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Tobacco cessation and household spending on non-tobacco goods: results from the US Consumer Expenditure Surveys

10 hours 50 min ago
Objectives

To estimate the impact of tobacco cessation on household spending on non-tobacco goods in the USA.

Methods

Using 2006–2015 Consumer Expenditure Survey data, 9130 tobacco-consuming households were followed for four quarters. Households were categorised during the fourth quarter as having: (1) recent tobacco cessation, (2) long-term cessation, (3) relapsed cessation or (4) no cessation. Generalised linear models were used to compare fourth quarter expenditures on alcohol, food at home, food away from home, housing, healthcare, transportation, entertainment and other goods between the no-cessation households and those with recent, long-term or relapsed cessation. The full sample was analysed, and then analysed by income quartile.

Results

In the full sample, households with long-term and recent cessation had lower spending on alcohol, food, entertainment and transportation (p<0.001). Recent cessation was further associated with reduced spending on food at home (p<0.001), whereas relapsed cessation was associated with higher spending on healthcare and food away from home (p<0.001). In the highest income quartile, long-term and recent cessations were associated with reduced alcohol spending only (p<0.001), whereas in the lowest income quartile, long-term and recent cessations were associated with lower spending on alcohol, food at home, transportation and entertainment (p<0.001).

Conclusions

Households that quit tobacco spend less in areas that enable or complement their tobacco cessation, most of which may be motivated by financial strain. The most robust association between tobacco cessation and spending was the significantly lower spending on alcohol.

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Preliminary evidence that high levels of nicotine on childrens hands may contribute to overall tobacco smoke exposure

10 hours 50 min ago
Background

Dust and surfaces are important sources of lead and pesticide exposure in young children. The purpose of this pilot study was to investigate if third-hand smoke (THS) pollutants accumulate on the hands of children who live in environments where tobacco is used and if hand nicotine levels are associated with second-hand smoke (SHS), as measured by salivary cotinine.

Methods

Participants were parents and children (n=25; age mean (SD)=5.4 (5.3) years) presenting to the emergency department with a potentially SHS-related illness. A convenience sample of participants were recruited at baseline from an ongoing two-group, randomised controlled trial of a SHS reduction and tobacco cessation intervention. Parents were current smokers; thus, all children were at risk of SHS and THS exposure to varying extents. Primary outcome measures, which were assessed in child participants only, were hand nicotine and salivary cotinine. Parents reported sociodemographics and smoking patterns; children’s medical records were abstracted for chief complaint, medical history and discharge diagnosis.

Results

All children had detectable hand nicotine (range=18.3–690.9 ng/wipe). All but one had detectable cotinine (range=1.2–28.8 ng/mL). Multiple linear regression results showed a significant positive association between hand nicotine and cotinine (p=0.009; semipartial r2=0.24), independent of child age.

Discussion

The higher-than-expected nicotine levels and significant association with cotinine indicate that THS may play a role in the overall exposure of young children to tobacco smoke toxicants and that hand wipes could be a useful marker of overall tobacco smoke pollution and a proxy for exposure.

Trial registration number

ClinicalTrials.gov Identifier: NCT02531594

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Compliance with Uruguays single presentation requirement

10 hours 50 min ago
Introduction

Tobacco companies vary pack colours, designs, descriptors, flavours and brand names on cigarette packs to target a multitude of consumers. These different brand variants can falsely imply that some brand variants are less harmful than others. Uruguay is the only country that requires cigarette companies to adhere to a single presentation (one brand variant) per brand family.

Methods

An existing, systematic pack purchasing protocol was adapted for data collection. Neighbourhoods in Montevideo were categorised into five strata by percentage of poor households. Five neighbourhoods within each stratum were selected based on geographical variation. In each neighbourhood, a ‘starting hub’ was identified and a systematic walking protocol was implemented to purchase unique packs at four key vendor types.

Results

Unique packs were purchased in 9 out of 25 neighbourhoods. Fifty-six unique packs were purchased, representing 30 brands. Of these, 51 packs were legal, representing 26 brands. The majority of the legal brands (n=16; 62%) were compliant with the requirement. The remaining packs were non-compliant due to differences in colour, design element, brand name, crest and descriptors. Although not prohibited by the single presentation requirement, 16 legal brands had more than one stick count (10, 11, 14 or 20 sticks), and packs from four brands had more than one packaging type (hard, soft or tin).

Conclusion

Overall, compliance with Uruguay’s single presentation requirement was good. In addition to the current restrictions, future single presentation requirements could expand to include packs in more than one stick count and packaging type.

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Recommendations to the European Commission implementing a priority list of additives that should have more stringent reporting requirements: the opinion of the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR)

10 hours 50 min ago
The EU Tobacco Products Directive

The European Commission’s Tobacco Products Directive 2014/40/EU (TPD)1 came into force in 2014 and lays out rules governing the manufacture, presentation and sale of tobacco and related products, including cigarettes, roll-your-own tobacco, cigars, cigarillos, smokeless tobacco, electronic cigarettes and herbal products for smoking. It strengthens the rules regarding the reporting on ingredients contained in tobacco products and regulates permissible additives (or levels thereof) to improve the functioning of the internal market while guaranteeing a high level of public health. Articles 6 and 7 specifically focus on additivesi to tobacco products. More in detail article 7 lists prohibition of specific tobacco products, among which

  • tobacco products with a characterising flavour (Art 7 (1))

  • tobacco products containing the following additives2 (Art 7 (6)):

  • vitamins or other additives that create the impression that a tobacco product has a health benefit or presents reduced...

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    Australias $40 per pack cigarette tax plans: the need to consider equity

    10 hours 50 min ago

    In May 2016, the Australian Government announced that it would implement annual increases in tobacco excise of 12.5% up to and including 2020, raising the cost of a pack of cigarettes to $A40. This increase will lead to Australia having one of the highest prices of cigarettes in the world. Increasing the cost of tobacco is considered by public health experts to be one of the most effective strategies to reduce tobacco use, and is generally well supported by the public. However, tobacco tax increases differentially impact various subgroups of the population. Based on a review of existing literature, this paper examines some of the potential (unintended) consequences of the tax to individual and family income; illicit trade; social stigma and opportunities for lobbying by the tobacco industry. In light of these considerations, we offer strategies that might be used by policymakers to mitigate potential harms. While this paper focuses on the impacts primarily on populations in Australia, the consequences and strategies offered may be useful to other countries implementing tobacco excise increases.

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    Tobacco industrys T.O.T.A.L. interference

    10 hours 50 min ago

    Swedish Match and the National Association of Tobacco Outlets launched a website in 2016 that encourages retailers and policy makers to oppose regulating the tobacco retail environment.1 2 T.O.T.A.L., an acronym for Tobacco Ordinances – Take Another Look, features talking points for defeating U.S. state and local efforts to restrict the sale of flavoured tobacco, regulate tobacco product displays in stores, restrict price discounting by eliminating coupon redemption and other discounts, increase the minimum package size of small cigars, and increase the minimum legal purchase age to 21. The industry website highlights U.S. cities where such restrictions are proposed and uses video testimonials to engage retailers in opposition.

    T.O.T.A.L. employs many of the same arguments that the tobacco industry uses to influence marketing restrictions in other countries. Using a taxonomy of argument frames identified by Savell and her colleagues,3 table 1...

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    Lamborghini brand sharing and cigarette advertising

    10 hours 50 min ago
    Lamborghini brand sharing and cigarette advertising

    Licensing and brand sharing arrangements, where a fee or royalty is paid for use of a name, is a common strategic consideration to provide a newly introduced product or service with an immediate and proven brand identity (table 1).1 Serving as such an example, Korean Tomorrow and Global (KT&G), which is South Korea’s leading tobacco firm, launched a new cigarette brand, Tonino Lamborghini, on 18 April 2012, where the branding resembles the legendary Italian luxury sports car maker (figure 1A,B).2 3 According to The Moodie Report, it took 1 year of negotiation to reach a brand licensing agreement and 3 years to develop the cigarette product.4 The cigarette brand was initially offered in two variants, L8 (predominantly black package) and L6 (predominantly yellow package), with reported tar deliveries of 8.0 mg...

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    Into the black: Marlboro brand architecture, packaging and marketing communication of relative harm

    10 hours 50 min ago

    In 2008, Philip Morris International (PMI) launched a new global brand architecture for Marlboro, which involved establishing three Marlboro brand families known as Red (centred on flavour), Gold (based on contemporary style with contrasting diameters and taste profiles) and Fresh (being mentholated and dubbed as ‘refreshing taste sensations’). The new brand architecture includes Marlboro brand variants being offered in black-coloured cigarette packages. For example, as part of the Marlboro Fresh product line, Marlboro Black Menthol was launched in Japan during 2008, and soon thereafter offered in several additional markets, including Indonesia and the Philippines.1 According to PMI’s 2008 annual report, Marlboro Black Menthol was launched ‘to deliver a cigarette with a bold, long-lasting, high-cooling sensation in a striking black pack. The brand’s boldness is represented by a strong black stallion in motion, the main element of the communication campaign’ (figure 1).2 Additional Marlboro offerings...

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    &#039;Stop me before I kill again: why Philip Morris International needs governments help to quit smoking, and why governments need more pressure to do so

    10 hours 50 min ago

    As reported elsewhere in this issue and in numerous media outlets, Philip Morris International (PMI) recently published advertisements in several UK newspapers claiming its New Year’s Resolution was ‘We’re trying to give up cigarettes’.1 Numerous observers noted that there was no specific plan or date attached to this goal, the company continues aggressively promoting cigarettes in low-income and middle-income countries, and previous similar makeover efforts undertaken by the company have been a smokescreen. Lending credence to sceptics’ responses, the company is currently ‘upgrading’ a UK version of its top-selling Marlboro cigarettes at the same time.2

    The company has long been urged to just stop promoting and/or selling cigarettes. For many years, public health advocates have attended shareholder meetings and called on the company to stop. The most recent call, however, came in an open letter to the company endorsed by more than 100 organisations from around...

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    The Tobacco Control Vaccine: a population-based framework for preventing tobacco-related disease and death

    10 hours 50 min ago

    Vaccines serve a critical role in the prevention and control of communicable diseases.1 Vaccines have prevented countless cases and saved millions of lives globally from diseases such as polio, smallpox, measles, diphtheria, influenza and multiple others.1 Given the critical importance and past impact of population-based prevention interventions in combating the tobacco epidemic,2 3 we describe a population-based model for reducing tobacco use and secondhand smoke exposure using the public health principles of vaccination.

    The Tobacco Control Vaccine is comprised of proven population-based preventive measures to reduce tobacco use and tobacco-related morbidity and mortality (figure 1). It is founded on existing evidence-based frameworks,3 4 such as MPOWER,4 and is intended to serve as a public health messaging complement to these frameworks to enhance understanding and implementation of proven interventions. In addition to the components...

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    Worldwide news and comment

    10 hours 50 min ago
    South Africa: from tobacco control leader to loser

    When the 17th World Conference on Tobacco or Health takes place in March 2018, the eyes of the global health community will be on the host nation South Africa. Unfortunately, although South Africa was a tobacco control leader in the 1990s and early 2000s, today the country is falling behind. Public interest in tobacco control is flagging, and the network of non-government organisations (NGOs) and public health officials so crucial to progress are lacking both financial and human resources.

    All articles written by Marita Hefler unless otherwise attributed. Ideas and items for News Analysis should be sent to: marita.hefler@menzies.edu.au

    South Africa’s national ban on smoking in public places came into force on 1 January 2001. It followed from the first Tobacco Products Control Act (the Act) which was published in 1993, amended in 1997 and then activated by regulations published...

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    Modelling the implications of reducing smoking prevalence: the public health and economic benefits of achieving a &#039;tobacco-free UK

    10 hours 50 min ago
    Introduction

    Smoking is still the most preventable cause of cancer, and a leading cause of premature mortality and health inequalities in the UK. This study modelled the health and economic impacts of achieving a ‘tobacco-free’ ambition (TFA) where, by 2035, less than 5% of the population smoke tobacco across all socioeconomic groups.

    Methods

    A non-linear multivariate regression model was fitted to cross-sectional smoking data to create projections to 2035. These projections were used to predict the future incidence and costs of 17 smoking-related diseases using a microsimulation approach. The health and economic impacts of achieving a TFA were evaluated against a predicted baseline scenario, where current smoking trends continue.

    Results

    If trends continue, the prevalence of smoking in the UK was projected to be 10% by 2035—well above a TFA. If this ambition were achieved by 2035, it could mean 97 300 +/- 5 300 new cases of smoking-related diseases are avoided by 2035 (tobacco-related cancers: 35 900+/- 4 100; chronic obstructive pulmonary disease: 29 000 +/- 2 700; stroke: 24 900 +/- 2 700; coronary heart disease: 7600 +/- 2 700), including around 12 350 diseases avoided in 2035 alone. The consequence of this health improvement is predicted to avoid £67 +/- 8 million in direct National Health Service and social care costs, and £548 million in non-health costs, in 2035 alone.

    Conclusion

    These findings strengthen the case to set bold targets on long-term declines in smoking prevalence to achieve a tobacco ‘endgame’. Results demonstrate the health and economic benefits that meeting a TFA can achieve over just 20 years. Effective ambitions and policy interventions are needed to reduce the disease and economic burden of smoking.

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    Randomised controlled trial of stand-alone tailored emails for smoking cessation

    10 hours 50 min ago
    Introduction

    Digital technology has created opportunities for delivering smoking cessation assistance at the population level. However, the efficacy of sending multiple, automated, tailored emails providing motivation, support and information for quitting is unknown.

    Methods

    Smokers planning to quit (n=1070) were randomly assigned to (1) 27 tailored cessation emails (deluxe email group (DEG)), (2) 3 to 4 tailored emails with links to downloadable booklets (basic email group (BEG)) or (3) a single non-tailored email (single email group (SEG)). All emails included links to quitting resources. Self-reported 7-day point-prevalence abstinence was assessed at 1 month, 3 months and 6 months postenrolment.

    Results

    Across follow-ups, abstinence was significantly greater for smokers in the DEG (34%) compared with the SEG (25.8%; OR=1.47, 95% CI 1.07 to 2.02, p=0.02) but there was no difference between the BEG (30.8%) and the SEG (p=0.13). Results were independent of baseline cigarettes per day, interest in quitting, smoker in household, use of nicotine replacement therapy (NRT) or varenicline and gender, themselves associated with abstinence (ps<0.05). Missing=smoking and multiple imputation analyses based on 25 data sets corroborated results. Participants in the DEG were also more likely to use non-medication aids (eg, quit smoking website, cessation class/clinic) compared with the SEG (OR=1.34, p=0.02, CI 1.06 to 1.71), but use of these or NRT by the 4-week follow-up (vs no use) increased abstinence across follow-ups primarily for those in the SEG.

    Conclusions

    Stand-alone tailored, multiple emails providing support, motivation and information during a quit attempt are an easily deployable, inexpensive mode of providing effective cessation assistance to large numbers of smokers planning to quit.

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    Recruiting and retaining youth and young adults: challenges and opportunities in survey research for tobacco control

    10 hours 50 min ago
    Introduction

    Evaluation studies of population-based tobacco control interventions often rely on large-scale survey data from numerous respondents across many geographic areas to provide evidence of their effectiveness. Significant challenges for survey research have emerged with the evolving communications landscape, particularly for surveying hard-to-reach populations such as youth and young adults. This study combines the comprehensive coverage of an address-based sampling (ABS) frame with the timeliness of online data collection to develop a nationally representative longitudinal cohort of young people aged 15-21.

    Methods

    We constructed an ABS frame, partially supplemented with auxiliary data, to recruit this hard-to-reach sample. Branded and tested mail-based recruitment materials were designed to bring respondents online for screening, consent and surveying. Once enrolled, respondents completed online surveys every 6 months via computer, tablet or smartphone. Numerous strategies were utilized to enhance retention and representativeness

    Results

    Results detail sample performance, representativeness and retention rates as well as device utilization trends for survey completion among youth and young adult respondents. Panel development efforts resulted in a large, nationally representative sample with high retention rates.

    Conclusions

    This study is among the first to employ this hybrid ABS-to-online methodology to recruit and retain youth and young adults in a probability-based online cohort panel. The approach is particularly valuable for conducting research among younger populations as it capitalizes on their increasing access to and comfort with digital communication. We discuss challenges and opportunities of panel recruitment and retention methods in an effort to provide valuable information for tobacco control researchers seeking to obtain representative, population-based samples of youth and young adults in the U.S. as well as across the globe.

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    The Lighter Side

    10 hours 50 min ago

    Categories: Tobacco News Feed

    A randomised controlled trial of a complex intervention to reduce childrens exposure to secondhand smoke in the home

    10 hours 50 min ago
    Objectives

    Exposing children to secondhand tobacco smoke (SHS) causes significant harm and occurs predominantly through smoking by caregivers in the family home. We report a trial of a complex intervention designed to reduce secondhand smoke exposure of children whose primary caregiver feels unable or unwilling to quit smoking.

    Design

    An open-label, parallel, randomised controlled trial.

    Setting

    Deprived communities in Nottingham City and County, England

    Participants

    Caregivers resident in Nottingham City and County in England who were at least 18 years old, the main caregiver of a child aged under 5 years living in their household, and reported that they were smoking tobacco inside their home.

    Interventions

    We compared a complex intervention combining personalised feedback on home air quality, behavioural support and nicotine replacement therapy for temporary abstinence with usual care.

    Main outcomes

    The primary outcome was change in air quality in the home, measured as average 16–24 hours levels of particulate matter of < 2.5 µm diameter (PM2.5), between baseline and 12 weeks. Secondary outcomes included changes in maximum PM2.5, proportion of time PM2.5 exceeded WHO recommended levels of maximum exposure of 25 µg/mg3, child salivary cotinine, caregivers’ cigarette consumption, nicotine dependence, determination to stop smoking, quit attempts and quitting altogether during the intervention.

    Results

    Arithmetic mean PM2.5 decreased significantly more (by 35.2 %; 95% CI 12.7% to 51.9 %) in intervention than in usual care households, as did the proportion of time PM2.5 exceeded 25 µg/mg3, child salivary cotinine concentrations, caregivers’ cigarette consumption in the home, nicotine dependence, determination to quit and likelihood of having made a quit attempt.

    Conclusions

    By reducing exposure to SHS in the homes of children who live with smokers unable or unwilling to quit, this intervention offers huge potential to reduce children’s’ tobacco-related harm.

    Trial registration number

    ISRCTN81701383.

    This trial was funded by the UK National Institute for Health Research (NIHR): RP-PG-0608-10020

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    Tobacco retail availability and risk of relapse among smokers who make a quit attempt: a population-based cohort study

    10 hours 50 min ago
    Introduction

    The availability of tobacco is thought to influence smoking behaviour, but there are few longitudinal studies examining if the location and number of tobacco outlets has a prospective impact on smoking cessation.

    Methods

    The Ontario Tobacco Survey, a population-representative sample of Ontario adult smokers who were followed every 6 months for up to 3 years, was linked with tobacco outlet location data from the Ontario Ministry of Health. Proximity (distance), threshold (at least one outlet within 500 m) and density (number of outlets within 500 m) with respect to a smokers’ home were calculated among urban and suburban current smokers (n=2414). Quit attempts and risk of relapse were assessed using logistic regression and survival analysis, adjusted for neighbourhood effects and individual characteristics.

    Results

    Increased density of tobacco outlets was associated with decreased odds of making a quit attempt (OR: 0.54; 95% CI 0.35 to 0.85) in high-income neighbourhoods, but not in lower income ones. There was an increased risk of relapse among those who had at least one store within 500 m (HR: 1.41 (95% CI 1.06 to 1.88). Otherwise, there was no association of proximity with quit attempts or relapse.

    Conclusions

    The existence of a tobacco retail outlet within walking distance from home was associated with difficulty in succeeding in a quit attempt, while the increased density of stores was associated with decreased attempts in higher income neighbourhoods. The availability of tobacco may influence tobacco use through multiple mechanisms.

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    Flavour chemicals in a sample of non-cigarette tobacco products without explicit flavour names sold in New York City in 2015

    10 hours 50 min ago
    Background

    Youth who experiment with tobacco often start with flavoured products. In New York City (NYC), local law restricts sales of all tobacco products with ‘characterising flavours’ except for ‘tobacco, menthol, mint and wintergreen’. Enforcement is based on packaging: explicit use of a flavour name (eg, ‘strawberry’) or image depicting a flavour (eg, a fruit) is presumptive evidence that a product is flavoured and therefore prohibited. However, a tobacco product may contain significant levels of added flavour chemicals even when the label does not explicitly use a flavour name.

    Methods

    Sixteen tobacco products were purchased within NYC in 2015 that did not have explicit flavour names, along with three with flavour names. These were analysed for 92 known flavour chemicals plus triacetin by gas chromatography/mass spectrometry.

    Results

    14 of the 16 products had total determined flavour chemical levels that were higher (>0.3 mg/g) than in previously studied flavour-labelled products and of a chemical profile indicating added flavour chemicals.

    Conclusions

    The results suggest that the tobacco industry has responded to sales restrictions by renaming flavoured products to avoid explicitly identifying them as flavoured. While chemical analysis is the most precise means of identifying flavours in tobacco products, federal tobacco laws pre-empt localities from basing regulations on that approach, limiting enforcement options. If the Food and Drug Administration would mandate that all tobacco products must indicate when flavourings are present above a specific level, local jurisdictions could enforce their sales restrictions. A level of 0.1 mg/g for total added flavour chemicals is suggested here as a relevant reference value for regulating added flavour chemicals in tobacco products.

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    Market-level exposure to state antismoking media campaigns and public support for tobacco control policy in the United States, 2001-2002

    10 hours 50 min ago
    Objective

    This study tests whether exposure to state antismoking media campaigns is associated with increased support for comprehensive bans on smoking indoors and cigarette advertising.

    Methods

    We combine commercially available data on market-level state-sponsored antismoking advertisements with three waves of the Current Population Survey’s Tobacco Use Supplement to test the relationship between market-level volume of state antismoking advertising exposure and support for tobacco control policy between 2001 and 2002. We use logistic regression to assess which message themes employed in the advertisements are associated with increased support for tobacco control policy.

    Results

    The overall market-level volume of exposure to state antismoking ads targeted to adults or the general population was associated with significant increases in support for comprehensive indoor smoking bans. These effects were driven by exposure to ads emphasising the health consequences of smoking to others, anti-industry appeals and irrationality/addiction appeals. Evidence of campaign impact on support for tobacco advertising bans was less clear and, when statistically significant, small in magnitude relative to the impact of the state economic and tobacco control policy environment.

    Conclusions

    This study shows that that large-scale antismoking media campaigns can have a meaningful secondary impact on support for comprehensive indoor smoking bans. Future research should identify the conditions under which mass media campaigns primarily targeting smoking behaviour may influence public support for a variety of other tobacco control policies.

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    Defending strong tobacco packaging and labelling regulations in Uruguay: transnational tobacco control network versus Philip Morris International

    10 hours 50 min ago
    Objective

    Describe the process of enacting and defending strong tobacco packaging and labelling regulations in Uruguay amid Philip Morris International’s (PMI) legal threats and challenges.

    Methods

    Triangulated government legislation, news sources and interviews with policy-makers and health advocates in Uruguay.

    Results

    In 2008 and 2009, the Uruguayan government enacted at the time the world’s largest pictorial health warning labels (80% of front and back of package) and prohibited different packaging or presentations for cigarettes sold under a given brand. PMI threatened to sue Uruguay in international courts if these policies were implemented. The Vazquez administration maintained the regulations, but a week prior to President Vazquez’s successor, President Mujica, took office on 1 March 2010 PMI announced its intention to file an investment arbitration dispute against Uruguay in the International Centre for the Settlement of Investment Disputes. Initially, the Mujica administration announced it would weaken the regulations to avoid litigation. In response, local public health groups in Uruguay enlisted former President Vazquez and international health groups and served as brokers to develop a collaboration with the Mujica administration to defend the regulations. This united front between the Uruguayan government and the transnational tobacco control network paid off when Uruguay defeated PMI’s investment dispute in July 2016.

    Conclusion

    To replicate Uruguay’s success, other countries need to recognise that strong political support, an actively engaged local civil society and financial and technical support are important factors in overcoming tobacco industry’s legal threats to defend strong public health regulations.

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