Older smokers could be the strongest supporters for U.S. government regulation of tobacco: a focus group study
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Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, USA
Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, USA
Submission date: 2013-05-02
Acceptance date: 2013-08-13
Publication date: 2013-08-17
Corresponding author
Valerie B Yerger   

Department of Social and Behavioral Sciences, University of California, San Francisco, Box 0612, San Francisco, CA, USA
Tobacco Induced Diseases 2013;11(August):17
Targeting of marginalized groups with aggressive tobacco marketing has been identified as exacerbating health disparities. However, interpretation of such targeting by groups varies, from surprise and outrage to regarding such marketing as evidence of social legitimacy. We sought to learn how an often-overlooked marginalized group, older adults, would respond to industry documents offering evidence of tobacco company target marketing.

We conducted 10 focus groups in California cities with older (≥50 years) smokers and former smokers. A set of previously-undisclosed tobacco industry documents related to target marketing was shown to the group in sequence. Audiotaped discussions were transcribed and data analyzed using qualitative approaches.

Responses to evidence of tobacco industry targeting varied, with some regarding it as exploitive and others as normal business practice. However, in most groups, discussions turned to government’s failure to protect the public—even though government action /inaction was not prompted nor addressed in the discussion documents.

Given the Food and Drug Administration’s new authority to regulate tobacco products, these findings suggest that some of the tobacco industry’s “best customers” (older, established smokers and ex-smokers) may be strong supporters of government regulation of tobacco.

Dawel A, Anstey KJ: Interventions for midlife smoking cessation: a literature review. Aust Psychol. 2011, 46 (3): 190-195. 10.1111/j.1742-9544.2010.00014.x.
Doll R, Peto R, Boreham J, Sutherland I: Mortality in relation to smoking: 50 years’ observations on male British doctors. J Epidemiol Community Health. 2004, 58 (11): 930-930.
Critchley JA, Capewell S: Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003, 290 (1): 86-97. 10.1001/jama.290.1.86.
Eliasson B, Hjalmarson A, Kruse E, Landfeldt B, Westin A: Effect of smoking reduction and cessation on cardiovascular risk factors. Nicotine Tob Res. 2001, 3 (3): 249-255.
Kerr S, Watson H, Tolson D, Lough M, Brown M: Smoking after the age of 65 years: a qualitative exploration of older current and former smokers’ views on smoking, stopping smoking, and smoking cessation resources and services. Health Soc Care Community. 2006, 14 (6): 572-582. 10.1111/j.1365-2524.2006.00659.x.
Cataldo JK, Bero LA, Malone RE: A delicate diplomatic situation”: tobacco industry efforts to gain control of the Framingham Study. J Clin Epidemiol. 2010, 63 (8): 841-853. 10.1016/j.jclinepi.2010.01.021.
Cataldo JK, Malone RE: False promises: the tobacco industry, “low tar” cigarettes, and older smokers. J Am Geriatr Soc. 2008, 56 (9): 1716-1723. 10.1111/j.1532-5415.2008.01850.x.
Etter JF, Bullen C: Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Addict. 2011, 106 (11): 2017-2028. 10.1111/j.1360-0443.2011.03505.x.
McMillen R, Maduka J, Winickoff J: Use of emerging tobacco products in the United States. J Environ Public Health. 2012, 2012: 989474.
Regan AK, Promoff G, Dube SR, Arrazola R: Electronic nicotine delivery systems: adult use and awareness of the ‘e-cigarette’ in the USA. Tob Control. 2013, 22 (1): 19-23. 10.1136/tobaccocontrol-2011-050044.
Al-Delaimy WK, Pierce JP, Messer K, White MM, Trinidad DR, Gilpin EA: The California Tobacco Control Program’s effect on adult smokers: (2) daily cigarette consumption levels. Tob Control. 2007, 16 (2): 91-95. 10.1136/tc.2006.017061.
Anderson SJ, Glantz SA, Ling PM: Emotions for sale: cigarette advertising and women’s psychosocial needs. Tob Control. 2005, 14 (2): 127-135. 10.1136/tc.2004.009076.
Sepe E, Ling PM, Glantz SA: Smooth moves: bar and nightclub tobacco promotions that target young adults. Am J Public Health. 2002, 92 (3): 414-419. 10.2105/AJPH.92.3.414.
Pierce JP: Tobacco industry marketing, population-based tobacco control, and smoking behavior. Am J Prev Med. 2007, 33 (Suppl 6): 327-334.
Apollonio DE, Malone RE: Marketing to the marginalised: tobacco industry targeting of the homeless and mentally ill. Tob Control. 2005, 14 (6): 409-415. 10.1136/tc.2005.011890.
Balbach ED, Gasior RJ, Barbeau EM: R.J. Reynolds’ targeting of African Americans. Am J Public Health. 2003, 93 (5): 822-827. 10.2105/AJPH.93.5.822. 1988-2000.
Fernandez S, Hickman N, Klonoff EA, Landrine H, Kashima K, Parekh B, Brouillard CR, Zolezzi M, Jensen JA, Weslowski Z: Cigarette advertising in magazines for Latinas, White women, and men, 1998–2002: a preliminary investigation. J Community Health. 2005, 30 (2): 141-151. 10.1007/s10900-004-1097-5.
Landrine H, Klonoff EA, Fernandez S, Hickman N, Kashima K, Parekh B, Thomas K, Brouillard CR, Zolezzi M, Jensen JA, Weslowski Z: Cigarette advertising in Black, Latino, and White magazines, 1998-2002: an exploratory investigation. Ethn Dis. 2005, 15 (1): 63-67.
Portugal C, Cruz TB, Espinoza L, Romero M, Baezconde Garbanati L: Countering tobacco industry sponsorship of Hispanic/Latino organizations through policy adoption: a case study. Health Promot Pract. 2004, 5 (Supple 3): 143-156.
Smith EA, Offen N, Malone RE: Pictures worth a thousand words: noncommercial tobacco content in the lesbian, gay, and bisexual press. J Health Commun. 2006, 11 (7): 635-649. 10.1080/10810730600934492.
Yerger VB, Malone RE: African American leadership groups: smoking with the enemy. Tob Control. 2002, 11 (4): 336-345. 10.1136/tc.11.4.336.
Yerger VB, Przewoznik J, Malone RE: Racialized geography, corporate activity, and health disparities: tobacco industry targeting of inner cities. J Health Care Poor Underserved. 2007, 18 (Suppl 4): 10-38.
Yerger VB, Daniel MR, Malone RE: Taking it to the streets: responses of African American young adults to internal tobacco industry documents. Nicotine Tob Res. 2005, 7 (1): 163-172. 10.1080/14622200412331328385.
Smith EA, Thomson K, Offen N, Malone RE: If you know you exist, it’s just marketing poison”: meanings of tobacco industry targeting in the lesbian, gay, bisexual, and transgender community. Am J Public Health. 2008, 98 (6): 996-1003. 10.2105/AJPH.2007.118174.
Schroeder S: Stranded in the periphery–the increasing marginalization of smokers. N Engl J Med. 2008, 358 (21): 2284-2286. 10.1056/NEJMe0802708.
International Federation of Social Workers: Ageing and older adults.
Al-Delaimy W, White M, Mills A, Pierce J, Emory K, Boman M, Smith J, Edland S: Final Summary Report of: Two Decades of the California Tobacco Control Program: California Tobacco Survey, 1990-2008. 2010, La Jolla: University of California, San Diego.
Morgan DL: The focus group guidebook. 1998, Thousand Oaks: Sage Publications.
Morgan DL: Focus groups as qualitative research. 1997, Thousand Oaks: Sage Publications.
Anderson SJ, McCandless PM, Taketa RM, Klausner K, Salgado MV, Butter K, Yerger VB: Tobacco documents research methodology. Tob Control. 2011, 20 (Suppl 2): 8-11.
Mackinnon SA: October 1976 (761000) NFO data - quitting/switching and smoker profiles. Edited by: Reynolds RJ. 1977, Bates No. 500736095/6097. [].
Smokers attitudes about health: Smokers attitudes about health. 1978, Bates No. 1185.04. [].
Holbert N: Marketing Research Department report [on] quitters. 1980, Philip Morris, Bates No. 1005122741/2744. [].
Schussel R: Summary of Marlboro ‘low tar’ in-depth interviews. 1980, Philip Morris, Bates No. 2048724140/4144. [].
An exploratory study -- mature smokers MRD 5549/587. 1987, Lorillard Tobacco Company, Bates No. 93376238/6267. [].
Segmented Marketing Services Inc (SMSi): The NOW brand recommended field marketing approaches for Americans aged 50+. 1991, RJ Reynolds Tobacco Company, Bates No. 507580701/0725. [].
Age Wave Inc: NOW cigarettes and the 50+ consumer preliminary “C-MES” Meeting. 1991, RJ Reynolds, Bates No. 508514646/4682. [].
Seniors Project. 1992, : Philip Morris USA, Bates No. 2060222688/2696. [].
Murray J: Carlton age profile. 1994, American Tobacco, Bates No. 970495393/5395. [].
Kane KB: Baby boomer analysis. 1995, Brown and Williamson, Bates No. 484010570/0580. [].
Carlton bond direct mail. : Brown and Williamson, Bates No. 634050714. [].
Chan C, Brykczynski K, Malone RE, Benner P: (Interpretive phenomenology in health care research. 2010, Indianapolis: Sigma Theta Tau International Press.
Benner P: Interpretive phenomenology: embodiment, caring, and ethics in health and illness. 1994, Thousand Oaks: Sage Publications.
Rabinow P, Sullivan WM: The interpretive turn: a second look. Interpretive social science: a second look. Edited by: Rabinow P, Sullivan WM. 1987, Berkeley: University of California Press, 1-30.
Jennings BL: Interpretive social science and policy analysis. Ethics, the social sciences, and policy analysis. Edited by: Callahan D, Jennings B. 1983, New York: Plenum Press, 3-35.
NVivo 8: QSR International. 2008, Melbourne, Australia: QS Research.
Hiscock R, Bauld L, Amos A, Fidler JA, Munafo M: Socioeconomic status and smoking: a review. Ann NY Acad Sci. 2012, 1248: 107-123. 10.1111/j.1749-6632.2011.06202.x.
Cataldo JK, Slaughter R, Jahan TM, Pongquan VL, Hwang WJ: Measuring stigma in people with lung cancer: psychometric testing of the cataldo lung cancer stigma scale. Oncol Nurs Forum. 2011, 38 (1): E46-54. 10.1188/11.ONF.E46-E54.
Else-Quest NM, LoConte NK, Schiller JH, Hyde JS: Perceived stigma, self-blame, and adjustment among lung, breast and prostate cancer patients. Psychol Health. 2009, 24 (8): 949-964. 10.1080/08870440802074664.
Halding AG, Heggdal K, Wahl A: Experiences of self-blame and stigmatisation for self-infliction among individuals living with COPD. Scand J Caring Sci. 2011, 25 (1): 100-107. 10.1111/j.1471-6712.2010.00796.x.
United States District Court for the District of Columbia, United States of America, Plaintiff, and Tobacco-Free Kids Fund, American Cancer Society, American Heart Association, American Lung Association, Americans for Nonsmokers’ Rights, and National African American Tobacco Prevention Network, Interveners U.S.v. Philip Morris USA, Inc: Defendants: Civil Action No. 99-CV-02496 (GK). US Dist Court Dist Columbia. 2006, 449: i-2454.
Family Smoking Prevention and Tobacco Control Act. Public Law No. 111-31, div. A, sec. 2(1), (2), (13)&(14), (6)-(7), 123 Stat. 1776, 1777. 2009.
Change Lab Solutions: Law & Policy innovation for the common good. What’s the status of the court challenges against the new graphic warning labels for cigarette packages. 2013, : , [].
Koh HK: U.S. Department of Health and Human Services. A steadfast commitment to end the tobacco epidemic.
Chapman S, Freeman B: Markers of the denormalisation of smoking and the tobacco industry. Tob Control. 2008, 17 (1): 25-31. 10.1136/tc.2007.021386.
Malone RE, Grundy Q, Bero LA: Tobacco industry denormalisation as a tobacco control intervention: a review. Tob Control. 2012, 21 (2): 162-170. 10.1136/tobaccocontrol-2011-050200.
Roeseler A, Burns D: The quarter that changed the world. Tob Control. 2010, 19 (Suppl 1): 3-15.
Consumers’ Preferences for Electronic Nicotine Delivery System Product Features: A Structured Content Analysis
Christine Kistler, Trisha Crutchfield, Erin Sutfin, Leah Ranney, Micah Berman, Gary Zarkin, Adam Goldstein
International Journal of Environmental Research and Public Health