ACKNOWLEDGEMENTS
This paper was prepared by Michael Perley, Director of the Ontario Campaign for Action on Tobacco and tobacco policy advisor to the Ontario Medical Association, with direction and support from Dr. Ted Boadway, Executive Director, Ontario Medical Association. Valuable comments and contributions were obtained from members of the OMA committee on Population Health, as well as from members of the OMA Board of Directors.
The Ontario Medical Association also wishes to express its gratitude to a number of organizations for material from analyses of tobacco industry-sponsored programs they have already prepared and, in some cases, published. These include the critiques of "Operation ID," "Operation ID/School Zone" and "Wise Decisions" prepared by the Quebec Coalition for the Control of Tobacco, separate analyses by the Media Network at Cancer Care Ontario, and the review of "Wise Decisions" prepared for the Ontario Lung Association.
Valuable material about the history of voluntary industry programs in Canada was drawn from "Smoke and Mirrors: the Canadian Tobacco War," by Canadian Cancer Society Senior Legal Counsel Rob Cunningham. The editorial assistance of Jeff Henry, Director of Communications & Design Services, was particularly appreciated.
Please Note:
This paper may be reproduced for use as an advocacy document providing authorship is acknowledged.
Web site: www.oma.org ISBN: 0-919047-41-6
1. Introduction: Best Practices in Tobacco Control
2. The Programs
1. "Operation ID" (OID) and "Operation ID/School Zone" (OID/SZ)
3. Why Tobacco Industry-Sponsored Sales to Minors Prevention Programs Don’t - And Can’t Work
4. Why Tobacco Industry-Sponsored Decision-Based School Prevention Programs Don’t and Can’t Work
5. Conclusion and Recommendations
Appendices
A. Members of the Canadian Coalition for Responsible Tobacco Retailing
B. Operation ID School Zone Community Partners
For over a decade, federal, provincial, state and local authorities in both Canada and the United States have implemented and evaluated a wide range of tobacco control programs and identified best practices. These authorities, and health agencies with similar goals, have concluded that tobacco control must be comprehensive and must include, at a minimum, local community programs; chronic disease prevention; school programming; tobacco control policy enforcement; media advocacy; smoke-free spaces; cessation assistance and counter-marketing programs.
Experience to date has shown that comprehensive tobacco control programs based on best practices can dramatically reduce both consumption and disease incidence.
Reducing youth access to tobacco industry products is a component of most comprehensive tobacco control programs, but there is considerable doubt whether reducing youth access in fact reduces youth consumption.
In recent years, the tobacco industry has faced unprecedented legal and regulatory challenges. In response, the industry has developed and disseminated two programs - "Operation ID" and "Operation ID/School Zone" - allegedly aimed at reducing youth access to tobacco products by encouraging retailers to demand ID, and is testing a school-based program - "Wise Decisions" - designed to teach decision-making skills about tobacco use.
The Ontario Medical Association has undertaken a comprehensive review of these programs, including examination of tobacco industry documents, program materials and independent research. The OMA concludes that:
To address these concerns, the OMA recommends that all parties interested in reducing tobacco use endorse a comprehensive tobacco control program. The OMA further recommends that all community groups and associations that have endorsed these programs, be asked to withdraw their endorsement or withhold such endorsements if asked. The OMA will work with the Canadian Medical Association and other interested parties to ensure that this statement receives broad dissemination. Finally, the OMA recommends that all such tobacco industry-sponsored programs be carefully monitored in the future.
The OMA's detailed recommendations are as follows:
"the key 15-19 age group is a must for RBH"
- RBH-1134 Strategic Plan 1997/98 Sales & Marketing quoted in opening statement of the Government of Canada’s defence of the legal challenge to the Tobacco Act by JTI-McDonald Corp., Imperial Tobacco Limited and Rothmans, Benson & Hedges Inc. (RBH)
1. Introduction: Best Practices in Tobacco Control
This position statement is intended as an assessment and evaluation of the merit, and reasons behind, three tobacco industry-sponsored programs that have allegedly been prepared to reduce youth tobacco consumption. The OMA’s concerns about the merits of these programs and our assessment of whether current evidence supports their validity, will become clearer throughout the course of this analysis. To begin with, however, we wish to place our concerns in the context of what is known today about the best methods of reducing tobacco use. These methods, usually referred to collectively as "best practices in comprehensive tobacco control," have been in development in the United States and Canada for over a decade. Together with our assessment of the programs themselves, this brief review of best practices will, we hope, assist the reader in determining not only whether the programs themselves work, but whether they have any legitimate place in mainstream tobacco control programming.
The reduction of tobacco use, particularly among young people, is an objective shared by the vast majority of Canadians (including many who smoke). The exceptions are those who benefit financially from increasing the use of tobacco - tobacco growers, product manufacturers, wholesalers, smugglers, retailers and their various suppliers. Based on this consensus, all levels of government and non-governmental health organizations (NGOs) and other interested agencies have worked for decades to develop effective tobacco control interventions via legislation, fiscal policy, mass media communications, community activism and broad-based education. This collective endeavour has led to a reduction in tobacco use to an average of about one in four Canadians, down from one in two several decades ago.
An important feature of the effort to reduce the use of the number one cause of preventable morbidity and mortality in Canada has been the diversity of means employed to accomplish this goal. Throughout the late 1980s and most of the 1990s, many jurisdictions developed, implemented and evaluated various combinations of tobacco control interventions, to the point where the essentials of what is now called "comprehensive tobacco control" are well defined. As we will see, many jurisdictions have complemented the basic elements of comprehensive tobacco control by additional initiatives, particularly those in the area of legislative policy reform.
In an effort to consolidate existing knowledge about best practices in tobacco control, the U.S. Centers for Disease Control and Prevention (CDC) published a major report in August 19991 that reviewed best practices for comprehensive tobacco control programs based on experience during the past decade in several U.S. states. This document was based on published evidence-based practices and experiences in various U.S. jurisdictions, notably programs in the states of California and Massachusetts. To be successful, the CDC concluded that a comprehensive program must have some level of activity in each of the following areas:
While best practices concepts were being refined and implemented in the U.S., similar activities had been taking place in some parts of Canada. The federal government began the process by setting up the National Strategy to Reduce Tobacco Use in the early 1990s. In 1993-1994, the Ontario Ministry of Health produced the Ontario Tobacco Strategy (OTS), founded on the three principles of prevention, protection and cessation. The OTS’s legislative centerpiece, the Ontario Tobacco Control Act (the Act), made retail sales to minors under age 19 illegal, required a number of public places to be smoke-free, banned tobacco sales in pharmacies and from vending machines, and required reports on the activities of tobacco wholesalers and distributors. Compliance procedures and non-compliance penalties, including prohibition of the right to sell tobacco, were central components of the Act.
The OTS was one of the first provincial strategies to incorporate the comprehensive approach to tobacco control in Canada, working from U.S. best practice models. This approach has been further validated, refined and expanded throughout North America, to the point where the concept is now embodied in emerging international instruments, such as the Framework Convention on Tobacco Control being developed by the World Health Organization, and tobacco control programs either implemented or proposed by the Government of Canada and a number of other Canadian provinces.
A central concern in virtually every jurisdiction that has embarked on tobacco control efforts has been the need to reduce youth access to tobacco. Legislative tools used to reduce youth access include statutory requirements that retailers may not sell to minors, that identification must be obtained from anyone who may be under the age of majority (usually 18 or 19), and that certain signs must be posted stating that such sales are illegal. Governments which have implemented sales-to-minors regulations, supportive health agencies, and tobacco control analysts have generally agreed that sales to minors restrictions should be included in comprehensive tobacco control programs. However, serious questions have arisen as to whether youth access restrictions reduce youth tobacco consumption, and whether even very high rates of retailer compliance with such restrictions actually prevent young people from obtaining tobacco products. Some attention has been paid to these issues in the research literature. In the United States, the Independent Task Force on Community Preventive Services is preparing an assessment of youth access restrictions, including laws that regulate and enforce bans on selling tobacco products to minors. Laws that prohibit minors from purchasing, possessing or consuming these products will also be considered.2 In anticipation of the conclusions of this review, a 1999 assessment of the research literature completed by the American Non-Smokers’ Rights Foundation (ANRF), concluded in part that:
"There are numerous studies demonstrating that aggressive efforts to enforce age-of-sale laws can succeed in reducing the percentage of merchants who sell tobacco products to minors. Most of these efforts involve some combination of merchant education and enforcement activities, such as sting operations. However, there is also evidence that merchants quickly return to old habits when vigilant efforts at sustaining high compliance are no longer in place.
A more central question, however, is whether increasing the number of merchants who comply with age-of-sale laws accomplishes the more important aim of reducing underage tobacco consumption. If restricting supply via enactment and enforcement of youth access laws does little to change youth consumption of tobacco, then devoting frequently limited resources to accomplishing higher rates of merchant compliance may be misguided."3
A common conclusion in the studies reviewed by the ANRF, and in those reviewed in a similar analysis prepared for the Ontario Tobacco Strategy Media Network at Cancer Care Ontario (CCO) in November 2000, is that in the absence of a consistent, sustained and effective enforcement regime, sales-to-minors restrictions are not effective in reducing consumption, and do not significantly reduce young people’s ability to obtain cigarettes. As the CCO analysis states, "A decade of experience in implementing laws prohibiting tobacco sales to minors in many jurisdictions, both as part of comprehensive strategies and as stand-alone measures, has proven that retailer compliance is not an accurate measure of youth access (author’s emphasis) to tobacco. Only a few retailers continuing to sell to minors can mean that tobacco products remain readily accessible; moreover, social contacts are also an important source of supply for youth.
There is limited evidence from a few uncontrolled studies that restrictions on youth access to tobacco products can (author’s emphasis) reduce youth consumption - but only when adequately enforced."4
Public health agencies routinely subject programs to peer review by colleagues through evaluations published in the standard research literature. This process is regarded as essential by any agency genuinely seeking to refine a program and account for resources expended. The OMA has been unable to locate any evaluations of tobacco industry-sponsored youth prevention programs in the standard peer review literature. In a review of Philip Morris’ "Action Against Access" program, commissioned by the company in 1997, former U.S. Senator Warren Rudman found that two-thirds of U.S. retailers surveyed did not believe that tobacco companies are really committed to preventing sales to minors. Senator Rudman also found that most retailers used their own evaluation to determine a tobacco purchaser’s age, instead of relying on tobacco industry-provided calendars showing "cut-off" dates.5
Restrictions on sales to minors as an effective youth access prevention tool pale in comparison to the effectiveness of increased tobacco taxes (perhaps the most effective deterrent of youth consumption)6, 7, and the core elements of "traditional" comprehensive tobacco control programs implemented by states such as California and Massachusetts (higher prices, plus intensive and sustained mass media, legislation banning smoking in public places and work places, intensive community activism, coalition building, and education).
An indication of the kind of results that can be achieved by effective comprehensive tobacco control programs can be found in the state of California, which has the longest-running comprehensive program in North America. For the period 1988 to 1997, lung cancer rates in California declined 14 per cent, compared to a 2.7 per cent decline in eight comparison states and municipalities elsewhere in the United States. From 1989 to 1996, there were 58,900 fewer deaths from heart disease in California, and total direct medical cost savings of $497 million, compared to total tobacco control program costs of $411 million. Even more strikingly, when California’s total program costs for 1990 to 1998 are compared with savings in direct medical costs and in indirect costs such as foregone income and lost productivity for the same period, the comparison is $836 million on program expenditures versus $8.4 billion on total cost savings.8 (All figures are in U.S. dollars)
One of the fundamental lessons taught by California’s experience is the critical importance of changing the status and acceptability of tobacco in the adult world as a pre-condition to successfully reducing young people’s tobacco use. The state’s experience is reviewed in a September 20, 2001 presentation to Ontario Health and Long-Term Care Minister Tony Clement by staff of the state’s Department of Health Services Tobacco Control Section. The presentation notes at the outset that the goal of the state program is to change social norms about tobacco through a "denormalization" strategy based on
"reducing the social acceptability of:
The primary importance of focusing on change in the adult world is underlined by the Tobacco Control Section’s conclusion that "lasting change in youth behavior regarding tobacco can only be secured by first changing the adult world in which youth grow up."10
Elsewhere in the U.S., comprehensive programs have:
A similar emphasis on the importance of change in the adult world to reducing youth consumption can be found in Ontario. In 1998, former health minister Elizabeth Witmer convened an expert panel to assess how to revise the Ontario Tobacco Strategy referred to earlier.12 This expert panel based its work on existing best practices evaluations and experiences from jurisdictions already mentioned. The panel also devoted considerable attention to the CDC’s recommendation about the need for enforcement of tobacco control policies (i.e. legislative restrictions) by adding some important requirements to its comprehensive plan that included:
The panel’s recommendations also included greatly expanded cessation programs for the province, and pointed to a number of reasons why the Government of Ontario should sue the tobacco industry to recover health-care costs paid by the province as a result of tobacco use.
Shortly thereafter, the Tobacco Control Program Group at Health Canada, in addition to citing all of the central elements of comprehensive tobacco control under federal jurisdiction in its planning documents, added the need for new regulations pertaining to product modification and the enforcement of existing restrictions on advertising and promotion, including sponsorship advertising.13
Elsewhere in Canada during the past three years, comprehensive tobacco control strategies have been either proposed and implemented (in British Columbia), partially proposed and/or partially implemented (Nova Scotia, New Brunswick, Quebec, Newfoundland and Saskatchewan), or are under active development either at the programming or legislative level (Alberta).
Throughout many of these program and policy development exercises, a new and increasingly common theme has been emerging: the public disclosure of tobacco industry tactics. These tactics include the industry’s use of scientific disinformation concerning the consequences of tobacco use, evaluation of youth behaviour and marketing of tobacco products to young people, the facilitation of tobacco smuggling, and opposition to virtually every significant legislative and policy component of comprehensive tobacco control.
The 1990s amounted to a unique decade in the number and variety of comprehensive initiatives undertaken in tobacco control, including legislation, programs, litigation and media coverage directed at the past and present tactics, strategies and behaviour of the North American tobacco industry.14 During the same period, a large and growing number of international, national, state, provincial, and independent scientific reports and analyses continued to document rapidly increasing knowledge of the multiple effects of tobacco on the human organism. Legislation at the national, state and local levels, in both Canada and the U.S., significantly reduced the exposure of smokers and non-smokers alike to second-hand smoke, identified as the third leading cause of preventable morbidity and mortality in both countries. Major restrictions on direct and indirect tobacco advertising were implemented in both the U.S. and Canada. Anti-tobacco media campaigns proliferated.
In perhaps the most dramatic development of the decade, litigation against the U.S. tobacco industry by four states (Florida, Texas, Mississippi and Minnesota), and a subsequent Master Settlement Agreement between the remaining 46 states and U.S. tobacco companies, led to the release of over 35 million pages of internal tobacco industry documents. These documents reveal that the industry has long known of the negative effects of its products upon the human organism, and has developed a variety of lobbying and public relations strategies designed to deny these effects. They also demonstrate that the industry has challenged scientists and researchers whose work proves these negative effects, and has recruited "experts" to promote tobacco industry views alleging, for example, the inadequacy of the science demonstrating second-hand smoke to be a human health risk.15, 16, 17 Industry funding of think-tanks and research groups, such as Canada’s Fraser Institute and the U.S. Cato Institute, has been revealed. These groups have served as vehicles to promote industry challenges to health science conclusions about the effects of tobacco use, and to underwrite its ongoing attacks on both public and private-sector critics in both countries. Evidence of widespread links between tobacco companies and the hospitality industry has also emerged.
In the face of such challenges to its legitimacy and long-term survival, the tobacco industry has not sat idle. In the past several years, the industry in Canada has embarked on a well-orchestrated and co-ordinated campaign to rehabilitate its image, to ingratiate itself with various community groups, and to create the impression that it shares a goal that is strongly supported by virtually all Canadians: the need to prevent young people from smoking. As it mounts an international attack on the credibility of the science demonstrating second-hand smoke health consequences,18 and attacks virtually every proven effective tobacco control intervention proposed by governments or suggested by the health community, the industry has simultaneously devoted significant resources to presenting itself as a community partner seriously concerned about the problem of youth smoking.
The basic implausibility of this concern is evident in one simple fact: research demonstrates that almost 90 per cent of regular smokers begin using tobacco at or before the age of 18.19 Actually stopping young people from smoking would be tantamount to self-destruction for the industry. At the same time, any overt effort to recruit new young clients to replace those who have quit using industry products, or died from using them, would guarantee both Canada-wide public outrage and severe government reprisals against the industry. Rather than passively defending itself against repeated charges and evidence concerning its interest in recruiting younger smokers, the tobacco industry has adopted a proactive strategy of increasingly endorsing and promoting its own version of youth access restriction and youth education programs.
The industry’s public attitude toward the matter of youth access to tobacco products can be found in comments made by former Canadian Tobacco Manufacturers Council President Robert Parker, to a hearing of an all-party committee of the Saskatchewan legislature in March 2000, as the committee considered tobacco control legislation for that province: "No we don’t market to children; we don’t think that children should smokewe do not want or need the business of underage smokers."20 Despite Mr. Parker’s denial of the industry’s need for "underage smokers," the tobacco industry has in fact spent a great deal of time and resources on assessing and evaluating the behaviour of young people, determining how to reach them, and creating various pro-smoking messages and icons (i.e. Joe Camel) to carry these messages.21, 22 As previously mentioned, it has also opposed some of the most demonstrably effective youth tobacco control interventions, notably higher prices, advertising restrictions and smoke-free spaces.
A more likely and well-documented explanation for the industry’s interest in youth prevention can be found in a 1991 U.S. Tobacco Institute discussion paper, made public during the Minnesota court case, which reads in part as follows:
"The youth program and its individual parts support the Institute’s objective of discouraging unfair and counter-productive federal, state and local restrictions on cigarette advertising, by:
This strategy is fairly simple:
Together with other industry documents cited throughout this analysis, this passage is critical to an understanding of the real objectives behind the tobacco industry's promotion of youth prevention programs.
The Canadian versions of the industry's youth prevention strategy are "Operation ID," (OID) its related program "Operation ID - School Zone" (OID/SZ), and "Wise Decisions," (WD).
2. The Programs
Launched in 1996 by Canadian tobacco companies and a number of retail and labour organizations grouped under the Canadian Coalition for Responsible Tobacco Retailing (see Appendix A), OID is described as a program designed "to help retailers and their staff uphold the law and put an end to the illegal sale of tobacco to minors."24 Kits are made available to retailers which contain signs stating that a potential purchaser must show ID and that the retailer displaying signage does not sell to minors, together with "information on tobacco regulations and suggestions for managers and clerks on dealing with underage customers."25
A variation of OID, OID/SZ, is described as being targeted at retailers within a one kilometre radius of schools. Evidence of the dissemination of one or both of these programs has appeared in retail outlets in all 10 provinces. OID staff have informed the Ontario Tobacco Research Unit that the program is operating in 7,000 communities in Canada. The OID Website states that "more than 93,000 Operation ID kits have been distributed to retailers across Canada.". If the OID figures are correct, then each community in which the organizers claim the program is running has received an average of just over 13 kits each. Even if the largest communities have received the largest number of kits, it is hard to conclude that comprehensive coverage of retail tobacco outlets across Canada has been achieved.
A key feature of the OID/SZ program variation is the solicitation of community organizations to lend their names to publicity and advertising released into participating communities. A typical example of an OID/SZ launch occurred in late November 2000 in Kingston, Ontario. Newspaper ads announced the advent of the program to Kingston, noting that stores located next to schools had received special display materials and other supports to help them comply with the laws restricting the sale of tobacco to minors.26 The ads contained the logos of the Greater Kingston Chamber of Commerce, the Boys and Girls Club of Greater Kingston, the Kingston Jaycees, the Kingston KIMCO Voyageurs hockey club, and the Kingston Whig Standard. Advertising in the Whig Standard featured the logos of the Chamber of Commerce, the Kingston JCs, Junior Achievement, the Whig Standard, itself and the Municipality of Greater Kingston.
Throughout 2001, OID/SZ advertising continued to appear in local Kingston media, containing the names of additional service clubs and other community organizations alleged to be "working with" the program. Following the November 2000 launch of the program, staff at the Kingston, Frontenac, Lennox and Addington Health Unit watched its spread with some concern: the program had no capacity to be enforced, and the advertising made no mention of the harmful effects of tobacco use, nor the tobacco industry’s long history of misinformation about the effects of its products. In late 2001, this concern led health unit staff to contact some of the organizations cited in the advertising as "working with" the OID/SZ program. Staff were informed by the Kingston Police Department that the Department was not sponsoring the program. Big Sisters informed the health unit that it was not supporting the program, and Big Sisters was concerned to see its name in OID/SZ program advertising.
It is not surprising that community groups with an interest in the welfare of young people would see a program ostensibly designed to reduce youth access to tobacco as laudable, and that they would allow their names to be publicly associated with the program. Once service clubs and other community associations whose names have been publicly associated with OID/SZ are informed about the evidence concerning the tobacco industry’s development of youth access programs, the OMA would expect most, if not all, to reconsider their association with the program.
The community organizations lending their names to OID/SZ in Kingston were reflective of the types of organizations that have endorsed the program in other Canadian communities. (See a complete list in Appendix B). Of the 134 individuals and organizations named as "community partners" on the program’s Web site, only five27 have any direct association with the health community. Nowhere in the Kingston advertising or, for that matter, in any other local, regional, or national OID or OID/SZ advertising, are there any endorsements from medical professionals, medical organizations (i.e. the Canadian Medical Association or its provincial divisions), ministries of health, hospitals, medical/scientific researchers specializing in tobacco control issues, or any of the leading NGOs involved in tobacco control policy and advocacy across Canada (such as the Canadian Cancer Society, Heart and Stroke Foundation of Canada, Canadian Lung Association, Canadian Public Health Association, or any of their regional affiliates).
In an April 2001 program announcement,28 OID, Imperial Tobacco Limited, JTI-McDonald Corp., and Rothmans Benson and Hedges Inc. announced that they had put aside competitive issues and donated the use of their retail display space across the country to raise public support for tobacco retailers:
"Starting April 1, 2001, representatives from each tobacco company will install public awareness posters in their allocated display spaces and retail outlet across Canada. These posters will be displayed for three months."
This apparently straightforward announcement bears closer scrutiny:
Before proceeding to a more general discussion of the reasons why the credibility, authenticity and effectiveness of these programs must be questioned, we will briefly review the other major tobacco industry youth-focused program being rolled out across Canada.
This tobacco industry-sponsored program is designed by a Toronto consulting firm, Cunningham Gregory and Company, and is being pilot-tested in a number of Canadian communities. In at least one Toronto school board, free computers are being offered to schools that agree to test the program.
The program manual examines attitudes, decisions and influences that, according to the authors, affect the decisions of students in grades 6-8 to smoke or not to smoke. The document is written for teachers, divided into four thematic units, and "explores the influence of family, friends, the world around us, and the student’s ability to promote a healthy, smoke-free lifestyle."29
WD lessons focus on young people’s personal attitudes toward smoking, the factors that influence these attitudes, the influence of family and friends upon their decisions, the decision-making process and health lifestyles. A heavy emphasis is placed throughout on communication skills.
The program provides no information on the harmful effects of tobacco, the conduct of the tobacco industry in opposing tobacco control interventions, or the industry’s history of researching the behaviour of young people to determine their attitudes towards smoking and how to prepare them to become adult smokers.
One WD unit asks students if they agree with quotations like "smoking cigarettes will lead to diseases that kill" and "smokers can be healthy individuals," without mentioning that there is actually a correct answer. Teachers are urged to be uncritical of students and their opinions: "It is imperative that teachers make it clear from the onset that they will not be evaluating the student’s attitudes or decisions in this program. Rather, they will be assessing the students’ understanding of the decision-making process and of the influences upon them as they make decisions."30
WD is reminiscent of an R.J. Reynolds (RJR) school-based education program, "Right Decisions. Right Now," which was launched in the U.S. in 1991. The RJR program material notes that smoking is a risk factor, like "many factors statistically associated with an individual’s chances of developing disease."31 It states that kids smoke because of "the power of peer pressurea very strong influence,"32 and reinforces the industry’s central position that there are many behaviours adults engage in that young people should not. While there is no evidence that the "Right Decisions" program had any influence on tobacco use in the United States, Canadian representatives of RJR-Macdonald Inc. (now JTI Inc.) have referred to the need for youth education programs in Canada and that these programs "require a dialogue like our U.S. ‘Right Decisions. Right Now.’" program.33
The OMA’s analysis of tobacco industry-sponsored youth prevention programs and changes in youth prevalence and consumption in Canada lead to nine major conclusions about the authenticity and effectiveness of these programs:
"Advertising was to be directed to adults, models were to be at least 25 years old, health claims in ads were restricted, athletes and celebrities were not to be used, and poster or bulletin-board advertising was not to be ‘immediately adjacent’ to schools. No advertising was to ‘state or imply that cigarette smoking is essential to romance, prominence, success or personal advancement.’ Not surprisingly, the use of the word essential meant that this provision would be completely ineffective at curbing lifestyle advertising."
Cunningham points to a number of other examples of the voluntary code’s ineffectiveness:
OID representatives have tried to claim credit for positive changes in compliance with sales-to-minors restrictions. In a March 8, 1999 letter to the Ontario Lung Association’s London program co-ordinator, OID/SZ Manager Anne Viau cited statistics from an A.C. Neilson study to the effect that in Ontario, retailer compliance with sale-to-minors restrictions was measured at 69.4 per cent in 1997, up from 62.2 per cent in 1995. Ms. Viau then pointed out that over 20,000 OID kits had been distributed during the previous two years in Ontario, and implied credit to the OID program for the increase in compliance. In fact, according to independent analysis by the Ontario Tobacco Research Unit,38 there had been an increase in retailers willing to sell to minors in Ontario from 26 per cent in 1996 to 31 per cent in 1997.
In a further example of an unjustified claim of credit for increased compliance, the same letter referenced a "successful pilot project" of OID/SZ launched in 1998 in Kelowna, British Columbia, and stated that the program caused an increase in "retailer compliance" from 74 per cent to 92 per cent. What the letter did not mention was whether there was any change in the ability of Kelowna’s young people to actually obtain cigarettes, or whether there was any real change in youth smoking prevalence, or consumption, as a result of this pilot project. It was also not clear who determined this change in retailer compliance, or who conducted so-called "mystery visits" to retailers described in an October 2, 1998 OID/SZ news release about the Kelowna experience, which Ms. Viau cited in her letter.
While Ms. Viau clearly implied that the change in retailer compliance in Kelowna was directly due to the OID/SZ program, the British Columbia government had recently embarked on an aggressive provincewide tobacco control program, including mass media-based public education and increased sales-to-minors enforcement. It is at least as likely that the provincial program had more of an effect on retailer compliance - if indeed the effect took place - than that the local OID/SZ program had any effect at all.
A further factor undermining the potential success of ID-based youth access programs is that many young people today have access to false ID. Therefore, basing a sales-to-minors restriction program on production of ID guarantees that many underage youth will still successfully purchase tobacco. Easy access to false ID also may serve to indemnify retailers who sell to teenagers by offering a legal defence that ID was in fact checked.
Even if the weaknesses in retail ID-based programs were to be corrected, there remains the fact that the majority of adolescents may in fact get cigarettes from non-commercial sources:
"One recent survey found that 73.7 per cent of 8th, 9th and 10th graders who reported having ever smoked obtained their most recent cigarette from a friend or family member, as compared with 22.6 per cent who obtained it from a commercial source."39
These contradictory statistics and questionable claims mirror results from other research done in the United States on similar tobacco industry-sponsored, voluntary retailer compliance programs. In a 1996 article in the American Journal of Public Health, researchers looked at the success of the U.S. Tobacco Institute’s "It’s the Law" campaign, which utilized an approach to reducing retailer sales-to-minors very similar to OID. The authors found that the program was not associated with a significant reduction in illegal sales either through vending machines or from over-the-counter sources. As noted earlier, it has now been confirmed that the actual purpose of the "It’s the Law" program was to improve the low public image of the tobacco industry, while legitimizing certain industry lobbying efforts.40
Paradoxically, "success" under the WD program would be measured by the number of young people who, having taken the program, conclude that there is a legitimate decision to be made between smoking and not smoking. For some children who have never previously entertained the thought of smoking, WD may in fact represent an introduction to the possibility of smoking.
"As we discussed the ultimate means for determining the success of ("It’s the Law") will be:
"Our objective is to communicate that the tobacco industry in not
interested in having young people smoke and to position the industry as ‘a
concerned corporate citizen’ in an effort to ward off further attacks by the
anti-tobacco movement."50
A frequently-quoted summary from a New York advertising agency working
for the tobacco industry in the mid-1970s concisely summarizes how the industry
should reach young starter smokers:
"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-identityThus, an attempt to reach young
smokers, starters, should be based, among others, on the following major perimeters:
The OMA has learned that the Saskatchewan Committee for Responsible Tobacco Retailing, a group that has been lobbying intensively to have Saskatchewan’s legislative ban on point-of-sale promotions eliminated, has identified itself as a subcommittee of the Canadian Coalition For Responsible Tobacco Retailing, the major coalition which sponsors OID and OID/SZ. This fact, together with internal industry documents such as that quoted at the outset of this analysis, clearly demonstrate the hypocrisy inherent in claims by the tobacco industry and its retail allies that they do not support sales to minors. The Saskatchewan legislation is designed to have tobacco placed out of sight behind counters in retail sales outlets. This move would have no effect on the ability of adults - the industry’s alleged target audience - to obtain tobacco products, but would remove a powerful message, repeated tens, if not hundreds, of thousands of times across the country every day to young people who go into corner stores and local convenience outlets, that tobacco is a normal consumer product just like any other.
In summary, there is no credible, independent evidence that shows that voluntary, tobacco industry-sponsored programs like OID and OID/SZ have any sustained or significant effect upon either youth consumption or retailer compliance. In fact, many in the tobacco control community believe that voluntary, industry-sponsored programs like OID and OID/SZ are not simply public relations programs designed to improve the industry’s image: they may be designed to make tobacco products appeal to teenagers by presenting tobacco as a "forbidden fruit," which should only be legally available to adults.
4. Why Tobacco Industry-Sponsored Decision-Based School
Prevention Programs Don’t - and Can’t - Work
Although at first glance the concept of a program that provides decision-making advice to young people concerning tobacco use might appear to be a useful activity, the "Wise Decisions" (WD) program is based on highly questionable premises:
5. Conclusion and Recommendations
At best, Operation ID, Operation ID School Zone, and Wise Decisions may be ineffective diversions which siphon resources away from truly effective tobacco control interventions. At worst, they position tobacco industry products as desirable badges of adulthood, encourage young people to smoke, and give a misleading impression to governments, community groups, parents, teachers and other interested parties that the tobacco industry sincerely embraces the need to prevent young people from using its products. Part of the purpose of these programs may also be to create the appearance of an industry co-operating with, or even championing, widely held societal goals about preventing young people from smoking. This posture may in turn be motivated by the industry’s desire to avoid potential future liability in lawsuits or cost-recovery actions.
What is clear is that there is a significant gap between the demonstrated lack of effectiveness of these programs in reducing youth smoking, and the efficacy of best practices in tobacco control as identified by both Canadian and international authorities, practices whose implementation has been directly or indirectly opposed by the tobacco industry and its allies in many jurisdictions.
It is anticipated that the tobacco industry will continue to disseminate these programs, and continue with its efforts to rehabilitate its image and portray itself as a good corporate citizen. Accordingly,
To help expedite the implementation of this recommendation, the OMA will work with the Canadian Medical Association, other provincial medical associations, and interested health agencies and non-governmental health organization (NGOs), to ensure that this statement receives the widest possible dissemination. Further, we will be forwarding the statement to federal, provincial and territorial ministries of health and education.
Members of the Canadian Coalition for Responsible Tobacco Retailing
Operation ID School Zone Community Partners include:
|
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(See www.operationid.com)
Partners in the retailing, wholesaling, distributing and manufacturing sectors include
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References
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| 1. U.S. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs. Atlanta GA: U.S. Department of Health & Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Control and Prevention and Health Promotion, Office on Smoking and Health, August 1999. |
| 2. Task Force on Community Preventive Services. "Recommendations regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke." Am J Prev Med 2001; 20(2S). |
| 3. America Non-Smokers' Rights Foundation. "Restricting Youth Access to Tobacco: Does It Reduce Youth Tobacco Consumption? A Summary of Research Findings." February 10, 1999. Accessible at www.no-smoke.org/youth3.html. |
| 4. Tilson Consulting for OTS Media Network - Cancer Care Ontario. "The Impact of Selected Comprehensive Tobacco Control Programs on Youth Tobacco Use: A Comparative Analysis". November 2000. |
| 5. Doug Levy, "Tobacco plan has some success," USA Today, July 2, 1997, p. D1. |
| 6. Canadian Cancer Society. "Compilation of Selected Evidence Regarding the Impact of Higher Prices on Tobacco Use: A Submission Prepared for the House Of Commons Standing Committee on Finance." Volumes 1-7. September 2001. |
| 7. The damage to industry sales caused by tax increases has long been recognized by the industry. In a 1987 memorandum, a Philip Morris employee reviewed the impact of price increases earlier in the decade on Philip Morris sales: "The 1982-83 round of price increases caused 2 million adults to quit smoking and prevented 600,000 teenagers from starting to smoke. Those teenagers are now 18-23 years old, and since about 70% of 18-21 year-olds and 35% of older smokers smoke a PM brand, this means that 700,000 of those adult quitters had been PM smokers and 420,000 of the non-starters would have been PM smokers…We were hit disproportionately hard. We don't need to have that happen again." (emphases in original text). Myron Johnston to Jon Zoler, September 1987, Bates No. 2022216179. Quoted in "Danger: PR in the Playground," Action on Smoking and Health (UK), 2001. |
| 8. Shimizu, Robin (Assistant Chief) and Lloyd, Jon (Chief, Data Analysis
and Evaluation Unit), Tobacco Control Section, Department of Health Services,
State of California. Presentation for Minister of Health, Ontario, Canada.
September 20, 2001, pp. 11-12. Sources cited in this presentation include: Fichtenberg, Caroline M. and Glantz, Stanton A. "Association of the California Tobacco Control Program With Declines in Cigarette Consumption and Mortality from Heart Disease." New England Journal of Medicine 2000; 343:1772-77; Fichtenberg, et al. New England Journal of Medicine 2001; 344:1797-1799; Lightwood, et al. Circulation 1997; 96:1089-1096; Lightwood, et al. Pediatrics 1999; 104:1312-1330. |
| 9. Shimizu, Ibid, p. 2. |
| 10. Shimizu, Ibid, p. 2. |
| 11. Tilson Consulting, op cit, pp. 9-13, 17-18. |
| 12. "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. (see http://www.camh.net/otru, click on 'Documents'). |
| 13. Health Canada. Tobacco Control Program: Healthy Environments and Consumer Safety Branch, Operational Planning, 2001-2002. |
| 14. Canadian and American tobacco companies are inter-related: · Imperial Tobacco of Canada, with 70% of the Canadian cigarette market, is now a wholly owned subsidiary of UK-based British American Tobacco (BAT), which bought out minority shareholders in 2000. BAT's U.S. subsidiary is Brown & Williamson, which has a market share of 10.5% (2000) in the United States, and also manufactures several major international brands for export (notably Lucky Strike). Brown & Williamson was a key member of the now-defunct Tobacco Institute and the Council for Tobacco Research. BAT and Philip Morris are the two main players in the world cigarette market. · Rothmans, Benson & Hedges (RBH) is Canada's No. 2 tobacco company, with a particular strength in the roll-your-own segment, which it dominates. It has 21.5% of the total tobacco market (roughly 18% of the manufactured cigarette market in 2001). RBH has two shareholders: Philip Morris (40%) and Rothmans Inc. (60%). Rothmans Inc. is a publicly held company, listed on the Toronto Stock Exchange, with no single controlling shareholder. RBH has traditionally relied on Philip Morris for technical and strategic advice. Philip Morris is the dominant US tobacco firm, with a market share of 50.5% (2000 figures). · JTI-Macdonald is Canada's No. 3 tobacco company, with a single major brand: Export 'A', and a declining market share of about 12%. JTI-Macdonald is a wholly owned subsidiary of Japan Tobacco International, whose major shareholder is the Japanese government. JTI-Macdonald was formerly (until 1999) known as RJR-Macdonald, and was owned by R.J. Reynolds, the No. 2 tobacco company in the United States. In 1999, R.J. Reynolds sold all of its non-US interests to Japan Tobacco, including RJR-Macdonald and rights to the flagship Camel brand. |
| 15. Samet, Johnathan M. and Burke, Thomas A. "Turning Science into Junk: The Tobacco Industry and Passive Smoking." American Journal of Public Health. Volume 91, No. 11, November 2001: 1742-1744. |
| 16. Yach, Derek, and Bialous, Stella Aguinaga. "Junking Science to Promote Tobacco." American Journal of Public Health. Volume 91, No. 11, November 2001: 1745-1748. |
| 17. Ong, Elisa K. and Glantz, Stanton A. "Constructing 'Sound Science' and 'Good Epidemiology': Tobacco, Lawyers and Public Relations Firms." American Journal of Public Health. Volume 91, No. 11, November 2001: 1749-1757. |
| 18. Samet et al, op.cit.; Yach et al, op. cit.; Glantz et al, op.cit. |
| 19. U.S. Centers for Disease Control. "Preventing Tobacco Use Among Young People: A Report of the Surgeon General." 1994. |
| 20. See the full text of Parker's comments to the hearing at http://www.legassembly.sk.ca/tcc/Docs/000307Tobacco.htm. |
| 21. Cunningham, Rob. "Smoke and Mirrors: The Canadian Tobacco War." International Development Research Centre. Ottawa, Canada. 1996, pp. 165-173. |
| 22. See especially Pollay, R.W. Targeting tactics in selling smoke: Youthful aspects of twentieth-century cigarette advertising. Journal of Marketing Theory and Practice, 3, 1-22, 1995, and Pollay, R. W. and Lavack, A. The targeting of youth by cigarette marketers: Archival evidence on trial. In L. McAlister & M.L. Rothschild (Eds.), Advances in consumer research, pp. 266-271. Provo, Utah: Association for Consumer Research. |
| 23. Discussion paper found at: http://www.tobacco.org/Documents/910129TIMNO164422ythpgm.html - Document ID: TIMNO164422/4424, Document Date: 19910129, Case Name: Minnesota Attorney General. Quoted in "Operation ID School Zone - Part 1." Background document, Ontario Tobacco Strategy Media Network, June 12, 2001. |
| 24. See www.operationid.com. |
| 25. See www.operationid.com. |
| 26. Kingston Whig Standard, November 30, 2000. |
| 27. Brandon Health Inspector, Brandon Regional Health Authority, Central Okanagan Community Health Advisory Committee, Kelowna Health Unit, Okanagan Similkameen Health Region. |
| 28. See www.operationid.com. |
| 29. Cunningham Gregory and Company. "Wise Decisions." 2001. |
| 30. Ibid, p. II. |
| 31. Quoted in American Non-Smokers' Rights Foundation, op. cit., p. 3. |
| 32. Although friends and peers were identified by 38% of those responding to the 2000 Canadian tobacco use monitoring survey as the group with most responsibility for youths starting to smoke, other influences added up to a significantly higher percentage. Twenty-two percent assigned responsibility to young people themselves, 17% to parents, 13% to the tobacco industry, and 10% to a combination of other influences such as celebrities and other adults. |
| 33. RJR-MacDonald Inc.: Key discussion points, Ottawa-November 5, 1996, p. 1. |
| 34. Cunningham, op. cit., pp. 61, 69, 300. |
| 35. Ontario Tobacco Research Unit. "Monitoring the Ontario Tobacco Strategy: Progress Toward Our Goals, 2000/2001." Seventh Annual Monitoring Report, November 6, 2001, p. 43. |
| 36. Ibid p. 42. |
| 37. See www.operationid.com, "% retailers refusing to sell by region - measurement of retailer compliance with respect to the Tobacco Act and provincial tobacco legislation," AC Nielsen, March 2001. Dr. Tom Abernathy, executive director of Ontario's Central West Health Planning Information Network, and a long-time analyst of youth restrictions, offered the following comments on the AC Nielsen figures: "The results are inconsistent and impossible to interpret. There is no clear trend either among individual communities or between them. In fact, since confidence levels are not reported with the percentages, there is no way to tell whether or not any differences exist at all. Second, because evaluation methods are not available, we do not know if (1) the merchants who took part in the program were self selected; (2) if the same merchants always participated in the different surveys, (3) what methods were used to measure compliance (i.e. the time of day, age and sex of test shoppers, mix of different types of establishments). There is also no way anyone could confirm the results by independent evaluation. Taken together, these issues create questions about the industry's claims of success and exclude this approach from consideration as a 'best practice for tobacco control'." |
| 38. Ontario Tobacco Research Unit. "Monitoring the Ontario Tobacco Strategy: Progress Toward Our Goals." Fourth annual report, 1997/98. |
| 39. Wolfson, M. et al. "Adolescent smokers' provision of tobacco to other adolescents." American Journal of Public Health, April 1997: 87 p. 649. Quoted in "Key Insights from Select Experts" - Philip Morris USA YSP Department, 1998. |
| 40. Jason L, et al. "Active enforcement of cigarette control laws in the prevention of cigarette sales to minors." Journal of the American Medical Association 1991; 226: 3159 - 3161. |
| 41. Rigotti, N. et al. "The Effect of Enforcing Tobacco-Sales Laws on Adolescents' Access to Tobacco and Smoking Behaviour." New England Journal of Medicine, 337:1044-1051, 1997. |
| 42. Difranza, J. et al. "A model for the efficient and effective enforcement of tobacco sales laws." American Journal of Public Health 88 (1998): 1100-1101. |
| 43. A November 15, 2001 story in the Charlottetown Guardian on ODI/SZ contains an admission from the program's regional consultant in Charlottetown that the compliance rates of retailers refusing to sell tobacco to minors in the Maritimes, including PEI, had dropped "a bit" compared to the fall of 2000. Instead of attributing the compliance decline to the ineffectiveness of their program, both the consultant and the national manager for Operation ID OID/SZ, Anne Viau, attribute the decline to the fact that "retailers have a lot on their plate and they need to be reminded," and that the changeover rate of young clerks is very high. |
| 44. Lewit EM, et al. "Price, public policy, and smoking in young people". Tobacco Control 1997, 6 (suppl2):S17-S24. |
| 45. Hinds M.W. "Impact of a local ordinance banning tobacco sales to minors." Public Health Reports 1992; 107:356-358. |
| 46. Chaloupka F, Grossman M. "Price, Tobacco Control Policies, and Youth Smoking," Cambridge, MA 02138: National Bureau of Economic Research; 1996. |
| 47. Forster JL, et al. "The Effects of Community Policies to Reduce Youth Access to Tobacco." Tobacco Control 1998; 38:1193-1197. |
| 48. Monitoring the Ontario Tobacco Strategy: Progress Toward Our Goals 1997/1998. Fourth Annual Report. |
| 49. Slavitt, J. "TI (Tobacco Institute) Youth Initiative." February 12, 1991. (Philip Morris memo, available from http://www.pmdocs.com/getallimg.asp?DOCID=2500082629). |
| 50. Lieber, C. "Youth Campaign for Latin America." September 23, 1993. (Philip Morris memo available from http://www.pmdocs.com/getallimg.asp?DOCID=2503016523/6524). |
| 51. Ted Bates (advertising agency) New York. "What we have learned from people: a conceptual summarization of 18 focus group interviews on the subject of smoking." May 26, 1975, quoted in "Danger! PR in the Playground-Tobacco Industry Initiatives on Youth Smoking.", October 2000 (available at http://www.ash.org.uk/html/advspo/pdfs/playgroundreport.pdf). |
| 52. DiFranza, J. and McAfee, T. "The Tobacco Institute: Helping Youth Say 'Yes' to Tobacco." Journal of Family Practice 34, 6 (1992), quoted in Coalition Québécoise Pour le Contrôle du Tabac, "Tobacco Industry Prevention Programs: 'Wise Decisions'," August 2001. |
| 53. Coalition québécoise, op cit, p. 8. |
| 54. Zacour, R. "Re: Review of Wise Decisions." Letter to Alan McFarlane, Ontario Lung Association, April 9, 2001. |