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Background and aims: The ubiquity of tobacco retailers helps to sustain the tobacco epidemic. A tobacco retail reduction approach that has not been tried is transitioning tobacco sales to state‐controlled alcohol stores (TTS), which are limited in number and operate under some restrictions, e.g. regarding opening hours or marketing materials. This study summarizes policy experts' and advocates' views of TTS, including (1) advantages and disadvantages; (2) feasibility; and (3) potential implementation obstacles. Design: This study was a qualitative content analysis of semi‐structured interviews. Setting: Ten US states with alcoholic beverage control systems were included. Participants: The participants comprised a total of 103 tobacco control advocates and professionals, public health officials, alcohol policy experts and alcohol control system representatives, including two tribal community representatives. Measurements Interviewees' perspectives on their state's alcoholic beverage control agency (ABC, the agency that oversees or operates a state alcohol monopoly) and on TTS were assessed. Findings Interviewees thought TTS offered potential advantages, including reduced access to tobacco products, less exposure to tobacco advertising and a greater likelihood of successful smoking cessation. Some saw potential long‐term health benefits for communities of color, due to the smaller number of state alcohol stores in those communities. Interviewees also raised concerns regarding TTS, including ABCs' limited focus on public health and emphasis on revenue generation, which could conflict with tobacco use reduction efforts. Some interviewees thought TTS could enhance the power of the tobacco and alcohol industries, increase calls for alcohol system privatization or create difficulties for those in recovery. Conclusions: In the United States, transitioning tobacco sales to state‐controlled alcohol stores (TTS) could have a positive public health impact by reducing tobacco availability, marketing exposure and, ultimately, tobacco use. However, tensions exist between alcohol control system goals of providing revenue to the state and protecting public health. Should a state decide to pursue TTS, several guardrails should be established, including building into the legislation an explicit goal of reducing tobacco consumption. [ABSTRACT FROM AUTHOR]

Background: In June 2019, Beverly Hills, California, became the first American city in the 21st century to pass an ordinance ending the sale of most tobacco products, including cigarettes, and it is unlikely to be the last. Knowledge of previous efforts to ban tobacco sales in the US, both successful and unsuccessful, may help inform tobacco control advocates' approach to future efforts. Methods: We retrieved and analyzed archival tobacco industry documents. We confirmed and supplemented information from the documents with news media coverage and publicly available state and local government materials, such as meeting minutes and staff reports, related to proposed bans. Results: We found 22 proposals to end the sale of cigarettes or tobacco products from 1969–2020 in the US. Proposals came from five states, twelve cities or towns, and one county. Most came from elected officials or boards of health, and were justified on public health grounds. In opposing tobacco sales bans, the tobacco industry employed no tactics or arguments that it did not also employ in campaigns against other tobacco control measures. Public health groups typically opposed sales ban proposals on the grounds that they were not evidence-based. This changed with Beverly Hills' 2019 proposal, with public health organizations supporting this and other California city proposals because of their likely positive health impacts. This support did not always translate into passage of local ordinances, as some city council members expressed reservations about the impact on small businesses. Conclusion: Tobacco control advocates are likely to encounter familiar tobacco industry tactics and arguments against tobacco sales ban proposals, and can rely on past experience and the results of a growing body of retail-related research to counter them. Considering how to overcome concerns about harming retailers will likely be vital if other jurisdictions are to succeed in ending tobacco sales. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco content has been identified in popular video games played by adolescents. To date, there are no established instruments for categorizing tobacco content. We describe development and demonstrate the use of an instrument to categorize types of tobacco content.Methods: Interviews were conducted with 61 participants: 20 adolescents (mean age 17.7), and 41 adults (mean age 23.9), who discussed favorite games and recalled tobacco content. All games mentioned were examined for tobacco content by watching movies of game play on YouTube, examining individual game Wiki sites, and reviewing content descriptors provided by the Entertainment Software Rating Board (ESRB), Common Sense Media, and the Internet Movie Database (IMDb). A typology of tobacco content was created and correlated with gamer recall of tobacco content.Results: Participants together mentioned 366 games, of which 152 were unique. Tobacco content was verified in 39.5% (60/152) of games. Six categories of content were identified, including "no tobacco content." Of games containing tobacco, 88% (53/60) contained at least two categories of content. Games with more categories were associated with greater gamer recall of tobacco content.Conclusion: Tobacco content is present in video games and consciously recalled by players, with higher accuracy of recall associated with games featuring multiple types of tobacco content and more engaging, player-active content.Implications: Playing video games is now a daily part of most adolescents' lives. Tobacco content is present in many popular games. Currently there are no published instruments to assist in categorizing tobacco content in video games. This study describes a systematic approach to categorize tobacco content in video games and demonstrates that games featuring more categories of tobacco content are associated with more accurate gamer recall of the presence of tobacco content when compared with games with fewer categories of content. Understanding the extent of such content will be essential in formulating tobacco control strategies to address tobacco content in games. [ABSTRACT FROM AUTHOR]

Purpose: To explore why some hotels have implemented 100% smoke-free policies voluntarily, the perceived consequences of doing so, and media responses.Design: Qualitative study of hotel management and quantitative content analysis of media coverage of smoke-free hotels.Setting: Hotels and media based in the United States.Participants: Eleven representatives of 5 independent and 4 chain hotels. Other data included 265 news items about smoke-free hotels.Method: We conducted 30-minute semi-structured interviews with hotel representatives and analyzed the data using qualitative content analysis. We also searched 3 online news databases for news items about hotels in our study, and collaboratively coded retrieved items; we analyzed the content and slant of news items.Results: Business considerations, including guest requests, competitor action, and cost savings, were the primary motivations for implementing 100% smoke-free guest-room policies. Health concerns played a minimal role. Hotels received positive feedback from customers and employees. Media coverage was favorable, emphasizing positive aspects of going smoke-free; the overall slant of news items was positive or neutral. However, few hotels marketed the change.Conclusions: Since hotel customers and employees are likely to experience long periods of smoke exposure and smoke-free hotels appear to be so well received, it may be timely to pursue policies making all hotels smoke-free. [ABSTRACT FROM AUTHOR]

Objectives: Although the United States Air Force (USAF) has been a leader in efforts to reduce tobacco use among service members, tobacco continues to be a problem and initiatives to decrease tobacco use further require buy-in from leadership. We explored line leaderships' perspectives on tobacco. Methods: A diverse group of 10 senior commissioned and 10 non-commissioned personnel were interviewed. Results: Respondents reported substantial changes in the culture of tobacco use during their years of service, from near ubiquity to restricted use areas. They also perceived mixed messages coming from the USAF, including simultaneous discouragement of and accommodations for tobacco use, and variability in policies and enforcement. Many respondents indicated that allowing tobacco use creates conflict and undermines military discipline and suggested that a tobacco-free policy would be the best way to eliminate these contradictions. Conclusions: Although there has been substantial movement away from a culture of tobacco in the USAF, current policies and variable enforcement of these policies create unnecessary contradictions. Establishing a tobacco-free service would resolve these issues in addition to improving the health of service members and veterans. [ABSTRACT FROM AUTHOR]

Introduction: Video games are played by a majority of adolescents, yet little is known about whether and how video games are associated with smoking behavior and attitudes. This systematic review examines research on the relationship between video games and smoking.Methods: We searched MEDLINE, psycINFO, and Web of Science through August 20, 2014. Twenty-four studies met inclusion criteria. Studies were synthesized qualitatively in four domains: the prevalence and incidence of smoking imagery in video games (n = 6), video game playing and smoking behavior (n = 11), video game addiction and tobacco addiction (n = 5) and genre-specific game playing and smoking behavior (n = 3).Results: Tobacco content was present in a subset of video games. The literature is inconclusive as to whether exposure to video games as a single construct is associated with smoking behavior. Four of five studies found an association between video game addiction and smoking. For genre-specific game playing, studies suggest that the type of game played affected association with smoking behavior.Conclusions: Research on how playing video games influences adolescents' perceptions of smoking and smoking behaviors is still in its nascence. Further research is needed to understand how adolescents respond to viewing and manipulating tobacco imagery, and whether engaging in game smoking translates into changes in real-world attitudes or behavior. Smoking imagery in video games may contribute to normalizing adolescent smoking.Implications: A large body of research has shown that smoking imagery in a variety of media types contributes to adolescent smoking uptake and the normalization of smoking behavior, and almost 90% of adolescents play video games, yet there has never been a published systematic review of the literature on this important topic. This is the first systematic review to examine the research on tobacco and video games.We found that tobacco imagery is indeed present in video games, the relationship between video game playing and smoking remains unclear, there appears to be a correlation between problem gaming and smoking and the genre of games may play a role in adolescent smoking behavior. [ABSTRACT FROM AUTHOR]

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]

Purpose. To examine perceptions of military personnel about tobacco use. Design. Secondary analysis of (1) focus group and (2) interview data. Setting. U.S. military. Subjects. Total participants (n = 241): Enlisted personnel, supervisors (n = 189 individuals participating in 23 focus groups), tobacco control managers, and policy leaders (n = 52 interview participants). Intervention. Not applicable. Measures. Not applicable. Analysis. Inductive, iterative coding for salient themes using an interpretive approach. Application of the concept of mediatory myths, used by institutions to cover over internal contradictions. Results. All types of participants endorsed the idea that tobacco was needed in the military for stress relief. Types of stress identified included fitting in, (relationships with coworkers and superiors) and control of workflow (taking breaks). Participants also discussed beliefs about the impact of tobacco on the military mission, and institutional sanction of tobacco use. Conclusion. Despite tobacco's well-documented negative effects on fitness, the myth that tobacco relieves stress serves several institutional functions in the military. It serves to minimize perceptions of stress on the fitness of personnel, suggests that stress can be managed solely by individuals, and institutionalizes tobacco use. Growing recognition among military leadership that countering stress is essential to fitness offers an opportunity to challenge this myth. [ABSTRACT FROM AUTHOR]

Background: In the US, denormalizing tobacco use is key to tobacco control; less attention has been paid to denormalizing tobacco sales. However, some localities have placed limits on the number and type of retailers who may sell tobacco, and some retailers have abandoned tobacco sales voluntarily. Understanding community norms surrounding tobacco sales may help accelerate tobacco denormalization. Methods: We conducted 15 focus groups with customers of California, New York, and Ohio retailers who had voluntarily discontinued tobacco sales to examine normative assumptions about where cigarettes should or should not be sold, voluntary decisions to discontinue tobacco sales, and government limits on such sales. Results: Groups in all three states generally agreed that grocery stores that sold healthy products should not sell tobacco; California groups saw pharmacies similarly, while this was a minority opinion in the other two states. Convenience stores were regarded as a natural place to sell tobacco. In each state, it was regarded as normal and commendable for some stores to want to stop selling tobacco, although few participants could imagine convenience stores doing so. Views on government's role in setting limits on tobacco sales varied, with California and New York participants generally expressing support for restrictions, and Ohio participants expressing opposition. However, even those who expressed opposition did not approve of tobacco sales in all possible venues. Banning tobacco sales entirely was not yet normative. Conclusion: Limiting the ubiquitous availability of tobacco sales is key to ending the tobacco epidemic. Some limits on tobacco sales appear to be normative from the perspective of community members; it may be possible to shift norms further by problematizing the ubiquitous presence of cigarettes and drawing connections to other products already subject to restrictions. [ABSTRACT FROM AUTHOR]

Background: Tobacco retailers are key players in the ongoing tobacco epidemic. Tobacco outlet density is linked to a greater likelihood of youth and adult smoking and greater difficulty quitting. While public policy efforts to address the tobacco problem at the retail level have been limited, some retailers have voluntarily ended tobacco sales. A previous pilot study examined this phenomenon in California, a state with a strong tobacco program focused on denormalizing smoking and the tobacco industry. We sought to learn what motivated retailers in other states to end tobacco sales and how the public and media responded. Methods: We conducted interviews with owners, managers, or representatives of six grocery stores in New York and Ohio that had voluntarily ended tobacco sales since 2007. We also conducted unobtrusive observations at stores and analyzed media coverage of each retailer’s decision. Results: Grocery store owners ended tobacco sales for two reasons, alone or in combination: health or ethics-related, including a desire to send a consistent health message to employees and customers, and business-related, including declining tobacco sales or poor fit with the store’s image. The decision to end sales often appeared to resolve troubling contradictions between retailers’ values and selling deadly products. New York retailers attributed declining sales to high state tobacco taxes. All reported largely positive customer reactions and most received media coverage. Forty-one percent of news items were letters to the editor or editorials; most (69%) supported the decision. Conclusion: Voluntary decisions by retailers to abandon tobacco sales may lay the groundwork for mandatory policies and further denormalize tobacco. Our study also suggests that high tobacco taxes may have both direct and indirect effects on tobacco use. Highlighting the contradictions between being a responsible business and selling deadly products may support voluntary decisions by retailers to end tobacco sales. [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. Calls for public health practices, including research, to better integrate social theories of power, agency, and social change suggest that increased reflexivity about both the process and outcomes of community engagement is warranted. Yet few community-based participatory research (CBPR) projects specifically report nonresearch outcomes of such projects. The authors analyzed “secondary outcomes” of Protecting the ’Hood Against Tobacco (PHAT), a CBPR project conducted in San Francisco, California. Methods. Interpretive analysis of quasi-ethnographic project documentation, including meeting minutes, field notes, retrospective observations, and interviews. Results. PHAT participation created “ripple effects,” encouraging healthier behaviors and public health promotion among community research partners, prompting academics to confront power asymmetries and recognize community knowledge, and widening social networks. Conclusions. CBPR benefits both communities and researchers beyond the findings of the research itself. More systematically capturing these effects, perhaps through wider use of ethnographic approaches, could help enhance understanding of CBPR’s true contributions. [ABSTRACT FROM PUBLISHER]

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]

The Institute of Medicine recently called for a tobacco-free military, citing evidence that high rates of tobacco use harm readiness and create enormous costs for the Department of Defense and the Veterans Administration. The pro-tobacco activities of the tobacco industry and others, sometimes supported by military authorities even when prohibited by policy, have created a culture highly hospitable to smoking. Through qualitative secondary analysis of data from interviews and focus groups, this article explores the reasons enlisted personnel and their supervisors, installation tobacco control managers, and service policy leaders give for why tobacco control policy change "cannot" effectively be achieved. Three primary reasons were given: policies would impinge on the "right to smoke," policies would be unenforceable and lead to disciplinary breakdown, and the rights of civilian workers on military installations precluded policy enforcement. Yet evidence suggests that these reasons are not only invalid, but inconsistent with military policies addressing other threats to the health of personnel. This pervasive tobacco "exceptionalism" is a significant barrier to achieving a tobacco-free military. The military, Congress, and the President should re-evaluate the "can'ts" that have prevented effective action, and act to regulate and eventually abolish tobacco use in the armed forces. [ABSTRACT FROM AUTHOR]

Objective: To conduct a review of research examining the effects of tobacco industry denormalisation (TID) on smoking-related and attitude-related outcomes. Methods: The authors searched Pubmed and Scopus databases for articles published through December 2010 (see figure 1). We included all peer-reviewed TID studies we could locate that measured smoking-related outcomes and attitudes toward the tobacco industry. Exclusion criteria included: non-English language, focus on tobacco use rather than TID, perceived ad efficacy as sole outcome, complex program interventions without a separately analysable TID component and non peer-reviewed literature. We analysed the literature qualitatively and summarised findings by outcome measured. Results: After excluding articles not meeting the search criteria, the authors reviewed 60 studies examining TID and 9 smoking-related outcomes, including smoking prevalence, smoking initiation, intention to smoke and intention to quit. The authors also reviewed studies of attitudes towards the tobacco industry and its regulation. The majority of studies suggest that TID is effective in reducing smoking prevalence and initiation and increasing intentions to quit. Evidence is mixed for some other outcomes, but some of the divergent findings may be explained by study designs. Conclusions: A robust body of evidence suggests that TID is an effective tobacco control intervention at the population level that has a clear exposure response effect. TID may also contribute to other tobacco control outcomes not explored in this review (including efforts to 'directly erode industry power'), and thus may enhance public support and political will for structural reforms to end the tobacco epidemic. [ABSTRACT FROM AUTHOR]

Research on the role of businesses in tobacco control has focused primarily on retailers, advertising firms and the hospitality industry, all of which have tended to support tobacco industry interests and resist effective tobacco control policies. However, in several countries, businesses have a history of voluntarily adopting tobacco-related policies that may advance tobacco control objectives. These phenomena have received little research attention. Existing literature on businesses ending tobacco sales, instituting voluntary workplace smoking restrictions and establishing non-smoker only hiring policies was reviewed. A research agenda on voluntary business initiatives would enhance and complement research on mandatory tobacco control policies by identifying new advocacy opportunities; suggesting avenues for strengthening or reinforcing existing policy initiatives; laying the groundwork for new mandatory policies; helping to inform ethical debates about contentious voluntary policies; and contributing to a better understanding of how alliances between the tobacco industry and other businesses might be weakened. [ABSTRACT FROM AUTHOR]

Background: Tobacco control efforts in Japan have lagged other high income countries, possibly because the Japanese government partially owns Japan Tobacco, Inc. In Japan, tobacco use is still often regarded as an issue of manners rather than an issue of health. Information about tobacco is available, but may not always be accurate. We explored what information Japanese consumers might access by reading popular Japanese books about tobacco. Methods: We searched Amazon.com Japan using the term "Tobacco", identifying the top 12 books by "relevance" and "bestselling." We eliminated duplicates and books not concerned with tobacco use and classified the remaining books as pro-smoking, anti-smoking, or neutral. We reviewed the pro-smoking books, published 2004-2009, and analyzed examples of misinformation by theme. Results: Pro-smoking popular books conveyed five types of misinformation: doubt about science; suggestions that smoking increased health, longevity, virility, etc.; trivializing tobacco's effects; attacking public health advocates/ authorities; and linking tobacco use with authenticity, history, or civil rights. At least one book was authored by a former Japan Tobacco employee; another used a popular Japan Tobacco advertising phrase. Conclusions: Creating doubt and confusion about tobacco serves tobacco industry interests and re-creates a strategy developed by US tobacco interests more than 40 years ago. Japanese readers may be misled by texts such as those reviewed. Tobacco control and public health advocates in Japan and globally should expose and counter such misinformation. "Naming and shaming" may be effective. [ABSTRACT FROM AUTHOR]

Introduction:: Smoking imagery on the online video sharing site YouTube is prolific and easily accessed. However, no studies have examined how this content changes across time. We studied the primary message and genre of YouTube videos about smoking across two time periods. [ABSTRACT FROM PUBLISHER]

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]

Smoking rates among military personnel are high, damaging health, decreasing short- and long-term troop readiness, and costing the Department of Defense (DOD). The military is an important market for the tobacco industry, which long targeted the military with cigarette promotions. Internal tobacco industry documents were examined to explore tobacco sponsorship of events targeted to military personnel. Evidence was found of more than 1,400 events held between 1980 and 1997. In 1986, the DOD issued a directive forbidding such special promotions; however, with the frequently eager cooperation of military personnel, they continued for more than a decade, apparently ceasing only because of the restrictions of the Master Settlement Agreement. The U.S. military collaborated with the tobacco industry for decades, creating a military culture of smoking. Reversing that process will require strong policy establishing tobacco use as unmilitary. [ABSTRACT FROM AUTHOR]

Through analysis of tobacco company documents, we explored how and why Philip Morris sought to enhance its corporate image among American women. Philip Morris regarded women as an influential political group. To improve its image among women, while keeping tobacco off their organizational agendas, the company sponsored women's groups and programs. It also sought to appeal to women it defined as “active moms” by advertising its commitment to domestic violence victims. It was more successful in securing women's organizations as allies than active moms. Increasing tobacco's visibility as a global women's health issue may require addressing industry influence. [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]

Many people may search for information about tobacco use, the largest cause of preventable mortality in the United States, on the Internet. In 1999, Philip Morris U.S.A. (PM), the country's biggest cigarette manufacturer, posted a Web site and launched a campaign to encourage people to obtain information about tobacco and health issues there. The company asserted that its goal was to deliver the messages of the public health community about tobacco. However, internal tobacco company documents reveal that the site was a public relations effort intended to help the company avoid punishment and regulation. Examination of the language on the Web site reveals many contradictions and omissions that may undermine public health messages. Among these are vague and confusing information about addiction, tar, and nicotine, a lack of motivators to quit smoking, and silence about tobacco-related mortality. By appearing to join with public health organizations in disseminating “responsible” messages about tobacco, PM may improve its image, thus facilitating its ability to continue to sell its lethal products. Public health nurses should be prepared to examine health information on the Internet for subtle biases, to counter PM's specific language about smoking to patients, and to challenge PM's larger corporate goals. [ABSTRACT FROM AUTHOR]

This archival study explored why military tobacco control initiatives have thus far largely failed to meet their goals. We analyzed more than 5,000 previously undisclosed internal tobacco industry documents trade public via an online database and additional documents obtained from the U.S. military. In four case studies, we illustrate how pressures exerted by multiple political actors resulted in weakening or rescinding military tobacco control policy initiatives. Our findings suggest that lowering military smoking rates will require health policymakers to better anticipate and counter political opponents. The findings also suggest that effective tobacco control policies may require strong, explicit implementation instructions and high-level Department of Defense support. Finally, policy designers should also consider ways to reduce or eliminate existing perverse incentives to increase tobacco consumption, such as allowing exchange store tobacco sales to fund Morale, Recreation, and Welfare Programs. [ABSTRACT FROM AUTHOR]

To investigate the role of the tobacco industry in marketing to and sustaining tobacco addiction among older smokers and aging baby boomers, We performed archival searches of electronic archives of internal tobacco company documents using a snowball sampling approach. Analysis was done using iterative and comparative review of documents, classification by themes, and a hermeneutic interpretive approach to develop a case study. Based on extensive marketing research, tobacco companies aggressively targeted older smokers and sought to prevent them from quitting. Innovative marketing approaches were used. “Low tar” cigarettes were developed in response to the health concerns of older smokers, despite industry knowledge that such products had no health advantage and did not help smokers quit. Tobacco industry activities influence the context of cessation for older smokers in several ways. Through marketing “low tar” or “light” cigarettes to older smokers “at risk” of quitting, the industry contributes to the illusion that such cigarettes are safer, although “light” cigarettes may make it harder for addicted smokers to quit. Through targeted mailings of coupons and incentives, the industry discourages older smokers from quitting. Through rhetoric aimed at convincing addicted smokers that they alone are responsible for their smoking, the industry contributes to self-blame, a documented barrier to cessation. Educating practitioners, older smokers, and families about the tobacco industry's influence may decrease the tendency to “blame the victim,” thereby enhancing the likelihood of older adults receiving tobacco addiction treatment. Comprehensive tobacco control measures must include a focus on older smokers. [ABSTRACT FROM AUTHOR]

Much has been written about current and future nursing shortages and the numerical gap between nurses available and projected nursing needs. Very little analysis has focused on the implications of the pending expertise gap within the nursing workforce. A graying and retiring registered nurse workforce will greatly increase the proportion of novice nurses with minimal experience in bedside practice. The expertise gap will also affect nursing education. This article explores the implications of these phenomena. Without careful planning, efforts to address the numerical shortage may inadvertently worsen the expertise gap, contributing to unsafe care and affecting nursing retention. [ABSTRACT FROM AUTHOR]

The tobacco industry usually keeps its commercial and political communications separate. However, the images of the smoker developed by the two types of communication may contradict one another. This study assesses industry attempts to organize 'smokers' rights groups,' (SRGs) and the image of the smoker that underlay these efforts. Methods: Searches of the Legacy Tobacco Documents Library, the British American Tobacco documents database, and Tobacco Documents Online. Results: 1100 documents pertaining to SRGs were found, including groups from across Europe and in Australia, New Zealand, and Hong Kong. From the late 1970s through the late 1990s they were active in numerous policy arenas, particularly the defeat of smoke-free laws. Their strategies included asserting their right to smoke and positioning themselves as courteous victims of tobacco control advocates. However, most SRGs were short-lived and apparently failed to inspire smokers to join in any significant numbers. Conclusion: SRGs conflated the legality of smoking with a right to smoke. SRGs succeeded by focusing debates about smoke-free policies on smokers rather than on smoke. However, SRGs' inability to attract members highlights the conflict between the image of the smoker in cigarette ads and that of the smokers' rights advocate. The changing social climate for smoking both compelled the industry's creation of SRGs, and created the contradictions that led to their failure. As tobacco control becomes stronger, the industry may revive this strategy in other countries. Advocates should be prepared to counter SRGs by exposing their origins and exploiting these contradictions. [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]

The role of melanin in nicotine uptake and metabolism has received little attention. Because nicotine has been shown to accumulate in tissues containing melanin, exploring links between melanin and nicotine may provide additional clues to understanding smoking behavior and disease effects. To examine the scientific literature on the relationship between melanin and nicotine, we conducted a PubMed search. We also searched online archives of internal tobacco industry documents. We retrieved and reviewed 82 published research papers related to melanin and nicotine or melanin and metabolism of other drugs, and 150 relevant internal tobacco industry documents. The published literature suggests that nicotine may accumulate in human tissues containing melanin and this retention may increase melanin synthesis. Existing research on the relationship between melanin and nicotine lacks an adequate consideration of this relationship's potential impact, if any, on nicotine metabolism, level of nicotine dependence, and ability to quit smoking. Differential accumulation of nicotine in melanin‐containing tissues could have implications for individuals with high levels of melanin. [ABSTRACT FROM AUTHOR]

This article proposes a basic framework for assessing the policy environment. Environment is a key concept in nursing's much-discussed "metaparadigm," but the policy environment is rarely considered. Too often, bedside nurses do not recognize the policy dimensions of clinical practice issues. Yet nursing assessment involves identifying and appraising aspects of patients' situations that are salient to their responses to actual or potential health problems. Policy may be such a salient factor, as it shapes the physical aspects of patients' surroundings; the relationships possible between practitioners and patients; the institutions in which health care is offered; and, on a broader scale, the prospects for global survival. This article proposes a question-based framework for clinical practice nurses to use in assessing the policy environment. [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]

This paper considers the spatial dynamics of nurse–patient relationships within hospitals, primarily in the USA, under conditions of organizational restructuring, and situates them within social theoretical perspectives on space. As a human practice to which relationship is considered essential, nursing depends upon sustaining an often taken-for-granted proximity to patients. But hospital nursing, I argue in this paper, is increasingly constrained by spatial–structural practices that disrupt relationship and reduce or eliminate such proximity. Three kinds of proximity are threatened: physical, narrative, and moral. Examining these proximities through a place–space lens suggests that nursing is increasingly “distal” to patient care. There are potentially dangerous implications in this loss of proximity. [Copyright &y& Elsevier]

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]

How issues are covered in the media is an important factor in influencing public opinion, policy, and individual behavior. During the 1990s, the tobacco control movement developed a youth focus, prompted by research showing that most adult smokers begin tobacco use as teens. However, concern has been raised that this youth focus has derailed the overall goal of achieving a smoke-free society. Numerous studies have analyzed tobacco coverage and documented the impacts of media messages on youth. To learn how tobacco is covered in a medium primarily produced by and for youth, we conducted an analysis of tobacco coverage in high school newspapers. High school newspapers, like other media, communicate social messages through both content selection and framing. We surveyed a national sample of high school journalists and conducted content and frames analyses of tobacco articles (n = 257) from their publications. The most commonly used frame was "kids" (46%), followed by "killer" (31 %), "nonsmokers' rights" (10%), and "choice" (5%). "Kids"-framed articles were less likely to mention health effects and less likely to be favorable toward tobacco control policies than "killer"-framed articles. In addition, many "kids" articles included "resistance statements" congruent with viewing tobacco use as rebellion and / or independence. Lack of a consistently used frame has been identified as a barrier to effective tobacco control. Tobacco control media advocacy should focus on developing frames that are easily communicated, consistently used, and compatible with the developmental tasks of adolescents. Youth journalists should also be included in media advocacy efforts. [ABSTRACT FROM AUTHOR]

News media play critical rôles in public understandings of health issues. Media presentation of scientific evidence seems to involve the 'facts', which are then discussed and interpreted by various 'experts'. From an ethnomethodological or social constructionist perspective, however, news 'facts' themselves are socially constituted. Examining how health science is reported thus offers important insight into the social construction of health policy problems. We offer an interpretive account of United States newspaper coverage of passive smoking during a time in which several major scientific studies of the issue were conducted and reported upon. We argue that newspaper journalists, through the use of several rhetorical devices, constructed an account of the passive smoking issue in which scientific 'facts' were less important than moral 'facts'. Rather than (or sometimes, in addition to) explicating science, newspaper coverage conveyed a moral narrative highlighting tensions between American cultural values of individual liberty and protection of the public health. [ABSTRACT FROM AUTHOR]

Presents information on a study to determine the role of emergency department (ED) overutilization in terms of inadequate access to appropriate primary medical care. Focus on heavy users (HU) of EDs in two inner-city hospitals; Problems associated with ED overutilization; Findings of the study.

Reflects on the perception of people on health policy as a product. How it affects the outcome of the policymaking process; Implications on the delivery of health care services; Insights on the role of health care providers in the policymaking issue.

Presents nurses' accounts of the hardships as well as the rewards of nursing in a developing country. Description of working conditions; Cultural differences; Discussion of personal experiences; Qualifications that are required; Vital role that nursing plays in world health. INSET: Got a passport? (nursing overseas)..

An introduction is presented in which the editors discuss various reports within the issue on topics including the importance of human rights movement on tobacco control measures, approaches for regulating tobacco products, and the role of public liability litigation.

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]

In the USA, California's highly-regarded Tobacco Control Program (CTCP) has defined its goal as "ending the tobacco epidemic for all population groups" by 2035. To understand local advocates' perceptions of endgame-oriented policies, we interviewed 28 advocates from California communities that had recently adopted tobacco control policies. There was no consensus among participants on which specific policies would constitute the tobacco endgame in California. There was an agreement, however, that policymakers should promote policies that would impact communities with the highest tobacco use prevalence and that policies should be 'clean', avoiding exemptions. Participants were cognizant of California's history of tobacco control policy innovations beginning locally and eventually being adopted at the state level. Many commented that recent policy innovations in the state had begun a conversation that made more 'radical' ideas seem possible. California tobacco control advocates are engaged in local endgame policy discussions and prepared to advance California's endgame goal. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including electronic-cigarettes made specially for inmates of prisons and jails, the socioeconomic impact of tobacco control interventions, and the link between racial discrimination and smoking.