After 50 years of disappointing failures in a nationwide effort to reduce tobacco use to a rare occurrence, a more recent convergence of four significant factors contribute now to a ripening opportunity in which a crippling blow might be struck against the killer tobacco industry. These four factors include:

1. A broad awareness of the dramatically rising health care costs in a time of economic collapse.

2. A universal call for a redoubling of anti-tobacco advocacy efforts.

3. The most favorable, supportive anti-tobacco political climate to date.

4. Promising advances in the field of cognitive science relating to social change.

It appears vital to the eventual success of anti-killer tobacco efforts that this most advantageous moment yet in the history of the tobacco wars be recognized for the inspiring and liberating opportunity it presents.

The purpose of this paper is to clarify this opportunity and encourage the conscious reframing of anti-tobacco strategies sufficient to promote the translation to, and application of, scientific evidence in all public policy efforts including prevention and intervention programs, diagnostic approaches and remedy-seeking litigation.

1. Dramatically rising health care costs:

Smoking is a significant contributor to the rising costs of health care in the U.S. The Center for Disease Control and Prevention (CDC) reports:

“For every person who dies from tobacco use, another 20 suffer with at least one serious tobacco-related illness. Half of all long-term smokers die prematurely from smoking-related causes. In 2004, this addiction cost the nation more than $96 billion per year in direct medical expenses as well as more than $97 billion annually in lost productivity. Furthermore, exposure to secondhand smoke causes premature death and disease in non-smokers. In 2005 . . . exposure to secondhand smoke cost the United States $10 billion per year.”

2. A universal call for a redoubling of anti-tobacco advocacy efforts:

• From an article in the June 29, 2008 issue of the Washington Post: “Feds find a leveling off in teen use of tobacco.” This article by Rob Stein quotes dismayed federal health officials and anti-smoking advocates as fearing “that one of the nation’s most important public health priorities is faltering”

• Also in the June 29, 2008 Washington Post: “This is the most dramatic indication that the great progress we were making has stalled,” said Terry Pechacek of the Federal Center for Disease Control and Prevention.” He also stated “This has very negative long-term implications.”

• Also in the June 29, 2008 Washington Post: Mathew Myers of the campaign for Tobacco-free Kids, a Washington advocacy group, writes: “The lack of greater progress in recent years is a clear warning to elected officials to resist complacency and redouble efforts to reduce tobacco use.”

• An Associated Press story: “Bill: Put FDA over Tobacco” claims: “Despite decades of health warnings and smoking bans in most outdoor spaces, about one in five adults still smoke.” The article further explains that smoking-related illnesses “claim an estimated 440,000 lives a year, more than 10 times the number who die in traffic accidents.” According to WHO, these annual deaths in the U.S. amount to a cost of $180 billion per year.

3. The most favorable and supportive anti-tobacco political climate to date:

After decades of resistance congress has finally passed a bill giving the Federal Drug Administration (FDA) powers of regulation over the tobacco industry. The once mighty tobacco lobby has lost much of its former clout with congress, the passing of time and the growing mountain of scientific evidence against lethal tobacco having taken its toll. (See the May/June, 1996 edition of Mother Jones magazine for an in-depth expose’ documenting the tobacco lobby’s corrupting influence on the political process.)

4. Promising advances in the field of cognitive science and social change: The development of frame theory and the concept of reframing as social change are presented in this paper. As a tool for critical analysis of public discourse the application of frame theory proves effective in the development of insights that promise startling improvements in the design of effective, persuasive, motivating, anti-tobacco appeals.

Allan M. Brandt, in his book The Cigarette Century” (Basic Books, 2007) includes the following piece on Judge Keisler’s decision in the 1998 case United States v. Philip Morris:

“In August 2006, Judge Kessler issued her decision in the case, finding that the tobacco industry had violated the racketeering statutes. Although there had been other adverse decisions for the companies in litigation, the monumental scope of the Kessler decision, its precision and scope, was unprecedented. According to Judge Kessler, the industry had engaged in a fifty-year conspiracy, lying to the American public about their product and its dire consequences for health. ‘Put more colloquially and less legalistically,’ Judge Kessler explained in her 1,683 page opinion, ‘over the course of 50 years, defendants lied, misrepresented, and deceived the American public, including smokers and the young people they avidly sought as ‘replacement smokers,’ about the devastating health effects of smoking and environmental tobacco smoke.’ The companies ‘suppressed research, they destroyed documents, they manipulated the use of nicotine so as to increase and perpetuate addiction . . . and they abused the legal system in order to achieve their goal – to make money with little if any regard for individual illness or suffering, soaring health care costs, or the integrity of the legal ‘system’. Judge Kessler’s decision was a model of reasoned historical and legal analysis”.

In their study, “The tobacco settlement: an analysis of newspaper coverage of a national policy debate (Journal of nicotine and tobacco research) the authors, Lima and Siegel, sought to identify the tobacco control frames, and the dominant frame, appearing in 117 newspaper articles. They also sought to examine trends in tobacco control frames over time. In listing results, the authors note that “in no instance was the problem of tobacco seen as one of a deadly product.”

The following summary of the deadly consequences of tobacco use, globally and in the United States, comes from the President’s Cancer Panel 2006-2007 annual report: “Tobacco use caused an estimated 100 million deaths worldwide during the 20th century; most of these deaths occurred in developed countries where smoking became popular in the 1920’s through 1940’s. Tobacco use is the number one cause of preventable death in the United States. It now is the second leading cause of death in the world, causing four to five million deaths annually. It is estimated that if current tobacco use trends continue, by 2020 approximately 10 million tobacco-related deaths will occur each year, with more than a billion tobacco-related deaths in the 21st century.

“Cigarettes kill more than 400,000 Americans every year – more deaths than from AIDS, alcohol, car accidents, murders, suicides, drugs, and fires, combined. Half of all long-term smokers – particularly those who began smoking as teens – will eventually die prematurely from a disease caused by tobacco; half of these people will die in middle age, losing on average 20 – 25 years of life expectancy. More than 12 million premature deaths attributable to smoking have occurred in the United States since publication of the first U.S. Surgeon General’s report on smoking and health in 1964. Of these, 4.1 million have been due to cancer.”

The CDC’s publication, “Best Practices for Comprehensive Tobacco Control Programs – 2007″, presents the following day by day, statistical breakdown:

Each day in the United States:

• The tobacco industry spends nearly $36 million to market and promote its products.

• Almost 4,000 adolescents start smoking.

• Approximately 1,200 current and former smokers die prematurely from tobacco-related diseases.

• The nation spends more than $260 million in direct medical costs related to smoking.

• The nation experiences nearly $270 million in lost productivity due to premature deaths from tobacco-related diseases.

The 2008 World Health Organization Report on the Global Tobacco Epidemic includes the following findings:

“The biggest killer in the world, tobacco was responsible for 5.4 million deaths per year – 70 per cent of them in developing countries – and could kill one billion people in the twenty-first century unless governments act now to dramatically reduce consumption.”

On 30 May 2011, the World Health Organization reported: “This year, the tobacco epidemic will kill nearly 6 million people, including some 600,000 nonsmokers who will die from exposure to tobacco smoke. By 2030, it could kill 8 million.”

This paper seeks to answer the call for a redoubling of efforts to reduce tobacco use. This paper presents a three-part critical analysis of the public discourse surrounding the anti-tobacco advocacy with the aim of determining where the called-for redoubling of efforts might best focus. The two objectives of this critical analysis are as follows:

1. To reveal through critical analysis those specific message design elements which currently fail to effectively convey to the public with sufficient impact the motivating anti-tobacco evidence provided by science.

2. To identify those persuasive message design elements anchored in science most likely to improve prevention rates and motivate increased cessation efforts among whole populations.

Exhaustive scientific investigation over the past 50 years has produced irrefutable evidence correctly identifying tobacco smoke as poisonous, addictive, diseasing and lethal (President’s Cancer Panel 2006-2007).

1. Tobacco smoke is poisonous.

Cigarette smoke contains approximately 4,000 chemicals (e.g., cyanide, formaldehyde, benzene, arsenic, DDT, methanol, acetylene, ammonia), including 69 known carcinogens as well as poisonous gases including nitrogen oxide and carbon monoxide.

2. Tobacco smoke is addictive.

“We have irrefutable evidence on the addictiveness of tobacco and the lethal and detrimental health effects of tobacco use and smoke exposure. Nicotine in tobacco causes addiction, and the pharmacologic and behavioral processes that determine nicotine addiction are similar to those that determine addiction to drugs such as cocaine and heroin. Nicotine stimulates brain reward.”

3. Tobacco smoke is diseasing.

Tobacco use has been established unequivocally as a causative or contributory agent in the development of a growing list of cancers. At least 30 percent of cancer deaths and 87 percent of lung cancer deaths are attributable to smoking. The risk of developing cancer is about 23 times higher in male smokers and 13 times higher in female smokers compared with lifelong nonsmokers. The disparity in lung cancer risk between male and female smokers largely reflects differences in smoking patterns.

Overall five-year lung cancer survival (all stages combined) is 16 percent. This rate has improved by only three percent since 1970. In addition to the cancer mortality and morbidity associated with tobacco use, smoking is a major cause of heart and cerebrovascular disease, chronic bronchitis and emphysema; it also is associated with gastric ulcers.”

4. Tobacco smoke is lethal.

Tobacco use caused an estimated 100 million deaths worldwide during the 20th century. Tobacco use is the number one cause of preventable death in the United States. It is now the second leading cause of death in the world. More than 12 million premature deaths attributable to smoking have occurred in the United States since publication of the first U.S. Surgeon General’s Report on smoking and health in 1964.

Habermas – Communicative Competency Theory

The first part of this three-part critical analysis develops and applies Jurgen Habermas’ communicative competency theory. This piece of the analysis was initially developed in 1989 as part of my masters’ project and was subsequently included in a paper, “Arsenic and Old Language,” and presented to the 1990 International Communication Association Conference, Trinity College; Dublin, Ireland.

 

Lakoff – Frame Theory

The second piece of the analysis applies George Lakoff’s approach to frame theory and was developed in 2008 as an update confirming and expanding on Habermas’ earlier use of frame theory as an effective analytical instrument within his overarching theory of social change.

 

Chapman – Argument for Use of Scare Tactics

The third piece of the analysis is a brief analytical exploration of Simon Chapman’s argument validating the use of “scare” tactics in anti-tobacco campaigns. This exploration of Chapman’s impressive work seeks to document the current movement within tobacco control circles using frame theory in an effort to improve the motivational quality of its anti-smoking persuasive appeals. Chapman’s work on promoting the use of scare tactics is presented in his book, Public Health Advocacy and Tobacco Control, and serves to foreshadow the universal reframing of the public discourse surrounding the anti-tobacco advocacy which is proposed in the discussion section of this paper.