The growing casino industry in the U.S. is built on a model of profitability that bears very close resemblance to two other industries: the tobacco industry and the opioid pain medication industry. While it is rather obvious that all three industries have demonstrated the ability to be consistently profitable, the model used to achieve that profitability are remarkably similar. All three industries began with addictive products. Through investments in research and development, they continually refined their product designs to emphasize and amplify addiction as a design element in order to increase profits. In each case, aggressive and deceptive marketing tactics were employed to target vulnerable populations and to normalize their addictive products despite the risks they posed to consumers. In each case, these products created substantial social costs. For the tobacco industry this includes the premature deaths of nearly half a million Americans annually, an enormous healthcare burden, and a substantial loss of productivity. For the opioid pain medication industry this includes thousands of deaths, tens of thousands of overdoses and an illicit market for other opioids that create enormous healthcare and criminal justice expenditures funded by tax dollars. The casino industry's products do not directly cause physical harm such as lung cancer or opioid overdose. Rather, this industry's products, designed to induce consumers to get in "the zone" and "play to extinction," The impact on communities caused by casinos are latent, much like the lung cancer that appears in a smoker a quarter century after she takes her first of more than a million puffs. An addicted gambler will potentially experience bankruptcy, divorce, unemployment, and perhaps engage in embezzlement or larceny to keep gambling. The volume of such individuals reduces civic engagement and family stability in communities located in the vicinity of casinos. Other social costs include loss of productivity and healthcare costs associated with comorbidities related to the addiction to casino industry products. The accumulation of social costs and misery caused by highly profitable industries may provoke responses in social attitudes and policy. Over the past twenty-five years or so, federal, state, and local policies have regulated and reduced the impact of tobacco industry products. Litigation, too, has had an impact not only on tobacco industry profits but also in increasing transparency regarding tobacco industry behavior through discovery and whistleblower testimony. Such transparency has contributed to a denormalization of that industry's business model. More recently, the opioid crisis, driven by the opioid pain medication industry, has initiated policymaking as well as thousands of lawsuits against industry leaders. The casino industry, highly reliant upon electronic gambling machines designed to addict consumers may soon find itself in a very defensive legal and policy posture much like the tobacco and opioid pain medication industries which share its business model.

Fifty years after the original 1964 US Surgeon General’s Report on Smoking and Health three paths can lead the world to largely eliminating tobacco use altogether: (i) expand current practices for demand reduction, (ii) make use of current legislators to build programs into the future, and (iii) think out of the box with new ideas, such as reducing nicotine in cigarettes to non-addictive levels. It is possible to believe that tobacco use can be eliminated before the 100th anniversary.

•Four months after an online survey over 80% of students had decreased their tanning.•Qualitative data indicated that the survey had contributed to decreases in tanning.•Completing an online survey might decrease tanning with no intentional intervention.

We investigated how industry claim-makers countered concerns about obesity and other nutrition-related diseases in newspaper coverage from 2000, the year before the US Surgeon General's Call to Action on obesity, through 2012. We found that the food and beverage industry evolved in its response. The defense arguments were made by trade associations, industry-funded nonprofit groups, and individual companies representing the packaged food industry, restaurants, and the nonalcoholic beverage industry. Individual companies used the news primarily to promote voluntary self-regulation, whereas trade associations and industry-supported nonprofit groups directly attacked potential government regulations. There was, however, a shift away from framing obesity as a personal issue toward an overall message that the food and beverage industry wants to be "part of the solution" to the public health crisis.

We examined the tobacco industry’s rhetoric to frame personal responsibility arguments. The industry rarely uses the phrase “personal responsibility” explicitly, but rather “freedom of choice.” When freedom of choice is used in the context of litigation, the industry means that those who choose to smoke are solely to blame for their injuries. When used in the industry’s public relations messages, it grounds its meaning in the concept of liberty and the right to smoke. The courtroom “blame rhetoric” has influenced the industry’s larger public relations message to shift responsibility away from the tobacco companies and onto their customers. Understanding the rhetoric and framing that the industry employs is essential to combating this tactic, and we apply this comprehension to other industries that act as disease vectors.

Introduction. - Indoor tanning is associated with increased risk of melanoma and is particularly prevalent among female college students in the U.S.Objectives. - The present study aimed to explore why female students decide to engage, and keep engaging in indoor tanning.Methods. - We included eighteen female undergraduates who participated in group discussions. The group discussions were recorded and transcribed, then they were organized into themes.Results. - Three main themes appeared: appearance reasons for tanning, tanning-related health risks, and tanning salon-marketing strategies. Students were overall informed regarding tanning-related health risks, and suggested that they justified their tanning behaviors by rationalizations. They also revealed that the marketing strategies employed by tanning salons made them more likely to tan frequently. Finally, students spoke about how the health risks, the affects on appearance, and leaving the college setting might lead them to stop tanning.Conclusions. - These findings suggest that tanning among students could be reduced both by engaging students in programs addressing rationalizations about the risks associated with tanning, and policies targeting marketing techniques and tanning salon locations. (C) 2015 Elsevier Masson SAS. All rights reserved.

AffiliationsLori Dorfman, Andrew Cheyne, Pamela Mejia, and Laura Nixon are with Berkeley Media Studies Group, a project of the Public Health Institute, Berkeley, CA. Mark A. Gottlieb and Lissy C. Friedman are with the Public Health Advocacy Institute, Boston, MA. Richard A. Daynard is with Northeastern University School of Law, Boston, MA.

Objective The aim of this study is to describe trends in the consumption of manufactured and roll-your-own cigarettes between 1991 and 2012 in Spain, and to project these trends up to 2020. Methods We estimated daily consumption per capita during 1991–2012 using data on sales of manufactured cigarettes (20-packs) and rolling tobacco (kg) from the Tobacco Market Commission, and using data of the Spanish adult population from the National Statistics Institute. We considered different weights (0.5, 0.8 and 1 g) to compute the number of rolled cigarettes per capita. We computed the annual per cent of change and assessed possible changes in trends using joinpoint regression, and projected the consumption up to 2020 using Bayesian methods. Results Daily consumption per capita of manufactured cigarettes decreased on average by 3.0% per year in 1991–2012, from 7.6 to 3.8 units, with three trend changes. However, daily consumption per capita of roll-your-own cigarettes increased on average by 14.1% per year, from 0.07 to 0.92 units of 0.5 g, with unchanged trends. Together, daily consumption per capita decreased between 2.9% and 2.5%, depending on the weight of the roll-your-own cigarettes. Projections up to 2020 indicate a decrease of manufactured cigarettes (1.75 units per capita) but an increase of roll-your-own cigarettes (1.25 units per capita). Conclusions While the consumption per capita of manufactured cigarettes has decreased in the past years in Spain, the consumption of roll-your-own cigarettes has increased at an annual rate around 14% over the past years. Whereas a net decrease in cigarette consumption is expected in the future, use of roll-your-own cigarettes will continue to increase.

Tobacco control's unparalleled success comes partly from advocates broadening the focus of responsibility beyond the smoker to include industry and government. To learn how this might apply to other issues, we examined how early tobacco control events were framed in news, legislative testimony, and internal tobacco industry documents. Early debate about tobacco is stunning for its absence of the personal responsibility rhetoric prominent today, focused instead on the health harms from cigarettes. The accountability of government, rather than the industry or individual smokers, is mentioned often; solutions focused not on whether government had a responsibility to act, but on how to act. Tobacco lessons can guide advocates fighting the food and beverage industry, but must be reinterpreted in current political contexts.

The tobacco industry consistently frames smoking as a personal issue rather than the responsibility of cigarette companies. To identify when personal responsibility framing became a major element of the tobacco industry's discourse, we analyzed news coverage from 1966 to 1991. Industry representatives began to regularly use these arguments in 1977. By the mid 1980s, this frame dominated the industry's public arguments. This chronology illustrates that the tobacco industry's use of personal responsibility rhetoric in public preceded the ascension of personal responsibility rhetoric commonly associated with the Reagan Administration in the 1980s.

OBJECTIVE:This study seeks to analyse the prevalence and correlates of electronic cigarette (e-cigarette) use, purchase location and satisfaction with its use in a sample of the general population of the city of Barcelona, Spain.DESIGN, SETTING AND PARTICIPANTS:We used participants from a longitudinal study of a representative sample of the adult (≥16 years old) population of Barcelona (336 men and 400 women). The field work was conducted between May 2013 and February 2014. We computed the prevalence, adjusted odds ratios (ORs) and their corresponding 95% confidence interval (CI).RESULTS:The prevalence of ever e-cigarette use was 6.5% (95% CI 4.7% to 8.3%): 1.6% current use, 2.2% past use and 2.7% only e-cigarette experimentation. 75% (95% CI 62.8% to 87.3%) of ever e-cigarette users were current cigarette smokers at the moment of the interview. E-cigarette use was more likely among current smokers (OR=54.57; 95% CI 7.33 to 406.38) and highly dependent cigarette smokers (OR=3.96; 95% CI 1.60 to 9.82). 62.5% of the ever users charged their e-cigarettes with nicotine with 70% of them obtaining the liquids with nicotine in a specialised shop. 39.6% of ever e-cigarette users were not satisfied with their use, a similar percentage of not satisfied expressing the smokers (38.9%) and there were no statistically significant differences in the satisfaction between the users of e-cigarettes with and without nicotine.CONCLUSIONS:E-cigarette use is strongly associated with current smoking (dual use) and most users continue to be addicted to nicotine. Six out of 10 e-cigarette users preferred devices that deliver nicotine. The satisfaction with e-cigarette use is very low.

Currently, there is an intensive debate about the regulation of the use of electronic cigarettes (e-cigarettes) in indoor places. The aim of this study was to assess the attitudes toward e-cigarette use in indoor workplaces and selected public and private venues among the general population in Barcelona (Spain) in 2013-2014.This is a cross-sectional study of a representative sample of the population of Barcelona (n = 736). The field work was conducted between May 2013 and February 2014. We computed the prevalence and the adjusted odds ratios (OR) derived from multivariable logistic regression models.The awareness of e-cigarettes was 82.3%. Forty five percent of respondents did not agree with the use of e-cigarettes in public places and 52.3% in workplaces. The proportion of disapproval of the use of e-cigarettes in indoor places was higher at 71.5% for schools and 65.8% for hospitals and health care centers; while the prevalence of disapproval of e-cigarette use in homes and cars was lower (18.0% and 32.5%, respectively). Respondents who disagreed on the use of e-cigarettes in indoor workplaces were more likely to be older (OR = 1.64 and 1.97 for groups 45-64 and ≧65 years old, respectively), those with a high educational level (OR = 1.60), and never and former smokers (OR = 2.34 and 2.16, respectively). Increased scores in the Fagerström test for cigarette dependence were also related to increased support for their use.Based on this population based study, half of the general population of Barcelona does not support the use of e-cigarettes in indoor workplaces and public places, with the percentage reaching 65% for use in schools, hospitals and health care centers. Consequently, there is good societal support in Spain for the politicians and legislators to promote policies restricting e-cigarettes use in workplaces and public places, including hospitality venues.

The Family Smoking Prevention and Tobacco Control Act exempted menthol from a flavoring additive ban, tasking the Tobacco Products Safety Advisory Committee to advise on the scientific evidence on menthol. To inform future tobacco control efforts, we examined the public debate from 2008 to 2011 over the exemption. Health advocates regularly warned of menthol's public health damages, but inconsistently invoked the health disparities borne by African American smokers. Tobacco industry spokespeople insisted that making menthol available put them on the side of African Americans' struggle for justice and enlisted civil rights groups to help them make that case. In future debates, public health must prioritize and invest in the leadership of communities most affected by health harms to ensure a strong, unrelenting voice in support of health equity.

Since 2004, 25 states have passed Commonsense Consumption Acts (CCAs) to shield the food industry from civil liability for claims arising from obesity-related health harms. These laws continue to be introduced. CCAs have generally been discussed in terms of "tort reform." For this article, we conducted a systematic analysis of the content of all 25 state laws and found that the potential impact of CCAs goes well beyond obesity-related tort reform to limits on state Attorney General (AGs) authority and significant reforms to future statutory consumer protection claims by AGs, individuals and classes of consumers. Moreover, every CCA state had pre-existing legal protections against frivolous litigation-greatly undercutting arguments made by CCA proponents.

Cigarettes result in over 400,000 preventable American deaths each year. In 2011, fewer than twenty percent of adults smoked. Since the publication of the first U.S. Surgeon General's Report on Smoking and Health nearly fifty years ago, when smoking prevalence was around forty percent, policies such as smoke-free laws, large tax increases, and litigation have collectively contributed to cut smoking prevalence in half. Unfortunately, no one expects the mix of policies currently proposed, which includes further tax increases, spatial smoking restrictions, somewhat higher minimum age restrictions, adverse publicity, and quitting assistance, to reduce U.S. smoking prevalence below fifteen percent in the foreseeable future.The rule adopted by the U.S. Food and Drug Administration (FDA) to require hard-hitting graphic warnings on cigarette packages, as is currently done in dozens of other countries, has thus far been rejected by federal judges who have found that warnings designed to arouse negative emotions violate cigarette manufacturers’ First Amendment rights.

The recognition that tobacco control and human rights concerns overlap is quite recent. This commentary reflects upon tobacco control's growth through allying with other domains, and details a particular effort to build alliances between tobacco control and human rights practitioners.