Cited by 53Smoking Behavior and CessationGlobal Public Health Policies and EpidemiologyIndigenous Health, Education, and Rights

The DOI matches its Crossref record; 26 of the 27 references it cites were found in a registry or an index; none of the 95 sources its claims cite is checked for support yet.

Tobacco Industry Promotional Strategies Targeting American Indians/Alaska Natives and Exploiting Tribal Sovereignty

Open access
Lempert, Lauren K, Glantz, Stanton A·2019·Nicotine & Tobacco Research

Abstract

BACKGROUND: American Indians/Alaska Natives have the highest commercial tobacco use in the United States, resulting in higher tobacco-caused deaths and diseases than the general population. Some American Indians/Alaska Natives use commercial tobacco for ceremonial as well as recreational uses. Because federally recognized Tribal lands are sovereign, they are not subject to state cigarette taxes and smoke-free laws. This study analyzes tobacco industry promotional efforts specifically targeting American Indians/Alaska Natives and exploiting Tribal lands to understand appropriate policy responses in light of American Indians'/Alaska Natives' unique sovereign status and culture. METHODS: We analyzed previously secret tobacco industry documents available at the Truth Tobacco Documents Library (https://industrydocuments.library.ucsf.edu/tobacco/). RESULTS: Tobacco companies used promotional strategies targeting American Indians/Alaska Natives and exploiting Tribal lands that leveraged the federally recognized Tribes' unique sovereign status exempting them from state cigarette taxes and smoke-free laws, and exploited some Tribes' existing traditional uses of ceremonial tobacco and poverty. Tactics included price reductions, coupons, giveaways, gaming promotions, charitable contributions, and sponsorships. In addition, tobacco companies built alliances with Tribal leaders to help improve their corporate image, advance ineffective Youth Smoking Prevention programs, and defeat tobacco control policies. CONCLUSIONS: The industry's promotional tactics likely contribute to disparities in smoking prevalence and smoking-related diseases among American Indians//Alaska Natives. Proven policy interventions to address these disparities including tobacco price increases, cigarette taxes, comprehensive smoke-free laws, and industry denormalization campaigns to reduce smoking prevalence and smoking-related disease could be considered by Tribal communities. The sovereign status of federally recognized Tribes does not prevent them from adopting these measures. IMPLICATIONS: American Indians/Alaska Natives suffer disparities in smoking prevalence and smoking-related diseases as compared with other groups. The tobacco industry has used promotional tactics including price reductions, coupons and giveaways, casino and bingo promotions, charitable contributions and sponsorships, and so-called Youth Smoking Prevention (YSP) programs to specifically target American Indians/Alaska Natives and exploit Tribal sovereignty, which likely contribute to disparities in tobacco use and related diseases and deaths among this population. Tribal and public health policy makers should consider rejecting ineffective YSP programs and instead consider adopting proven policy interventions including tobacco price increases, cigarette and casino taxes, comprehensive smokefree laws, and anti-industry denormalization campaigns to reduce smoking and smoking-related disease.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This analysis of previously secret tobacco industry documents shows companies targeted American Indians/Alaska Natives with price reductions, coupons, casino and bingo promotions, contributions, sponsorships, and ineffective youth smoking prevention programs while exploiting Tribal sovereignty and ceremonial tobacco. It argues these tactics likely contribute to smoking disparities and that Tribes can adopt proven tobacco control policies despite sovereign status.

Key findings

  • American Indians/Alaska Natives had the highest tobacco use in the United States; in 2013, 40.1% reported current commercial tobacco use, including 56.7% of young adults aged 18–25 and 20.3% of youth aged 12–17.
  • Price reduction dominated industry promotion: it accounted for 96% of $8.9 billion in advertising and promotional spending in 2013, including $7.6 billion (85%) on price discounts. Examples included RJR’s 1986 Indian Reservation Program reducing some cigarettes to as low as $4.99 per carton and Lorillard offering $2–$5 coupons and discounts on reservations between 1995 and 2000.
  • Tribal stores sold disproportionate volume: 31 Tribal cigarette stores in Arizona accounted for “over 14%” of total industry volume in the state; 16 Tribal stores in New Mexico accounted for 13.4%; and eight American Indian stores in North and South Dakota accounted for 2.7%.
  • PM’s contributions to American Indian/Alaska Native organizations and causes rose to $564,800 in 1998, 9% of its $6.3 million total corporate contributions, despite American Indians/Alaska Natives being 1.5% of the US population. Its YSP ads were ineffective: for “Shawl Dancer,” only about half of 10- to 14-year-olds understood the basic “don’t smoke” message, <0.5% understood “smoking is not good for you,” 2% understood “smoking causes cancer,” and 3% understood “you can die from smoking/smoking can kill you”; for “I Stand Out,” only 30% of teens aged 15–17 understood the “not to smoke/don’t smoke” message, 2% understood “smoking causes cancer,” and <0.5% understood body-harm or death messages.

Methods

  • Qualitative analysis of previously secret tobacco industry documents available at the UCSF Truth Tobacco Documents Library, searched between April 2013 and September 2017 using standard snowball search techniques.
  • Searches began with broad terms such as Indian, American Indian, Native American, marketing, promotion, and advertising, then added terms including Alaska Native, American Indian/Alaska Native, Tribal promotion, Tribal marketing, and AI/AN Tribes; after initial review, ~500 documents merited closer review and 94 documents were used.
  • The paper states it used well-established tobacco industry documents research methods described in methods studies, with more details in Supplementary Material.

Limitations

  • Stated: because the research is based primarily on Truth Tobacco Industry Documents, there are gaps in information; many documents, especially industry marketing reports and correspondence with industry lawyers, are not viewable because they are marked “Confidential.”
  • Stated: although no direct link was found, the defeat of proposed Guilford County Board of Health smoke restrictions closely followed Lorillard’s support of the Guilford Native American Association’s pow-wows.
  • Evident: the document-based design cannot establish causal effects of industry promotions on smoking prevalence; the paper consistently says the tactics “likely contribute” to disparities rather than demonstrating causation.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1093/ntr/nty048

Cites

26 of 26 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

38 Sources not found · 14 Own interpretation · 11 No basis given · 8 Not checked yet · 7 Own result · 5 Check pending · 1 Own method

Verify all 11 references — free account

Show all 28 claims

  • It may state two separate claims as one. 40
  • Probably not a substantial claim. 24
56 of 56
  • The paper relies on this without support.

    Youth Smoking Prevention programs are ineffective.

    “advance ineffective Youth Smoking Prevention programs”
  • The paper relies on this without support.

    Tobacco price increases, cigarette taxes, comprehensive smoke-free laws, and industry denormalization campaigns are proven to reduce smoking prevalence and smoking-related disease.

    “Proven policy interventions to address these disparities including tobacco price increases, cigarette taxes, comprehensive smoke-free laws, and industry denormalization campaigns to reduce smoking prevalence and smoking-related disease”
  • The paper relies on this without support.

    The previously secret tobacco industry documents available at the Truth Tobacco Documents Library are authentic and representative of industry activities.

    “We analyzed previously secret tobacco industry documents available at the Truth Tobacco Documents Library”
  • The paper relies on this without support.

    Federally recognized Tribes are sovereign nations that are not subject to the tax, licensing, and health laws and regulation of the states where they are geographically located.

    “While there are 566 federally recognized Tribes in the Unites States and American Indian/Alaska Native communities are diverse, they are similar in that they are all sovereign nations that are not subject to the tax, licensing, and health laws and regulation of the states where they are geographically located.”
  • The paper relies on this without support.

    Tobacco is used for ceremonial purposes in many American Indian communities.

    “In addition, tobacco is used for ceremonial purposes in many American Indian communities.”
  • The paper relies on this without support.

    The Truth Tobacco Industry Documents are authentic and provide a reliable account of industry strategies.

    “Because this research is based primarily on the Truth Tobacco Industry Documents, there are gaps in information.”
6 of 6

Citations

Cites

Show all 27 references

Research works printed but not linked: 4

  1. Williams v. Lee, 358 U.S. 217 (1959)
  2. US National Cancer Institute, 2008, The Role of the Media in Promoting and Reducing Tobacco Use. Tobacco Control Monograph 19
  3. US National Cancer Institute, 2017, A Socioecological Approach to Addressing Tobacco-Related Health Disparities. National Cancer Institute Tobacco Control Monograph 22. NIH Publication No. 17-CA-8035A
  4. Washington Post, Babcock C, 1992, Philip Morris Donations Target Minority Groups, Internal Company Memos Indicate Strong Lobbying Against Tax and Anti-Smoking Bills

Cited by

Sorted by citations

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Metadata

Authors
Lempert, L. K., & Glantz, S. A.
Affiliations
University of California, San Francisco (US)
Corresponding author
Glantz, Stanton A
Venue
Nicotine & Tobacco Research
Published
2018-03-12
Volume
21
Issue
7
Pages
940-948
ISSN
  • 1462-2203 (ISSN-L)
  • 1469-994X
OpenAlex
W2789625769
Cited by
53
References
27
Citations by year
2026: 9 · 2025: 6 · 2024: 9 · 2023: 4 · 2022: 10 · 2021: 4 · 2020: 3 · 2019: 7 · 2018: 1
FWCI
3.50
Type
journal article
Language
en
Open access
Locations
  • Nicotine & Tobacco Research (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion)
Funders
  • National Cancer Institute (CA-087472, CA-061021)
  • National Institute on Drug Abuse (DA-043950)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Public Health Policies and Epidemiology
  • Social Sciences › Health › Indigenous Health, Education, and Rights
Keywords
tobacco industry promotion, American Indians and Alaska Natives, tribal sovereignty, tobacco control, cigarette taxes, smoking bans, tobacco price increases, smoking disparities
MeSH terms
Games, Recreational, Alaska Natives, Female, Humans, Indians, North American, Male, United States, Prevalence, Tobacco Industry, Tobacco Products

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