The tobacco endgame concept reorients discussion away from the persistent control of tobacco toward plans for ending the tobacco epidemic, and envisions a tobacco-free future. A variety of policy approaches have been proposed, with many offered prior to the introduction of the unifying term ‘endgame’. We conducted a qualitative synthesis of the literature on tobacco control endgames, and drew on media accounts and discussion of analogous ideas for illustrative purposes. We identified proposals focused on the product, user, market/supply or larger institutional structures. Research on public support for these proposals was limited, but suggestive of some public appetite for endgame ideas. Advocates should be encouraged to explore new policy options and consider the goal of a tobacco-free future.

ABSTRACT. Objective: The purpose of this study was to investigate the preferred drinking contexts of different gender and ethnic groups (white, black, and Hispanic men and women), by examining where these groups do most of their drinking and to what extent drinking contexts preferences are associated with certain drinking-related consequences. Method: The study used data from the 1984, 1995, and 2005 U.S. National Alcohol Surveys. Among current drinkers, cluster analyses of volume drunk in six contexts (restaurants, bars, others' parties, or when spending a quiet evening at home, having friends drop over at home, and hanging out in public places) were used to classify individuals by their drinking context preferences in each gender by ethnicity subgroup. Results: We identifi ed three highly similar drinking context-preference clusters within each of the six subgroups: (1) bar-plus group (did most drinking in bars, plus much in other venues), (2) home group (did most drinking at home, and a fair amount elsewhere), and (3) light group (drank almost nothing quietly at home and also less in other settings than the other two clusters). For a number of ethnic-by-gender groups, context preference group assignment predicted drinking-related problems, over and above general drinking patterns. For example, for all groups, the bar-plus preference group relative to the light group showed higher risk of arguments, fi ghting, and drunk driving, after taking into account the volume consumed, frequency of heavy drinking, age, and year of survey. Conclusions: Examining individuals' preferred drinking contexts may provide important information to augment overall drinking patterns in risk and prevention studies. (J. Stud. Alcohol Drugs 70: [16][17][18][19][20][21][22][23][24][25][26] 2009) T HE RELATIONSHIP BETWEEN drinking patterns and alcohol-related problems is well established; that is, drinking more and in heavy quantities increases the likelihood of experiencing alcohol-related problems (Greenfi eld and Rogers, 1999;Heeb and Gmel, 2005;Treno et al., 2000;Wells et al., 2005). Drinking contexts also infl uence how much individuals drink. For example, most drinkers consume more alcohol in bars and at parties than at restaurants and in other settings (Clark, 1985;Searles et al., 1995). Similarly, a recent multilevel analysis by Kairouz and Greenfi eld (2007) showed that a large part of the variability in drinking relates to the context, whereas much stems from individual differences such as gender. Previous research on drinking contexts has focused on exploring frequency and amount of drinking in various settings rather than classifying people by where they do the most drinking (Clark, 1985;Harford, 1978;Treno et al., 2000). Researchers have explored what kinds of individuals go to given drinking contexts; for example, how often black, white, or Hispanic individuals visited particular settings, such as bars or street corners, and how often they drank in those settings (Clark, 1988;Caetano and Herd, 1988). Research by Herd ...

Objective:To analyse the implications of Philip Morris USA’s (PM’s) overtures toward tobacco control and other public health organisations, 1995–2006.Data sources:Internal PM documents made available through multi-state US attorneys general lawsuits and other cases, and newspaper sources.Methods:Documents were retrieved from several industry documents websites and analysed using a case study approach.Results:PM’s Project Sunrise, initiated in 1995 and proposed to continue through 2006, was a long-term plan to address tobacco industry delegitimisation and ensure the social acceptability of smoking and of the company itself. Project Sunrise laid out an explicit divide-and-conquer strategy against the tobacco control movement, proposing the establishment of relationships with PM-identified “moderate” tobacco control individuals and organisations and the marginalisation of others. PM planned to use “carefully orchestrated efforts” to exploit existing differences of opinion within tobacco control, weakening its opponents by working with them. PM also planned to thwart tobacco industry delegitimisation by repositioning itself as “responsible”. We present evidence that these plans were implemented.Conclusion:Sunrise exposes differences within the tobacco control movement that should be further discussed. The goal should not be consensus, but a better understanding of tensions within the movement. As the successes of the last 25 years embolden advocates to think beyond passage of the next clean indoor air policy or funding of the next cessation programme, movement philosophical differences may become more important. If tobacco control advocates are not ready to address them, Project Sunrise suggests that Philip Morris is ready to exploit them.

Background: The global tobacco epidemic claims 5 million lives each year, facilitated by the ability of transnational tobacco companies to delay or thwart meaningful tobacco control worldwide. A series of cross-company tobacco industry "issues management organizations" has played an important role in coordinating and implementing common strategies to defeat tobacco control efforts at international, national, and regional levels. This study examines the development and enumerates the activities of these organizations and explores the implications of continuing industry cooperation for global public health.

BackgroundIn California, some 40, 000 retailers sell tobacco products. Tobacco's ubiquitousness in retail settings normalizes use and cues smoking urges among former smokers and those attempting cessation. Thus, limiting the number of retailers is regarded as key to ending the tobacco epidemic. In the past decade, independent pharmacies and local grocery chains in California and elsewhere have voluntarily abandoned tobacco sales. No previous studies have examined the reasons for this emerging phenomenon. We sought to learn what motivated retailers to discontinue tobacco sales and what employees and customers thought about their decision.MethodsWe conducted case studies of seven California retailers (three grocery stores, four pharmacies) that had voluntarily ceased tobacco sales within the past 7 years. We interviewed owners, managers, and employees, conducted consumer focus groups, unobtrusively observed businesses and the surrounding environment, and examined any media coverage of each retailer's decision. We analyzed data using qualitative content analysis.ResultsFor independent pharmacies, the only reason given for the decision to end tobacco sales was that tobacco caused disease and death. Grocers listed health among several factors, including regulatory pressures and wanting to be seen as "making a difference." Media coverage of stores' new policies was limited, and only three retailers alerted customers. Management reported few or no customer complaints and supportive or indifferent employees. Pharmacy employees were pleased to no longer be selling a deadly product. Grocery store management saw the decision to end tobacco sales as enhancing the stores' image and consistent with their inventory of healthy foods. Focus group participants (smokers and nonsmokers) were largely unaware that retailers had stopped selling tobacco; however, almost all supported the decision, viewing it as promoting public health. Many said knowing this made them more likely to shop at the store. Most thought that advertising the store's policy was essential to generate good public relations and tobacco norm changes.ConclusionsVoluntary retailer abandonment of tobacco sales both reflects and extends social norm changes that have problematized tobacco in California. Our findings suggest that such voluntary initiatives by retailers are welcomed by consumers and should be publicized, enhancing public health efforts.

Objective:To investigate Philip Morris’s support of US Food and Drug Administration (FDA) regulation of tobacco products and analyse its relationship to the company’s image enhancement strategies.Data sources:Internal Philip Morris documents released as part of the Master Settlement Agreement.Methods:Searches of the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu) beginning with such terms as “FDA” and “regulatory strategy” and expanding to include relevant new terms.Results:Philip Morris’s support for government regulation of tobacco is part of a broader effort to address its negative public image, which has a damaging impact on the company’s stock price, political influence, and employee morale. Through regulation, the company seeks to enhance its legitimacy, redefine itself as socially responsible, and alter the litigation environment. Whereas health advocates frame tobacco use as a public health policy issue, Philip Morris’s regulatory efforts focus on framing tobacco use as an individual choice by informed adults to use a risky product. This framing allows Philip Morris to portray itself as a reasonable and responsible manufacturer and marketer of risky products.Conclusions:Philip Morris’s ability to improve its image through support of FDA regulation may undermine tobacco control efforts aimed at delegitimising the tobacco industry. It may also create the impression that Philip Morris’s products are being made safer and ultimately protect the company from litigation. While strong regulation of tobacco products and promotion remain critical public health goals, previous experiences with tobacco regulation show that caution may be warranted.

Background Cigarette butt litter is a potential target of tobacco control. In addition to its toxicity and non-biodegradability, it can justify environmental regulation and policies that raise the price of tobacco and further denormalize its use. This paper examines how the tobacco industry has managed the cigarette butt litter issue and how the issue has been covered in the media. Methods We searched the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu) using a snowball strategy. We analyzed data from approximately 700 documents, dated 1959–2006, using an interpretive approach. We also searched two newspaper databases, Lexis/Nexis and Newsbank, and found 406 relevant articles, dated 1982–2009 which we analyzed quantitatively and qualitatively. Results The tobacco industry monitored and developed strategies for dealing with the cigarette litter issue because it affected the social acceptability of smoking, created the potential for alliances between tobacco control and environmental advocates, and created a target for regulation. The industry developed anti-litter programs with Keep America Beautiful (KAB) and similar organizations. Media coverage focused on industry-acceptable solutions, such as volunteer clean-ups and installation of ashtrays; stories that mentioned KAB were also more frequently positive toward the tobacco industry. Among alternative approaches, clean outdoor air laws received the most media attention. Conclusions Cigarette litter, like secondhand smoke, is the result of smoker behavior and affects nonsmokers. The tobacco industry has tried and failed to mitigate the impact of cigarette litter. Tobacco control advocates should explore alliances with environmental groups and propose policy options that hold the industry accountable for cigarette waste.

Objective To determine the time course and prandial effects of short-term, medium-dose prednisone on 24-hour metabolic patterns under standardized conditions. Context Glucocorticoids (GCs) adversely affect glucose homoeostasis but 24-hour profiles of glucose, insulin, C-peptide and free fatty acids (FFAs) following short-term, medium-dose prednisone treatment in persons with varying degrees of glucose tolerance are not well defined. Design An open-label cross-sectional interventional study. Subjects Three groups were prospectively studied: persons with type 2 diabetes (T2DM) (n = 7), persons ‘at risk’ for T2DM (AR) (n = 8) and persons with normal glucose tolerance (NGT) (n = 5). Methods Before and after 3-day treatment with prednisone 20 mg each morning, subjects underwent 24-hour frequent blood sampling. Eucaloric mixed meals were provided at 0800 h, 1200 h and 1800 h. Insulin/glucose ratio provided an estimate of â-cell response to meal stimuli. Measurements Plasma glucose, insulin, C-peptide, haemoglobin A1c and FFA. Results Prednisone induced greater increases in glucose levels from midday (P = 0.001) to midnight (P = 0.02) in the T2DM than the AR and NGT groups. In contrast, insulin (P = 0.03) and C-peptide (P = 0.04) levels decreased postbreakfast in the T2DM group, whereas no changes in the morning but higher C-peptide levels (P = 0.03) from midday to midnight were observed in the AR group. In the T2DM group, insulin/glucose ratio decreased postbreakfast (P = 0.04) and increased postdinner (P = 0.03). Fasting glucose, insulin and C-peptide levels were unchanged in all groups, and FFA levels modestly increased postdinner (P = 0.03) in the NGT group. Conclusion Short-term, medium-dose prednisone treatment induces postprandial hyperglycaemia in T2DM and AR predominantly from midday to midnight because of suppression of insulin secretion followed by decreased insulin action that dissipates overnight. Effective treatment of prednisone-induced hyperglycaemia should target both rapid onset relative insulin deficiency and a less than 24-hour total duration of effect.