Documents discussions elicited various responses from participants, including expressions of anger, intimidation, and surprise about the tobacco industry’s targeted marketing of older individuals and attempts to keep them smoking regardless of their age. Each document sparked lively discussions, which often expanded to include participants’ personal experiences. Though several themes emerged from discussions, this paper will focus on five themes that provide insight into areas related to older people that have not previously been reported in the literature. These themes are responses to target marketing, choice, and the broad theme of responsibility, which we further sub-coded into personal, tobacco industry, and government responsibility. The themes of target marketing, choice, and tobacco industry responsibility were discussed in all ten focus groups, as would be expected given the selection of documents reviewed; personal and government responsibility came up in nine and eight groups, respectively, a key finding since these topics were not addressed in the documents nor prompted by the moderator.
Segmented marketing to older smokers
A copy of a field research report that Segmented Marketing Services, Inc. (SMSi) conducted for RJ Reynolds demonstrated how the tobacco industry valued older smokers as reliable and loyal customers [36
]. Because this was the first document presented to each group, the highlighted quotations in the SMSi document elicited an initial response of surprise. Participants were unaware that, as a group, older adults had received special attention from the tobacco industry. This document showed that the tobacco industry was interested in older people because the number of older Americans was “rapidly growing” and the “increasing disposable income of older Americans makes this segment a prime target of many products and services” [36
The report’s mention of “increasing disposable income” led to emotionally charged responses from participants, who took issue with this characterization of older smokers for marketing purposes. “Where do we have an increasing disposable income? We have less income…our income is so limited now…it’s very insulting to me.” (M, FG-2) The “insult” in this instance appeared to be the marketers’ misapprehension of the financial status of many older smokers. Given that smokers generally tend to be poorer than nonsmokers [47
], this perception reflects the likely experience of many older smokers who may be living on fixed incomes or may be disabled and unable to work. Though there might have been some conflation of the idea of “disposable income” (money left over after paying essential expenses) with their own social “disposability,” the insult here appears to lie in a stereotyped version of older people that did not reflect participants’ experience.
A participant in another group also characterized the same document as an “insult,” but for a different reason:
“I find it to be insulting that…as we grow older… they want to keep us smoking until the day we die…It makes me feel like the cigarette industry is looking at me as being disposable and they’re going to keep me hooked as long as they can… until the day I drop dead of emphysema or lung cancer. .. I find that insulting. (M, FG-1)”
It is evident here that the “insult” is experienced as exploitation, in which older smokers are used up and then discarded and that there is something disturbing about continuing to market deadly products to those who are advanced in age.
However, not all participants found the tobacco industry’s targeting of older people offensive. “Well, first thing, I’m a smoker… I wish I didn’t… But considering that I do smoke, that doesn’t bother me that they’re watching or even advertising.” (M, FG-9) This sentiment was shared by several participants. Though most participants had previously been unaware of the tobacco industry’s intentional targeting of older people, there was a general acceptance across all groups that these activities could be considered “business as usual,” because the tobacco companies’ main objective was money-making. “The tobacco companies, they had medical evidence that smoking is bad for you…[they’re] not in the business to worry about your health [but] to move the product.” (M, FG-3) Participants frequently spoke of not being surprised by the industry’s focus on older smokers, because “part of their job is trying to make all the money they can.” (M, FG-7)
These discussions were often followed by discussions about the role of personal choice. “Well, I believe that businesses have the right to earn money… it’s my choice to smoke. Any way that they can target [consumers] to get that money, God bless them.” (M, FG-4) Similar conversations arose in eight other focus groups. For example, after describing her decision to smoke as based solely on her personal choice to do so, a female participant met resistance from a male participant, who questioned whether she was able to make a choice if she was uninformed about the addictiveness of the product. “You weren’t given the choice to make a responsible decision,” he argued, “Because you didn’t know what you were smoking.” (M, FG-6)
However, consistent with studies that have found older smokers/lung cancer patients to engage in self-blame [48
], others insisted that smoking was solely their own choice: “I can’t blame the tobacco companies; it is still me. Because I still have the ultimate choice.” (M, FG-2) “I think, ultimately, the responsibility is ours… Ultimately, it wasn’t their [tobacco industry] responsibility. It was ours.” (F, FG-6)
A dialogue between two male participants in FG-2 illustrates the tension in trying to decide whom to hold accountable: the tobacco industry or the individual: “I know better, and I smoke because I like it… But I don’t like being manipulated.” (M1, FG-3) “How can you really say that you have been manipulated when you have a choice?” (M2, FG-3)
It was generally accepted that because tobacco companies have a product to sell, they will do whatever it takes to sell more of it. “I’m not really surprised because it’s a billion-dollar industry, and they have to make their money, whatever they have to do by any means necessary. It’s not a good thing, but that’s just the way it is.” (M, FG-1) This understanding of the reasons for aggressive industry practices, however, did not mean that they were condoned. Rather, participants pointed out the need for stronger government regulatory action.
Roles of government
Though government’s role was not addressed in the discussion documents presented to any of the groups, participants frequently raised on their own the issue of the government’s responsibility for protecting consumers and holding the tobacco industry accountable for the marketing of deadly products. Focus group participants honed in on government accountability as discussions developed around tobacco companies’ business activities and why there were no regulations or regulatory actions against such activities. Several participants displayed skepticism, however, about whether the government could or would intervene to protect the public from the tobacco industry. Whenever this topic came up, participants were quick to respond with reasons for the government’s permissive allowance of industry activity. One participant blamed “money” for the government’s relaxed stance on regulating the tobacco industry. “Why doesn’t the government just say, ‘Okay. Let’s just stop this. Ban it. Cut it out totally’? It goes back to one thing…money.” (M, FG-5) The nature of these perceived monetary disincentives for government regulation, however, appeared vague.
There were concerns that the government would not enforce existing regulations because it was somehow colluding with or profiting from the tobacco industry. “We realize that the tobacco company has a plan, like [making] a dollar. That the Surgeon General, our government won’t do anything because they got their hands in it. That’s why they’re not going to say anything.” (M, FG-2). The government’s role in protecting the industry’s profit continued as a focus of discussion in the same group:
“I guess they just all got together to see, you know, what was going to be profitable, and what were they going to have to do to continue their [products] to keep [them] flowing, you know; so they could keep getting the income that they were receiving from it, not really caring about whose life they were destroying, if they cared at all… People that’s up high that’s making all the money, they don’t care about nobody down here, as long as their money keeps coming through, you know?… It’s a sad situation… You know what I mean… it’s just sad. (F, FG-2)”
The discussion continued as others chimed in about mistrust of the government’s commitment to protect public health over and above the protection of industry profits. “I wouldn’t put that past our government. As long as [it] can get a profit, [it] will continue to let this go on.” (M, FG-2)
“And they’re sitting around watching millions and thousands of people die every year from lung cancer, some kind related to tobacco -- some kind of diseases.... It’s funny how our [government] don’t stop this horrible crime that’s being committed by Philip Morris products, it’s a crime…As long as there’s money, [the government doesn’t] give a damn. (M, FG-2)”
A similar discussion took place in another focus group: “[Tobacco companies faced] some big lawsuits, and they lost, whatever. But, they still continue to sell cigarettes. If people in high places were so concerned, cigarettes would be banned… it’s too much money with it.” (M, FG-5)
Legality does not absolve government of responsibility
Government’s logic in sorting out which types of “bad behavior” should be sanctioned versus tolerated was a source of bafflement. For these participants, the “legality” of tobacco did not absolve government from its obligations to protect the public by prosecuting not only those who committed acts of immediate physical violence, but those committing acts of slower and more hidden structural violence, addicting consumers to deadly products.
“But what I’m saying is how can they get upset because people are shooting people, if these people are basically killing me, just slower? They’re still taking my life and the government is aware that it’s taking my life, but it’s okay? (F, FG-1)”
For many participants, the apparent inconsistency of prosecuting people for illegal drugs or gun violence while allowing tobacco companies to continue making a profit from products that cause much greater levels of harm was inexplicable. Most participants were unaware of the United States Department of Justice lawsuit against the tobacco industry, in which the major tobacco companies were adjudged to have committed fraud and racketeering [51
“But, the government knows that these tobacco growers are growing the tobacco, which is killing people. So, why can’t [the government] in turn prosecute the tobacco [company executives] like they’re doing [with] the drug dealers?… What’s the difference? Because [the tobacco companies are] white collar and [the drug dealers are] “street”? (F, FG-2)”
“It’s intentional murder. I don’t care how you put it…they done gave us something that’s the most addictive thing there is, and they knew it. (M1, FG-5)”
Though they displayed only a vague awareness of legal challenges tobacco companies faced and industry losses in court, participants questioned why there were no visible consequences or penalties for ongoing promotion and sales of cigarettes. Regarding the government’s obligation to protect its citizens, one participant asked, “-- why tobacco is on the market when it’s obvious that it’s going to kill you?” (M, FG-8)
“Because the United States government sits there and allows them to do it…I think all of what we do is based on being informed or not being informed. And we all, as a population -- it doesn’t matter what class you’re in – generally if you are not informed, misinformed, or targeted as this…is something to the company’s benefit. (M2, FG-5)”
The failure on the part of the government to intervene more aggressively came up in another group: “The Surgeon General says that these could be a hazard to your health, but they didn’t say it caused cancer…they did not tell you that directly…because the United States government [only allowed] them to say so much.” (M, FG-5) The government, in the views of these participants, should not continue to tolerate “business as usual”. “I just don’t think that [selling tobacco is] honest business. I think it’s very dishonest and very deceitful the way [the tobacco companies] do it, the way they market and study the different age groups. And then the government goes along with this?” (F, FG-2)
In one instance, a participant spoke approvingly of how the government had successfully intervened to reduce the public’s exposure to secondhand smoke in restaurants and other public venues. “I’m so happy that the government has stopped the secondhand smoke in restaurants and out in the public.” (M, FG-7) Participants in another group pointed out how the government had sometimes acted to protect the public in the past:
“I think Vantage even went as far as to send out sample packs of Vantage cigarettes in the mail. Because you would get three cigarettes in a little, bitty [packs]…But I think the government stopped that. The companies weren’t allowed to mail unsolicited [cigarettes]. (M, FG-6)”
This discussion about the government interrupting the mailing of free samples of cigarettes also took place in other focus groups. One male participant reminisced and pointed out that the government took some action, but implied more action needs to be taken.
“You know like you said, back in the 50s and 60s you [would] see all kinds of commercials for cigarettes. The United States government said it was bad for your health. That’s why they cut the [television] commercials out, right? [But,] they put them in magazines and stuff like that, and billboards. (M, FG-5)”