Category Archives: Tobacco

Selected Bibliography on Retail Practices and Health by Industry

Selected Bibliography on Retail Practices and Health in the Alcohol, Automobile, Firearms, Food and Beverage, Pharmaceutical, and Tobacco industries.

Alcohol Industry

Cohen DA, GhoshDastidar B, Scribner R, Miu A, Scott M, Robinson P, et al. Alcohol outlets, gonorrhea, and the Los Angeles civil unrest: A longitudinal analysis. Soc Sci Med. 2006;62(12):3062-3071.

Gruenewald PJ, Freisthler B, Remer L, Lascala EA, Treno A. Ecological models of alcohol outlets and violent assaults: Crime potentials and geospatial analysis. Addiction. 2006;101(5):666-677.

Gruenewald PJ, Johnson FW, Treno AJ. Outlets, drinking and driving: A multilevel analysis of availability. Stud Alcoho. 2002;63(4):460-468.

Gruenewald PJ, Millar AB, Treno AJ, Yang Z, Ponicki WR, Roeper P. The geography of availability and driving after drinking.Addiction. 1996;91(7):967-983.

Kotecki JE, Fowler JB, German TC, Stephenson SL, Warnick T. Kentucky pharmacists’ opinions and practices related to the sale of cigarettes and alcohol in pharmacies. J Community Health. 2000;25(4):343-355.

Lapham SC, Gruenwald PJ, Remer L, Layne L. New Mexico’s 1998 driveup liquor window closure. Study I: Effect on alcohol involved crashes. Addiction. 2004;99(5):598-606.

Miller T, Snowden C, Birckmayer J, Hendrie D. Retail alcohol monopolies, underage drinking, and youth impaired driving deaths. Accid Anal Prev. 2006;38(6):1162-1167.

Montgomery JM, Foley KL, Wolfson M. Enforcing the minimum drinking age: State, local and agency characteristics associated with compliance checks and Cops in Shops programs. Addiction. 2006;101(2):223-231.

Reynolds RI, Holder HD, Gruenewald PJ. Community prevention and alcohol retail access. Addiction. 1997;92 Suppl 2:S261-S272.

Treno AJ, Gruenewald PJ, Johnson FW. Alcohol availability and injury: The role of local outlet densities.  Alcohol Clin Exp Res. 2001;25(10):1467-1471.

Treno AJ, Gruenewald PJ, Wood DS, Ponicki WR. The price of alcohol: A consideration of contextual factors. Alcohol Clin Exp Res. 2006;30(10):1734-1742.

Treno AJ, Grube JW, Martin SE. Alcohol availability as a predictor of youth drinking and driving: A hierarchical analysis of survey and archival data. Alcohol Clin Exp Res. 2003;27(5):835-840.


Automobile Industry

Devaraj S, Matta KF, Conlon E.  Product and Service Quality: The Antecedents of Customer Loyalty in the Automotive Industry.Production and Operations Management.  2001; 10(4): 424-439.

Hellinga LA, McCartt AT, Haire ER. Choice of teenagers’ vehicles and views on vehicle safety: Survey of parents of novice teenage drivers. J Safety Res.2007;38(6):707-713.

Joetan E, Kleiner BH. Incentive practices in the US automobile industry. Management Research News. 2004;27(7):49–62.

Koppel S, Charlton J, Fildes B, Fitzharris M. How important is vehicle safety in the new vehicle purchase process? Accid Anal Prev. 2008;40(3):994-1004.

Koppel S, Charlton J, Fildes B. How important is vehicle safety in the new vehicle purchase/lease process for fleet vehicles?Traffic Inj Prev. 2007;8(2):130-136.

Van Alst JW.  Fueling Fair Practices: A Road Map to Improved Public Policy for Used Car Sales and Financing, National Consumer Law Center, (March 5, 2008), Available at


Firearms Industry

Cook, PJ, Molliconi S, Cole, TB.Regulating gun markets. The Journal of Criminal Law and Criminology. 1995;86(1):59-92.

Lewin NL, Vernick JS, Beilenson PL, Mair JS, Lindamood MM, Teret SP, Webster DW. The Baltimore Youth Ammunition Initiative: A model application of local public health authority in preventing gun violence. Am J Public Health. 2005;95(5):762-765.

Miller M, Azrael D, Hemenway D. Firearm availability and unintentional deaths, suicide, and homicide among 5-14 year olds. The Journal of Trauma. 2002;52(2):267-275.

Miller M, Azrael D, Hemenway D. Firearm availability and unintentional deaths. Accident Analysis and Prevention. 2001;33:477-484.

Miller M, Azrael D, Hemenway D. Firearm availability and unintentional deaths, suicide, and homicide among women.Journal of Urban Health. 2002; 79(1):26-38.

Sorenson SB, Berk RA. Handgun sales, beer sales, and youth homicide, California 1972-1993. Journal of Public Health Policy. 2001;22(2):182-197.

Vernick JS, Mair JS. How the law affects gun policy in the United States: Law as intervention or obstacle to prevention. J Law Med Ethics. 2002;30(4):692-704.

Vernick JS, Webster DW, Bulzacchelli MT, Mair JS. Regulation of firearm dealers in the United States: An analysis of state law and opportunities for improvement. J Law Med Ethics. 2006;34(4):765-775.

Webster DW, Vernick JS, Buzacchelli MT. Effects of a gun dealer’s change in sales practices on the supply of guns to criminals. The Journal of Urban Health. 2006; 83(5):778-787.

Webster DW, Bulzacchelli MT, Zeoli AM, Vernick JS. Effects of undercover police stings of gun dealers on the supply of new guns to criminals. Inj Prev. 2006;12(4):225-230.

Webster DW, Vernick JS, Bulzacchelli MT. Effects of state-level firearm seller accountability policies on firearm trafficking. J Urban Health. 2009;86(4):525-537.

Webster DW, Vernick JS, Hepburn LM. Relationship between licensing, registration, and other gun sales laws and the source state of crime guns. Inj Prev. 2001;7(3):184-189.

Wintemute GJ. Where the guns come from: The gun industry and gun commerce. The Future of Children. 2003;12(2):55-71.


Food and Beverage Industry

Altekruse SF, Yang S, Timbo BB, Angulo FJ. A multi-state survey of consumer food-handling and food-consumption practices.Am J Prev Med. 1999;16(3):216-221.

Angell SY, Silver LD, Goldstein GP, Johnson CM, Deitcher DR, Frieden TR, Bassett MT. Cholesterol control beyond the clinic: New York City’s trans fat restriction. Ann Intern Med. 2009;151(2):129-134.

Austin SB, Melly SJ, Sanchez BN, Patel A, Buka S, Gortmaker SL. Clustering of fast food restaurants around schools: A novel application of spatial statistics to the study of food environments. Am J Public Health. 2005;95(9):1575-1581.

Baker EA, Schootman M, Barnidge E, Kelly C. The role of race and poverty in access to foods that enable individuals to adhere to dietary guidelines. Prev Chronic Dis. 2006;3(3):A76.

Borgmeier I, Westenhoefer J. Impact of different food label formats on healthiness evaluation and food choice of consumers: A randomized-controlled study. BMC Public Health. 2009;12(9):184.

Burton S, Creyer EH, Kees J, Huggins K. Attacking the obesity epidemic: the potential health benefits of providing nutrition information in restaurants. Am J Public Health.2006;96(9):1669-1675.

Cassady D, Housemann R, Dagher C. Measuring cues for healthy choices on restaurant menus: Development and testing of a measurement instrument. Am J Health Promot. 2004;18(6):444-449.

Creel JS, Sharkey JR, McIntosh A, Anding J, Huber JC Jr. Availability of healthier options in traditional and nontraditional rural fast-food outlets. BMC Public Health. 2008;8:395.

Dumanovsky T, Nonas CA, Huang CY, Silver LD, Bassett MT. What people buy from fast-food restaurants: Caloric content and menu item selection, New York City 2007. Obesity (Silver Spring). 2009; 17(7):1369-1374.

Dwyer JJ, Macaskill LA, Uetrecht CL, Dombrow C. Eat Smart! Ontario’s Healthy Restaurant Program: Focus groups with non-participating restaurant operators. Can J Diet Pract Res. 2004.;65(1):6-9.

Economos CD, Folta SC, Goldberg J, Hudson D, Collins J, Baker Z, Lawson E, Nelson M. A community-based restaurant initiative to increase availability of healthy menu options in Somerville, Massachusetts: Shape Up Somerville. Prev Chronic Dis. 2009.;6(3):A102

Fielding JE, Aguirre A, Palaiologos E. Effectiveness of altered incentives in a food safety inspection program. Prev Med. 2001;32(3):239-244.

Ford PB, Dzewaltowski DA. Disparities in obesity prevalence due to variation in the retail food environment: Three testable hypotheses. Nutr Rev. 2008 Apr;66(4):216-228.

French SA, Harnack L, Jeffery RW. Fast food restaurant use among women in the Pound of Prevention study: Dietary, behavioral and demographic correlates. International Journal of Obesity & Related Metabolic Disorders. 2000;24(1):1353.

French SA. Pricing effects on food choices. J.Nutr. 2003;133(3):841S-843S.

French SA, Jeffery RW, Story M, Breitlow KK, Baxter JS, Hannan P, et al. Pricing and promotion effects on lowfat vending snack purchases: The CHIPS Study. Am J Public Health. 2001 ;91(1):112-117.

French SA, Story M, Neumark Sztainer D, Fulkerson JA, Hannan P. Fast food restaurant use among adolescents: Associations with nutrient intake, food choices and behavioral and psychosocial variables. Int J Obes Relat Metab Disord.2001;25(12):1823-1833.

Fried EJ, Nestle M. The growing political movement against soft drinks in schools. JAMA.2002 ;288(1):2181-2181.

Gerend MA. Does calorie information promote lower calorie fast food choices among college students? J Adolesc Health. 2009;44(1):84-86.

Glanz K, Resnicow K, Seymour J, Hoy K, Stewart H, Lyons M, Goldberg J. How major restaurant chains plan their menus: The role of profit, demand, and health. Am J Prev Med. 2007;32(5):383-388.

Hannan P, French SA, Story M, Fulkerson JA. A pricing strategy to promote sales of lower fat foods in high school cafeterias: Acceptability and sensitivity analysis. Am.J.Health Promot. 2002 ;17(1):16,ii.

Hanni KD, Garcia E, Ellemberg C, Winkleby M. Targeting the taqueria: Implementing healthy food options at Mexican American restaurants. Health Promot Pract. 2009;10(2 Suppl):91S-99S.

Harnack LJ, French SA. Effect of point-of-purchase calorie labeling on restaurant and cafeteria food choices: A review of the literature. Int J Behav Nutr Phys Act. 2008 Oct 26;5:51.

Harnack LJ, French SA, Oakes JM, Story MT, Jeffery RW, Rydell SA. Effects of calorie labeling and value size pricing on fast food meal choices: Results from an experimental trial. Int J Behav Nutr Phys Act. 2008 ;5:63.

Jacobson MF, Brownell KD. Small taxes on soft drinks and snack foods to promote health. Am J Public Health 2000;90:854-857.

Jetter KM, Cassady DL. Increasing fresh fruit and vegetable availability in a low-income neighborhood convenience store: A pilot study. Health Promot Pract. 2009 Feb 12. [Epub ahead of print]

Kim D, Kawachi I. Food taxation and pricing strategies to “thin out” the obesity epidemic.  Am. J. Prev. Med.2006;30(5):430-437.

Kimathi AN, Gregoire MB, Dowling RA, Stone MK. A healthful options food station can improve satisfaction and generate gross profit in a worksite cafeteria. J Am Diet Assoc. 2009;109(5):914-917.

Kuo T, Jarosz CJ, Simon P, Fielding JE. Menu labeling as a potential strategy for combating the obesity epidemic: A health impact assessment. Am J Public Health. 2009;99(9):1680-1686.

Kwate N O A. Fried chicken and fresh apples: Racial segregation as a fundamental cause of fast food density in black neighborhoods. Health and Place. 2008;14:32-44.

Kwate NO, Yau CY, Loh JM, Williams D. Inequality in obesigenic environments: Fast food density in New York City.Healthand Place. 2009;15(1):364-73

Lang T, Rayner G, Kaelin E. The Food Industry, Diet, Physical Activity and Health: A Review Of Reported Commitments And Practice Of 25 Of The World’s Largest Food Companies. 2006.

Larson NI, Story MT, Nelson MC. Neighborhood environments: Disparities in access to healthy foods in the U.S. Am J Prev Med. 2009;36(1):74-81.

Ludwig DS, Brownell KD. Public health action amid scientific uncertainty: The case of restaurant calorie labeling regulations.JAMA. 2009;302(4):434-435.

Lynch RA, Elledge BL, Griffith CC, Boatright DT. A comparison of food safety knowledge among restaurant managers, by source of training and experience, in Oklahoma County, Oklahoma. J Environ Health. 2003;66(2):9-14, 26.

Macdonald L, Cummins S, Macintyre S. Neighbourhood fast food environment and area deprivation-substitution or concentration? Appetite. 2007l;49(1):251-254.

Maddock J. The relationship between obesity and the prevalence of fast food restaurants: State level analysis. Am J Health Promot. 2004;19(2):137-143.

Mashta O. UK firms sign up to display calories on menus. BMJ. 2009;338:b182.

Morland KB, Evenson KR. Obesity prevalence and the local food environment.  Health and Place. 2009; 15(2):491-495

Nielsen SJ, Siega Riz AM, Popkin BM. Trends in food locations and sources among adolescents and young adults. Prev Med.2002;35(2):107-113.

O’Dougherty M, Harnack LJ, French SA, Story M, Oakes JM, Jeffery RW. Nutrition labeling and value size pricing at fast-food restaurants: A consumer perspective. Am J Health Promot. 2006;20(4):247-250.

Phillips ML, Elledge BL, Basara HG, Lynch RA, Boatright DT. Recurrent critical violations of the food code in retail food service establishments. J Environ Health. 2006;68(10):24-30, 55.

Pomeranz JL, Brownell KD. Legal and public health considerations affecting  the success, reach, and impact of menu-labeling laws. Am J Public Health. 2008;98(9):1578-1583.

Roberto CA, Agnew H, Brownell KD. An observational study of consumers’ accessing of nutrition information in chain restaurants. Am J Public Health. 2009;99(5):820-821.

Rose D, Hutchinson PL, Bodor JN, Swalm CM, Farley TA, Cohen DA, Rice JC. Neighborhood food environments and Body Mass Index: The importance of in-store contents. Am J Prev Med. 2009;37(3):214-219.

Rydell SA, Harnack LJ, Oakes JM, Story M, Jeffery RW, French SA. Why eat at fast-food restaurants: reported reasons among frequent consumers. J Am Diet Assoc. 2008;108(12):2066-2070.

Sharkey JR, Horel S, Han D, Huber JC Jr. Association between neighborhood need and spatial access to food stores and fast food restaurants in neighborhoods of colonias. Int J Health Geogr. 2009;8:9.

Song HJ, Gittelsohn J, Kim M, Suratkar S, Sharma S, Anliker J. A corner store intervention in a low-income urban community is associated with increased availability and sales of some healthy foods. Public Health Nutr. 2009:1-8.

Spencer EH, Frank E, McIntosh NF. Potential effects of the next 100 billion hamburgers sold by McDonald’s.Am.J.Prev.Med. 2005 ;28(4):379-381.

Story M, Kaphingst KM, Robinson-O’Brien R, Glanz K. Creating healthy food and eating environments: Policy and environmental approaches. Annu Rev Public Health. 2008;29:253-72.


Pharmaceutical Industry

Brooks JM, Doucette WR, Wan S, Klepser DG. Retail pharmacy market structure and performance. Inquiry. 2008;45(1):75-88.

Carroll NV. Estimating the impact of Medicare part D on the profitability of independent community pharmacies. J Manag Care Pharm. 2008;14(8):768-779.

Fincham JE. An unfortunate and avoidable component of American pharmacy: Tobacco. Am J Pharm Educ. 2008;72(3):57

Garattini L, Motterlini N, Cornago D. Prices and distribution margins of in-patent drugs in pharmacy: A comparison in seven European countries. Health Policy. 2008;85(3):305-313.

Gellad WF, Choudhry NK, Friedberg MW, Brookhart MA, Haas JS, Shrank WH. Variation in drug prices at pharmacies: Are prices higher in poorer areas? Health Serv Res. 2009;44(2 Pt 1):606-617.

Gitlin M, Wilson L. Repackaged pharmaceuticals in the California workers’ compensation system: From distribution and pricing options to physician and retail dispensing. Am J Ind Med. 2007;50(4):303-315.

Montoya ID, Jano E. Online pharmacies: Safety and regulatory considerations. Int J Health Serv. 2007;37(2):279-289.

Retail and mail copayments on the rise. Manag Care. 2009;18(6):50.

Rudholm N. Entry of new pharmacies in the deregulated Norwegian pharmaceuticals market– consequences for costs and availability. Health Policy.2008;87(2):258-263

Stafford E. Pharmacy initiatives target prescription drug costs. J Mich Dent Assoc. 2008;90(9):22.

Stevenson FA, Leontowitsch M, Duggan C. Over-the-counter medicines: Professional expertise and consumer discourses.Sociol Health Illn. 2008;30(6):913-928.

Tobacco Industry

Andersen BS, Begay ME, Lawson CB. Breaking the alliance: Defeating the tobacco industry’s allies and enacting youth access restrictions in Massachusetts. Am J Public Health. 2003;93(11):1922-1928.

Celebucki CC, Diskin K. A longitudinal study of externally visible cigarette advertising on retail storefronts in Massachusetts before and after the Master Settlement Agreement. Tob Control. 2002;11 Suppl 2:ii47-53.

Chriqui JF, Ribisl KM, Wallace RM, Williams RS, O’Connor JC, el Arculli R. A comprehensive review of state laws governing Internet and other delivery sales of cigarettes in the United States. Nicotine Tob Res. 2008;10(2):253-265.

Feighery EC, Ribisl KM, Achabal DD, Tyebjee T. Retail trade incentives: How tobacco industry practices compare with those of other industries. Am J Public Health. 1999;89(10):1564-1566.

Feighery EC, Ribisl KM, Clark PI, Haladjian HH. How tobacco companies ensure prime placement of their advertising and products in stores: Interviews with retailers about tobacco company incentive programmes. Tob Control. 2003;12(2):184-188.

Feighery EC, Ribisl KM, Schleicher N, Lee RE, Halvorson S. Cigarette advertising and promotional strategies in retail outlets: results of a statewide survey in California. Tob Control. 2001;10(2):184-188.

Feighery EC, Ribisl KM, Schleicher NC, Clark PI. Retailer participation in cigarette company incentive programs is related to increased levels of cigarette advertising and cheaper cigarette prices in stores. Prev Med. 2004;38(6):876-884.

Gilbertson T. Retail point-of-sale guardianship and juvenile tobacco purchases: assessing the prevention capabilities of undergraduate college students. J Drug Educ. 2007;37(1):1-30.

Gilpin EA, White VM, Pierce JP. How effective are tobacco industry bar and club marketing efforts in reaching young adults?Tob Control. 2005;14(3):186-192.

Glanz K, Sutton NM, Jacob Arriola KR. Operation storefront Hawaii: Tobacco advertising and promotion in Hawaii stores. J Health Commun. 2006;11(7):699-707.

Henriksen L, Feighery EC, Schleicher NC, Cowling DW, Kline RS, Fortmann SP. Is adolescent smoking related to the density and proximity of tobacco outlets and retail cigarette advertising near schools? Prev Med. 2008;47(2):210-4.

Henriksen L, Feighery EC, Schleicher NC, Haladjian HH, Fortmann SP. Reaching youth at the point of sale: cigarette marketing is more prevalent in stores where adolescents shop frequently. Tob Control. 2004;13(3):315-318.

Henriksen L, Feighery EC, Wang Y, Fortmann SP. Association of retail tobacco marketing with adolescent smoking. Am J Public Health. 2004;94(12):2081-2083.

Lavack AM, Toth G. Tobacco point-of-purchase promotion: Examining tobacco industry documents. Tob Control. 2006;15(5):377-384.

Loomis BR, Farrelly MC, Mann NH. The association of retail promotions for cigarettes with the Master Settlement Agreement, tobacco control programmes and cigarette excise taxes. Tob Control. 2006;15(6):458-463.

Loomis BR, Farrelly MC, Nonnemaker JM, Mann NH. Point of purchase cigarette promotions before and after the Master Settlement Agreement: exploring retail scanner data. Tob Control. 2006;15(2):140-

Pollay RW. More than meets the eye: on the importance of retail cigarette merchandising. Tob Control. 2007;16(4):270-274.

Sepe E, Ling PM, Glantz SA. Smooth moves: bar and nightclub tobacco promotions that target young adults. Am J Public Health. 2002;92(3):414-419.

Slater S, Chaloupka FJ, Wakefield M. State variation in retail promotions and advertising for Marlboro cigarettes. Tob Control. 2001;10(4):337-339.

Slater S, Giovino G, Chaloupka F. Surveillance of tobacco industry retail marketing activities of reduced harm products.Nicotine Tob Res. 2008;10(1):187-193.

Slater SJ, Chaloupka FJ, Wakefield M, Johnston LD, O’malley PM. The impact of retail cigarette marketing practices on youth smoking uptake. Arch Pediatr Adolesc. Med. 2007;161(5):440-445.

Slater SJ, Chaloupka FJ, Wakefield M, Johnston LD, O’Malley PM. The impact of retail cigarette marketing practices on youth smoking uptake. Arch Pediatr Adolesc Med. 2007;161(5):440-445.

Smith EA, Blackman VS, Malone RE. Death at a discount: how the tobacco industry thwarted tobacco control policies in US military commissaries. Tob Control. 2007;16(1):38-46.


Studies of Multiple Industries

Ashe M, Jernigan D, Kline R, Galaz R. Land use planning and the control of alcohol, tobacco, firearms, and fast food restaurants. Am J Public Health. 2003;93(9):1404-1408.

Feighery EC, Ribisl KM, Achabal DD, Tyebjee T. Retail trade incentives: how tobacco industry practices compare with those of other industries. Am J Public Health. 1999;89(10):1564-1566.

Freudenberg N, Galea S, Fahs M. Changing corporate practices to reduce cancer disparities. J Health Care Poor Underserved.2008; 19(1):26-40.

Hemenway D. The public health approach to motor vehicles, tobacco, and alcohol, with applications to firearms policy. J Public Health Policy. 2001;22(4):381-402.

Kotecki JE. Sale of alcohol in pharmacies: results and implications of an empirical study. J Community Health. 2003;28(1):65-77.


News Updates: New Reports on the Alcohol, Tobacco and Firearms Industries

The gun industry’s role in trafficking weapons to Mexico, the FDA set to regulate tobacco, and the new venues of alcohol advertising: the influence of corporations on population health is all over the news! Check out highlights from three new reports that focus on regulation.


Out-of-Home Alcohol Advertising: A 21st: Century Guide to Effective Regulation

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This report, by the Marin Institute (March 2009), the alcohol policy advocacy center, provides advocates and policymakers with suggestions for designing effective regulation of alcohol advertising at the state and local levels. With an eye on emerging trends in out-of-home advertising (e.g., digital billboards, advertising in public transit), this 12-page report focuses on the strengths and weaknesses of laws on the books in various jurisdictions across the U.S. It summarizes the factors advocates should consider when designing effective oversight of alcohol advertisements. With examples of restrictions likely and unlikely to withstand legal challenge and examples of model language from current laws on the books in cities in California and Pennsylvania, this report can help those interested in achieving effective regulation of alcohol advertising in their communities.


The Family Smoking Prevention and Tobacco Control Act

On April 2nd, the House of Representatives passed H.R. 1256, the Family Smoking Prevention and Tobacco Control Act by a vote of 298 to 112. This act amends the Federal Food, Drug, and Cosmetic Act (FFDCA) to grant the FDA authority to regulate the manufacturing, marketing and sale of tobacco products. The bill adds a new chapter to the FFDCA to regulate tobacco products. Tobacco products would not be regulated under the “safe and effective” standard currently used for other products under the agency’s purview, but under a new standard—”appropriate for the protection of the public health.” With the support of President Obama, Senator Edward Kennedy is expected to soon introduce a version of the house bill in the Senate. Two tobacco-state senators, Richard Burr, a Republican, and Kay Hagan, a Democrat, both from North Carolina, have submitted a weaker substitute bill that would create a new tobacco regulatory agency within the Department of Health and Human Services. As the New York Times noted in an April 25th editorial, “such a fledgling agency would almost certainly be much less effective than the F.D.A., especially since the senators don’t propose to grant it the broad powers and ample resources provided by the House-passed bill.”

Key features of the House of Representatives-passed bill include:

  1. Restrictions on marketing and sales to youth
  2. Specific authority granted to FDA to restrict tobacco marketing
  3. Detailed disclosure required of ingredients, nicotine and harmful smoke constituents
  4. FDA allowed to require changes to tobacco products to protect the public health
  5. Strictly regulated “reduced harm” products
  6. Requirement for bigger, better health warnings
  7. FDA activity funding through a user fee on manufacturers of cigarettes, cigarette tobacco and smokeless tobacco, allocated by market share

For a special report on the Family Smoking Prevention and Tobacco Control Act from the Campaign for Tobacco Free Kids, go to:


Exporting Gun Violence: How Our Weak Gun Laws Arm Criminals in Mexico and America

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The Brady Center to Prevent Gun Violence has issued a new report on the problem recently reported in the New York Times (“Loopholes to let gun smuggling to Mexico flourish,” April 14, 2009) entitled, “Exporting Gun Violence: How Our Weak Gun Laws Arm Criminals in Mexico and America.” Arguing that same laws that allow gun trafficking into Mexico have long allowed trafficking of guns to American criminals, the Brady campaign supports new laws that make background checks mandatory for all gun purchases and beefing up the authority of the Bureau of Alcohol, Tobacco and Firearms (ATF) to enforce laws.

In the report, the Brady Campaign urges U.S. leaders to look further than just enforcement of existing laws, and strengthen American gun laws to make it harder for Mexican criminals to arm themselves with U.S. firearms. The report stresses the urgent need for stronger gun laws that make it more difficult for military-style assault weapons and other guns to be sold by American gun dealers to gun traffickers who take guns over the border into Mexico, supplying weapons to fuel the violent drug cartels.

New Reports on Food, Alcohol and Tobacco Marketing

In the last few months, government and advocacy organizations have released new reports on the impact of tobacco marketing, inequities in how grocery chains serve low-income neighborhoods, and the alcohol industry’s compliance with its own voluntary guidelines. To help readers keep up, we summarize some of this summer’s publications and provide links to the full reports.


As elected officials, public health researchers and advocates increasingly recognize that corporate policies and practices have a major influence on health, Corporations and Health Watch readers may have trouble keeping up with the many reports on the subject. Since these reports often appear in the “gray literature” and are not centrally indexed, it’s easy to miss information that could inform research or practice.  To assist readers in this task, CHW summarizes a few recent reports; we do not review their claims or assess their methodologies.

Bloomberg M. Press Release: Mayor Bloomberg and Shaquille O’neal Announce New Food Standards For City Agencies, September 19, 2008.

On September 19th, New York City Mayor Michael R. Bloomberg and NBA basketball player Shaquille O’Neal announced the launch of New York City’s new food standards designed to improve the nutritional quality of the 225 million snacks and meals served by City agencies each year. These standards make New York City the first major US city to establish nutrition standards for all food purchased or served by city agencies. The new standards cover snacks and meals served in places such as schools, senior centers, homeless shelters, child care centers, after school programs, correctional facilities, public hospitals and parks. The standards mandate City agencies to serve only healthier beverages such as skim or 1 percent milk (with exceptions for babies), phase out deep frying, include two servings of fruits and vegetables in every lunch and dinner, lower salt content and increase the amount of fiber in meals.

Blue Ribbon Commission on L.A.’s Grocery Industry and Community Health.  Feeding our Communities.  A Call for Standards for Food Access and Job Quality in Los Angeles Grocery Industry. Los Angeles, July 2008.  Available in [pdf]

The Alliance for Healthy and responsible Grocery Stores, a city-wide Los Angeles coalition of 25 community, faith-based, labor, and environmental organizations last July released “Feeding Our Communities: A Call for Standards for Food Access and Job Quality in Los Angeles’ Grocery Industry”. Based on public hearings in which residents, industry experts, academics, workers and clergy gave testimony regarding the practices of L.A.’s grocery industry, the report describes the growing disparities between the industry’s treatment of L.A.’s better off and poor communities.  The report presents evidence that LA supermarket chains ignore and mistreat the area’s low-income communities. The Alliance expects to propose citywide legislation that would establish uniform standards for grocery stores in Los Angeles, ensuring that low income neighborhoods receive more equitable treatment.

Federal Trade Commission. Marketing Food to Children and Adolescents A Review of Industry Expenditures, Activities, and Self-Regulation. A Report to Congress. Washington, D.C.: Federal Trade Commission, July 2008.  Available in [pdf]

From the FTC press release on the report:
“The Federal Trade Commission today announced the results of a study on food marketing to children and adolescents. The report, Marketing Food to Children and Adolescents: A Review of Industry Expenditures, Activities, and Self-Regulation, finds that 44 major food and beverage marketers spent $1.6 billion to promote their products to children under 12 and adolescents ages 12 to 17 in the United States in 2006. The report finds that the landscape of food advertising to youth is dominated by integrated advertising campaigns that combine traditional media, such as television, with previously unmeasured forms of marketing, such as packaging, in-store advertising, sweepstakes, and Internet. These campaigns often involve cross-promotion with a new movie or popular television program. Analyzing this data, the report calls for all food companies “to adopt and adhere to meaningful, nutrition-based standards for marketing their products to children under 12.”

Kolish ED, Peeler CL.  Changing the Landscape of Food and Beverage Advertising: The Children’s Food and Beverage Initiative in Action.  Arlington, VA: Council of Better Business Bureaus, July 2008.  Available at:

From the Executive Summary:
During July through December 2007, the six companies scheduled to implement during this period, Campbell Soup Company, The Coca-Cola Company, the Hershey Company, Kraft Foods Global, Inc., Mars, and Unilever, successfully implemented their pledges in which they committed either to not engage in child-directed advertising or to feature only better-for-you products in child-directed advertising.

  • No child-directed advertising. Based on our review, Coca-Cola, Hershey and Mars did not engage in child-directed advertising as they had pledged.
  • Advertising only for better-for-you products. Based on our review, Kraft limited all, and Campbell and Unilever limited virtually all, of their child-directed advertising to better-for-you products as specified in their pledges.

Campbell reported, and the BBB separately observed, that during the initial start up period, it had overlooked removing, primarily on its child-directed company-owned websites, a relatively small amount of content that referenced or displayed products that do not (or did not then) meet its nutrition guidelines. These problems have been remedied. Its television advertising, which represented a substantially larger amount of its media expenditures, was otherwise compliant with its pledge.

  • The BBB found that Unilever, while otherwise fully in compliance, had overlooked removing a couple of products, out of many, from its child-directed company-owned website. It has corrected this issue.

During July through December 2007, Burger King Corp., Cadbury Adams, General Mills, Kellogg Company, McDonald’s, and PepsiCo began the process of implementing their pledges. Many of them, ahead of schedule, implemented their pledges to a significant degree by limiting or changing what they advertised to children, or by early implementation of other parts of their pledges, such as product placement commitments.

Langlois, A. and Crossley, R.    Proof of the Pudding: Benchmarking Ten of the World’s Largest Food Companies’ Response to Obesity and Related Health Concerns. New York: JP Morgan,  April 2008. Available in [pdf]

In April 2008, JP Morgan Limited released a report in which it evaluated ten major food companies against a best practice framework developed by Insight Investment and the International Business Leaders Forum ‘HEAL’ partnership, published in 2007: ‘A Recipe for Success’.

The report includes the key components of a comprehensive corporate response to consumer health and obesity challenges. All companies were initially evaluated on the basis of their public disclosure and assigned a score for the quality of reporting: sources used included annual reports, SEC filings, corporate responsibility reports or similar, websites.

Researchers offered to meet with managers of all the companies to discuss initial findings and provide a comprehensive explanation of their strategies and program. Seven companies took the opportunity to meet while Cadbury, Heinz and Kraft were not in a position to meet. Final analysis and score for performance completed on the basis of additional information provided in company meetings. Companies sent final provisional scores and offered the opportunity to review and provide additional information, which several did.

Marin Institute.  Why Big Alcohol Can’t Police Itself A Review of Advertising Self-regulation in the Distilled Spirits Industry.  Marin Institute, September 2008.  Available in [pdf]

In this September 2008 report, the Marin Institute analyzes the Distilled Spirits Council of the United States (DISCUS) Code of Responsible Marketing Practices reports from 2004-2007. The Federal Trade Commission relies upon a system of voluntary self-regulation to ensure responsible marketing practices by the alcohol industry. This report publishes for the first time a systematic review of the DISCUS oversight process, and concludes that the process is inherently biased and consistently fails to protect the public from irresponsible advertising.

National Cancer Institute.  The Role of the Media in Promoting and Reducing Tobacco Use.  NCI Tobacco Control Monograph Series. No 19.  Washington DC, National Institutes of Health, July 2008.  Available in [pdf]

src=”uploads/images/old_archives/img/clip_image012_0000.gif” alt=”Role of the Media in Promoting and Reducing Tobacco Use” hspace=”10″ vspace=”5″ width=”131″ height=”197″ align=”right” />Summarized from page vii of report:  This 684 page report is the most current and comprehensive distillation of the scientific literature on media communications in tobacco promotion and tobacco control. It synthesizes findings from the disciplines of marketing, psychology, communications, statistics, epidemiology, and public health and was compiled by five scientific editors, 23 authors, and 62 external peer reviewers. The report has six main parts. Part 1 frames the rationale for report’s organization and presents the key issues and conclusions of the research as a whole and of the individual chapters. Part 2 explores tobacco marketing—the range of media interventions used by the tobacco industry to promote its products, such as brand advertising and promotion, as well as corporate sponsorship and advertising. This section also evaluates the evidence for the influence of tobacco marketing on smoking behavior and discusses regulatory and constitutional issues related to marketing restrictions. Part 3 explores how both the tobacco control community and the tobacco industry have used news and entertainment media to advocate their positions and how such coverage relates to tobacco use and tobacco policy change. The section also appraises evidence of the influence of tobacco use in movies on youth smoking initiation. Part 4 focuses on tobacco control media interventions and the strategies, themes, and communication designs intended to prevent tobacco use or encourage cessation, including opportunities for new media interventions. This section also synthesizes evidence on the effectiveness of mass media campaigns in reducing smoking. Part 5 discusses tobacco industry efforts to diminish media interventions by the tobacco control community and to use the media to oppose state tobacco control ballot initiatives and referenda. Finally, Part 6 examines possible future directions in the use of media to promote or to control tobacco use and summarizes research needs and opportunities.

United Food and Commercial Workers International Union.  The Two Faces of Tesco.  Washington, D.C.: United Food and Commercial Workers International Union, June 2008. Available in [pdf]

From the press release for the report:
In June 2008, the United Food and Commercial Workers Union, a US union representing 1.3 million workers in the retail food market, launched a UK campaign to expose The Two Faces of Tesco. The report examines how Tesco operates in the United Kingdom, its home base, and the United States, and compares Tesco policies and rhetoric with its practices.

At a London press launch chaired by UK Member of Parliament Jon Cruddas the union said that it is stepping up a campaign already begun in the United States to shame Tesco to talks on union recognition and employee pay and benefits.

The UFCW seeks to represent some of the lowest-paid and least secure retail workers in the USA, more than half of whom are women, and has been seeking talks with Tesco for two years since the world’s third-largest retailer announced its entry into the US grocery market. All attempts have so far fallen on deaf ears, reports the UFCWU, and Tesco launched its chain of Fresh & Easy supermarkets in 2007 as non-union stores. UFCW says that it is seeking the chance for dialogue, to build the same constructive partnership that Tesco enjoys in the UK with the shop workers’ union USDAW.

Tracking on Corporations and Health

Those seeking to modify corporate practices that harm health often have to track changes in corporate or government policy to assess their progress. Here, Corporations and Health Watch describes a few databases and websites useful for tracking local and nation policy and the social responsibility performance of major corporations.

Tracking local policies:

Looking for policies to propose to solve a local problem related to food industry practices that reduce access to healthy food? Visit Prevention Institute’s Local Policy databasean online resource of local policies that can improve opportunities for healthy eating and physical activity. For example, a search for policies on unhealthy foods located 21 specific local policies, mostly in California, enacted to reduce promotion of unhealthy foods.


Tracking federal legislation:

Open Congress tracks legislative proposals and bills on various issues and industries. Its website explains different ways to use the site. For example, OpenCongress bill pages bring together news coverage, blog buzz, insightful comments, and more. Linking to OpenCongress thus gives readers access to the big picture as well as the official details on specific legislative proposals. If you write a blog post about a bill and include the official title (for example, H.R.800), then a link to your blog post will appear on that bill page. Another section shows the most-viewed bills, or hot bills by issue area. The site includes one-click sharing to Digg, StumbleUpon, Facebook, e-mail a friend, and more. It also allows visitors to find their members of Congress and to track their actions and what people are saying about them.

To illustrate topics of interest to Corporate and Health Watch readers, visitors can track legislative proposals on the following topics, among many others:

Alcohol taxes
Automobile industry
Food industry
Pharmaceutical research
Tobacco industry


Tracking corporate responsibility:

Several organizations have ranked corporations on their social responsibility.

Fortune Magazine ranks 100 of the Fortune 500 on business responsibility.

The Ethics & Policy Integration Centre provide a user-friendly resource for tracking US and emerging global standards in corporate responsibility. It includes sections on environmental and human righs standards, but not health or consumer protection standards.

Corporate Responsibility Index The British group Business in the Community’s CR Index is the United Kingdom’s leading benchmark of responsible business. It helps companies to integrate and improve responsibility throughout their operations by providing a systematic approach to managing, measuring and reporting on business impacts in society and on the environment. Each year the CR Index lists and rates the top 100 companies in the UK.


Tobacco and the 2008 Presidential Election

With all the political differences between Barack Obama and John McCain, few voters are likely to pay much attention to their differences on tobacco policy. Yet tobacco will continue as the nation and world’s top killer for the next few decades, making tobacco policy an important influence on health. In this report, Corporations and Health Watch reviews the major tobacco issues that the next President will face and analyzes the positions of Senators Obama and McCain on these subjects.

Tobacco decisions for the next Administration

After 2009, the President and Congress will need to decide several questions including:

  • Should the Food and Drug Administration be given the authority to regulate tobacco?
  • Should the federal government raise the excise tax on tobacco?
  • Should the United States ratify the global treaty that seeks to reduce the health burden from tobacco?
  • Should the Federal Trade Commission set new standards for tobacco marketing?
  • What should be the expectations of future Supreme Court justices on such issues as corporate rights, commercial free speech, and the government’s responsibilities for public health?

FDA and tobacco Congress is currently considering legislation to give the Food and Drug Administration oversight of tobacco products. According to the New York Times, the bill calls for the establishment of a new center for tobacco regulation within the F.D.A., gives the agency the authority to regulate the content of tobacco products and bans candy-flavored cigarettes. Recently, legislators have debated whether or not to also regulate menthol in tobacco. The Congressional Black Caucus has opposed a plan to drop menthol from the list of regulated additives, arguing that menthol cigarette advertising targets Black smokers and may exacerbate tobacco’s adverse health impact. The bill calls for the new FDA tobacco unit to be financed by tobacco industry fees projected at more than $5 billion over the next 10 years.

The FDA bill has bipartisan support, with more than 50 Senate and 215 House sponsors. Some Republicans have threatened to block further consideration of the bill and President Bush has not supported it. Big Tobacco has split on the bill, with Philip Morris endorsing it, in part, analysts say, because it will help PM consolidate its position as industry leader by restricting additional advertising. Reynolds American, the second largest tobacco company, opposes the FDA bill and has launched an advertising campaign charging that the FDA lacks the capacity to take on new responsibilities. The TV ads use a vaudeville style plate spinner to make the point that the FDA already has too many responsibilities on its plate.

Federal excise tax on tobacco Currently, the average state excise tax on tobacco is $1.13 (generating $14.5 billion in annual revenue), while the federal excise tax is 39 cents a pack (for annual revenues of $7.3 billion) ( Last year, President Bush vetoed the child health insurance bill that included a substantial hike in taxes on cigarettes. The next President and Congress will be hard pressed to find the revenues needed to support rebuilding public health and health care programs. In the current political and economic climate, where new taxes are opposed by many constituencies, tobacco taxes offer a popular source for new income.

Framework Convention on Tobacco Control In 2005, the Framework Convention on Tobacco Control (FCTC), the world’s first public health treaty, became international law. The treaty requires ratifying countries to enact proven measures to reduce tobacco use and its public health and economic burdens.

While the United States joined 167 nations in signing the FCTC, President Bush has yet to send the treaty to the Senate for ratification. In April 2008, Russia ratified the treaty, leaving the United States virtually alone among major nations that have not yet ratified. The next President and Senate will have to decide whether to maintain or change that status.

Federal Trade Commission and Tobacco Currently the Federal Trade Commission provides oversight of tobacco advertising. In the current administration, the FTC has generally favored industry positions on regulation of marketing. While changes in the FDA role may lead to changes in the FTC mandate, a new President and Congress could beef up the FTC. Through appointments, legislation and public pressure, the FTC could again become a force in tobacco control, as it had been at various points in the 1960s.

Supreme Court appointments In a recent analysis of the Supreme Court published in the New York Times magazine, George Washington University law professor Jeffrey Rosen observed that the current court is more pro-business than any in recent history. Even its more liberal members, he writes, regularly support corporate over consumer interests, a trend he attributes to a concerted 35 year effort to transform the court into the most consistently business-friendly branch of government. In 2007, for example, the Supreme Court over-turned an Oregon court’s $79.5-million punitive damages judgment against Philip Morris for its marketing of tobacco; Justice Stephen Breyer, one of the more liberal justices, wrote the majority opinion).

Any tobacco issues related to the FDA, federal taxation, changes in FTC policies or practice, commercial free speech, global treaties, liability litigation or other issues will likely eventually make their way to the Supreme Court. Thus, who the next President appoints and the Senate approves to sit on the Supreme Court will have a major influence on federal oversight of the practices of the tobacco industry. On Jan. 20, 2009, six of the nine Supreme Court justices will be over the age of 70.

McCain and Obama on Tobacco

Whoever wins the 2008 Presidential election, the next occupant of the White House will be a less dependable friend of the tobacco industry than its current resident. As Paul Billings, vice president of national policy advocacy for the American Lung Association, observed, This administration hasn’t been particularly positive on a tobacco-control agenda. Box 1 shows the responses the two candidates provided to the American Cancer Society Cancer Action Network’s (ASC CAN) question on tobacco control.


As president, will you work with Congress to enact legislation (specifically, S. 625/H.R. 1108) to rein in the most egregious manufacturing and marketing practices of the tobacco industry, and will you substantially increase the federal tobacco tax to help improve public health, save lives, and protect children from a lifetime of smoking?

ANSWER: John McCain, Republican
Responses provided by candidate

 John McCain has consistently supported regulation of tobacco products by the Federal Drug Administration and is an original cosponsor of S. 625, the Family Smoking Prevention and Tobacco Control Act. He also was a leading voice in Congress calling on tobacco companies to cease marketing campaigns for tobacco products that target children, such as the Joe Camel campaign. John McCain does not propose to increase tobacco taxes, believes that the more efforts should be made to provide educational and preventive media campaigns to discourage any American from starting to smoke, and will work to make smoking cessation programs more widely available.

ANSWER: Barack Obama, Democrat
Responses provided by candidate

I am a cosponsor of S.625 and support greater tobacco regulation at the federal level. In addition, I was an ardent supporter of reauthorization of the Children’s Health Insurance Program, which included a significant increase in the federal tobacco tax. As president, I will also increase resources for public health programs that tackle smoking, particularly for programs targeting children, individuals with mental illness and other vulnerable populations.


ACS CAN, along with the prestigious Institute of Medicine and the President’s Cancer Panel, strongly supports giving the US Food and Drug Administration authority to regulate the production and marketing of tobacco products. Today, the tobacco industry markets its deadly products to children with impunity. Every day 4,000 kids try their first cigarette 1,000 of them go on to become regular smokers. Enacting S. 625/H.R. 1108 will prevent more kids from smoking and it will save lives. ACS CAN also supports substantially increasing the federal tobacco tax because we know that every 10% increase in the cost of a pack reduces youth smoking by 7% and overall cigarette consumption by 4%. 87% of lung cancer deaths are caused by tobacco use and more than 400,000 Americans still die from tobacco related causes every year. Sensible regulation of the tobacco industry and increasing cigarette taxes will save lives.

Credit: American Cancer Society Cancer Action Network

Candidates responses to surveys provide one source of information on their positions should they be elected; another comes from their legislative voting record.

McCain’s Record on Tobacco

In the late 1990s, Senator McCain led an ultimately unsuccessful effort to give the FDA a mandate to regulate tobacco in exchange for protecting the tobacco industry against liability claims. In retaliation, the tobacco industry helped to fund negative ads against McCain in the 2000 South Carolina primary election. His loss in that state helped to force him out of the 2000 race. Currently, McCain supports legislation to give the FDA the power to regulate tobacco although he has not spoken out forcefully on the bill.

In the past, McCain has also supported increases in excise taxes on tobacco. In 2007, however, with President Bush, he voted against a children’s health insurance bill that was funded in part by an increase in the federal tobacco excise tax, a funding source McCain now opposes.

Senator McCain has promised to appoint conservative Supreme Court Justices, pointing to Justices Samuel Alito, John Roberts and Antonin Scalia as models. As Steven G. Calabresi and John O. Mcginnis, law professors at Northwestern University, observed in an op ed in the Wall Street Journal, On judicial nominations, [McCain] has voted soundly in the past from Robert Bork in 1987 to Samuel Alito in 2006. It seems unlikely that a President McCain would appoint Justices likely to change the pro-business slant of the current court.

While the tobacco industry has not provided much support to Senator McCain’s Presidential campaign, former tobacco industry lobbyists play key roles in his campaign. Charlie Black, a top campaign aide, was formerly director of BKSH and Associates, one of Washington’s most powerful lobbying groups. According to Open Secrets, since 1998 BKSH earned almost $1.3 million in lobbying fees from Philip Morris. Black’s wife, Judy Black, also an adviser to McCain, was a former executive of the Tobacco Institute, the research arm of the tobacco industry until the Master Settlement Agreement forced its dissolution. Black rejects charges that his former work for tobacco companies disqualifies him to work on McCain’s campaign. I think you can change professions and unless you did something unethical or criminal, your past profession should not be injected into the candidate’s campaign, he said. It’s absurd.

Obama’s Record on Tobacco

Senator Barack Obama has recently quit smoking, claiming that his wife would not let him run for President until he did. His policy positions on tobacco, however, date back to his time in the Illinois state Senate. According to a recent review of Obama’s legislative record on tobacco by Clifford Douglas, the Executive Director of the University of Michigan’s Tobacco Research Network, Barack Obama has:

  • With nine other Senators called on President Bush to send to the Senate for ratification the Framework Convention on Tobacco Control
  • Served as one of the original co-sponsors of legislation to give the FDA the authority to regulate tobacco products and marketing
  • Voted in support of the Display of Tobacco Products Act that makes it illegal to sell or give away tobacco products in self-service settings
  • Co-sponsored an Illinois state bill to use money from the Tobacco Settlement Recovery Fund to support a comprehensive tobacco use prevention program.

None of Obama’s current staff have been found to have worked for the tobacco industry and Obama voted against confirmation of Supreme Court Justices Alito and Roberts. In a recent analysis of the Presidential candidates positions on Supreme Court appointments in the Columbia Journalism Review, Zachary Roth wrote:

For instance, on the issue of the appropriate balance between corporate and individual rights: the press should make clear that Obama’s appointees, in keeping with his desire for empathy, can be expected to take a broader interpretation of laws designed to protect individuals; while McCain’s, if they are indeed in the Roberts-Alito mold, will interpret these laws more narrowly, and more often come down on the side of corporations.

However, whether Barack Obama will appoint Supreme Court Justices (or whether the Senate will confirm them if he does) who can reverse the pro-corporate tilt of the current court and restore a more balanced consideration of the rights of consumers and public health remains an open question.

2008 Election opportunities for tobacco control advocates?

In summary, the 2008 Presidential election campaign offers voters two major party candidates who are likely to provide somewhat more support for tobacco control than the current administration. Unfortunately, it seems unlikely that tobacco control will surface as a major campaign issue. By understanding the similarities and differences between Senators McCain and Obama on tobacco, by linking the issue of tobacco control to debates on health care policy, and by encouraging the candidates and the media to focus on their plans for the Supreme Court, tobacco control advocates may find some windows of opportunity to advance their cause.

View CHW’s coverage on Corporations, Health and the 2008 Presidential Race: Part 1: Following the Money
Part 2: Clinton, Obama and McCain on the Role of Corporations
Part 3: Clinton, McCain, Obama and the Food Industry
Part 4: Fixing the FDA: Options for the Next President

Corporate Targeting and the Impact of Corporate Practices on Socioeconomic, Racial/ethnic, Gender and Age Inequities in Health

Selected Peer-reviewed Articles

A small but growing number of studies examine how corporate practices influence health inequities. Studies have described and analyzed how corporations target selected populations for marketing of unhealthy products, assessed the impact of these practices on differences in health behavior and health, and explored other ways that corporate decisions maintain or exacerbate health disparities.

Here Corporations and Health Watch summarizes a few of these recent reports and invites readers to submit additions to the list for subsequent posting.


Baker EA, Schootman M, Barnidge E, Kelly C. The role of race and poverty in access to foods that enable individuals to adhere to dietary guidelines. Prev Chronic Dis.2006; 3(3):A76.

Analyzes the results of an audit of community supermarkets and fast food restaurants to assess the location and availability of food choices that enable individuals to meet the dietary guidelines established by the U.S. Department of Agriculture. The researchers used supermarket and fast food restaurant audit tools to assess the availability of healthy food choices in the urban area of St. Louis, Missouri. The researchers found that two factors (race and income) are associated with the location of food outlets and the selection of foods available. Individuals living in mixed or white high-poverty areas and in primarily African American areas are less likely to have access to foods that would enable them to make healthy food choices. The researchers recommend collaborations with the business community and political structures to make it economically viable to provide equal access to healthy food choices.


Brody H, Hunt LM. BiDil: assessing a race-based pharmaceutical. Ann Fam Med. 2006; 4(6): 556-60.

Analyzes scientific evidence on BiDil, the first drug approved by the Food and Drug Administration to be marketed to a single racial-ethnic group, African Americans, for the treatment of congestive heart failure. The authors discuss the problems that can arise when race is viewed as a biological-medical construct, leading to an overly simplistic assumption of a racial and hence presumed genetic difference while obscuring the “economic, social, cultural, and ethical issues lurking in the background.” The authors predict that the manufacturer will launch a publicity campaign targeting African Americans, and that family medicine doctors will be asked by their patients for the new “for blacks only” medication.


Freudenberg N, Galea S, Fahs M. Changing corporate practices to reduce cancer disparities. J Health Care Poor Underserved. 2008; 19(1):26-40.

Reviews data on disparities in cancer morbidity and mortality in the United States, and reviews evidence on corporate practices contribute to cancer risk behavior, incidence, and cancer disparities. The authors propose that the practices of the tobacco, alcohol and food industries be considered as modifiable social determinants of health. The authors conclude with recommendations for research, practice, and policy that would lead to what they term “less carcinogenic” corporate practices.


Kwate N O A. Fried chicken and fresh apples: Racial segregation as a fundamental cause of fast food density in black neighborhoods. Health and Place 2008;14:32-44.

Analyzes pathways by which racial segregation contributes to higher density of fast food outlets in Black neighborhoods in US. The author proposes that population characteristics, economic characteristics, physical infrastructure and social processes of Black neighborhoods each contribute to creation of “localized geographic areas for targeting by fast food corporations and operators.”


Kwate NO, Lee TH. Ghettoizing outdoor advertising: disadvantage and ad panel density in black neighborhoods. J Urban Health. 2007;84(1):21-31.


Investigates correlates of density of outdoor advertising in predominantly African American neighborhoods in New York City. Authors found that that black neighborhoods have more outdoor advertising space than white neighborhoods, and these spaces disproportionately market alcohol and tobacco advertisements. By linking census data with property data at the census block group level, investigators found that two neighborhood-level determinants of ad density were income level and physical decay.


Macdonald L, Cummins S, Macintyre S. Neighbourhood fast food environment and area deprivation-substitution or concentration? Appetite. 2007l;49(1):251-4.

Investigates associations between area deprivation and the location of the four largest fast-food chains in Scotland and England. The authors report statistically significant increases in density of outlets from more affluent to more deprived areas for each individual fast-food chain and all chains combined. They conclude that these findings support a “concentration” effect whereby environmental risk factors for obesity appear to be ‘concentrated’ in more deprived areas.


Monsivais P, Drewnowski A. The rising cost of low-energy-density foods. J Am Diet Assoc. 2007; 107(12): 2071-6.

Discusses the results of a study on the energy density and retail prices of 372 foods and beverages in major supermarket chains in the Seattle, WA metropolitan area in 2004 and 2006 (energy density and prices were calculated in terms of $/100g and $/1,000 kcal). The researchers discuss the role of lower energy-density foods as a strategy for managing overweight and obesity. The two-year price change for the least energy-dense foods was +19.5% whereas the price change for the most energy-dense foods was -1.8%. The researchers suggest that the lower price of energy-dense foods and the resistance of energy-dense foods to price inflation may help explain why the highest rates of obesity in the United States are observed among those with limited economic means.


Morrison MA, Krugman DM, Pumsoon P. Under the radar: smokeless tobacco advertising in magazines with substantial youth readership. Am J Public Health. 2008; 98(3): 543-48.

Reviews the level of advertising of smokeless tobacco products before and after the Smokeless Tobacco Master Settlement Agreement (STMSA). The researchers determined that the STMSA appears to have had a limited effect on adolescents’ exposure to the advertising of smokeless tobacco in magazines with high youth readership. The researchers determined that adolescent boys (aged 12-17) are at greatest risk for exposure to smokeless tobacco advertisements.


Primack BA, Bost JE, Land SR, Fine MJ. Volume of tobacco advertising in African American markets: systematic review and meta-analyses. Public Health Rep. 2007; 122(5): 607-15.

Reviews the peer-reviewed literature on the density of pro-tobacco media messages. Of the studies identified for inclusion, 11 met the eligibility criteria for the current review. The researchers pooled the results of these studies in a meta-analysis and conclude that African Americans are exposed to a higher volume of pro-tobacco advertising. The researchers also cite evidence demonstrating that African Americans bear the greatest morbidity and mortality burdens due to smoking, and that exposure to pro-tobacco media messages predicts cigarette smoking.


Schor JB, Ford M. From Tastes Great to Cool: Children’s Food Marketing and the Rise of the Symbolic. Journal of Law, Medicine & Ethics. 2007; Spring issue on Childhood Obesity: 10-21.

Discusses the increasing participation of children in the consumer markets, their heavy media use and exposure to high levels of advertising. The researchers discuss deteriorating diets and rising obesity, as well as the shift in children’s food advertisements from product attributes to symbolic messages. The researchers cite studies that demonstrate that exposure to junk food marketing is much higher for low-income children as well as racial and ethnic minority children, groups that also have higher rates of obesity.


Thompson DA, Flores G, Ebel BE, Christakis DA. Comida en venta: after-school advertising on Spanish-language television in the United States. J Pediatr. 2008; 152(4): 576-81.

Analyzes the content of food and drink commercials aired during after-school hours (3 to 9 p.m.) on two Spanish-language television stations in the United States. The researchers found that children viewing Spanish-language television in the United States after school are exposed to food and drink commercials, mostly advertising unhealthy foods, including fast foods and sugared drinks. The researchers propose that food and beverage advertising to children via Spanish-language television may contribute to the high rates of obesity among Latino children.


Yerger VB, Przewoznik J, Malone RE. Racialized geography, corporate activity, and health disparities: tobacco industry targeting of inner cities. J Health Care Poor Underserved. 2007; 18(4 Suppl): 10-38

Reviews more than 400 internal documents from the tobacco industry to explore the ways in which the tobacco industry targeted inner cities populated predominately by low-income African American residents in the 1970s-1990s. The authors cite studies demonstrating that smoking rates remain higher among the poor, the less educated and other underserved populations, despite significant reductions in the overall smoking rate in the United States. This archival analysis demonstrates how the tobacco industry’s promotion activities and the “menthol wars” fought by tobacco companies in America’s inner-cities have contributed to the tobacco-related health disparities that we observe today.

Commentary: Shifting priorities in public health: from changing lifestyles to changing political, economic, and social circumstances

Public health researchers seeking to focus greater attention on the role of corporate practices in health and disease often encounter the argument that the only significant modifiable determinant of health is lifestyle.  In this commentary, social epidemiologist Sandro Galea, MD, DrPH, Associate Professor at the University of Michigan School of Public Health makes the case for a broader perspective.

The typical public health observational study goes something like this.  We identify a disease of interest.  We then try to figure out if an exposure is indeed associated with this disease. We conduct a study and collect data from participants.  We then use a variety of increasingly sophisticated analytic tools to isolate the relationship between the exposure of interest and the disease.  Once we have identified such an association with some confidence, we recommend a behavior change that will limit exposure to that particular factor.  For example, here is the conclusion from a recent, well done study aimed at understanding several factors that may cause cardiovascular disease: “strategies should focus on reducing obesity, in particular through physical activity, elimination of cigarette smoking, and moderation of alcohol intake” (1).

In other words, to reduce heart disease, we need a lifestyle change, to eat less, exercise more, and smoke less, in order to become healthier.  These types of conclusions come from peer-reviewed academic papers published in reputable public health journals. In many ways, these recommendations arise naturally and logically from the dominant public health paradigm.  We understand the factors that make us sick and now all we have to do is to change the way we live so that we are no longer exposed to those factors.

Although it is seldom stated in this manner, the public health literature veritably shrugs in disbelief when contemplating these issues, suggesting “how could they possibly keep smoking (or drinking too much etc) when we tell them over and over how bad that is for their health?” Or, “how could they possibly continue having such an unhealthy lifestyle?”

Tobacco as a Lifestyle Problem

Let’s look back at one of the great triumphs of modern public health science to provide us with hints about our lifestyle and whether we truly can do something about it.  All students of public health well know the details of what the Centers for Disease Control and Prevention (CDC) rightly identified as modern pubic health’s greatest triumph—the identification of tobacco smoking as a risk for disease(2).  In the middle of the twentieth century a few physicians-turned-epidemiologists used follow-up cohort studies to show that cigarette smoking was associated with lung cancer and heart disease.   These studies led to other comparable studies confirming these findings.  There was opposition to this observation at first, primarily from cigarette companies, but, with the production of the surgeon general’s report on smoking in 1964, the fact that smoking causes poor health in many forms became accepted within public health circles.  What followed of course was a dramatic burgeoning public health effort to help eliminate smoking.  A large industry grew around health education programs to teach all of us about the adverse consequences of smoking and countless education programs aimed to help smokers quit.

Smoking prevalence dropped throughout North America from 42% in 1965 to 25.5% in 1990 to a current prevalence of approximately 20.8% percent (3).

Clearly, public health research and practice “saved the day”.   Through careful empiric research, we were able to identify a health menace and we have, ever since, been devoting energy to help eradicate this menace. One cannot walk through any major US urban area without seeing a plethora of health education messages touting the evils of smoking, offering Quit-Lines and other aides to quite smoking and, increasingly, rather horrifying pictures of the pathologic consequences of smoking aimed at scaring us into not smoking.

But we, or at least 1 in every 5 of us, keep smoking. In fact, we keep participating in many of these factors that we surely must by now know cause poor health, including 1 in 5 of us drink too much on a regular basis, 1 in 3 of us are overweight, and 1 in 3 of us own firearms (4).  All of these factors are well recognized to be among the leading causes of death in this country (5).

Why do people choose unhealthy lifestyles? 

Which then brings us to the issue at hand. Why is it that so many patently harmful factors in our lifestyle continue despite public health’s valiant effort?   The existing literature suggests three common answers.  First, some posit that there are psychological reasons, including pleasure in risk taking and defying conventional wisdom, in continuing to embrace unhealthy lifestyles.   Second, some argue that public health professionals are not as good as we need to be at conveying what unhealthy lifestyles should be avoided. A third explanation asserts that ultimately people do not care much about being healthy and would rather do as they please without regard for health.  All these can be summarized to say that fundamentally, people choose the lifestyle they want, irrespective of what public health might say.

While these (and other)  explanations all have some validity,  they should matter little to us as public health professionals because a focus on lifestyle is simply not the most efficient or effective approach for public health to take.  Why?

Perhaps another example, one that contrasts with the previous smoking one, illustrates the point. Another of the CDC’s great recent achievements in public health is the reduction in motor vehicle injuries and deaths (2). As the automobile took the US by storm by the middle of the twentieth century, the rates of motor vehicle accidents and deaths were soaring. There were 93,803 unintentional motor vehicle related deaths in 1960, for example (5).  Clearly, our lifestyle choice to drive was also killing us. One approach would have been for the public health establishment to urge every American to drive less, to walk instead or take mass transit – to change their transportation life style.  But that is not what happened.

Instead, a consumer movement emerged that demanded the automobile industry to make safer cars  and Congress passed laws to make that happen, usually over the objection of the automobile industry and with significant compromises.   For example, Ralph Nader’s Unsafe at any speed (1965) resulted in changes that substantially changed the contribution of motor vehicle accidents to our burden of disease morbidity and mortality.  However, in stark contrast to the tobacco example, the focus of the changes aimed at reducing car-related disease was not on the “users” of the car but rather on the circumstances of the driving.  Certainly driver education improved, but it is widely recognized that the greatest contributor to the change in car-related morbidity and mortality were safer cars, safer roads and better enforcement of traffic regulations aimed at making those collisions that were inevitable less injurious. As a result, although there are now more than 200 million drivers on the roads on a regular basis, compared to under 90 million in 1960, the rates of motor vehicle accidents in the US is less than 1.5 per 100 million vehicle miles traveled compared to approximately 5 per 100 million vehicle miles traveled in 1960 (6, 7).  In other words, we did not really change our lifestyle (driving) at all (in fact, we are driving much more than ever), but still improved our health. We can argue about whether a different approach might have led to more sustainable and better environmental outcomes, but in this case changing corporate practices rather than lifestyle led to dramatic improvements in public health.

In contrast, until the last decade or so, tobacco control focused primarily on changing individual behavior.  As new policies were passed to ban smoking in public places and increase tobacco sales taxes, the declines in tobacco smoking accelerated, showing the value of integrating strategies to change individual lifestyle and policy.

Both these examples in fact reinforce the observation that changing lifestyles is immeasurably difficult, requiring not only efforts to change deeply held beliefs and practices one person at a time but also to continue to “treat”  the new recruits into tobacco use, or eating or drinking too much.  Thus, perhaps changing lifestyles should not be the point of what we do in public health but rather changing circumstances should be. Perhaps it is time to recognize that changing lifestyles is in fact very difficult and that a more efficient and effective approach would be to change the political, economic, and social circumstances within which  people live their life as they please, to the fullest. This strategy also acknowledges that people do not choose lifestyles in a vacuum but are influenced by corporate practices such as advertising and product design, by public policies, and by the “opportunity structures” of our market economy.

Objections to a critique of lifestyle

This argument can lead to complaints along three grounds.  First, some would object to leaving individuals to their own lifestyle choices within a healthier environment as insufficient given that some lifestyles are inherently injurious to self or others.  Second, some critics might assert that if public health were to take responsibility for the circumstances within which we live, it would contribute to a “nanny state”, highly unpopular in a country where individual autonomy is prized almost above all other virtues.  Third, some public health experts believe that it is outside our professional domain to seek to change economic, political, and social circumstances. In my view, each of these criticisms is in fact wrong. Let us tackle each one.

We cannot avoid dealing with lifestyles; some lifestyles are always harmful. It may seem that some lifestyles are simply harmful in an absolute sense, but is this really the case?  Let’s return to the cigarette example.  We now know that tobacco companies worked hard to make cigarettes more addictive to increase consumption and therefore profit. From the point of view of addictiveness and carcinogenicity, they are harmful by design.  To take another example, people choose high fat, high calorie food in part because that is what has been most advertised and made most available.  In these two cases, the health consequences of lifestyle “choices” are the direct result of efforts to make a profit.  With different food or tobacco policies, the default choices could be very different.  So what do public health professionals work to change—the environments and policies that make some lifestyle choices unhealthy or the behaviors themselves?

Public health cannot tackle political, economic, or social circumstances because that threatens individual autonomy. Would a public health focus on changing the circumstances within which we live mean that public health would reduce individual autonomy?  Of course it could but the critical point is that doing so would not be any different than what is already done to our individual autonomy by forces other than public health.  We do not choose the cigarettes we smoke—we smoke cigarettes that are made for us by corporations acting under a set of their own incentives (primarily to maximize profits) that are often not aligned with the goal of improving our health.  We often have little choice about the food we eat.  Recent research shows that those living in poor neighborhoods have more access to unhealthy foods and less to healthy ones. Not surprisingly, they then eat those available foods.  Similarly, for the most part drivers do not choose to drive in safer cars, on safer roads than we used to drive on 50 years ago. These choices are made for us by political, economic, and social forces that are larger than ourselves. It has always been so and it will always be so. Urging public health to tackle reshaping our circumstances would introduce a player among these forces that shape our circumstances whose interest is in the promotion of health rather than in the promotion of profit (as in the case of corporations) or electoral success (as in the case of political parties).  The choice is not whether parents should have sole rights to make health decisions about their children – our world is too complicated for that.  Rather, the question is who do Americans want looking out for their children’s health—public health professionals or McDonalds?  Public health professionals should welcome an opportunity to argue they will better protect autonomy than Ronald McDonald.

Public health simply is not equipped to tackle changing contexts. This third objection is a plaintive one—but what can public health do?  Public health arises from medicine, which is concerned with the health of individuals. The forces of public health are much weaker than are political, economic, or social forces.  How could we possibly compete?  It is self-evident that unless we try to compete we cannot succeed. It is also true that challenging contextual forces that shape health as a central focus would require substantial retooling of the public health profession.  It would require re-thinking how we teach our students, the goals and methods of professional practice, and the value of being well-regarded by all sectors of society.  But other professions have been able to conduct similar retooling. Why then not public health?  For example, many US State Attorneys General were, in the 1970s and 1980s focused on the eradication of organized crime.  This scarcely remains the focus on AG efforts nationwide today. In fact, AG efforts have been, in the past decade, much more focused on curtailing illegal financial sector activity than on what the AG offices used to work on a decade ago. Surely such focus shifting could not have been easy. But it happened, and arguably the law-abiding citizenry is better for it.

Another approach to public health is possible

Similarly, public health can decide that the old target, lifestyle, is no longer, or perhaps never was, such a fruitful target for our efforts, and move toward another target, the circumstances within which we live, the political, economic, and corporate practices that shape our environment, with the goals of effecting change here in order to promote the health of the public.   The objections to such an approach rest primarily on a lack of imagination on our part that we can indeed achieve a change in focus in the profession.  I argue that such a change is not optional, as much as necessary, for public health achievement in the twenty-first century.

Sandro Galea is the editor of Macrosocial Determinants of Health (Springer 2007) and can be reached at



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2. CDC. Ten great public health achievements–United States, 1900-1999. MMWR 1999;48:241-3.

3CDC. Surveillance for Selected Tobacco-Use Behaviors — United States, 1900-1994. MMWR 1994; 43: 5-6.

4.  Mokdad AH,  et al. Actual causes of death in the United States, 2000.  JAMA. 2004;291(10):1238-45.

5.  Okoro et al. Prevalence of household firearms and firearm-storage practices in the 50 states and the District of Columbia: findings from the Behavioral Risk Factor Surveillance System, 2002. Pediatrics. 2005;166(3):e370-e376

6.  CDC.  Achievements in Public Health, 1900-1999 Motor-Vehicle Safety: A 20th Century Public Health Achievement. MMWR 1999; 48(18);369-374.

7.  Fatality Analysis Reporting System.  Encyclopedia.  Available at