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

• Published date: 01 September 2019
• Date: 01 September 2019
• DOI: http://doi.org/10.1002/wmh3.310

270

doi: 10.1002/wmh3.310

© 2019 Policy Studies Organization

Messaging and Advocacy in U.S. Tobacco Control Policy,

2009–19

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 anti‐tobacco 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 Tobacco‐Free 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

Introduction

Since the publication of the 1964 U.S. Surgeon General’s 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, media‐and school‐based 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 health‐care and lost

productivity costs that are attributable each year to cigarette smoking, as well as the

“epidemic”of 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

“blended”issue that exhibits public health, political economy, and morality di-

mensions depending on successful interest group framing. Taking Studlar’s 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 Tobacco‐Free

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 campaign’s 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 Studlar’s 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 industry’s conduct, its responsibility for tobacco‐related 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