News analysis

Philip Morris’ subsidiary in India, Godfrey Phillips India Ltd (GPI), has recently been using ‘‘research’’ to cloak illicit cigarette promotions inside one of India’s premier educational institutions, Punjab University (PU) at Chandigarh. Since December 2004, India has banned the sale of tobacco products within a radius of 100 yards (91.4 m) of all educational institutions. In April 2006 GPI reached inside PU with a team of young people, each paid 1000 rupees (US$22) per day—about five times a typical wage for sales promotion work— to conduct what they described as ‘‘research’’. The item being researched was Red & White Mild cigarettes. ‘‘Researchers’’ found at PU were confronted and asked about their research objectives. They produced a form for collecting details from those they engaged in conversation or those whom they provided with a sample cigarette or a pack. The promotions proceed like this: tobacco retailers are offered 1000 rupees and free cigarette packs. Posters are put up and the shop and the nearby surroundings decorated with dangling point-of-sale advertisements for Red & White cigarettes. Large, attractive display-boards showing cigarettes and pictures of gifts being offered are also set up. The promoted cigarette brand is made available in the shop and gifts promised on purchase of the brand are displayed on a mannequin dummy. Attractive young, uniformed members of the sales team roam around smiling and greeting all in the vicinity. The moment they find any young person showing the slightest interest, they are immediately engaged in conversation about the launch of a new brand, emphasising that this is a milder version of the cigarette. Brochures explaining a prize scheme involving winnings such as mobile phones and other attractive gifts are produced. Free cigarettes are then offered. The next step is to try to make a sale which includes a free number-coded card inside the cigarette pack. We observed sales in about half such encounters. The ‘‘researcher’’ collects personal details even when a sale is not made. Each person is told that they will be invited to frequent smokers’ parties in which their selected friends will be welcome, provided they participate in the research. Once the pack is purchased, the GPI promoters guide the person to open the pack and locate the card insert. Purchasers are then instructed to send an SMS (text message from their mobile telephones) to the number printed on the card, ensuring that purchasers’ mobile numbers are recorded in the GPI data bank. Within minutes, the person gets a return call thanking them for purchasing the cigarette pack and congratulating them on winning a gift. Personal details including postal address are collected after the winners are told that their gifts will be couriered within two weeks to the address just provided, naturally also entered into a marketing database. During the following week, those recruited this way get many SMS messages, with messages such as, ‘‘Thanks for taking part in Red & White Milds taste of adventure offer – keep on participating as you enjoy the great taste of Red & White Milds.’’ These keep coming for weeks. (For a pack purchased on 20 April, we were still getting messages nearly a month later.) The moment we discovered this activity, we made a formal complaint to the government and the police. When nothing resulted, we went to the press and increased the pressure during the next four days through other tactics. GPI officials flew to Chandigarh and declared in a press conference that they would sue us for libel. A month later, we were still waiting. After two more days of inaction from the police we physically detained a person promoting cigarettes in a market until the police were left with no other option than to take action, confiscate all advertising material and register a complaint. The marketing activity stopped the next day, but the police still had not proceeded with a prosecution six weeks later. We continued to fight for it. The Cigarettes and Other Tobacco Products Act, 2003 clearly states that promoting or advertising tobacco products by direct or indirect means is an offence attracting up to five years of imprisonment. It seems that GPI must be confident that little if any action will All articles written by David Simpson unless otherwise attributed. Ideas and items for News Analysis should be sent to: d.simpson@iath.org ‘‘Researchers’’ from Philip Morris’ subsidiary in India illicitly conduct cigarette promotions inside one of the country’s premier educational institutions, Punjab University. Note the mannequin dummy (right) displaying gifts available on purchase of the brand under promotion. 274

Philip Morris' subsidiary in India, Godfrey Phillips India Ltd (GPI), has recently been using ''research'' to cloak illicit cigarette promotions inside one of India's premier educational institutions, Punjab University (PU) at Chandigarh.
Since December 2004, India has banned the sale of tobacco products within a radius of 100 yards (91.4 m) of all educational institutions. In April 2006 GPI reached inside PU with a team of young people, each paid 1000 rupees (US$22) per day-about five times a typical wage for sales promotion workto conduct what they described as ''research''. The item being researched was Red & White Mild cigarettes.
''Researchers'' found at PU were confronted and asked about their research objectives. They produced a form for collecting details from those they engaged in conversation or those whom they provided with a sample cigarette or a pack. The promotions proceed like this: tobacco retailers are offered 1000 rupees and free cigarette packs. Posters are put up and the shop and the nearby surroundings decorated with dangling point-of-sale advertisements for Red & White cigarettes. Large, attractive display-boards showing cigarettes and pictures of gifts being offered are also set up. The promoted cigarette brand is made available in the shop and gifts promised on purchase of the brand are displayed on a mannequin dummy. Attractive young, uniformed members of the sales team roam around smiling and greeting all in the vicinity.
The moment they find any young person showing the slightest interest, they are immediately engaged in conversation about the launch of a new brand, emphasising that this is a milder version of the cigarette. Brochures explaining a prize scheme involving winnings such as mobile phones and other attractive gifts are produced. Free cigarettes are then offered. The next step is to try to make a sale which includes a free number-coded card inside the cigarette pack. We observed sales in about half such encounters.
The ''researcher'' collects personal details even when a sale is not made. Each person is told that they will be invited to frequent smokers' parties in which their selected friends will be welcome, provided they participate in the research. Once the pack is purchased, the GPI promoters guide the person to open the pack and locate the card insert. Purchasers are then instructed to send an SMS (text message from their mobile telephones) to the number printed on the card, ensuring that purchasers' mobile numbers are recorded in the GPI data bank.
Within minutes, the person gets a return call thanking them for purchasing the cigarette pack and congratulating them on winning a gift. Personal details including postal address are collected after the winners are told that their gifts will be couriered within two weeks to the address just provided, naturally also entered into a marketing database.
During the following week, those recruited this way get many SMS messages, with messages such as, ''Thanks for taking part in Red & White Milds taste of adventure offer -keep on participating as you enjoy the great taste of Red & White Milds.'' These keep coming for weeks. (For a pack purchased on 20 April, we were still getting messages nearly a month later.) The moment we discovered this activity, we made a formal complaint to the government and the police. When nothing resulted, we went to the press and increased the pressure during the next four days through other tactics. GPI officials flew to Chandigarh and declared in a press conference that they would sue us for libel. A month later, we were still waiting. After two more days of inaction from the police we physically detained a person promoting cigarettes in a market until the police were left with no other option than to take action, confiscate all advertising material and register a complaint. The marketing activity stopped the next day, but the police still had not proceeded with a prosecution six weeks later. We continued to fight for it.
The Cigarettes and Other Tobacco Products Act, 2003 clearly states that promoting or advertising tobacco products by direct or indirect means is an offence attracting up to five years of imprisonment. It seems that GPI must be confident that little if any action will All articles written by David Simpson unless otherwise attributed. Ideas and items for News Analysis should be sent to: d.simpson@iath.org be taken against it if it disguises blatant sales promotion as market ''research''.

Australia: BAT corporate social irresponsibility
British American Tobacco (BAT) is as noisy trumpeting its odious claims to corporate social responsibility (CSR) in Australia as it is anywhere, despite a private admission some years ago that the country holds little for it in the future. But in its 2003 Social Report, BAT made a claim so absurd that even some of its allies must now be embarrassed. Despite doing its utmost over many years to stop effective health warnings being put on cigarette packs, in case its customers were to get a better idea of what its wretched products are doing to their bodies, BAT sanctimoniously expressed concern about the packaging of contraband cigarettes. The precise cause of its anxiety? A fear that contraband packs were ''undermining the effectiveness of health warnings''.
Fast forward to 2006, and we see that such sentiments are not even shortlived, but for CSR reports only. True to form, faced with having to comply with Australia's new graphic health warnings, BAT has changed the pack design of its leading brand in Australia, Winfield, by adding a message inside the flip-top box. The message is actually a promotional slogan for Winfield. It uses the catchphrase of a popular Australian comedian, Paul Hogan, well known for down-to-earth utterances in his broad ''Ocker'' accent, punctuated with a word instantly recognisable as his own, ''Anyhow,…'' BAT used Hogan and his catchphrase to sell Winfield in the days of legal tobacco promotion. What an inspiration, then, to re-cycle the Hogan link now. Just as smokers may be given pause to consider the often shocking photographs of tobaccoinduced disease in the new warnings on the outside of the flip-top, when they open up and see the inside, BAT encourages them to shrug it off with the infamous message, ''Any-how…have a Winfield''.
If that one was dreamed up by the marketing people, it seems that BAT's public relations staff have been busy, too. Going for gold to exploit newsworthy topics of public concern, while furthering their company's corporate aims to resist moves to total workplace smoking bans, they recently came up with a real scorcher. In Australia, as in many other countries, there is an increasing problem of people in bars having their drinks surreptitiously ''spiked'' with drugs, by those who want to rob or abuse them. Thus BAT solemnly expressed its concern that if smokers drinking in a totally smoke-free bar were to be forced to go outside to light up, leaving their drinks unattended, they would risk becoming the victims of drink spiking by people surreptitiously adding psychoactive chemicals to their drinks. Imagine if tobacco companies were to surreptitiously add psychoactive chemicals to cigarettes...

UK: familiar smell at the airport
Travellers passing though London's two largest airports, Heathrow and Gatwick, in recent months have noticed two things: special smoking booths, opentopped and see-though, equipped with banks of expensive-looking ventilation and filtration units; and-unsurprisingly-an all-pervasive, unpleasant smell of tobacco smoke. What they have witnessed is the outcome of a tobacco industry project going back many years, a hi-tech development within the ''accommodation'' strategy.
Companies that are bitter competitors in the marketplace have long worked in harmony to try to get ventilation equipment manufacturers to do the impossible. The idea was a machine so effective that it would avoid what they most fear: a total ban in public places, with saleskilling results and serious damage to the already battered social acceptability of smoking.
Responding to a disgruntled traveller annoyed by the smell in a lounge housing such a booth, a Heathrow employee described it in glowing terms. It is made by a company called Tornex, and creates ''an artificial tornado to trap the smoke in its processing unit, in which the air is then cleaned before being released back into the environment''. As if quoting from an industry wish-list, she went on to say that with this new concept, there was no need to have an enclosed smoking area. ''The technology does not remove the smell of smoke 100%, but does remove the bad smoke particulates that can be harmful and unpleasant to non-smokers,'' she trilled. The traveller replied that as long as he smelt tobacco smoke in a nonsmoking section, which she had admitted was still there, then there was tobacco smoke, and poisons. Others have since sent the Heathrow apologist important information that the ventilation and tobacco industries must have forgotten to mention.
Basic searches show Tornex featuring in internal tobacco documents of both Philip Morris and British American Tobacco as far back as the 1990s. But this particular industry plan to hold on to public smoking has not fooled all British airport operators: Birmingham decided on a total ban instead. Even Heathrow knows what is coming: while asserting that the Tornex system was installed in good faith, it is clearly aware of impending legislation to bring England alongside Ireland and Scotland with a total workplace ban, and changes to its smoking arrangements are ''seriously being considered''. Heathrow may have wasted a shed-load of money going down the tobacco industry runway, but it had better do more than consider a total ban: it will soon be imposed by law.

Canada: end of the smoking zone
Capital Health, one of Canada's largest integrated health authorities, recently closed the doors on the last of its smoking rooms. Its new policy protects all staff, patients, visitors and volunteers against exposure to secondhand smoke, and also prohibits smoking in homes while receiving care. However, it goes one step further by banning all smoking on outdoor property, including smoking within vehicles and parking areas. Perhaps the most striking achievement of all is that psychiatric and other sensitive units have been included, a sticking point still preventing full smoke-free policies in many other parts of the world.
The impetus for tobacco policy reform was multi-pronged and included compliance with civic bylaws and federal tobacco and customs acts, complaints of exposure to secondhand smoke, and fatigue in monitoring outdoor smoking areas. Legal opinions were obtained for the changed policy, and the process was carefully planned, communicated, and executed, with wide consultation and supervision by a consultant.
Concern was expressed regarding a perceived obligation requiring staff to ''get patients to quit''. Health professionals recognise that permanent behaviour change requires willingness and readiness rather than policy declarations. This discord led to discussions centred on facilitating smokers to go off property rather than supporting them to abstain.
However, once the distinction between supporting involuntary abstinence (while receiving care) and cessation measures (for those wanting to quit) was clearly defined, capacity building and support requirements could be identified and implemented.
In situations of involuntary abstinence, prevention of withdrawal symptoms requires communication, respectful assessment and immediate support achievable through measures such as nicotine replacement products (NRT), and standing orders for nursing staff to initiate care in the absence of a physician.
In contrast, tobacco cessation is an ongoing process requiring interventions such as cognitive behavioural therapy, pharmacotherapy and group support. The objective of ongoing abstinence after discharge is supported by the establishment of community-based clinics and an open-label clinical trial funded by Health Canada (the health ministry), Pfizer Consumer Healthcare, and the Alberta Alcohol and Drug Abuse Commission. Management's responsibility in the policy process was the abolition of tobacco sales on hospital property, reframing tobacco as a behavioural incentive, and supporting capacity building.
Two hundred staff members received training to enhance the capacity for treatment of tobacco dependence, and the development of tobacco reduction and cessation clinics. An additional opportunity for smoking cessation was created for staff members to quit smoking, and the interest and success have been significant.
Although the policy came into effect in October 2005, psychiatry, palliative care, geriatrics, brain injury, and tuberculosis units were granted a grace period until 1 April 2006. This extra time was considered necessary because of concerns that psychiatric patients would abscond to purchase cigarettes; tuberculosis patients could infect others by Capital Health, one of Canada's largest health authorities, has banned all smoking on its outdoor property, as well as indoors, including psychiatric and geriatric units.
Argentina: PM ads and educational materials In Latin America, Philip Morris (PM) has sponsored a school programme ''Yo tengo poder'' (I have power) through a non-governmental organisation, giving information to teachers and students which it says is to prevent young people from starting to smoke. In some countries, the company is even allowed to work with the government. In Argentina, PM won an award for its work with the community. But in Bahia Blanca, on the coast to the north of Patagonia, there are few laws on tobacco control and many cigarette advertisements on the streets, with a special focus on teenagers and girls. The local government support the development of smoke-free places and it is forbidden to smoke in the hospital, but despite this, inside the hospital there are frequently huge tobacco ads from PM, and visitors arriving in the city via the main street are welcomed by a message on a large Marlboro billboard.
going off property to smoke; there could be an appearance of heartlessness by restricting smoking of palliative patients; cognitive impairment would make tobacco abstinence difficult; psychiatric patients would not access care because of smoking restrictions; and risk to the safety of staff members due to agitation and disorganised behaviour.
After the final closure, compliance appears to be optimal. There have been no reports of patients leaving against medical advice as a result of the policy, and no major disruptions experienced. Several other regions have expressed interest in duplicating the policy, and asked for input to benefit from some of the lessons learnt.

China: athlete runs into trouble
Olympic 110 metres hurdles champion Liu Xiang was recently in trouble, not for the first time, over his links to one of China's most popular cigarette brands.
One of the companies that has sponsored him since he won gold at Athens in 2004 is the Baisha corporation, a major Chinese cigarette manufacturer. What has stirred up the latest round of trouble is a book called, ''My Heart is Flying: A Liu Xiang Photobook,'' with more than 50 photographs of the athlete. But that is the trouble: they are not just of him, as it contains nearly as many pictures of that very emblematic Chinese bird, the crane, whose flying image serves as an instantly recognisable logo on Baisha cigarette packs. Nowadays, officials grappling with China's massive burden of disease caused by smoking speak out much more vociferously in such cases than in former times. A senior health ministry official told the media that the association would have a large negative impact, especially with regard to children, as the flying crane was such as a well-known symbol of the tobacco company. She also said she had approached the Track and Field Administration of the National Sports Bureau to try to recruit Liu to work with other national sporting heroes on anti-smoking campaigns. However, his minders said he was too busy training, and in any case he had already supported other campaigns, such as on environmental protection. Another health leader, the deputy secretary of the Chinese Association on Tobacco Control, also spoke out against top athletes being associated with tobacco, and recalled how an earlier occasion when a television ad using the slogan ''My Heart is Flying'' was banned after complaints by health officials (see Tobacco Control 2005;14:150).

Malaysia: Camel tourism trick
In May, readers of the New Sunday Times were confronted with an advertisement for a contest involving what the advertiser called Camel active fashion products. It was supported by the South African tourism board, presumably on the basis that would-be Malaysian macho-men would be tempted to come on down to South Africa, Camel cigarette cartons in hand, to enjoy a riproaring holiday in its wide open spaces.
Liaison between Malaysian and South African health advocates resulted in correspondence with the tourism board, explaining the tobacco industry's-and particularly Camel's-history of brandstretching. In a throw-back to the more innocent 1980s, the tourist people replied that the Camel being advertised in the ad was a brand of clothing, not cigarettes. They nearly coined the term rand-stretching-the country's currency is the rand-saying, ''…to stretch the rand as it were, we also explore opportunities for collaboration with projects/ services that are reflective of our destination-offer and remain true to the lifestyle preferences of our target consumers.'' So they do want the machomen.
Despite presenting copious evidence drawn from tobacco industry documents of the intentions of Camel brand-stretching, health advocates began to wonder whether anything would make the CEO of the South African tourism board see the light. Their evidence included a seven page letter from an advertising agency in 1980 to a senior RJ Reynolds Tobacco (RJR) executive, urging his firm to spend $520 000 (worth considerably more today) to support the autumn Camel Collection clothing range. Among the reasons was that it would ''maximize the relationship between the CAMEL collection and the CAMEL Way of Life as expressed in the new CAMEL Family advertising which will break in September weeklies.'' And in 1983, RJR produced a 262page promotion training manual showing that the link was still flourishing. One section described the CAMEL Prime Prospect: ''Independent -Exciting -Adventurous -Pleasure-Seeking -Somewhat Upscale -Age: 18-24''. Trainees were told that merchandise items must be ''in line with CAMEL's user imagery, items that the CAMEL man would readily wear or use. They should be high quality, have long-term appeal and not be overly 'trendy'. Prime Prospect: -Younger adult male (18-24 years). Independent, adventurous, masculine, pleasure-oriented lifestyle. -A leader among men with traditional/ conservative values.'' While RJR's non-US operations are now owned by Japan Tobacco, it is hard to think that the sales force has forgotten the link. Presumably when a company buys an international brand Indonesia: company sponsors football broadcasts Before and during the 2006 football World Cup, a leading maker of Indonesia's distinctive clove-flavoured cigarettes, the Djarum tobacco company, used the official broadcasts of the games to promote its Djarum Super brand. The company re-branded the event to Super Soccer for the purposes of its ads on television and on billboards all over the capital, Jakarta, even suggesting it was the official sponsor of the World Cup broadcasts on SCTV Indonesia. that has relied on brand-stretching to target certain markets, the arrangement, however convoluted to try to avoid health legislation, does not simply evaporate, but is there to be used by the new owner. South African tourism officials, please note.
USA: advocates keep up pressure at tobacco AGMs While many US tobacco control budgets suffer cuts as scarce prevention funds are shifted from tobacco to obesity and other serious health issues, health advocates have been striving to keep the pressure up, and maintain the American public's awareness of just how serious the tobacco problem remains. If anything has served as reassurance recently that the worldwide tobacco pandemic will not drop away from the headlines, it was the record level of protests at the annual shareholders' meetings of two of the world's largest tobacco companies. A wide range of activities ensured that both bosses and shareholders of Philip Morris and RJ Reynolds American were left in no doubt at all about the tobacco epidemic, not only on home ground, but in developing countries and others all over the world.
Altria Group, the parent company of Kraft, Philip Morris USA and Philip Morris International, held its meeting at the end of April. More than 100 youth and adult advocates from the USA and around the world participated in advocacy events focused on the meeting. A youth advocacy training day was followed by a demonstration in front of Altria's headquarters in New York the next day as the meeting convened. The demonstrators called on Altria/Philip Morris (PM) to ''Give the World a Break'' from tobacco advertising, lobbying on the Framework Convention on Tobacco Control (FCTC), bogus ''youth smoking prevention'' programmes, and their legal challenges to effective tobacco control legislation.
Twenty-five went inside the meeting to confront Altria chief executive Louis Camilleri about the company's practices around the world. The rest, who had decided to make a silent protest, stood in a long line with their mouths taped shut to symbolise the millions of people killed-silenced-by tobacco around the world each year. Every seven seconds, one would kneel to the ground to represent another person killed by tobacco. A small group tried to deliver a bunch of satirical ''Happy 50th Birthday Marlboro'' cards collected by Americans for Nonsmokers Rights from young people around the country, but this was prevented by a New York City police detective. By the end of the demonstration, a total of 67 police cars had surrounded the area. One officer told demonstrators it was a routine weekly drill. Another, seen to be on friendly terms with Altria security guards, said it was ''a show of force against terrorism''.
The young advocates inside the meeting challenged Camilleri to make the company cease its bad practices; unsurprisingly, he refused. But when challenged about PM's use of the Maori name in its Maori Mix cigarette brand, he apologised.
If that was humiliation PM-style, then the people at RJ Reynolds American (RJR) had done some of theirs in advance. Following the success of tobacco control advocates at last year's meeting, when respirator-wielding Anne Morrow Donley, a Virginia shareholder and health activist, got the meeting made smoke-free (see Tobacco Control 2005;14:222-3), shareholders arriving at this year's event in Winston-Salem found a pastel blue and white sign already in place at the registration desk stating that this would be ''a non-smoking meeting''. True, smoking was permitted in the hallways and stairways outside the auditorium, but for the second year running, local media made no mention of the historic ''atmosphere''. Asked by Ms Donley whether he had noticed the sign at the registration desk, a photographer from the Winston-Salem Journal said he had not, and when she took him to see it, he smiled and said, ''Very interesting,'' but took no photograph, and the report once again failed to mention the highly unusual occurrence at the annual meeting of one of the country's biggest tobacco companies. Other activists present included Father Michael Crosby, and nurses from the Nightingales group. An interesting addition to last year's meeting was a group of RJ Reynolds workers protesting outside and inside the meeting, pressing to form a labour union.

Bangladesh: bicycles, not cigarettes
In April, MANOBIK, a campaigning non-governmental organisation working against the harm caused by drug Demonstrators outside Altria's New York headquarters, their mouths taped shut to symbolise the millions of people ''silenced'' by tobacco every year.
Nurses from the Nightingales group make their presence felt at the annual shareholders meeting of RJ Reynolds American.
A cycle rally was held in the Bangladesh capital Dakha to demand an increase in tobacco taxes-and a decrease in bicycle taxes. use, organised a rally with a difference. For one thing, it was carried out by members and supporters on bicycles; and its purpose was unusual, too-to demand an increase in tobacco taxes and a reduction in bicycle taxes in the next budget.
After a cycle journey though the capital, Dakha, participants presented the chairman of the National Board of Revenue with a petition, explaining that tobacco causes harm both directly and indirectly to developing countries, adversely affecting public health, the economy, and the environment. They said that to reduce the use of tobacco, the most effective measure was to raise the tax, which would not only yield more government revenue, but also result in a decrease in medical costs to treat people suffering from the diseases caused by tobacco use.
The tax on cigarettes currently ranges from 35-65%, yet the price of cigarettes has remained essentially unchanged for years, despite significant increases in the prices of essential goods. MANOBIK said tax increases tend to cause lower income workers and students to quit, leaving more money available for basic needs. On the other hand, transport expenditures, say the group, are a major strain on the poor, and the most affordable transport, after walking, is cycling, which is both healthy and pollution-free. However, the tax on bicycles is 69.5%. Cleverly combining the themes to make an unassailable case, the rally participants demanded that tobacco taxes be increased by 100%, and the tax on bicycles greatly reduced in the next budget. Montreal's English-language daily, The Gazette, ran a large, four-part weekly series in the run up to the legislative changes that saw smoking banned from restaurants and bars. This cartoon ran on the editorial page as the series began while the same edition's front page included a suggestively shaped, crushed cigarette, under the headline 'the big butt-out'.