Elias I. Traboulsi, M.D.

• Cleveland Clinic Foundation
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This chapter explores the key principles of tobacco advertising and promotion and reviews important developments in regulating this promotion mens health 042013 chomikuj pilex 60 caps fast delivery. Specific areas discussed here include n 3 Use of market segmentation by tobacco firms to target consumers by demographics mens health us buy discount pilex 60caps, geographic region prostate cancer zoledronic acid 60 caps pilex for sale, behavioral factors man healthy discount pilex 60 caps online, and the psychographics of specific population groups Tools and strategies used by tobacco firms in communicating a consistent brand image prostate cancer 4 big questions generic 60caps pilex overnight delivery, including brand logos prostate oncology quotes buy 60caps pilex visa, taglines, pictorial elements, and color, as well as the development and repetition of a consistent brand message Arguments for the regulation of tobacco promotion, including the health consequences of tobacco use, the use of deceptive or misleading promotional tactics, the failure of tobacco industry efforts to self-regulate, and the ineffectiveness of partial restrictions on tobacco advertising and promotion n n 53 3. Key Principles of Promotion and Rationales for Regulation Introduction this chapter examines the promotion of tobacco products from two perspectives: its economic importance to the tobacco industry and the growing argument for its regulation as part of global tobacco control efforts. First, the chapter gives an overview of tobacco company efforts to build strong brands with an identity, a market position, and an execution aimed consistently over time at well-defined target audiences. Tobacco advertising and promotion efforts have been remarkably effective in the eyes of both consumers and the advertising industry, as evidenced by the consistent high rankings of cigarette advertising campaigns among lists of leading twentieth-century advertising campaigns reported by advertising and marketing trade publications. For Advertising Age, the Marlboro Man was the top advertising icon of the century, reflecting that this image had the most powerful resonance in the marketplace with respect to effectiveness, longevity, recognition, and cultural impact. Furthermore, Marlboro was ranked as the third-best advertising campaign of the century, surpassed only by Volkswagen and Coca-Cola. Advertising campaigns for Benson & Hedges, Winston, Camel, and Lucky Strike were also on the Advertising Age top 100 list. The value of these tobacco trademarks has been quite durable, persisting despite growing awareness 54 of the health consequences of cigarette use, an increasingly stringent regulatory environment, and ongoing litigation against the industry. As a global public health issue that is now being addressed through international law and treaty, important developments and illustrative examples from outside the United States are reviewed to lay out the broader context in which tobacco marketing-and efforts to restrict this marketing-are occurring. However, the focus of this chapter, like that of the monograph as a whole, is on the promotion of tobacco products in the United States, within the context of its corresponding legal environment. Key Principles of Tobacco Advertising and Promotion the development of a marketing strategy involves specifying a target market and establishing a related marketing mix, which is commonly broken down into four classes known as the 4Ps-product, price, place. The Role of the Media considered particularly essential for newly developed or "introduced" products, and related communications efforts are meant to tell potential customers something about the product. Promotions with an aim of persuading often focus on the reasons that one brand is better than competing brands. The promoter seeks to develop a favorable set of brand beliefs and attitudes among customers so that they will buy and keep buying the product4 (see chapter 2 for a discussion of persuasion-based processes and expectancy-value models of attitude change). In addition to focusing on brand beliefs and attitudes, persuasion-based promotions also commonly link products with desirable images (such as lifestyle imagery) and identities (such as slogans, jingles, or brand symbols). The aim is for consumers to associate the brand or product use with either positive emotions or the reduction of negative emotions. Persuasion strategies that focus on desirable image and identity characteristics are particularly important for product categories such as cigarettes, because differences among various brands are often very subtle or intangible. Finally, promotions with the goal of reminding are typically directed toward buyers who already have positive, well-established attitudes about a product, including its price, features, availability, or image. Rather, promotions tend to be directed toward well-defined consumer groups according to dimensions such as age, gender, ethnicity, income, occupation, religion, family life cycle, place of residence, lifestyles, interests, and values. Chapter 5 discusses several population groups defined by these dimensions that have been targeted by tobacco companies. The message in a segmented marketing campaign typically has reasonably broad appeal. The target audience will heavily affect communication decisions regarding what will be said, how it will be said, when it will be said, where it will be said, and who will say it. Gender Tobacco marketing aimed at women dates back to the 1920s, when American Tobacco urged women to "Reach for a Lucky instead of a sweet," playing directly to concerns about body weight8,9 (chapter 5). The audience may consist of potential buyers, current users, those who make the buying decision, or those who influence it. Segmentation is a commonly used approach for defining the target market, in which specific audiences are identified for a product by dividing a mass market into subsets on the basis of variables such as demographics, geography, preference for product benefits, consumption patterns, and psychographics. Key Principles of Promotion and Rationales for Regulation are promoted as "feminine" and explicitly targeted toward women (chapter 5 also includes discussion about cigarette brands targeted toward men). Race/Ethnicity Roughly three-fourths of African-American smokers consume mentholated cigarettes, with Newport, Kool, and Salem representing the most popular brands. For example, n Brands offering relatively high tar content and strong flavors are promoted as "masculine," often corresponding with appeals that have an action, excitement, and adventure orientation. Brands with cross-gender positioning often use promotional appeals designed to attract both sexes, such as messages about upward status and being upscale. The Role of the Media brands are commonly depicted in cigarette advertising that is targeted toward African Americans. As documented by Balbach and colleagues,16 internal tobacco industry documents show that advertising for menthol brands was designed around lifestyle appeals relating to "fantasy and escapism," "expensive objects," and "nightlife, entertainment, and music" themes. Appeals designed around concepts of "youthfulness, silliness, and fun" were also aimed at African Americans, as well as messages conveying the refreshing and medicinal aspects of menthol. Detroit, Baltimore, Washington, Memphis, Birmingham, Jackson, and New Orleans are other U. Reviews of internal tobacco industry documents reveal that cigarette trademarks are successfully marketed to youth, including consumers who are classified as "starters" or "new smokers" (chapters 5 and 7). The rationale for directing promotions toward youth is that the pivotal period for smoking initiation in the United States is early adolescence. Smokers are also known to be extremely brand loyal, so the brand choice of consumers during the early stages of their smoking "careers" becomes crucial. In the United States, less than 10% of smokers switch brands annually, with less than 8% switching companies. Researchers who examined tobacco industry documents that are accessible primarily as a result of two sets of court proceedings in Canada-the 1989 federal trial to decide the constitutionality of the Tobacco Products Control Act and the 2002 Quebec Superior Court trial to determine the constitutionality of the Tobacco Act-have reached similar conclusions. Market research for Lorillard Tobacco revealed, "The success of Newport has been fantastic during the past few years. Key Principles of Promotion and Rationales for Regulation shows this brand being purchased by black people (all ages), young adults (usually college age), but the base of our business is the high school student. Promotion philosophy of trial generation and meeting competition approved"20(Bates no. Cigarette advertising that is targeted at 18- to 24 year-olds often can appeal simultaneously to young adults and adolescents because many teenagers start smoking as a way to propel themselves into maturity. Reynolds underwent particular scrutiny for its Camel advertising campaign, in which a cartoon camel (Old Joe) was the central figure, with the theme "smooth character. Reynolds Tobacco Company, Civil Number 939359: the case that rid California and the American landscape of "Joe Camel. The Role of the Media regional differences within a domestic or international market, and climate, may also play a role in the development of promotional strategies for various brands. For example, during the early 1980s, market research for Philip Morris distinguished smoking trends among four U. It is not clear whether such a distribution indicates a long-term strategy or whether these cities are meant to act as test markets. New cigarette products, including line extensions, are commonly test-marketed on a geographically limited basis. Advance is targeted at "health conscious" smokers with a campaign that includes the following advertising copy: "Great taste-less toxins," "Advance the way you smoke," and "Everyone knows quitting is the best thing. Although geographic segmentation plays a role in the development of advertising strategies and media buys, for the most part it is national brands that dominate the U. Regional variations in cigarette brand success do not seem nearly as pronounced in the United States relative to other markets such as Canada and Australia. A review of internal tobacco industry documents reveals that the Australian cigarette market is also decidedly regionalized. Escort is a popular brand in South Australia, while Winfield has been a brand leader in Western Australia, New South Wales, and Victoria. Key Principles of Promotion and Rationales for Regulation play a role in the development of product and related promotional strategies. Camel Exotic Blends includes flavors such as Kauai Kolada and Twista Lime, which are identified as "summer" blends. With respect to occasions of use as a segmentation variable, marketers assess whether consumers are likely to use a product primarily on special occasions or more regularly. Product consumption patterns often fluctuate from month to month (described in management and marketing as "the rhythm of the business"), and cigarettes are no exception. In the United States, cigarette sales peak during the summer months, June through August. The warmer weather during the summer months may also prompt smokers to more frequently go outside to smoke in locales where indoor smoking laws have been enacted. The situation in which products are used can be considered as a market segmentation variable. Smoking is frequently done in conjunction with the consumption of alcohol or coffee, and cigarette promotions may include pictorials that encourage the co-use of these products. The statement "Complements Your Cocktail" is found on the packaging of Camel Izmir Stinger, which is one of the Exotic Blends line extensions. Reflecting the synergy between smoking and drinking alcohol, as well as a similar target consumer, several examples of industry efforts co-promote cigarette brands with particular liquor and beer brands whose cultural identity Behavioral Segmentation Behavioral segmentation involves dividing consumers into groups according to occasions of use, usage situation, extent of use, user status, and benefits sought. As cultural anthropologist Grant McCracken explains, "The meaning of a good is best (and sometimes only) communicated when this good is surrounded by a complement of goods that carry the same significance. Within this complement, there is sufficient redundancy to allow the observer to identify the meaning of the good. Conversely, Winston cigarettes combined with a bottle of fine wine would seem inappropriate. When segmenting a market, marketers also account for user status, which may involve classifying groups of consumers into nonusers, ex-users, potential users, first-time users, sporadic users, and heavy users of a product. An appearance of healthfulness and reassurance is particularly likely to be seen in the advertising of cigarette brands such as Carlton and Merit Ultra Lights, which are promoted with messages about their low-tar yields. Meanwhile, cigarette brands such as Marlboro and Camel are both classified "Value" brand advertisement for Doral cigarettes 61 3. Key Principles of Promotion and Rationales for Regulation and promoted as "premium" brands. The "premium" moniker conveys that the product is of high quality and a market leader, suggesting status redemption for its user. Tobacco advertisements are also used to link smoking with a variety of other supposed benefits such as affording pleasure, improving social confidence, advancing relaxation, reducing stress, aiding concentration, and helping in weight reduction71 (chapter 5). Reynolds that detailed an assessment of various product designs, consumer benefits can include "prestige," "cost," "time management," "social interaction," "mood enhancement," "health," "implied health," and "taste burnout. Tobacco companies, and the market research firms that do contract work for them, extensively study the personality characteristics of smokers. Personality characteristics identified by Lorillard during the mid-1980s included the rugged man, pleasure seekers, unsettled dreamers, outdoor individualists, refined ladies, satisfied secures, and social strivers. As discussed in chapter 4, there are several ways to communicate with consumers, including advertising, event sponsorship, celebrity endorsements, packaging, coupons, personal selling, sampling, contests, publicity, product placement, and public relations. For conventional advertising, the copy platform entails the formation of creative promises. Communicating brand image is considered particularly crucial for product categories Psychographic Segmentation Psychographics, also referred to as lifestyle analysis, is another commonly used segmentation approach in which the personality, activities, interests, and opinions of the target market are considered. Several content analysis studies reveal that health and vitality, 62 Monograph 19. The Role of the Media such as cigarettes and beer; several brands possess minimal product differentiation, yet have a high degree of social visibility. Such characteristics are the basis for these goods sometimes being coined badge products. Particular brands are depicted as expressions of success, sophistication, femininity, rebellion, and so on. Branding the use of a name, term, symbol, or design to identify a product is known as branding. Tobacco product brand names spring from a wide range of sources, from product-positioning factors to company history. Slims, meanwhile, refers to a reduced-circumference cigarette; this product feature was innovative when the brand was launched in 1968. The Winston and Salem cigarette brand names reflect that the head office of producer R. Key Principles of Promotion and Rationales for Regulation for example, is legendary. Raymond Loewy, widely considered to be the father of industrial design and well known for designing several celebrated brand icons, including the Exxon and Shell Oil logos and the U. Taglines and Slogans Taglines (or slogans) are another integral part of a promotional campaign and are commonly developed with the objective of being understandable and memorable as well as linking benefits or positive images to a brand. It can be money well spent if it is created in a way that consumers identify with it immediately. Acknowledging that many advertisements attract limited and indirect attention from the viewer amid all of the "clutter," advertisers often design messages that draw attention or stand out but do not require large amounts of time and effort to understand. This is facilitated through the visual imagery predominating in many advertisements, with its function illustrated by the aphorisms, "A picture is worth a thousand words," and "Seeing is believing. Brand imagery is further reinforced or enhanced in advertising visuals through the use of lifestyle portrayals, which do not necessarily require depictions of people. Cobranding, event sponsorship, and endorsements exemplify three ways of enriching the symbolic value of brands or trademarks. Product endorsement from an Olympic gold medalist would potentially associate a trademark with qualities of nationalism, leadership, and high performance. The personality of the particular athlete might also be transferred to the endorsed brand. Clearly, associating a brand or trademark with other objects, settings, and people that are rich in meaning can effectively convey lifestyle imagery and brand personality. Blue is frequently associated with calmness, coolness, introspection, wisdom, and solitude, and green suggests nature, renewal, new beginnings, healing, health, and harmony. Repetition, Consistency, and Relevance Repetition of a promotional message or brand identity, over time, across multiple media, and across advertising executions leads to familiarity and increased advertising effectiveness.

The Role of the Media Expenditures on Advertising and Promotion for Cigarettes From 1940 to 2005 prostate quadrants discount pilex 60caps with amex, the tobacco industry spent about $250 billion on cigarette advertising and promotion-averaging more than $10 million per day androgen-independent hormone-refractory metastatic prostate cancer buy pilex 60 caps low cost. The unadjusted expenditure in 2005 is equivalent to $63 per person aged 18 years and older prostate cancer 97 buy pilex 60 caps on-line, or $47 per capita for the entire population (using 2000 census data) prostate doctor discount pilex 60caps with mastercard. The total annual expenditures from 1970 to 2005 (in 5-year increments until 1995 man health cure generic 60 caps pilex, and then annually) are presented in table 4 prostate 3x pilex 60caps overnight delivery. The nature of the expenditures, following the definitions provided earlier, are detailed in table 4. The "price discounts" category now accounts for the overwhelming percentage of advertising and promotional expenditures (77. Once the "price discounts" category is extracted, the two categories that earlier accounted for the bulk of marketing expenditures are now considerably diminished: 1. In 2005, just under $1 billion, or just under 7% of total marketing expenditures, was spent on "promotional allowances. Ty p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n Figure 4. Adjusted expenditures are adjusted to 2006 dollars using the consumer price index (all items). Correspondingly, the percentage of marketing expenditures devoted to promotional activities increased during this period, from 18% to almost 100%. The trade magazine Advertising Age publishes annual data on the A-S ratio for the 200 industries with the largest dollar volume of advertising in measured media. The A-S ratio for cigarettes was substantially higher than the median value in past decades, with correspondingly high rankings among the top-200 advertisers. Ty p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n Table 4. A-S ratio = advertising-to-sales ratio (advertising expenditures as a percentage of net sales). In a ranking of total domestic advertising spending in measured media by industry, "cigarettes & tobacco" ranked 29th in both 2004 and 2005. In 1965, each of the six major tobacco firms was among the 25 leading national advertisers (table 4. In 2005, Altria Group (the corporate name adopted by Philip Morris in 2003) was the 20th leading advertiser in the United States, spending $1. Ty p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n Note. Expenditures are for advertising in measured media for all tobacco and nontobacco products sold by each company. Ty p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n to promotional activities, as well as the increasing market share-and advertising "share of voice"-of Altria/Philip Morris. In 2005, the Marlboro brand had 40% of the market and Philip Morris brands overall had 50% of the market. Consistent with the shift in cigarette marketing expenditures from advertising in measured media to promotional activities (table 4. According to the Media Records classification system used in the 1980s,117,118 national advertising expenditures for products and services were classified into major categories. By using the subcategories in this classification system, it was found that cigarettes were the most heavily advertised product or service in outdoor media and the second most heavily advertised product or service in magazines (after passenger cars) in both 1985 and 1988. For newspaper advertising, cigarettes were ranked third (after passenger cars and airlines) in 1985 and sixth in 1988. Until the 1990s, the percentage of dollars allocated to advertising and promotion for light cigarettes exceeded their share of the market. Two possible explanations for this disparity are that the low-tar segment of the market is more competitive than higher-tar segments, or the companies were trying to drive smokers toward low-tar brands, perhaps in the hope that healthconscious smokers would be less likely to quit if they switched to a brand perceived as less hazardous. Chapter 5 reviews the content of advertisements for low-tar cigarettes and other brands aimed at "concerned smokers. Total expenditures for cigar advertising and promotion in the United States increased by 32% from 1996 ($30. Report to Congress for 1998 pursuant to the Federal Cigarette Labeling and Advertising Act. Percentage of marketing expenditures is the proportion of total cigarette advertising and promotional expenditures devoted to light cigarettes. As noted above, broadcast advertising has been prohibited by law for manufactured cigarettes (since 1971), smokeless tobacco (since 1986), and "little cigars" (since 1973) but is still permitted for other cigars, pipe tobacco, and roll-your-own cigarette tobacco. The report also noted Some portion of the $339,000 reported as expenditures for endorsements and product placements was money spent to place cigars on television shows. Cigar use began to increase in the United States after promotional activities for cigars increased beginning in 1992. Promotional activities for cigars have increased the visibility of cigar consumption, normalized cigar use, and broken down barriers to cigar use. The total amount spent (a small amount compared with that spent on cigarette advertising and promotion) was $258. About 60% of all cigarettes sold in the United States are purchased in convenience stores. The 2002 report indicates that, on average, customers recalled in-store advertising for 29% of products purchased. Among the 10 products listed in the report, cigarettes ranked highest, followed by carbonated beverages, coffee, food service, noncarbonated beverages, beer, candy/gum/mints, salty snacks, sweet snacks, and milk. At this level, Philip Morris brands are placed in a vertical and horizontal L-shaped combination beginning at the top left of the fixture. At this level, Philip Morris brands are placed vertically in the middle of the tobacco fixture, allowing the retailer to choose how to stock the vertical space on either side. The amount of space is the same at each level; only the configuration of the display changes. In 1999, the presence of tobacco point-of-purchase advertising was examined in a national U. More than one-third (36%) had selfservice cigarette pack placement, and onequarter (25%) had multipack discounts. At this level, Philip Morris gets the most desirable shelf space-a horizontal portion at the very top of the fixture. Ty p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n carrying interior store advertising for tobacco products and the extent of that advertising; (2) the percentage of stores carrying exterior advertising for tobacco products and the extent of that advertising; (3) the percentage of stores carrying a range of promotions, including gift with purchase, cents-off promotions, and multipack discounts; and (4) the percentage of stores carrying tobacco-related functional objects and the extent to which these objects were in the store. In response to the changing regulatory climate, tobacco firms are exploring new ways to promote their products, such as viral marketing and a presence on the Internet. In the meantime, tobacco marketing expenditures overwhelmingly involve discounting and promotional allowances for in-store marketing, together with other channels such as coupons and specialty item distribution. Data on trends in tobacco advertising and promotion highlight the economic importance of effective marketing efforts for tobacco industry interests. These trends, combined with shifts in marketing expenditures across categories of advertising and promotion, underscore the need to critically examine the evolution of tobacco advertising and promotional efforts. Such an examination, in turn, must continue to inform ongoing tobacco control efforts aimed at reducing the morbidity and mortality associated with smoking and other forms of tobacco use. The Role of the Media cigarette advertising and promotion ($37 million per day on average). From 1970 to 2005, the pattern of marketing expenditures shifted dramatically; the proportion of expenditures allocated for advertising in "measured media" decreased from 82% in 1970 to almost none in 2005. Expenditures for smokeless tobacco advertising and promotion reached $259 million (in 2006 dollars) in 2005. About 60% of all cigarettes sold in the United States are purchased in convenience stores, where cigarettes are the top in-store product category in terms of consumer sales. As cigarette advertising is being curtailed in some traditional media, cigarette companies are exploring the use of new or nontraditional media for distributing protobacco messages and images, including the Internet and cigarette packages. Ty p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n References Federal Trade Commission. Federal Trade Commission report to Congress pursuant to the Comprehensive Smokeless Tobacco Health Education Act of 1986. Report of the Committee on Governmental Affairs, United States Senate, to accompany S. Consultation on the draft: Tobacco advertising and promotion (sponsorship) transitional regulations; tobacco advertising and promotion (point of sale) regulations; tobacco advertising and promotion (brandsharing) regulations. How to circumvent tobacco advertising restrictions: the irrelevance of the distinction between direct and indirect advertising. Department of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services, Office of Applied Studies. A study on youth smoking: Plain packaging, health warnings, event marketing and price reductions. Generic packaging: A possible solution to the marketing of tobacco to young people. Ty p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n 50. The potential of the Internet as a medium to encourage and discourage youth tobacco use. Product communication in the context of varying degrees of advertising restriction. Effect of viewing smoking in movies on adolescent smoking initiation: A cohort study. Tobacco in movies and impact on youth: A study on tobacco in Indian movies released in 2004, 2005 [and] influence of movies on youngsters. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 137 4. Ty p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n 104. Tobacco industry price-subsidizing promotions may overcome the downward pressure of higher prices on initiation of regular smoking. Marketing smokeless tobacco in California communities: Implications for health education. The role of tobacco advertising and promotion: Themes employed in litigation by tobacco industry witnesses. Point-of-purchase tobacco environments and variation by store type-United States, 1999. This chapter provides an overview of specific themes and population targets employed in tobacco advertising and promotion based on studies of marketing materials and tobacco industry documents. Specific targeting criteria for tobacco advertising and promotion can include age, gender, race or ethnicity, and sexual orientation. Such groups can be targeted directly-for instance, by focusing on rugged individualism for men or weight control for women-or indirectly through adult themes such as independence or peer acceptance that also appeal to young smokers. Tobacco brands are frequently designed to appeal to specific market segments or population subgroups, such as blue-collar women, African Americans, and young adult smokers. Marketing objectives for these channels range from creating new markets to attracting young smokers who are making their long-term brand choice. Understanding targeted marketing is also an important consideration in designing tobacco control efforts. T h e m e s a n d Ta r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n Introduction As explained in chapter 3, the practice of targeting marketing efforts to specific population subgroups is a general principle of marketing strategy and is therefore common to most consumer marketing efforts. In addition, consumer marketing seeks to develop and associate images or themes appealing to the target audience with a consumer product, so that when consumers purchase the product, they subscribe to the image associated with it. However, to the extent that such targeted marketing efforts have resulted in greater smoking uptake and less smoking cessation in the targeted subgroups, such marketing practices have contributed to the enormous tobacco-related harms and costs faced by modern American society. While chapter 7 presents details on the effects of tobacco marketing on tobacco use, this chapter aims to provide a descriptive overview of population subgroups that have been targeted by specific tobacco industry marketing strategies, and to give examples of how these strategies have been pursued, so that readers can appreciate the nature and scope of this activity. It also examines the campaign themes and strategies used to reach these specific subgroups to provide background and context to these targeted marketing efforts. The chapter is not exhaustive but provides examples of images and appeals that have been made to specific population subgroups. In general, the chapter focuses on the United States, using data drawn from published studies of tobacco advertising materials and industry documents, but examples from other countries are used when informative or illustrative. Congress was considering legislation that would, among other things, 142 ban cigarette advertising on television and radio. The tobacco industry offered to voluntarily discontinue advertising cigarettes on the broadcast media if Congress would give the cigarette companies an exemption from antitrust laws to allow them to take this action in concert. Tobacco corporations have long identified segments of the population with strong potential as customers. Their research has produced tailored brand lines and sophisticated messages delivered through the communication channels with the greatest likelihood of reaching these groups. The Role of the Media activities are likely to include encouraging smoking initiation, establishing and maintaining brand loyalty, increasing tobacco consumption, and averting cessation efforts2 (see chapter 7 for an overview of effects of tobacco marketing on smoking behavior). Less direct but still potent public relations efforts are aimed at the leadership of varied groups to discourage opposition to tobacco marketing activities and to salvage tobacco corporate reputations; such public relations efforts are discussed further in chapter 6. Philip Morris, the largest tobacco corporation in the United States, has developed marketing plans and product lines based on consumer attitudes, aspirations, and lifestyles. Marlboro, for example, would appeal to the 50s Throwbacks, while Marlboro Lights are for Uptown Girls. Both corporations tackle young adult price concerns by using marketing strategies such as free samples and coupons in locations where young adults take on new behaviors- for example, bars, colleges, workplaces, and the military.

The illness and outrage categories included advertisements that both aroused negative emotion (fear prostate cancer awareness color purchase pilex 60 caps amex, sadness man health product cheap pilex 60caps without prescription, or anger) and presented serious health consequences of smoking androgen hormone yang generic 60 caps pilex with amex. The "other Massachusetts" ads and Philip Morris categories included advertisements that did not discuss consequences in a serious manner prostate 70cc cheap 60caps pilex amex. Instead prostate cancer untreated life expectancy order pilex 60caps with amex, they focused on normative issues prostate cancer x-ray radiation treatment purchase pilex 60caps visa, such as smoking is not "cool," smoking makes it hard to do well at sports, smoking sets a bad example for siblings, and such. In this study, youth saw advertisements featuring the serious consequences of smoking as significantly more effective than both the Massachusetts advertisements that did not discuss illness and the Philip Morris "Think. O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l One study used a somewhat different approach but found similar results. Of those who had quit smoking in the prior two years, 32% reported being influenced by a television commercial. Of those who reported having been helped by a television commercial, 70% described an advertisement featuring an emotional or a graphic depiction of the harm done to the protagonist or a loved one by smoking. Only 20% of the media weight of all mentioned advertisements was in this category. Only 1% of the individuals described a pharmaceutical advertisement although 58% of the total media weight was due to pharmaceutical advertisements. Although people are only partially aware of factors that influence their behavior, this study provides evidence that emotional advertisements about negative health consequences may be effective in promoting smoking cessation. Advertisements that used humor-whether to make fun of teenagers who smoked, make fun of tobacco companies, or portray the health benefits of nonsmoking in an exaggerated way. In practice, informational content, level of emotion, valence of emotion, and format tend to correlate. With regard to theme and valence of emotion, advertisements that portray negative health consequences of smoking-to smokers or to those around them-tend also to evoke negative emotions of fear, sadness, anger, disgust, or loss. Advertisements focusing on the benefits of quitting and those providing information or support for quitting tend to evoke positive emotions such as humor, pride, and hope. Advertisements that focus on the social consequences of smoking-both negative. Advertisements that focus on anti-industry messages are more difficult to summarize. Some attempt to evoke anger and outrage by showing that tobacco companies are aware of the harms of tobacco, whereas others use parody to evoke humor. Personal testimonials from "real people" (nonactors) are most often used to illustrate negative health consequences of smoking. Consequently, it is unclear whether the relatively successful performance of advertisements focusing on negative health consequences of smoking through testimonials or visceral negative imagery is due to the theme, format, negative emotion, or level of emotion, or some combination of these factors. The studies reviewed here, however, suggest that this is difficult to accomplish with antitobacco messages. Some structural features of advertisements that tend to increase the extent to which they are perceived as arousing are independent of the informational or emotional content. These include pacing, use of loud music, and cuts or edits,120 which are linked to increased message sensation value. Many organizations that resist sponsoring advertisements that arouse high levels of negative emotion would welcome this type of outcome. Administrators prefer to associate their agencies with positive 459 Arousal, Negative Emotion, and Advertising Impact In advertising theory, for an advertisement to be effective it must first be attended to , then decoded and understood, and ultimately acted upon. Those cognitive resources are distributed to a number of potential sources of incoming information in the environment. However, Lang and other colleagues120,121 have demonstrated that automatic responses to the content and structural features of what is broadcast control these processes to some extent. These researchers conducted a series of experiments on the role of level of arousal and valence of emotion on attention to and memory for media messages. This research helps account for the consistent finding that antitobacco advertisements that perform well in immediate ratings and indicators of message processing evoke high levels of negative emotion using personal testimonials of loss and pain; include graphic shots of diseased bodily organs; 1 1. O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l uplifting messages rather than with those that emphasize the darker consequences of health-damaging behaviors. This is true even though the latter messages demonstrate a more successful performance. Corrective Advertising for "Light" or "Low-Yield" Cigarettes Tobacco manufacturers have long marketed low-tar or "light" cigarettes to smokers who are concerned about the health effects of their smoking125,126 (see chapter 5). However, authoritative reviews have concluded that low-yield cigarettes are designed to allow compensatory smoking behaviors that enable a smoker to derive a wide range of tar and nicotine yields from the same brand, offsetting much of the theoretical benefit of a cigarette with reduced tar. For example, in 1994, the Massachusetts Department of Public Health aired two 30-second television advertisements about "light" cigarettes. One advertisement focused on vent blocking; that is, the small vent holes around the filters of most "light" cigarettes can dilute the inhaled smoke, but in practice smokers may block these filter holes with their fingers when inhaling, thus delivering a higher dose of smoke constituents. In the other advertisement, an animated "skull and crossbones" speaks, saying it should be- but is not-warning smokers about light cigarettes. An evaluation survey showed that within Massachusetts, compared with a nationwide sample, smokers who saw the anti-light-cigarette advertisements were 460 less likely to think light cigarettes decreased the risk of health problems (26% versus 44%) and more likely to know of filter vents (64% versus 47%). A study by Koslowski and colleagues randomized smokers of light cigarettes who participated in a telephone survey to hear (n = 293) or not hear (n = 275) a 60-second radio advertisement cautioning that light cigarettes are no safer than regular cigarettes and that listeners should think about quitting. Koslowski and colleagues followed up about one-half of the respondents in each group who could be contacted seven months later to determine whether there were any persistent effects from hearing the radio advertisement. However, they did not report greater intention to quit or more knowledge of filter ventilation. These results suggest that smokers found the information in the radio advertisement important and remembered it, especially given that the information was played only once seven months beforehand. Shiffman and colleagues also experimentally assessed responses to differently framed persuasive messages about light cigarettes. The Role of the Media and 30-second television advertising concepts,134 smokers were most likely to change their beliefs about light cigarettes and be more interested in quitting when exposed to a message emphasizing that the sensory effect of light cigarettes can be deceptive. However, studies have not yet examined quit rates among those exposed or not exposed to this type of advertising. It is important to know whether tailoring antitobacco advertisements yields a substantial improvement in effectiveness because tailoring increases the cost of producing media campaigns. Targeting Age Groups Most campaigns create different types of advertisements for youth and for adults. Beaudoin138 performed a content analysis of 197 antitobacco advertisements produced between 1991 and 1999. Among the dimensions coded were (1) the type of consequence presented (health, social, or both); (2) whether the consequences were short term, long term, or both; and (3) whether the appeal used humor, fear, sociability, or several other strategies. Beaudoin found that advertisements targeting youth commonly used sociability and humor appeals and presented short-term consequences. Advertisements targeting adults commonly used fear appeals and addressed the long-term health consequences. However, the empirical findings presented in this section indicate that, like adults, youth tend to respond more favorably to advertisements warning of serious long-term health consequences of smoking presented in an emotionally evocative way. This involves identifying population subgroups whose members are similar to each other and distinct from other groups along dimensions that are meaningful in the context of the product being marketed or the behavior to be changed. O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l found that youth respond favorably to adult-targeted advertisements. Wakefield and colleagues140 showed that the adult cessation focus of the Australian campaign ("Every Cigarette Is Doing You Damage") was as likely as a teen-focused campaign to make teenagers in South Australia feel they should not smoke. By using national and state survey data in Victoria, Australia, White and colleagues141 found that youth perceived the adult campaign as relevant to them and effective in promoting antismoking attitudes. Schar and Gutierrez142 describe an evaluation of the English testimonial campaign that targeted adults and featured a 34-year-old man with lung cancer and a teenage girl speaking about her father who has lung cancer. Considerable debate has occurred about whether tobacco control campaigns should focus primarily on youth (because most people initiate smoking before age 18) or on adults. This may be due to such adult-targeted campaigns changing broader social norms about smoking. Very few campaign evaluations pit a general-audience message against a tailored message to compare audience reactions. Farrelly and colleagues147 conducted a content analysis of 51 advertisements broadcast by Legacy ("truth" campaign), Philip Morris ("Think. Advertisements were coded as to message sensation value, an index of features believed to elicit arousal reactions: number of cuts, use of loud music, surprise endings, intense visual images, and theme. Repeated cross-sectional telephone surveys of white, African American, Hispanic, and Asian youth assessed recall and appraisal of varying groups of advertisements. Multivariate analyses demonstrated that advertisement characteristics were more important than audience race/ethnicity as a determinant of appraisal. Wakefield and colleagues100 repeated in Australia and Great Britain the study in the United States described earlier. The purpose of this study was to determine whether youth of different nationalities responded similarly or differently to antitobacco advertisements. The researchers found that participants in these three English-speaking countries responded in very similar ways Monograph 19. As was true in Chicago and Boston, youth in Australia and Great Britain responded not to the theme or target audience but to the arousal characteristics of the advertisements. These findings suggest that advertisements that perform well on immediate ratings and indicators of message processing tend to do so among many population subgroups. This implies that the added expense of designing tailored executions for small subgroups may not need to be incurred. The findings also suggest that advertisements can be shared, at least among more-developed countries, provided language requirements can be met. This could reduce costs in areas where funding for tobacco control advertising is scarce. Internet, 63% reported using the Web to obtain information on a specific disease or medical problem and 6% had used the Web for information about how to quit smoking. Those who are less likely to access the Internet tend to be less educated, African American, and 65 years or older. Why do people use the Internet as opposed to other sources of assistance and information An earlier Pew report152 found that of those using the Internet for health information, 93% thought it was important to obtain the information at any convenient hour and 80% liked the ability to obtain health information anonymously without having to talk to anyone. In addition, cigarette smokers who use the Internet have expressed a desire for anonymity and noted discomfort in speaking with human counselors. The proportion of adults (18 years and older) in the United States with Internet access in 2007 exceeded 72%. O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l untested. In a systematic analysis of the content, quality, and usability of smoking cessation treatments on the Internet, Bock and colleagues154 found that 80% of such sites failed to address one or more key components of recommended smoking cessation treatment guidelines, with the interactive nature of the Internet generally ignored. In reviews of computer-generated health behavior change interventions, the application of theoretically informed approaches for health behavior change and/or decision making has been found to be poor or nonexistent. Thus, digital "pamphlet racks" persist as the most common type of smoking cessation Internet sites because they are easy to build. Unfortunately, research on Internet-based health programming continues to focus on these simple information transfer models. Bock and colleagues154 provide an excellent review of, and criteria for, Internet-based smoking cessation programming. Once in a site, users search for the information relevant to their needs and interests. Similar to a library, the Internet has methods of searching for the large amount of available health information. Also like a library, however, the Internet does not automatically make available the best information or advice that an individual needs at a particular time. A number of studies in the general non-Internet-specific educational literature have found that, when compared with fixed sequencing of instructional material, user control results in deviations from important information or methods of instruction and subsequent lower performance. Four types of interactivity relevant to smoking cessation programming are (1) user navigation, (2) expert systems, (3) collaborative filtering, and (4) human-to-human interaction. The expert systems tested in the health behavior area typically require (1) a collection of characteristics, at an individual level, relevant to the targeted behavior change; (2) an algorithm that uses these data to generate messages tailored to the specific needs of the user; and (3) a feedback protocol that combines these messages in a clear, vivid manner. The inferences made from the data are an attempt to reflect standards of a human expert. Some of these tailored programs have been migrated to the Internet after testing in non-Internet-based settings, such as by telephone or print-mediated delivery systems. The evidence was strongest for tailored materials compared with no intervention but also supported tailored materials as more helpful than standard materials. The review concluded that part of this effect could be due to the additional contact or assessment required to obtain individual data. Results of two randomized clinical trials of Internet-based expert systems for smoking cessation have been positive and consistent with the results of computer-tailored print materials. A noteworthy study by Lipkus and colleagues171 found a significantly higher cessation rate among low-income and indigent African-American smokers receiving tailored smoking cessation materials plus provider advice than among those who received provider advice alone. Supporting these results, McDaniel and colleagues172 found high satisfaction among 100 low-income inner-city female smokers who participated in a usability study of an interactive, computer-mediated smoking cessation program in Indianapolis, Indiana. At a one-week follow-up, there was a significant decrease in favorable attitudes to smoking and an increase in cognitive change processes related to smoking. However, a challenge for the reach of these kinds of programs is that low-income populations have less access to the Internet. O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l Further published controlled trials of Internet-based expert systems in this area are greatly needed.

In time of peace prostate cancer genetic testing buy cheap pilex 60caps online, the sign described in paragraph 4 may prostate oncology specialists marina generic 60 caps pilex with mastercard, with the consent of the competent national authorities prostate cancer psa scale purchase pilex 60caps free shipping, be used for civil defence identification purposes prostate 02 buy discount pilex 60 caps on line. The identification of civil defence medical and religious personnel man health after 50 buy discount pilex 60 caps on-line, medical units and medical transports is also governed by Article 18 androgen hormone in pregnancy discount pilex 60 caps without a prescription. Members of the armed forces and military units assigned to civil defence organizations shall be respected and protected, provided that: 166 X. Law of armed conflict (a) such personnel and such units are permanently assigned and exclusively devoted to the performance of any of the tasks mentioned in Article 61; (b) if so assigned, such personnel do not perform any other military duties during the conflict; (c) such personnel are clearly distinguishable from the other members of the armed forces by prominently displaying the international distinctive sign of civil defence, which shall be as large as appropriate, and such personnel are provided with the identity card referred to in Chapter V of Annex 1 to this Protocol certifying their status; (d) such personnel and such units are equipped only with light individual weapons for the purpose of maintaining order or for self-defence. The provisions of Article 65, paragraph 3 shall also apply in this case; (e) such personnel do not participate directly in hostilities, and do not commit, or are not used to commit, outside their civil defence tasks, acts harmful to the adverse Party; (f) such personnel and such units perform their civil defence tasks only within the national territory of their Party. Military personnel serving within civil defence organizations shall, if they fall into the power of an adverse Party, be prisoners of war. In occupied territory they may, but only in the interest of the civilian population of that territory, be employed on civil defence tasks in so far as the need arises, provided however that, if such work is dangerous, they volunteer for such tasks. Relief actions for the benefit of the civilian population of occupied territories are governed by Articles 59, 60, 61, 62, 108, 109, 110 and 111 of the Fourth Convention, and by Article 71 of this Protocol, and shall be implemented without delay. If the civilian population of any territory under the control of a Party to the conflict, other than occupied territory, is not adequately provided with the supplies mentioned in Article 69, relief Geneva Conventions: Additional Protocol I 167 actions which are humanitarian and impartial in character and conducted without any adverse distinction shall be undertaken, subject to the agreement of the Parties concerned in such relief actions. In the distribution of relief consignments, priority shall be given to those persons, such as children, expectant mothers, maternity cases and nursing mothers, who, under the Fourth Convention or under this Protocol, are to be accorded privileged treatment or special protection. The Parties to the conflict and each High Contracting Party concerned shall encourage and facilitate effective international co-ordination of the relief actions referred to in paragraph 1. Where necessary, relief personnel may form part of the assistance provided in any relief action, in particular for the transportation and distribution of relief consignments; the participation of such personnel shall be subject to the approval of the Party in whose territory they will carry out their duties. Each Party in receipt of relief consignments shall, to the fullest extent practicable, assist the relief personnel referred to in paragraph 1 in carrying out their relief mission. Under no circumstances may relief personnel exceed the terms of their mission under this Protocol. In so far as they are affected by a situation referred to in Article 1 of this Protocol, persons who are in the power of a Party to the conflict and who do not benefit from more favourable treatment under the Conventions or under this Protocol shall be treated humanely in all circumstances and shall enjoy, as a minimum, the protection provided by this Article without any adverse distinction based upon race, colour, sex, language, religion or belief, political or other opinion, national or social origin, wealth, birth or other status, or on any other similar criteria. The following acts are and shall remain prohibited at any time and in any place whatsoever, whether committed by civilian or by military agents: (a) violence to the life, health, or physical or mental well-being of persons, in particular: (i) (ii) (iii) (iv) murder; torture of all kinds, whether physical or mental; corporal punishment; and mutilation; (b) outrages upon personal dignity, in particular humiliating and degrading treatment, enforced prostitution and any form of indecent assault; (c) (e) the taking of hostages; threats to commit any of the foregoing acts. No sentence may be passed and no penalty may be executed on a person found guilty of a penal offence related to the armed conflict except pursuant to a conviction pronounced by an impartial and regularly constituted court respecting the generally recognized principles of regular judicial procedure, which include the following: (a) the procedure shall provide for an accused to be informed without delay of the particulars of the offence alleged against him and shall afford the accused before and during his trial all necessary rights and means of defence; (b) no one shall be convicted of an offence except on the basis of individual penal responsibility; Geneva Conventions: Additional Protocol I 169 (c) no one shall be accused or convicted of a criminal offence on account of any act or omission which did not constitute a criminal offence under the national or international law to which he was subject at the time when it was committed; nor shall a heavier penalty be imposed than that which was applicable at the time when the criminal offence was committed; if, after the commission of the offence, provision is made by law for the imposition of a lighter penalty, the offender shall benefit thereby; (d) (e) (f) anyone charged with an offence is presumed innocent until proved guilty according to law; anyone charged with an offence shall have the right to be tried in his presence; no one shall be compelled to testify against himself or to confess guilt; (g) anyone charged with an offence shall have the right to examine, or have examined, the witnesses against him and to obtain the attendance and examination of witnesses on his behalf under the same conditions as witnesses against him; (h) no one shall be prosecuted or punished by the same Party for an offence in respect of which a final judgement acquitting or convicting that person has been previously pronounced under the same law and judicial procedure; (i) anyone prosecuted for an offence shall have the right to have the judgement pronounced publicly; and (j) a convicted person shall be advised on conviction of his judicial and other remedies and of the time-limits within which they may be exercised. Persons who are arrested, detained or interned for reasons related to the armed conflict shall enjoy the protection provided by this Article until final release, repatriation or re-establishment, even after the end of the armed conflict. In order to avoid any doubt concerning the prosecution and trial of persons accused of war crimes or crimes against humanity, the following principles shall apply: (a) persons who are accused of such crimes should be submitted for the purpose of prosecution and trial in accordance with the applicable rules of international law; and (b) any such persons who do not benefit from more favourable treatment under the Conventions or this Protocol shall be accorded the treatment provided by this Article, whether or not the crimes of which they are accused constitute grave breaches of the Conventions or of this Protocol. No provision of this Article may be construed as limiting or infringing any other more favourable provision granting greater protection, under any applicable rules of international law, to persons covered by paragraph 1. Women shall be the object of special respect and shall be protected in particular against rape, forced prostitution and any other form of indecent assault. Pregnant women and mothers having dependent infants who are arrested, detained or interned for reasons related to the armed conflict, shall have their cases considered with the utmost priority. In recruiting among those persons who have attained the age of fifteen years but who have not attained the age of eighteen years, the Parties to the conflict shall endeavour to give priority to those who are oldest. If, in exceptional cases, despite the provisions of paragraph 2, children who have not attained the age of fifteen years take a direct part in hostilities and fall into the power of an adverse Party, they shall continue to benefit from the special protection accorded by this Article, whether or not they are prisoners of war. If arrested, detained or interned for reasons related to the armed conflict, children shall be held in quarters separate from the quarters of adults, except where families are accommodated as family units as provided in Article 75, paragraph 5. No Party to the conflict shall arrange for the evacuation of children, other than its own nationals, to a foreign country except for a temporary evacuation where compelling reasons of the health or medical treatment of the children or, except in occupied territory, their safety, so require. Where the parents or legal guardians can be found, their written consent to such evacuation is required. If these persons cannot be found, the written consent to such evacuation of the persons who by law or custom are primarily responsible for the care of the children is required. With a view to facilitating the return to their families and country of children evacuated pursuant to this Article, the authorities of the Party arranging for the evacuation and, as appropriate, the authorities of the receiving country shall establish for each child a card with photographs, which they shall send to the Central Tracing Agency of the International Committee of the Red Cross. Journalists engaged in dangerous professional missions in areas of armed conflict shall be considered as civilians within the meaning of Article 50, paragraph 1. They shall be protected as such under the Conventions and this Protocol, provided that they take no action adversely affecting their status as civilians, and without prejudice to the right of war correspondents accredited to the armed forces to the status provided for in Article 4 A 4) of the Third Convention. This card, which shall be issued by the government of the State of which the journalist is a national or in whose territory he resides or in which the news medium employing him is located, shall attest to his status as a journalist. The High Contracting Parties and the Parties to the conflict shall without delay take all necessary measures for the execution of their obligations under the Conventions and this Protocol. The Parties to the conflict shall grant to the International Committee of the Red Cross all facilities within their power so as to enable it to carry out the humanitarian functions assigned to it by the Conventions and this Protocol in order to ensure protection and assistance to the victims of conflicts; the International Committee of the Red Cross may also carry out any other humanitarian activities in favour of these victims, subject to the consent of the Parties to the conflict concerned. The Parties to the conflict shall grant to their respective Red Cross (Red Crescent, Red Lion and Sun) organizations the facilities necessary for carrying out their humanitarian activities in favour of the victims of the conflict, in accordance with the provisions of the Conventions and this Protocol and the Fundamental Principles of the Red Cross as formulated by the International Conferences of the Red Cross. The High Contracting Parties and the Parties to the conflict shall facilitate in every possible way the assistance which Red Cross (Red Crescent, Red Lion and Sun) organizations and the League 172 X. Law of armed conflict of Red Cross Societies* extend to the victims of conflicts in accordance with the provisions of the Conventions and this Protocol and with the Fundamental Principles of the Red Cross as formulated by the International Conferences of the Red Cross. The High Contracting Parties and the Parties to the conflict shall, as far as possible, make facilities similar to those mentioned in paragraphs 2 and 3 available to the other humanitarian organizations referred to in the Conventions and this Protocol which are duly authorized by the respective Parties to the conflict and which perform their humanitarian activities in accordance with the provisions of the Conventions and this Protocol. Legal advisers in armed forces the High Contracting Parties at all times, and the Parties to the conflict in time of armed conflict, shall ensure that legal advisers are available, when necessary, to advise military commanders at the appropriate level on the application of the Conventions and this Protocol and on the appropriate instruction to be given to the armed forces on this subject. The High Contracting Parties undertake, in time of peace as in time of armed conflict, to disseminate the Conventions and this Protocol as widely as possible in their respective countries and, in particular, to include the study thereof in their programmes of military instruction and to encourage the study thereof by the civilian population, so that those instruments may become known to the armed forces and to the civilian population. The provisions of the Conventions relating to the repression of breaches and grave breaches, supplemented by this Section, shall apply to the repression of breaches and grave breaches of this Protocol. Acts described as grave breaches in the Conventions are grave breaches of this Protocol if committed against persons in the power of an adverse Party protected by Articles 44, 45 and 73 of this Protocol, or against the wounded, sick and shipwrecked of the adverse Party who are protected by this Protocol, or against those medical or religious personnel, medical units or medical transports which are under the control of the adverse Party and are protected by this Protocol. In addition to the grave breaches defined in Article 11, the following acts shall be regarded as grave breaches of this Protocol, when committed wilfully, in violation of the relevant provisions of this Protocol, and causing death or serious injury to body or health: (a) making the civilian population or individual civilians the object of attack; * On 10 February 1992 the Swiss Federal Council, government of the State depositary of the 1949 Geneva Conventions, notified all States party to the Conventions that on 28 November 1991 the League of Red Cross and Red Crescent Societies had changed its name to "International Federation of Red Cross and Red Crescent Societies". Geneva Conventions: Additional Protocol I 173 (b) launching an indiscriminate attack affecting the civilian population or civilian objects in the knowledge that such attack will cause excessive loss of life, injury to civilians or damage to civilian objects, as defined in Article 57, paragraph 2 (a) (iii); (c) launching an attack against works or installations containing dangerous forces in the knowledge that such attack will cause excessive loss of life, injury to civilians or damage to civilian objects, as defined in Article 57, paragraph 2 (a) (iii); (d) making non-defended localities and demilitarized zones the object of attack; (e) making a person the object of attack in the knowledge that he is hors de combat; (f) the perfidious use, in violation of Article 37, of the distinctive emblem of the red cross, red crescent or red lion and sun or of other protective signs recognized by the Conventions or this Protocol. In addition to the grave breaches defined in the preceding paragraphs and in the Conventions, the following shall be regarded as grave breaches of this Protocol, when committed wilfully and in violation of the Conventions or the Protocol: (a) the transfer by the Occupying Power of parts of its own civilian population into the territory it occupies, or the deportation or transfer of all or parts of the population of the occupied territory within or outside this territory, in violation of Article 49 of the Fourth Convention; (b) unjustifiable delay in the repatriation of prisoners of war or civilians; (c) practices of apartheid and other inhuman and degrading practices involving outrages upon personal dignity, based on racial discrimination; (d) making the clearly-recognized historic monuments, works of art or places of worship which constitute the cultural or spiritual heritage of peoples and to which special protection has been given by special arrangement, for example, within the framework of a competent international organization, the object of attack, causing as a result extensive destruction thereof, where there is no evidence of the violation by the adverse Party of Article 53, sub-paragraph (b), and when such historic monuments, works of art and places of worship are not located in the immediate proximity of military objectives; (e) depriving a person protected by the Conventions or referred to in paragraph 2 of this Article of the rights of fair and regular trial. Without prejudice to the application of the Conventions and of this Protocol, grave breaches of these instruments shall be regarded as war crimes. The High Contracting Parties and the Parties to the conflict shall repress grave breaches, and take measures necessary to suppress all other breaches, of the Conventions or of this Protocol which result from a failure to act when under a duty to do so. The fact that a breach of the Conventions or of this Protocol was committed by a subordinate does not absolve his superiors from penal or disciplinary responsibility, as the case may be, if they knew, or had information which should have enabled them to conclude in the circumstances at the time, that he was committing or was going to commit such a breach and if they did not take all feasible measures within their power to prevent or repress the breach. The High Contracting Parties and the Parties to the conflict shall require military commanders, with respect to members of the armed forces under their command and other persons under their control, to prevent and, where necessary, to suppress and report to competent authorities breaches of the Conventions and of this Protocol. In order to prevent and suppress breaches, High Contracting Parties and Parties to the conflict shall require that, commensurate with their level of responsibility, commanders ensure 174 X. Law of armed conflict that members of the armed forces under their command are aware of their obligations under the Conventions and this Protocol. The High Contracting Parties and Parties to the conflict shall require any commander who is aware that subordinates or other persons under his control are going to commit or have committed a breach of the Conventions or of this Protocol, to initiate such steps as are necessary to prevent such violations of the Conventions or this Protocol, and, where appropriate, to initiate disciplinary or penal action against violators thereof. The High Contracting Parties shall afford one another the greatest measure of assistance in connexion with criminal proceedings brought in respect of grave breaches of the Conventions or of this Protocol. Subject to the rights and obligations established in the Conventions and in Article 85, paragraph 1, of this Protocol, and when circumstances permit, the High Contracting Parties shall cooperate in the matter of extradition. They shall give due consideration to the request of the State in whose territory the alleged offence has occurred. Co-operation In situations of serious violations of the Conventions or of this Protocol, the High Contracting Parties undertake to act, jointly or individually, in co-operation with the United Nations and in conformity with the United Nations Charter. At the meeting, the representatives shall elect the members of the Commission by secret ballot from a list of persons to which each of those High Contracting Parties may nominate one person. Geneva Conventions: Additional Protocol I 175 (b) the declarations referred to above shall be deposited with the depositary, which shall transmit copies thereof to the High Contracting Parties. The Chamber may also seek such other evidence as it deems appropriate and may carry out an investigation of the situation in loco. The Commission shall establish its own rules, including rules for the presidency of the Commission and the presidency of the Chamber. Those rules shall ensure that the functions of the President of the Commission are exercised at all times and that, in the case of an enquiry, they are exercised by a person who is not a national of a Party to the conflict. The administrative expenses of the Commission shall be met by contributions from the High Contracting Parties which made declarations under paragraph 2, and by voluntary contributions. The Party or Parties to the conflict requesting an enquiry shall advance the necessary funds for expenses incurred by a Chamber and shall be reimbursed by the Party or Parties against which the allegations are made to the extent of fifty per cent of the costs of the Chamber. Where there are counter-allegations before the Chamber each side shall advance fifty per cent of the necessary funds. The instruments of ratification shall be deposited with the Swiss Federal Council, depositary of the Conventions, article 94. This Protocol shall enter into force six months after two instruments of ratification or accession have been deposited. They shall furthermore be bound by this Protocol in relation to each of the Parties which are not bound by it, if the latter accepts and applies the provisions thereof. The authority representing a people engaged against a High Contracting Party in an armed conflict of the type referred to in Article 1, paragraph 4, may undertake to apply the Conventions and this Protocol in relation to that conflict by means of a unilateral declaration addressed to the depositary. Such declaration shall, upon its receipt by the depositary, have in relation to that conflict the following effects: (a) the Conventions and this Protocol are brought into force for the said authority as a Party to the conflict with immediate effect; (b) the said authority assumes the same rights and obligations as those which have been assumed by a High Contracting Party to the Conventions and this Protocol; and (c) the Conventions and this Protocol are equally binding upon all Parties to the conflict. The text of any proposed amendment shall be communicated to the depositary, which shall decide, after consultation with all the High Contracting Parties and the International Committee of the Red Cross, whether a conference should be convened to consider the proposed amendment. The depositary shall invite to that conference all the High Contracting Parties as well as the Parties to the Conventions, whether or not they are signatories of this Protocol. Not later than four years after the entry into force of this Protocol and thereafter at intervals of not less than four years, the International Committee of the Red Cross shall consult the High Contracting Parties concerning Annex 1 to this Protocol and, if it considers it necessary, may propose a meeting of technical experts to review Annex 1 and to propose such amendments to it as may appear to be desirable. Unless, within six months of the communication of a proposal for such a meeting to the High Contracting Parties, one third of them object, the International Committee of the Red Cross shall convene the meeting, inviting also observers of appropriate international organizations. Amendments to Annex 1 may be adopted at such a conference by a two-thirds majority of the High Contracting Parties present and voting. The depositary shall communicate any amendment so adopted to the High Contracting Parties and to the Parties to the Conventions. An amendment considered to have been accepted in accordance with paragraph 4 shall enter into force three months after its acceptance for all High Contracting Parties other than those which have made a declaration of nonacceptance in accordance with that paragraph. Any Party making such a declaration may at any time withdraw it and the amendment shall then enter into force for that Party three months thereafter. The depositary shall notify the High Contracting Parties and the Parties to the Conventions of the entry into force of any amendment, of the Parties bound thereby, of the date of its entry into force in relation to each Party, of declarations of non-acceptance made in accordance with paragraph 4, and of withdrawals of such declarations. If, however, on the expiry of that year the denouncing Party is engaged in one of the situations referred to in Article 1, the denunciation shall not take effect before the end of the armed conflict or occupation and not, in any case, before operations connected with the final release, repatriation or re-establishment of the persons protected by the Conventions or this Protocol have been terminated. Any denunciation under paragraph 1 shall not affect the obligations already incurred, by reason of the armed conflict, under this Protocol by such denouncing Party in respect of any act committed before this denunciation becomes effective. The depositary shall also inform the Secretariat of the United Nations of all ratifications, accessions and denunciations received by it with respect to this Protocol. The regulations concerning identification in this Annex implement the relevant provisions of the Geneva Conventions and the Protocol; they are intended to facilitate the identification of personnel, material, units, transports and installations protected under the Geneva Conventions and the Protocol. The competent authorities may, subject to the relevant provisions of the Geneva Conventions and the Protocol, at all times regulate the use, display, illumination and detectability of the distinctive emblems and signals. The identity card shall be made out, if possible, in duplicate, one copy being kept by the issuing authority, which should maintain control of the cards which it has issued. In no circumstances may permanent civilian medical and religious personnel be deprived of their identity cards. In the event of the loss of a card, they shall be entitled to obtain a duplicate copy. The identity card for temporary civilian medical and religious personnel should, whenever possible, be similar to that provided for in Article 2 of these Regulations. When circumstances preclude the provision to temporary civilian medical and religious personnel of identity cards similar to those described in Article 2 of these Regulations, the said personnel may be provided with a certificate signed by the competent authority certifying that the person to whom it is issued is assigned to duty as temporary personnel and stating, if possible, the duration of such assignment and his right to wear the distinctive emblem. For the shapes of the cross, the crescent or the lion and sun, the High Contracting Parties may be guided by the models shown in Figure 2. The distinctive emblem shall, whenever possible, be displayed on a flat surface, on flags or in any other way appropriate to the lay of the land, so that it is visible from as many directions and from as far away as possible, and in particular from the air. The distinctive emblem may be made of materials which make it recognizable by technical means of detection. Medical and religious personnel carrying out their duties in the baThle area shall, as far as possible, wear headgear and clothing bearing the distinctive emblem. All distinctive signals specified in this Chapter may be used by medical units or transports. In the absence of a special agreement between the Parties to the conflict reserving the use of flashing blue lights for the identification of medical vehicles, ships and craft, the use of such signals for other vehicles, ships and craft is not prohibited. Temporary medical aircraft which cannot, either for lack of time or because of their characteristics, be marked with the distinctive emblem, may use the distinctive signals authorized in this Chapter. The High Contracting Parties and, in particular, the Parties to the conflict which use lights of other colours should give notification of this. In order to facilitate the communications referred to in paragraphs 1 and 2, as well as the communications referred to in Articles 22, 23 and 25 to 31 of the Protocol, the High Contracting Parties, the Parties to a conflict, or one of the Parties to a conflict, acting in agreement or alone, may designate, in accordance with the Table of Frequency Allocations in the Radio Regulations annexed to the International Telecommunication Convention, and publish selected national frequencies to be used by them for such communications. The International Telecommunication Union shall be notified of these frequencies in accordance with procedures approved by a World Administrative Radio Conference.

Findings Attitude-opinions of cigarette advertisements as exciting mens health 55 style rules cheap pilex 60caps visa, interesting androgen hormone acne pilex 60 caps overnight delivery, eyecatching prostate 25 generic 60caps pilex with amex, glamorous man health solution cheap pilex 60caps mastercard, or witty Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued) 252 Receptivity-ownership of cigarette promotional items prostate japanese translation generic pilex 60 caps amex, specification of favorite brand Being a smoker or being further along the smoking uptake continuum was more likely if a participant owned a cigarette promotional item mens health magazine uk cheap pilex 60caps with visa, even when controlling for social influences to smoke. The more cigarette promotional items owned, the further along the initiation continuum the students were. Even when controlling for social influences to smoke, experimentation was significantly greater for those with more exposure to magazine advertisements or in-store advertisements, receipt of mailings from a cigarette company, or ownership of promotional items. Self-reported exposure to cigarette advertisements in magazines, on billboards, in stores, or at sports or community events, and of receiving advertisements or promotions through the mail; also ownership of promotional items Levels of exposure to printed media and attitude toward cigarette advertising 2-level status: (1) smokers- at least 1 cigarette/day and (2) nonsmokers-never smokers or <1 cigarette/day Although smokers and nonsmokers had the same level of exposure to media, in each case smokers had more favorable evaluations of the cigarette advertisements than did nonsmokers. Attitude toward cigarette advertisements was significantly related to smoking status, even when controlling for friend and family smoking. I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r Sin 1997147 588 11- to 16-year-old students (grades 7 through 9) in 4 secondary schools in Hong Kong Table 7. However, for junior high/middle school students and for all students combined, those who smoke (regular and at-risk) were more likely than were nonsmokers to pay attention to cigarette advertisements. Regular smokers were significantly more familiar than were nonsmokers with cigarette characters and brands. Significantly more current smokers owned a tobacco promotional item and had been offered a cigarette by a tobacco company representative compared with never smokers. Brand recognition/favorite tobacco advertisements and willingness to wear or use tobacco-branded products were found to be associated with intention to smoke. These associations remained significant in a multivariate analysis that included social influences. Self-reported exposure to advertisements was not related to intention when other measures of exposure to advertising. Twentyseven percent believed the advertisements influenced them, and 66% supported banning cigarette advertisements. Beliefs about whether advertising influenced them to smoke did not differ between smokers and nonsmokers. Exposure to cigarette advertisements, attention paid to cigarette advertisements, and familiarity with cigarette characters and brand names Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued) Study Setting/sample size Smith and Stutts 1999 148 246 junior/middle school, high school, and college students in a medium-sized metropolitan area in the southwest U. Adolescents with high levels of depressive symptoms and high receptivity to tobacco advertisements were more likely to smoke currently than were their counterparts without elevated symptoms. Younger age of smoking initiation was associated with all three measures of receptivity, even when sibling, parent, and friend smoking were controlled. Receptivity to tobacco advertising Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued) 254 Receptivity to protobacco media: having a favorite advertisement, having received a promotional item, and willingness to use promotional items Advertisement rating and liking: recognition of tobacco and alcohol brands, liking of these advertisements; liking of advertising, assessed with 3-point-scale answer to "How much do you like the advertisement (not the product) Susceptible nonsmokers liked the tobacco advertisements at a significantly greater level than did nonsusceptible nonsmokers and at a level comparable to that of smokers. Smoking susceptibility was significantly associated with liking for Marlboro cigarette advertising. I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r Unger et al. Perceived pervasiveness of protobacco marketing was significantly higher among established smokers than among susceptibles, and the susceptibles were significantly lower in this measure than never smokers, experimenters, and established smokers. The choice of Marlboro cigarettes was associated with the presence of a gift with the purchase and greater brand share of interior and exterior advertising voice. The choice of Camel cigarettes was associated with a greater share of interior advertisement voice but unrelated to a gift with purchase and negatively associated with a greater share of exterior advertising voice. Findings Factor analysis of exposure measures identified 4 factors: perceived pervasiveness of both protobacco and antitobacco marketing, recognition of specific antitobacco marketing, and receptivity to protobacco marketing. Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued) Study Setting/sample size Unger et al. I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r positive study, Schooler and colleagues46 obtained data from an ethnically diverse sample of 571 7th-grade students in San Jose, California. Participants rated how often they saw advertisements in magazines, on billboards, in stores, or at sporting or community events. They also reported whether they had received mailings from cigarette companies and whether they owned cigarette promotional items. Even when controlling for social influences to smoke, experimentation with cigarettes was significantly greater for those with more exposure to magazine or in-store advertisements, receipt of mailings from a cigarette company, or ownership of cigarette promotional items. In addition to the study by Schooler and colleagues,46 10 other studies of this type controlled for social influences to smoke. Like that study, they found that exposure to cigarette advertising was associated with smoking even when the influence of peers and/or family members on smoking was controlled statistically. In a sample of 818 6th and 8th graders in two Wisconsin middle schools, these researchers used a path analysis and showed that both protobacco and antitobacco advertisements had a significant indirect effect on adolescent smoking through their effects on peer norms. One did not perform a statistical test, although the trend was for a positive relationship. The study involved a total of 72 independent variables (7 regarding social influences) and found that none of the exposure variables (television, billboard, newspapers and magazines, community events) was related to smoking level. The invasiveness of this marketing practice may have eclipsed the exposure variables. This study should have employed extensive data reduction and chosen a more appropriate analytic method. The investigators conducted regression analyses to examine whether any association existed between these measures and smoking status. Young people were very aware of all forms of tobacco marketing communications; more than onehalf of all of the smokers studied had participated in some form of promotion. The first regression analysis showed that some individual marketing communication techniques (coupon loyalty offers and brand stretching) were associated with being a smoker. Perhaps more important, from an integrated marketing communications perspective, a second analysis found that the greater the number of tobacco marketing techniques a young person was aware of, the more likely he or she was to be a smoker. In other words, the investigators identified a dose-response relationship for marketing communications exposure and smoking behavior. The Role of the Media Bivariate analyses from a study from the Czech Republic149 indicated that both current smokers and never smokers had similar high levels of exposure to protobacco messages in magazines and newspapers. However, smokers were significantly more likely to possess a cigarette promotional item and to have been offered a cigarette by a tobacco company representative. Another study that included multiple exposure measures did not find recall significantly related to smoking, but found other measures. Finally, a study of Hong Kong students also showed no difference in smoking behavior for those exposed and not exposed to cigarette advertising, but found that smokers viewed the advertisements more favorably than did nonsmokers. This study116 found that, among 11- to 14-year-old Scottish youth, smokers were better than nonsmokers at recognizing the brand of cigarette shown in advertisements that had identifying characteristics removed, when controlling for friend, sibling, and parent smoking. As an example of a "positive" study, Unger and colleagues94 had 386 8th-grade students from Southern California attempt to identify the brand advertised in six cigarette advertisements, five alcohol advertisements, and nine other product advertisements. The researchers found smoking status to be significantly related to cigarette brand recognition for the brands depicted (Marlboro, Kool, Newport, Virginia Slims, Camel, and Capri). Twelve of these studies found that attitudes toward advertising were significantly more positive among those who smoked or were susceptible to smoking. One "positive" study found a significant association when variables were assessed bivariately, but the relationship was not significant when a multivariate analysis controlled for social influences. Three additional studies found no significant relationship between attitudes 257 7. I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r toward cigarette advertisements and smoking. One study that did not find a relationship between attitudes toward cigarette advertising and smoking asked adolescents whether they believed that advertising influenced young people to smoke. This measure is conceptually distinct from measures of the degree to which adolescents like or find cigarette advertisements appealing. An adolescent who himself or herself does not find advertising appealing could still believe that it influences other adolescents to smoke. These findings suggest that depressed adolescents may be especially vulnerable to cigarette advertising. Tercyak and colleagues found that adolescents experiencing high levels of depressive symptoms and who were high in receptivity to tobacco advertisements were more likely to smoke cigarettes than were those who were receptive but not depressed. A study by Sargent and colleagues146 of 1,265 students (grades 6 through 12) in New Hampshire and Vermont assessed only whether they owned a cigarette promotional item. Investigators found a doseresponse relationship between the number of promotional items owned and both being a smoker and being further along the continuum of the smoking initiation process. Receptivity to Cigarette Marketing Eighteen studies used indices of receptivity to cigarette marketing including owning or willingness to use cigarette promotional items. This relationship held even when researchers controlled for exposure to social influences to smoke. These researchers obtained data from 1,123 high school freshmen in Northern Virginia. In addition to assessing receptivity, they evaluated * Longitudinal Studies Table 7. After controlling for other variables including social influences, a significant link was present in all but two studies. Because of the importance of Twelve of the studies published before 2003 were reviewed previously in Lovato, C. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. Children with less appreciation of cigarette advertisements were significantly more likely to become more negative in their intention to smoke, even when friends, parents, and sibling influences were controlled. Recall of advertising for specific brands of cigarettes, recognition of brands in advertisements with brand information removed, appreciation of cigarette advertisements (ratings of liking for cigarette advertisements in general, recall of liked advertisements, and opinion about banning cigarette advertisements) Longitudinal Studies Predicting Later Smoking Behavior from Measures of Exposure to Tobacco Marketing at Baseline Document Setting/ sample size Aitken et al. This was true even when prior experimentation, rebelliousness, and smoking by adults and friends were controlled. For girls, awareness of at least one cigarette brand significantly predicted the uptake of smoking (sometimes or regularly) even when smoking by parents and friends was controlled. Receptivity to tobacco advertising and promotions was a significant predictor of established smoking. Those who were highly receptive to tobacco marketing were 70% more likely to become established smokers at follow-up compared with those who were minimally receptive. This was true even when relationships with family members and family and friends who smoked were controlled. I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r Choi et al. Being a current established smoker Despite lower rates of current as a young adult 6 years later established smoking in the second cohort, the effects of high and moderate receptivity on the outcome variable were similar and significant in both cohorts after controlling for social influences to smoke. New and at least weekly smoker at follow-up Awareness level (provided brand for none, 1, 2, or 3 advertisements) predicted new weekly smokers at follow-up, after controlling for social influences to smoke. Having a favorite advertisement in 1993 predicted which nonsusceptible never smokers would progress by 1996, even when controlling for family and peer smoking. Possession of or willingness to use a tobacco promotional item was even more strongly associated with future progression, even when family and peer smoking was controlled. Findings Were asked: "Do you believe that it is [all right] that there is tobacco advertising Receptivity to tobacco advertising and promotions Longitudinal Studies Predicting Later Smoking Behavior from Measures of Exposure to Tobacco Marketing at Baseline (continued) 262 Advertising receptivity, curiosity about smoking, and susceptibility to smoking Any smoking by follow-up in full sample, and susceptibility or any smoking among nonsusceptible never smokers For the full sample, both curiosity about smoking and being susceptible to smoking predicted smoking by follow-up. In the nonsusceptible never smokers, only curiosity predicted progression toward smoking. A further cross-sectional analysis showed receptivity and friends who smoked to be related to curiosity (dependent variable), suggesting that these factors may induce curiosity. Brand of exposure in magazines at baseline was significantly correlated with brand of initiation 4 years later, brand smoked by current smokers at follow-up, and naming of the brand that attracted attention the most at follow-up. External measure of brand-specific Brand first smoked by new ever exposure to cigarette advertising smokers at follow-up, brand in magazines the youth read smoked by current smokers at follow-up, and brand whose advertisements attracted attention the most. Analysis in this paper focused on 894 adolescents whose parents were classed as authoritative. Increases in receptivity to cigarette promotions between the first and second or second and third assessments also significantly predicted progression to smoking (higher status level). Report of exposure to either or both protobacco settings was significantly related to progression by follow-up. Report of exposure to antitobacco media was significantly protective of future progression. Analyses were adjusted for demographics and whether or not the school had an antitobacco program but not for social influence variables. Girls who named Benson & Hedges as a brand they were aware of were significantly more likely to be smoking 1 year later. The same was true for girls who named Benson & Hedges and Silk Cut (the two most advertised cigarette brands). Receptivity to cigarette promotions measured by ownership or willingness to use a cigarette promotional item Longitudinal Studies Predicting Later Smoking Behavior from Measures of Exposure to Tobacco Marketing at Baseline (continued) Document Setting/ sample size Sargent et al. I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r this methodological approach, each of these studies is described in detail below. A multiple regression analysis indicated that those who approved of cigarette advertising were significantly more likely to report smoking at the second assessment. The analysis took account of smoking by friends and siblings, which also were significant predictors of later smoking.

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