title: The vector of the tobacco epidemic: tobacco industry practices in low and middle-income countries.
abstract: OBJECTIVE
  To understand transnational tobacco companies' (TTCs) practices in low and middle-income countries which serve to block tobacco-control policies and promote tobacco use.
  
  
  METHODS
  Systematic review of published research on tobacco industry activities to promote tobacco use and oppose tobacco-control policies in low and middle-income countries.
  
  
  RESULTS
  TTCs' strategies used in low and middle-income countries followed four main themes-economic activity; marketing/promotion; political activity; and deceptive/manipulative activity. Economic activity, including foreign investment and smuggling, was used to enter new markets. Political activities included lobbying, offering voluntary self-regulatory codes, and mounting corporate social responsibility campaigns. Deceptive activities included manipulation of science and use of third-party allies to oppose smoke-free policies, delay other tobacco-control policies, and maintain support of policymakers and the public for a pro-tobacco industry policy environment. TTCs used tactics for marketing, advertising, and promoting their brands that were tailored to specific market environments. These activities included direct and indirect tactis, targeting particular populations, and introducing new tobacco products designed to limit marketing restrictions and taxes, maintain the social acceptability of tobacco use, and counter tobacco-control efforts.
  
  
  CONCLUSIONS
  TTCs have used similar strategies in high-income countries as these being described in low and middle-income countries. As required by FCTC Article 5.3, to counter tobacco industry pressures and to implement effective tobacco-control policies, governments and health professionals in low and middle-income countries should fully understand TTCs practices and counter them.
authors.affiliation: Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA 94143-1390, USA.
authors.forename: Sungkyu
authors.initials: S
authors.lastname: Lee
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Ling
authors.forename: Stanton A
authors.initials: SA
authors.lastname: Glantz
mesh_terms: D019049:Developed Countries / Q000191:economics; D058872:Epidemics / Q000191:economics*; D006801:Humans; D040541:Marketing / Q000191:economics; D011057:Politics; D011634:Public Health / Q000191:economics; D011640:Public Policy / Q000191:economics; D012907:Smoking / Q000191:economics* / Q000453:epidemiology*; D012941:Social Responsibility; D013660:Taxes / Q000191:economics; D019460:Tobacco Industry