News analysis

As increasing numbers of governments ban smoking in workplaces, including hospitality venues such as bars and restaurants, the protestations of the tobacco industry are heard louder and ever more desperate, trying to convince employers that it is bad for business. We should not be surprised that economic arguments are being used as if employment and profits were preferable to passive smoking disease reduction— after all, the huge burden of premature death caused by active smoking never stopped the industry trying to dilute tobacco control policies on the grounds of supposed damage to the economy. What is surprising, as well as alarming, is the way the commercial world still swallows what the tobacco spin doctors serve up as evidence about workplace bans. Among the most discussed bans in Europe has been the one implemented in Ireland. Reports of its economic effects have ranged from claims of doom and gloom among publicans, put about by the industry side, to reports of increased pub sales. There have even been whispered admissions in Dublin that takings are up so much, as nonsmoking pub-goers return to enjoy the buzz and chat of the capital’s famous watering holes, that some publicans do not want to divulge too many details for fear of inspections of tax records that may not always be entirely comprehensive and up to date. A new report presented at the Smokefree Europe conference in Luxembourg in June shows that ending smoking in all workplaces and enclosed public places has not damaged the economy in the many countries, cities, and states around the world that have adopted such legislation. A Europe wide trend to drink more alcohol at home and less in bars and pubs appears to account for the apparent downturn in trade after the Irish smoke-free legislation was introduced in 2004. Luk Joossens, Advocacy Officer for the Association of European Cancer Leagues, compared statistics from regions that have introduced smokefree legislation, and compiled new data on drinking trends from across Europe. He said, ‘‘Tobacco companies are at pains to show that smoking bans in bars and restaurants have a negative impact on business and lead to drops in sales and job losses. They frequently use anecdotal facts and speculative projections to make these claims. But rigorous analysis of studies from Ireland, New York, British Columbia and other places shows that smoke-free legislation does not damage profits. In some places it could even have a positive economic effect.’’ Joossens only analysed research that met stringent quality criteria and had been funded by a source with no links to the tobacco industry. He also examined economic trends before the introduction of bans. The main argument used by the tobacco industry to try to avert bans is that drinking and smoking go together, and if that were the case, a ban on smoking in pubs would be expected to affect Ireland, whose citizens drink more in bars than any other European nationality. But the evidence shows that the ban did not affect Ireland’s bar economy. In fact, objective measures such as till receipts and peer reviewed research show that going smoke-free has not damaged the economy of any country examined so far. Although representatives of the Irish hospitality industry have estimated losses in the pub trade of 15–20% since the ban was enforced, the actual decrease in sales of alcohol was in line with declines that started in 2002, which follow a Europe wide trend towards consuming more alcohol at home. In Ireland, the estimated share of beer sales consumed in private homes has almost doubled, from 12% in 2000 to 23% in 2003. No doubt fuelled by panic and false data emanating from the tobacco industry, the hospitality industries in countries considering smoke-free legislation tends to overplay its hand. For example, a Belgian hospitality trade mission to Ireland reported that an Irish style ban in Belgium would lead to between 20 000 and 40 000 job losses—yet its own website showed that only 14 183 people worked in drinking places in Belgium in 2003. The new report will not stop attempts by the tobacco and hospitality industries to fight smoke-free legislation, but it does provide health advocates with a useful resource to help convince politicians to do the right thing. The report, Smoke Free Europe makes economic sense: a report on the economic aspects of smoke free policies, can be obtained from the Smokefree Europe 2005 website (http:// www.smokefreeeurope. com/economic_ report.htm).

As increasing numbers of governments ban smoking in workplaces, including hospitality venues such as bars and restaurants, the protestations of the tobacco industry are heard louder and ever more desperate, trying to convince employers that it is bad for business.We should not be surprised that economic arguments are being used as if employment and profits were preferable to passive smoking disease reductionafter all, the huge burden of premature death caused by active smoking never stopped the industry trying to dilute tobacco control policies on the grounds of supposed damage to the economy.What is surprising, as well as alarming, is the way the commercial world still swallows what the tobacco spin doctors serve up as evidence about workplace bans.
Among the most discussed bans in Europe has been the one implemented in Ireland.Reports of its economic effects have ranged from claims of doom and gloom among publicans, put about by the industry side, to reports of increased pub sales.There have even been whispered admissions in Dublin that takings are up so much, as nonsmoking pub-goers return to enjoy the buzz and chat of the capital's famous watering holes, that some publicans do not want to divulge too many details for fear of inspections of tax records that may not always be entirely comprehensive and up to date.
A new report presented at the Smokefree Europe conference in Luxembourg in June shows that ending smoking in all workplaces and enclosed public places has not damaged the economy in the many countries, cities, and states around the world that have adopted such legislation.A Europe wide trend to drink more alcohol at home and less in bars and pubs appears to account for the apparent downturn in trade after the Irish smoke-free legislation was introduced in 2004.
Luk Joossens, Advocacy Officer for the Association of European Cancer Leagues, compared statistics from regions that have introduced smokefree legislation, and compiled new data on drinking trends from across Europe.
He said, ''Tobacco companies are at pains to show that smoking bans in bars and restaurants have a negative impact on business and lead to drops in sales and job losses.They frequently use anecdotal facts and speculative projections to make these claims.But rigorous analysis of studies from Ireland, New York, British Columbia and other places shows that smoke-free legislation does not damage profits.In some places it could even have a positive economic effect.'' Joossens only analysed research that met stringent quality criteria and had been funded by a source with no links to the tobacco industry.He also examined economic trends before the introduction of bans.The main argument used by the tobacco industry to try to avert bans is that drinking and smoking go together, and if that were the case, a ban on smoking in pubs would be expected to affect Ireland, whose citizens drink more in bars than any other European nationality.But the evidence shows that the ban did not affect Ireland's bar economy.In fact, objective measures such as till receipts and peer reviewed research show that going smoke-free has not damaged the economy of any country examined so far.
Although representatives of the Irish hospitality industry have estimated losses in the pub trade of 15-20% since the ban was enforced, the actual decrease in sales of alcohol was in line with declines that started in 2002, which follow a Europe wide trend towards consuming more alcohol at home.In Ireland, the estimated share of beer sales consumed in private homes has almost doubled, from 12% in 2000 to 23% in 2003.
No doubt fuelled by panic and false data emanating from the tobacco industry, the hospitality industries in countries considering smoke-free legislation tends to overplay its hand.For example, a Belgian hospitality trade mission to Ireland reported that an Irish style ban in Belgium would lead to between 20 000 and 40 000 job losses-yet its own website showed that only 14 183 people worked in drinking places in Belgium in 2003.
The new report will not stop attempts by the tobacco and hospitality industries to fight smoke-free legislation, but it does provide health advocates with a useful resource to help convince politicians to do the right thing.The report, Smoke Free Europe makes economic sense: a report on the economic aspects of smoke free policies, can be obtained from the Smokefree Europe 2005 website (http:// www.smokefreeeurope.com / economic_ report.htm).

Italian style
Fashion and smoking have been inextricably linked for decades.Models smoke on catwalks (and not just when wearing Yves St Laurent's iconic Le Smoking trouser suit) and in fashion spreads.Supermodels such as Naomi Campbell and Kate Moss appear in the celebrity press smoking in ''real life''.And some fashion designers are happy to associate their brand and products with smoking, such as the ads for Gucci handbags that appeared in several top European fashion magazines last autumn showing cigarette ash ''stylishly'' scattered across their expensive bags.
It therefore was a surprise to many when earlier this year Italy, arguably the All articles written by David Simpson unless otherwise attributed.Ideas and items for News Analysis should be sent to: d.simpson@iath.orgSri Lanka: Marlboro imitation time In common with many countries where cigarette promotion has saturated the marketplace, numerous other products, such as this clock on sale in Colombo, ''borrow'' the most promoted names and logos to try to enhance their value in the eyes of consumers.
most fashion conscious and stylish country in the world, passed and implemented more comprehensive legislation on smoke-free public places.Furthermore, the legislation appears to be working, with few breaches being reported.However, it would appear that some in the Italian fashion world are finding their addiction to tobacco more difficult to break.The March and April editions of Italian Vogue (regarded as the international fashion ''bible'') persisted in showing young female models smoking in their fashion pages.The March edition featured four single and three double fashion spreads, while the April edition showed smoking in three single and one double spread.In Vogue's own words, and illustrated by the seductive images of the world famous photographer Steven Meisel who took many of these pictures, young women's smoking still symbolises glamour (''Perfection Everyday''), style (''Variations on Chic''), emancipation (''The power of Vogue Style''), sexual allure (''Madame''), and European womanhood (''Black Russian'', ''Frenchoutsider, don't do it, chic and wild, dark and elegant, fashion, attitude, rebel'').
Given the continued positive promotion of smoking by top fashion magazines it is not surprising that, as shown in a recent paper in Tobacco Control by Huisman and colleagues (Tobacco Control 2005;14:106-13), female smoking in Italy (as in all the countries studied) is highest among young women.It is to be hoped that the recent cultural shift around the social acceptability of smoking in public places in Italy will also impact positively on fashion editors' and photographers' attitudes about the desirability of polluting their magazines with smoking images.

AMANDA AMOS
University of Edinburgh Medical School, UK; Amanda.Amos@ed.ac.ukUSA: injuries in the smoking room when a nuclear sub crashes In January this year a US nuclear powered attack submarine, the USS San Francisco, crashed into an undersea mountain that was not marked on the navigation chart being used.A total of 99 crew members were injured, particularly in the areas that were relatively open: the smoking room, the crew's mess, and the engine rooms.The one crew member who sustained fatal injuries was smoking in the smoking room at the time.
It is perhaps surprising to think that there is actually space in a submarine for a smoking room.Indeed, it seems somewhat alarming that smoking is permitted given that there must be some (albeit small) increased fire risk.Furthermore, there are concerns around the performance of nicotine dependent workers-given the data that smokers are at increased risk of workplace injuries.One survey has reported that 55% of submariners (from two UK nuclear submarines) felt that it would be justifiable to enforce a ban on smoking in submarines.
No-smoking policies have been trialled for US navy ships.Perhaps it is time for navies with submarines to catch up with other work settings when it comes to state-of-the-art tobacco control?Alternatively, submarine patrols could be suspended with the realisation that the Cold War has now been over for 15 years and that resources are needed to address health and social concerns.

NICK WILSON GEORGE THOMSON
Wellington Medical School, University of Otago, New Zealand; gthomson@wnmeds.ac.nz

USA: PM's fouls come home to roost
Philip Morris (PM), the world's largest transnational tobacco company, may try to hide its corporate head under the wing of its parent company, Altria, these days, but it cannot escape the attentions of health advocates trying to make it accountable for its actions.If Altria's annual stockholders' meeting in April was anything to go by, when it faced a record level of protest accusing it of spreading the smoking epidemic around the world, things can only get worse.
Altria's worldwide earnings are now so large that they dwarf the entire economic activity of many a small nation whose citizens are daily encouraged to smoke Marlboro cigarettes.In 2004, its net revenue was $89.6 billion, more than two and a half times the gross domestic product of Kenya, seven times more than Nicaragua's, and 12 times that of Malawi, one of the largest tobacco producers in the world (and the most tobacco dependent).
Not surprisingly, Altria's chief executive, Louis Camilleri, is well rewarded for his group's success.Although on a basic salary last year of ''only'' $1.5 million (he has a 16% rise for this year), his stock options and other remuneration, much of it performance related, took his annual earnings to around $6.7 million.At more than $18 000 per day, every day of the year, that's probably still enough to be worth anyone getting out of bed for, even when they know their big day will be marred by a bunch of protesters.Even when those protesters relate first hand experience of the death and disease the company's number one product causes to millions of sufferers, or customers who have chosen to smoke, as Mr Camilleri may prefer to think of them.
At this year's annual meeting in East Hanover, New Jersey, not only did the Nightingales fly in again (see USA: nightingales sing at PM's AGM.Tobacco Control 2004;13:218), but a truly diverse and international group took part.Some were well known from previous protests, but others who came new to the fray, many from the very markets health advocates are most concerned about, also made themselves heard.
The Nightingales are a group of registered nurses from more than 25 American states who, like the other protestors, became shareholders in Altria so they could speak out about the tobacco caused suffering they witness in their daily work (www.nightingalesnurses.org).''Altria claims to be trying to be responsible,'' said Ruth Malone, associate professor of nursing at the University of California, San Francisco, addressing Mr Camilleri, as she recalled lung cancer patients for whom she has cared, ''but do the top executives and investors really fully understand the unspeakable suffering that cigarettes cause with ordinary use?If not, why not?If so, how can you possibly continue to promote these deadly products?'' The nurses displayed a banner made up of letters sent to the company by grieving families and dying consumers, and shared stories of the suffering they witness in caring for tobacco users and their families.They also spoke to several of the proposed shareholder resolutions, including one addressing cigarette sales to pregnant women.
Among other protestors, more than 100 young people and adults from India, Indonesia, Nigeria, Thailand, California, Hawaii, and the USA turned up at the meeting, organised by Essential Action and several youth empowerment programmes, with some 30 going inside to denounce PM's global expansion.Since Altria is celebrating Marlboro's 50th anniversary this year, also the 50th anniversary of PM's overseas expansion, demonstrators marked the anniversaries outside the meeting with a ''Happy 50th Deathday'' cake, black balloons, a 15 foot (4.6 m) high Marlboro pack labelled ''50 Years of Death'', and photographs of the company's tobacco promotions around the world.
Inside the meeting, Camilleri was presented with a ''Happy 50th Deathday'' card.As he started to list all the company's ''socially responsible'' activities around the world, such as Asian tsunami relief, support of domestic violence victims, and food for the hungry, about two dozen youths and adults covered themselves in black death shrouds bearing skull images and large ''Happy 50th Deathday'' stickers, and stood up.Mr Camilleri interrupted his speech to order everyone to sit down and stop blocking other people's view, whereupon two protestors then moved to the aisle and stood facing the audience for the remainder of the meeting.It is good to see Big Tobacco being confronted by increasing levels of protest by those speaking up against what it is doing around the world.
Altogether, protest speeches accounted for around an hour of Altria's annual shareholders' meeting.It can only get worse.

USA: Reynolds goes smoke-free
Three days after the Altria/PM annual meeting (see above), Reynolds American (Reynolds) held its own annual shareholders' meeting.It is the holding company of RJ Reynolds Tobacco, the second largest cigarette company in the USA, which manufactures and markets about one third of the cigarettes sold there, and is the only part of the former RJ Reynolds group not bought up by Japan Tobacco.As with Altria, Reynolds found itself facing a record number of activists, including Anne Morrow Donley, cofounder and president of the anti-tobacco group Virginia GASP.
The activists dominated the meeting, though unfortunately for them, the press was not there in force; tobacco companies probably now prefer to deal with financial press privately to ensure that their all important financial results and future prospects get reported free of inconvenient content related to the human realities of their trade.Previous meetings had been filled with smoke, so Anne Morrow Donley brought along a respirator.Getting to the meeting an hour early to discuss the situation with the company (it was at Reynolds' headquarters in Winston Salem, North Carolina), she suggested that either the meeting would have to be smokefree, or she would have to wear the respirator.
At first she was told she should wear the respirator if she was comfortable doing so, but soon other company officials became involved and tried to get a wireless microphone to work from the non-smoking observers' room.However, practical considerations seemed too difficult to resolve, and they decided that the simplest solution was…to make the meeting smoke-free.As the activists walked into the meeting room, ushers Singapore: laying down the tar Always ahead of the pack with its tobacco control policies and ever changing, creative new ways of bringing the message home, Singapore recently came up with another first.A series of health education ''advertisements'' were painted on road surfaces, like this one on the pedestrian crossing area at a busy street junction.Singapore's prevalence of daily cigarette smoking among adults declined significantly from 15.2% in 1998 to 12.6% in 2004, with males down from 27.1% to 21.8%, though young females (18-29 years) were up from 5.2% to 6.6%.This year's annual meeting of Altria attracted a diverse group of demonstrators, including the Nightingales (upper panel), a group of registered nurses from more the 25 US states.Other demonstrators marked the 50th anniversary of Marlboro with a ''Happy 50th Deathday'' cake and card.
on either side were saying over and over again to everyone attending, ''This meeting is smoke-free.Please do not light up''.When Reynolds president and chief executive Andrew Schindler opened the meeting, his welcome was quickly followed by the same request, and the explanation that the meeting was smoke-free ''at the request of shareholders and guests''.
A reporter from the The Winston-Salem Journal remarked that he was ''stunned'' by the announcement.He was reminded by another activist, Father Michael Crosby, the Catholic priest well known for his campaigning work to reduce tobacco deaths, that when the company did the right thing, no one challenged it.(Crosby seconded a resolution to require Reynolds to make self-extinguishing cigarettes for all markets, reminding Schindler that in 1997, a cigarette fire caused $1 million in damage to Schindler's vacation home and surrounding properties.Schindler made no response.)Despite the reporter's amazement, the subsequent report in The Winston-Salem Journal carried no mention of the historic move to a nonsmoking meeting.

Swedish Match: sucked into controversy, worldwide
Swedish Match used not to feature much in international tobacco control discussions-it supplied the Swedish market with its oral tobacco (snus) products, and that, it seemed, was only a matter of concern for Swedish colleagues.But in recent years, as cigarette manufacturers have been hurling themselves ever more forcefully into the great scramble for the developing world, Swedish Match has been going international too.For example, realising that India was the world's largest oral tobacco market, it launched its Click brand there (see Gupta PC.India: Swedish Match steps in.Tobacco Control 2001;10:307).Recently, it has been seen in action, and controversy, in several more overseas markets.
When British American Tobacco (BAT) caused a stir earlier this year by announcing it was launching an oral tobacco product in South Africa, few outside the country realised there was much of a snuff market there.In fact, it has been around for some time, and Swedish Match became the second largest producer in 1999, when it acquired a local manufacturer.Its Taxi brand is the country's top seller, and Swedish Match also markets a brand called Tobaccorette.Many feel the name is uncomfortably close to the smoking cessation product Nicorette, a nicotine containing chewing gum.South Africa has a total ban on tobacco promotion, and it seems Tobaccorette was introduced into parts of the country through ''viral'' marketing.Produced in Zimbabwe, it does not carry the warning label ''Causes Cancer'' as required by law for smokeless tobacco products.
As public health workers around the world continue to debate harm reduction policies, including the place within them of oral tobacco, South Africa may be about to see whether a significant new body of South African cigarette smokers replaces some or all of their smoking with snus.They will also be watching to see how BAT markets the product and whether it tries to make health claims about it.Last year, scientists at the University of Pretoria confronted Swedish Match about health claims on a website advertisement that implied that Tobaccorette had no health hazards.The company later shut down the site, claiming it had not approved of the ad.
It appears that Swedish Match may be somewhat out of touch with what is done to promote its products around the world.Earlier this year, health advocates in Scotland, where tobacco control laws may soon be significantly stronger than in other parts of the UK after its devolved parliament votes on a workplace smoking ban, were alerted by ASH Scotland to yet another insidious tobacco related campaign aimed at university students.Free samples of The prospect of having Anne Morrow Donley wearing her respirator at the annual shareholders' meeting may have had something to do with Reynolds' hasty and highly unusual decision to make the meeting smoke-free.
An advertisement for the Swedish Match company's oral tobacco product, Tobaccorette.
The Styx boxes distributed to students contained a reference to a website (http://www.styxpapers.com)clearly aimed at a youth audience, but with no manufacturer details.The website included details of recruitment opportunities last December, for students to give out free samples.But the promotion was not limited to cyberspace-eye catching Smart cars, highly popular among young people, and conspicuously decorated with the Styx name and logo, were being driven and parked in areas frequented by students.Even the most basic Smart car retails for around £6800 (US$12 500) in the UK, some 31 000 times the price of a pack of Styx papers.
Research showed that the Styxpapers website was registered to Swedish Match UK Limited.During 2004, it recruited students to participate in a competition by distributing packets of cigarette rolling paper in their spare time.Applicants were promised training in sales techniques, a Smart car, and a competitive salary.''So sticky, it's criminal'' was one of the slogans, apparently trying to mimic teenage slang.Swedish Match was not mentioned; in fact, Styx is not made by the company, but is being sold, together with filter tips, on a trial basis in the UK.The packaging, in different colours, resembles chewing gum packs.
Challenged on its home ground by Swedish health advocates, Swedish Match said it had not been aware of the website: its overseas operations are decentralised with each division having a high degree of independence.However, websites must be approved by central management, which had not happened in this case.The company agreed that the UK website was inappropriate, and promised to discuss it with the UK division, who would probably shut it down.Since then, the site has consisted solely of the familiar announcement that it is under construction.
In a recent survey by GES Investment Services in Stockholm, Swedish Match ranked low in comparison with 12 other leading international tobacco companies on the question of how well its policies comply with the prohibitions on marketing and sales to minors contained in the World Health Organization's Framework Convention on Tobacco Control.Perhaps it is just less organised, and less crafty about trying to wear the ''corporate social responsibility'' cloak.Or perhaps the Styx campaign merely demonstrates the apparently incurable addiction of tobacco marketing executives to trying to catch yet another generation of young people.

Canada: the case of the unexpected website
For some years now, health organisations in several countries have been using creative internet strategies to counter tobacco promotions.One technique is to set up a health oriented website with a very similar name to a tobacco industry site involved in cigarette promotion aimed at internet savvy young people.The key feature of the health site is to give the lie to what the industry site is really all about.For example, in 2002, when BAT was caught out for the second time trying to encourage young people to attend venues where it sold and promoted its cigarettes by using a site called www.However, while bensonandhedges.org is no longer useful to Airspace, the group has realised that there may be other places in the world where Benson & Hedges cigarettes are still heavily promoted, such as by cricket and other sporting events, so it is asking colleagues around the world to suggest deserving organisations.The domain was about to expire, and understandably, its current sponsors were reluctant to see any companies that promote B&H cigarettes having the chance to claim it for themselves.

New Zealand: butt bids
A cigarette butt must be one of the more bizarre items to be auctioned on an Eye catching cars, decorated with the Styx name and logo, were offered to students in a competition organised by Swedish Match UK.
UK: Scotland prepares for smoke-free vote A postcard developed by CAN!, a coalition group campaigning for ''cleaner air now'', for people in Scotland to use to lobby members of the Scottish parliament to support a bill to make all workplaces smoke-free, along the lines of the pioneering legislation in Ireland.
Joe Chemo, a satirical character used in demonstrations against tobacco promotion before Canada's total ban, being wheeled to a tobacco sponsored fireworks display in Vancouver.This sort of story and image regularly appeared on the bensonandhedges.orgwebsite.
internet website, but the sale drew widespread attention and more than 130 000 bids earlier this year.It was not just any old butt, but one certified by the owners of Malt, a popular bar in Auckland, New Zealand's largest city, to be the remains of the last cigarette legally smoked in the bar in the last few seconds of the day on 9 December last year.At midnight, the country's stringent ban on smoking in workplaces came into force.
Within a short time of being advertised, bids for the butt, mounted in a transparent showcase and accompanied by the certificate of authenticity, had shot up into thousands of dollars, for what many web surfers described as an unusual ''collector's item'' and piece of ''kiwiana'' (the kiwi is the flightless bird found only in New Zealand, a name borrowed as an informal word for the country's inhabitants).Fellow kiwis heaped praise on the seller for his extraordinary creativity in thinking of putting such an unlikely item up for sale, and attracting such high bids.The successful bidder paid NZ$7475 (US$5377).
Those kiwis interested in public health might consider trying to find, and then auctioning, another bit of kiwiana from the first half of the last century.Older public health workers recall a time when their country had a law prohibiting the sale of cigarettes to children, but with a permitted exception.Shops were allowed to make the sale if a doctor's certificate was produced, certifying that there was a medical reason why the child should be supplied with the cigarettes.One of those original certificates would look very good on anyone's wall.
citygobo.com,Action on Smoking and Health UK (ASH) set up www.citygobo2.com,which left visitors in no doubt at all about what BAT was up to (see BAT: caught out again.Tobacco Control 2002;11:9).Now comes news from Canada, where several years ago, Airspace Action on Smoking and Health, faced with a major Benson & Hedges promotion in Vancouver every summer, fought back with, among other things, a crafty website.The group found they could set up a site with the address http:// bensonandhedges.org/.Thanks to subsequent tobacco advertising restrictions in Canada, the notorious Benson & Hedges (B&H) Symphony of Fire promotion is now a thing of the past, though it still receives an average of 15 ''hits'' per day.