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Open Access Publications from the University of California

Scholarly Works (42 results)

  • Article
  • Peer Reviewed
UC San Francisco Previously Published Works (2018)
There has been a global decline in tobacco consumption that, if continued, will negatively impact the tobacco industry's profits. This decline led the industry to invent and market new products, including heated tobacco products (HTP). HTP are an extension of the industry's strategies to undermine government's tobacco regulatory efforts as they are being promoted as part of the solution for the tobacco epidemic. Under the moniker of 'harm reduction', the tobacco companies are attempting to rehabilitate their reputation so they can more effectively influence governments to roll back existing tobacco control policies or create exemptions for their HTP. Rolling back tobacco control policies will make it easier for the companies to renormalise tobacco use to increase social acceptability for all their products. When regulations are absent or when loopholes exist in classifying HTP as a tobacco product (thus subject to all tobacco control regulations), the industry's marketing of HTP is making these products more visible to the public and more accessible. Governments need to ensure that HTP are regulated as tobacco products or drugs and reject partnerships with the tobacco companies to promote 'harm reduction'. The tobacco companies remain the vector of the tobacco-caused epidemic and cannot be part of the global tobacco control solution.
    Cover page: Heated tobacco products: another tobacco industry global strategy to slow progress in tobacco control
    • Thesis
    • Peer Reviewed
    UC San Francisco Electronic Theses and Dissertations (2024)

    Background: Tuberculosis (TB) is one of the leading causes of infectious disease deaths worldwide. Despite effective and widely available treatment, in 2022, an estimated 10.6 million people were infected with TB and 1.3 million people died from TB.1 TB is also the leading cause of death among people living with HIV (PLHIV), causing 167,000 deaths worldwide in 2022 and highlighting the importance of the TB/HIV “syndemic.”2 Both TB and HIV have long been recognized as diseases that disproportionately impact the impoverished who primarily reside in resource limited settings. To break out of the cycle of poverty and disease, interventions to minimize socioeconomic vulnerability, termed social protection interventions, are now a key pillar of the World Health Organization (WHO) End TB Strategy, the 2023 United Nations General Assembly High-level meeting commitments for TB-affected individuals and households, the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the United Nations’ Sustainable Development Goals (SDGs). However, there are significant gaps in understanding the impact of, and barriers to access social protection interventions among people with TB and or HIV in high burden, low income countries (LICs). Further, key information about how to operationalize social protection in LICs is lacking. Objectives: To address the aforementioned gaps, this study used a multimethod approach that uses published research and programmatically available data to quantify the extent to which social protection interventions improve TB treatment success and HIV viral load suppression, as well as empirical data collection to inform the design of policies and strategies that may improve the uptake of social protection for TB and HIV affected individuals and communities. The three aims of this dissertation were to quantify the effect of social protection interventions on TB treatment and socioeconomic outcomes (Aim 1), to estimate the association between socioeconomic characteristics and HIV treatment outcomes, as well as outcomes pertaining to antenatal care among pregnant and lactating women with HIV in Zimbabwe (Aim 2), and to describe barriers and facilitators to accessing social protection interventions among PLHIV both with TB and at risk for acquiring TB (Aim 3). Methods: For Aim 1, we conducted a systematic review and meta-analysis to evaluate if people with TB who had been recipients of social protection interventions demonstrated an improvement in TB treatment or socioeconomic outcomes when compared to people with TB who had not been recipients of social protection interventions. For Aim 2, we used generalized estimating equations to quantify the association between sociodemographic characteristics and various clinical outcomes among pregnant and lactating women with HIV in Zimbabwe. Lastly, for Aim 3, we conducted in depth, semi-structured interviews with 25 PLHIV (with and without TB) in Zimbabwe to assess barriers and facilitators to accessing social protection interventions. Results: Our systematic review and meta-analysis yielded 46 articles for inclusion. Our meta-analysis demonstrated that recipients of social protection interventions had 2.12 times the odds of TB treatment success (defined as cure or completion of treatment) compared to individuals who were not recipients of these interventions (95% CI 1.7, 2.6). Our findings also suggested improved economic outcomes, such as lower rates of catastrophic costs (total costs in excess of 20% of annual household income), among recipients of social protection interventions. Using generalized estimating equations, we found that in Zimbabwe, pregnant and lactating women with HIV experience many forms of poverty and socioeconomic vulnerability. Intimate partner violence was significantly associated with HIV viral load non-suppression across several models. Additionally, dissaving, or negative financial coping strategies, was associated with delayed presentation to antenatal care. Lastly, the semi-structured interviews provided key insights into barriers and facilitators accessing social protection interventions. These barriers included lack of knowledge about existing social protection interventions, limited reach of social protection interventions, and limited sustainability of social protection interventions. Conclusions: When implemented effectively, social protection interventions can significantly improve TB treatment outcomes for at-risk individuals. Pregnant and lactating women with HIV are particularly vulnerable to the co-occurring effects of HIV and poverty, but additional research is needed to better understand how to target social protection interventions to support at-risk populations effectively. Lastly, PLHIV with and without TB in Zimbabwe experience a range of socioeconomic vulnerabilities, but encounter multiple barriers to accessing social protection interventions. Efforts must be made to improve access to social protection among vulnerable populations to optimize their potential benefit.

      Cover page: Barriers, facilitators, and potential impact of linkage to social protection interventions for individuals with tuberculosis and/or HIV in Zimbabwe
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2020)
        Cover page: The World Needs 6 Million More Nurses: What Are We Waiting For?
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2024)

        Background

        British American Tobacco (BAT) released an industry-first human rights report in 2020, which extolled the efforts and objectives of the tobacco industry giant for promoting human rights. How BAT came to brand itself as a human rights champion, being a leader in an industry long accused of enabling human rights violations from leaf-to-stub including profiting from a product which inherently violates the right to health, is unknown. Exploring BAT's evolution through reviewing its materials and Tobacco Industry Documents could shed light on their development and what it means in the tobacco control and human rights context.

        Methodology

        We reviewed publicly available materials from BAT as well as conducted archival research in the Tobacco Industry Documents digital archives at University of California San Francisco. We focused on how and when BAT used terms such as 'human rights', 'right to health', 'sustainable development goal' and 'harm reduction' as well as 'Framework Convention on Tobacco Control'.

        Results

        We reviewed 48 BAT publications and 45 documents from the Tobacco Industry Documents archives. These materials demonstrate both BAT's increasing utilisation of human rights language as well as BAT's reuse of the same language, concepts and general rhetoric. BAT has not engaged significantly or meaningfully on the human right to health.

        Conclusion

        BAT's increasing use of human rights rhetoric does not appear to reflect a shift in the company's human rights positions, particularly with respect to the right to health of consumers and BAT's lack of impactful measures to eliminate the harms of its tobacco products.
          Cover page: Tobacco industry’s human rights makeover: an archival review of British American Tobacco’s human rights rhetorical veneer
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2020)
          Growing research and public awareness of the environmental impacts of tobacco present an opportunity for environmental science and public health to work together. Various United Nations agencies share interests in mitigating the environmental costs of tobacco. Since 2000, transnational tobacco industry consolidation has accelerated, spotlighting the specific companies responsible for the environmental and human harms along the tobacco production chain. Simultaneously, corporate social responsibility norms have led the industry to disclose statistics on the environmental harms their business causes. Yet, independent and consistent reporting remain hurdles to accurately assessing tobacco's environmental impact. This article is the first to analyze publicly available industry data on tobacco manufacturing pollution. Tobacco's significant environmental impact suggests this industry should be included in environmental analyses as a driver of environmental degradation influencing climate change. Countries aiming to meet UN Sustainable Development Goals must act to reduce environmental harms caused by the tobacco industry.
            Cover page: The environmental externalities of tobacco manufacturing: A review of tobacco industry reporting
            • Article
            • Peer Reviewed
            UC San Francisco Previously Published Works (2021)

            Background

            Increasingly, international health bodies frame public health measures, including tobacco control, in the context of human rights (HR). It is unclear how prevalent is the connection between human rights and tobacco control within global health governance. This paper describes the inclusion of HR in tobacco control governance, and the inclusion of tobacco control in HR treaty oversight. We depict the current reach of HR's normative influence in framing the tobacco epidemic in global, regional, and country-specific contexts.

            Methods

            We reviewed documents (agenda, reports) from 2010 to 2019 from the World Health Assembly (WHA); the WHO Western Pacific Regional Committee Meetings (RCM); the WHO Framework Convention on Tobacco Control (WHO FCTC) Conferences of the Parties (COP); and documents provided by Pacific Island Countries party to, or by committees overseeing, HR treaties. We purposively selected the Western Pacific Region, and Pacific Island Countries specifically, to represent countries of varying populations, capacities, and governance.

            Results

            Tobacco control and HR are infrequently mentioned together in the WHAs, and primarily in only one COP. Tobacco control is mentioned in 47 HR treaty committee documents for Pacific Island Countries, mostly under the Convention of the Rights of the Child recognizing or calling for ratification of the WHO FCTC. HR and tobacco control are connected in WHO Western Pacific RCM, particularly through their two most-recent action plans adopted by respective RCMs.

            Discussion

            Tobacco control as a HR concern is gaining traction within HR treaty bodies, at least with respect to children's health in the Western Pacific Region.

            Conclusion

            Globally, HR is just emerging as an influence in global health governance for tobacco discussions. Within the Western Pacific Region however tobacco control is seen by some authorities as a HR issue. Similarly, to HR experts, tobacco control is becoming important to how Pacific Island Countries fulfill their treaty obligations, suggesting tobacco control advocates might explore these mechanisms to further influence the development of strong tobacco control measures to implement the WHO FCTC.
              Cover page: Assessing the links between human rights and global tobacco control through statements made on global fora
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2023)

              Background

              The cannabis industry has been described using the commercial determinants of health framework because it seeks to increase sales and profits through efforts to change the political environment. To increase understanding of these cannabis industry's efforts, this study describes cannabis industry campaign contributions in Colorado through an analysis of public records.

              Methods

              We reviewed datasets posted online at the Colorado Secretary of State's Transparent in Contribution and Expenditure Reporting (TRACER) Campaign Finance System. We generated descriptive data on cannabis industry contributions to elections and conducted regressions to identify predictors of contributions, and associations between lagged contributions and a legislator's cannabis industry score (how closely aligned lawmaker's legislative history is with the cannabis industry from -1 to 1).

              Results

              Between 2005-2021, 429 cannabis-affiliated contributors gave $4,658,385 (2021 inflation-adjusted) to 512 electoral committees. Contributions came primarily from non-profits (45%), businesses (27%), and individuals (25%). After recreational legalization in 2012, contributions from non-profit donors with industry ties gave way to contributions from cannabis businesses, business owners, and lobbyists. Cannabis industry contributions to local and state-wide ballot initiative campaigns historically made up the majority of the industry spending, but contributions to candidate committees more than tripled between the 2009-2010 legislative cycle and the 2019-2020 cycle. From 2017-2020, every $10,000 in lagged campaign donations from cannabis industry affiliated contributors was associated with a 0.245-point increase in a legislator's cannabis industry score (p=0.04).

              Conclusion

              Cannabis-affiliated interests made substantial campaign contributions in Colorado. Public health advocates should monitor industry connections to lawmakers and industry tactics used to mask the source of political contributions. Continued surveillance of the cannabis industry is essential to exposing conflicts of interest and preventing undue industry influence.
                Cover page: Cannabis industry campaign expenditures in Colorado, 2005-2021Creative Commons 'BY' version 4.0 license
                • Article
                • Peer Reviewed
                UC San Francisco Previously Published Works (2014)
                  Cover page: WHO FCTC article 5.3: promise but little progress
                  • Article
                  • Peer Reviewed
                  UC San Francisco Previously Published Works (2022)
                  The US Food and Drug Administration (FDA) issued orders in July 2020 authorising Philip Morris Products S.A. to market its heated tobacco product (HTP) IQOS inside the USA with claims that it reduces exposure to some dangerous substances. FDA's 'reduced-exposure' orders explicitly prohibit the marketing of IQOS with claims that IQOS will reduce harm or the risk of tobacco-related diseases. Under US law, FDA's IQOS orders are problematic because FDA disregarded valid scientific evidence that IQOS increases exposure to other dangerous toxins and that Philip Morris Products S.A. failed to demonstrate that consumers understand the difference between reduced-exposure and reduced-harm claims. Unfortunately, both 'reduced-exposure' and 'reduced-harm' are classified as 'modified risk tobacco products' under US law. Exploiting this confusion, Philip Morris International used the FDA decision as the basis for marketing and public relations campaigns outside the USA to press governments to reverse policies that ban or regulate the sales and marketing of HTPs, including IQOS. Parties to the WHO Framework Convention on Tobacco Control should reject tobacco companies' unsubstantiated explicit or implied claims of reduced harm associated with HTPs and resist Philip Morris International's and other companies' calls to relax HTP regulations based on the FDA's actions. Instead, parties should adopt policies aligned with the Framework Convention on Tobacco Control when dealing with HTPs and other novel tobacco products.
                    Cover page: FDA’s reduced exposure marketing order for IQOS: why it is not a reliable global model
                    • Article
                    Reports on Industry Activity from Outside UCSF (2002)

                    “Profits Over People” is the result of over a year of investigation of more than 10,000 pages of internal tobacco company documents, mainly from Philip Morris and British American Tobacco, who together have most of the market share in LAC, obtained through the Internet and through the Guildford depository in the United Kingdom. The report shows that the tobacco companies:

                    were intensely competitive but collaborated in campaigns against common threats to the industry;

                    hired scientists throughout the region to misrepresent the science linking secondhand smoke to serious diseases, while cloaking in secrecy any connection of these scientists with the tobacco industry;

                    designed “youth smoking prevention” campaigns and programs primarily as public relations exercises aimed at deterring meaningful regulation of tobacco marketing;

                    had detailed knowledge of smuggling networks and markets and actively sought to increase their share of the illegal market by structuring marketing campaigns and distribution routes around it; and

                    enjoyed access to key government officials and succeeded in weakening or killing tobacco control legislation in a number of countries.

                    Although these tactics and strategies are not unique to the Americas region, this is the first study to comprehensively document the industry’s specific activities in LAC.

                    • 1 supplemental PDF
                    Cover page: Profits Over People: Tobacco Industry Activities to Market Cigarettes and Undermine Public Health in Latin America and the Caribbean
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