At last Friday's installment of the Experimental College-sponsored "A Taste of Tufts: A Sampling of Faculty Research" lecture series, Edith Balbach, senior lecturer and director of the community health program, spoke about her research on the marketing and political behaviors of the tobacco industry.
Balbach began by admitting that she originally had no intention of pursuing a career in tobacco research. She was completing her doctoral work in public policy at the University of California at Berkeley and planning to write her dissertation on interagency collaboration when California passed Proposition 99.
Proposition 99, or the Tobacco Tax Health Protection Act of 1988, raised the tax on tobacco by 25 cents per pack, and mandated the extra profit be used toward tobacco education, prevention programs and tobacco-related research.
"My advisor called me in and asked if I was interested in smoking research, Balbach said. "By the time my dissertation was done, I could care less about interagency collaboration, but I was really fascinated by the tobacco industry … and how it behaves in public areas. It has sculpted my career ever since."
According to Balbach, the threat that tobacco poses to public health is growing, both in the United States and around the globe.
"Currently, almost six million people [globally die each year from] tobacco related diseases. If things don't change, it will be eight million people by 2030," she said.
But Balbach noted that tobacco use is often not high on lists of the most pressing public health issues. She explained three main reasons for this: 1) Tobacco is a slow-motion killer, 2) the diseases caused by tobacco use are not considered communicable and 3) these diseases are often labeled as resultant of personal failure.
According to Balbach, this perception is reflective of the tobacco industry's marketing strategies.
"The framing of tobacco is a direct result of systematic efforts of the tobacco industry to normalize and underestimate tobacco use," she said. "The tobacco industry's behavior is what drives a lot of what I do and think about."
For Balbach, a milestone for public health research on tobacco was the litigation against the tobacco industry that resulted in the Tobacco Master Settlement Agreement in 1998, which required that millions of pages of internal documents from tobacco companies be made public. At first, the pages were only available in a warehouse in Minneapolis, Minn., where Balbach, among other researchers, combed through the documents.
"In an effort to thwart a lawsuit, you can either narrowly comply and send as little information as possible, or you can paper them to death. The tobacco industry opted to go with papering them to death," she said.
The tobacco companies sent semi-trailer trucks full of documents to Minnesota, and Balbach compared the organization of the documents to having librarians deliberately making information difficult to find and as confusing as possible.
"Industry research has gotten fascinating, if you have the patience to do it," she said.
The information has since gone online, due to a huge donation of settlement money to the University of California, San Francisco, which scanned millions of pages of documents.
Despite the difficulty of finding relevant information, Balbach was able to glean a wealth of knowledge about the tobacco industry by virtue of having access to written documents from tobacco companies themselves.
Balbach focused on researching the marketing strategies of the tobacco industry, and she also looked at specific groups targeted by the tobacco industry, specifically women, people of low socioeconomic status, African-Americans and unions.
In order to sell cigarettes, Balbach said, tobacco companies have to overcome the inherent challenges of peddling a product that common knowledge dictates is deadly.
"To convince people to pick up a rod of burning leaves and suck it into their lungs is not something people are going to start doing naturally," Balbach said. "You have to make it addictive, but you also have to make it aspirational — cool and desirable. Making it acceptable, socially and culturally, is really important, as well as to make it widely available and as cheap as possible."
During the lecture, Balbach displayed cigarette ads dating back to the 1920s, to illustrate these tactics, as well as the tobacco companies' efforts to market to specific populations.
For example, cigarette companies have been targeting women by advertising that cigarettes will suppress the appetite for almost a century. She showed a Lucky Strike ad from the 1920s with the slogan, "To keep a slender figure, no one can deny, reach for a Lucky instead of a sweet."
This strategy was increasingly used in the 1960s with the introduction of Virginia Slims in 1968, a brand that was marketed directly toward women. Additionally, Virginia Slim's slogan, "You've come a long way, baby," was a tactic used to make smoking cigarettes something to aspire to, she said.
Balbach also displayed documents that outlined the tobacco industry's analysis of particular target populations.
One statement read, "Less educated, working class smokers are becoming more important. This may lead to a greater want of self-esteem, success, control and savings." Additionally, the documents included plans for targeting women, young adults, African-Americans and Hispanics.
Another project that Balbach worked on, which she completed last summer, was exploring the strategy of tobacco companies collaborating with organized labor. She studied the relationship — in the mid-1980s, focusing on two major policy areas: excise tax increases and smoke-free worksites. According to Balbach, tobacco and labor unions ended up having a successful relationship that she referred to as "symbiotic."
Unlike many fields, Balbach said, public health research on tobacco aims to make substantive changes.
"We are a normative field," she said. "If we get a result from research, we have to do something with it."
