A total of 26 (14 by Institute 1 and 12 by Institute 2) in-depth interviews were conducted with past and current stakeholders at the various levels in the field of tobacco control. Majority of them were males (84.6%) and most were in service (73.1%) i.e. they were serving either a government-institution (38.5%), a non-government institution (42.3%), or a private organization (19.2%). Half of them (57.7%) were engaged in tobacco control activities from the last 5-10 years. The characteristics of study participants are summarised in Table-1.
Almost all respondents perceived tobacco industry as ‘Manufacturers’ (Mean score = 9) while more than half of them associated ‘advertisers’, ‘public relation (PR) companies’, ‘wholesalers’, ‘vendors’, and ‘Government firms having TI stocks’ as tobacco industry. (Table-2). Power ranking method on prioritizing the players of tobacco industry’s involvement in various themes of TI interferences showed that the ‘manufacturers’ and ‘PR companies’ were involved in all six types of industry interferences identified in the study. Industry led unions and farmer’s corporations were involved in all types of interferences except Tobacco Advertising, Promotion, and Sponsorship (TAPS) activities. Industry sponsored hospitality sector was also involved in all types of interferences except hampering implementation of tobacco control in the country (Table 3). Majority of role players including ‘wholesalers’, ‘bidi rollers’, ‘politicians’, ‘bureaucrats’ and ‘civil society organizations’ were found to be associated with four types of industry led interferences in the country. (Table 4)
Table 1
General details of the respondents invited for in-depth interviews.
|
Institute 1
|
Institute 2
|
Total
|
Total
|
14 (100)
|
12 (100)
|
26 (100)
|
Gender
|
|
|
|
Male
|
11 (78.6)
|
11 (91.7)
|
22 (84.6)
|
Female
|
3 (21.4)
|
1 (8.3)
|
4 (15.4)
|
Age
|
|
|
|
25–45 years
|
3 (21.4)
|
5 (41.7)
|
8 (30.8)
|
45-above
|
5 (35.7)
|
5 (41.7)
|
10 (38.5)
|
Not mentioned
|
6 (42.8)
|
2 (16.6)
|
8 (3.8)
|
Occupation status
|
|
|
|
In service
|
8 (57.1)
|
11(91.7)
|
19 (73.1)
|
Retired
|
1 (7.1)
|
1(8.3)
|
2 (7.7)
|
Self employed
|
5 (35.7)
|
-
|
5 (19.2)
|
Organization
|
|
|
|
Government
|
5 (35.7)
|
5 (41.7)
|
10 (38.5)
|
Non-Government
|
4 (28.5)
|
7(58.3)
|
11 (42.3)
|
Private
|
5 (35.7)
|
-
|
5 (19.2)
|
Years of Association with tobacco control
|
|
|
|
5–10 years
|
10 (71.4)
|
5 (41.7)
|
15 (57.7)
|
11–20 years
|
2 (14.3)
|
5 (41.7)
|
7 (26.9)
|
20 years above
|
2 (14.3)
|
2 (16.6)
|
4 (15.4)
|
Table 2
Perception of study participants regarding Tobacco Industry using ‘Power Ranking Methodology’.
Stakeholders
|
Average score (N = 10)
|
Manufacturer
|
9
|
Wholesaler
|
6.8
|
Vendors
|
6.2
|
Advertisers
|
7
|
PR Company
|
6.7
|
Government with tobacco stocks
|
5.8
|
Government without tobacco stocks
|
2.2
|
Tobacco union workers
|
4.6
|
Farmers
|
3.8
|
Farmers corporations
|
4
|
Pension funds and other Financial incentive schemes
|
2.6
|
Banks and financial institutions
|
3.6
|
Bidi rollers
|
4.6
|
Politicians
|
5
|
Bureaucrats
|
4
|
Civil Society Organization
|
3.6
|
Hospitality Industry
|
0.6
|
Table 3
Role of tobacco industry in interfering tobacco control activities in India
Themes
|
Sub-themes
|
Influencing the policy and administrative decisions
|
Projected revenue generation and livelihood creation
|
Providing sponsorships for government events & political parties
|
Using policy loopholes
|
Offering undue favors
|
Lack of prioritization towards tobacco control
|
Interference with implementation of tobacco control laws and activities
|
Interference in the judiciary system
|
Interfering with work of tobacco control officials
|
Interference in functioning of NGOs who work on tobacco control
|
Prompting sellers for non-cooperation with tobacco control officials
|
False propaganda and hiding the truth
|
Exaggerating the economic impact of tobacco and loss of livelihood
|
Hiding facts about tobacco harms
|
Promoting CSR activities to gain social respectability
|
Hiding involvement in sponsored events
|
Misguiding tobacco growers
|
Manipulating through front action groups
|
Instigating protests and non-cooperation
|
Threatening tobacco shop owners
|
Rampant tobacco advertising and promotion activities
|
Promoting surrogate advertisements
|
Creating new customer base with attractive offers
|
Support and bonus for tobacco shops and vendors
|
Others
|
Evidence of Government honoring tobacco industry officials
|
Poor awareness on harmful effects of tobacco among ancillary stakeholders of tobacco industry
|
Lack of cohesion at institutional levels for tobacco control discussion at state and national level
|
Lack of understanding and support for tobacco control initiatives
|
Situational priority i.e. tobacco control taking backseat over other priority issues
|
Table 4
Perception of study participants regarding involvement of “Tobacco industry role players” in various identified themes.
Tobacco industry role players
|
Theme 1 (Influencing the policy and administrative decision)
|
Theme 2 (Interference with implementation of tobacco control laws and activities)
|
Theme 3 (False propaganda and hiding the truth)
|
Theme 4 (Manipulating front action groups)
|
Theme 5 (Rampant TAPS activities)
|
Theme 6 (Others)
|
Manufacturer
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Wholesaler
|
|
Y
|
Y
|
Y
|
Y
|
|
Vendors
|
Y
|
Y
|
|
|
Y
|
|
Advertisers
|
|
Y
|
Y
|
|
Y
|
|
PR Companies
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Government with tobacco stocks
|
Y
|
Y
|
|
Y
|
|
Y
|
Government without tobacco stocks
|
|
Y
|
|
Y
|
|
Y
|
Tobacco union workers
|
Y
|
Y
|
Y
|
Y
|
|
Y
|
Farmers
|
|
|
Y
|
Y
|
|
Y
|
Farmers corporations
|
Y
|
Y
|
Y
|
Y
|
|
Y
|
Pension funds and other financial incentives schemes
|
|
|
Y
|
Y
|
|
|
Banks etc.
|
Y
|
Y
|
|
Y
|
|
|
Bidi rollers
|
Y
|
Y
|
|
Y
|
|
Y
|
Politicians
|
Y
|
Y
|
|
Y
|
Y
|
|
Bureaucrats
|
Y
|
Y
|
Y
|
Y
|
|
|
Civil Society Organizations
|
Y
|
|
Y
|
Y
|
Y
|
|
Hospitality Industry
|
Y
|
|
Y
|
Y
|
Y
|
Y
|
“TI are various kinds of people who lead or who are part of tobacco production and selling (tobacco). Whosoever works for furthering the interests of TI are also part of TI; even though they may be peers, packagers, marketers, or advertisers are also TI.” (One respondent).
“It's an established industry which is present in both organized and unorganized industry and well connected (politically).” (a health professional)
Interference of tobacco industry with tobacco control activities
The analysis of all the key informant interviews regarding interference of TI with tobacco control activities generated six themes and categories as shown in Table 3 and Figure 1.
-
Influencing the policy and administrative decisions
TI has been seen by participants as a prime intruder in policy making and key administrative decisions of the government. The participants opined that TI uses monetary and power tactics to influence policy makers in placing tobacco control to backseat.
Nearly everybody was of the opinion that TI structures significant supporters towards income for the administration and making business for some families like tobacco producers and tobacco venders. A participant surmised that TI has been traditionally involved in various governmental development projects which is a direct contradiction to Article 5.3 of FCTC.
“TI are spending crores of money in various states. They are sponsoring a lot of money in the food industry.” (A tobacco control advocate)
“Recently we had got an order issued for increased taxation on tobacco products which was immediately reversed by our government, possibly due to pressure (of TI). Similarly, political leaders opposed the ban of Gutka (oral chewable tobacco) in parliament on the pretext of loss of income of farmers” (A tobacco control advocate)
The participants felt that TI creates an impression of ‘no immediate threat associated with tobacco’ among the public, which results in lack of public pressure on policy makers and politicians in framing effective tobacco control policies.
“Unlike accident and epidemics, tobacco use is not seen as an immediate danger to politicians and public, which is effectively utilized by TI. Whenever we go to public for a raid (COTPA enforcement), they throw a question on us, asking, 'why don't you close the tobacco companies rather than making the people suffer?” (A government official)
The respondents also shared that many political parties and officials in the government receive favors from TI, which undermine the tobacco-related policy decisions.
“In one of our state’s budgets, then minister declared a 5% VAT on bidis, which was immediately reversed to zero percent on the behest of TI, which we could sense.” (A government official)
“The government’s framework is unreactive towards tobacco control, the huge amount of cost involved with care of tobacco-related morbidities and mortalities. Lack of priority for tobacco control, poor funding, no dedicated staff exclusively for tobacco control and frequent transfer of trained staff explains that.” (A tobacco control activist).
Tobacco is still not considered as an illegal product and no license is needed for processing, manufacturing or selling of tobacco products unlike liquor by the law of the land. TI makes use of this argument to convince policy makers in making tobacco products easily accessible at various Point of Sale.
“The biggest challenge for us is that we are one of the largest tobacco-growing and exporting countries. It's not an illegal product. TI use this argument for its easy accessibility in markets” (A health professional)
TI takes advantage of slow legal proceedings and poor implementation of tobacco control laws. The conflicting orders from different ministries provide opportunity for the TI to carry out promotional activities.
“TI have people who find loopholes in government policies, which leads to slowing of legal proceedings.” (A government official)
The participants reported undue favors being offered by the TI representatives to higher officials in the form of gift hampers or financial support to the organizations as a tool to influence them to take policy decisions in their favour.
“TI also affects the opinion of the committee that constitutes to finalize the policy rules and regulations” (A study participant).
“One of the Corporation official’s daughter marriage was completely conducted by the TI, starting from booking hall to buying jewelry and everything for the wedding was managed by the Gutka industry.” (A tobacco control activist)
“Once the Gutka industry people came and offered undue favors. 'We will give you one crore and if you are finding it difficult to receive as a cash, then, we will buy you a house in the centre of the city”. (A tobacco control activist)
Most of the respondents felt that the TI makes use of existing corruption within the system and week political setup to their benefit.
“TI tries to build pressure through their political representatives to delay or dilute the policies.” (A participant).
“Vested interests of politicians results in lack of their will to combat Tobacco menace.” (A participant)
Few of the respondents threw light on the way how TI manipulates policy making and implementation by challenging such procedures in court by using fake documents and poorly generated scientific evidence. Respondents reported witnessing instances where the TI had used fake of self-sponsored researches in favour of TI.
“Smokeless tobacco lobby always tries to threaten them. They also support high-level officials to refine the fake evidence which are provided by TI in support of their business.” ( A respondent)
“TI influences people, law enforcers, policy makers, doctors, lawyers, scientist, and high-level official against the good work done by you.” (A respondent)
-
Interference with implementation of tobacco control laws and activities
The participants were of the opinion that since TI is a well-established sector with huge amount of money, they interfere with implementation of tobacco control laws and activities by influencing judiciary, implementing officials, non-government officials and merchant association or tobacco sellers. The respondents stated that legal challenges (litigations, RTIs etc.), offering undue favors , issuing threats are being used as weapons by the TI to interfere in implementation of tobacco control laws.
“TII has top level lawyers who challenge every favorable decision in the court of law, which dilutes effective implementation” (A tobacco control advocate).
“After a state high court had given an order about the 85% pictorial warning on tobacco packets, TI went to court several times which delayed its implementation.” (An academician and researcher)
“TI representatives met me with an only agenda to stop supporting govt. initiatives in tobacco control program.” (A public health activist)
“TI threatened me for implementing tobacco control activities in my state and even filed many RTIs to build the pressure.” (A government official)
“Sometimes, when we are creating awareness among shopkeepers, some agents used to come from a particular company, and question us why are we stopping their business?” (A tobacco cessation expert)
“Unfortunately, one or two of the shopkeepers who received the award for not selling the product also started selling it (tobacco) again because of the threat (from tobacco dealers) and also the public is expecting us to sell it.” (A respondent
“A lot of money power (stressed). So, what can the police do when they are informed not to enforce.” (A health professional
“He came and opposed my public awareness program on the railway station. Why are you propagating this at all?” (An NGO official)
“Once, when we were traveling, a person (from TI) had accidentally or purposefully hit our vehicle and issued threat.” (A leading tobacco control advocate)
“Foundation for Smoke Free World associated with a multinational tobacco company, is trying to influence people who are working for tobacco control. This foundation approached many tobacco control advocates through one to one meetings and mails also. The foundation approached President of an association but he denied their proposal. I sense that TI has used its financial muscle power to cancel FCRA of many associations.” (A respondent)
“Not approached as an individual but two prominent national organizations are being approached by TI to support their school Intervention program.” (Director of an organization)
Most of the respondents said that the TI creates a non-cooperative attitude among the distributors and point-of-sale owners by performing various activities like installing and replacing advertisement boards removed during enforcement drives, compensating for losses in case of seizers or challans.
“A point of sale owner told me that TI people came to them and reimburse challan (fine) money and even replace my advertisement boards removed in enforcement drives” (An academician and researcher)
“TI instructs the sellers of this product (cool lips- a flavored form of smokeless tobacco) to distribute among the children for which they pay us incentives.” (A tobacco control enforcing official)
Most of the stakeholders opined that there is dearth of awareness at all levels i.e. among the stakeholders, the enforcers, the policy makers and the masses as a whole, which hinders proper implementation of the tobacco control laws.
“Law enforcers are not very much aware about the COTPA and other tobacco control laws.” (A Director of a NGO)
“Lack of awareness and passion for tobacco control is the root cause of the challenges that came up during the implementation of tobacco control policies in the state.” (A Deputy Director working in tobacco control)
-
False propaganda and hiding of truth
Responses from the interviews provided an insight into how the TI paints a bright picture in front of public and policy makers and hide their vested interests under the garb of health promotion social activities performed by them.
Many responses from the interviewees highlighted the fact that TI undertakes corporate social responsibility (CSR) by which they depict their companies as ethically correct and economically productive to the society.
“TI offered to support our school intervention program, which we denied” (A tobacco control expert)
“Earlier, we (in NGO) used to carry out only the tobacco control activities in collaboration with other NGOs. But, when the tobacco companies started CSR activities, they started funding many NGOs, which resulted in rifts between NGOs to garner funds from them (TI).” (A leading tobacco control advocate)
“TI want to build hospitals, and if the government is allowing that, then it will become the biggest threat.” (Director of a NGO)
By discrediting scientific evidence, TI misguides the existing as well as future customers and also discourages tobacco users to quit.
“They (TI) are advocating that the tobacco is not harmful, tobacco is not causing cancer. They have many such studies (false evidence) to prove their statements”. (An academician and researcher)
Misleading claims by TI representatives, of being a support for global tobacco regulation that aligns with the FCTC, was reported by few respondents
“A person who worked for tobacco control ,later joined as the head of ‘Foundation for Smoke Free World’, an initiative by a leading multinational tobacco company, wrote a mail to about 300 people all over the globe to join their organization and the people who did not know much about TI easily accept his proposal.” (A Behavioral Scientist)
“People participate in such programs (conducted/sponsored by tobacco companies) without knowing that they are conducted by tobacco companies; like cultural shows, cultural events”. (A public-health professional)
Tobacco growing is the only means of earning for a section of people. For their business interests, the TI doesn’t want the tobacco growers to switch over to other means of livelihood.
“Most of them, either tobacco growers, or tobacco users are not aware of the big industry involved. Only middlemen are aware of the industry nexus.” (A leading health professional)
“They are saying that, 'we are increasing the wage for them (bidi workers), which affirms belief of workers in them (TI).” (A leading tobacco control activist)
-
Manipulating front action groups
Most of the respondents stressed upon the manipulative powers of the TI. As per them the main tactics used by the TI were threats and maneuvering acts.
Threats of legal action are a popular means used by the TI to intimidate governments and activists who introduce and support effective tobacco control policies. Others provide physical threats to them. As per the respondents the mere threat of such litigations and physical threats discourages the whole implementation process.
“There is large production house of a tobacco company in the State, so the industry always tries to delude our efforts. Smokeless tobacco lobby always tries to threaten our staff” (An Executive Director of an NGO)
“TI tries their best efforts to influence public health policies by providing them with policy loopholes and manipulating the facts. They are all directed towards the single motive of increasing their business.” (A Manager working with an NGO)
“When we ask them (tobacco sellers), why they are again selling, they tell that because of the physical threat (from tobacco dealers)” (A tobacco cessation advocate)
With a vested interest, the tobacco company instigates the front action groups to protest the implementation of tobacco control laws citing livelihood issue and harassment.
“I’m more than closely working with the government tobacco control cell. See, recently they have instigated the retailers to protest, over the livelihood issue.” (A leading health professional working for an NGO)
“TI picks the merchant association or restaurant association, push them to the front who then submit memorandums to the collector”. (A leading tobacco control advocate)
-
Rampant TAPS activities
As per the respondents the TI uses tobacco advertising, promotion, and sponsorship (TAPS) to increase consumption of their products. The TI uses deceptive, misleading, and predatory tactics to make tobacco use appear glamorous and socially acceptable, while minimizing perceptions of products’ adverse health effects.
A respondent working in the implementation sector said that the TI supports distributors and wholesalers by performing various activities like paying daily wages to petty sellers and providing signage’s and other posters mandated under law to these retailer/venders etc. Similarly, by endorsing other brands and partnering with other organization for sponsored events, they indirectly advertise their company. This persuades the existing customers from quitting tobacco use.
“They do things indirectly, and it is like hide and seek game with them (tobacco companies); because, surrogate advertisements are still there, which we (government) need to find or somebody has to inform us.” (A public health professional)
“We have also taken efforts to stop various competitions like 'Sun-feast competition', 'Spell bee', and 'Mangal deep' singing competitions. So, these are against that order (Order 242).” (An advocate)
Besides, TI uses different tactics to create a new customer base and maintain the existing one. Lowering of price and selling components separately was another tactic.
“We got to know that the TI came up with two cigarette pack. So, that is a pack (tobacco pack) and it’s not a loose cigarette.” (An academician)
“We convinced the new government to ban Gutkha. But, since then, we see that Gutkha is being marketed with tobacco and betel leaves separately in smaller packets and reducing the rates.” (An academician).
Flavored chewable tobacco products at point-of-sale attract new customers especially students and children.
“We had recently faced difficulty to seize a product named ‘Cool tips’. This is a chewable form of tobacco sold like chocolates targeting the school children. The pictures of the product are also available on the internet.” (A tobacco control enforcing official).
TI provides financial support in the form of reimbursement for the penalty imposed by officials and bonuses for selling tobacco products. This encourages the tobacco sellers and vendors to continue promoting tobacco products despite legal actions.
“Those cigarette companies, dealers used to promote the product by giving some bonus or cash prizes to the shopkeepers; they (shopkeepers) want that also.” (A tobacco cessation advocate)
-
Others
Certain themes were generated that couldn’t be categorized into any of the above-mentioned major domains were compiled to constitute the sixth domain.
- Government honoring TI officials (e.g.: a leading cigarette manufacturers CEO was awarded India’s highest civilian award). Honoring TI officials acts as a catalyst for TI to expand their business.
- Poor awareness on harmful effects of tobacco among ancillary stakeholders of TI (e.g. tobacco plant growers, tobacco sellers) The TI takes advantage of the lack of awareness on harmful effects of tobacco among lower level stakeholders.
- Lack of common platform for tobacco control discussion (reason for ineffective, uncoordinated decision making and poor implementation of tobacco control laws)
- Lack of understanding of tobacco control and limited support among government officials and policymakers (especially elected politicians) with respect to tobacco control. Situational priority for other communicable diseases, poor funding, and lack of understanding on tobacco control among government officials, poor coordination between different government departments prompt TI to flourish their business.
- Situational priority (several immediate issues are prioritized over tobacco control at the grassroots)
Challenges faced and the factors perceiving to the same
Many factors pose challenges at various level of tobacco control. Our respondents enumerated a list of challenges faced by them during the implementation of the tobacco-control activities. The challenges are at different levels and encroach the domain identified earlier in table 3. Different stakeholders, attempt interference in different domain as summarised in table 4. However, major challenges and main difficulties in implementation and enforcement are described subsequently in table 5.
Table 5
Tobacco industry interference and actors which challenge tobacco control efforts, based on responses of tobacco control experts who participated in the study.
Tactic
|
Goal
|
Key stakeholders for tobacco industry
|
Example
|
Lobbying
|
Influence political and decision-making processes by presenting specious data and distracting officials from tobacco control
|
Front groups, PR firms
|
Lobbying by PR firms during Committee of Subordinate Legislation on pack warning (2015-16), TII
|
Creating alliances and front groups
|
Present exaggerated and widespread negative impact tobacco control legislation/ tobacco control policies
|
Civil society, farmers networks etc.
|
FAIFA,
State level farmers associations
All India Bidi Federation
|
Political funding
|
Contribute to local and national political parties for campaign and seek favours from elected politicians
|
Political parties and party leaders
|
ITC annual reports
Report of various tracts through which political funding is routed
|
Litigation
|
Challenge laws and intimidate tobacco control advocates
|
Vendors, farmer associations, vested interest groups, Industry
|
Ghodawat pan masala pvt. ltd v.
/s The state of Maharashtra and others (WP no. 1632 OR 2012);
|
Participate in decision making with government
|
Promise investments to state government
|
Industry associations and government bodies
|
Investments promised by ITC, GPI, and DS Group to states
|
Intimidation
|
Use its power to harass and threaten tobacco control community
|
Politician and bureaucrats
|
Recent cancellation of permissions of tobacco control organisations
|
Public relations
|
Shape public opinion by using media to and promote positions favourable to the tobacco industry and its allies
|
Media houses, PR companies, Government flagship programmes
|
Participation of tobacco companies in Government flagship programmes
|
Philanthropy and Corporate Social Responsibility
|
Re-normalise and re-legitimize tobacco with society; gain social respectability by participating in social and economically relevant issues.
|
Through reputed NGOs and government schemes
|
Support neglected areas of investment. Eg: GPI supports vendors in flood affected areas by creating tobacco vends
Partner with Govt in its flagship schemes like Swachh Bharat Abhiyan etc, floods/drought situation/ pandemic
|
Supporting Government agencies that assist tobacco sector
|
Garner support from within the government
|
Ministries of Finance, Labour, Agriculture, Commerce, Tobacco Board
|
Various policy measures
|
A. Tobacco control not given highest priority by Government officials:
1. Tobacco control is not high on the priority list of the government especially for departments other than health. Revenue earned from TI is projected and the loss due to tobacco-related diseases is undermined. Limited dedicated funds or workforce is allotted for tobacco control. Trained officials are frequently transferred which leads to intermittent implementation of tobacco control laws.
2. Inadequate political support against TI and limited documented evidence
I. Lack of cohesion at institutional levels: There is no common platform for discussion and adopting strategies for tobacco control. Many departments are not aware of their roles and responsibilities.
II. Lack of funding from international donors and local corporates for tobacco control: There are not many donors for tobacco control. The corporate world seems to restrain itself from investment in tobacco control.
B. Difficulty in implementation and enforcement
I. Lack of awareness: Second round of the Global Adult Tobacco Survey (GATS)-India (2016-17) [17] has depicted adequately high awareness regarding the harmful impact of tobacco use. However, some of the enforcing officials (police), politicians and judiciary system are still unaware of impact of tobacco use and its consequences on society. TI sponsored competitions, surrogate advertisements and partnerships are evidence for low awareness among various stakeholders
II. Differential priority and lack of interest among enforcement officials:
Most of the enforcing officials are multitasked. For instance, they are delegated with responsibilities of mitigating seasonal communicable diseases (like Dengue) which poses an immediate threat. Many senior officials are not convinced enough to attend all the tobacco-related meetings.
Mode of approach by tobacco industry:
TI contacts different tobacco control activists and officials for preventing tempering with their business. Half of the participants reported to be approached by TI in various ways. Two of the participants were approached directly whereas three of them indirectly. One participant reported being approached by both means. Various reasons cited were 1) not to create awareness on harmful effects of tobacco 2) not to harass shopkeepers in the name of COTPA violations 3) enquire about tobacco cessation activities implemented by the government. Two participants reported being threatened directly by TI for interfering with their business. Even one participant was offered undue favors to distance from TI business. Three participants reported being aware of tobacco control advocates who were threatened by TI.