Winter 2000.
465.
[B.C. students were shown a video with 12 ads discouraging smoking. Students chose as
the most effective Aorta, an ad vividly showing health effects.]
NOW Communications, “Ministry of Health Post Analysis Report; Critics’
Choice – The Sequel” March 25, 1999.
466.
[B.C. students were shown a video with 12 different ads; students chose as the most
effective Stroke, an ad vividly depicting health effects.]
NOW Communications, “Ministry of Health Post Analysis Report, Critics’
Choice – Episode 3” March 24, 2000.
467.
Analysis of trends in per capita cigarette consumption indicates that the start of the
California Tobacco Control Program in 1989 was associated with a 50% more rapid rate of
decline that was unique to California. After 1993, the rate of decline in per capita
consumption in California slowed to less than one third of the rate observed from 1989
through 1993 and to less than one half of the rate of decline observed before the program
began. However, this post-1993 rate of decline was still significantly more rapid in
California than in the rest of the United States, for which the decline in consumption halted.
The smoking prevalence trends from the combined survey data are fairly consistent with the
changes observed in per capita consumption. (p.897)
- 156 Pierce, J.P., Gilpin, E.A., Emery, S.L., White, M.M., Rosbrook, B., Berry, C.C.
“Has the California tobacco control program reduced smoking?” Journal of the
American Medical Association 1998;280(10):893-899.
468.
A community antismoking campaign began in Sydney, Australia in 1983, and in
Melbourne in 1984. These campaigns purchased prime-time television advertising spots
to set the community agenda. An intense effort was made to ensure that antismoking
activities were maximized at the school, organizational, and community level. . . . At the
beginning of the campaigns, there was an immediate drop of more than two percentage
points in male and female smoking prevalence in both cities. Thereafter, a decline of
about 1.5 percentage points per year was observed among males. No post campaign trend
was observed in smoking prevalence for women. (p.565)
Pierce, J.P., Macaskill, P., Hill, D. “Long-Term Effectiveness of Mass Media Led
Antismoking Campaigns in Australia” American Journal of Public Health
1990;80(5):565-569.
469.
In response to uncued questions, 6.7 percent of those interviewed indicated that they had
been influenced to quit by an advertisement they had seen or heard on radio, television or
billboards. In response to direct questions about the media campaign, 34.3 percent of the
respondents indicated that the media campaign’s advertisement had played a part in their
decision to quit. (p.510)
Popham, W.J., Potter, L.D., Bal, D.G., Johnson, M.D., Duerr, J.M., Quinn, V. “Do
Anti-Smoking Media Campaigns Help Smokers Quit?” Public Health Reports,
1993;108(4):510-513.
470.
The videotape about smoking was a British television program called “Dying for a fag?”
which was broadcast in April 1975. It is an impressive hard-hitting film based on an
extended interview with a middle-aged man who is dying from lung cancer, intercut with
footage in which a chest physician discusses the risks to health.(p.21)
...
Perhaps the first point that should be made concerns the evidence here for the potential of
“Dying for a fag?” as a means for influencing smokers’ attitudes and behavior. Relative to
the control videotape, it aroused more fear and strengthened the subjects’ intentions to try to
stop smoking. Furthermore, it increased the subjects’ perceived importance of reducing their
chances of getting lung cancer, and among the older people, it strengthened the belief that
stopping smoking would be efficacious in achieving this. More important, the videotape had
a large effect on self-reported behavior in the subsequent 3-month period. A greater
proportion of those who saw “Dying for a fag?” said that they made an attempt to stop or to
cut down, though the success rates among those who tried were similar. This finding
replicates, in a field –experimental setting, the results of a postal survey conducted about 6
months after the program was originally shown on British television (Eiser et al., 1978).
(p.28-29)
Sutton, S.R., Eiser, J.R., “The Effect of Fear-Arousing Communications on
Cigarette Smoking: An Expectancy-Value Approach” Journal of Behavioral
Medicine, 1984;7(1):13-33.
- 157 471.
The analysis suggests that major “events” in the campaign (e.g. the Surgeon General’s
Report) caused immediate though transitory decreases of 4 to 5 per cent in annual per capita
consumption. However, the cumulative effect of persistent publicity, supported by other
public policies, has been substantial: in the absence of the campaign, per capita consumption
likely would have exceeded its actual 1975 value by 20 to 30 per cent. (p.645)
...
[I]t is seen that the anti-smoking ads on TV and radio in 1968-70 were associated with a
significant reduction in cigarette consumption: actual consumption . . . fell from 4,280
cigarettes per adult in 1967 to 3,971 in 1970, rather than continuing the slow but steady
growth which would have been expected following the immediate reaction to the Surgeon
General’s Report. (p.648)
...
British researchers have credited the Royal College of Physicians’ 1962 report on Smoking
and Health with decreasing cigarette consumption from 4.6 to 9 per cent that year. (p.649)
Warner, K.E. “The Effects of the Anti-Smoking Campaign On Cigarette
Consumption” American Journal of Public Health 1977;67(7):645-650.
International Reaction to New Canadian Warnings
472.
New large, explicit and graphic tobacco health warnings proposed by the Canadian
Government should be the new benchmark for the European Union says ASH.
Action on Smoking and Health [U.K.], “Canadian super-strong health warnings
show the way ahead for Europe” January 20, 2000 [press release].
473.
Health warnings on cigarette packets needed to be urgently upgraded to boost their impact
and save more lives, a leading health insurer said today.
MBF chief medical officer Gavin Frost said tobacco companies should now be forced to
devote at least 70 per cent of cigarette packet space to anti-smoking messages.
Packets should also be made to carry more detailed information on where smokers could go
for help in quitting, Dr. Frost said.
Australian Associated Press, “Cigarette pack health warnings need urgent upgrade”
January 21, 2000.
474.
Thailand Tobacco Monopoly says it lacks the time and money to produce cigarette
packets with enlarged health warnings. Printing pictures of smoking-induced ailments on
packets was out of the question for the same reason, it said yesterday. The firm was
given far too little time to produce packets with new warnings enlarged from 30% to 50%
of the packet size, TTM said. The National Commission on Tobacco Consumption
Control is meeting next month to consider the proposal for bigger warnings so its
endorsement can be announced before World No-Smoking Day on May 31.
Bangkok Post, “No cash for new warnings” April 28, 2000.
475.
Canada today has set a new international standard for cigarette labeling and reporting to
help consumers fully understand the lethal health consequences of using tobacco
products.
- 158 Campaign for Tobacco-Free Kids [U.S.], “Statement of Matthew L. Myers,
President of the Campaign for Tobacco-Free Kids, On Canadian Government’s
Announcement of Tough New Tobacco Labeling Rules,” January 19, 2000 [news
release].
476.
Today as Canada announced new requirements for cigarette warning labels, two U.S.
Senators announced they are drafting a bipartisan bill to revamp American labels.
Senators Frank R. Lautenberg (D-NJ) and Richard G. Lugar (R-IN) are preparing
legislation that would change tobacco package warning labels and require disclosure of
product ingredients and health effects.
Lautenberg, F., “As Canada Unveils New Cigarette Labels . . . Senators Lautenberg
& Lugar Propose Bipartisan Tobacco Labeling Bill” January 19, 2000 [news
release].
Toxic Constituent Labelling
477.
It is now widely accepted that the existing ISO system of machine-measured tar and nicotine
yields fails to characterise the relative dangers of different tobacco products. The machine
measurements simply do not account for the way in which smokers of lower yielding brands
adjust their smoking behaviour in order to achieve a satisfactory intake of nicotine – a
process known as compensation. The result has been the creation of a generation of ‘light’
or ‘low-tar’ cigarettes that appear to the consumer to be significantly less harmful than they
actually are. The machine-measured tar and nicotine yields displayed on the packet are
achieved mainly by varying the degree of filter ventilation: they are not an intrinsic
characteristic of the tobacco used which varies little between low-tar cigarettes and
conventional filter cigarettes. Furthermore, the toxicity and carcinogenicity of tar itself also
varies markedly between different tobacco products and has changed over time. This has
further health implications not reflected in the existing system of measurement, regulation
and labelling. (p.1 in tab)
...
We are also concerned that manufacturers’ branding implying that ‘low tar’ cigarettes are
significantly less harmful than ‘full strength’ cigarettes has not been subject to any evidencebased justification. As we argue above, the measurements should be withdrawn but it is also
important that implied or explicit health claims made by manufacturers, for example through
‘light’ or ‘low tar’ branding, should be either justified by credible evidence or withdrawn.
The evidence that is available suggests that such claims cannot be justified. (p.2)
Alberti, G. (President, Royal College of Physicians), Nurse, P. (Director General,
Imperial Cancer Research Fund), McVie, G. (Director General, Cancer Research
Campaign), Busk, L. (Director General, British Heart Foundation), Bogle, I.
(Chairman of Council, British Medical Association), Close, T. (Chairman, Health
Education Authority) Bates, C. (Director, Action on Smoking and Health), Letter to
Tessa Jowell (Minister of State for Public Health), October 2, 1998.
478.
Many smokers think that ‘light’ cigarettes are safer than regular cigarettes, and that by
smoking ‘light’ cigarettes they will inhale fewer cancer-causing chemicals, or less nicotine.
- 159 B.C.’s new smoking tests have shown how wrong this belief can be. The reports filed by the
tobacco companies show that light cigarettes are likely to deliver as many (or more) poisons
and toxins to smokers as regular cigarettes. (p.1)
British Columbia Ministry of Health and Ministry Responsible for Seniors, “1998
Reports on Cigarette Additives and Ingredients and Smoke Constituents; 5. Results
for ‘light’ cigarettes” December 16, 1998.
479.
CLAIM: Tobacco smoke constituent levels should be printed on tobacco packs and ads, or
otherwise published, to protect the consumer
RESPONSES:
The purpose of consumer information is to provide information that is useful to them in
making purchase decisions – in the case of tobacco, the data on constituent yields may be
misleading to the consumer.
Such labelling would suggest that tobacco smoke contains harmful substances – although
tobacco smoke constituents are among the most heavily researched substances in the world,
no constituent as found in cigarette smoke has been shown to cause cancer or any other
human disease.
Reported constituent levels are of limited value since inhalation machines used to measure
smoke components can’t duplicate the way humans smoke – no two smokers smoke the
same way and no smoker smokes the same way all the time. These testing difficulties have
been acknowledged by the US government. (p.699141399)
Brown and Williamson document collection, “Health ‘Addiction’ Public Smoking
‘Social Costs’ Advertising Constituents Warning Labels” circa 1984, Bates No.
699141292-417.
480.
1 mg. “tar”, 0.1 mg. nicotine av. per cigarette by FTC method. Actual tar and nicotine
deliveries will vary based on how you hold and smoke your cigarette. It is not our intention
to suggest that a 1 mg. “tar” cigarette is safer than other cigarettes. [Carlton ad]
Box Kings, 16 mg. “tar”, 1.2 mg. nicotine av. per cigarette by FTC method. Actual tar and
nicotine deliveries will vary based on how you hold and smoke your cigarette. [Kool ad]
Brown and Williamson, 1999 advertisements for Carlton and Kool cigarettes.
481.
[This document cites tobacco industry documents and testimony of tobacco company
executives. For example, one 1982 study prepared for Imperial Tobacco stated: “The
reasons for smoking [low tar/nicotine] cigarettes, all of which involve the low tar feature,
may be classified as follows: 1. health considerations, i.e. coughing etc; 2. concern about the
safety of cigarette smoking due to publicity and articles; 3. pressure to smoke safer cigarettes
exercised by relatives and friends; 4. attempts to give up smoking altogether (p.6 of item
three in Table of Contents)]
Canadian Council on Smoking and Health, “Shedding Some Light on the Labelling
of Tobacco Products; A selection of extracts from official Court Transcripts and
Exhibits, RJR-MacDonald Inc. and Imperial Tobacco Ltd. vs. Attorney General of
Canada, Quebec Superior Court, Montreal, Quebec; Submitted To Packaging and
Labelling Section, Consumer Products Branch, Consumers and Corporate Affairs”
December 1990.
- 160 482.
[C]igarette ratings for tar, nicotine, and carbon monoxide are currently determined by
machine testing conducted in accordance with a method originally adopted by the Federal
Trade Commission in 1967. Both the accuracy and continued validity of this method have
come under question. In particular, the National Cancer Institute conducted a review of the
method and concluded that significant changes should be made to the FTC testing protocol.
The NCI found, among other things, that the existing system does not accurately reflect
actual human smoking behavior, which varies widely among smokers, and that smokers who
switch to lower tar and nicotine cigarettes may change their smoking behaviour in ways that
negate potential health benefits.
Clark, D.S. (on behalf of the Federal Trade Commission), Letter to the Donna E.
Shalala (Secretary, U.S. Department of Health and Human Services), November 19,
1998.
483.
Results. Few smokers knew the tar level of their own cigarettes (the exception being
smokers of 1- to 5-mg tar cigarettes), and a majority could not correctly judge the relative tar
levels of cigarettes. Smokers were unsure whether switching to lower-tar cigarettes would
reduce their personal health risks. Many smokers relied on absolute numbers in making
trade-offs between number of cigarettes smoked and their tar levels, thus confusing
machine-rated tar yields with actual amounts ingested. (p.18)
...
[A]t least one quarter of smokers . . . clearly have been misled about the meaning of the tar
yield numbers. Interestingly, this increases to 44% for very low tar smokers, in line with
other evidence presented here and with our concern about the safety reassurances that such
very low tar cigarettes appear to provide.
The final issue under study in this survey was whether smokers report having used these tar
numbers to make judgments about the relative safety of different brands of cigarettes. In
answering this question, only 14% of the sample indicated doing so. Once again, however,
the 1- to 5-mg tar smokers were quite different: 56% of them reported doing so. (p.23)
Cohen, J.B. “Smokers’ Knowledge and Understanding of Advertised Tar Numbers:
Health Policy Implications” American Journal of Public Health, 1996;86(1):18-24.
484.
Two major conclusions emerge from this report:
 Public health objectives for lower yield cigarettes were subverted by tobacco company
actions. Light and mild cigarettes have probably resulted in more smoking, less
quitting and more adenocarcinoma of the lung.
 Tobacco companies knew their products were hazardous but publicly denied this
knowledge. They knew that cigarettes could give higher yields than advertised,
deliberately set about to make sure that smokers would compensate more often than
not, and deliberately hid this deception from the public. (p.3 news release)
Collishaw, N.E. “Manipulation: The Story of Imperial Tobacco and its Cigarettes”
Physicians for a Smoke-free Canada, October 1999. [Accompanied by overheads
and corresponding comments.] Physicians for a Smoke-free Canada, “Imperial
Tobacco’s ‘Elastic’ Cigarettes; Study Shows That Cigarettes Were Designed to
Release More Nicotine” November 11, 1999 [news release], with accompanying
fact sheets “The Engineering of Canadian Cigarettes” “Research on Cigarette
Toxicity at ITL’s Montreal Laboratory”.
- 161 485.
The most distressing aspect of the emergence of low-yield cigarettes is how this has
inhibited smokers from quitting, as indicated by the following excerpts from tobaccoindustry marketing documents:
We have evidence of virtually no quitting among smokers of those brands [of under 6 mg of
tar], and there are indications that the advent of ultra low tar cigarettes has actually retained
some potential quitters in the cigarette market by offering them a viable alternative. –
Imperial Tobacco Ltd., “Response of the Market and of Imperial Tobacco to the Smoking
and Health Environment,” 1978. . . . (pp.163-164)
Cunningham, R. Smoke & Mirrors: The Canadian Tobacco War (Ottawa:
International Development Research Centre, 1996).
486.
Imperial Tobacco’s success in introducing low-tar or light cigarettes dramatically extended
the lifespan of the Canadian tobacco industry and Imasco.
Deutsch, S. “A revisionist view of Imasco; Conglomerate had history of bad
investments, low shareholder value” Globe & Mail, February 8, 2000.
487.
We present to you the results of the study by Health Canada regarding 50 of the most
popular brands in the country. Tar, nicotine and carbon monoxide content levels measured
using the modified method are from 2 to 24 times higher than the levels indicated on
cigarette packages. And that’s not all: those cigarettes that the manufacturers label as “light”
or “mild” contain the same quantities of harmful chemical substances as regular cigarettes!
(p.4)
Dô, S. « Cigarettes. Les vrais chiffres! » Protégez-vous, [« Cigarettes. The real
figures » Protect-yourself] January 2000, pp.4-7 [translation].
488.
Health Canada is warning consumers that it has determined that “light” and “mild” tobacco
products have the same potential to be debilitating and lethal as other types of tobacco. This
conclusion is based on a wide range of research and academic studies.
Health Canada, “ ‘Light’ and ‘Mild’ Cigarettes; Consumer Warning” January 1999.
489.
Strategies to Provide Meaningful Cigarette Labeling
...
 Develop machine-testing parameters based on data relevant to how people smoke and
base yield ratings on maximal yields
...
 Ban the use of terms such as "light" and "ultralight" (p.313)
Henningfield, J.E., Kozlowski, L.T., Benowitz, N.L. “A proposal to Develop
Meaningful Labeling for Cigarettes” Journal of the American Medical Association,
1994;272(4):312-314.
490.
Dr. Martin Jarvis of Imperial Cancer Research Fund said: “We know that low-tar cigarettes
offer no meaningful benefits to smokers and may even be more harmful. The biggest threat
to the tobacco companies is that people will quit and leave the market for good – these
cigarettes are there to persuade smokers there is a healthy way to remain as loyal
customers.”
- 162 Imperial Cancer Research Fund [U.K.], Action on Smoking and Health [U.K.],
“Why low-tar cigarettes don’t work and how the tobacco industry fools the smoking
public” March 18, 1999 [news release].
491.
With low tar cigarettes, smokers can adopt a range of ‘tricks’ to ensure they take in the
nicotine they need, even if the cigarette is supposed to be low in tar and nicotine. These
include: drawing more deeply; taking more puffs per cigarette; smoking more of the
cigarette; blocking ventilation holes in the filter with fingers or saliva. These ‘tricks’ may be
performed unconsciously as a smoker subliminally learns how to achieve a satisfying smoke
from a low tar cigarette. Since tar intake is closely linked to nicotine intake, the tar exposure
also increases. (p.3 of internet print out)
...
. . . There is also evidence that compensation, by drawing smoke more deeply into the lungs,
has led to a rise in adeno-carcinomas – a previously rare variety of lung cancer that afflicts
the tiniest airways of the lungs. A 1997 study linked increased smoking of Light and Ultra
Light cigarettes to adeno-carcinoma and showed that in the US, adeno-carcinoma increased
17-fold in women and 10-fold in men between 1959 and 1991.
It is clear that the numbers displayed on cigarette packets are worse than useless. This is
because they are widely (and rationally) interpreted as health information, when in fact they
communicate misleading information. The effect is likely to be that genuine health concerns
among smokers are being ‘captured’ by a switch to low tar cigarettes when the only real
health option is to quit. (p.7)
...
Internal tobacco industry documents released through US litigation show that the industry
has well understood the compensation effect for at least twenty years. The documents show
the industry has:
 Known for many years that low tar cigarettes offer consumers false reassurance.
 Understood the role of nicotine addiction in making smokers compensate to achieve a
satisfactory dose of nicotine.
 Wrestled with the ethical implications of designing products that will register as low tar
when measured on smoking machine and reported on labels but will deliver high tar
levels to the smoker – then gone ahead anyway. (p.8)
Jarvis, M., Bates, C. “Why low-tar cigarettes don’t work and how the tobacco
industry fools the smoking public” 1999 edition, March 18, 1999, accessed
November 24, 1999, www.ash.org.uk/papers/big-one.html
492.
The purpose of this study was to examine in a systematic, controlled fashion the reactions of
smokers to scientifically correct information about the risks of smoking Light cigarettes
(about 6-15mg tar by the FTC method). . . . Those who heard the message were more likely
to report that one Light cigarette could give a smoker the same amount of tar as one Regular
cigarette and that Light cigarettes were more dangerous: 55% said the message made them
think more about quitting and 46% said the message increased the amount they wanted to
quit; 42% said that after hearing the message they thought Light cigarettes were more
dangerous. . . . Seventy-three per cent of the smokers agreed that it was important to play
such messages widely on the radio; 77% agreed that there should be a warning on packs that
vent blocking increases tar; 61% agreed that the location of filter vents should be marked.
The majority of smokers of Light cigarettes seem to value being informed that Light
cigarettes are as dangerous for them as Regular cigarettes, and this information increases
their intentions to quit smoking.(p.67)
- 163 ...
63% of respondents said that they would tell others about the message (p.73)
Kozlowski, L.T., Goldberg, M.E., Sweeney, C.T., Palmer, R.F., Pilliteri, J.L., Yost,
B.A., White, E.L., Stine, M.M., “Smoker reactions to a “radio message” that Light
cigarettes are as dangerous as Regular cigarettes” Nicotine and Tobacco Research
1999;1:67-76.
493.
[This document quotes industry internal documents and other statements. Two examples
follow. “From an historical perspective, the adoption of filters in the late 1940s and early
1950s was probably not animated by a desire to lower deliveries. Advertising claims to the
contrary aside, earlier filtered cigarettes had deliveries equal to or in excess of their
unfiltered cousins.” – late 1980s attorney work product by Jones, Day Reavis & Pogue for
an industry client.
“We have been taking note of public health concerns by developing ‘lighter’ products, but
we cannot promote these products as ‘safer’ cigarettes because we simply don’t have
sufficient understanding of all the chemical processes to do so.” – 1997, BAT co. (p.434)
Leavell, N.-R. “The low tar lie” Tobacco Control 1999;8(4):433-439.
494.
[This report cites internal industry documents regarding light and mild cigarettes. One
example is the following from Imperial Tobacco in 1984.] ‘Lights’ in Canada was a brand
not a product revolution. The industry tried filters, charcoal, tobacco blends, advertising
claims attempting, generally unsuccessfully, to solve the health problem in product terms
while virtually ignoring the paradoxical nature of the smokers’ dilemma. Although they
wished they weren’t, they were and virtually every effort forced them to give up the things
they continued to smoke for. Telling smokers that you had a product was not the problem.
Telling them they could smoke it with honour was.
...
Smokers remain prepossessed by exactly the same concerns that brought about the
proliferation of successful lighter brands. They, presumably, remain open to and need new
ways of delivering less. The underlying premise for the last convulsion is unchanged and
incompletely satisfied by lights. It is useful to consider lights more as a third alternative to
quitting and cutting down – a branded hybrid of smokers’ unsuccessful attempts to modify
their habit on their own. (pp.3-4 of tab)
‘Light’ Cigarettes. Evidence from the BAT files at Guildford. July 1, 1999,
tobaccopapers.org.
495.
[S]tudies have shown that with the introduction of “low nicotine” cigarettes in the 1970’s,
smokers have been found to compensate for the lower nicotine level by smoking more
frequently, smoking more deeply, and increasing puff volume. This results in a higher level
of nicotine actually being delivered to the body than what is reported on the cigarette
packaging. The proposed regulations will require tobacco manufacturers to report nicotine
levels using a method which more accurately reflects actual smoking behavior.
Massachusetts Department of Public Health, “Massachusetts Seeks Truth About
Tobacco Products” November 19, 1996 [news release].
496.
An NCI expert committee recommended that the current FTC cigarette testing method
should be replaced with a new method which provides a range of tar, nicotine, and carbon
- 164 monoxide yields that most smokers should expect from each cigarette sold in the United
States. (p.1 of tab)
...
The committee also concluded
...
 Constituents other than tar, nicotine and carbon monoxide should be listed on each pack
and in all advertising, and these constituents should be classified by toxic effects.
 Brand names and classifications such as “light” and “ultra light” represent health claims
and should be regulated. (p.2)
National Cancer Institute [U.S.], “NCI Announces Monograph on FTC Test
Method” May 28, 1996 [press release].
497.
Smokers should not assume that brand descriptors such as “light” or “ultra light” indicate
with precision either the actual amount of tar and nicotine that they will inhale from any
particular cigarette, or the relative amount as compared to competing cigarette brands. Some
researchers report that consumers who smoke “light” cigarettes inhale as much tar and
nicotine as from full-flavor brands. . . . (pp.3-4 of tab)
Philip Morris does not imply in its marketing, and smokers should not assume, that loweryielding brands are “safe”, or are “safer” than full-flavor brands. Health warnings are
required on all of our brands, irrespective of their tar and nicotine yields. (p.4)
Philip Morris, “Tobacco Issues: Understanding Tar and Nicotine” October 13, 1999,
downloaded from Philip Morris website.
498.
To our knowledge there is no research indicating cigarettes containing additive-free tobacco
are safer than cigarettes with tobacco containing additives.
Sante Fe Natural Tobacco Company, 1999 advertisement for Natural American
Spirit cigarettes.
499.
Discussion and Conclusions
Descriptive language on cigarette labels at best confuses and at worst misleads. Reported
levels of toxins within descriptor categories vary widely in most cases. Tobacco company
officials have testified that descriptors are not meant to encompass similar reported tar and
nicotine levels, but rather to indicate relative levels within brand families. However, the data
reveals that descriptors are not necessarily consistent or informative even in this context.
(p.4)
Selin, H. “Face Value? Descriptive Cigarette Brand Labelling and Reported Toxin
Levels” Smoking and Health Action Foundation, March 1997.
500.
In September 1997, the Commission proposed revisions to its test method. The proposal
was made in response to concerns that the existing system does not accurately reflect actual
human smoking behavior, which varies widely among smokers. The National Cancer
Institute and the U.S. Food and Drug Administration stated in comments that new data
suggests that the limited health benefits, previously believed to be associated with lower tar
and nicotine cigarettes, may not exist.
U.S. Federal Trade Commission, “FTC Statement in Response to Senator Frank
Lautenberg’s Letter” November 24, 1998 [news release].
- 165 -
501.
The ratings published in these reports reflect the relative yields of different cigarettes when
they are smoked by a machine under identical conditions. They are not intended to reflect
what any individual consumer would get from any particular cigarette. Research indicates
that many smokers of cigarettes with lower ratings “compensate” by blocking tiny
ventilation holes in cigarette filters that are designed to dilute smoke with air. Compensatory
smoking behavior can significantly affect the amount of “tar”, nicotine, and carbon
monoxide a smoker gets from any cigarette – smokers of cigarette brands with lower “tar”
and nicotine ratings may get as much “tar” and nicotine as smokers of much higher rated
brands.
U.S. Federal Trade Commission, “FTC Releases Results of “Tar”, Nicotine and
Carbon Monoxide Testing for 1262 Varieties of Domestic Cigarettes Sold in 1996
and 1252 Varieties Sold in 1997”, September 28, 1999 [news release].
502.
[T]he Commission has been concerned for some time that the current test method may be
misleading to individual consumers who rely on the ratings it produces as indicators of how
much “tar” and nicotine they actually get from their cigarettes. In fact, the current ratings
tend to be relatively poor predictors of “tar” and nicotine exposure. This appears to be due
primarily to compensation – the tendency of smokers of lower rated cigarettes to take bigger
or more frequent puffs, or otherwise alter their smoking behavior to get the amount of
nicotine they need. Such variations in the way people smoke can have significant effects on
the amount of “tar” from a 15 mg. “tar” cigarette as from a 5 mg. “tar” cigarette. In fact, if
compensation is sufficiently great, it is possible for smokers to get as much “tar” and
nicotine from relatively low rated cigarettes as from higher rated ones. Although these
limitations have been present in the system since its initiation in 1967, they have become of
substantial concern more recently because of changes in modern cigarette design and a better
understanding of the effects of compensatory smoking behavior. (pp.1-2)
...
In light of these concerns, in 1998 the Commission requested that the Department of Health
and Human Services (“HHS”) conduct a complete review of the FTC’s cigarette testing
methodology. This review will be completed in September 2000.
While that review is underway, the Commission believes that all smokers should know the
following facts:
 “Tar” and nicotine ratings were never intended to reflect what any individual consumer
would get from any particular cigarette;
 How much “tar” and nicotine an individual gets from a cigarette depends on how he or
she smokes it – smokers of cigarette brands with lower “tar” and nicotine ratings who
take larger or more frequent puffs may get as much “tar” and nicotine as smokers of
higher rated brands;
 Many cigarettes have ventilation holes that, when blocked, substantially increase
exposure to the harmful constituents in smoke;
 There is no such thing as a safe smoke, no matter what the “tar” and nicotine ratings
are; and
 People who are concerned about the health effects of smoking should quit. (pp.3-4)
U.S. Federal Trade Commission, “Report of “Tar,” Nicotine and Carbon Monoxide
of the Smoke of 1252 Varieties of Domestic Cigarettes For the Year 1997”, 1999.
- 166 503.
The current machine tests need to be revamped or new ones developed by increasing the
machine-smoking parameters to be more consistent with human smoking, such as increased
puff volume and durations. This would lead to delivery values based on the average of
blocked and unblocked ventilation holes or a range based on blocked and unblocked
ventilation holes or a range based on blocked versus unblocked. This is a simple
methodology and would be a step in the right direction in providing test results that are more
meaningful and realistic to the consumer. This change is further militated by the fact that the
industry has known about ventilation blocking and has skewed machine-smoked testing
results for years. These revised machine-smoke results should become part of the product
labeling and advertisements here and abroad, thereby eliminating a substantive misleading
of the consumer. (p.336-337)
Wigand, J.S. “Cigarette testing methods, product design, and labelling: time to clean
up the “negative baggage” Tobacco Control 1998;7(4):336-337.
- 167 -
Part III
Expert Opinions – Health Warnings
- 168 -
- 169 -
Part III
Expert Opinions – Health Warnings
Introduction
This section contains expert opinions supporting enhanced package warnings. Most of
the opinions were provided to the Canadian Cancer Society in response to a request from Ken
Kyle, Director of Public Issues for the Canadian Cancer Society. The experts were invited to
endorse a standard document, which many did (as evident from the statements in this section), or
to provide a separate statement. Many of the experts endorsing the standard document provided
additional comments, comments which have been reproduced. (There were two versions of the
standard document, with the longer version provided to experts after a certain date.) At the time
the experts provided their statements, most of them had in hand package mock-ups with picturebased health warnings covering 60% of the package front and back. The mock ups had been
prepared by health organizations. The 60%-size for warnings -- under consideration at the time-was larger than the 50% required in the final regulations.
The opinions of the following were contained in letters addressed to Allan Rock, Minister
of Health: George A. O. Alleyne, Hatai Chitanondh, Joseph R. DiFranza, Ronald A. Dovell, Todd
Harper, Judith Mackay, Eliezer Robinson, Karen Slama (first item), Witold Zatonski. The
opinion of Scott Thompson (second item) was contained in a letter to Katrina Edwards of Health
Canada.
The expert opinions had been provided by the Canadian Cancer Society to Health
Canada, primarily in 1999, during the regulatory development process. Further, the expert
opinions were tabled on June 1, 2000 with the House of Commons Standing Committee on
Health as part of the Canadian Cancer Society submission “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. The
Standing Committee on Health was conducting hearings regarding the Tobacco Products
Information Regulations and the Tobacco Reporting Regulations. Further, the expert opinions
were included collectively as exhibit KK-22 to the July 26, 2000 affidavit of Kenneth L. Kyle.
This affidavit was filed in Quebec Superior Court by the Canadian Cancer Society in opposition
to an application by tobacco companies. The companies sought a preliminary injunction to block
implementation of the new Canadian health warnings pending the outcome of a constitutional
trial. On September 20, 2000, the Court dismissed the application.
Expert Opinions
504.
I understand that the Canadian Department of Health is considering enhanced warnings
for cigarette packages. Using the top 60% of the front and back of cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
I currently head up the Department of Preventive Medicine and direct the
Tobacco Control Project at the University of Kansas School of Medicine. I speak to the
issues of Smoking Cessation and Tobacco Control in undeserved populations regionally,
- 170 nationally, and as well as internationally. Also, as a practicing internist, I am keenly
aware of the issues related to smoking cessation and tobacco control as they relate to
patients.
Clearly, warning signs alone to do not change behavior. However, there is both
anecdotal evidence, face validity, and some scientific evidence to show that warning
signs, especially when they are 60% of allocated space, will change behavior. There is
no question that if tobacco were to come on the market today, no scientific,
governmental, or other body would either approve its legal use, or even would have the
guts to bring it to market, since the product is deadlier than most banned products.
Canada has been a leader, and other countries fortunately have begun to follow many of
the great things that you have done in policy. Take advantage of this opportunity and
continue to forge ahead. If we are to prevent the premature death and illness of the
citizens of Canada, the America’s, and the world, we need to do this and more.
I am always willing to help and if I can be of further assistance, please do not
hesitate to contact me. I am attaching a copy of my one page bio and curriculum vitae for
your use as needed.
Jasit S. Ahluwalia, MD, MPH, MS, Vice Chair, Director of Research and
Associate Professor of Preventive Medicine, Associate Professor of
Internal Medicine, Department of Preventive Medicine, School of
Medicine, University of Kansas Medical Center, Kansas City, Kansas,
Letter to Ken Kyle (Canadian Cancer Society), September 3, 1999.
505.
I am writing to congratulate you on the Government of Canada’s proposals to improve
health warnings on tobacco packages. The Government is to be commended for taking
this important measure to protect the health of Canadians.
These messages, when implemented, will represent the most effective example of
health information on tobacco packages anywhere in the world. Canada’s actions will
serve as an important model for other countries in the Americas and around the globe.
Please accept our support in this and in your many other efforts to improve the
health of Canadians.
George A. O. Alleyne, Director, Pan American Health Organization,
Washington, D.C., Letter to Allan Rock (Minister of Health), May 2,
2000.
506.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that includes pictures would be
more effective than a series of warnings that includes just text alone.
Since people generally do not read the “fine print”, I am in favour of making the
message as clear, large & noticeable as possible. Nothing less than 60% would suffice!
This type of marketing should be part of the early educational system – let’s
inform the potential consumer of this product of the risks associated with smoking.
Remember, the whole objective should be to “dry up” the source of future smokers.
- 171 Professor Douglas E. Angus, Director, Master of Health Administration
Program, Faculty of Administration, University of Ottawa, Ottawa,
Ontario, Canada, September 16, 1999.
507.
I am aware that Minister Rock is considering enhanced health warnings for cigarette
packages. I am writing to express strong support for warnings in the form recommended
by the Canadian Cancer Society and others from the health community. It is critically
important that the new warnings command the smoker’s attention and that they be
perceived as serious messages of importance. In this regard, the larger the warning the
better. At least 60% of the package front should be devoted rotated warnings and
effective use should be made of other surfaces of the package, as illustrated by the
package examples prepared by the health groups. The use of pictures is, in my view,
essential.
With colleagues I have conducted research on the knowledge and attitudes of
Ontarians with regard to tobacco and tobacco control. In a 1983 survey a clear
knowledge deficit among smokers compared to non-smokers with regard to the health
effects of active and passive smoking was shown. Since then two more studies have been
conducted, one in 1991 and one in 1996, which confirmed that this knowledge deficit is
substantial and that it persists. Further, in the most recent survey, 60% of smokers agreed
that cigarette packages should include an insert describing the health hazards of smoking
and tips on quitting. These findings are now ‘in press’ in Cancer Prevention and Control.
Recently, I chaired the expert panel appointed by the Ontario Minister of Health
regarding the renewal of the Ontario Tobacco Strategy. In that report, “Actions will
Speak Louder than Words: Getting Serious about the Tobacco Control in Ontario:
(http://www.arf.org/otru). The panel reviewed the evidenced concerning the
effectiveness of health warnings. In its recommendations, of which there were 29 in all,
the panel recommended enhanced health warnings on packages and instructive packages
inserts as part of the education component of a comprehensive tobacco control strategy.
Effective warnings are not only an essential component of a comprehensive
program, but if implemented now, by themselves, they would help prepare the ground for
other tobacco control measures which will have to be introduced if the epidemic of
tobacco deaths is to be seriously addressed by the Government of Canada.
Professor Mary Jane Ashley, M.D., M.Sc., F.R.C.P.C., Department of
Public Health Sciences, Faculty of Medicine, University of Toronto,
Principal Investigator, Ontario Tobacco Research Unit, Toronto, Ontario,
Canada, Letter to Ken Kyle (Director of Public Issues, Canadian Cancer
Society), September 2, 1999.
508.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that includes pictures would be
more effective than a series of warnings that includes just text alone.
In my view, 40% of the package is sufficient space for manufacturers to be able
to distinguish on brand from another.
- 172 I believe the larger, photo enhanced warnings would have a significant effect on
smoking incident – especially among the youth. I therefore support this initiative and
urge the government to make this requirement of the tobacco companies.
Professor Wes Balderson, Faculty of Management, University of
Lethbridge, Lethbridge, Alberta, Canada, August 30, 1999.
509.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that includes pictures would be
more effective than a series of warnings that includes just text alone.
Long overdue.
Susan Bondy, Scientist, Institute for Clinical Evaluative Sciences,
Toronto, Ontario, Canada, August 24, 1999.
510.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that includes pictures would be
more effective than a series of warnings that includes just text alone.
I write as a senior member of the team which did the formative research for
Australia’s current-health warnings (Centre for Behavioural Research in Cancer, 1992,
see also Borland & Hill 1997) and has conducted evaluations of their impact (Borland &
Hill 1997 in Tobacco Control; Borland 1997 in Addiction).
Work our group did that led to Australia’s current warnings showed us that
bigger warnings had bigger impact. (NB we did not go nearly as high as 60% in our
experimental work but I am confident the relationship will hold). One of the important
roles of warnings is to be commensurate with the risk. There is no doubt in my mind that
even at 60% the warnings are still small for the risk involved. You have gone a long way
towards solving this problem by using inside parts of the pack – but are such inserts
appropriate for all packets sold? I am not sure of the utility of all the information inside
the pack, although it will probably be read by adolescents, and it reinforces the “amount
of warning needed message” – so it may be useful.
I applaud your use of photographs. In our 1992 report we recommended against
graphics, but did so on the basis of using simple symbol which could be co-opted to other
purposes (eg the glamour of the skull and crossbones). I see no potential downside in
graphically portraying potential harms using photographs or data. This is real and
unambiguous.
If adopted, these warnings will set the benchmark for the world to emulate. You
are to be congratulated on your initiative.
Dr. Ron Borland, Ph.D., Deputy Director, Centre for Behavioural
Research in Cancer, Anti-Cancer Council of Victoria, Carlton South,
Victoria, Australia, November 11, 1999.
- 173 -
511.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that includes pictures would be
more effective than a series of warnings that includes just text alone.
David M. Burns, M.D., Professor of Medicine, Medicine/Tobacco
Control Policies Project, University of California, San Diego, San Diego,
California, U.S.A., September 21, 1999.
512.
Thank you for asking me to review the array of cigarette package warnings developed by
CCS. They are certainly attention catching and the larger warning signs will be more
effective than smaller. Evidence from recent research in both Australia and Canada has
shown larger signs, graphic messages and blunt facts are more effective in increasing
awareness of the health risks of smoking. Repeated surveys of youth including Canadian
youth, show they consistently underestimate the risks of tobacco and the risks of
addiction. Your own research with the proposed warnings shows both youth and adults
overwhelmingly support the use of larger warnings and that pictures and text are more
effective than text alone. Additional data on the inside flap is an excellent use of space.
Your work is extremely important and I am very supportive of your efforts to
work with government to reduce the terrible economic and social costs of tobacco.
Thank you for your work.
H. Sharon Campbell, Ph.D., Associate Director, Centre for Behavioural
Research and Program Evaluation, National Cancer Institute of Canada,
Waterloo, Ontario, Canada, Letter to Ken Kyle (Director of Public
Issues, Canadian Cancer Society), September 10, 1999.
513.
I would like to express my full support for the proposal that 60% of the principal surfaces
of cigarette packages be allotted for the health warnings, messages printed on the inside
of the package, and colour pictures of the health hazards of smoking be placed on
cigarette packages in Canada. If successful this measure would not only be very valuable
for tobacco control in Canada but it would also pave the way for other countries to
follow. In my country the health warnings cover 33% of the surfaces and we would
increase them further.
Hatai Chitanondh, M.D., F.I.C.S., F.R.C.S., President, Thailand Health
Promotion Institute, The National Health Foundation, and Past President,
Asia Pacific Association for Control of Tobacco, Bangkok, Thailand,
Letter to Allan Rock (Minister of Health), August 25, 1999.
514.
I am an Assistant Professor in the department of Public Health Sciences at the University
of Toronto and a Principal Investigator of the Ontario Tobacco Research Unit, Centre for
Health Promotion, University of Toronto. I have a PhD in Health Policy and
administration form the University of North Carolina – Chapel Hill and I have been
- 174 conducting tobacco policy research for several years. I am very pleased to hear that the
Government is seriously considering new and improved warnings for cigarette packages.
There is a growing body of research pointing to the positive impacts on health of
large, prominent warnings on cigarette packages. In Australia, new warnings resulted in
better informed smokers, thoughts among smokers of the negative effects of smoking, as
well as reduced cigarette consumption. In South Africa, 58% of smokers identified new
health warnings as an impetus to them wanting to quit or reduce their consumption. A
study prepared for Health Canada found that the location, size and colour of warnings
influenced their recall by smokers and half of smokers said that cigarette package
warnings were a contributing factor to their quit attempt or reduced cigarette use.
The report Health Warnings and Contents Labelling on Tobacco Products
prepared for the (Australian) Ministerial Council on Drug Strategy Tobacco Task Force
concluded that theory and empirical evidence suggest that cigarette package warnings
that are more noticeable, variable, interesting and informative could result in reduced
tobacco use and, subsequently, reduced morbidity and mortality from this preventable
and costly cause of death. The report specified a number of characteristics of package
warnings that could increase their effectiveness including increased size, the use of
graphic symbols, and novel elements.
It is clear form our own research here in Ontario that there still remain deficits in
knowledge among smokers about the health effects of smoking and second hand smoke.
Cigarette packages are an excellent vehicle for targeting educational efforts at smokers.
In fact, we found that 60% of smokers supported the inclusion of an insert in cigarette
packages describing the health hazards of smoking and tips on how to quit.
Unfortunately, cigarette smoking is still a major public health concern in Canada.
Improved cigarette packaging and health warnings are an important part of a
comprehensive strategy to reduce tobacco use in this country.
Joanna Cohen, Ph.D., Ontario Tobacco Research Unit, Toronto, Ontario,
Canada, Letter to Ken Kyle (Director of Public Issues, Canadian Cancer
Society), September 3, 1999.
515.
I understand that the federal Department of Health is considering new regulations for
enhancing the warnings on cigarette packaging. The proposed new warnings would
cover 60% of the front and back of cigarette packages as well as having printed messages
on the inside slide of the package. I strongly support the plan to enhance the health
warnings and, in particular, to increase the size of the current warning and use pictures to
graphically illustrate the warning messages. The plan to use colored pictures (eg.
Diseased mouth, black lungs, etc) as part of the warning is particularly innovative and
likely to be much more effective than the current warnings informing consumers about
the dangers associated the use of cigarettes. Clearly, the more prominently the warning is
displayed the more effective it will be. Thus, the plan to increase the size of the warning
of its current 30% to 60% seems reasonable, although, I’m not aware of any empirical
evidence that would suggest that a warning that is somewhat smaller would be as
effective. The concept of including additional messages on the inside slide, including a
telephone helpline number for smokers to obtain assistance in quitting smoking, is novel
and follows the similar strategy that has been used in Australia.
There is no doubt that consumers continue to be misinformed about the nature
and dangers posed by tobacco products. Requiring more detailed information to be
printed on and within cigarette packs seems like a reasonable approach to educate
smokers so that they can truly make more informed decisions about their smoking
behavior. In this regard, I would encourage Canadian government to match specific
- 175 warning messages of products to enhance their impact. For example, cigarette that are
marketed as lower in tar and nicotine, light or ultra-light should be required to carry a
message warning consumers about the problem of smoker compensation. Similarly,
tobacco products utilizing filter vent holes should be required to carry a message
educating consumers about the fact that covering the vent holes can greatly change the
tar, nicotine and carbon monoxide delivery associated with the product.
No doubt, the proposed graphic warnings will serve to compliment other tobacco
control initiatives, such as those carried out through the media, in schools and through
health care provider offices. Here at Roswell Park Cancer Institute, one of our most
requested educational pamphlets includes a series of colored pictures illustrating the
health damage associated with tobacco use. Requiring such pictures to be displayed on
the outside of cigarette packs seems like fair and truthful advertising and would certainly
be more effective than the series of text only warnings that are now in use.
K. Michael Cummings, Ph.D., M.P.H., Chair, Department of Cancer
Prevention, Epidemiology & Biostatistics, Roswell Park Cancer Institute,
Buffalo, New York, U.S.A., Letter to Ken Kyle (Director of Public
Issues, Canadian Cancer Society), September 13, 1999.
516.
It has come to my attention that the Department of Health is now considering enhanced
health warnings for cigarette packages. I have been involved with planning a research
project concerning cigarette package design. Thus, I have just recently reviewed the
scientific literature on this topic. It is clear that through the use of color and design the
tobacco companies are able to distract from the health warnings and deliver contradictory
messages. For example, a white package confers a message of health, purity, and safety.
In consumer tests, subjects are more likely to remember the promotional aspects of a
package (the color and design) than the health warnings.
The package is a billboard upon which the tobacco industry and the public health
community compete with opposing messages. To be effective, health warnings must be
much larger and in COLOUR. The goal should be to make the warnings large enough so
that they drown out the promotional message of the tobacco companies. If the health
warnings are not the most prominent and colorful message on the pack, the overall
impact of the pack will be one which promotes smoking. Why have health warnings at
all if they are not going to be effective?
I have been conducting tobacco control research for almost 20 years and have
published 50 research papers on tobacco. I believe the research supports the need for
very large and colorful warnings. I hope you will go with the proposal for 60% of the
package to be covered with health warnings.
Joseph R. DiFranza, M.D., Professor of Family Medicine and
Community Health, University of Massachusetts Medical School,
Worcester, Massachusetts, U.S.A., Letter to Allan Rock (Health
Minister), September 14, 1999.
517.
I would firstly like to congratulate your federal Department of Health and the Canadian
Government for their political courage and public health foresight with respect to these
proposed enhanced warnings. If adopted they would provide an international model for
other jurisdictions to aspire to.
By way of background, I am a member of the Australian Government’s National
Expert Advisory Committee on Tobacco, and have a long history (since 1982) of
behavioural science research into various aspects of smokers’ beliefs, attitudes and
- 176 behaviours, including conducting research for the Australian Government into pack
warnings and generic packaging.
In addition, I have been involved in commercial market research for some 25
years, with considerable experience in national-brand fast moving consumer goods
(FMCGs). In that capacity I developed a packaging test, which has been used to assess
various pack characteristics of FMCGs, including attention-getting power,
distinctiveness, and the communication of product attributes and product positioning. In
addition to my University positions I remain a director of NFO-Donovan Research, a
wholly owned subsidiary of NFO Worldwide, the largest custom marketing research firm
in North America, and among the top three in the world.
I fully support the Canadian Department of Health’s proposed enhanced
warnings for cigarette packs. It is well established that size is related to attention-getting
power, and hence the 60% warning would attract a smoker’s attention more that any
lesser size such as 40% or 50%. Size also reflects importance or power. Hence it is
likely that a bigger warning will also have a greater impact on the cognitive processing
and effect of the health message contained in the warning.
I particularly support the use of pictures to be included in the warnings, and
especially where the visual images are taken from media advertising. While printed word
warnings can be minimally attended to by the eye in sweeping movements that avoid
focusing on the words per se, visual information is not only far more intrusive, but can be
processed even where the eye lingers for a fraction of a second. Furthermore, research
with commercial products shows that packages containing visuals from the brand’s
advertising, generate increased favourable attitudes toward the product at the point of
sale. It would be expected therefore that visuals from anti-smoking ads, when placed on
the packs, would generate thoughts and feelings about smoking that occurred in prior
exposures to the advertising. Given that the ads did generate appropriate thoughts and
feelings (i.e., were effective), then the generation of these thoughts and feelings in
purchase and consumption situations would be clearly advantageous, and would extend
and amplify the campaign effect.
Good luck with your efforts with these packs. I will endeavour to have this sort
of packaging considered by NEACT and the Australian Government.
Professor Rob Donovan, Ph.D., Professorial Fellow in Marketing,
Graduate School of Management, and Co-Director, Health Promotion
Evaluation Unit (Department of Public Health and Graduate School of
Management joint project), University of Western Australia, Nedlands,
Western Australia, Australia, Letter to Ken Kyle (Director of Public
Issues, Canadian Cancer Society), September 24, 1999.
518.
In 1994 I completed my Master’s Degree at Queen’s University, Kingston. As a research
thesis I evaluated programs to reduce tobacco access to youth. I am now completing my
Ph.D. through the University of British Columbia and am researching the uptake of
tobacco among Canadian adolescents.
You may be interested to know that one component of my research has involved
a survey of tobacco retailers. {Dovell, Mowat, Dorland, and Lam.98} Telephone
questionnaires were administered to 160 tobacco outlets. Over 80% of the respondents
were owners or managers and 70% of the businesses were independently owned. You
can appreciate that for many of these respondents, a large portion of their income may be
derived from the sale of tobacco products. Therefore, quite frankly I was surprised at
their answers: they are obviously very concerned about tobacco use among youth.
Roughly ¾ feel that tobacco sales to minors is a serious issue. Only 7.4% said they
- 177 should be able to sell to minors. Most wanted more government influence to help solve
this problem; only 16% wanted less influence. If this amount of support can be expected
from retail tobacco merchants, then a high level of support can be expected from the
general public. How many voters would be in opposition to larger and more graphic
warnings on packages? Minuscule!
Most people are aware of the overall weight of evidence showing the health
consequences of smoking. Most agree that government controls are necessary.
However, the specifics and actual extent of the problem are not well known. Perhaps we
have become somewhat complacent due to a downward trend among the proportion of
adult smokers. When we look at trends among youth and the potential future
consequences, there is cause for alarm and action.
As you know, it is illegal in both the U.S. and Canada to sell tobacco to young people
under the age of 18 (19 in many states and provinces). In spite of this recently upgraded
legislation, the young people still report that it is easy to obtain tobacco. In addition to their
verbal reports, the evidence is provided by their behaviour:
- 40% of smokers begin experimenting prior to becoming a teenager
- 80% adopt the habit before leaving their teenage years.
- Between 1965 to 1996 in the U.S., both the incidence of first use (initiation) and the
prevalence of first daily use has been increasing among the 12-17 year age group.
{Centers for Disease Control and Prevention.98)
- Every day approximately 7,000 North American minors experiment with tobacco and
3,500 become daily smokers. One in three of these teenage smokers will eventually
die of smoking related causes. Globally, if current trends continue, more than 200
million persons who are currently children and teenagers will die from tobaccorelated illnesses. {Peto, Lopez, Boreham, Thun, and Heath.94)
In the past, Canada has been recognized as a leader in Tobacco Control.
{Editorial News analysis.93;Studlar.98} While actions are laudable, there is no room for
complacency until the evidence shows results, as measured by the behaviour Canadian
adolescents.
To a large extent the key to solving the problem lies in the social context of
young people. Numerous opportunities exist for adults to influence this context. One
option is in the design of tobacco packaging. Counter-advertising has become an
accepted procedure as part of comprehensive programs to reduce tobacco consumption.
It really is time to tell the truth, rather than making tobacco appear glamorous and
appealing. Plain packaging or large (>=60%) graphic warnings can help send the true
message.
You may also want to consider some of the messages being revealed in my
current Ph.D. research. Responses from 10,207 young people (11-15 years) are being
analyzed. Contrary to becoming glamorous or appealing, compared to non-smokers the
young smokers report:
- feeling less healthy
- feeling less happy
- much greater likelihood of ever being drunk
- much greater likelihood of ever taking marijuana
- greater difficulties with other students at school
- feeling more lonely
- stronger desire to leave their home
These responses paint a solemn picture of young smokers. I would not say that
smoking causes these characteristics but it is certainly not part of the answer. Tobacco
has been falsely depicted as part of the solution; in contrast, the drug exacerbates the
problem.
- 178 It is time to tell the truth: as forcefully as possible. I encourage you to
strengthen the proposed packaging regulations as much as possible. This includes
rotating the messages, utilizing graphics and ensuring the space allotted for health
warnings is more extensive than the false promotional appeal.
Thank you for your attention to this important issue.
Ronald A. Dovell, Ph.D. candidate, University of British Columbia, in
Kingston, Ontario, Canada, Letter to Allan Rock (Minister, Health
Canada), September 4, 1999.
519.
We understand that the Federal Department of Health is considering enhanced warnings
for cigarette packages, and that you are communicating with them regarding the specifics
of those warnings. Plans are to develop warnings that cover 60% of the front and back of
packages, as well as having messages printed on the inside of the package. The use of
pictures as part of the warning is also under consideration.
Research and expert opinion agree that the larger the warning, the more effective
it will be. Not only is it more likely to be noticed by a smoker, but it reduces the amount
of space available for displaying product–specific colours and designs. These colours
and designs can evoke strong visual images among smokers from their memory bank of
past advertising that connected smoking certain brands with being sophisticated, cool,
with it, wealthy, fun-loving, etc. It is important to mention that effectiveness of warning
messages in terms of noticeability and recall is well-supported by the research evidence,
but that direct impacts of these measures on smoking behaviour have not been, nor can
they be, proven. We urge you to continue to promote coverage of 60% of the front and
back of the cigarette package with warnings.
Rotated health warnings are more effective. In the course of conducting our
work, PTCC staff have heard anecdotes from smokers such as “I ask the salesperson not
to give me the pack with the warning about smoking in pregnancy”. This is just one
illustration of what research has shown us, that smokers do notice and read the warnings,
and that warnings, will affect different people in different ways. There is no question that
personalized or targeted messages are more effective than general message; thus as
number of warnings that target different groups will be more effective than a single,
general warning.
We also applaud and support the value of using pictures as part of the warning.
It’s very true that “a picture is worth a thousand words”. We have evidence to believe
that a picture can draw attention to the warning and provide a graphic illustration.
Pictures can evoke emotions much more effectively than words can. Decisions to change
behaviours such as quitting smoking are as much emotional as they are rational.
The PTCC is a resource center of the Ontario Tobacco strategy funded by the
Ontario Ministry of Health to provide training and consultation services to community
groups in Ontario on tobacco control program development and implementation. The
center has been in operation since the fall of 1993, and is a partnership between the
Ottawa-Carleton Health Department, RBJ Health management Associates and the Centre
for Applied health research at the university of Waterloo. The PTCC’s Senior
Consultant, Josie d’Avernas, was involved in the design and implementation of a multicentre, international study on the impact of plain packaging of cigarettes that was
conducted from 1993 to 1996, and involved focus group testing as well as a survey of
students on Grades 7 and 9 in Ontario.
G.C. Dunkley, M.D., C.C.F.P., F.R.C.P., Director, Program Training and
Consultation Centre, and Deputy Medical Officer of Health, Region of
Ottawa-Carleton Health Department, Ottawa, Ontario, Canada;
- 179 K. Stephen Brown, Ph.D., Associate Director, Program Training and
Consultation Centre and Member, Centre for Applied Research,
University of Waterloo, Waterloo, Ontario, Canada;
J.R. d’Avernas, M.Sc., Senior Consultant, Program Training and
Consultation Centre and Partner, RBJ Health Management Associates,
Kitchener, Ontario, Canada, Letter to Ken Kyle (Canadian Cancer
Society), October 19, 1999.
520.
I understand that the Federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front. A system of
rotated health warnings that includes pictures would likely be more effective than a series
of warnings that include just text alone.
I am a researcher who has conducted tobacco-related research for the past
decade. The proposed warnings are an important step forward in tobacco control. I
strongly urge you to implement these recommendations.
Professor Karen M. Emmons, Dana-Farber Cancer Institute (Teaching
Affiliate of Harvard University), Boston, Massachusetts, U.S.A., Letter
to Ken Kyle (Canadian Cancer Society), September 21, 1999.
521.
Recently, I learned that the Canada Ministry of Health is considering requiring larger and
more graphic warnings for cigarette packages. As the Director, Office on Smoking and
Health, Centers for Disease Control and Prevention, I am writing to encourage the efforts
in Canada to ensure that consumers, especially vulnerable youth, are better informed of
the health hazards associated with tobacco use.
The scientific and medical literature demonstrates that, globally, many smokers
are not truly aware of the health hazards associated with smoking, even in such countries
as Canada, Australia, and the U.S. Recent studies from Australia further demonstrate that
more prominent warnings can increase awareness about the dangers associated with
smoking and can lead to smoking avoidance, smoking fewer cigarettes or stubbing them
out early, and at least talking about the issues. (Initial Impact of the New Australian
Tobacco Health Warnings on Knowledge and Beliefs, Tobacco Control, 1997; 6:317-325)
It makes sense that the larger and more graphic the warnings or health messages
on tobacco packages (and in advertisements), the more effective they will be. The
doctrine of informed consent is enshrined in our countries’ legal systems, not only as a
consumer rights issue but also as a health issue. When it comes to young persons, this
right is even more important. Since it is a signatory to the International Convention on
the Rights of the Child, the Canadian government has a further legal basis and obligation
to protect youth from health hazards and exploitation by the tobacco industry. Along
with other programmatic interventions such as counter advertising, school-based health
education, and smoke-free indoor air policies, enhanced labeling can play as important
role in informing consumers and countering the ubiquitous social cues toward smoking
acceptability.
It is especially important to make as prominent as possible warnings and
messages about the hazards of tobacco to counter the allure of smoking created by the
tobacco industry’s aggressive promotional activities. In countries like Canada and the
- 180 U.S., where courts have ruled against advertising bans, the need to counter the social
acceptability and misleading messages about smoking through enhanced labeling – more
prominent size, graphics, inclusion on inside slide as well as on front, back and sides of
packages, is even more critical.
Canada has a unique opportunity to serve as a model and world leader on
progressive tobacco labeling requirements. As national governments around the world
assess their legal authority to control tobacco in preparation for the Framework
Convention on Tobacco Control, they will be looking to Canada, with its renown for
comprehensive legal authority for tobacco control, as a model. This is an opportunity not
to be missed; one that will serve to protect Canadian consumers as well as others.
Michael P. Eriksen, Sc.D., Director, Office on Smoking and Health,
National Center for Chronic Diseases Prevention and Health Promotion,
Centers for Disease Control and Prevention, Public Health Service, U.S.
Department of Health and Human Services, Atlanta, Georgia, U.S.A.,
Letter to Ken Kyle (Canadian Cancer Society), November 15, 1999.
522.
We have learned that the Canadian government is considering new rules for the health
warning notices placed on cigarette packages. As health behavior scientists with
substantial research experience in assessing cigarette smoking cessation and prevention
programs we support these proposals.
Cigarettes are the most important cause of preventable death and disease in the
advanced industrial societies, and are likely to achieve that lamentable distinction
worldwide within a couple of decades. Although it is not possible to simply eliminate
this extremely dangerous product, it is important that all feasible steps be taken to reduce
its impact. We believe that the proposed warning notice changes will make a stronger
contribution to this goal than current health warnings.
Cigarette smoking is an exceptionally difficult habit to change. For most
smokers the process of successful quitting requires a clearcut decision that quitting is best
course of action for them. For most smokers, a strong knowledge of the health effects of
smoking on themselves and others is an important element in these decisions.
Although most smokers generally agree that smoking is not good for their health,
few comprehend the astonishingly wide range of these health effects, or have a clear
grasp of any specific facet of these effects. Increasing smokers’ knowledge of the
breadth and particulars of the health effects of cigarettes will contribute in the short term
to more individual decisions to quit and, combined with other educational and policy
changes, to increases in quit rates, reductions in tobacco use, and improvements in the
health of the population.
We strongly support proposals to strengthen health warnings on cigarette
packages because of the links between improved knowledge of health effects and
increased likelihood of quitting among current smokers. Because of the seriousness of
these health effects and the positive impact of improved knowledge we urge you to
support the strongest possible methods of presenting this information directly to smokers
through the medium of cigarette packaging. The specific changes we support include:
using the top 60% of the front and back of the packages; using pictures to clearly
communicate the major health effects; using the inner slide section to convey further
health information.
Although Canada has already taken a leadership position on this and other
tobacco control issues, more vigorous action is needed to achieve the benefits of lower
tobacco use rates. The Canadian commitment to reduction of tobacco use and to
- 181 providing international leadership for tobacco control efforts will be strengthened by
adopting these proposed health warning regulations.
Brian S. Flynn, Sc.D., Research Professor and Director, Office of Health
Promotion Research, College of Medicine, University of Vermont,
Burlington, Vermont, U.S.A.;
Laura J. Solomon, Ph.D., Research Professor, Office of Health
Promotion Research, College of Medicine, University of Vermont,
Burlington, Vermont, U.S.A.;
John K. Worden, Ph.D., Research Professor, Office of Health Promotion
Research, College of Medicine, University of Vermont, Burlington,
Vermont, U.S.A., Letter to Kenneth Kyle (Director of Public Issues
(National), Canadian Cancer Society), September 1, 1999.
523.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that includes pictures would be
more effective than a series of warnings that includes just text alone.
In my view, 40% of the package is sufficient space for manufacturers to be able
to distinguish one brand from another.
Professor Dan Gardiner, Faculty of Commerce, University of British
Columbia, Vancouver, British Columbia, U.S.A., September 7, 1999.
524.
The American Lung Association applauds Health Canada for considering enhanced
warnings on cigarette packages and for taking action against the tobacco industry’s
ineffective tobacco package warnings. This has the potential to set an important
international precedent with respect to package warnings. These measures are needed to
reverse the effect of decades of destructive tobacco industry promotion.
Smoking-related diseases claim an estimated 3.5 million deaths a year
worldwide. Using 60 percent of the front and back of cigarette packages for hard-hitting,
no nonsense tobacco package warnings, in color, with pictures and graphics will send a
strong and fair message that cigarettes are a lethal product. Cigarettes contain at least 43
distinct cancer-causing chemicals. Smoking is directly responsible for 87 percent of lung
cancer cases and causes most cases of emphysema and chronic bronchitis. It is also a
major factor in coronary heart disease and stroke. The American Lung Association
believes that a cigarette package warning that tells the truth will not only help addicted
smokers, but also will play an important role in discouraging young people from starting
a lifelong addiction to tobacco.
The American Lung Association hopes that Canada will continue to lead the
world with their measures and provide fair warnings for a lethal product and not allow
the tobacco industry to addict another generation of Canadian youths.
John Garrison, Chief Executive Officer, American Lung Association,
Washington, D.C., U.S.A., Letter to Ken Kyle (Director of Public Issues,
Canadian Cancer Society), November 2, 1999.
- 182 525.
To introduce myself, I am an epidemiologist working in cancer and tobacco related
research for over three decades in India. I had obtained a Doctor of Science degree in
Epidemiology from the Johns Hopkins University School of Hygiene and Public Health,
Baltimore, USA in 1975. I was a Takemi Fellow in International Health at the Harvard
School of Public health, Boston, USA during 1984-85 and a Senior Visiting Scientist at
the International Agency for Research on Cancer, Lyon, France during 1993-94. I am
connected with various national and international organizations working on cancer
research and tobacco related research. I have authored or co-authored over 100 scientific
publications, almost all relating to tobacco.
I understand that the federal Department of Health is considering enhanced
warnings for cigarette packages in Canada. Using the top 60% of the front and back of
cigarette packages for warnings is under consideration, as is the use of pictures as part of
the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that includes pictures would be
more effective than a series of warnings that includes just text alone.
I look upon the proposed design of the cigarette pack as the part of the Consumer
Protection information. Commercially manufactured consumer products are requited to
carry consumer protection information about possible harm that may be caused by
inadvertent or non-intended use of the product. Obviously no consumer product is
manufactured with intention to cause harm to the user. Cigarettes are exceptional, they
cause serious diseases and are responsible for premature death of 50% of the users even
when the use is exactly as the manufacturer instructed. Compared to this, the risk of
death from inadvertent or unintended use of a consumer product (say electric shock or
electrocution from and electric appliance) is absolutely miniscule. The death of one
human being by mistake, however, is one death too many and as a civilized society we all
strive for maximum safety designs and appropriate consumer protection information for
every consumer product.
Judging by the same principles, how much consumer protection information
ought to mandatory for cigarettes? Cigarettes are inherently defective consumer
products, they have not yet been made risk free to any acceptable level. Almost every
smoker is already physiologically dependent on nicotine. Almost all new and targeted
users are children.
This background I hope makes it quite clear that the intended proposals are in
right direction towards better consumer protection information. Canada was the first
country to require warning labels on 25% area of cigarette packs. With proposed new
warnings on cigarette packs, it would assume a world leadership role once again.
Prakash C. Gupta, D.Sc., F.A.C.E., Senior Research Scientist, Tata
Institute of Fundamental Research, Bombay, India, Letter to Kenneth
Kyle (Director of Public Issues, Canadian Cancer Society), September
14, 1999.
526.
It was quite a pleasant surprise to see the proposal that 60% of the surface of a packet of
cigarettes contains warnings of the harmful nature of 100% of the contents.
As you know, the Seventh-day Adventist Church has a long history of supportive
anti-tobacco processes, as well as running programs to assist smokers to quit. The
research that led to Zyban being used as an anti-smoking agent was done at our university
in Loma Linda, California by Dr. Linda Ferry.
- 183 Being a Canadian, seconded to the USA as the Health Ministries Director for the
World Church of Seventh-day Adventists, I was pleased to see Canada taking the lead.
We encourage and support you in this action.
Allan R. Handysides, M.B., Ch.B., F.R.C.S.(C), F.R.C.P.(C), Director,
Health Ministries Department, Seventh-Day Adventist Church, Silver
Spring, Maryland, U.S.A., Letter to Ken Kyle (Director of Public Issues,
Canadian Cancer Society), September 27, 1999.
527.
I am writing to support the proposed tobacco package warnings that will take up 60% of
the front and back of Canadian tobacco packs. Australian research has shown that to be
effective health warnings need to be noticed, persuasive and provide guidance for
appropriate action by smokers.
Strengthening warnings and extending pack warning information is an important
part of a comprehensive tobacco control strategy. There is strong symbolic value in
governments being seen to have a strong commitment to reduce tobacco-related disease
through powerful health warnings. Health warning regulations are also a means available
to government at low cost for enhancing the effectiveness of other smoking reduction
programs.
Currently, as part of our National Tobacco Strategy, Australia is planning to
evaluate our current warnings (which are similar to what Canada now has) and on the
basis of this, will be making recommendations as to changes. In adopting these warnings
Canada has the potential to set an important international precedent for improving
Australian pack warnings, as it has done in the past.
Todd Harper, Executive Director, Victorian Smoking and Health
Program, Cancer Control Research Institute, Carlton, Victoria, Australia,
Letter to Allan Rock (Minister of Health), September 2, 1999.
528.
In Hong Kong, a community with generally good health indices, tobacco related disease
stands out as a major cause of avoidable morbidity and mortality. The majority of regular
adult smokers in Hong Kong begin to smoke before age 18. In its approach to the
development of effective tobacco control measures the Council on Smoking and Health
regards radical changes and strengthening of health warnings as on of the most important
next steps.
We are impressed with the designs for warnings proposed by the Canadian
Cancer Society. We have passed these on to the Secretary for Health and Welfare, Hong
Kong Government, with a request and recommendation that they be considered in any
further deliberations on the content of warnings. The Council will now use these models
to develop designs which meet Hong Kong’s cultural and language needs.
The dissemination of the new proposed designs has been an important stimulus to
review health warnings in Hong Kong.
We strongly support the Canadian Cancer Society proposal and hope that these
will be implemented.
A.J. Hedley, MD, Chairman, Hong Kong Council on Smoking and
Health, Professor of Community Medicine, The University of Hong
Kong, Hong Kong, Letter to Ken Kyle (Director of Public Issues,
Canadian Cancer Society), September 10, 1999.
- 184 529.
Thank you for your recent letter. On behalf of the American Medical Women’s
Association (AMWA), I am delighted to comment on the proposal to enlarge and
enhance warning labels on Canadian cigarettes.
AMWA is the national association of women physicians and physicians-intraining. Founded in 1915, we represent more than 10,000 medical women in the United
States. Our two-fold mission includes promoting and protecting women’s health. We
have worked closely with our international colleagues, including those in Canada, on
many women’s health issues. Tobacco is a key focus of AMWA’s activities because it is
the leading cause of premature, preventable death among both women and men in nearly
all countries of the developed world. We note with pride that our tobacco control
activities have merited financial support from the (U.S.) Centers for Disease Control and
the Robert Wood Johnson Foundation.
Several factors must be taken into account as we consider how to reach smokers
with health education messages. Research demonstrates that smokers often have a poor
understanding of the magnitude of harm caused by smoking and the degree to which they
themselves are likely to be harmed. Although they are generally aware that tobacco is
dangerous, they tend to underestimate the degree of risk, relative to other hazards, and
tend not to personalize the risks. As a consequence, many smokers don’t appreciate the
urgency of quitting. They may hope to quit some day in the future, by aren’t ready to
undertake the task as yet.
Lastly, in both Canada and the United States, tobacco use is increasingly
restricted to people with lower levels of education and lower incomes. These same
citizens often have less access to health information and may have greater difficulty
understanding it. In addition, their lives are often burdened with other problems that
make paying attention to their smoking more of a challenge.
The tobacco industry has long understood that cigarette packages are an effective
tool to promote smoking. Packages are carried on the person and handled by the smoker
literally dozens of times each day. Especially for youthful smokers, who are very brand
conscious, the cigarette pack conveys membership in a “club”, as depicted in the imagery
of the campaign for that particular cigarette.
Manufacturers carefully design cigarette packages to be attractive, ornamental
and to complement ongoing marketing schemes. Prominent, graphic health warnings
have the ability to disrupt manufacturer’s ability to use the cigarette pack to promote
smoking. This is an important public health goal.
Just as packages can be used to promote smoking, they can also be an effective
means of reaching smokers with health education messages multiple times a day. We
support Canada’s proposal to increase the size of the warning to 60% because larger and
more prominent warnings will be more difficult for smokers to ignore. The larger the
warning the better. Pictures, especially graphic color pictures, would be an effective
addition to print messages. Because “a picture is worth a thousand words”, an arresting
picture can greatly enhance the words printed on the warning label. Since many of the
smokers we most want to reach have limited literacy, pictures can enhance the
effectiveness of the warning label.
We also believe that adding an inside “slide” for additional health education
messages and pictures would be very valuable. An inside “slide” would increase the
space available to provide warnings, pictures, smoking cessation advice, or other
messages. Since part of our task is to break through the denial and complacency of
smokers, the more warnings and more times the smoker needs to deal with health
education messages the better.
Research demonstrates that behavior change is more likely to occur when health
education messages are delivered repeatedly though multiple channels. Health messages
- 185 on cigarette packs could complement and extend the reach of messages delivered through
the media, school and community groups and other means. In fact, we would
recommend using all of these in a coordinated approach to reach smokers.
In conclusion, we applaud Canada’s proposal to enlarge and improve cigarette
package warnings. No single approach to decreasing tobacco use is a “magic bullet”.
However, we believe the proposed package warning label changes have enormous
potential to reach youth and adult smokers and decrease their use of tobacco products.
Enacting and evaluating these changes will help solidify your leadership role in tobacco
control and prevention efforts.
Thank you again for the opportunity to comment on this proposal. Please do not
hesitate to contact me if I can provide further information to you.
Clarita E. Herrera, M.D., President, American Medical Women’s
Association, Alexandria, Virginia, U.S.A., Letter to Ken Kyle (Canadian
Cancer Society), November 2, 1999.
530.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that includes pictures would be
more effective than a series of warnings that includes just text alone.
I write to offer strong support for the proposals to enhance warnings on cigarette
packs. In 1992, the Centre for Behavioural Research in Cancer, of which I am the
director, undertook a major consultancy for the Australian Federal Government on
tobacco pack health warnings (Centre for Behavioural Research in Cancer, 1992).
On the basis of that work and subsequent studies in the literature of which I am
aware, I am confident that the proposed Canadian modifications do provide a significant
advance in the program to reduce the harmful effects of cigarette smoking.
Our experience with the Australian National Tobacco Campaign (Hassard, 1999)
has strongly supported the notion that smokers can be assisted in their efforts to quit
smoking by vivid health warning material. I see no reason why graphic pictorial
portrayals on cigarette packs should not operate in the same way as we found them to
operate when transmitted though television.
Dr. David Hill, Director, Centre for Behavioural Research in Cancer,
Anti-Cancer Council of Victoria, Carlton South, Victoria, Australia,
September 11, 1999.
531.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that includes pictures would be
more effective than a series of warnings that includes just text alone.
I fully support the proposed enhanced warnings for cigarette packages. From my
own research, it is clear that such enhanced warnings will more likely highlight and alert
- 186 people to health risks associated with smoking, as well as helping people feel more
vulnerable to such risks. Enhanced cigarette warnings can and do raise the consciousness
of the public about the dangers of smoking. Indeed, in Australia, the use of enhanced
cigarette warnings, in conjunction with other health messages, may have been largely
responsible for turning the majority of the Australian public against smoking as a habit.
Robert Ho, Associate Professor (Psychology), School of Psychology and
Sociology, Central Queensland University, Australia, November 30,
1999.
532.
Thank you for your letter of August 18, 1999, and the sample labels that are being
recommended to your government. Having been involved in the Minnesota Tobacco
Trial, I have first-hand knowledge of the deceptiveness of the tobacco industry, and truly
believe that the only way to confront that is with the truth. I have attached a copy of a
paper that Dr. Channing Robertson and I wrote about our experience with these
previously secret internal tobacco industry documents. As we wrote in this article, we
believe that the evidence from this trial unequivocally supports the position of the need
for full disclosure and full accountability on the part of the industry. One way to do that
is to display the truth on the packages of their products.
As you read the quotes from our article concerning the strategic planning that
went on in 1954, and their discussion of the cause and effect relationship between
cigarette smoking and diseases such as lung cancer and heart disease, it should make you
realize how long this trail of deceit has been. We all remember the 1994 picture of the
CEO’s before our Congress testifying that nicotine was not addicting, whereas this was
acknowledged internally in the early 1960’s. Other issues such as the low tar, low
nicotine charade and manipulation of the form of nicotine (i.e. free-basing nicotine), are
other topics that should be of interest to not only the reader, but also the smoker
consuming these products.
I applaud your interest and fully support your activities to tell the truth about
cigarettes by changing the labeling to more accurately reflect what they actually do.
Richard D. Hurt, M.D., Director, Nicotine Dependence Center, Mayo
Clinic, Rochester, Minnesota, U.S.A., Letter to Ken Kyle (Canadian
Cancer Society), September 9, 1999.
533.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that includes pictures would be
more effective than a series of warnings that includes just text alone.
I just completed an interview with a 42 y/o Caucasian female who smokes to
relax “like movie stars in the 1930’s & 40’s” – her favourite genre.
Pictures large print (& humor)  strong counteradvertising is needed to change
the long history of subliminal tobacco advertising & its associations.
Lori Karan, MD, Internist/Addiction Medicine, Division of Clinical
Pharmacology and Experimental Therapeutics, University of California,
San Francisco, San Francisco, California, U.S.A., September 20, 1999.
- 187 -
534.
I am writing to support the National “Tobacco or Kids” Campaign for large, explicit,
truthful and fair labeling for tobacco products.
My credentials and history on this issue – I am presently the Provincial Health
Officer for British Columbia. I have spent three years as President and CEO of Ontario’s
Addiction Research Foundation (ARF) and six years as Medical Health Officer for the
old city of Toronto. I have been a recipient of the Non-Smokers Rights Association
Award of Merit and the ARF’s Community Achievement Award. Both given in
recognition of anti-tobacco measures taken during my tenure as Medical Health Officer
in Toronto.
I have been, and still am, a proponent of plain packaging as the most efficient
way of reducing tobacco promotion. However, as the federal government will allow 40
per cent of the packaging for promotional activity it is critical that this promotion space
be offset and countered by the visual rendering of some of the more common diseases
and illnesses caused by tobacco. Written warnings are clearly insufficient on their own.
Research has shown that they can be ignored though familiarity. The pictorial element
however, is harder to put aside and the combination of visual and pictorial information
are likely to be more effective than wording alone in both positioning and delivering a
message and countering the promotional allure of broad symbol and color.
In addition, the visual identity and message can be tied in with other elements in
an environmental multimedia campaign to dissuade young smokers from starting or
continuing. A visual tie in to posters or TV spots will reinforce the message and do so
using the precepts of successful grand marketing.
In short, it is critical that the federal government be urged and supported to make
warnings as large as possible, to compliment the printed words with graphic imagery, and
to complement package warnings with poster, print media and TV/Movie spots.
Dr. P.R.W. Kendall, MBS, M.Sc., F.R.C.P.C., Provincial Health Officer,
British Columbia, Ministry of Health and Ministry Responsible for
Seniors, Victoria, British Columbia, Canada, Letter to Ken Kyle
(Director of Public Issues, Canadian Cancer Society), September 8,
1999.
535.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that includes pictures would be
more effective than a series of warnings that includes just text alone.
In my view, 40% of the package is sufficient space for manufacturers to be able
to distinguish one brand from another.
Thanks for sending me the package of information; I certainly support your
position.
I wonder if you are aware of the “Plain Packaging” report that was prepared by
Health Canada in 1995! I was a member of the Govt. Panel and many of our findings
support your position.
Professor Gurprit S. Kindra, M.B.A., M.A., Ph.D., Faculty of
Administration, University of Ottawa, Ottawa, Ontario, Canada, 1999.
- 188 -
536.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that includes pictures would be
more effective than a series of warnings that includes just text alone.
In my view, 40% of the package is sufficient space for manufacturers to be able
to distinguish one brand from another.
Stick to pictures and graphs with some text. All graphs and pictures have to be
simple. I don’t like “baby” pictures as an advice against smoking. Too complex for
many and too over used.
Use inside ‘slide’ for more detailed info. However, the main impact comes from
the outside package. I would guess 80-90%. Inside message can be ignored by a smoker.
40% is enough space for producer.
Have some “fun” messages like: “Do you like to smell like an ashtray?” to your
boy/girlfriend? “If you like to smell like a smoker put some butts in your shirt.”
Professor Elko Kleinschmidt, Faculty of Business, McMaster University,
Hamilton, Ontario, Canada, September 1, 1999.
537.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that includes pictures would be
more effective than a series of warnings that includes just text alone.
1. Health warning located on 60% of the cigarette package front warns with its
expressive capacity especially children and adolescents and is more effective than
any other one.
2. The colour picture gives more precise information about consequences of tobacco use
and discourage especially children and adolescents.
3. Yes, because it breaks up an attractive cigarette package face.
4. Yes, they are very useful for those who are not well informed and for those who
intend to stop smoking. They enhance motivation to quit.
5. Yes, public information has to be as broad as possible.
Jiri T. Kozak, Chairman, Czech Committee, European Medical
Association Smoking or Health, Prague, Czech Republic, October 30,
1999.
538.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
- 189 In my view, a system of rotated health warnings that includes pictures would be
more effective than a series of warnings that includes just text alone.
In my view, 40% of the package is sufficient space for manufacturers to be able
to distinguish one brand from another.
Mockups provided by the Canadian Cancer Society clearly demonstrate these
affirmations with no serious rebuttal.
Michel Laroche, MSRC, Professor of Marketing, Concordia University,
Montreal, Canada, August 26, 1999 [translation].
539.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that includes pictures would be
more effective than a series of warnings that includes just text alone.
In my view, 40% of the package is sufficient space for manufacturers to be able
to distinguish one brand from another.
The major impact of an advertisement or visual is already recognized by the
scientific world, especially with regard to the recall of the announcement and its effect on
brand loyalty.
Undoubtedly, there is a relationship between the size and placement of warnings
on cigarette packages. Everyone says they believe that these warnings will result in the
reduction of use among young people. In fact, university students shown these warnings
recognize their soundness, and share this opinion. To reduce the social costs associated
with this product, it is now time to take action in favour of the proposals listed above.
Dr. Gaston LeBlanc, Vice-Dean, Professor of Marketing, Faculty of
Business Administration, University of Moncton, Moncton, New
Brunswick, Canada, September 17, 1999.
540.
As a lifelong advocate for smoke free healthy environments, as a clinician who works to
assist people to quit smoking and as an author of a national program designed to assist
women who a pregnant to quit smoking, I am writing this letter to endorse the federal
governments intention to develop innovative new packaging for cigarettes.
I understand that the federal Department of Health is considering enhanced
warnings for cigarette packages. Using the top 60% of the front and back of cigarette
packages for warnings is under consideration, as is the use of pictures as part of the
warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that includes health pictures
would be more effective than a series of warnings that includes just text alone.
I believe this new packaging will influence new smokers, who are mainly
adolescents, not to begin to smoke, and enhance established smokers understanding of the
effects of smoking on their health, thus motivating them to quit while they are ahead!
Dr. Cheryl Levitt, Professor and Chair, Faculty of Health Sciences,
Department of Family Medicine, McMaster University, Hamilton,
- 190 Ontario, Canada, Letter to Ken Kyle (Director of Public Issues, Canadian
Cancer Society), August 30, 1999.
541.
It was a pleasure meeting you in Geneva last year. Since then, Dr. Brundtland has
appointed me to chair the policy and strategy committee of her cabinet project on
tobacco. I work closely with the Programme Manager, Dr Derek Yach. Her commitment
has certainly led to a far higher priority being giver to tobacco, as witnessed by the WHA
support for the Framework Convention of Tobacco Control. Canada’s role in, and
support for, the latter is highly appreciated.
I am also writing to support your proposal for new health warnings that will, at
minimum, cover 60% of the front and back of the package.
Many nations in Asia and elsewhere look to Canada for leadership in tobacco
control, so that any action taken by you will have considerable repercussions globally.
If Canada fails to act now in an exemplar role, it will be even harder for
developing countries to initiate and implement similar measures. Indeed, it is difficult to
imagine Laos, India or Kenya taking such measures on their own, especially as they come
under increasing pressure from the transnational tobacco companies.
With very best wishes for the expected battle ahead with industry.
Dr. Judith Mackay, M.B.E., J.P., F.R.C.P.(Edin), F.R.C.P.(Lon),
F.H.K.A.M., Director, Asian Consultancy on Tobacco Control, Hong
Kong, Chair, World Health Organization Policy, Strategy Advisory
Committee for Tobacco Free Initiative, Letter to Allan Rock (Minister of
Health), August 18, 1999.
542.
I understand that the federal Department of Health is considering enhanced warning for
cigarette packages. Using the top 60% of the front and back of cigarette packages is
under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that includes pictures would be
more effective than a series of warnings that includes just text alone.
In my view, 40% of the package is sufficient space for manufacturers to be able
to distinguish one brand from another.
If tobacco companies oppose larger warnings on the grounds they will be no
more effective than smaller warnings – why bother objecting to the proposed change?
Professor Lindsay Meredith, Marketing Professor and Associate Dean,
Faculty of Business Administration, Simon Fraser University, Burnaby,
British Columbia, Canada, August 30, 1999.
543.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of the cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A warning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
- 191 Robin Mermelstein, Ph.D., Associate Professor of Psychology, Deputy
Director, Health Research and Policy Centers, University of Illinois at
Chicago, Chicago, Illinois, U.S.A., September 22, 1999.
544.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of the cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
The larger warning (60%) is better since it is much more evident, enhancing the
probability of changing comportment of the smoking.
The use of colour pictures will increase the awareness of adverse health effects.
The use of internal messages is a very good idea, because the increase of the
awareness will be greater, acting as a complementary information about the bad effects of
smoking. All these are complementary strategy and should be pursued.
Dr. Antonio Pedro Mirra, Coordinator, Sao Paulo Cancer Registry,
Department of Epidemiology, Faculty of Public Health, University of
Sao Paulo, Sao Paulo, Brazil, September 15, 1999.
545.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of the cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
I am in public health - I work with practitioners across Ontario to assist them
with skill building and information on tobacco use reduction.
I believe changing the cigarette packaging would make our job easier in
demonstrating that cigarettes are harmful.
I also live across the street from an Ottawa High School and see many packages
of cigarettes on the ground. My children often pick them up – if the warnings were
cleaver it would make it a good teaching tool as well!
Janet Nevala, Coordinator, Program Training and Consultation Centre,
Ottawa, Ontario, Canada, September 10, 1999.
546.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of the cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
- 192 Sweden introduced rotated health warnings, covering about 20% of the package
front in 1977. The wording of the warnings were changed a few times during the
following decade. In 1995, the system was abandoned as Sweden - when joining the
European Union – had to adopt the European standard. Now, however, the European
standard is to be changed, probably into something which is more like the Canadian
proposal. Sweden supports such changes.
In my opinion, our Swedish health warnings – rather innovative for their time –
have contributed to our success: today less than 20% of the Swedish adult population are
daily smokers.
Paul Nordgren, Principal Administrative Officer, National Institute of
Public Health, Stockholm, Sweden, September 8, 1999.
547.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of the cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
As a behavioral scientist who has worked in the field of nicotine dependency for
24 years, I applaud and support the efforts of the Canadian government to increase the
size of the health warnings to cover 60% of the front and back of cigarette packages. We
know that the majority of new smokers are adolescents and teenagers. Using these larger
and more graphic warnings will help show children that tobacco products are harmful to
them and others around them. While enhanced warnings will not influence all adults or
kids, an effective warning system is one of many measures needed to combat decades of
tobacco advertising and should be an important part of a national or provincial tobacco
control program. I urge the Canadian government to adopt these new requirements for
enhanced tobacco warnings.
Judith K. Ockene, Ph.D., M.Ed., Professor of Medicine and Director,
Division of Preventive and Behavioral Medicine, University of
Massachusetts Medical School, Worcester, Massachusetts, U.S.A.,
September 21, 1999.
548.
For nearly 25 years, I have been an active researcher in the epidemiology and etiology of
substance use among youth. The research that I have been associated with has shown
very clearly that use of certain substances can be greatly affected by perceived risk of
harm associated with those substances. Trends in use of marijuana and cocaine, for
example, seem to be explainable in large part by trends in perceived risk of harm
associated with use of those substances. This has been shown to be true for adolescents
as young as 13 and 14, as well as for older adolescents. Use of cigarettes is also
influenced by perceived risk of harm.
It is unfortunately the case that young adolescents currently perceive less risk of
harm from smoking cigarettes than older adolescents. This is particularly significant
because young adolescents are most in danger of initiating smoking. Indeed, in 1997
only 53% of 8th graders (ages 13-14) recognized that there is great risk of harm
associated with being a pack-a-day smoker. Thus, anything that will increase the
- 193 perception of harm associated with smoking has the potential to decrease the prevalence
of smoking among adolescents.
Use of package warnings will almost certainly to contribute to raising young
adolescents’ perceptions that cigarette smoking is harmful. But to be most effective, the
warnings must be attended to by the adolescent. Large warnings with color pictures will
undoubtedly [be] more effective in gaining the adolescent’s attention than just textual
material.
Therefore, I believe that improved cigarette package warnings, with color
pictures, are an important ingredient in efforts to improve the health of the children of all
nations.
Patrick M. O’Malley, Ph.D., Senior Research Scientist, Survey Research
Center, Institute for Social Research, University of Michigan, Ann
Arbor, Michigan, U.S.A., Letter to Ken Kyle (Canadian Cancer Society),
August 31, 1999.
549.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of the cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
Dr. Ron Plotnikoff, Assistant Professor, Center for Health Promotion
Studies, University of Alberta, Edmonton, Alberta, Canada, October 8,
1999.
550.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of the cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
In my view, 40% of the package is sufficient space for manufacturers to be able
to distinguish one brand from another.
40% is far more than needed to distinguish brands. Brands could be unique with
colors and names in text 20% or less of surface of package.
Rick Pollay, Professor of Marketing, Faculty of Commerce, University
of British Columbia, Vancouver, British Columbia, Canada, September
1, 1999.
551.
I have examined the cigarette pack disclaimers being proposed for cigarettes marketed in
Canada. I wish to state that I strongly endorse the approach recommended by Health
Canada, as it accurately conveys the real risks of smoking and begins to counter the
fanciful associations and false promises of cigarette advertisements. I concur that larger
warnings, color pictures, the posting of additional information on the inside slide of the
- 194 pack, and frequency of repetition are an effective rejoinder to the pervasive and one-sided
promotions of manufacturers. I commend the Canadian Health Ministry for taking such a
bold step in the face of what must be concerted efforts by vested interests in the
advertising and tobacco industry to protect their monopoly on information. It’s high time
that public health messages were presented to the public in ways that are at least as
attention getting as those used by commercial interests.
I have worked in the area of nicotine research and tobacco control for over 25
years and have been involved in both the development of behavioral programs for
smoking cessation and basic research on the mechanisms underlying nicotine addiction. I
support this attempt to limit tobacco use and I think that organizations concerned with the
long-term health of the population should take the initiative in presenting the realities
about smoking to the public at large. Who can do this if they do not?
I wish you much success in this important endeavor.
Ovide F. Pomerleau, Ph.D., Professor of Psychology in Psychiatry,
Director, Department of Psychiatry Behavioral Medicine Program,
University of Michigan, Ann Arbor, Michigan, U.S.A., Letter to Ken
Kyle (Director of Public Issues, Canadian Cancer Society), September 1,
1999.
552.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of the cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
Canada has in many ways pioneered the international tobacco control work. The
plan to increase the visibility and information value of the package warnings is great and
well founded by all the evidence on the addictive nature and great health damages caused
by the product. Such a decision will, no doubt, show the way for similar decisions in
many other countries.
Pekka Puska, Director, Division of Health and Chronic Diseases,
National Public Health Institute, Helsinki, Finland, November 1, 1999.
553.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of the cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
Cigarette package warnings constitute a cost-effective and efficient means for
reaching and appealing to smokers. The media is filled with positive images of smoking,
particularly among youth. Tobacco manufacturers persist in their ability to effectively
promote their brands, even when direct advertising is prohibited. Unfortunately most
youth have a positive perception of smoking. In the absence of clear, unequivocal antismoking messages, the social environment is essentially tobacco positive for youth,
- 195 perhaps even more so than for adults. Studies in the US have found that most youth do
not recall package warnings. Large, blunt and graphic warnings are not likely to be
forgotten.
Dr. Pamela A. Ratner, Assistant Professor, Faculty of Nursing, Assistant
Director, Institute of Health Promotion Research, University of British
Columbia, Vancouver, British Columbia, Canada, September 10, 1999.
554.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of the cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
In my opinion, the proposed packages will also diminish promotional
possibilities related to the brand and design of the package. This is one of the factors
luring young people to start smoking.
Matti Rautalahti, Chief Medical Officer, Health Education and
Communication, Cancer Society of Finland, Helsinki, Finland, October
18, 1999.
555.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of the cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
Nancy A. Rigotti, M.D., Director, Tobacco Research & Treatment
Center, Medical Practice Evaluation Center, Massachusetts General
Hospital, Boston, Massachusetts, U.S.A., September 2, 1999.
556.
I would like to congratulate you on your and the Government of Canada’s initiative to
increase the size of the health warnings, front and back, on cigarette packs to 60%.
From data gathered from studies and experience in Canada and worldwide, the
size of the warning and its graphic presentation have great significance in regard to the
effectiveness of the message and its influence on smokers or potential smokers. The
combination of pictures and color with the warnings has significant weight and can
increase the effectiveness of the warning, as the basic rule in communication – “A picture
is worth a thousand words”.
Canada is the spearhead in the fight against smoking, setting an example to the
world, especially in regard to health warnings on cigarette packs. We, in Israel, are also
working on the matter of rotating warnings. Implementation of your decision to increase
the size of warnings to 60% and include colorful warnings will assist us here as well as in
other countries, to promote the subject and help us in our efforts to reduce smoking and
as a result, disease and mortality.
- 196 We wish you and the Canadian people success in your task.
Professor Eliezer Robinson, Chairman, Israel Cancer Association, Israel,
Letter to Allan Rock (Minister of Health), August 24, 1999.
557.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of the cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
Irving Rootman, Ph.D., Director, Centre for Health Promotion,
University of Toronto, Toronto, Ontario, Canada, August 24, 1999.
558.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of the cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
In my view, 40% of the package is sufficient space for manufacturers to be able
to distinguish one brand from another.
Philip Rosson, Professor, Business Administration, Dalhousie
University, Halifax, Nova Scotia, Canada, October 1, 1999.
559.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of the cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
Michelle Scollo, former Director, Victoria Smoking and Health Program,
Australia, September 9, 1999.
560.
Thank you for the information regarding proposed changes to cigarette packaging. As a
health educator and researcher, my experiences with smokers and in particular youth
support the need for changes to packaging of tobacco products.
Any initiatives which can “de-glamorize” the smoking habit will impact on the
youth population. If we are to ameliorate the issues of tobacco use among young people,
a strong stance must be taken.
I have included specific comments on the enclosed form in reference to proposed
packaging.
- 197 I understand that the federal Department of Health is considering enhanced
warnings for cigarette packages. Using the top 60% of the front and back of the cigarette
packages for warnings is under consideration, as is the use of pictures as part of the
warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
The 60% warning with text and pictures will be less appealing to youth.
Packages will be less glamorous in appearance.
Similar messages in media ads, education and packaging act as reinforcers to
messages health promoters are attempting to send.
I believe we are on the right path.
Marilyn Seguire, RN, MN, Lecturer, Faculty of Nursing, University of
Manitoba, Winnipeg, Manitoba, Canada, August 26, 1999.
561.
It is my understanding that the Federal government of Canada is developing and
considering new regulations for cigarette package warnings. I appreciate your sending
me samples of these packages with the warnings; I looked at them with great interest with
regard to both the content, package placement, and size of the warnings on the cigarette
packages. The first and striking thing about the warning labels of course is the size. In
contrast to the United States, where the package warning labels are very small and on the
side of the pack, which renders them very ineffective, the proposal from the Federal
Department of Health for Canada would be to use the top 60% of the front and back of
the cigarette package for the warnings. I strongly support these large warnings, as I feel
they will be much more effective in warning the public of the risk of smoking cigarettes.
The small warnings used in the United States are minimally effective and when we
interview smokers, they really have poor recall of the label warning. There have been a
number of research studies showing that bold, large warnings on the front of the package
are much more effective in terms of warning the user of the risks involved and using this
product. I believe that it is incumbent upon the Government to take a public health
perspective here and to warn the public of the health risks involved in smoking cigarettes.
I believe that the use of color pictures is a significant enhancement to these warnings, as
we are all more attracted to color and pictures as opposed to black and white text. The
combination of both text warning and picture, I think makes a much more powerful
warning to the user.
In sum, I have been involved in tobacco control for over 30 years and I strongly
support the rotated health warnings that are proposed. I believe that by using 60% of the
package it will be a much more effective warning than using a smaller area of the
package and the use of pictures with the message will enhance the impact. Over the
years smokers have increasingly become aware of health risks from a variety of sources
but I believe that any comprehensive tobacco control strategy must include a stronglyworded, highly-visible package warning on each package of tobacco products. I believe
that Canada leads the way on this issue and that your adoption of these significant
warning labels can pave the way for the United States and other countries to learn a more
effective way of helping smokers understand the health consequences of regular tobacco
use.
If I can be of further assistance to you in this matter, please feel free to call me at
1-541-484-2123, extension 211. I might add that the Oregon Research Institute is a non-
- 198 profit research institute that has been involved in research on tobacco cessation and
prevention for the past 25 years and this research area represents a significant aspect of
my professional career.
Herbert H. Severson, Ph.D., Senior Research Scientist, Oregon Research
Institute, Eugene, Oregon, U.S.A., Letter to Ken Kyle (Canadian Cancer
Society), September 7, 1999.
562.
I am writing to add my organisation's comments on the new pack warnings proposed by
health agencies in Canada, and being considered by the government.
In summary, we would strongly support the warning being at least 60% of the
pack front and preferably also the same amount of the back; we believe these would be
more effective than smaller warnings, of say 40% or 50%. We also support the idea of
warnings featuring striking pictorial images, such as those proposed and circulated by a
coalition of health agencies in Canada; and of rotating warnings with striking pictures,
believing this system to be more effective than just a series of written warnings.
We offer these views not just in terms of effectiveness in Canada itself, but
because our work provides strong evidence that there could be a significant, beneficial
knock-on effect in developing countries, from a strong lead being taken in Canada.
As you know, the main work of my organisation is to provide and ongoing
information and advice service to tobacco control colleagues in countries with fewer
resources, mainly developing countries and those of Central and Eastern Europe. We
have been doing this work since 1991 and at present we have 188 client organisations in
108 countries. Frequent contact with these agencies, which include both governmental
and non-governmental bodies, gives us a privileged view of the problems they face in
their work, and of the factors which help to encourage their own governments to take
effective action.
Among the frequently expressed views of our overseas colleagues is that strong
tobacco control action by countries in the industrialised world is very helpful to cite to
their own governments; and for those of our clients which are themselves departments of
government health ministries, such precedents are also very important in framing their
own legislation. This point also came through clearly in the contributions of health
ministers, politicians and government officials at the international tobacco control
conference for legislators and law-makers which was held in Washington DC, USA, in
March this year.
I should like to set out some additional arguments supporting the strongest action
in this context:
1. The strongest possible warnings would be more effective for many reasons, including
the effect on the consumers themselves: consumer tests in several countries have shown
that larger, pictorial warnings are best. But also, strong new warnings inevitably generate
substantial press coverage, which in turn helps increase public knowledge about the
dangers of smoking, and helps motivate smokers to try to quit.
2. Cigarettes are unique in the scale of the risk involved in smoking, in terms of being
always highly dangerous (not just dangerous when abused or used in excess), not to
mention the issue of addiction. It therefor follows that they require a unique scale of
warning label. A pack which has more than half its external surface covered with
warnings, and with warnings commanding the eye to study them, and containing
informative, rotating messages inside, begins to address the current, extraordinary
situation where the scale and impact of warnings falls vastly short of being
commensurate with the risks of the product.
- 199 3. The tobacco industry's vigorous opposition is inevitable, and should be seen as the
most reliable evaluation available of the effectiveness of strong warnings.
4. The industry's argument about infringement of its trademark is clearly nonsensical, as
it is not apparently proposed that the warnings should remove or destroy the image of the
trademark. The industry's position on this is as absurd as it would be if Air Canada
claimed that its trademark was infringed by being prevented from covering an entire
aircraft, flight-deck windows included, with its name and logo. Concerns for health and
safety would prevent this, and in view of the unique and massive risks of tobacco, similar
considerations, which over-ride commercial considerations, must apply to cigarette
packs.
5. Aside from its acknowledged world leadership in tobacco control, there is nothing
unique about the measures being considered in Canada. The industry's opposition stems
only form the fact that the new measures could be a significant improvement in reducing
tobacco consumption first in Canada, and then, by means of exemplar imitation, in other
countries. The industry applies similar opposition to effective measures all over the
world; and undoubtedly there are precedents of the industry using virtually identical
arguments in other countries, even though the measures being proposed were much less
stringent than those being considered now in Canada. In other words, there are no logical
limits as to what can be done, providing the will of a government to protect public health
is strong enough, and whatever the measures being proposed, the industry will use similar
arguments in the hope of scaring legislators from making improvements.
I hope these observations are helpful, and if you think I can be of any further
assistance towards the goal of getting Canada to implement world-leading health
warnings of the sort devised by the health agencies, please let me know, and I shall do
my best.
David Simpson, Director, International Agency on Tobacco and Health, London,
United Kingdom, Letter to Ken Kyle (National Public Issues Office, Canadian
Cancer Society), October 28, 1999.
563.
I have been informed about the Canadian government’s intention to increase the size of
health warnings on tobacco packages to cover 60% of the front and back, and to include
colour pictures to accompany health warnings which will be printed both on the outside
of the packs and the inside. Legislating such strong measures is a very important step
that Canada is taking and corresponds to past innovations in protecting public health that
have been a hallmark of Canada’s lead concerning the tobacco epidemic.
As a researcher in smoking cessation, I discovered early in my career the very
strong tendency of smokers to defend themselves from health messages about tobacco by
minimising dangers and applying them to other smokers but not themselves. In the past,
this could be done because the messages were sporadic and from few sources, and people
who smoked were apparently in good health. The actual effects of tobacco use were
hidden behind hospital walls. And so, for decades, tobacco caused premature death and
private grief, not public outrage.
By ensuring that the true health costs of tobacco use are clearly indicated, your
proposed legislation will enable current and potential smokers to be given information
they can use to make informed choice. And because other messages about the toxicity
and addictiveness of tobacco use are becoming more available to them from health
education campaigns, doctors’ advice, school programmes, etc., informed choice
becomes more than a slogan.
About specifics. Is 60% better than 50% or 40% or 25%. Yes, it is. Health
warnings in many countries were often disregarded as a potent tobacco control measure
- 200 because they were hardly noticeable. That is not a true health warning. The bigger it is,
the more likely it is that it cannot be disregarded. Can the message be reinforced by
colour pictures? Of course. The colour pictures are nothing but the truth about these
diseases, but they are not easily dismissed. Is the Health Ministry serious about the
message? Yes, because it is printed at several places on the package.
I wish to thank you for preparing legislation that can impact not only on the
health of Canadians, but also provide a model for other nations.
Dr. Karen Slama, Ph.D., Head, Tobacco Prevention Division,
International Union Against Tuberculosis and Lung Disease, Paris,
France, Letter to Allan Rock (Minister of Health), October 13, 1999.
I understand that the federal Department of Health is considering enhanced
warnings for cigarette packages. Using the top 60% of the front and back of the cigarette
packages for warnings is under consideration, as is the use of pictures as part of the
warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
This is as major step in providing accurate information that will be noticed by
smokers and experimenters.
The big difference between youth uptake rates between countries is in what
percentage of those who “try” a cigarette go on to become smokers – In the US, Canada
or Australia, it may be as high as 40 to 45%. In places where health messages and
tobacco control efforts are minimal it can be 80% or more.
These health messages will protect young people from going beyond
experimentation and keep many from trying at all.
Dr. Karen Slama, Ph.D., Head, Tobacco Prevention Division,
International Union Against Tuberculosis and Lung Disease, Paris,
France, October 13, 1999.
564.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of the cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
Tobacco advertising practices is the best proof that larger and colour pictures
work better. The same with larger and colour warnings. It is also well known that
information is more effective if it is attractive, impressive and arousing emotionally; thus
larger warnings with colour pictures will better help to change attitudes, beliefs and
behaviour than just a plain warning text.
Additional message on the inside “slide” is a good idea. It attracts attention
when opening the pack and adds to cumulative effect. Repeated information increases
awareness so warnings should be complementary to other tobacco control means.
- 201 Tomas Stanikas, Lecturer, Department of Preventive Medicine, Kaunas
University of Medicine, Kaunas, Lithuania, October 14, 1999.
565.
I understand that the federal Department of Health is considering enhanced warnings for
cigarette packages. Using the top 60% of the front and back of the cigarette packages for
warnings is under consideration, as is the use of pictures as part of the warnings.
In my view, it is likely that the larger the warning, the more effective the warning
will be. A waning that is 60% of the package front would be more effective than a
smaller warning, such as a warning that is 50% or 40% of the package front.
In my view, a system of rotated health warnings that include pictures would be
more effective than a series of warnings that include just text alone.
Matt Tesoriero, Account Supervisor, Account Management, Arnold
Communications, Boston, Massachusetts, U.S.A., September 21, 1999.
566.
Seeing is Believing
The tobacco industry continues to successfully defend itself in product liability
suits on the grounds that existing warning labels make the risks of smoking universally
known. “Whatever judgments have been made about tobacco over the years have been
made with full awareness of all the pros and cons,” claimed a tobacco attorney on his
way to winning a case in a US court in March this year. (“Tobacco Companies
Victorious Trial With Union Health Funds,” Wall Street Journal Interactive Edition,
3/19/1999)
Yet a study on risk awareness among US smokers published in the Journal of the
American Medical Association the same month (Vol. 28 (11), Mar. 17) showed that “only
29% and 40% of current smokers believed they have a higher-than-average risk of
myocardial infarction or cancer, respectively, and only 39% and 49% of heavy smokers
(> or= 40 cigarettes per day) acknowledged these risks.”
Evidently most smokers do not find current US warning labels convincing. They
may, as the industry contends, be aware of the risks, but they tend not to believe or
acknowledge them.
A more recent JAMA report (Vol. 282 (13)), Oct. 6) on smoking in China
revealed that despite warning labels on packs there, “[o]nly a minority of smokers
recognized that lung cancer (36%) and heart disease (4%) can be caused by smoking.”
Clearly not all cigarette pack warning labels have sufficient impact on public
perception to justify the claims of the tobacco industry. The Canadian government can
and should again take the lead in tobacco control by showing its constituents, graphically
and unequivocally, what diseases are commonly caused by smoking.
The tobacco industry, in the interest of its continued success in the courtroom,
should welcome such labeling changes.
Scott Thompson, Editor, STOP! Magazine, Inc., San Clemente,
California, U.S.A., 1999.
As the editor of a magazine for people who want to stop smoking and an
advocate for international tobacco control efforts, I would like to express my support for
the labelling initiatives currently under consideration in Canada.
Although the tobacco industry continues to argue in court (often successfully)
that everyone who smokes fully understands the health risks involved, there is much
evidence that most smokers are not very well informed on the subject of tobacco
- 202 epidemiology.” It seems to me, therefore, that cigarette producers in Canada should be
leading the effort to introduce the new graphic warning labels in order to fortify their
legal position.
Instead, what we see is resistance from the tobacco industry on the dubious
grounds that printing the new labels is not technically feasible in Canada. This argument
is highly suspect considering the technological parity between the United States and
Canada. Coming from the “can-do” people who have succeeded in making their socially
offensive and highly toxic merchandise the most successful consumer product in world
history, this argument is all the more difficult to believe.
This argument reminds me of one presented a few years ago by tobacco
multinationals in Poland, where legislation had been proposed to enlarge and clarify
cigarette pack warning labels. **In that case, the argument was that the design change
would simply be too costly. A figure of $100 million was quoted. Curiously this same
figure is often used by the tobacco industry in various public declarations, for example
the amount Philip Morris is currently spending on a media campaign in the US to
demonstrate its good citizenship. However, cost did not seem to be a barrier to the pack
design changes for marketing purposes which were occurring with considerable
frequency in Poland at the time. In April 1998, the new warning labels were introduced
and smoking rates in Poland continued to decline at the unprecedented rates which had
followed initial tobacco control legislation of the mid – 1990’s.
The public health benefits Poles have enjoyed as a result of declining smoking
rates are due largely to the leadership and support of advocates in other countries,
especially Canada. As a US citizen working in Poland for most of the last decade, I was
repeatedly impressed by the commitment of Canadian colleagues to the cause of tobacco
control in developing countries, and equally ashamed of my own country’s neglect of this
issue. I very much hope that Canada will implement the new warning label and cessation
support mandates, for the benefit of public health both in Canada and abroad and to set a
standard of rational policymaking my country may someday be able to achieve as well.
Scott Thompson, Editor, STOP! Magazine, Inc., San Clemente,
California, U.S.A., Letter to Katrina Edwards (Health Canada), February
2, 2000.
567.
Thank you for your letter dated August 31, 1999, which I only just received. I feel that
the Canadian initiative to increase the size of health warnings from 30% to 60% is an
excellent measure, and the Alliance Française pour la Santé (French Health Alliance), of
which I am honoured to be the president, proposed this same measure to the European
Commission in Brussels several months ago.
There is no doubt that if Canada were to adopt this decision, it would ultimately
help us in our task. I remind you that, in the past, the adoption by Canada of the act
limiting tobacco advertising was a great help to us in passing a law in France (the Loi
Evin) and voting on the European Directive. Conversely, I believe that the adoption of
these laws in Europe has helped in the fight against tobacco in Canada. Thus there is
useful interaction between what is happening in Europe and in Canada in this matter.
We are asking for larger health warnings for the following reasons:
1 – In spite of the health information campaign efforts, through studies we have become
aware of the fact that the dangers of tobacco were highly underestimated, especially in
the lower-educated professional social environments and low-income households, which
have the highest smoking rates.
2 – Adolescents ignore these risks because they wrongly believe that they will easily be
able to quit smoking whenever they want, which unfortunately is not the case. Among
- 203 French women who smoke, only 40% are able to stop during pregnancy, and presently in
France one child in four is born to a mother who smoked during the pregnancy, along
with the inherent problems. We feel it is necessary to stress this point in order to reach
adolescents, and it will be one of the strong points of the upcoming campaigns, and
should be part of a health warning.
Thus, we strongly hope that Canada will adopt this measure and set an example
for the European Community.
Professor Maurice Tubiana, Alliance française pour la santé coalition
contre le tabagisme [French Health Alliance, Coalition Against
Tobacco], Paris, France, Letter to Ken Kyle (Canadian Cancer Society),
October 12, 1999 [translation].
568.
I would like to express my support for the work activities that you are carrying out to
encourage the Government of Canada to change its policy regarding the information
provided to consumers of very dangerous products such as tobacco products.
The work that I have been doing for the past 20 years as a public health specialist
in the fight against tobacco use has opened my eyes daily to the startling
misunderstanding on the part of citizens with regard to the true nature of the health
menace caused by tobacco use in all its forms.
It is one thing to know that tobacco use is not good for one’s health (which well
sums up the level of people’s understanding), and it is another thing to see the harm that
is caused by tobacco use for victims of this addiction. Wherein the importance of taking
advantage of the modifications of the regulation governing tobacco package warnings, in
order to turn this packaging into the authentic educational tools that they should be.
Thus, it is important that the largest possible area of the packaging be reserved to
deliver this message. And this information must include illustrations, photos and any
other means to enable true and relevant information to be passed on to citizens who
purchase tobacco products. It is of the utmost importance that citizens, especially those
victims of tobacco use, be saved from their lack of knowledge as measured by the
surveys taken to measure their knowledge on the avoidable illness and death caused by
tobacco use.
Fernand Turcotte, Professor, Faculty of Medicine, Department of Social
and Preventive Medicine, Laval University, Quebec City, Quebec,
Canada, Letter to Ken Kyle (Director of Public Issues, Canadian Cancer
Society), September 13, 1999 [translation].
569.
I have learnt of the new Regulations which the Canadian Government is developing on
cigarette package warnings.
I would strongly recommend the Canadian Government to make the warnings as
large as possible. As you yourself will certainly be aware, the Health Education
Authority of the U.K. in their report on Health warnings on cigarettes and tobacco packs:
report on research to inform European standardisation, London, 1990 stated:
Quote
“There is a tendency to interpret the smallness of the warnings as evidence of
government duplicity, more worryingly, there also seems to be tendency to equate the
size of the warning with the magnitude of the risk.”
Unquote
All the evidence indicates that a 60% warning is better than a smaller warning
and the more noticeable the warning and the less it is interfered with by the marketing
- 204 messages of the tobacco companies, the better. Additionally, we would strongly
recommend that warnings also be included on the inside of the package, on the “slide” as
well as on the exterior as this is evidently much more effective.
Of course, warnings are only part of an overall strategy to control the tobacco
endemic.
As the NGO’s attending the recent WHO Meeting on the Framework Convention
on Tobacco Control pointed out, during the five-day meeting almost 50,000 people have
died from tobacco –related disease.
A.J. Turnbull, Executive Director, International Union Against Cancer,
Geneva, Switzerland, Letter to Ken Kyle (Director of Public Issues,
Canadian Cancer Society), November 2, 1999.
570.
I am very pleased to hear that Canada is taking the next step in developing a new,
stronger health warning for cigarettes. As a physician and an oncologist, I have very
strong feelings that this carcinogenic product needs to be stigmatized.
I feel a special obligation to support my Canadian colleagues. In Poland, we
have had a high level of support from Canadian physicians and disease control specialists
for our work to improve public health after 30 years of communism. Thanks to our
Canadian colleagues and an enlightened Polish parliament, Poland has had the world’s
biggest health warnings on cigarettes since the beginning of last year. Canada’s health
warning was an inspiration to us in fighting for this, and we expect that Canada will now
return to its leading role.
We can also report good news – the warnings are working. During our research,
conducted 6 months after the introduction of the warning, approximately 3% of smokers
told us the warning was the reason they quit. This is about 200,000 people, so the
warning has saved tens of thousands of lives and improved the quality of life for may
more. We wish you success in an effort that is important not only to your country, but all
around the world.
Professor Witold Zatonksi, Health Promotion Foundation and Center for
Cancer Epidemiology and Prevention, Warsaw, Poland, Letter to Allan
Rock (Minister of Health), August 20, 1999.
- 205 -
Part IV
Expert Opinions – Plain Packaging
- 206 -
- 207 -
Part IV
Expert Opinions – Plain Packaging
Introduction
The expert opinions in this section were originally provided to the Canadian Cancer
Society in 1994 while the Canadian House of Commons Standing Committee on Health was
studying the issue of plain packaging. The expert opinions were provided to the Committee.
Subsequently, on June 1, 2000, the expert opinions were tabled with the House of
Commons Standing Committee on Health as part of the Canadian Cancer Society submission
“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.
All of the opinions start off with an endorsement of a standard document, with many of
the experts including additional comments. Those opinions in French have been translated into
English. (The standard document in French differed somewhat from the standard document in
English.)
Expert Opinions
571.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, plain packaging of tobacco products will have some impact on
decreasing demand in addition to any affect it would have on market share.
Rolando Arellano, Professor, Department of Marketing, Laval
University, Quebec City, Quebec, Canada, May 12, 1994 [translation].
572.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, it is more likely than not that plain packaging of tobacco products
would have some impact on decreasing demand in addition to any affect it would have on
market share.
I agree with the position taken by the Canadian Cancer Society.
Wes Balderson, Associate Professor, University of Lethbridge,
Lethbridge, Alberta, Canada, May 2, 1994.
- 208 573.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, it is more likely than not that plain packaging of tobacco products
would have some impact on decreasing demand in addition to any affect it would have on
market share
It is absurd to claim that teenagers are not affected by colourful, flashy packaging
that has been carefully associated with powerful images. Such packaging is symbolic and
the power of symbols on people cannot be underestimated.
Corporate pushers of already addictive drugs that can also kill bystanders should
not be allowed use of such a powerful marketing technique.
John D. Bishop, Professor of Marketing and Business Ethics, Trent
University, Peterborough, Ontario, Canada, May 2, 1994.
574.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, plain packaging of tobacco products will have some impact on
decreasing demand in addition to any affect it would have on market share.
Alain Bouchard, Professor, Administrator, University of Quebec at
Chicoutimi, Chicoutimi, Quebec, Canada, May 5, 1994 [translation].
575.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, plain packaging of tobacco products will have some impact on
decreasing demand in addition to any affect it would have on market share.
Yes, I am in favour of the position adopted by the Canadian Cancer Society.
Keep up the good work.
Gilles Boucher, Professor, University of Moncton, Moncton, New
Brunswick, Canada, May 5, 1994 [translation].
576.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, plain packaging of tobacco products will have some impact on
decreasing demand in addition to any affect it would have on market share.
I agree with this idea. All cigarette packages should be similar. With no
difference, those consumers not already fixed will look for other ways to identify
themselves and improve their image. I am ready to debate the question with anyone.
Philippe Chapuis, Ph.D., Professor of Marketing, University of Quebec
at Hull, Hull, Quebec, Canada, April 26, 1994 [translation].
- 209 577.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, plain packaging of tobacco products will have some impact on
decreasing demand in addition to any affect it would have on market share.
Carole Duhaime, Professor, School of Commerce, University of
Montreal, Montreal, Quebec, Canada, May 1, 1994 [translation].
578.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, it is more likely than not that plain packaging of tobacco products
would have some impact on decreasing demand in addition to any affect it would have on
market share.
While I cannot by any means claim to be an expert on tobacco marketing, it is
my opinion, based on what I have read and observed, that plain packaging of tobacco
products would make those products less attractive to consumers, particularly
adolescents.
Katherine Gallagher, Assistant Professor, Marketing, Memorial
University of Newfoundland, St. John’s, Newfoundland, Canada, May
16, 1994.
579.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, it is more likely than not that plain packaging of tobacco products
would have some impact on decreasing demand in addition to any affect it would have on
market share.
D.F. Gardiner, Professor, Commerce, University of British Columbia,
Vancouver, British Columbia, Canada, May 9, 1994.
580.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, it is more likely than not that plain packaging of tobacco products
would have some impact on decreasing demand in addition to any affect it would have on
market share.
I agree generally with the tone of your report. Packaging as part of the
product/promotion aspect of a marketing strategy will have at least a marginal impact on
some segments. Neutralizing this parameter may reduce the attractiveness of the offering
to the younger segment of potential/actual smokers. But don’t expect too much!
Elko J. Kleinschmidt, Associate Professor, McMaster University,
Hamilton, Ontario, Canada, May 3, 1994.
- 210 -
581.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, it is more likely than not that plain packaging of tobacco products
would have some impact on decreasing demand in addition to any affect it would have on
market share.
Makes a lot of sense to me.
David Large, Ph.D., Assistant Professor, Marketing, University of
Ottawa, Ottawa, Ontario, Canada, April 26, 1994.
582.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, it is more likely than not that plain packaging of tobacco products
would have some impact on decreasing demand in addition to any affect it would have on
market share.
Labelling on package is a form of promotion of the contents (in that sense similar
in nature and intent to advertising). This is clearly stated in most textbooks on marketing
(including mine).
Michel Laroche, Professor of Marketing, Concordia University,
Montreal, Quebec, Canada, May 2, 1994.
583.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, plain packaging of tobacco products will have some impact on
decreasing demand in addition to any affect it would have on market share.
In marketing, it is recognized that the packaging has a direct effect on product
sales. This relationship was established back in the 1950s. Moreover, the slogan
“advertising doesn’t sell – packaging sells” is used by many business people. It is high
time that companies that market tobacco products recognize their social responsibilities
and adapt to market realities.
Dr. Gaston LeBlanc, Professor of Marketing, University of Moncton,
Moncton, New Brunswick, Canada, May 2, 1994 [translation].
584.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, it is more likely than not that plain packaging of tobacco products
would have some impact on decreasing demand in addition to any affect it would have on
market share.
- 211 Dr. Lindsay Meredith, Professor and Director, Graduate Programs,
Faculty of Business, Simon Fraser University, Burnaby, British
Columbia, Canada, May 9, 1994.
585.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, plain packaging of tobacco products will have some impact on
decreasing demand in addition to any affect it would have on market share.
It is a very judicious step that I fully support. Everything must be done to fight
this social scourge.
Benny Rigaux-Bricmont, Professor of Marketing, Laval University,
Quebec City, Quebec, Canada, April 29, 1994 [translation].
586.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, plain packaging of tobacco products will have some impact on
decreasing demand in addition to any affect it would have on market share.
Guy Robert, Professor of Marketing, University of Quebec at
Chicoutimi, Chicoutimi, Quebec, Canada, April 29, 1994 [translation].
587.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, it is more likely than not that plain packaging of tobacco products
would have some impact on decreasing demand in addition to any affect it would have on
market share.
Philip Rosson, Professor, Dalhousie University, Halifax, Nova Scotia,
Canada, May 2, 1994.
588.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, plain packaging of tobacco products will have some impact on
decreasing demand in addition to any affect it would have on market share.
This is an opinion, and not a proven scientific fact. However, the attached article
shows how serious this is. [Article attached: Agence-France Presse, “Washington s’en
prend au chameau fumeur” (“Washington attacks the smoking camel”) La Presse,
August 13, 1993.]
Jean Roy, Professor, University of Quebec at Chicoutimi, Chicoutimi,
Quebec, Canada, April 28, 1994 [translation].
- 212 -
589.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, it is more likely than not that plain packaging of tobacco products
would have some impact on decreasing demand in addition to any affect it would have on
market share.
I support the position that the CCS is taking on this issue. If tobacco companies
are allowed to sell an addictive drug that kills, then certain restrictions must apply.
Product packaging is indeed one of the most important elements in the marketing mix. It
is a widely researched topic. Packaging helps to define a products personality,
augmenting other marketing variables. Plain packaging would result in the tobacco
manufacturers shifting greater resources towards pricing, distribution and promotional
programs. They have already shown a great deal of originality in circumventing
legislation. Costs of health care outweigh tobacco company profits. Plain packaging
won’t solve the problem but it is a step in the right direction.
Peter D. Sianchuk, Assistant Professor of Commerce, Mount Allison
University, Sackville, Nova Scotia, Canada, May 24, 1999.
590.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, it is more likely than not that plain packaging of tobacco products
would have some impact on decreasing demand in addition to any affect it would have on
market share.
Tobacco products have no positive attributes. They are sold through image only.
A plain package would make it difficult to market positive brand image.
Packages are used to tie cigarettes to other products which can be legally
advertised. Packages also are used to associate cigarettes with positive images such as
race cars and sporting events. This is accomplished through color and design. Plain
packages would eliminate this connection.
Tobacco companies have decades of experience, unlimited funds, political
connections, and the ability to punish marketing organizations which work against them.
Write a law which will stand up under pressure.
Richard Sparkman, Associate Professor of Marketing, Acadia University,
Wolfville, Nova Scotia, Canada, May 10, 1994.
591.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, it is more likely than not that plain packaging of tobacco products
would have some impact on decreasing demand in addition to any affect it would have on
market share.
Although I am not an expert in this area, the cumulative evidence that plain
packaging would reduce youth start-up, and cigarette consumption overall appears
compelling.
- 213 M.V. Thakor, PhD, Assistant Professor, Marketing, Concordia
University, Montreal, Quebec, Canada, June 8, 1994.
592.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, it is more likely than not that plain packaging of tobacco products
would have some impact on decreasing demand in addition to any affect it would have on
market share.
My views are represented by the following quotations from the Kotler-Turner
text “Marketing Management” (which I co-author):
“In recent times, packaging has become a potent marketing tool. Well-designed
packages can create convenience value for the consumer and promotional value
for the producer.
. . .The importance of packaging cannot be overemphasized, considering the
functions it performs in attracting and satisfying customers.”
Thus it seems reasonable to believe that packaging can influence potential new
customers, as well as existing customers.
Ronald E. Turner, Professor, Queen’s University, School of Business,
Kingston, Ontario, Canada, April 29, 1994.
593.
Plain packaging would require that all tobacco packages be sold in standardized dullcoloured packages. The warning and tar/nicotine/carbon monoxide listings would
continue to appear. Trademarks and other distinguishing features would be prohibited
except for the brand name appearing in a standard font in black ink.
In my view, it is more likely than not that plain packaging of tobacco products
would have some impact on decreasing demand in addition to any affect it would have on
market share.
Douglas C. West, Associate Professor, University of Calgary, Calgary,
Alberta, Canada, May 12, 1994.
- 214 -
Bibliographical List
To facilitate research and reference, this section contains a list of the items found
later in this report. The items are listed in the order that they appear in the report.
Should an item appear more than once, such as in the Parts dealing with
advertising/promotion and package labelling respectively, the item is accordingly listed
more than once in this section.
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499.
Selin, H. “Face Value? Descriptive Cigarette Brand Labelling and Reported Toxin Levels” Smoking
and Health Action Foundation, March 1997.
500.
U.S. Federal Trade Commission, “FTC Statement in Response to Senator Frank Lautenberg’s Letter”
November 24, 1998 [news release]
501.
U.S. Federal Trade Commission, “FTC Releases Results of “Tar”, Nicotine and Carbon Monoxide
Testing for 1262 Varieties of Domestic Cigarettes Sold in 1996 and 1252 Varieties Sold in 1997”,
September 28, 1999 [news release].
502.
U.S. Federal Trade Commission, “Report of “Tar,” Nicotine and Carbon Monoxide of the Smoke of
1252 Varieties of Domestic Cigarettes For the Year 1997”, 1999.
503.
Wigand, J.S. “Cigarette testing methods, product design, and labelling: time to clean up the “negative
baggage” Tobacco Control 1998;7(4):336-337.
Part III – Expert Opinions – Health Warnings
504.
Jasit S. Ahluwalia, M.D., M.P.H., M.S., Vice Chair, Director of Research and Associate Professor
of Preventive Medicine, Associate Professor of Internal Medicine, Department of Preventive
Medicine, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas,
U.S.A., Letter to Ken Kyle (Canadian Cancer Society), September 3, 1999.
505.
George A. O. Alleyne, Director, Pan American Health Organization, Washington, D.C., U.S.A.,
Letter to Allan Rock (Minister of Health) May 2, 2000.
506.
Professor Douglas E. Angus, Director, Master of Health Administration Program, Faculty of
Administration, University of Ottawa, Ottawa, Ontario, Canada, September 16, 1999.
507.
Professor Mary Jane Ashley, M.D., M.Sc., F.R.C.P.C., Department of Public Health Sciences,
Faculty of Medicine, University of Toronto, Principal Investigator, Ontario Tobacco Research
Unit, Toronto, Ontario, Canada, Letter to Ken Kyle (Director of Public Issues, Canadian Cancer
Society), September 2, 1999.
508.
Professor Wes Balderson, Faculty of Management, University of Lethbridge, Lethbridge, Alberta,
Canada, August 30, 1999.
509.
Susan Bondy, Scientist, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,
August 24, 1999.
510.
Dr. Ron Borland, Ph.D., Deputy Director, Centre for Behavioural Research in Cancer, AntiCancer Council of Victoria, Carlton South, Victoria, Australia, November 11, 1999.
511.
David M. Burns, M.D., Professor of Medicine, Medicine/Tobacco Control Policies Project,
University of California, San Diego, San Diego, California, U.S.A., September 21, 1999.
512.
H. Sharon Campbell, Ph.D., Associate Director, Centre for Behavioural Research and Program
Evaluation, National Cancer Institute of Canada, Waterloo, Ontario, Canada, Letter to Ken Kyle
(Director of Public Issues, Canadian Cancer Society), September 10, 1999.
- 248 -
513.
Hatai Chitanondh, M.D., F.I.C.S., F.R.C.S., President, Thailand Health Promotion Institute, The
National Health Foundation, and Past President, Asia Pacific Association for Control of Tobacco,
Bangkok, Thailand, Letter to Allan Rock (Minister of Health) August 25, 1999.
514.
Joanna Cohen, Ph.D., Ontario Tobacco Research Unit, Toronto, Ontario, Canada, Letter to Ken
Kyle (Director of Public Issues, Canadian Cancer Society), September 3, 1999.
515.
K. Michael Cummings, Ph.D., M.P.H., Chair, Department of Cancer Prevention, Epidemiology &
Biostatistics, Roswell Park Cancer Institute, Buffalo, New York, U.S.A., Letter to Ken Kyle
(Director of Public Issues, Canadian Cancer Society), September 13, 1999.
516.
Joseph R. DiFranza, M.D., Professor of Family Medicine and Community Health, University of
Massachusetts Medical School, Worcester, Massachusetts, U.S.A., Letter to Allan Rock (Health
Minister), September 14, 1999.
517.
Professor Rob Donovan, Ph.D., Professorial Fellow in Marketing, Graduate School of
Management, and Co-Director, Health Promotion Evaluation Unit (Department of Public Health
and Graduate School of Management joint project), University of Western Australia, Nedlands,
Western Australia, Australia, Letter to Ken Kyle (Director of Public Issues, Canadian Cancer
Society), September 24, 1999.
518.
Ronald A. Dovell, Ph.D. candidate, University of British Columbia in Kingston, Ontario, Canada,
Letter to Allan Rock (Minister, Health Canada), September 4, 1999.
519.
G.C. Dunkley, M.D., C.C.F.P., F.R.C.P., Director, Program Training and Consultation Centre, and
Deputy Medical Officer of Health, Region of Ottawa-Carleton Health Department, Ottawa,
Ontario, Canada;
K. Stephen Brown, Ph.D., Associate Director, Program Training and Consultation Centre and
Member, Centre for Applied Research, University of Waterloo, Waterloo, Ontario, Canada;
J.R. d’Avernas, M.Sc., Senior Consultant, Program Training and Consultation Centre and Partner,
RBJ Health Management Associates, Kitchener, Ontario, Canada, Letter to Ken Kyle (Canadian
Cancer Society), October 19, 1999.
520.
Professor Karen M. Emmons, Dana-Farber Cancer Institute (Teaching Affiliate of Harvard
University), Boston, Massachusetts, U.S.A., Letter to Ken Kyle, September 21, 1999.
521.
Michael P. Eriksen, Sc.D., Director, Office on Smoking and Health, National Center for Chronic
Diseases Prevention and Health Promotion, Centers for Disease Control and Prevention, Public
Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia, U.S.A., Letter
to Ken Kyle (Canadian Cancer Society), November 15, 1999.
522.
Brian S. Flynn, Sc.D., Research Professor and Director, Office of Health Promotion Research,
College of Medicine, University of Vermont, Burlington, Vermont, U.S.A.;
Laura J. Solomon, Ph.D., Research Professor, Office of Health Promotion Research, College of
Medicine, University of Vermont, Burlington, Vermont, U.S.A.;
John K. Worden, Ph.D., Research Professor, Office of Health Promotion Research, College of
Medicine, University of Vermont, Burlington, Vermont, U.S.A., Letter to Kenneth Kyle (Director
of Public Issues (National), Canadian Cancer Society), September 1, 1999.
523.
Professor Dan Gardiner, Faculty of Commerce, University of British Columbia, Vancouver,
British Columbia, U.S.A., September 7, 1999.
524.
John Garrison, Chief Executive Officer, American Lung Association, Washington, D.C., U.S.A.,
Letter to Ken Kyle (Director of Public Issues, Canadian Cancer Society), November 2, 1999.
- 249 525.
Prakash C. Gupta, D.Sc., F.A.C.E., Senior Research Scientist, Tata Institute of Fundamental
Research, Bombay, India, Letter to Kenneth Kyle (Director of Public Issues, Canadian Cancer
Society), September 14, 1999.
526.
Allan R. Handysides, M.B., Ch.B., F.R.C.S.(C), F.R.C.P.(C), Director, Health Ministries
Department, Seventh-Day Adventist Church, Silver Spring, Maryland, U.S.A., Letter to Ken Kyle
(Director of Public Issues, Canadian Cancer Society), September 27, 1999.
527.
Todd Harper, Executive Director, Victorian Smoking and Health Program, Cancer Control
Research Institute, Carlton, Victoria, Australia, Letter to Allan Rock (Minister of Health),
September 2, 1999.
528.
A.J. Hedley, MD, Chairman, Hong Kong Council on Smoking and Health, Professor of
Community Medicine, The University of Hong Kong, Hong Kong, Letter to Ken Kyle (Director of
Public Issues, Canadian Cancer Society), September 10, 1999.
529.
Clarita E. Herrera, M.D., President, American Medical Women’s Association, Alexandria,
Virginia, U.S.A., Letter to Ken Kyle (Canadian Cancer Society), November 2, 1999.
530.
Dr. David Hill, Director, Centre for Behavioural Research in Cancer, Anti-Cancer Council of
Victoria, Carlton South, Victoria, Australia, September 11, 1999.
531.
Robert Ho, Associate Professor (Psychology), School of Psychology and Sociology, Central
Queensland University, Australia, November 30, 1999.
532.
Richard D. Hurt, M.D., Director, Nicotine Dependence Center, Mayo Clinic, Rochester,
Minnesota, U.S.A, Letter to Ken Kyle (Canadian Cancer Society), September 9, 1999.
533.
Lori Karan, MD, Internist/Addiction Medicine, Division of Clinical Pharmacology and
Experimental Therapeutics, University of California, San Francisco, San Francisco, California,
U.S.A., September 20, 1999.
534.
Dr. P.R.W. Kendall, MBS, M.Sc., F.R.C.P.C., Provincial Health Officer, British Columbia,
Ministry of Health and Ministry Responsible for Seniors, Victoria, British Columbia, Canada,
Letter to Ken Kyle (Director of Public Issues, Canadian Cancer Society), September 8, 1999.
535.
Professor Gurprit S. Kindra, M.B.A., M.A., Ph.D., Faculty of Administration, University of
Ottawa, Ottawa, Ontario, Canada, 1999.
536.
Professor Elko Kleinschmidt, Faculty of Business, McMaster University, Hamilton, Ontario,
Canada, September 1, 1999.
537.
Jiri T. Kozak, Chairman, Czech Committee, European Medical Association Smoking or Health,
Prague, Czech Republic, October 30, 1999.
538.
Michel Laroche, MSRC, Professor of Marketing, Concordia University, Montreal, Canada,
August 26, 1999.
539.
Dr. Gaston LeBlanc, Vice-Dean, Professor of Marketing, Faculty of Business Administration,
University of Moncton, Moncton, New Brunswick, Canada, September 17, 1999.
540.
Dr. Cheryl Levitt, Professor and Chair, Faculty of Health Sciences, Department of Family
Medicine, McMaster University, Hamilton, Ontario, Canada, Letter to Ken Kyle (Director of
Public Issues, Canadian Cancer Society), August 30, 1999.
- 250 541.
Dr. Judith Mackay, M.B.E., J.P., F.R.C.P.(Edin), F.R.C.P.(Lon), F.H.K.A.M., Director, Asian
Consultancy on Tobacco Control, Hong Kong, Chair, World Health Organization Policy, Strategy
Advisory Committee for Tobacco Free Initiative, Letter to Allan Rock (Minister of Health),
August 18, 1999.
542.
Professor Lindsay Meredith, Marketing Professor and Associate Dean, Faculty of Business
Administration, Simon Fraser University, Burnaby, British Columbia, Canada, August 30, 1999.
543.
Robin Mermelstein, Ph.D., Associate Professor of Psychology, Deputy Director, Health Research
and Policy Centers, University of Illinois at Chicago, Chicago, Illinois, U.S.A., September 22,
1999.
544.
Dr. Antonio Pedro Mirra, Coordinator, Sao Paulo Cancer Registry, Department of Epidemiology,
Faculty of Public Health, University of Sao Paulo, Sao Paulo, Brazil, September 15, 1999.
545.
Janet Nevala, Coordinator, Program Training and Consultation Centre, Ottawa, Ontario, Canada,
September 10, 1999.
546.
Paul Nordgren, Principal Administrative Officer, National Institute of Public Health, Stockholm,
Sweden, September 8, 1999.
547.
Judith K. Ockene, Ph.D., M.Ed., Professor of Medicine and Director, Division of Preventive and
Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts,
U.S.A., September 21, 1999.
548.
Patrick M. O’Malley, Ph.D., Senior Research Scientist, Survey Research Center, Institute for
Social Research, University of Michigan, Ann Arbor, Michigan, U.S.A., Letter to Ken Kyle
(Canadian Cancer Society), August 31, 1999.
549.
Dr. Ron Plotnikoff, Assistant Professor, Center for Health Promotion Studies, University of
Alberta, Edmonton, Alberta, Canada, October 8, 1999.
550.
Rick Pollay, Professor of Marketing, Faculty of Commerce, University of British Columbia,
Vancouver, British Columbia, Canada, September 1, 1999.
551.
Ovide F. Pomerleau, Ph.D., Professor of Psychology in Psychiatry, Director, Department of
Psychiatry Behavioral Medicine Program, University of Michigan, Ann Arbor, Michigan, U.S.A.,
Letter to Ken Kyle (Director of Public Issues, Canadian Cancer Society), September 1, 1999.
552.
Pekka Puska, Director, Division of Health and Chronic Diseases, National Public Health Institute,
Helsinki, Finland, November 1, 1999.
553.
Dr. Pamela A. Ratner, Assistant Professor, Faculty of Nursing, Assistant Director, Institute of
Health Promotion Research, University of British Columbia, Vancouver, British Columbia,
Canada, September 10, 1999.
554.
Matti Rautalahti, Chief Medical Officer, Health Education and Communication, Cancer Society of
Finland, Helsinki, Finland, October 18, 1999.
555.
Nancy A. Rigotti, M.D., Director, Tobacco Research & Treatment Center, Medical Practice
Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, U.S.A., September 2,
1999.
556.
Professor Eliezer Robinson, Chairman, Israel Cancer Association, Israel, Letter to Allan Rock
(Minister of Health), August 24, 1999.
- 251 557.
Irving Rootman, Ph.D., Director, Centre for Health Promotion, University of Toronto, Toronto,
Ontario, Canada, August 24, 1999.
558.
Philip Rosson, Professor, Business Administration, Dalhousie University, Halifax, Nova Scotia,
Canada, October 1, 1999.
559.
Michelle Scollo, former Director, Victoria Smoking and Health Program, Australia, September 9,
1999.
560.
Marilyn Seguire, RN, MN, Lecturer, Faculty of Nursing, University of Manitoba, Winnipeg,
Manitoba, Canada, August 26, 1999.
561.
Herbert H. Severson, Ph.D., Senior Research Scientist, Oregon Research Institute, Eugene,
Oregon, U.S.A, Letter to Ken Kyle (Canadian Cancer Society), September 7, 1999.
562.
David Simpson, Director, International Agency on Tobacco and Health, London, United
Kingdom, Letter to Ken Kyle (National Public Issues Office, Canadian Cancer Society), October
28, 1999.
563.
Dr. Karen Slama, Ph.D., Head, Tobacco Prevention Division, International Union Against
Tuberculosis and Lung Disease, Paris, France, October 13, 1999 [two items, including Letter to
Allan Rock (Minister of Health)].
564.
Tomas Stanikas, Lecturer, Department of Preventive Medicine, Kaunas University of Medicine,
Kaunas, Lithuania, October 14, 1999.
565.
Matt Tesoriero, Account Supervisor, Account Management, Arnold Communications, Boston,
Massachusetts, U.S.A., September 21, 1999.
566.
Scott Thompson, Editor, STOP! Magazine, Inc., San Clemente, California, U.S.A., 1999, and
Feburary 12, 2000 [two items, including letter to Katrina Edwards (Health Canada)].
567.
Professor Maurice Tubiana, Alliance française pour la santé, Coalition contre le tabagisme,
[French Health Alliance, Coalition Against Tobacco] Paris, France, Letter to Ken Kyle (Canadian
Cancer Society), October 12, 1999.
568.
Fernand Turcotte, Professor, Faculty of medicine, Department of Social and Preventive Medicine,
Laval University, Quebec City, Quebec, Canada, Letter to Ken Kyle (Director of Public Issues,
Canadian Cancer Society), September 13, 1999.
569.
A.J. Turnbull, Executive Director, International Union Against Cancer, Geneva, Switzerland,
Letter to Ken Kyle (Director of Public Issues), November 2, 1999.
570.
Professor Witold Zatonksi, Health Promotion Foundation and Center for Cancer Epidemiology
and Prevention, Warsaw, Poland, Letter to Allan Rock (Minister of Health) August 20, 1999.
Part IV – Expert Opinions – Plain Packaging
571.
Rolando Arellano, Professor, Department of Marketing, Laval University, Quebec City, Quebec,
Canada, May 12, 1994.
572.
Wes Balderson, Associate Professor, University of Lethbridge, Lethbridge, Alberta, Canada, May
2, 1994.
- 252 573.
John D. Bishop, Professor of Marketing and Business Ethics, Trent University, Peterborough,
Ontario, Canada, May 2, 1994.
574.
Alain Bouchard, Professor, Administrator, University of Quebec at Chicoutimi, Chicoutimi,
Quebec, Canada, May 5, 1994.
575.
Gilles Boucher, Professor, University of Moncton, Moncton, New Brunswick, Canada, May 5,
1994.
576.
Philippe Chapuis, Ph.D., Professor of Marketing, University of Quebec at Hull, Hull, Quebec,
Canada, April 26, 1994.
577.
Carole Duhaime, Professor, School of Commerce, University of Montreal, Montreal, Quebec,
Canada, May 1, 1994.
578.
Katherine Gallagher, Assistant Professor, Marketing, Memorial University of Newfoundland, St.
John’s, Newfoundland, Canada, May 16, 1994.
579.
D.F. Gardiner, Professor, Commerce, University of British Columbia, Vancouver, British
Columbia, Canada, May 9, 1994.
580.
Elko J. Kleinschmidt, Associate Professor, McMaster University, Hamilton, Ontario, Canada, May
3, 1994.
581.
David Large, Ph.D., Assistant Professor, Marketing, University of Ottawa, Ottawa, Ontario,
Canada, April 26, 1994.
582.
Michel Laroche, Professor of Marketing, Concordia University, Montreal, Quebec, Canada, May
2, 1994.
583.
Dr. Gaston LeBlanc, Professor of Marketing, University of Moncton, Moncton, New Brunswick,
Canada, May 2, 1994.
584.
Dr. Lindsay Meredith, Professor and Director, Graduate Programs, Faculty of Business, Simon
Fraser University, Burnaby, British Columbia, Canada, May 9, 1994.
585.
Benny Rigaux-Bricmont, Professor of Marketing, Laval University, Quebec City, Quebec,
Canada, April 29, 1994.
586.
Guy Robert, Professor of Marketing, University of Quebec at Chicoutimi, Chicoutimi, Quebec,
Canada, April 29, 1994.
587.
Philip Rosson, Professor, Dalhousie University, Halifax, Nova Scotia, Canada, May 2, 1994.
588.
Jean Roy, Professor, University of Quebec at Chicoutimi, Chicoutimi, Quebec, Canada, April 28,
1994.
589.
Peter D. Sianchuk, Assistant Professor of Commerce, Mount Allison University, Sackville, Nova
Scotia, Canada, May 24, 1999.
590.
Richard Sparkman, Associate Professor of Marketing, Acadia University, Wolfville, Nova Scotia,
Canada, May 10, 1994.
591.
M.V. Thakor, PhD, Assistant Professor, Marketing, Concordia University, Montreal, Quebec,
Canada, June 8, 1994.
- 253 592.
Ronald E. Turner, Professor, Queen’s University, School of Business, Kingston, Ontario, Canada,
April 29, 1994.
593.
Douglas C. West, Associate Professor, University of Calgary, Calgary, Alberta, Canada, May 12,
1994.