Messaging and Advocacy in U.S. Tobacco Control Policy, 2009–19

Published date01 September 2019
Date01 September 2019
doi: 10.1002/wmh3.310
© 2019 Policy Studies Organization
Messaging and Advocacy in U.S. Tobacco Control Policy,
Kathleen Ferraiolo
Social science and public health researchers have spent decades investigating the effectiveness of
various interventions designed to lower smoking rates and educate the U.S. public about the damages
of tobacco consumption. This manuscript addresses two deficiencies in the existing literature. First, it
examines important changes in tobacco control policy since the passage of the 2009 Family Smoking
Prevention and Tobacco Control Act, the most significant antismoking legislation in decades. Second,
it analyzes the ways in which governmental and nongovernmental antitobacco advocates have framed
their arguments. Using a seminal article by Donley Studlar (2008)as its point of departure, this paper
employs data from annual reports, press releases, and advertising campaigns to explore the similarities
and differences in the antismoking strategies and messaging of two government agencies (the Food
and Drug Administration and the Centers for Disease Control and Prevention)and two advocacy
groups (the Truth Initiative and the Campaign for TobaccoFree Kids)from 2009 to 2019. The
analysis reveals an ongoing tension between themes of industry denormalization (which generates
arguments grounded in morality)and harm reduction (which generates a more regulatory approach to
policymaking)in modern tobacco control policy.
KEY WORDS: tobacco control, tobacco policy, denormalization, harm reduction
Since the publication of the 1964 U.S. Surgeon Generals report that definitively
linked smoking to illness and death, antismoking advocates have worked tirelessly
to lower smoking rates and educate the American public about the dangers of
tobacco consumption. Through a variety of strategies including labeling require-
ments, tax increases, smoking restrictions, mediaand schoolbased educational
campaigns, and litigation, tobacco control advocates helped bring about dramatic
reductions in smoking rates and a broader denormalization (Studlar, 2008)of the
tobacco industry. In 2016, 15.5 percent of U.S. adults were current smokers, down
from 20.9 percent in 2005 and a high of over 40 percent in 1965, and youth smoking
rates have experienced similar declines (Centers for Disease Control and Pre-
vention [CDC], n.d.a). Efforts by antismoking groups have clearly been successful
in reducing smoking rates over time. However, public health advocates still lament
the 480,000 preventable deaths and the $300 billion direct healthcare and lost
productivity costs that are attributable each year to cigarette smoking, as well as the
epidemicof youth electronic nicotine delivery system (ENDS)use that threatens
to undo decades of progress by antismoking advocates (Gottlieb, 2017).
In an article that investigates the framing of tobacco control policy from the late
nineteenth century until 2008, Studlar (2008)argues that tobacco control is a
blendedissue that exhibits public health, political economy, and morality di-
mensions depending on successful interest group framing. Taking Studlars con-
tribution as a point of departure, this article has two primary goals. First, it ana-
lyzes key developments in U.S. tobacco control policy since 2009, a year that
witnessed the passage of the most significant antismoking legislation in decades.
Second, it examines the strategies and content of antitobacco advocacy on the part
of two government agencies (the Food and Drug Administration and the Centers
for Disease Control)and two advocacy groups (the Campaign for TobaccoFree
Kids and the Truth Initiative)from 2009 to 2018.
Studlar (2008)concludes by questioning whether the next era of tobacco control
will feature a focus on neoprohibitionism or harm reduction. This article utilizes
annual reports, fact sheets, press releases, policy papers, advertising and social
media campaigns, and other resources to evaluate the content of modern anti-
tobacco advocacy. In the case of the Truth Initiative, the article relies on annual
reports from 2010 to 2017 and the campaigns online Vault resource, which contains
links to 50 articles, 220 facts, 10 videos, and a variety of other resources, to evaluate
its approach to antitobacco advocacy. Consistent with some of Studlars pre-
dictions, the results show that government agencies have moved in a harm re-
duction direction that is more regulatory in nature, while nongovernmental groups
continue to use the language of denormalization and morality. Much of the re-
search in the field of tobacco control focuses on the effectiveness of various cam-
paigns and strategies for disparate groups and populations. This study looks in-
stead at the content of the messaging itself, situating antitobacco campaigns within
the relevant policy environment, evaluating similarities and differences between
those campaigns, and assessing the implications for current and future tobacco
control policy. The study begins by briefly reviewing the literature on industry
denormalization and harm reduction.
Industry Denormalization and Harm Reduction in Tobacco Control Policy
Lavack (1999, p. 82)defines tobacco denormalization as all the programs and
actions undertaken to reinforce the fact that tobacco use is not a mainstream or
normal activity in our society.In his seminal article, Studlar (2008)traces the
history of denormalization from the 1950s and 1960s (when he argues tobacco as a
product and smoking as a behavior started to be denormalized)through the 1980s
(when industry denormalization began, which typically takes the form of criticisms
of the tobacco industrys conduct, its responsibility for tobaccorelated death and
disease, and its manipulative or unethical tactics).Social denormalization strat-
egies,on the other hand, include limiting where smoking may take place, how
tobacco products may be sold and advertised, and informing the public about the
dangers of secondhand smoke through media campaigns(Bell, Salmon, Bowers,
Ferraiolo: Messaging and Advocacy in U.S. Tobacco Control Policy 271

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