Tobacco Foes Attack Ads

"We've done a good job of reaching middle-class white America, but not the groups most at risk," says American Cancer Society (ACS) spokesman Steve Dickinson. So new ACS ads twist the tobacco industry's images of success and sophistication. As a beautiful, darkskinned woman smoking a cigarette becomes covered with a gloppy substance, the ad asks, "If what happened on your insides happend on your outsides, would you continue to smoke?" 

Initiative in the black community has been ignited by a virtual wallpapering of inner-city areas with tobacco and alcohol billboards and by now-aborted plans to market a brand of cigarettes, called Uptown, to urban blacks.

"When our people desperately need the message of health promotion, Uptown's message is more disease, suffering, and death for a group already bearing more than its share of smoking-related illness and mortality," complains Department of Health and Human Services Secretary Louis W. Sullivan, MD, who helped keep the brand off the market--though a similar campaign is being used for a brand called Salem Box. 

Nicotine addiction afflicts 34% of black adults vs 28% of whites and 27% of Hispanics, according to a 1989 survey by the Simmons Market Research Bureau. That is why lung cancer and heart disease rates are higher among blacks, says Sullivan, who hopes the vitory against Uptown is "just the beginning of an all-out effort." 

Women's groups are similary out-raged over a campaign for Dakota cigarettes that said they would be marketed to "virile females." Native Americans, who suffer very high addiction rates to many substances, are also incensed at the misuse of the word Dakota, which means friend, says Shirley Butts, RN, of Fort Totten, ND, a Turtle Mountain Chippewa and member of Dakotans Against Dakota Cigarettes. Uptown and Dakota "made it very clear tobacco companies are targeting, and gave us something we can rally around as women and minorities," says Virginia Ernster, PhD, an epidemiologist at the University of California, San Francisco, who has testified before Congress on the tobacco industry's efforts at recruiting women. 

"The industry does target women, minorities, and youth. They know the statistics on who's going to replace the 2.5 million smokers the industry loses each year," 400 000 of them to tobacco-related deaths, says Michele Bloch, MD, PhD, director of the Women vs Smoking Network in Washington, DC. "Those replacement smokers are always children," with the average age for starting now 12.5 years, she says. 

"If present trends continue, by 1995 women will outnumber men because more girls start smoking than boys and women quit less often," says Bloch. Among high school seniors, 20% of females smoke vs 16% of males, with higher rates for high school dropouts. By 2000 only 5% of college graduates will smoke vs 30% of high school dropouts, all largely due, says Bloch, to targeting. 

Opposition to Uptown and Dakota, though, created "a one-two punch that has made the climate in Congress acceptable for legislation limiting tobacco ads in a way no one would have anticipated a year ago," she says, particularly a bill that would ban pictures of people. 

"Adults respond to claims of low tar and nicotine, whereas kids respond to the Marlboro man," says John Madigan, a spokesman for the cancer society's Washington office. 

Those associations can last a lifetime, as organizers of a boycott against Marlboro cigarettes and Miller beer are finding out. AIDS (acquired immunodeficiency syndrome) activists want gay and lesbian bars to stop stocking both products because of parent company Philip Morris' support for Sen Jesse Helms (R, NC). But while patrons "don't bat an eye" when a bartender says there is no Miller, they go next door to buy Marlboro when it is removed from vending machines, says Frank Smithson, boycott coordinator in NewYork. "People are very fond of their cigarette brands. The graphics are part of who and what they are." 

A total ad ban is not likely soon because there is little grassroots support, says Mark Pertschuk, executive director of Americans for Nonsmokers Rights in Berkely, Calif. 

Canada and other countries do have such bans, but Sheila Banks, media affairs director for Philip Morris USA, says the bans do not cut youth smoking rates. Finland, for example, has the world's highest rate of smoking among teenage boys despite a dozen years without tobacco advertising, she says. 

And in the United States there is "a very basic First Amendment issue," says David Fishel, senior vice president for public relations for the R. J. Reynolds Tobacco Company. 

Pertschuk says banning ads for products that are deadly or harmful "in no way violates the First Amendment." 

But Fishel warns that such an effort would engender a "backlash from smokers. It's getting to the point where you have to say, 'Hey, this is still America.'" 

Fishel and Banks both insist they scrupulously avoid any pitch to the underaged. Banks says the fact that teens and preteens account for nearly 90% of new smokers is "probably true because kids try that which they associate with being an adult. The harder you tell them not to do something the more they want to do it." 

Pertschuk's group uses that fact to turn tobacco ads inside out. "Children hate to be manipulated. We harness that and use the industry's own ads to ridicule" the ideas in them. 

Only ridicule can countereact the seductive adult mystique surrounding cigarettes, says Alan Blum, MD, founder of Doctors Ought to Care (DOC), which attacks specific brands on a Mad Magazine level, for example, "Barfboro" and "Wimpston." 

"People say it's so sophomoric, but how else are we supposed to appeal to kids other than to be juvenile?" asks Blum, a family practitioner and assistant professor at Baylor College of Medicine in Houston. "I've never seen a kid go into a store and say 'A pack of cigarettes, please.' Kids are 'branded' for Marlboro and Camel," says Blum. "You're not going to get to kids by talking about the danger or the smell. But no one wants to be associated with a brand name that's ridiculed."

In the adult world, no one wants to be associated with a brand promoting itself to children. That fact is helping DOC get tobacco ads off popular Rocky Mountain ski slopes. 

The Jackson Hole Ski Resort at Teton Village in Wyoming is removing Marlboro flags from a coin-operated racecourse there after DOC surveyed all the fourth and fifth graders in town, says DOC member Brent Blue, MD, a family practitioner in Jackson Hole. "We got a much higher correlation of kids who raced at Teton Village knowing Marlboro than those who did not." The Aspen Skiing Company in Colorado is also dropping Marlboro sponsorship. And Jackson Hole Ski Corp president Paul McCollister plans to proposes a nationwide ban on tobacco sponsorship to the United Ski Industries Association. "When you stop and think about it, it's ridiculous not to," he says. 

That sentiment is not shared by many other sports businessmen, though. Houston Astrodeome officials had security guards remove Blum and other protestes at a Camel-sponsored Cinco de Mayo clebration there, which Blum says was aimed at Hispanic children. 

DOC is campaigning against tobacco billboards in sports arenas as well, on the grounds that they constitute illegal television advertising. A protest in August against such ads in San Francisco's Candlestick Park got support from many smokers, says Susan Smith, administrator of Tobacco-Free California. "They don't want their kids exposed even if they themselves smoke."

A letter-writing campaign to US Attorney General Richard Thornburgh is under way, asking him to assess the $10 000-per-violation fines. Blum says the world Marlboro was televised during virtually half the 93-minute Marlboro Grand Prix. 

"If they'd keep track of all sporting events over the next 6 months we could erase the national deficit," says DOC president Rick Richards, MD, of Augusta, GA. "The Federal Trade Commission ignores the ads, even though the amount companies pay is based on the number of exposures they are likely to get during the telecast," says Richards. Enforcement would "require no new legislation, just sitting down with a videotape player." Existing legislation is one tool black leaders in Baltimore, Md, are using against the ubiquitous billboards pushing legal drugs in low-income areas there. Many billboards came down when neighborhood organizations found a 20-year-old residential area zoning restriction, says Robert Blackwell, an inspector in the city's zoning office. 

Whitewashing of billboards by black leaders in New York helped get the attention of Philip Morris, which plans to turn over some billboards it rents to community groups, says Banks. 

Advertising to minorities is a "catch-22" issue, says RJ Reynolds' Fishel. "In the past we've been criticized for not including blacks, now they're saying we funnel too much." 

Tobacco support for minority organizations is also under fire. The National Association of Black Journalists turned down a $40 000 Philip Morris donation.

"It was a tough decision because tobacco companies have long been supporters of black media when very few others have. But we couldn't take money from an organization deliberately targeting minority populations with a substance that clearly causes cancer," says the group's president, Thomas Morgan. "We simply because more aggressive in our fund-raising so we could do without it." 

That option does not exist for many minority publications, which would fold without tobacco dollars. 

Tobacco revenues cause self-censorship of antismoking stories, says Kenneth Warner, PhD, professor of public health policy at the University of Michigan School of Public Health, Ann Arbor. Last April, at the Seventh World Conference on Tobacco and Health in Perth, Australia, he presented an analysis of 99 magazines over 25 years that found a statistically significant negative correlation between cigarette ad revenue and coverage of smoking, especially in women's magazines. 

A "favorite tactic" of the American Medical Women's Association is "cleaning these magazines out of our waiting rooms," says president Susan Stewart, MD. (See JAMA. 1989;262:1290-1295.) 

Women's organizations also often take tobacco money because "so little other money is available. Many corporations that earn money from women do not support womens' groups," says Bloch. Both she and Banks agree that Virginia Slims put women's tennis on the map when no one else would. "It is ironic that a product which causes major damage to the heart and lungs is associated with a sport requiring top physical fitness and aerobic capacity," says Stewart, accusing Virginia Slims of "taking advantage" of the inadequate funding of women's sports. 

DOC's answer is its own tenns tournament, the Emphysema Slims, held September 15 and 16 in Santa Fe, NM. It is billed as the world's largest throw-tobacco-out-of-sports protest.