Abstract
Objective
To investigate the role of the tobacco industry in marketing to and sustaining tobacco addiction among older smokers and aging Baby Boomers.
Methods
Archival searches of electronic archives of internal tobacco company documents using a snowball sampling approach. Analysis utilizing iterative and comparative review of documents, classification by themes, and a hermeneutic interpretive approach to develop a case study.
Results
Based on extensive marketing research, tobacco companies aggressively targeted older smokers and sought to prevent them from quitting. Innovative marketing approaches were used. “Low tar” cigarettes were developed in response to the health concerns of older smokers, despite industry knowledge that such products had no health advantage and did not help smokers quit.
Conclusion
Tobacco industry activities influence the context of cessation for older smokers in several ways. Through marketing “low-tar” or “light” cigarettes to older smokers at risk at quitting, the industry contributes to the illusion that such cigarettes are safer; however, “light” cigarettes may actually make it harder for addicted smokers to quit. Through targeted mailings of coupons and incentives, the industry discourages older smokers from quitting. Through rhetoric aimed at convincing addicted smokers that they alone are responsible for their smoking, the industry contributes to self-blame, a documented barrier to cessation. Educating practitioners, older smokers and families about the tobacco industry’s influence may decrease the tendency to “blame the victim,” thereby enhancing the likelihood of tobacco addiction treatment for older adults. Comprehensive tobacco control measures must include a focus on older smokers.
Keywords: Older Smokers, Tobacco Industry, Marketing Cigarettes, Smoking Cessation, Tobacco Control
In 2004, 3.7 million people aged 65 or older were smokers 1 and 16% of all people 50 or older smoked 2 . Older smokers (> 50 years old) are less likely than younger smokers to believe illness is a consequence of smoking 3, 4, are more likely to blame themselves for their smoking behaviors 5–7, and are less likely to be treated for tobacco use. 8–10 These factors may stem from common myths: that smoking is a choice (rather than an addiction) 11, that “low tar” cigarettes (used by more older smokers than younger smokers) are “less harmful” 12, 13, and that quitting at older ages is futile or even harmful. 14, 15
Research shows that tobacco industry activity affects the contexts of tobacco use among many marginalized and vulnerable groups, including African Americans 16, Asian Americans 17, Latinos 18, gays and lesbians 19, and homeless and mentally ill persons. 20 Numerous studies have described industry activity targeting youth and young adults 21, 22, but no previous studies have explored the tobacco industry’s activities related to older people. This paper describes the role of the tobacco industry’s targeting of older smokers and aging Baby Boomers, and considers its implications for health practitioners working with seniors.
Background
By 2030, older adults will account for roughly 21% of the U.S. population. 23 Tobacco-related diseases are the leading causes of death in older adults. 23 In 2004, smoking rates among those aged 50 and older were highest for African Americans at 19.8%. 2 Older smokers tend to be non-white and socially disadvantaged. 24 However, older smokers are often ignored in discussions of the marginalized groups most impacted by tobacco.
There are differences between younger and older smokers. Older smokers are the major consumers of “low tar” cigarettes (though lung cancer risk is no different in smokers of “light” or “low tar” cigarettes than in those who smoke “full flavor” brands). 25 They are more likely than younger smokers to succeed at smoking cessation and less likely to relapse.26, 27 Smoking cessation is beneficial, even in the frail elderly, decreasing cancer, cardiovascular disease, overall morbidity and mortality, and increasing quality of life. 3, 28, 29
Numerous factors are relevant to the context of cessation for smokers of any age, including interpersonal characteristics and dynamics 30, social and policy contexts 31, access (or lack thereof) to cessation resources 32, and the support of health care providers. 33–35 However, the activities of the tobacco industry are rarely discussed.
Methods
Between September 2006 –August 2007, we searched previously undisclosed tobacco industry documents, made public as a result of the Minnesota Tobacco Settlement and other cases. 36 We conducted iterative searches of the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu/), an online archive of more than 7 million documents. Using a snowball sampling approach 37, we expanded our search from keywords “senior”, “mature smoker”, and “baby boomer” to other terms identified in reviewed documents. We used EndNote software for data management. Initial searches produced 15,728 documents. After screening documents based on index entries, we identified 2270 to review. After eliminating duplicates and documents found irrelevant to the focus of our study, we analyzed 977 relevant documents (table 1), cited here representatively rather than exhaustively . As an example, the “ Mature NOT Tobacco AND Market” search in table 1 was developed based on the following: We used the term “mature” because we found in previous searches that it was commonly used by the tobacco industry for smokers 50 years old and older. To focus the search, we included a “NOT” statement for “tobacco,” because the industry often referred to tobacco crops as “mature tobacco” and these documents were irrelevant to our inquiry. To narrow the search further, we used “AND market” in order to capture documents relevant to the mature market. Documents we located in this manner that were relevant to our topic also frequently contained information we could use to conduct more refined searches, such as the names of mature market analyses and projects, the names of file folders or box numbers, and the names of individuals involved in mature market projects. More detailed information on search strategies has been previously published 36.
Table 1.
Search Terms | Number of Document”Hits” Retrieved |
Documents Reviewed For Relevance and/or Duplication |
Relevant Documents |
---|---|---|---|
Seniors NOT School | 3,402 | 200 | 47 |
“Senior Smokers” NOT School NOT college |
8 | 8 | 8 |
“Senior Citizens” AND Smok* NOT Anti-Smoking |
2,246 | 110 | 29 |
Mature NOT Tobacco AND Market |
5,306 | 80 | 97 |
“Mature Market” AND “Focus Group” |
190 | 209 | 83 |
“Mature Market” AND Psychographic |
60 | 60 | 29 |
“Older Cohort” AND Market |
80 | 80 | 37 |
“50+” AND “Market Research” AND Mature NOT Tobacco |
587 | 289 | 90 |
“50+ Segment” | 339 | 176 | 78 |
“Baby Boomer” | 633 | 201 | 66 |
“Baby Boomer” AND Quitting |
70 | 70 | 67 |
“Baby Boomer” AND Market |
479 | 93 | 59 |
“Baby Boomer” AND Aging |
227 | 89 | 18 |
Boomer AND Graying | 25 | 25 | 12 |
“Quitting Propensity” AND Age |
12 | 12 | 10 |
Quitting AND “Senior Citizen” |
142 | 142 | 51 |
“Mature Market” and Low- tar AND Target |
601 | 114 | 63 |
Low-tar AND “older smoker” |
1,017 | 319 | 94 |
Low-tar AND “older smoker” AND understand |
272 | 81 | 27 |
Lite AND “older smoker” AND understand |
32 | 32 | 12 |
Total | 15,728 | 2,270 | 979 |
We analyzed the documents using a hermeneutic interpretive approach 38, 39 This involved iteratively reviewing documents, comparing them with others across time and across companies, and attempting to appraise the meaning of the material within the context of the time and place in which it was produced. We then assembled the analysis into a thematically organized case study. 40
Results
Mature Smokers and Aging Baby Boomers
As sophisticated marketing research developed during the last part of the twentieth century, the tobacco industry closely tracked economic and social changes within the mature market segment. 41 Older cohorts (born before 1945) grew up when "the act of smoking was highly socially acceptable and these values don’t die easily [sic]”. 42 However, Baby Boomers (born between 1946 and 1964), the largest demographic cohort in U.S. history, were different from their predecessors. Three decades ago, the tobacco industry saw Baby Boomers as holding “tremendous potential for product purchases”. 43 A 1978 Lorillard Tobacco Company market research presentation suggested:
“the age group all but ignored by marketers is now gaining recognition through their growing numbers: those 65 and over …We must … fulfill the needs and tastes of the swelling Baby Boomer and senior citizen segments of the population” .44
Psychographic analysis (which focuses on lifestyle rather than demographic information) and cohort analysis (which focuses on age periods that include social and cultural change) were used by all major tobacco companies to understand how the Boomer segment differed from previous cohorts of mature smokers and what that meant for the future. 45–51 Research suggested that Boomers were likely to respond to messages that encouraged independence and individuality. 52
In 1984, RJ Reynolds Tobacco Company (RJR) marketing consultants anticipated that the future “great majority of growth” would come from Boomers moving into Sun Belt states. 53 By 1991, a market report prepared for RJR crowed: “‘opportunity’ is the word that describes the mature market”. 49 Philip Morris was also interested in the mature market. PM’s 1988 PM “Five Year Plan” noted that despite the company’s “dominant share among young adult smokers,” a priority was “retaining older smokers”. 54 In 1992, PM launched the “Philip Morris USA Seniors Project” to:
“Generate …volume by attracting and converting competitive senior (55+) smokers to a PM premium brand… Learning gained from targeting 55+ smokers will better enable PM to retain its young smokers who are aging”. 55
By the mid 1990’s, the importance of the aging market was well established. According to a Brown and Williamson (B&W) tobacco company memo, “smoking incidence [was] higher among Baby boomers (27.6%) than the general population group (23.5%)”. 52 A 1997 B&W “Cohort Analysis” suggested: “…We can expect to see the effects of this peak continue to move with the cohort over the next twenty years…” 51
“Low-Tar” and the Mature Market
Consumers of “low-tar” cigarettes were predominantly older smokers. Older smokers, with more years of smoking, began “to take health issues more seriously” 56 and buy low-tar. 47, 56–58 Smokers 50 years or older (50+) were more likely than younger groups to smoke an “ultra low tar” cigarette (ULT). 58–61 A qualitative study of attitudes toward low tar conducted for B&W found:
The only smokers who could be considered to have finally and unequivocally rejected Low Tar cigarettes were all younger…. At this age the idea of death or serious illness seemed unreal… But these smokers would age and would quite soon reach the stage in life when the health issue began to provoke anxiety… eventually all non Low Tar smokers were potential candidates for the type of Low Tar brand which could promise smoking enjoyment as well as the supposed health advantage”. 59
The tobacco industry developed numerous filtered cigarettes and “low-tar” options, competing intensely for the older low-tar market. In 1979, for example, RJR noted that competitor Lorillard was the only company with the majority of its business in low-tar (80%), and thus enviably positioned for future growth. “The major improvement in Lorillard’s position,” RJR noted, “seems to have come from older smokers”. 60 RJR responded by promoting its own low tar brand: “…advertising will emphasize that Doral [low tar brand]was designed for and delivers to the unique wants and taste of the mature, 50+ smoker”.61
Lorillard sought to “target the 50+ segment” to sustain sales and “reduce switching” to other brands. 62 The company sought to be “well positioned” to profit from Baby Boomer and Mature markets. 63 American Tobacco Company (AT) likewise suggested in 1994 that the company “ride the trend and capitalize on the Graying of America,” arguing:
“…they’re entering the Carlton Zone…As the Boomers age, they will want to reduce their tar level. CARLTON [an ULT brand] needs to be firmly positioned, well supported and visible when they ‘awaken’. All our resources should be concentrated against the "Graying Boomer". 64
Qualitative research conducted for RJR in 1980 had showed that the ULT market was older and divided into two major sub-segments based on motivation to smoke ULT cigarettes: “Get Off My Back” and the “Dieters.” The “Get Off My Back” group smoked ULT “against their will,” having switched to ULT “because of strong pressure from friends and families”. “Dieters” were described as “smoking in much the same way the overweight person would approach dieting…they have a desire to reduce the tar level of their cigarette” 65. Although older smokers were “loyal” heavy smokers, 48 besides price, “the one thing capable of dislodging mature smokers from their current brand choice [was] tar related issues…” 66
Research showed that older smokers often felt guilty about smoking 47, 67. Tobacco companies sought to learn more about how to reassure them. Lorillard’s 1987 focus groups with mature smokers found that “smoking a lower tar brand makes them ‘feel less guilty’”. 47 A confidential RJR report, “US Cigarette Market in the 1990’s,” identified “social guilt” as an important “personal concern” of older smokers. The “social guilt age profile” skewed 35+ and was concentrated in age 50+ smokers.67 The report highlighted the importance of addressing “beleaguered” smokers’ concerns:
“…personal concerns will continue to be important as Baby Bubble smokers reach the ages where these concerns are relevant…marketing to the ‘90’s smoker will differ substantially from the past…brand postings must tap into values and mindsets consistent with a more beleaguered smoker”. 67
Another 1990 RJR report suggested reaching older smokers by “help[ing] smokers relieve guilt [about their smoking]” by “reward[ing] them for choosing NOW [low-tar cigarette]”. 68
Choosing “low-tar” without understanding “low-tar”
Older smokers’ switch to “low tar” and “ultra” low tar cigarettes occurred across several decades. While mature smokers were not highly motivated by cigarette advertising, they noticed ads “featuring low-tar or ‘light’ claims, or advertising comparing brands on those factors”. 47 In a Lorillard survey of older smokers, brand switching was related to “interest in tar reduction”. 47 Survey participants considered “the best thing” about their current brand to be its “perceived tar count”. 47
However, it became clear that “the target” [mature smokers] did not understand tar levels and believed that all ULTs were basically similar. 65 In 1987, Lorillard mature smoker focus groups found that:
“…even though the term, ‘low tar’ is being used…almost none of the respondents know the specific tar count of the brands they smoke or of those they try… they ‘go by’ designations on the package …such as ‘low tar’ or ‘light’. 47
Discouraging Quitting Among Older Smokers
Quitting was a major concern for the tobacco industry, and cessation trends were closely watched. RJR’s 1989 study of “Quitting Rates by Age” confirmed that quitting increased steadily with age, and was highest among those aged 50 and older. 69
Switching to “low tar” cigarettes was not, however, a route to quitting, as a 1970s RJR report discussing low tar brands in relation to the demographic groups most at risk of quitting indicated:
“NOW and Carlton are not encouraging smokers to quit at an accelerated rate. There are no differences in quitting rates between ultra low "tar" brands and other low "tar" brands”. 70
PM found in 1980 that smokers of “low tar” brands quit less than other smokers:
“Low-tar smokers (and Ultra-lows) say they’ll quit more than smokers in general, but actually they quit less, especially Ultra-lows”. 71(emphasis in original)
A B&W study found that “ultra [low tar] smokers appear to go through a cycle of switching in, quitting and restarting”. 72 PM found in 1989 that “low tar” smokers attempted cessation more frequently, but ULT smokers were less likely to have tried to quit in the last year. 73
These findings may have been related to the industry’s nicotine manipulation, which has been discussed in other work. While nicotine and tar usually track together, a Food and Drug Administration analysis found that between 1982 and 1991, average tar levels in cigarettes fell steadily, while there was about a 10–15% increase in the average nicotine content of cigarettes. 74 There is considerable evidence that the industry increased/enhanced the nicotine in “low-tar” cigarettes in order to make quitting more difficult. 75
Tobacco companies developed strategies to identify older smokers most vulnerable to quitting. AT used direct mail surveys to target “very old, quitting prone smokers”. 76 RJR developed “a mailing list of smokers who could be identified by age as likely to quit smoking….” A 1990 AT “inswitch and outswitch study” related to Carlton emphasized the “critical need to keep ‘pump priming’ (adding new switchers)…and “retard exit defection [preventing out-switchers or quitters]”. 77
Marketing to Mature Smokers
In order to stem the “quitter trend,” 78 companies envisioned both new products and innovative marketing tactics. Although the most significant product developed for the aging market was “low-tar” cigarettes, all major tobacco companies planned and developed products and specific marketing strategies for older smokers.
Product Development
Product development emphasized issues regarded as important to mature smokers, such as health concerns (low-tar and nicotine products); taste enhancement (flavored cigarettes 79, 80); and social concerns (mouth freshener 79, smokeless 79). Flavored cigarettes, widely perceived as developed primarily for targeting youth 81, were also an industry response to the issue of impaired taste in aging smokers 79, 80. In 1990, PM called for flavor-enhanced products because of “Baby Boomer's [sic] search for variety and new sensations”. 80
Marketing Strategies
The tobacco industry focused marketing messages to older smokers not only in their homes, but wherever they went. Companies used mailing lists for direct mail couponing, geographically-targeted advertising, and sponsorships and sampling.
Direct Mail - Mailing Lists and Coupons
Tobacco companies developed mailing lists of older smokers in several ways: purchasing names from professional companies that sold demographically targeted mailing lists, obtaining lists from cooperating organizations, and building their own. 82, 83 Mailing coupons to older smokers who might be thinking of switching or quitting both discouraged this behavior and gave the companies additional information that could be used for future marketing. Mature smokers liked and used cigarette coupons. 47, 85–88 In 1990 AT developed the “Pall Mall Seniors Program” to:
“gather as many names as possible of Pall Mall Smokers, aged 50+ for use in an on-going direct mail retention program… Those joining the seniors program will receive $5.00 in carton or pack coupons every other month via the direct mail smoker retention program”. 83
Carlton’s target audience was older smokers 84, who likewise constituted the biggest proportion of brand consumers 85–89. In 1978 23% of Carlton smokers were 50+ 89; this rose by 1996 to 57.1% 88. The Carlton Direct Program provided important individual household-level information: “For each household, we’ll be able to measure not only the presence of a coupon redeemer, but also the number and value of coupons redeemed by that household [emphasis in original]”. 90
The Carlton Bond Direct Mail Program urged smokers to collect UPC’s (points on cartons) to earn a $50 bond. Program planners claimed: “In essence we have locked up our smokers for a full 8–10 weeks”. Those identified as most likely to quit or switch brands were provided with a special offer of a bond for only 8 UPCs; all others were required to submit 10 UPCs. The program rationale: “start of New Year is a vulnerable time for smokers” when, presumably, many would resolve to quit. 91 Carlton sent “targeted custom mailings …to demographically correct targets [seniors]…continuity retention programs will be deployed against highly vulnerable outswitchers”. 92
Geographic Advertising
To enhance sales among older people, RJR’s consultants “identified 12 key markets in which nearly 15 % of the 50+ U.S population resides” and developed “tailored field marketing approaches ” .49 AT implemented a “Zip Start” program identifying “affluent zip codes”93 and “opportunity stores” to receive promotions targeting Carlton smokers. 94–96 A 1984 Lorillard memo described “Mature Market Migrations,” identifying specific travel routes and times to target billboard advertisements on routes heavily traveled by vacationing seniors: “leafers in Smokies…snowbirds in Valley…Northeast Leafers…Nashville in summer and fall senior citizens bus tours to Opry Land”. 97
Sponsorship and Sampling
Tobacco companies sponsored or provided free cigarettes at events popular with older smokers, including bridge clubs and bingo games 62. Lorillard created “tie in discounts” with local merchants frequented by older smokers 62. RJR developed “NOW Fun and Fashion Mall Days” for mature smokers and sponsored discounted movie programs, beauty makeovers, money management seminars, and travel packages.49, 98 RJR and PM were both interested in sponsoring the PGA Senior Golf Tour. 99–101 Free cigarettes were distributed at senior club meetings, conventions and conferences 102–104. When requested, cigarette samples were also provided to nursing homes. 102, 105–107
Discussion
This is the first study to investigate tobacco industry activity in relation to older persons, and it shows that the tobacco industry has aggressively targeted older people and aging Baby Boomers. There is documentation that the tobacco industry used some “light” cigarettes to initiate young adults into smoking 108. However, what is unique about the industry’s targeting of older smokers is the focus on aggressively marketing “light” and “low-tar” cigarettes as an alternative to quitting, and the false implication that they were a healthier choice.
Our study has limitations. We may not have retrieved every relevant document, due to database size and indexing limitations. Some materials may have been destroyed or concealed by tobacco companies 109; others may have never been obtained in the legal discovery process. Post 1998, tobacco companies were aware that documents might eventually be made public. All archival research requires that decisions be made about which aspects and which materials to cite as representative; it is possible that other researchers might find other themes more interesting or informative. Despite these limitations, our study points to several previously unexamined aspects affecting the context within which older smokers may consider quitting.
Smokers of “light” brands are misinformed about the disease risks of using low-tar cigarettes. 110, 111 Lung cancer risk, for example, is no different in smokers of “light” or “low tar” cigarettes. 25 “Low tar” cigarettes deliver high levels of nicotine 74 and do not encourage smoking cessation 112, partly because smokers vary their puffing to regulate nicotine levels and compensate for low yield cigarettes by smoking them more intensely. 113 Thus, tar and nicotine delivered is greater than the machine smoked yields reported to consumers and regulators. 113 Although the truth about low tar cigarettes began to emerge in public health literature in the late 1990’s, the tobacco industry was aware of these issues as early as 1980. 71 In 2006, major U.S. tobacco companies, including those discussed here, were convicted in federal court of fraud and racketeering. The presiding judge concluded:
“…Defendants falsely marketed and promoted low tar/light cigarettes as less harmful than full-flavor cigarettes in order to keep people smoking and sustain corporate revenues”. 110
Educating older smokers about the tobacco industry’s influence on smoking behaviors may impact self-blame, a documented barrier to cessation 114. Informing practitioners about industry influence may decrease their tendency to “blame the victim” 115, 116, thereby increasing the likelihood that they may recommend tobacco addiction treatment for older adults. Informing older smokers, especially those using low-tar cigarettes, of the roles that the tobacco industry had in maintaining their tobacco addiction, emphasizing the level of risk and the health benefits of quitting even in later life, and informing older smokers that low-tar cigarettes confer no reduction in harm and may even make quitting more difficult, should be part of cessation counseling for this population.
The tobacco industry has long claimed that smoking is a “choice”. 11 However, as this study shows, the industry sought to thwart the “choice” of older smokers wanting to quit, working to exploit every identifiable vulnerability in order to keep them smoking. The tobacco industry’s interest in older smokers contrasts with the relative lack of interest shown by many health care providers in helping older smokers quit 8–10, 34, 35. Practitioners must recognize that the industry’s efforts to retain older smokers affect both their patients’ behavior and the context of cessation counseling. Receiving marketing materials by mail, for example, may deter smokers from quitting and should be addressed in anticipatory guidance.
This study also points to tobacco industry research findings that might be considered by health care practitioners and public health advocates working on ways to reach aging smokers. For example, industry research showed that Baby Boomers’ characteristics included the desire to have control over their lives 43, 50 and a responsiveness to messages suggesting independence and individuality. 52 These characteristics could bear a relationship to the self-exempting and/or self-blaming beliefs of older smokers. 6, 7, 117, 118 The industry’s efforts to emphasize “choice,” while denying or discounting nicotine addiction, may have shaped and reinforced these beliefs. Framing smoking cessation as a route to being in control and remaining more independent in later life might be effective.
As the population ages, all practitioners must make smoking cessation a priority for older patients’ care. Better understanding the industry’s influence on the context of cessation attempts may make these efforts more likely to succeed. Comprehensive tobacco control measures must address all populations across the life span and include a focus on older smokers.
Acknowledgments
This research was supported by the California Tobacco Related Disease Research Program grant no. 16RT-0149; Center for Tobacco Control Research and Education Fellowship (NCI grant no. CA-113710); and National Cancer Institute grant no. CA-109153.
References
- 1.Centers for Disease Control and Prevention. Tobacco use among adults - United States, 2005. MMWR. 2006;6(55):1145–1148. [Google Scholar]
- 2.U.S. Department of Health and Human Services. [cited 01/10/07];Current cigarette smoking by age, sex, and race: United States. 2006 Available from: http://209.217.72.34/aging/TableViewer/tableView.aspx.
- 3.Orleans C, Jepson C, Resch N, et al. Quitting motives and barriers among older smokers: The 1986 adult use of tobacco survey revisited. Cancer. 1994;74(7):2055–2061. doi: 10.1002/1097-0142(19941001)74:7+<2055::aid-cncr2820741712>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
- 4.Poland BD, Cohen JE, Ashley MJ, et al. Heterogeneity among smokers and non-smokers in attitudes and behaviour regarding smoking and smoking restrictions. BMJ. 2000;9(4):364–371. doi: 10.1136/tc.9.4.364. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Chapman S. Blaming tobacco's victims. Tob Control. 2002;11:167–168. doi: 10.1136/tc.11.3.167. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Chapple A, Ziebland S, McPherson A. Stigma, shame, and blame experienced by patients with lung cancer: qualitative study. BMJ. 2004;328(7454):1470. doi: 10.1136/bmj.38111.639734.7C. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Christensen AJ, Moran PJ, Ehlers SL, et al. Smoking and drinking behavior in patients with head and neck cancer: Effects of behavioral self-blame and perceived control. J Behav Med. 1999;22(5):407–418. doi: 10.1023/a:1018669222706. [DOI] [PubMed] [Google Scholar]
- 8.Doescher MP, Saver BG. Physicians' advice to quit smoking: The glass remains half empty. J Fam Pract. 2000;49(6):543–547. MMWR. [PubMed] [Google Scholar]
- 9.Ellerbeck EF, Ahluwalia JS, Jolicoeur DG, et al. Direct observation of smoking cessation activities in primary care practice. J Fam Pract. 2001;50(8):688–693. [PubMed] [Google Scholar]
- 10.Houston T, Allison J, Person S, et al. Post-myocardial infarction smoking cessation counseling: Associations with immediate and late mortality in older Medicare patients. Am J Med. 2005;118(3):269–275. doi: 10.1016/j.amjmed.2004.12.007. [DOI] [PubMed] [Google Scholar]
- 11.Balbach ED, Smith EA, Malone RE. How the Health Belief Model helps the tobacco industry: Individuals, choice, and "information". Tob Control. 2006;15 suppl 4:iv37–iv43. doi: 10.1136/tc.2005.012997. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Hamilton WL, diStefano Norton G, Ouellette TK, et al. Smokers' responses to advertisements for regular and light cigarettes and potential reduced-exposure tobacco products. Nicotine Tob Res. 2004;6:353–362. doi: 10.1080/14622200412331320752. [DOI] [PubMed] [Google Scholar]
- 13.Shiffman S, Pillitteri JL, Burton SL, et al. Smokers' beliefs about "Light" and "Ultra Light" cigarettes. BMJ. 2001;10 suppl 1:i7–i23. doi: 10.1136/tc.10.suppl_1.i17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Cataldo JK. Clinical implications of smoking and aging: Breaking through the barriers. J Gerontol Nurs. 2007;33(8):32–41. doi: 10.3928/00989134-20070801-06. [DOI] [PubMed] [Google Scholar]
- 15.Smith EA. 'It's interesting how few people die from smoking': Tobacco industry efforts to minimize risk and discredit health promotion. Eur J Public Health. 2007;17(2):162–170. doi: 10.1093/eurpub/ckl097. [DOI] [PubMed] [Google Scholar]
- 16.Yerger VB, Malone RE. African American leadership groups: Smoking with the enemy. Tob Control. 2002;11(4):336–345. doi: 10.1136/tc.11.4.336. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Muggli ME, Pollay RW, Lew R, et al. Targeting of Asian Americans and Pacific Islanders by the tobacco industry: Results from the Minnesota Tobacco Document Depository. Tob Control. 2002;11(3):201–209. doi: 10.1136/tc.11.3.201. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Bialous SA. Tobacco industry targeting of Latinos in the United States; California Department of Health Services Priority Populations Conference; 2003; 2003. pp. 13–15. [Google Scholar]
- 19.Smith EA, Malone RE. The outing of Philip Morris: Advertising tobacco to gay men. Amer J Public Health. 2003;93(6):988–993. doi: 10.2105/ajph.93.6.988. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Apollonio DE, Malone RE. Marketing to the marginalized: Tobacco industry targeting of the homeless and mentally ill. Tob Control. 2005;14(6):409–415. doi: 10.1136/tc.2005.011890. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Ling PM, Glantz SA. Why and how the tobacco industry sells cigarettes to young adults: Evidence from industry documents. Am J Public Health. 2002;92(6):908–916. doi: 10.2105/ajph.92.6.908. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Cummings KM, Morley CP, Horan JK, et al. Marketing to America's youth: Evidence from corporate documents. Tob Control. 2002;11:i5–i7. doi: 10.1136/tc.11.suppl_1.i5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Center for Disease Control and Prevention and the Merck Company Foundation. The state of aging and health in America 2007. Whitehouse Station, New Jersey: The Merck Co. Foundation; 2007. [Google Scholar]
- 24.Augustson EM, Marcus SE. Use of the current population survey to characterize subpopulations of continued smokers: A national perspective on the" hardcore" smoker phenomenon. Nicotine Tob Res. 2004;6(4):621–629. doi: 10.1080/14622200410001727876. [DOI] [PubMed] [Google Scholar]
- 25.American Cancer Society. [cited 01/18/07];Cancer Facts and Figures - 2006. 2006 Available from: http://www.cancer.org/downloads/STT/CAFF2006PWSecured.pdf.
- 26.Hyland A, Li Q, Bauer J, et al. Predictors of cessation in a cohort of current and former smokers followed over 13 years. Nicotine Tob Res. 2004;6:363–369. doi: 10.1080/14622200412331320761. [DOI] [PubMed] [Google Scholar]
- 27.Salive ME, Cornoni-Huntley J, LaCroix AZ, et al. Predictors of smoking cessation and relapse in older adults. Am J Public Health. 1992;82:1268–1271. doi: 10.2105/ajph.82.9.1268. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Burns DM. Cigarette smoking among the elderly: Disease consequences and the benefits of cessation. Am J Health Promot. 2000;14(6):357–361. doi: 10.4278/0890-1171-14.6.357. [DOI] [PubMed] [Google Scholar]
- 29.Levi F, Lucchini F, Negri E, et al. Changed trends of cancer mortality in the elderly. Ann Oncology. 2001;12(10):1467–1477. doi: 10.1023/a:1012539213643. [DOI] [PubMed] [Google Scholar]
- 30.Whitson H, Heflin M, Burchett B. Patterns and predictors of smoking cessation in an elderly cohort. J Am Geriatr Soc. 2006;54(3):466–471. doi: 10.1111/j.1532-5415.2005.00641.x. [DOI] [PubMed] [Google Scholar]
- 31.The Center for Social Gerontology. [cited 01/18/07];Smoke-Free Environments Law Project. 2006 Available from: http://www.tcsg.org/sfelp/SmokeFreeLTCFacilitiesMemo.pdf.
- 32.Rimer B, Orleans C. Tailoring smoking cessation for older adults. Cancer. 1994;74(7):2051–2054. doi: 10.1002/1097-0142(19941001)74:7+<2051::aid-cncr2820741711>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
- 33.Brown D, Croft J, Schenck A, et al. Inpatient smoking-cessation counseling and all-cause mortality among the elderly. Am J Prev Med. 2004;26(2):112–118. doi: 10.1016/j.amepre.2003.10.004. [DOI] [PubMed] [Google Scholar]
- 34.Buckland A, Connolly MJ. Age-related differences in smoking cessation advice and support given to patients hospitalized with smoking-related illness. Age Ageing. 2005;34(6):639–642. doi: 10.1093/ageing/afi199. [DOI] [PubMed] [Google Scholar]
- 35.Maguire CP, Ryan J, Kelly A. Do patient age and medical condition influence medical advice to stop smoking? Age Ageing. 2000;29(264–266) doi: 10.1093/ageing/29.3.264. [DOI] [PubMed] [Google Scholar]
- 36.Malone RE, Balbach E. Tobacco industry documents: Treasure trove or quagmire? Tob Control. 2000;9:334–338. doi: 10.1136/tc.9.3.334. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.MacKenzie R, Collin J, Lee K. The tobacco industry documents: An introductory handbook and resource guide for researchers. London: London School of Hygiene & Tropical Medicine; 2003. [Google Scholar]
- 38.Taylor C. Theories of meaning. In: Taylor C, editor. Human agency and language: Philosophical papers. Cambridge[Cambridgeshire]: New York: Cambridge University Press; 1985. pp. 248–292. [Google Scholar]
- 39.Taylor C. Interpretation and the sciences of man. In: Taylor C, editor. Philosophy and the human sciences: Philosophical papers 2. Cambridge [Cambridgeshire]; New York: Cambridge University Press; 1985. pp. 33–81. [Google Scholar]
- 40.Hill M. Archival strategies and techniques. Newbury Park, California: Sage Publications; 1993. [Google Scholar]
- 41.Smith RM. Yankelovich Monitor of Social Values-No. 8. the Mature Market. 17 Aug 1977. RJ Reynolds. http://legacy.library.ucsf.edu/tid/xpk49d00.
- 42.00 1991. RJ Reynolds. http://legacy.library.ucsf.edu/tid/dlj93d00.
- 43.Salem Spirit Lifestyle Seminars. Management Summary. 06 Feb 1984. RJ Reynolds. http://legacy.library.ucsf.edu/tid/dmb19d00.
- 44.00 1978. Lorillard. http://legacy.library.ucsf.edu/tid/dbr60e00.
- 45.Leo Burnett Lifestyle Study (820000). 00 1982. Philip Morris. http://legacy.library.ucsf.edu/tid/nfz03e00.
- 46.'Prime Lifers' (50 to 64 Years Old). 21 Apr 1987. Lorillard. http://legacy.library.ucsf.edu/tid/wvj10e00.
- 47.An Exploratory Study -- Mature Smokers 00 Apr 1987. Lorillard. http://legacy.library.ucsf.edu/tid/sfq60e00.
- 48.Mature Smoker Behavior and Attitude Information. 29 May 1987. Lorillard. http://legacy.library.ucsf.edu/tid/omf90e00.
- 49.The Now Brand Recommended Field Marketing Approaches for Americans Aged 50+. 00 1991. RJ Reynolds. http://legacy.library.ucsf.edu/tid/cjk24d00.
- 50.Yankelovich Partners. Generational Cohorts Through Time: Profile Of Mature Smokers. 12 Apr 1994. American Tobacco. http://legacy.library.ucsf.edu/tid/sld21a00.
- 51.Kempke KA. Cohort Analysis July 1997. 00 Jul 1997. Brown & Williamson. http://legacy.library.ucsf.edu/tid/dyn02d00.
- 52.Kane KB. Baby Boomer Analysis. 17 Jan 1995. Brown & Williamson. http://legacy.library.ucsf.edu/tid/lhs30f00.
- 53.Agency Recommendations for the 1984 (840000) and Future Salem Marketing Plans. Salem Spirit Lifestyle Seminars. 06 Feb 1984. RJ Reynolds. http://legacy.library.ucsf.edu/tid/kpm85d00.
- 54.Five Year Plan 880000 – 920000. 00 1988. Philip Morris. http://legacy.library.ucsf.edu/tid/bfp92e00.
- 55.Philip Morris USA Seniors Project. 19 Aug 1992. Philip Morris. http://legacy.library.ucsf.edu/tid/kem62e00.
- 56.Summary of Marlboro 'Low Tar' in-Depth Interviews. 27 Oct 1980. Philip Morris. http://legacy.library.ucsf.edu/tid/zzh16e00.
- 57.Wallace JM. Rl Concept Appeal by Age Groups. 08 Mar 1977. RJ Reynolds. http://legacy.library.ucsf.edu/tid/tyu79d00.
- 58.Low Tar Switchers -- Detailed Demographic Profiles. 24 Apr 1987. Lorillard. http://legacy.library.ucsf.edu/tid/zmf90e00.
- 59.Attitudes toward low tar. 00 1900. B&W. http://legacy.library.ucsf.edu/tid/zbd72d00.
- 60.RJR Long Range Plan 1980 – 1984 (800000 – 840000). New Trends and Developments. External Forecasts. 00 Jul 1979. RJ Reynolds. http://legacy.library.ucsf.edu/tid/hgu68d00.
- 61.How Consumers Currently View the Brand. 00 1984. RJ Reynolds. http://legacy.library.ucsf.edu/tid/qzx45a00.
- 62.Mature Market (50+). 21 Apr 1987. Lorillard. http://legacy.library.ucsf.edu/tid/lsh10e00.
- 63.Reagan N. [Rapidly changing age population]. 00 1992. Lorillard. 00 http://legacy.library.ucsf.edu/tid/dsb60e00.
- 64.Murray J. Carlton age profile. 19 Apr 1994. American Tobacco Company. http://legacy.library.ucsf.edu/tid/ctl25f00.
- 65.Dorman RH. Ultra Low Tar Opportunities for Camel. 17 Dec 1980. RJ Reynolds. http://legacy.library.ucsf.edu/tid/jaf95d00.
- 66.Alternative positioning hypothesis. Winston Positioning7/17/84 (840717). . 19840717 RJ Reynolds. http://legacy.library.ucsf.edu/tid/qig68d00.
- 67.U.S. Cigarette Market in the 1990's. No Date. Mangini. http://legacy.library.ucsf.edu/tid/dky52d00.
- 68.In What Ways Might We Reach Older Adult (35+) Smokers. 07 Aug 1990. RJ Reynolds. http://legacy.library.ucsf.edu/tid/jsl45a00.
- 69.Burrows DS. Quitting Rates by Age. 06 Nov 1989. RJ Reynolds. http://legacy.library.ucsf.edu/tid/nmb13d00.
- 70.October 1976 (761000) Data - Quitting/Switching and Smoker Profiles. 21 Feb 1977. RJ Reynolds. http://legacy.library.ucsf.edu/tid/ddk39d00.
- 71.Marketing Research Department Report Quitters. 11 Sep 1980. Philip Morris. http://legacy.library.ucsf.edu/tid/txt54e00.
- 72.Ultra Low Tar Segment. No Date. Brown & Williamson. http://legacy.library.ucsf.edu/tid/nfu60f00.
- 73.Nicotine Free Concept Test. 00 Oct 1989. Philip Morris. http://legacy.library.ucsf.edu/tid/ndz74e00.
- 74.Kessler D. A question of intent: A great American battle with a deadly industry. New York: PublicAffairs; 2001. [Google Scholar]
- 75.Leavell N. The low tar lie. BMJ. 1999;8(4):433–437. doi: 10.1136/tc.8.4.433. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 76.Smith. Carlton Direct. 16 Oct 1992. American Tobacco. http://legacy.library.ucsf.edu/tid/wmn45f00.
- 77.Carlton In-Switch And Out-Switch Models. 18 Apr 1990. American Tobacco. http://legacy.library.ucsf.edu/tid/xqh55f00.
- 78.Consumer Demographics. 00 1985. Brown & Williamson. http://legacy.library.ucsf.edu/tid/vns13f00.
- 79.Marketing to Mature Adults: Top Level Action Plan. a Summary of Priority Topics Discussed in an Executive Meeting among R.J. Reynolds, Nabisco Foods, Nabisco Biscuit, and Planters Lifesavers Companies. 13 Sep 1990. RJ Reynolds. http://legacy.library.ucsf.edu/tid/asd24d00.
- 80.Flavor and Aroma Some Facts and Opportunities. 00 1990. Philip Morris. http://legacy.library.ucsf.edu/tid/tfy06e00.
- 81.Carpenter CM, Wayne GF, Pauly JL, et al. New cigarette brands with flavors that appeal to youth: Tobacco marketing strategies. Health Aff. 2005;24(6):1601–1610. doi: 10.1377/hlthaff.24.6.1601. [DOI] [PubMed] [Google Scholar]
- 82.True Demographic Comparison Tracking Study Vs. Database Vs. Purchased Lists Vs. Survey Mailing. 00 Feb 1992. Lorillard. http://legacy.library.ucsf.edu/tid/opt74c00.
- 83.Pall Mall Seniors Program. 00 1990. American Tobacco. http://legacy.library.ucsf.edu/tid/vbq35f00.
- 84.Exhibit I, Carlton Target Audience Demographics (12 Months Ending June, 1989). 00 Jun 1989. American Tobacco. http://legacy.library.ucsf.edu/tid/bwg25f00.
- 85.Demographics 12 Months Ending June. 00 1990. American Tobacco. http://legacy.library.ucsf.edu/tid/lfn45f00.
- 86.Table 1 Carlton Demographics. 00 1988. Lorillard. http://legacy.library.ucsf.edu/tid/pip13c00.
- 87.Carlton Brand Position Background Demographics Facts. 11 May 1994. Brown & Williamson. http://legacy.library.ucsf.edu/tid/hsz02d00.
- 88.Brand Demographics January–December 1996. No Date. Brown & Williamson. http://legacy.library.ucsf.edu/tid/phi40f00.
- 89.Carlton Demographics. 00 1979. Lorillard. http://legacy.library.ucsf.edu/tid/mbe20e00.
- 90.Carlton Direct Mail Response And Analysis Discussion Paper. 21 Mar 1988. American Tobacco. http://legacy.library.ucsf.edu/tid/tsh25f00.
- 91.Carlton bond direct mail. B&W. http://legacy.library.ucsf.edu/tid/evt80f00.
- 92.ATCo Facts & Figures, Did You Know… 19941100 1994. American Tobacco. http://legacy.library.ucsf.edu/tid/tbs25f00.
- 93.Murray J. Approval Recommendation: Carlton Co-Op Conquest Direct Mail Effort. 19 Mar 1992. American Tobacco. http://legacy.library.ucsf.edu/tid/qil21a00.
- 94.Carlton Zip Start. 00 1993. American Tobacco. http://legacy.library.ucsf.edu/tid/zpi35f00.
- 95.Choate. Approval Recommendation - 4th Quarter Zip Start. 14 Sep 1993. American Tobacco. http://legacy.library.ucsf.edu/tid/kzp45f00.
- 96.Premium Brands, Premium Brands Workshop Agenda. 00 1994. American Tobacco. http://legacy.library.ucsf.edu/tid/fhv25f00.
- 97.Mature Market Migrations. 15 Oct 1986. Lorillard. http://legacy.library.ucsf.edu/tid/ufk10e00.
- 98.Club Kent Conversion Study Final Report. 15 Jul 1986. Lorillard. http://legacy.library.ucsf.edu/tid/zva41e00.
- 99.Thompson J. Golf Digest Seniors PGA Tour journal. 22 Nov 1982. Philip Morris. http://legacy.library.ucsf.edu/tid/lvl05e00.
- 100.Orlowsky ML. PGA. 23 Dec 1985. RJ Reynolds. http://legacy.library.ucsf.edu/tid/lpd65d00.
- 101.Beman DR. Vantage Cup; Vantage Super Seniors; and Vantage Championship. 14 Jul 1988. RJ Reynolds. http://legacy.library.ucsf.edu/tid/mlb83d00.
- 102.Log of All Sample 4's Distributed to Lorillard Employees. 22 Feb 1983. Lorillard. http://legacy.library.ucsf.edu/tid/svg21e00.
- 103.Max Schmidt Requests Sample 10's for Elks Club State Convention. 20 Oct 1989. Lorillard. http://legacy.library.ucsf.edu/tid/yqk21e00.
- 104.Vantage. Special Events Plan. 05 Dec 1983. RJ Reynolds. http://legacy.library.ucsf.edu/tid/jhu75d00.
- 105.Requisition for Sample and or Experimental Tax Free Cigarettes. 14 Jun 1983. Lorillard. http://legacy.library.ucsf.edu/tid/axg21e00.
- 106.29 Jul 1985. Lorillard. http://legacy.library.ucsf.edu/tid/szg21e00.
- 107.07 Dec 1993. Philip Morris. http://legacy.library.ucsf.edu/tid/oam42e00.
- 108.Cummings KM, Morley CP, Horan JK, et al. Marketing to America's youth: Evidence from corporate documents. Tob Control. 2002;11:i5–i17. doi: 10.1136/tc.11.suppl_1.i5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 109.Liberman J. The shredding of BAT's defense: McCabe v British American Tobacco Australia. Tob Control. 2002;11:271–274. doi: 10.1136/tc.11.3.271. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 110.Beck K, Cork K, Mahoney M. The verdict is in: Findings from United States v. Philip Morris, Light Cigarettes. St. Paul: Tobacco Control Legal Consortium. 2006 [Google Scholar]
- 111.Cummings KM, Hyland A, Bansal MA, et al. What do Marlboro Lights smokers know about low-tar cigarettes? Nicotine Tob Res. 2004;6:323–332. doi: 10.1080/14622200412331320725. [DOI] [PubMed] [Google Scholar]
- 112.Hyland A, Hughes JR, Farrelly M, et al. Switching to lower tar cigarettes does not increase or decrease the likelihood of future quit attempts or cessation. Nicotine Tob Res. 2003;5(5):655–671. doi: 10.1080/1462220031000158663. [DOI] [PubMed] [Google Scholar]
- 113.Hammond D, Collishaw NE, Callard C. Secret science: tobacco industry research on smoking behaviour and cigarette toxicity. Lancet. 2006;367(9512):781–787. doi: 10.1016/S0140-6736(06)68077-X. [DOI] [PubMed] [Google Scholar]
- 114.Christensen AJ, Moran PJ, Ehlers SL, et al. Smoking and drinking behavior in patients with head and neck cancer: Effects of behavioral self-blame and perceived control. J Behav Med. 1999:407–418. doi: 10.1023/a:1018669222706. [DOI] [PubMed] [Google Scholar]
- 115.Chapman S. Blaming tobacco's victims. Tob Control. 2002;11:167–168. doi: 10.1136/tc.11.3.167. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 116.Gunderman R. Illness as failure: Blaming patients Hastings. Cent Rep. 2000;30:7–11. [PubMed] [Google Scholar]
- 117.Yong HH, Borland R, Siahpush M. Quitting-related beliefs, intentions, and motivations of older smokers in four countries: Findings from the international tobacco control policy evaluation survey. Addict Behav. 2005;30(4):777–788. doi: 10.1016/j.addbeh.2004.08.023. [DOI] [PubMed] [Google Scholar]
- 118.Richardson GE, Tucker MA, Venzon DJ, et al. Smoking cessation after successful treatment of small-cell lung cancer is associated with fewer smoking-related second primary cancers Smoking cessation after successful treatment of small-cell lung cancer is associated with fewer smoking-related second primary cancers. 1993;119(5):383–390. doi: 10.7326/0003-4819-119-5-199309010-00006. [DOI] [PubMed] [Google Scholar]