Tobacco and health

Figure 1. The tobacco industry used the image of healthcare professionals to publicise the merits of one brand of tobacco or another, as well as their safety. The pictures above show different examples of cigarette advertisements published in newspapers and magazines in the United States in the mid-twentieth century. / Standford School of Medicine

From the mid twentieth century, several studies showed that cigarette-smoking was related to the increase in the incidence of lung cancer. After their publication the tobacco industry felt threatened and used the media to counteract the effects these studies had on the population. From this perspective, the present article reviews the role of the media in the dissemination of tobacco-related information and the evolution in tobacco control policies that the approach has caused.

Keywords: tobacco, smoking, media, advertising, lobbying.

We know that tobacco is bad

Quite probably, almost every article or essay we read or write about tobacco today would start with a sentence like «Tobacco use kills nearly six million people annually, and it is estimated that it will cause a billion deaths during the 21st century» (Atusingwize, Lewis, & Langley, 2015). We have known this for a few decades. At the beginning of 1960, two reports titled «Smoking and Health» confirmed the causal relationship between tobacco smoking and cancer and other diseases. The first, written by United Kingdom’s Royal College of Physicians (1962), went largely unnoticed. The second was written by the North-American Luther L. Terry in 1964 (Surgeon General’s Advisory Committee on Smoking and Health, 1964).

Evidence had accumulated during the preceding decades and in 1950, three important papers on the tobacco-related risks of disease or death were published, three case studies with cancer patients and control groups that gave the scientific evidence for the relationship between tobacco smoking and lung cancer. Two of the studies were conducted in the United States by independent groups. Levi, Goldstein and Gerhardt’s study (1950) included 1,000 cancer patients and 600 cancer-free patients. All of them were asked in a questionnaire about their medical history, occupation and lifestyle, including smoking. The other study, published by Wynder and Graham (1950), included 684 lung cancer patients and 780 hospitalised cancer-free patients. Both studies consistently showed that the prevalence of tobacco use among the cases was much higher than among the members of the control group. The third study, conducted in the United Kingdom by Doll and Hill (1950), included 709 patients with lung cancer and another 709 patients without cancer. Information was collected using a questionnaire about tobacco use, age of starting the habit and degree of smoke inhalation. Doll and Hill observed that a higher frequency of smokers had lung cancer, and the fact that patients with the disease used more tobacco than the control group.

It is worth noting that the authors of the studies had great difficulty in publishing their research because, apart from using a new epidemiological design they used, they offered quite an uncomfortable answer to the question of the cause of the tragic lung cancer epidemic in the Western world. Smoking prevalence was very high, including the researchers themselves (Graham quit smoking in 1951 but died of lung cancer six years later). Even Graham warned Wynder when they were preparing the text: «You are going to have many difficulties. The smokers will not like your message. The tobacco interests will be vigorously opposed. The media and the government will be loath to support these findings» (Thun, 2005). The emphasis has been added, although the reader probably does not need it, because his words perfectly show the important role of the media, even according to these intrepid researchers.

Figure 2. In response to research connecting tobacco and lung cancer, tobacco companies launched the campaign A frank statement to cigarette smokers in magazines and newspapers in 1954. It was the beginning of the tobacco industry’s strategy to spread misinformation among the citizens regarding the effects of tobacco on health. / John W. Hill Papers State Historical Society of Wisconsin

The tobacco industry already knew

It is no surprise that the tobacco industry used health claims in the advertising of cigarettes during the 1950s and 1960s (Figure 1). Their advertising used people who were considered to be exemplary, like health care professionals, to publicise the merits of one brand of tobacco or another, as well as their safety. The media survive mainly thanks to advertising revenue, so they shamelessly (and probably with very little information) welcomed such advertising. In 1954, in response to other research on the direct carcinogenic effect of tobacco, tobacco companies launched the campaign (today it would be considered an advertorial) A frank statement to cigarette smokers (Figure 2) in the most important magazines and newspapers in the United States. The «frank statement» publication attributed statements like «there is no proof that cigarette smoking is one of the causes» of lung cancer to scientific experts. It marks the beginning of the tobacco industry’s strategy of spreading misinformation among the citizens regarding the effects of tobacco on health.

Figure 3. Another strategy used by the tobacco industry was to organise meetings to present their point of view on passive smoking, its economic impact and the effects of restrictive advertising legislation to journalists and pundits. The picture shows a Philip Morris document about a conference in Madrid in 1984 for Spanish and Latin American journalists, which was organised to that end. / Philip Morris / Legacy Tobacco Documents Library

The tobacco industry tried to influence the media

The tobacco industry pressured the media because they understood that media coverage influences the population’s behaviour. A study by Soto-Mas, Villalbí, Granero, Jacobson and Balcazar (2003) analysed internal industry documents (released after tobacco companies’ trial in the United States and publication of the Master Settlement Agreement¹ in 1998) and revealed the industry’s strategies for attracting journalists. For instance, in November 1984 a conference for Latin American journalists was organised in Madrid to «have the tobacco industry’s point of view clearly and fairly stated by exposing leading journalists to myths and realities about passive smoking (Figure 3), the economic impact of the tobacco industry, the negative effects of restrictive advertising, etc.» (Rothermel, 1984) or by organising the travel arrangements for journalists specialised in health issues (from La Vanguardia and El Mundo) to the United States to be shown the marvels of Philip Morris’s activities (Winokur, 1995).

The different ways the industry tried to influence journalists, informants and the media has been investigated, including the aforementioned documents or actively in the case of new laws (smoke-free spaces, prohibition of smoking in cars, etc.). Among their most frequent activities, travel to special events are organised, usually in privileged locations, combined with extraprofessional activities, as well as press releases as a source of information for journalists (Hiilamo, Kahl, & Lambe, 2009), although the effect on the media and journalists seems rather weak, with the exception of economy magazines.

A United States study (Pierce & Gilpin, 2001) on mass media news about health and tobacco between 1950 and 1983 proved the association between media coverage and changes in the rates of smoking cessation. Because of this, the World Health Organization (WHO) and the tobacco control movement included denouncement of the tobacco industry’s manoeuvring to manipulate the media among their priorities (World Health Organization, 2000).

Figure 4. The graph shows the number of articles published in La Vanguardia including the word «tabaquismo» (tobacco use) over time (1881-2015). / Font: La Vanguardia.

In Spain, the existence of the discussion in the media for most of 2005, before the Law 28/2005 for health care measures against smoking was passed (the law was passed on 26 December 2005 and entered into force on 1 January 2006), is evidence of the media’s importance. As described in the 2006 Informe Quiral (Fundació Vila Casas, 2007), the covers of the most important national newspapers included information on the proposals, negotiation of and amendments to the new law, with an approximate average of forty news items about tobacco per month, and a peak in December 2005 of over 200. The 700 news items about tobacco in 2005 almost doubled the figure published between 2002 and 2004, and tripled those of preceding years (1997 to 2001). This trend can also be observed in the news published by the veteran Spanish newspaper La Vanguardia, which has accessible online information about issues as far back as 1881, as shown in Figure 4.

The treatment of tobacco news has changed gradually over time. For instance, La Vanguardia was very timid in the way it presented the «Smoking and Health» report from the Royal College of Physicians of the United Kingdom, issued on 6 March 1962 in London. The report was only mentioned in a brief agency news note two days later (Figure 5).

Figure 5. On the left, the 1962 «Smoking and Health» report from the Royal College of Physicians of the United Kingdom. On the right, a brief note in La Vanguardia days after the report was published.

Evidently, the media have directed advertising and information on tobacco since it became established as a huge business, and the industry has tried to influence the media and its informants. Despite this, in Spain and in other developed countries, the media have been decisive in creating the social change required to control tobacco use.

1. An agreement reached in the United States in 1998 between, on the one hand, the lawyers of 46 states, five territories and the District of Columbia, and on the other, the main tobacco companies regarding the advertising and marketing of their products. (Go back)