Bans on traditional tobacco advertising highlight the strongly promotional role of tobacco imagery in films and video programs. On World No-Tobacco Day 2005, less than a year after India implemented its universal ban on tobacco advertising, its Minister of Health and Family Welfare announced a ban on tobacco imagery in the nation’s films and broadcast programs.

Opposition, including from the Ministry of Information & Broadcasting, which quickly announced the proposed ban was unworkable and advocated entertainment industry self-regulation, succeeded in delaying limits for on-screen tobacco for more than a year despite NGO advocacy efforts.

Elements of a policy compromise disclosed in June 2006 risk undermining the Ministry of Health’s intention: permanently to reduce adolescent exposure to tobacco imagery of major benefit the tobacco industry, particularly as Philip Morris International enters the Indian market to expand the market for premium cigarettes and battle for share British American Tobacco’s Indian affiliate, ITC.

Recommendations for an effective policy in India’s constitutional and policy environment include:

• In place of the subjective terminology favored by the tobacco industry and its film industry proxies around the world, a categorical standard of zero tobacco imagery except for (a) portrayals of actual historical figures documented to have used tobacco and (b) the unambiguous depiction of the dire health consequences of tobacco use, with no brand display in any case;

• An independent review committee, with no conflicts of interest, mandated to safeguard the public health by transparently applying the policy standards to the relatively few media productions that propose to include tobacco imagery despite the new policy;

• Identical treatment for films imported from overseas and Indian films released before the policy, namely strong anti-tobacco spots vetted by experts in tobacco prevention showing before and after the film or program in any and all distribution channels;

• Public certification, under penalty of perjury, by credited producers of any Indian film or video program with tobacco imagery released after the policy and all imported films and video programs with tobacco imagery that no one associated with the production accepted any consideration to include tobacco.

Forty‐one US states and several countries compete for big‐budget Hollywood film projects by offering valuable public subsidies. In 2008, states offered an estimated total of $1.3 billion to motion picture producers. On average, individual states now cover 24 percent of production costs for commercial feature films.

Because an estimated 1.1 million current adolescent smokers in the US were recruited to smoke by tobacco imagery in films about 350,000 of whom will ultimately die from tobacco‐induced diseases, this report estimates the size of recent public subsidies for youth‐rated (G/PG/PG‐13) films with tobacco imagery. It explores making tobacco imagery a determinant factor in eligibility for public film subsidies so that these awards no longer work in contradiction to public health.

A survey of the 147 films released to US theaters in 2008, each among the top ten box office earners in at least one week, finds two‐thirds of US‐developed, youth-rated film projects with tobacco imagery were filmed in the US, a rate typical of all films released by US studios over the past decade. Filmed in a dozen states now offering subsidies, these 35 movies contributed 71 percent of the 11.4 billion tobacco impressions delivered to US theater audiences by youth‐rated films in 2008.

Based on this film sample and on film industry production cost data, states awarded an estimated $830 million in public subsidies to films with tobacco, including $500 million to youth‐rated films with tobacco. For comparison, the states budgeted $719 million for all tobacco control in 2009. More than half of states subsidizing films (22/41), including New York and California, spend or earmark more money for commercial film subsidies than for anti‐tobacco programs. An estimated 62 percent ($830 million/$1.3 billion) of state film subsidies go to smoking films.

Objective: The California tobacco control program enacted in 1988 has been associated with declines in smoking and heart disease mortality. Since smoking also causes lung cancer, we investigated whether the program was associated with a decline in lung and other cancer incidence. Methods: Age-adjusted incidence rates of lung and bladder cancer (which are caused by smoking) and prostate and brain cancer (which are not) in the San Francisco-Oakland (SFO) Surveillance Epidemiology End Results (SEER) registry and other eight SEER registries from 1975 to 1999 were fitted in multiple regression analyses accounting for the time lag between program implementation and its effects on cancer incidence. Cigarette consumption over time was also analyzed and related to lung cancer incidence. Results: With a one year lag, the incidence of lung cancer in SFO, relative to eight other SEER registries, fell significantly below that predicted from the pre-1990 rates, by -0.981 (cases/100,000/year)/year (p=0.001). With a three year lag, the incidence of bladder cancer fell by -0.234 (cases/100,000/year)/year (p = 0.066). No association of the program was observed on prostate or brain cancers in SFO. During the first decade, the Program was associated with about a 6% reduction in lung cancer incidence; state-wide that corresponds to about 11,000 cases avoided. Conclusion: A comprehensive tobacco control program is associated with a lower incidence of lung cancer.

Objective: To examine an industry funded and controlled study of in Right air quality (IFAQ). Methods: Systematic search of internal tobacco industry documents available on the internet and at the British American Tobacco Guildford Depository. Results: Individuals from several tobacco industry companies, led by Philip Morris, designed, funded, conducted, and controlled the presentation of results of a study of IFAQ for the Scandinavian airline SAS in 1988 while attempting to minimise the appearance of industry control. Industry lawyers and scientists deleted results unfavourable to the industry's position from the study before delivering it to the airline. The published version of the study further downplayed the results, particularly with regard to respirable suspended particulates. The study ignored the health implications of the results and instead promoted the industry position that ventilation could solve problems posed by secondhand smoke. Conclusions: Sponsoring IFAQ studies was one of several tactics the tobacco industry employed in attempts to reverse or delay implementation of in-flight smoking restrictions. As a result, airline patrons and employees, particularly flight attendants, continued to be exposed to pollution from secondhand smoke, especially particulates, which the industry's own consultants had noted exceeded international standards. This case adds to the growing body of evidence that scientific studies associated with the. tobacco industry cannot be taken at face value.

Objective: To describe how the transnational tobacco industry has collaborated with local Asian tobacco monopolies and companies to promote a scientific and regulatory agenda. Methods: Analysis of previously secret tobacco industry documents. Results: Transnational tobacco companies began aggressively entering the Asia market in the 1980s, and the current tobacco industry in Asia is a mix of transnational and local monopolies or private companies. Tobacco industry documents demonstrate that, in 1996, Philip Morris led an organisation of scientific representatives from different tobacco companies called the Asian Regional Tobacco Industry Science Team (ARTIST), whose membership grew to include monopolies from Korea, China, Thailand, and Taiwan and a company from Indonesia. ARTIST was initially a vehicle for PM's strategies against anticipated calls for global smoke-free areas from a World Health Organization secondhand smoke study. ARTIST evolved through 2001 into a forum to present scientific and regulatory issues faced primarily by Philip Morris and other transnational tobacco companies. Philip Morris' goal for the organisation became to reach the external scientific and public health community and relators in Asia. Conclusion: The Asian tobacco industry has changed from an environment of invasion by transnational tobacco companies to an environment of participation with Philip Morris' initiated activities. With this, participation, tobacco control efforts in Asia face new challenges as Philip Morris promotes and integrates its scientific and regulatory agenda into the local Asian tobacco industry. As the local Asian tobacco monopolies and companies can have direct links with their governments, future implementation tobacco control may be at odds with national priorities.

The tobacco industry is a major political and legal force in Florida through campaign contributions, public relations efforts, lobbying and litigation, which at least from the late 1970s, has had a centralized political organization in Florida that defends and promotes its political and economic interests at the local and state levels of government. Although the industry has operated in the open in some political campaigns, it has also operated quietly behind the scenes, often through front groups, in various other state and local political campaigns.

In Dade County in 1979, GASP of Miami ran a clean indoor air initiative without the active support of the local affiliates of the American Cancer Society, American Lung Association, and American Heart Association. Despite being outspent by the tobacco industry 90 to 1, GASP only lost by 820 votes. Had the health groups provided public and political support, the initiative may well have won, substantially increasing the momentum for clean indoor air ordinances in Florida and elsewhere.

Prior to 1985, there were numerous ongoing local efforts to pass and enact a wide variety of local clean indoor ordinances. These efforts subsided considerably after the passage of the preemption clause in the weak Florida Clean Indoor Air Act (FCIAA) of 1985 which, at first, was supported by the American Cancer Society, American Lung Association, and American Heart Association. Since the passage of FCIAA, the tobacco industry has been able to stop all efforts by the three health groups and sympathetic politicians to repeal the preemption clause.

After the passage of campaign contribution limit laws in 1991 in Florida, tobacco industry campaign contributions have been redirected away from individual candidates and to the two major political parties. In the 1993-1994 election cycle, the industry gave the largest amount of contributions with $475,000 given to the parties compared to $95,856 to political candidates. The largest contribution to a political party came from Philip Morris, which gave $382,500 to the Republican Party. These contributions in conjunction with others has reinvigorated the two major parties as political power brokers who provide their candidates with advertising, technical assistance, and paid staff.

During the 1997-1998 electoral cycle, the tobacco industry's total campaign contributions were $398,194, with $310,250 given to the two major political parties in comparison to $84,194 for legislators. The Republican Party received $227,250 compared to the Democratic Party which received $82,500. The largest contribution to a political party came from Philip Morris, which contributed $125,000 to the Republican Party.

In August 1997, Florida and the industry settled a Medicaid fraud lawsuit. Under the terms of the settlement, the industry agreed to pay Florida $11.3 billion, end outdoor billboards, pay for public anti-tobacco campaigns, remove vending machines from places accessible to children, end tobacco advertising on buses and trains, complete an anti-tobacco youth campaign within two years of the settlement, and not name the industry in anti-tobacco ads. Due to further negotiations with the industry, on September 11, 1998, the amount paid to Florida was increased to $13 billion and restrictions on the two year time limit regarding the youth anti-smoking campaign and specifically naming the industry in anti-tobacco advertisements were lifted.

After February 1998, Florida began an effort to establish a $200 million youth anti-smoking campaign called the Tobacco Pilot Program in an effort to meet the two year deadline. The Tobacco Pilot Program has engaged in an extensive media campaign known as the "Truth Campaign" which began in late April 1998 and included tough in-your-face print, billboard, and media advertisements which ran throughout Florida. The major theme of this campaign is that Florida youth should choose "Truth" rather than use tobacco and be targets of industry advertising manipulation in the use of tobacco.

A report released on March 17, 1999 by the Florida Department of Health, Office of Tobacco Control regarding the progress of the Tobacco Pilot Program indicated that the Tobacco Pilot Program and its anti-tobacco media advertising campaign, in less than a year, had a substantial impact on influencing a significant number of Florida teens not to smoke. From February 1998 to 1999, the number of teens who were current smokers (smoked in the last 30 days) dropped from 23.3% to 20.9%. This represented 31,000 fewer Florida teenagers who were current smokers. These results represent the best results ever obtained in a large scale primary prevention program.

Although new Republican Governor Jeb Bush publicly called for the continuation of the Tobacco Pilot Program and the Truth Campaign, the program's funding was reduced from $70.5 million to $45.2 million (-36%) for the 1999-2000 Fiscal Year due to legislative votes by Republican colleagues in the House and the Senate to substantially reduce the funding of the program. These cuts were made despite public opinion polls showing that 49% of the public supported the program without any cuts and 30% supported the program with the $8.5 million cut proposed by Governor Bush. Two projects of the Tobacco Pilot Program which are crucial to maintaining the viability of the program including the Truth Campaign and administrative support for the Students Working Against Tobacco (SWAT) also received large budgetary reductions.

While the Tobacco Pilot Program received substantial funding cuts in the 1999 Legislative Session, funding for the American Heart Association's Youth Fitness Program of $3 million and $1 million for the Just The Facts program which was derived from the $45.2 million Tobacco Pilot Program budget, would have reduced the amount of funding for projects directly oriented towards tobacco control efforts to $41.2 million for 1999-2000. On May 27, 1999, Governor Bush vetoed these two diversionary projects, as well as the $2.5 million Sports for Life project which was related to tobacco control, further reducing the program's funding of projects directly related to tobacco control efforts from $70.5 million to $38.7 million (-45.1%).

For the past twenty years, a consistent pattern has emerged with respect to the American Cancer Society, the American Heart Association, and the American Lung Association missing key political opportunities that would have significantly advanced anti-tobacco efforts and public health in Florida. These lost opportunities included failing to support GASP of Miami in its 1979 Dade County clean indoor air initiative, supporting the preemption clause in the Florida Clean Indoor Air Act of 1985 which essentially quashed a blossoming grassroots anti-tobacco movement, and failing to forcefully advocate for the Tobacco Pilot Program by holding specific legislators directly and publicly accountable for the substantial funding cuts that occurred in the 1999 Legislative Session.

References which constitute the “data” for the paper “Civil Society and the Negotiation of the Framework Convention on Tobacco Control” by H.M. Mamudu and S.A. Glantz, published in Global Public Health, that are cited with numbers in the paper.