RESEARCH PAPER

How the health belief model helps the tobacco industry: individuals, choice, and "information"

Edith D Balbach¹, Elizabeth A Smith², Ruth E Malone²

¹ Tufts University, Medford, Massachusetts, USA
² University of California at San Francisco, San Francisco, California, USA

Correspondence to:
Correspondence to:
Dr Edith D Balbach
Community Health Program, Tufts University, 112 Packard Avenue, Medford, MA 02155, USA; edith.balbach{at}tufts.edu

Objective: To analyse trial and deposition testimony of tobacco industry executives to determine how they use the concepts of "information" and "choice" and consider how these concepts are related to theoretical models of health behaviour change.

Methods: We coded and analysed transcripts of trial and deposition testimony of 14 high-level executives representing six companies plus the Tobacco Institute. We conducted an interpretive analysis of industry executives’ characterisation of the industry’s role as information provider and the agency of tobacco consumers in making "choices".

Results: Tobacco industry executives deployed the concept of "information" as a mechanism that shifted to consumers full moral responsibility for the harms caused by tobacco products. The industry’s role was characterised as that of impartial supplier of value-free "information", without regard to its quality, accuracy and truthfulness. Tobacco industry legal defences rely on assumptions congruent with and supported by individual rational choice theories, particularly those that emphasise individual, autonomous decision-makers.

Conclusions: Tobacco control advocates and health educators must challenge the industry’s preferred framing, pointing out that "information" is not value-free. Multi-level, multi-sectoral interventions are critical to tobacco use prevention. Over-reliance on individual and interpersonal rational choice models may have the effect of validating the industry’s model of smoking and cessation behaviour, absolving it of responsibility and rendering invisible the "choices" the industry has made and continues to make in promoting the most deadly consumer product ever made.

Abbreviations: B&W, Brown and Williamson; DATTA, Deposition and Trial Testimony Archive; RJR, RJ Reynolds

Keywords: corporate social responsibility; tobacco industry; rational choice theory; health belief model; corporate ethics

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