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 smoking,2 and undermine public health policy,3, 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’.
10.17.1 Public opinions about tobacco companies
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. 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 had 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 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 A recent survey in the UK found that less than a fifth of respondents considered tobacco companies honest, ethical, and interested in reducing the harm caused by cigarettes.9 Smokers also report overwhelmingly negative attitudes toward the industry.10 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 how extensively 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.11 Results of the 2019 National Drug Strategy Household Survey (NDSHS) showed widespread support for further regulations to reduce the harms caused by tobacco: about two-thirds of Australians supported further tax increases on tobacco to cover health-related treatment costs (67%) and health education (65%), and 63% supported raising the minimum age of tobacco sales to 21.12 Research in Europe has also found majority support for greater tobacco regulation.9,13
An extension of tobacco industry disapproval is public perceptions of smoking itself. In the 2019 National Drug Strategy Household Survey, only 15% of people approved of regular adult use of tobacco. However, only 19% of people over the age of 14 years (correctly) thought tobacco caused the most drug-related deaths in Australia, and only 8% named tobacco as the drug most concerning to community; significant declines from earlier years. The proportion of people who first thought of tobacco when asked to name a drug associated with a drug problem was only 2%.12 These figures suggest that—despite the fact that so few people approve of its use—there is still room to improve the general public’s knowledge about the relative harms associated with tobacco use.
10.17.2 ‘Denormalisation’ of tobacco use and the tobacco industry
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. The tobacco industry itself has also been increasingly denormalised, in line with its declining public image. 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 Insider14 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).
There are many markers of the extensive denormalisation of smoking and the tobacco industry in Australia.14 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 often segregated. 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 covered by graphic health warnings. People advertising on dating sites or for housemates overwhelmingly specify a preference for non-smokers.14 Western Australia recently prohibited the inclusion of tobacco purchases in shopping reward schemes and loyalty programs.15
While the denormalisation of smoking plays an important role in encouraging quitting and discouraging uptake of smoking16, 17 it is important to consider whether it 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 and minority groups, and the mentally ill), these individuals may become further marginalised18 and have less motivation to quit or to access programs that might assist them.19, 20 Smokers who feel stigmatised are less likely to disclose their smoking status to health professionals,21 and they may experience guilt, loss of self-esteem, and defensiveness.17 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.14 A survey in the UK found that far more people attribute responsibility for smoking-related health problems to smokers (88%) than tobacco companies (55%).9
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. ( Last updated October 2020)
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. Moodie C, Sinclair L, Mackintosh AM, Power E, and Bauld L. How Tobacco companies are perceived within the United Kingdom: An online panel. Nicotine & Tobacco Research, 2016. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27179262
10. Johnson SE, Coleman BN, and Schmitt CL. It's complicated: Examining smokers' relationships with their cigarette brands. Psychol Addict Behav, 2016. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27831717
11. Young D, Borland R, Siahpush M, Hastings G, Fong G, et al. 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
12. Australian Institute of Health and Welfare. National Drug Strategy Household Survey (NDSHS) 2019 key findings data tables. Canberra: AIHW, 2020. Available from: https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/contents/table-of-contents.
13. Lykke M, Pisinger C, and Glumer C. Ready for a goodbye to tobacco? - assessment of support for endgame strategies on smoking among adults in a Danish regional health survey. Preventive Medicine, 2015. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26592689
14. 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
15. Tobacco Products Control Act 2006 (WA). Available from: https://www.legislation.wa.gov.au/legislation/statutes.nsf/main_mrtitle_983_homepage.html.
16. 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
17. Evans-Polce RJ, Castaldelli-Maia JM, Schomerus G, and Evans-Lacko SE. The downside of tobacco control? Smoking and self-stigma: A systematic review. Social Science & Medicine, 2015; 145:26–34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26439764
18. Antin TM, Lipperman-Kreda S, and Hunt G. Tobacco denormalization as a public health strategy: Implications for sexual and gender minorities. American Journal of Public Health, 2015:e1–e4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26469677
19. Schroeder SA. Stranded in the periphery − the increasing marginalization of smokers. New England Journal of Medicine, 2008; 358(21):2284−6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18499574
20. 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
21. Stuber J, Galea S, and Link BG. Smoking and the emergence of a stigmatized social status. Social Science & Medicine, 2008; 67(3):420–30. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18486291