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News analysis......

Australia: campaign gets smoking parents to cut down A campaign to protect children from environmental tobacco smoke (ETS) has achieved a significant level of behaviour change by smoking parents. The ‘‘Car and home: smoke free zone’’ campaign resulted in a 55.7% increase in the number of reported smoke-free homes occupied by smokers with children aged under 6. There was also a 41.8% increase in the number of reported smoke-free cars. The ‘‘Car and home: smoke free zone’’ campaign, launched in New South Wales in 2002, has ETS exposure can cause children proved successful in persuading smoking parents to reduce their children’s exposure to secondhand problems from asthma, lower respira- smoke. tory tract infections such as pneumonia and bronchitis, coughing, wheezing, discussions with parents who smoke. by this language group focused on this middle ear infections, and sudden This helped spread the message among issue ‘‘Your visit benefits us, but your infant death syndrome (SIDS). It has the target audience, as well as increas- smoke harms us’’. Another grant target- also been linked to an increased risk of ing the sustainability of the campaign ing Pacific Islander groups found that bacterial meningitis, learning difficul- message beyond the project’s lifespan. the campaign slogan conveyed a differ- ties, autism, behavioural problems, and Although smoking rates continue to ent meaning to the one intended. For heart disease. decline in NSW (the daily rate is 17.2% some of the Samoan language groups The ETS and Children Project was for males and 15.8% for females), rates ‘‘Car and home: smoke free zone’’ was launched in 2002 in New South Wales for Aboriginal and other culturally and taken literally, meaning, ‘‘This is an area (NSW) to limit the exposure of children linguistically diverse groups remain where you are free to smoke’’. The aged 0–6 to ETS in the car and home much higher. It was a priority for the resource developed for this community environment. Campaign activity was project to reach these groups, in view of used the slogan ‘‘Smoking makes kids http://tobaccocontrol.bmj.com/ funded by a $A2.4 million (US$1.8 their children’s ETS exposure being sick. Smoke outside your home and million) grant from the NSW correspondingly high, too. car’’. Culturally specific resources were Department of Health and was run by A community grants scheme enabled also developed for use by Aboriginal a taskforce of government and non- local groups to conduct culturally appro- communities, including professional governmental organisations (NGOs). priate projects within their own com- development material for Aboriginal The main message of the campaign munities. The funding for each group health workers. was summarised in the slogan ‘‘Car varied according to the scope and size of The campaign has been rigorously and home: smoke free zone’’ and their proposal and the type of activity evaluated. By the end of the campaign parents and carers were asked to make they wished to undertake, and ranged period 73% of homes with a smoker and their homes and cars smoke-free by from $A4850 to $A30 000 (US$3600– children aged 0–6 years reported being going outside if they needed to smoke 22 500). Applicants for the grants were totally smoke-free with a further 18% and by asking visitors to do the same. on September 29, 2021 by guest. Protected copyright. required to work with at least one of the reporting they did not smoke when their Resources were developed to deliver organisations represented on the task- children were in the same room. This is the campaign message in English and a force, which led to the formation of considered a great result and a good number of local community languages, strong networks. example of what can be achieved when which were reinforced in three Some grants translated existing government and NGOs work together. It media campaigns. Commercials aired all resources into community languages is also encouraging to see those parents over the state on television and radio, with the result that information is now and carers who are unable to quit, supported by billboards and stories and available in Arabic, Assyrian, Bosnian, change their smoking behaviour to features in newspapers and magazines. Croatian, Farsi, Greek, Khmer, Italian, protect the health of their children. Health professionals and childcare Mandarin, Samoan, Serbian, Spanish, workers were also targeted, to encou- LIAN YIOW Tongan, and Vietnamese. Some grant rage them to include information New South Wales Cancer Council, , recipients adapted resources to ensure about the health risks of ETS in their ; [email protected] that they were both linguistically and culturally appropriate for their commu- nity. For example, the issue of hospital- Lebanon: water pipe All articles written by David Simpson ity was seen as a potential barrier to unless otherwise attributed. Ideas and making the home smoke-free for some line to youth items for News Analysis should be sent Arabic speaking people, as they did not Most Arab countries, like many other to: [email protected] want to offend visitors by asking them low to middle income nations, are still to smoke outside. The slogan developed in the relatively early stages of the

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Tobacco Control 2003;12:338). Some think the latest trend marks a minor step forward, while others reckon it is merely a refinement of double stan- dards. The real motivation is probably commercial: tobacco companies know that, as in politics, a week is a long time for the truth about smoking to linger, allowing the glamorous fable to be resumed untainted. India: still at the bravery game In our last issue, we reported the good news that Godfrey Philips, Indian sub- sidiary of Philip Morris, had decided to In Lebanon, youth and women are the target of a marketing campaign featuring a new tobacco abandon the bravery awards scheme it product for use with the more traditional water pipe. had used so successfully for many years to promote its Red & White cigarette brand (see Tobacco Control 2005;14:297). cigarette tobacco epidemic. Lebanon has multinationals and more recently the However, it has already become apparent the dubious position among Arab coun- state sponsored tobacco companies are tries of being the only one with rela- of hip, trendy, and successful young tively equal rates of cigarette smoking persons enjoying the ideals more com- among men and women. The water pipe monly attributed to the west. Most is a traditional form of tobacco smoked recently, a picture of a bikini clad young in Arab countries, including Lebanon. woman lying beside a swimming pool in Recently, trends have shifted between Beirut and smoking a water pipe was tobacco types, and water pipe smoking widely circulated. To traditionalists, is becoming the preference for young such pictures will undoubtedly portray people and women specifically, ousting an image of Lebanon not welcomed by the once more popular cigarette. As an the eastern world. But to others, it will indicator of its popularity, thriving new seem an affirmation of the country’s delivery services have appeared, linked future prosperity. To those who want to to mobile phones. By using their phones profit from western minded young con- in accordance with prescribed direc- sumers, such images must seem like http://tobaccocontrol.bmj.com/ tions, customers can even specify the helpful free marketing. Whatever their number and flavour of pipes they want. cultural significance, the lifestyle they According to how many times they call illustrate has serious implications for the sales line, the appropriate water the health of future generations of pipe(s) will be delivered to their home Lebanese people. for the equivalent of just US$1 dollar apiece. RIMA AFIFI SOWEID Taking advantage of this visible trend, Faculty of Health Sciences, American University the state subsidised tobacco company of Beirut, Lebanon; [email protected] recently launched a new tobacco pro- duct for use with the water pipe. It is USA: TIME’s lingering clearly aimed at the youth market—its on September 29, 2021 by guest. Protected copyright. name, ‘‘Shabablek’’, literally translates double standard as ‘‘Youthful’’. Its advertisements depict The cover of TIME magazine on 17 young men and women enjoying eve- October 2005 invited readers to learn nings out on the town. Ironically, with about ‘‘living better longer’’. There was an eye on an ever ‘‘health conscious no tobacco advertisement on the back consumer’’, the new product comes in cover that week, but the following week individually wrapped portions (hitherto it was business as usual with a Camel ad in large bales) and the promise that it depicting a young female model. US has not been touched by human hands. health advocates say this illustrates a The new product got an unmistakable recent trend: when a publication carries boost by being launched under the aegis a major health article heralded on the of the minister of finance, indicating a cover, the rest of the magazine tends not continuing focus on short term financial to contain tobacco advertising, but it gain, rather than long term health resumes in the next issue. In the past, it planning. was not unusual to find a striking Wedged at the end of the announcement of a health article on TIME still carries advertising for tobacco Mediterranean, Lebanon strives to find the front cover, and a full page cigarette products, although now not usually in the same its way between differing cultures and advertisement on the back of the same issues as those featuring articles focusing on continents. The images promoted by issue (see the TIME covers shown in health.

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Toilet cubicles covered with EU health warnings in use at the XX 2005 in . Photos: Rainer Holz/Ba¨r + Knell; www.baer.knell.de. that the company sees far too much the event, were only informed one day accountants may be the ones to take benefit from the scheme to give it up in advance. the bravest, if inevitable decision. altogether. The society immediately fired off In its heyday, the Red & White urgent pleas to everyone from the state Bravery Awards let Godfrey Philips to governor and first and deputy first min- : health run massive advertising and public isters of the state government, to the relations campaigns around India, soli- police and the hotel, and even to the warnings at your citing nominations for various cate- president of India. Setting out a formid- convenience gories of personal bravery. Apart from able list of well argued reasons why the German artists Ba¨r + Knell came up event contravened the provisions of associating the name, colours and logo with the idea of using the European of Red & White cigarettes with laudable tobacco promotion law, and the interpre- Union health warnings to cover nearly human qualities and roping in opinion tations of the court, they urged the 1000 temporary toilets used at the http://tobaccocontrol.bmj.com/ leaders to hand over the awards, the recipients to cancel or at least boycott closing event of the XX World Youth presentation ceremonies allowed the the event. While no immediate response Day 2005 in Cologne in August. The company to schmooze up to the good was received from politicians or officials, toilet cubicles extended in lines totalling and the great. State government minis- and the event went ahead as planned, the more than 1.5 km, and were visited by ters and senior civil servants always disappointment of those concerned with many of the nearly one million young found time to attend, even though they health must be set in context. people who attended the event, many of may have been seriously behind with It may not seem like it now, but the such tasks as, say, implementing latest saga from Chandigarh almost whom kept a joint vigil with the tobacco control regulations already certainly signals the death throes of a before spending the night in the open passed by parliament, but requiring particularly cynical and inappropriate air. The idea went deeper than the some slight bureaucratic action to form of tobacco promotion. After all, shocking images that faced casual visi- become effective. what had once been an open, public tors to the cubicles. Gerhard Ba¨rof Ba¨r + on September 29, 2021 by guest. Protected copyright. For the cigarette makers, losing the show of glory proclaimed by a wealth of Knell observed that the toilet has always brand name was only a partial defeat: advertising and press coverage before, been a place where communication by changing the name of the scheme to during and after the awards ceremony, takes place—one need only think of all the Godfrey Philips Awards, they could has rapidly shrunk to a covert affair the graffiti that graces the walls of still run the gravy train for the influ- whose very existence was kept secret public toilets, he said, or the legendary ential people they need to cultivate for until the last moment. humour scrawled inside. Toilets are the the sake of their commercial future. So This sort of trend has been seen in ‘‘quiet places’’ where you have time to it was that late one night in October, other countries, such as Australia, think, but they are also the locations the Burning Brain Society, the non- where social acceptability as well as where the first cigarettes are secretly governmental organisation whose legal laws forced changes once thought smoked behind closed doors, where case led to the banning of the brand impossible. Tobacco companies that drugs are sold and consumed—and, name for the awards, learned that the once flaunted the glorious garb of sometimes, where people die. At the scheme was going ahead again, with corporate munificence, have sunk to end of the World Youth Day the toilet the name of the company in place of quick and furtive grabs at the hem of tents were due to be cleaned, dis- the brand, in their own state, Haryana. decision-makers’ raiment, in situations mantled, and re-erected in 1000 school It was to take place the very next reminiscent of the speak-easy. If pres- playgrounds all over Germany. The evening in the prestigious Taj Hotel in sure on politicians is maintained, it may project was carried out in collaboration the state capital, Chandigarh. Even the be increasingly difficult to recruit with the World Health Organization awardees themselves, as well as jour- worthwhile guests of honour. And with Collaborating Centre for Tobacco nalists the company hoped would cover secrecy paramount, the company’s Control in Heidelberg.

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(SLTA) hired the public relations firm the UK tobacco trade organisation, Media House and created a new alliance when it refuted the health evidence on called Against an Outright Ban (AOB) to secondhand smoke. It was SLTA, AOB, lobby Scottish politicians not to ban and other tobacco industry initiatives smoking in public places. British such as FOREST, Courtesy of Choice, tobacco companies, a tobacco industry and Atmosphere Improves Results, funded ‘‘smokers’ rights’’ group called which delivered the tobacco industry’s FOREST, AOB, and SLTA all used the messages. This approach was used tactics developed to fight secondhand successfully by the tobacco industry in smoke legislation in the USA in the Beverley Hills in California in 1987, but 1990s. They tried to create ‘‘marketable has subsequently failed in New York, science’’ to cause public confusion. For Ireland, and now Scotland. example, the SLTA sponsored research Scotland’s smoking ban will come on air quality and ventilation, mislead- into effect on 26 March 2006. With ingly suggesting there was no difference more than 1000 non-smokers dying in particulate matter averages between a every year in Scotland as a result of non-smoking pub and a smoky pub exposure to secondhand smoke, it is with ventilation in use. long overdue. Going smoke-free is the They also denied the health impact of most radical public health decision secondhand smoke: Imperial Tobacco taken in Scotland since devolution of gave evidence to the Scottish power for many areas of government Parliament claiming that secondhand policy to Scotland, a process started in smoke could not be proven to be 1997, and resulting in the Scottish harmful (as recently as 2003, its chief parliament that began work in 1999. It executive denied that active smoking has made Scotland the UK’s leader in caused lung cancer—see UK: judge says tackling secondhand smoke. advocacy links taint witnesses. Tobacco Control 2005;14:298–9). IAIN BROTCHIE Other familiar tactics included trying ASH Scotland to move the debate away from health [email protected] issues and toward ‘‘smoker’s rights’’—a concerted campaign by licensed trade Bhutan: a bellyful for journalists and FOREST put the issue of rights for smokers repeatedly onto the the police public agenda—and the issue of ventila- For places to conceal contraband cigar- tion. Hospitality groups and the tobacco ettes, the coffin found to contain 3000 industry consistently claimed that ven- packs in Poland seemed imaginative, if http://tobaccocontrol.bmj.com/ tilation systems were the solution to somewhat macabre (Tobacco Control eliminating secondhand smoke expo- 2004;13:10). But in Bhutan, where the sure in public places, even though sale of tobacco, as well as its public use, scientific experts consistently demon- was banned in December 2004, a boom- strate that ventilation systems cannot ing market of smuggled cigarettes seems remove the carcinogens present in sec- to have led to even more bizarre hiding ondhand smoke. And against all evi- places for illegal supplies. Macedonia: Seen recently in the small state of dence, the groups opposing the Hard pressed customs officials in Macedonia, the southern part of former legislation repeatedly claimed there Yugoslavia, which gained independence in Bhutan say smuggling is especially 1991, were these advertisements for cigarettes was no popular support for smoke-free difficult to control in their country, not made in Slovenia. public places. just because it is mountainous and The familiar predictions of dire eco- sparsely populated, but also because on September 29, 2021 by guest. Protected copyright. nomic consequences were made, too, people from all walks of life are UK: Scottish report including the usual prediction of a 30% involved. Many ordinary people are decline in licensed trade revenues. In lured into taking the risk by irresistible exposes tobacco tactics stark admission of the harm caused by rates of profit, not only from importing, In September, Action on Smoking and smoking, still denied by some on the but also from moving cigarettes intern- Health (ASH) Scotland launched a tobacco industry side, the chair of SLTA ally: a recent report cited a sixfold mark- report, The unwelcome guest: how Scotland even claimed that Scotland could not up on cigarettes smuggled from the invited the tobacco industry to smoke outside. afford to go smoke-free as the additional capital to a region only one day’s drive Using previously uncovered tobacco costs of people living longer had not away. But matching the wide range of industry documents as well as govern- been researched. smugglers is the variety of their con- ment, press and internal archives, the A feature of the tobacco industry’s cealment; illegal tobacco supplies have report shows how the campaign to go strategy is to use groups it creates or been found in everything from vegetable smoke-free in Scotland—the first part of supports to advocate its case, rather deliveries and general pick-up trucks to the UK to do it—was won, and how the than doing so directly itself. In army lorries, officials allege. To date, the tobacco industry tried to stop the Scotland, SLTA shared platforms with most ingenious, if tasteless Bhutanese legislation being passed. tobacco industry executives from rival to the Polish undertaker smuggler Hospitality groups such as the Imperial Tobacco as well as from the must be the man whose load was found Scottish Licensed Trade Association Tobacco Manufacturers’ Association, hidden in a pig’s carcase.

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Thailand: first to put cigarettes ‘‘out of sight’’ Thailand, which on any assessment has one of the world’s most advanced tobacco control programmes, now requires all tobacco displays to be kept out of sight. Tobacco Control thinks this is the first nation to have required this, although the Canadian state of Saskatchewan was the first jurisdiction to mandate the ‘‘under the counter’’ rule. A recent visit to Bangkok showed good compliance. The photograph on the left shows a bare display window viewed from the street, with a sign informing smokers that tobacco is sold inside. A few doors down from where this shot was taken, a 7-Eleven store’s in-shop display shows the chain’s as yet unaltered policy of displaying the packs—Simon Chapman, Editor

The Lighter Side...... http://tobaccocontrol.bmj.com/ on September 29, 2021 by guest. Protected copyright.

Bizarro, by Dan Piraro.E King Features Syndicate. Reprinted with permission – Torstar Syndication Services.

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