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Objectives. We sought to learn how employees reacted to changes in the corporate narrative of Philip Morris Companies (PMC) in the late 1990s and early 2000s. Methods. We analyzed archival internal tobacco industry documents about PMC's creation of a new corporate story. Results. In response to litigation and public opprobrium, PMC replaced its market success-oriented corporate narrative with a new one centered on responsibility. Although management sought to downplay inconsistencies between the old and new narratives, some employees reportedly had difficulty reconciling them, concerned that the responsibility focus might affect company profitability. However, others embraced the new narrative, suggesting radical ideas to prevent youth smoking. These ideas were not adopted. Conclusions. PMC's new narrative was unconvincing to many of its employees, who perceived it either as a threat to the company's continued profits or as incongruous with what they had previously been told. As it had done with the public, PMC misled its employees in explaining a narrative repositioning that would help the company continue business as usual. Moving toward a tobacco endgame will require ongoing discursive and symbolic efforts to disrupt this narrative. [ABSTRACT FROM AUTHOR]

Smoking impairs the readiness and performance of military personnel, yet congressional opposition has thwarted military tobacco control initiatives. Involvement of civilian organizations might alter this political dynamic. We interviewed 13 leaders of national civilian public health and tobacco control organizations to explore their perspectives on military tobacco control, inductively analyzing data for themes. Leaders believed that military tobacco use was problematic but lacked specific knowledge. Most supported smoke-free policies and prohibiting smoking in uniform; however, they opposed banning tobacco use, arguing that it would violate smokers’ rights. Most leaders inappropriately applied civilian models of policy development to the military context. A tobacco-free military is unlikely to be achieved without military–civilian partnerships that include educating civilian health leaders about military policy development and implementation. [ABSTRACT FROM AUTHOR]

Objectives. We examined Philip Morris USA's exploration of corporate social responsibility practices and principles and its outcome. Methods. We analyzed archival internal tobacco industry documents, generated in 2000 to 2002, related to discussions of corporate social responsibility among a Corporate Responsibility Taskforce and senior management at Philip Morris. Results. In exploring corporate social responsibility, Philip Morris executives sought to identify the company's social value-its positive contribution to society. Struggling to find an answer, they considered dramatically changing the way the company marketed its products, apologizing for past actions, and committing the company to providing benefits for future generations. These ideas were eventually abandoned. Despite an initial call to distinguish between social and economic value, Philip Morris ultimately equated social value with providing shareholder returns. Conclusions. When even tobacco executives struggle to define their company's social value, it signals an opening to advocate for endgame scenarios that would encourage supply-side changes appropriate to the scale of the tobacco disease epidemic and consistent with authentic social value. [ABSTRACT FROM AUTHOR]

Objectives. We examined Philip Morris USA's exploration of corporate social responsibility practices and principles and its outcome. Methods. We analyzed archival internal tobacco industry documents, generated in 2000 to 2002, related to discussions of corporate social responsibility among a Corporate Responsibility Taskforce and senior management at Philip Morris. Results. In exploring corporate social responsibility, Philip Morris executives sought to identify the company's social value-its positive contribution to society. Struggling to find an answer, they considered dramatically changing the way the company marketed its products, apologizing for past actions, and committing the company to providing benefits for future generations. These ideas were eventually abandoned. Despite an initial call to distinguish between social and economic value, Philip Morris ultimately equated social value with providing shareholder returns. Conclusions. When even tobacco executives struggle to define their company's social value, it signals an opening to advocate for endgame scenarios that would encourage supply-side changes appropriate to the scale of the tobacco disease epidemic and consistent with authentic social value. [ABSTRACT FROM AUTHOR]

Contemporary health care reformers, like those who promoted the failed Clinton era plan, face opposition from multiple corporate interests. However, scant literature has examined how relationships between corporations and other stakeholders, such as think tanks and advocacy groups, shape health care reform debate. We show how the 2 biggest US tobacco companies, Philip Morris and RJ Reynolds, and their trade association coordinated in mobilizing ideologically diverse constituencies to help defeat the Clinton plan. Unwittingly perhaps, some reform supporters advanced the tobacco industry's public relations blitz, contributing to perceptions of public opposition to the plan. As the current reform debate unfolds, this case highlights the importance of funding transparency for interpreting the activities of think tanks, advocacy groups, and "grassroots" movements. [ABSTRACT FROM AUTHOR]

The "We Card" program is the most ubiquitous tobacco industry "youth smoking prevention" program in the United States, and its retailer materials have been copied in other countries. The program's effectiveness has been questioned, but no previous studies have examined its development, goals, and uses from the tobacco industry's perspective. On the basis of our analysis of tobacco industry documents released under the 1998 Master Settlement Agreement, we concluded that the We Card program was undertaken for 2 primary purposes: to improve the tobacco industry's image and to reduce regulation and the enforcement of existing laws. Policymakers should be cautious about accepting industry self-regulation at face value, both because it redounds to the industry's benefit and because it is ineffective. [ABSTRACT FROM AUTHOR]

Deployment of young Americans in military engagements places them at increased risk for not only war hazards but also tobacco addiction and disease. Tobacco use diminishes troop health and readiness, and increases medical and training costs. Military tobacco control efforts began in 1986, yet tobacco use remains high. To determine whether and how the tobacco industry targets military personnel in wartime, we analyzed internal industry documents about the Gulf War (1990-1991) and constructed a historical case study. During this conflict, tobacco companies targeted troops with free cigarettes, direct advertising, branded items, ways to communicate with family, and "welcome home" events. Military authorities sometimes restricted this activity, but frequently enabled it; tobacco companies were regarded as benefactors. Considering tobacco use a benefit undermines military health priorities. Stronger policy is needed to reframe tobacco use as incompatible with military ideals. (Am J Public Health. 2009;99:1595-1602. doi:10.2105/AJPH.2008.152983) [ABSTRACT FROM AUTHOR]

Objectives. We explored what corporate "credibility" means to tobacco companies to determine why it matters to companies and what a lack of credibility means to them. Methods. We collected documents from an online tobacco industry document archive and analyzed them with an interpretive approach. Results. Tobacco companies conceptualized credibility not as being worthy of belief or confidence but as inspiring it. Thus, credibility was understood primarily as altering public perception of the industry. "Truth" was largely absent from tobacco industry conceptualizations of credibility, which were linked with "responsibility" and "reasonableness." However, industry research found that the public regarded credibility and responsibility differently, expecting these to entail truth telling, advertising reductions, less harmful products, apologies for deception, making amends, or exiting the tobacco business altogether. Overall, industry credibility-building projects failed repeatedly. Conclusions. Public health discourse increasingly attends to the roles of corporations in promoting disease. Industries such as tobacco and alcohol have been identified as profiting from harmful products. Yet corporations' ability to continue business as usual requires sustaining an implicit societal assent to their activities that depends on corporate credibility. For public health to address corporate disease promotion effectively, undermining corporate credibility may be strategically important. [ABSTRACT FROM AUTHOR]

Secondhand smoke (SHS) exposure is a known cause of disease among nonsmokers, contributing to lung cancer, heart disease, and sudden infant death syndrome, as well as other diseases. In response to the growing body of scientific literature linking SHS with serious diseases, many countries, states, and cities have established policies mandating smoke-free public spaces. Yet thousands of children remain unprotected from exposure to SHS in private homes and cars. New initiatives targeting SHS in these spaces have raised ethical questions about imposing constraints on private behavior. We reviewed legislation and court cases related to such initiatives and used a principlist approach to analyze the ethical implications of policies banning smoking in private cars and homes in which children are present. (Am J Public Health. 2008; 98:2140-2145. doi:10.2105/ AJPH.2007.130856) [ABSTRACT FROM AUTHOR]

To counter negative publicity about the tobacco industry, Philip Morris has widely publicized its philanthropy initiatives. Although corporate philanthropy is primarily a public relations tool, contributions may be viewed as offsetting the harms caused by corporate products and practices. That such donations themselves have harmful consequences has been little considered. Drawing on internal company documents, we explored the philanthropy undertaken as part of Philip Morris's PM21 image makeover. Philip Morris explicitly linked philanthropy to government affairs and used contributions as a lobbying tool against public health policies. Through advertising, covertly solicited media coverage, and contributions to legislators' pet causes, Philip Morris improved its image among key voter constituencies, influenced public officials, and divided the public health field as grantees were converted to stakeholders. (Am J Public Health. 2008;98: 2123-2133. doi:10.2105/AJPH. 2007,128231) [ABSTRACT FROM AUTHOR]

Objectives. To better understand how the tobacco industry responds to tobacco control activists, we explored Philip Morris's response to demands that consumers in developing countries be informed about smoking risks, and analyzed the implications of negotiating with a tobacco company. Methods. We reviewed internal tobacco industry documents and related materials, constructed a case history of how Philip Morris responded to a shareholder campaign to require health warnings on cigarettes sold worldwide, and analyzed interactions between (1) socially responsible investment activists, (2) Philip Morris management, (3) institutional investors, and (4) industry competitors. Results. After resisting for 11 years, Philip Morris unilaterally reversed direction, and proposed its own labeling initiative. While activists celebrated, Philip Morris's president detailed privately how the company would yield little and benefit disproportionately. Activists portrayed the tobacco industry as preying on the poor and uneducated and used delegitimization to drive a wedge between the industry and its financial and political allies. When Philip Morris "gave in" to their demands, it exchanged negative publicity for positive public relations and political credibility. Conclusions. Tobacco companies can appear to accommodate public health demands while securing strategic advantages. Negotiating with the tobacco industry can enhance its legitimacy and facilitate its ability to market deadly cigarettes without corresponding benefits to public health. (Am J Public Health. 2006;96:2048-2054. doi:10.2105/AJPH.2005.075119) [ABSTRACT FROM AUTHOR]

Community-based participatory research (CBPR) addresses the social justice dimensions of health disparities by engaging marginalized communities, building capacity for action, and encouraging more egalitarian relationships between researchers and communities. CBPR may challenge institutionalized academic practices and the understandings that inform institutional review board deliberations and, indirectly, prioritize particular kinds of research. We present our attempt to study, as part of a CBPR partnership, cigarette sales practices in an inner-city community. We use critical and communitarian perspectives to examine the implications of the refusal of the university institutional review board (in this case, the University of California, San Francisco) to approve the study. CBPR requires expanding ethical discourse beyond the procedural, principle-based approaches common in biomedical research settings. The current ethics culture of academia may sometimes serve to protect institutional power at the expense of community empowerment. (Am J Public Health. 2006,-96:1914-1919. doi: 10.2105/AJPH.2005.082172) [ABSTRACT FROM AUTHOR]

Objectives. This case study describes the events surrounding the first time a major tobacco company advertised in gay media. Methods. We analyzed internal tobacco company documents, mainstream newspapers, and the gay press. Results. Philip Morris was unprepared for the attention its entry into the gay market received. The company's reaction to this incident demonstrates that its approach to the gay community both parallels and diverges from industry strategies toward other marginalized communities. Conclusions. The tobacco industry's relationship to the gay community is relatively undeveloped, a fact that may provide tobacco control advocates an opportunity for early intervention. The gay community's particular vulnerabilities to the industry make development of gay tobacco control programs crucial to reducing gay smoking prevalence and industry presence in the community. (Am J Public Health. 2003;93:988-993) [ABSTRACT FROM AUTHOR]

Philip Morris Companies, the world's largest and most profitable tobacco seller, has changed its corporate name to The Altria Group. The company has also embarked on a plan to improve its corporate image. Examination of internal company documents reveals that these changes have been planned for over a decade and that the company expects to reap specific and substantial rewards from them. Tobacco control advocates should be alert to the threat Philip Morris's plans pose to industry-focused tobacco control campaigns. Company documents also suggest what the vulnerabilities of those plans are and how advocates might best exploit them. (Am J Public Health. 2003;93:553-556) [ABSTRACT FROM AUTHOR]

Objectives. The goal of this study was to describe how the tobacco industry collects information about public health groups. Methods. Publicly available internal tobacco industry documents were reviewed and analyzed using a chronological case study approach. Results. The industry engaged in aggressive intelligence gathering, used intermediaries to obtain materials under false pretenses, sent public relations spies to the organizations' meetings, and covertly taped strategy sessions. Other industry strategies included publicly minimizing the effects of boycotts, painting health advocates as "extreme," identifying and exploiting disagreements, and planning to "redirect the funding" of tobacco control organizations to other purposes. Conclusions. Public health advocates often make light of tobacco industry observers, but industry surveillance may be real, intense, and covert and may obstruct public health initiatives. (Am J Public Health. 2002;92:955-960) [ABSTRACT FROM AUTHOR]

Objectives. This study examined the accessibility and appeal to youth of cigar marketing sites on the Internet. Methods. Sites marketing cigars (n = 141) were examined for age restrictions, prices, health warnings, and other elements. Results, Although it is illegal for minors to purchase tobacco, only 36 sites (25.5%) prohibited purchases by minors. Sites offered low prices, and 32% accepted money orders, cashier's checks, or cash-on-delivery (COD) orders. Almost 30% of the sites included elements with potential youth appeal; only 3.5% displayed health warnings, Conclusions. The unregulated promotion of cigars on the Internet has the potential to attract youth, and there are few barriers to Internet tobacco purchases by minors. (Am d Public Health. 2000;90:790-792) [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Responsibility As an Ethical Framework for Public Health Interventions," by F. Turoldo in the July 2009 issue.

Tobacco use is prevalent among service members, but civilian public health groups have not effectively addressed military tobacco control policy issues. We conducted focus groups in 2010 and 2012 with participants from public health and tobacco control organizations regarding their understanding of the military and of tobacco use in that context. Misperceptions were common. Military personnel were believed to be young, from marginalized populations, and motivated to join by lack of other options. Tobacco use was considered integral to military life; participants were sometimes reluctant to endorse stronger tobacco control policies than those applied to civilians, although some believed the military could be a social policy leader. Engaging public health professionals as effective partners in tobacco-free military efforts may require education about and reframing of military service and tobacco control policy. [ABSTRACT FROM AUTHOR]

Tobacco use is prevalent among service members, but civilian public health groups have not effectively addressed military tobacco control policy issues. We conducted focus groups in 2010 and 2012 with participants from public health and tobacco control organizations regarding their understanding of the military and of tobacco use in that context. Misperceptions were common. Military personnel were believed to be young, from marginalized populations, and motivated to join by lack of other options. Tobacco use was considered integral to military life; participants were sometimes reluctant to endorse stronger tobacco control policies than those applied to civilians, although some believed the military could be a social policy leader. Engaging public health professionals as effective partners in tobacco-free military efforts may require education about and reframing of military service and tobacco control policy. [ABSTRACT FROM AUTHOR]

Military personnel and veterans are disadvantaged by inadequate tobacco control policies. We conducted a case study of a Department of Veterans Affairs (VA) effort to disallow smoking and tobacco sales in VA facilities. Despite strong VA support, the tobacco industry created a public relations–focused grassroots veterans’ opposition group, eventually pushing the US Congress to pass a law requiring smoking areas in every VA health facility. Arguing that it would be unpatriotic to deny veterans this “freedom” they had ostensibly fought for and that banning smoking could even harm veterans’ health, industry consultants exploited veterans’ organizations to protect tobacco industry profits. Civilian public health advocates should collaborate with veterans to expose the industry’s manipulation, reframe the debate, and repeal the law. [ABSTRACT FROM AUTHOR]

Objectives. We explored the relationship between tobacco companies and the Black press, which plays an important role in conveying information and opinions to Black communities. Methods. In this archival case study, we analyzed data from internal tobacco industry documents and archives of the National Newspaper Publishers Association (NNPA), the trade association of the Black press. Results. In exchange for advertising dollars and other support, the tobacco industry expected and received support from Black newspapers for tobacco industry policy positions. Beginning in the 1990s, resistance from within the Black community and reduced advertising budgets created counterpressures. The tobacco industry, however, continued to sustain NNPA support. Conclusions. The quid pro quo between tobacco companies and the Black press violated journalistic standards and represented an unequal trade. Although numerous factors explain today's tobacco-related health disparities, the Black press's service to tobacco companies is problematic because of the trust that the community placed in such media. Understanding the relationship between the tobacco industry and the NNPA provides insight into strategies that the tobacco industry may use in other communities and countries. [ABSTRACT FROM AUTHOR]

In this descriptive case study, we analyze the unsuccessful struggle to access disability pensions by veterans sickened by tobacco use begun during service. Drawing on tobacco industry documents and other material, we show how the US government, tobacco industry, and veterans' organizations each took inconsistent positions to protect their interests. Congress and Department of Veterans Affairs leadership, concerned about costs, characterized veterans' smoking as "willful misconduct," thereby contradicting the government's position in a federal lawsuit that tobacco companies addicted smokers. Veterans' groups supported the pensions, despite previously defending smoking as a "right." The tobacco industry wavered, fearing liability. Securing pensions was complicated by the notion that smoking is primarily a personal choice. The US government should compensate veterans fairly and should abolish military practices that encourage tobacco addiction. [ABSTRACT FROM AUTHOR]

In the United States, companies that use their own funds to test consumer products on their employees are subject to few regulations. Using previously undisclosed tobacco industry documents, we reviewed the history of that industry's efforts to create internal guidelines on the conditions to be met before employee taste testers could evaluate cigarettes made from tobacco treated with experimental pesticides. This history highlights 2 potential ethical issues raised by unregulated industrial research: conflict of interest and lack of informed consent. To ensure compliance with accepted ethical standards, an independent federal office should be established to oversee industrial research involving humans exposed to experimental or increased quantities of ingested, inhaled, or absorbed chemical agents. (Am J Public Health. 2006;96: 37-46.) [ABSTRACT FROM AUTHOR]

The article discusses research on tobacco use patterns among African American youths. In 1999, six focus groups were conducted in California with fifty consenting African American youths recruited at schools and community centers in two cities in the San Francisco area. The study found that the groups described three ways of referring to the word cigar. Findings from the pre-discussion and post-discussion questionnaires suggested confusion as to what exactly is meant by the word. It has been indicated that African American students are significantly more likely to smoke cigarettes than White students and the percentage of African American male youths who indicate that they are frequent users is reportedly higher than that of White or Hispanic male youths or that of female youths.

Objectives. Media play an important role in the diffusion of innovations by spreading knowledge of their relative advantages. We examined media coverage of retailers abandoning tobacco sales to explore whether this innovation might be further diffused by media accounts. Methods. We searched online media databases (Lexis Nexis, Proquest, and Access World News) for articles published from 1995 to 2011, coding retrieved items through a collaborative process. We analyzed the volume, type, provenance, prominence, and content of coverage. Results. We found 429 local and national news items. Two retailers who were the first in their category to end tobacco sales received the most coverage and the majority of prominent coverage. News items cited positive potential impacts of the decision more often than negative potential impacts, and frequently referred to tobacco-caused disease, death, or addiction. Letters to the editor and editorials were overwhelmingly supportive. Conclusions. The content of media coverage about retailers ending tobacco sales could facilitate broader diffusion of this policy innovation, contributing to the denormalization of tobacco and moving society closer to ending the tobacco epidemic. Media advocacy could increase and enhance such coverage. [ABSTRACT FROM AUTHOR]

Objectives. Media play an important role in the diffusion of innovations by spreading knowledge of their relative advantages. We examined media coverage of retailers abandoning tobacco sales to explore whether this innovation might be further diffused by media accounts. Methods. We searched online media databases (Lexis Nexis, Proquest, and Access World News) for articles published from 1995 to 2011, coding retrieved items through a collaborative process. We analyzed the volume, type, provenance, prominence, and content of coverage. Results. We found 429 local and national news items. Two retailers who were the first in their category to end tobacco sales received the most coverage and the majority of prominent coverage. News items cited positive potential impacts of the decision more often than negative potential impacts, and frequently referred to tobacco-caused disease, death, or addiction. Letters to the editor and editorials were overwhelmingly supportive. Conclusions. The content of media coverage about retailers ending tobacco sales could facilitate broader diffusion of this policy innovation, contributing to the denormalization of tobacco and moving society closer to ending the tobacco epidemic. Media advocacy could increase and enhance such coverage. [ABSTRACT FROM AUTHOR]

In 1986, the US Navy announced the goal of becoming smoke-free by 2000. However, efforts to restrict tobacco sales and use aboard the USS Roosevelt prompted tobacco industry lobbyists to persuade their allies in Congress to legislate that all naval ships must sell tobacco. Congress also removed control of ships' stores from the Navy. By 1993, the Navy abandoned its smoke-free goal entirely and promised smokers a place to smoke on all ships. Congressional complicity in promoting the agenda of the tobacco industry thwarted the Navy's efforts to achieve a healthy military workforce. Because of military lobbying constraints, civilian pressure on Congress may be necessary to establish effective tobacco control policies in the armed forces. [ABSTRACT FROM AUTHOR]

In the public health literature, it is generally assumed that the perception of "targeting" as positive or negative by the targeted audience depends on the product or message being promoted. Smoking prevalence rates are high among lesbian, gay, bisexual, and transgender (LGBT) individuals, but little is known about how they perceive tobacco industry targeting. We conducted focus groups with LGBT individuals in 4 US cities to explore their perceptions. Our findings indicated that focus group participants often responded positively to tobacco company targeting. Targeting connoted community visibility, legitimacy, and economic viability. Participants did not view tobacco as a gay health issue. Targeting is a key aspect of corporate — community interaction. A better understanding of targeting may aid public health efforts to counter corporate disease promotion. (Am J Public Health. 2008;98:99&-1003. doi:10.2105/AJPH.2007.118174) [ABSTRACT FROM AUTHOR]

This letter to the editor discusses the article "Children's secondhand smoke exposure in private homes and cars: an ethical analysis" written by J.A. Jarvie and R.E. Malone and published in volume 98 issue 12 of this journal in 2008.

Letters to the editor referring to a recent Journal article are encouraged up to 3 months after the article's appearance. By submitting a letter to the editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 10 references. Submit online at www.editorialmanager.com/ajph for immediate Web posting, or at ajph.edmgr.com for later print publication. Online responses are automatically considered for print publication. Queries should be addressed to the Editor-in-Chief, Mary E. Northridge, PhD, MPH, at men6@nyu.edu. [ABSTRACT FROM AUTHOR]