How tobacco companies use the revolving door between government and industry to influence policymaking: an Australian case study.

Objectives and importance of the study: The study investigates and documents how tobacco companies are using the revolving door between government and industry as a tactic to try to influence public health policymaking in Australia. This is the first Australian study to systematically investigate the revolving door tactic in tobacco lobbying and highlights the importance of strengthening integrity and transparency legislation and oversight bodies to eliminate the political influence of tobacco companies in Australia. STUDY TYPE: Mixed-methods including non-experimental descriptive and exploratory case studies. METHODS: To build a picture of tobacco lobbying through the revolving door in Australia, data was triangulated from multiple publicly available sources: 1) Australian federal, state and territory government lobbyist registers, 2) the online social networking platform, LinkedIn; and 3) Australian news media reports. RESULTS: Tobacco companies lobby the Australian government using 'in-house' employees, lobbyists working in firms acting on their behalf, and third-party allies with common interests. Almost half (48%) of internal tobacco company lobbyists had held positions in the Australian government (state, territory and/or federal) before or after working in the tobacco industry. Likewise, 55% of lobbyists acting on behalf of tobacco companies had held government positions before or after working as a lobbyist. In-house tobacco industry lobbyists, as well as those working on behalf of tobacco companies within lobbying firms, were found to have held senior governmental positions, such as a Member of Parliament (MP) or Senator, chief or deputy chief of staff, or senior advisor in a ministerial office, and many had moved into or out of government within 1 year of working for a tobacco company (56%) or as a lobbyist (48%). CONCLUSIONS: Tobacco companies are strategically using the revolving door between the government and the tobacco industry as a key political lobbying mechanism to try to influence public health policy in Australia.

Who sells tobacco, who stops? A comparison across different tobacco retailing schemes.

BACKGROUND: Licensing of tobacco retailers has been proposed as a mechanism to encourage retailers to stop selling tobacco. However, previous studies of tobacco licensing and/or of retailers who have stopped selling have been restricted to one legislative environment. This study examines patterns of tobacco retailing across three legislative environments with three different licensing schemes (an annual fee-based licence, a zero-cost, one-off notification scheme and no notification/licensing scheme). METHOD: A telephone survey was conducted of 2928 potential tobacco retailers who could personally choose whether or not to sell tobacco (rather than the decision being made at a head office). RESULTS: Unexpectedly, the annual licence fee to sell tobacco was not significantly associated with a lower rate of selling tobacco or a higher rate of stopping. After allowing for other factors, probability of selling, stopping selling and reported importance of tobacco sales varied across outlet types (p<0.001 for all three outcomes), and according to the remoteness of the retailer (p<0.001, p trend=0.041 and p=0.025 respectively). CONCLUSION: A fee of $A286 was not associated with a lower rate of selling, or a higher rate of stopping. The effect of licensing on retailer numbers will presumably be greater for higher licence fees, but will also depend on the perceived importance of tobacco sales to the retailer. In turn, importance of tobacco sales appears to depend on market factors, including proximity to major urban centres and low-cost competitors. A higher licence fee is likely to have a larger effect on discouraging retailers from selling.

'Friends with benefits': how tobacco companies influence sales through the provision of incentives and benefits to retailers.

BACKGROUND: In countries banning advertising and display of tobacco at point-of-sale, little is known about tobacco companies' continuing promotion of products through incentives and benefits to retailers. METHOD: A telephone survey of 4527 randomly selected Australian retailers was conducted in August 2018, and identified 800 current tobacco retailers (response rate: 72.4%) who were asked a series of questions about benefits offered to them by tobacco companies and what retailers agreed to in return. RESULTS: 41.1% of retailers reported being provided with a tobacco cabinet and 38.3% reported having a price list supplied by a tobacco company. One-third (33.3%) reported being offered at least one benefit from a tobacco company for doing something in return. Price discounts were the most frequently reported benefit (19.0%), followed by rebates (8.4%) and gifts (3.0%). Retailers also reported offers of prizes and incentives for increasing sales or demonstrating product knowledge. In return, retailers reported giving companies benefits such as prominence on the price list and/or in the tobacco cabinet and/or influence over the product range and stock levels. CONCLUSION: Tobacco companies are continuing to market tobacco and influence sales through provision of incentives and benefits to retailers. Laws that ban the supply of benefits to consumers should be extended to also prohibit the provision of benefits to tobacco retailers.

Understanding why some Australian retailers have stopped selling tobacco, some might and some are unlikely.

BACKGROUND: Widespread availability of tobacco has been shown to contribute to ongoing smoking and make quitting harder. This study investigates why some retailers in three Australian states decided to stop selling tobacco, others might stop selling and why others continue to sell in a declining market. METHODS: A telephone survey of 4527 randomly selected retailers was conducted in August 2018 (response rate=72.4%). This study examines responses to open-ended questions in the survey probing retailers' attitudes and beliefs regarding selling (or not selling) tobacco. RESULTS: 27.3% of the sample sold tobacco, and 13.3% had formerly sold. Outlets that had stopped selling most frequently mentioned minimal profit and/or sales as the reason for stopping selling (27.7% across all states). This was also the most frequent reason why retailers said they might stop selling. Uniquely in Western Australia (the only state in the study with a fee-based licensing scheme), 12.5% of former tobacco retailers named tobacco licensing as the reason for stopping sales-the second most frequent reason in Western Australia. Of current sellers who were unlikely to stop, the potential to lose sales was the most frequently named reason (31.0% across all states). CONCLUSION: Retailers report being driven by the profitability of tobacco when deciding whether or not to stop selling, although only a small percentage discussed losing incremental sales if they stopped selling. An annual licence fee contributed to some retailers stopping selling, showing that a fee-based tobacco license can contribute to a decline in retail availability of tobacco.

Plain packaging: legislative differences in Australia, France, the UK, New Zealand and Norway, and options for strengthening regulations.

By July 2018, five countries (Australia, France, the UK, New Zealand and Norway) had fully implemented plain (standardised) packaging. Using government documents, we reviewed the key legislative differences between these five countries to identify best practice measures and potential lacuna. We then discuss how governments planning to introduce plain packaging could strengthen their legislation. Differences between countries include the terminology used (either 'plain', 'standardised' or 'plain and standardised'), products covered and transition times (ranging from 2 to 12 months). Myriad differences exist with respect to the packaging, including the dimensions (explicitly stated for height, width and depth vs minimum dimensions for the health warnings only), structure (straight-edged flip-top packs vs straight, rounded and bevelled-edged flip-top packs and shoulder boxes) and size (minimum number of cigarettes and weight of tobacco vs fixed amounts) and warning content (eg, inclusion of a stop-smoking web address and/or quitline displayed on warnings on one or both principal display areas). Future options that merit further analysis include banning colour descriptors in brand and variant names, allowing pack inserts promoting cessation and permitting cigarettes that are designed to be dissuasive. Plain packaging legislation and regulations are divergent. Countries moving towards plain packaging should consider incorporating the strengths of existing policies and review opportunities for extending these. While plain packaging represents a milestone in tobacco-control policy, future legislation need not simply reflect the past but could set new benchmarks to maximise the potential benefits of this policy.

Tobacco product developments in the Australian market in the 4 years following plain packaging.

This paper aimed to identify continued and emerging trends in the Australian tobacco market following plain packaging implementation, over a period of substantial increases in tobacco taxes. Since 2012, our surveillance activities (including review of trade product and price lists, ingredient reports submitted by tobacco companies to government and monitoring of the retail environment) found several trends in the factory-made cigarette market. These include the continued release of extra-long and slim cigarettes and packs with bonus cigarettes, particularly in the mainstream and premium market segments; new menthol capsule products; other novel flavourings in cigarettes; filter innovations including recessed and firm filters; continued use of evocative and descriptive product names; the proliferation of the new super-value market segment; and umbrella branding, where new products are introduced within established brand families. Several similar trends were also observed within the smoking tobacco market. While not all of these trends were new to the Australian market at the time of plain packaging implementation, their continued and increased use is notable. Plain packaging legislation could be strengthened to standardise cigarette and pack size, restrict brand and variant names, and ban features such as menthol capsules and filters innovations that provide novelty value or that may provide false reassurance to smokers.

Tobacco price boards as a promotional strategy-a longitudinal observational study in Australian retailers.

BACKGROUND: Price boards in tobacco retailers are one of the few forms of tobacco promotion remaining in Australia. This study aimed to examine how these boards were used to promote products over a period of rapidly rising taxes. METHODS: Observations were made in a panel of 350 stores in Melbourne, Australia, in November of 2013 (just before) and in 2014 and 2015 (after 12.5% increases in tobacco duty). Fieldworkers unobtrusively noted the presence and characteristics of price boards, and the brand name, size and price of the product at the top of each board. RESULTS: Price boards were common in all store types apart from newsagent/lottery agents. The characteristics of the top-listed product changed notably over time: premium brands accounted for 66% of top-listed products in 2013, significantly declining to 43% in 2015, while packs of 20 cigarettes increased in prominence from 32% to 45%. The prevalence of packs of 20 cigarettes in budget market segments tripled from 2013 (13%) and 2014 (11%) to 32% in 2015, with no change in the proportion of packs that were under $A20 from 2014 (37%) to 2015 (36%). The rate of increase in the average price of the top-listed pack correspondingly flattened from 2014 to 2015 compared with 2013-2014. CONCLUSIONS: Price boards promote tobacco products in ways that undermine the effectiveness of tax policy as a means of discouraging consumption. Communication to consumers about prices should be restricted to information sheets provided to adult smokers on request at the point of sale.

Standardised packaging and new enlarged graphic health warnings for tobacco products in Australia-legislative requirements and implementation of the Tobacco Plain Packaging Act 2011 and the Competition and Consumer (Tobacco) Information Standard, 2011.

This paper describes the development, content and implementation of two pieces of Australian tobacco control legislation: one to standardise the packaging of tobacco products and the other to introduce new, enlarged graphic health warnings. It describes the process of legislative drafting, public consultation and parliamentary consideration. It summarises exactly how tobacco products have been required to look since late 2012. Finally, it describes implementation, most particularly, the extent to which packs compliant with the legislation became available to consumers over time.

Physicians' role in advancing tobacco control in China.

China has ratified the FCTC and is working towards implementing tobacco control measures to combat the massive health and economic consequences of tobacco use. Physicians will need to play a leading role in this fight as they have done in countries such as Australia where measures to address the tobacco epidemic are more advanced. At present in China barriers such as physicians' own smoking status and underestimation of the impact interventions with their patients can have means that their potentially positive contribution is far from realised. Physicians have a responsibility to lead in tobacco control. This should begin with their own behaviour and practices including quitting smoking if a smoker and counselling patients and families of patients to not smoke. Advocating to make hospitals and medical facilities smokefree should also be a priority for physicians. As centres where people attend to improve their health and receive treatment for illness, allowing a practice such as smoking is completely incongruous. Responsibility also rests with the facilities in which physicians work and the professional bodies who represent them, physicians should be provided with information, training and support to assist them to address their own and their patients tobacco use.