However, unlike many other behaviourally caused threats to public health, smoking is unusual in that it has a very powerful, multi-national backer -the tobacco industry promoting and encouraging its spread. An alternative answer to the question "why do young people smoker?" therefore, is that they do so because the tobacco In industry succeeds in recruiting and retaining them.

They achieve this success by using marketing: a tried and tested business discipline that underpins the success of all the major corporations, from Coca Coal to Nike In essence, marketing ensures that the company's efforts focus on the profitable satisfaction of consumer needs and that the operating environment .remains favourably disposed towards this end. Effective tobacco control must, therefore, combat the industry's marketing. The recent EU directive on tobacco advertising is a major step forward in this respect. It came about after years of careful examination of the industry's advertising (9) and the impact of this on smoking prevalence, especially amongst he young. The resulting insights were put in the public domain and formed the basis of highly professional and successful lobbying campaign.

What is tobacco marketing? Marketing is everything the tobacco industry does to encourage the profitable use of their products. At its most obvious level, it takes the form of advertising. Indeed, advertising and marketing are sometimes seen as synonymous. However, marketing is much more than this (10,11). Firstly, advertising is only one technique marketers use to speak to consumer about the product: a raft of other methods. Including sponsorship, direct mail, public relations, loyalty scheme, brand stretching, product placement and the pack itself are used to the same end. All this activity is brought together in the brand, which is carefully developed and honed to express the product's "personality".

Secondly, the marketer doesn't just need to tell people about the product, but also to ensure that it is priced, distributed and engineered correctly (11). In this context, "correctly" means in a way that meets the needs of the customer. This, of course is likely to vary from one customer to the next. The marketers therefore divides his potential market into segments with similar needs, such as young starters or older established smokers, and targets them with appropriate pricing, distribution and product strategies.

The last of these variables has become one of the most notorious in tobacco marketing. Disclosure of company documents, largely in the US, shows that manipulation of cigarette formulation is a key strategy. Many people now argue, for instance, that Marlboro's dominance of the cigarette market is as much due to the use of ammonia in their tobacco as it is to the ubiquitous cowboy (12). The ammonia enables the smoker to get quicker and more acute access to the nicotine, a necessity for the established smoker and a valuable hook for the star. Similarly, the addition of organic salts to tobacco makes the smoke more palatable, especially to the new customer. Pricing strategies are also important to tobacco. There is a strong link between price and product image and this provides a good way of reinforcing your brand and differentiating it from the competition.

For the starter segment, premium pricing is appropriate. Adolescents are extremely price insensitive and consistently opt for the more expensive products, if they are visible and socially important. Therefore the pricing strategy should clearly demonstrate the high quality and style of the brand, if the product is to meet the adolescents' needs for image and social status (13,14,15,16).

For established smokers, their addiction and maturity makes the price-image relationship less of an issue, making the more reluctant then starters to pay higher prices. However, the evidence suggests that consumers would rather cut back on essentials such as food than give up cigarettes altogether. The industry also runs couponing schemes and sales promotions to reduce the perceived price of smoking. These types of pricing strategy tie the established smoker to one particular brand and reward them for their custom.

Distribution strategy helps build the brand personality and target the specific needs of each segment. In the UK, for example, despite bans on the sales of cigarettes to minors, distribution tactics still play a big role in targeting them. Wide distribution ensures cigarettes become omnipresent and a cultural norm, encouraging adolescents to overestimate the extent, and underestimate the social disapproval, of smoking (17.18,19).

More practically, marketers can place their products in those outlets where it is easier for adolescents to buy cigarattes and many of them do so successfully. A survey conducted in Scotland (1) found that on the last occasion that 11-15 yea old smokers had tried to purchase cigarettes, as many of 83% of them had pruchased them successfully. The vast majority of these purchases were made in newsagents, tobacconists or sweets hops. Shops like these depend for their livlihood on the income from tobacco and most owe much of their overall sales to children, making them a good option for under-age distribution. Indeed. A leaked 1990 memo from RJ Reynolds revealed how the sales team were actively encouraged to make contact with tobacconists near schools and colleges (20). For the established, smoker, wide distribution also helps crate an environment of normality and reassurance. Furthermore, the distribution network is so complete that the smoker can rest assured that in almost all-social situations, cigarettes will be readily available with little trouble.

The product, pricing and distribution strategies are combined with the promotional strategy into a coherent whole, ore marketing mix, to maximise customer satisfaction. Careful and continuous market research will be used to develop, monitor and adjust this overall strategy. Research is the industry's eyes and ears, if we are to combat them effectively.

Beyond the customer
But even these does not do full justice to marketing. It also moves beyond the final customer, recognising that their choices are going to be influenced by their social context. For example, public places and subsidies to tobacco farmers are all likely to impact on their business. This means that tobacco marketers will also target politicians, retailers, farmers and even the scientific community to try and ensure that the operating environment remains as supportive as possible (21).

Furthermore, they also have a great interest in keeping more general public opinion as favorable as possible. The major threat to the industry comes from health advocates, legislators, and litigants, none of whom are likely to be susceptible to direct marketing activity. Interestingly, the threat they offer far outweighs that from rival tobacco companies-the extent of brand loyalty among smokers is virtually unheard of in any other consumer goods market, with consumers switching brands perhaps two or three times in their smoking lives (16.22)

The tobacco industry has therefore developed a highly sophisticated PR and publicity machine. From press releases, the lobbying of politicians, creating smokers' rights groups, supporting good causes, to donating its prominent billboard space to political parties, the industry aims to take a pro-active stance in defending itself.

A primary tactic of its PR machine is to passionately deny all claims that tobacco is either harmful, addictive or anything other than an exercise in free choice. Thus, the industry denies all claims that cigarette smoking is detrimental to the health of the smoker. Instead, via the use of media relations experts and its own strategically placed scientific experts, it claims that the relationship between cigarette smoking and disease is nothing more than the manipulation of statistics.

The industry has now lost the debate. The epidemiological evidence is overwhelming. The industry has also vehemently denied that nicotine is either addictive or a drug, the argument being that it is a sociable habit which is enjoyed as much as drinking coffee or eating chocolate. Again the scientific evidence is now becoming incontrovertible.

Finally, the industry has fought the idea that advertising influences consumption. Yet again their protests are looking increasingly feeble.

However, none of these areas are failures from the industry's perspective. The PR activity serves to confuse and dilute the health educators' message to the individual; it provides governments with an excuse to continue relying on the revenues from the industry; and it ties up health activist in increasingly esoteric arguments that demand expensive, time-consuming and ultimately barren research. Both interesting examples of mutually beneficial exchanges.

In the meantime the real concern - that large and powerful companies should continue to se a proven discipline and technology, marketing, to push a highly dangerous drug-goes largely unchallenged. Tobacco control needs to refocus attention on this issue by exposing their methods and specious arguments to public scrutiny.

Human behavior and strategic thinking
Two key ideas underpin tobacco marketing. First, tobacco companies recognise that their fundamental concern is with human behavior, whether it be that of the consumer or the politician. All manner of theories of behavior are therefore of interest. At base, however, these theories are reduced to two basic tenets: in a liberal democracy human behavior is voluntary and benefit driven. People do things because they want to and because there is something in it for them, As the tobacco industry might express it, adolescents use our products, retailers sell them and politicians help us behavior is voluntary and benefit driven. People do things bevause they want to and bevause there is something in it for them. As the tobacco industry might express it, adolescents use our products, retailers sell them and politicians help us bevause they want to, and they get a clear benefit out of so doing.

Furthermore, the industry approaches this task from a long term, strategic perspective. Customer loyalty has become a by-word of modern modern marketing, ever since researchers discovered that it costs five or six times as much to gain a new customer as keep an existing one (23). This has shifted the marketers focus from one off transactions to ongoing relationships. The extent of this strategic thinking is perhaps most obvious in branding. Ads for Marlboro or Camel dating back fifty years still have clearly regcognisable iconography.

Tobacco control's response must be built on the same two principles of voluntary, benefit driven behavior and strategic thinking. We too must build relation ships with key decision-makers. But first we need to undermine those of the tobacco industry.

What can you do?
The tobacco industry is to lung cancer what the mosquito is to malaria. If we are to reduce the dreadful toll from smoking related diseases, we need to combat their marketing effort. This in turn means we need to know much more about it.

We need to know what the industry is doing in every corner of the world, including your neighborhood. What advertising are they using? What product, pricing and distribution innovations are they introducing? How do they do their market research? Are they targeting vulnerable groups such as children and women? And at a higher level, what deals are they doing with decision-makers and politicians?

In those countries where there are restrictions on tobacco marketing, we need to know how they respond to these controls and especially what other marketing activity they are currently using or will introduce to circumvent them. In counties where there are no controls, information about tobacco marketing will provide the first important step towards their introduction. Further more, this task is urgent, because as the industry becomes more embattled in Europe, North America and the Antipodes it will increasingly turn its attention to the rest of the world. Tobacco is a global business, and we need to respond globally. Otherwise the horrific toll from smoking will not be reduced, it will only continue to be exported.

NGOs have a vital role to play in this process. Tobacco control cannot match the resources of big tobacco. We cannot invest millions of dollars in market research to monitor tobacco industry activities and deconstruct their marketing strategies. However, there are many people around the world working in health and welfare NGOs people like you who are becoming increasingly concerned about the smoking epidemic. If you were to start watching and reporting on the industry's marketing activities then our information and lobbying base would be greatly strengthened.

We would like you to monitor the tobacco industry's activity in your locale, and tell us what they are doing. Any of marketing activities described in this paper are of interest:

Please send material to
Prof. Gerard Hastings
Center for Tobacco Control Research
University of Strathclydc:
173 Cathedral Street Glasgow,
Scotland G40RQ UK

The Centre for Tobacco Control Research is core-funded by the Canter Research Campaign

References

1. Barton J, Jarvis L. Smoking among secondary school children in 1996: Scotland. 1997. Office for National Statistics. Social Survey Division. London. The Stationery Office.
2. Goddard E. Why children start smoking. 1990. London: HMSOIOPCS.
3. Jackson C, Henriksen L, Dickinson D, Messer L and Robertson SB. A longitudinal study predicting patterns of cigarette smoking in later childhood. Health Education and Behavior 1998; 25:436-447.
4. Morgan M and Grube JW. Adolescent cigarette smoking: a developmental analysis of influences. British Journal of Developmental Psychology 1989; 7: 179-189.
5. Health Education Authority. Teenage Tracking Survey (4). 1992. London: Health Education Authority.
6. Patton GC, Carlin JB, Wolfe CR, Hibbert M and Bowes G. The course of early smoking: a population based cohort study over three years. Addiction 1998; 93: 1251-1260.
7. Jarvis L, Office for National Statistics. Smoking amongs secondary school children in 1996: England. 1997 London: The Stationery Office, pp 90-395.
8. Royal College of Physicians. Health or smoking. 1983. London: The Royal College.
9. Hastings GB and Aitken PP. Tobacco advertising and children's smoking: a review of the evidence. European of Marketing 1995; 29: 6-17
10. Baker MJ. The Marketing Book. 1994. Oxford: Butterworth-Heinemann.
11. Kotler P. Marketing management: analysis, planning, implementation and control. 1991.
12. ASH. Tobacco additives: cigarette engineering and nicotine addiction. 1999. London: ASH.
13. Barnard M and Forsyth A. The social context of I under-age smoking: a qualitative study of cigarette brand preference. Health Education Jourma1 1996; 55: 175-184.
14. DiFranza JR et al. RJR -Nabisco's cartoon camel promotes camel cigarettes to children. Journal of the American Medical Association 1991; 266: 3149-3153.
15. DiFranza RJ. The effects of tobacco advertising on children. Slama K.Tobacco and Health. Proceedings of the9th World Conference on Health. 1995. New York: Plenum. pp. 87-90.
16. Pollay al. The last straw: cigarette advertising and realized market shares among youth and adults, 1979 1993. Journal of Marketing 1996; 60: 1-16.
17. Davis RM. Reducing youth access to tobacco. JAMA 1991; 266: 3186-3188.
18. Pierce JP et al. Influence of tobacco marketing and exposure to smokers on adolescent susceptibility to smoking. Journal of the National Cancer Institute 1995; 8'/.
19. Waketiejd M et al. Illegal cigarette sales to children in South Australia. Tobacco Control 1992; I: 114-117.
20. Hilts PJ. Smokescreen -The Truth behind the Tobacco Indust1J' Cover-up. 1996. Addison Wesley, p 96 quoting J P Mc.1ahon, Division Manager in RJR Sales, Memo to Sale!; Reps, Young Adult Market 1990, 10 January.
21. Koop CE. The tobacco scandal: where is the outrage? Tobacco Control 1998; 7: 393-396.
22. DiFranza JR et al. Tobacco acquisition and cigarette brand selection among youth. Tobacco Contro11994; 3: 334-338.
23. Knauer V. Increasing customer satisfaction. 1992. US Office: of Consumer Affairs: Puells, Co.