There is no doubt that the tobacco companies in Australia and in many other parts of the world have suffered devastating blows to their public image in recent decades. In the wake of litigation cases during the 1990s, which revealed duplicitous industry conspiracies to mislead and reassure smokers about the effects of tobacco use,1 encourage children to start smoking2 and undermine public health policy3,4, the companies have embarked upon a multi-faceted public relations offensive designed to persuade the general public they have turned over a new corporate leaf.
Several studies have examined Australian attitudes to tobacco companies. One of the earliest was undertaken in Western Australia in 1988, a time when the tobacco companies were still publicly denying that smoking caused disease, were challenging the mounting evidence on secondhand smoke, and contending with an increased demand for tobacco control measures from a growing number of Australian health concerns. This research found that on the basis of public credibility, 75% of respondents felt that tobacco industry representatives were 'not at all believable', rating them lower than used car salesmen (69%).5
Industry attempts to resuscitate its image appear not to have been of much influence. South Australian research in the late 1990s found that 80% of respondents (and 74% of smokers) thought that tobacco companies mostly did not, or never, told the truth about smoking and health;6 and Victorian research undertaken in 2004 reported similar findings.7 International research studying opinions in Canada, the US, the UK and Australia shows that overall, 80% of smokers do not believe that tobacco companies can be trusted to tell the truth.8 Distrusting the tobacco industry is associated with an increased likelihood of cessation behaviours among smokers,8 and negative attitudes to the industry have been harnessed by tobacco control advocates as a way of encouraging quitting.
Other research has investigated just how far people believe that the tobacco industry may reasonably be regulated. A survey of Australian smokers in 2004 showed that 69% of respondents felt that tobacco products should be more tightly regulated, and 49% agreed that tobacco companies should take responsibility for the harms caused by tobacco.9 Interestingly, 77% of smokers surveyed also believed the government does not really care about reducing the prevalence of smoking because of the revenue it receives from tobacco taxes. The authors of this study conclude that 'stronger government action to control tobacco products and the tobacco industry is likely to be supported by the majority of Australian smokers and that failure of governments to act is associated with cynicism about in whose interests governments operate' (p169).9
An extension of tobacco industry disapproval is the acceptability of smoking itself. When Australians are surveyed on their attitudes and perceptions of tobacco use when compared to other illicit and legal drugs, interesting insights are revealed. In the 2010 National Drug Strategy Household Survey, approval of regular adult use of tobacco was only 15.3%. Of the people surveyed aged over 14 years, the drug (correctly) perceived to be associated with the most number of deaths was tobacco, with 36.0% nominating it over all other illicit and legal drugs. However, fewer than half of these people (15.8%) named tobacco as the drug most concerning to community. The proportion of people who first thought of tobacco when asked to name a drug associated with a drug problem was only 2.2%.10 These figures suggest that—despite the fact that so few people approve of its use—there is still room to improve the knowledge that the general public has about the relative harms associated with tobacco use.
The changing public attitudes to the tobacco industry are a marker of the growing 'denormalisation' of tobacco use. Denormalisation refers to the transition in status of smoking from a widely practised and socially acceptable behaviour to one which is increasingly typified as destructive, dirty and anti-social. Denormalisation does not only apply to smoking. It has increasingly applied to the tobacco industry, which (as shown in the preceding section) has not enjoyed a particularly positive public profile in recent years. Public recognition that the industry has for many decades lied to smokers and the wider community about the health effects of tobacco use has been heightened by high profile legal cases and the public release of previously confidential industry documents. The industry has been cast as the villain in popular culture (such as John Grisham's novel The Runaway Jury and movies The Insider11 and Thank You for Smoking). The industry's adoption of corporate social responsibility programs has been a major public relations campaign to regain corporate credibility (see Section 10.11).
Chapman and Freeman detail many markers of denormalisation of smoking in Australia that demonstrate just how marginalised smoking—and its champion, the tobacco industry—has become.11 These include prevailing attitudes in the community, as evidenced through an array of media reports, environmental and health campaigns and advertising for items such as insurance, accommodation and cessation aids.
Increasing limits on where smoking may occur means that smokers are for the most part defined as a group whose unwelcome behaviour entails segregation. Provision of smoking accessories such as cigarette lighters and ashtrays in cars is no longer standard in cars of Australian manufacture and some imported European vehicles; once-elegant tobacco packets are now disfigured by graphic health warnings.11
In that denormalisation of smoking contributes to continued downward pressure on smoking rates by encouraging quitting and discouraging uptake of smokingi, it can be seen as a marker of progress. However it is important to consider whether the denormalisation of smoking might lead to the marginalisation of those people who continue to smoke. There is a risk that as smoking becomes more concentrated among populations that are already disadvantaged (such as lower socio-economic status groups and the mentally ill), these individuals may have less motivation to quit or to access programs that might assist them.13, 14 Stigmatisation of smokers could also lead to discrimination (for example in the workplace) and 'victim blaming' if smokers are regarded as responsible for their own illness.11
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1. Francey N and Chapman S. 'Operation Berkshire' - the international tobacco companies' conspiracy. British Medical Journal 2000;321(7257):371-4. Available from: http://www.bmj.com/cgi/reprint/321/7257/371.pdf
2. Carter SM. From legitimate consumers to public relations pawns: the tobacco industry and young Australians. Tobacco Control 2003;12(suppl. 3):iii71-8. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/12/suppl_3/iii71
3. Committee of Experts on Tobacco Industry Documents. Tobacco company strategies to undermine tobacco control activities at the World Health Organization. Geneva: WHO, 2000. Available from: http://www.who.int/tobacco/media/en/who_inquiry.pdf
4. Trochim WMK, Stillman FA, Clark PI and Schmitt CL. Development of a model of the tobacco industry's interference with tobacco control programmes. Tobacco Control 2003;12(2):140-7. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/12/2/140
5. Daube M. West Australians are unlikely to believe statements made by the tobacco industry [Media release from the Office of the Director]. Perth: Health Promotion and Education Services Branch, 1988.
6. Wakefield M, Miller C and Woodward S. Community perceptions about the tobacco industry and tobacco control funding. Australian and New Zealand Journal of Public Health 1999;23(3):240–4. Available from: http://www3.interscience.wiley.com/journal/120141553/abstract
7. Durkin SJ, Germain D and Wakefield M. Adult's perceptions about whether tobacco companies tell the truth in relation to issues about smoking. Tobacco Control 2005;14(6):429–30. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/14/6/429-a
8. Hammond D, Fong GT, Zanna MP, Thrasher JF and Borland R. Tobacco denormalization and industry beliefs among smokers from four countries. American Journal of Preventive Medicine 2006;31(3):225-32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16905033
9. Young D, Borland R, Siahpush M, Hastings G, Fong G and Cummings K. Australian smokers support stronger regulatory controls on tobacco: findings from the ITC Four-Country Survey. Australia and New Zealand Journal of Public Health 2007;31(2):164-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17461008
10. Australian Institute of Health and Welfare. 2010 National Drug Strategy Household Survey report. Drug statistics series no. 25, AIHW cat. no. PHR 145. Canberra: Australian Institute of Health and Welfare, 2011. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737419578&libID=10737419577
11. Chapman S and Freeman B. Markers of the denormalisation of smoking and the tobacco industry. Tobacco Control 2008;17(1):25-31. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/17/1/25.pdf
12. Alamar B and Glantz S. Effect of increased social unacceptability of cigarette smoking on reduction in cigarette consumption. American Journal of Public Health 2006;96(8):1359-63. Available from: http://www.ajph.org/cgi/content/full/96/8/1359
13. Schroeder SA. Stranded in the periphery - the increasing marginalization of smokers. The New England Journal of Medicine 2008;358(21):2284-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18499574
14. Bell K, Salmon A, Bowers M, Bell J and McCullough L. Smoking, stigma and tobacco denormalization: further reflections on the use of stigma as a public health tool. A commentary on Social Science & Medicine's Stigma, Prejudice, Discrimination and Health Special Issue (67: 3). Social Science & Medicine 2010;70(6):795-99. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20044187