'Cigarette designs and ingredients were manipulated to make the cigarettes more palatable to women and to complement advertising allusions of smooth, healthy, weight-controlling, stress-reducing smoke.'

The study has particularly disturbing implications for world health, as tobacco companies seek to increase smoking among women in developing countries, say the authors.

The documents, which were made public following the 1998 Tobacco Master Settlement Agreement, are examined in a paper in the June 2005 issue of Addiction, an international scientific journal.

Previous studies demonstrated that marketing strategies contributed to the association of smoking with appealing attributes -- including female liberation, glamour, success and thinness. Until now, however, the role of product design in targeting cigarettes to address how and why women smoke was less well understood.

'Far Beyond Marketing and Advertising'

"These internal documents reveal that the tobacco industry's targeting of women goes far beyond marketing and advertising," says lead author Carrie Murray Carpenter, M.S., Research Analyst, Tobacco Control Research and Training Program, Harvard School of Public Health.

Carpenter and colleagues reveal that the industry undertook a major effort that spanned more than 20 years to identify gender-based differences in motivational factors, smoking patterns, and product preferences in order to promote smoking among women and girls.

The resulting "female-friendly" products

The documents also show that cigarette makers went so far as to explore the use of appetite suppressants in cigarettes to promote smoking-mediated weight control, according to the researchers.

'Light' Cigarettes a Ploy

"Carpenter and her group reveal that cigarette designs and ingredients were manipulated to make the cigarettes more palatable to women and to complement advertising allusions of smooth, healthy, weight-controlling, stress-reducing smoke," according to an accompanying editorial in Addiction by Jack E. Henningfield, Ph.D., and colleagues at The Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health.

"For example, so called 'light' and 'reduced tar' cigarettes were designed to undermine prevention and cessation efforts by addressing smokers' concerns about the health effects of smoking -- but not by reducing the adverse health effects," Henningfield notes. Henningfield, who serves as director of The Robert Wood Johnson Foundation's Innovators Combating Substance Abuse program at Johns Hopkins University, is Adjunct Professor of Behavioral Biology, Department of Psychiatry and Behavioral Sciences in the university's School of Medicine.

Quotes from tobacco industry documents are sprinkled throughout the paper. One, from a 1993 internal Philip Morris report, describes a rationale for designing longer, slimmer cigarettes and creating the illusion of a "healthier" product: "Most smokers have little notion of their brand's tar and nicotine levels. Perception is more important than reality, and in this case the perception is of reduced tobacco consumption."

Troubling Implications for Developing World

Beginning in the 1970s, the documents reveal, the companies undertook internal research to identify numerous psychological and behavioral factors contributing to female-specific needs and motivations to smoke.

As brand preferences shifted between the 1970s and 1990s, the tobacco companies modified their product designs accordingly. "While the tobacco industry continues to target female smokers today, their current strategies are more multi-faceted and less readily identifiable than they were decades ago," the authors note.

The new paper's analysis suggests that the tobacco industry's behavior has particularly troubling implications for health officials in the developing world. While male smoking rates are declining throughout the world, female smoking rates are expected to continuing increasing and reach 20 percent by 2025, driven by the growth of female markets in developing countries.

Call to Action

Published research predicts the rapid growth of tobacco-related disease among women in these countries, and establishes that industry efforts to target women have resulted in the elevated female smoking and related disease rates that we see today.

Henningfield views these revelations as a "call to action" for the tobacco-control community: "Now that we know tobacco companies designed cigarettes to addict women, we need to look at prevention and cessation strategies to counter these efforts.

"Our most pressing priority should be to examine how Carpenter's findings can be used to counter the rising tide of smoking in women in developing countries, so that we don't see the corresponding increase in smoking-related deaths that we've already seen in the developed world," he concludes.