Conflicts of interest (COIs) have the potential to create bias in research, policy and practice. Although disclosure cannot fully protect individuals and public policy from vested interests, it is an important step to support trust in scientific and public discourse, and transparency in decision-making. However, COIs are often unreported, underreported or difficult to identify. This study aimed to assess the extent to which COIs are voluntarily declared by those who make submissions to government inquiries relating to health, focusing on the 2024 Australian Senate inquiry into perimenopause and menopause. There was no guidance or formal requirement to provide COI declarations in written submissions to the inquiry. However, a statement about COI declarations was given by the Chair of the inquiry at the start of public hearings in which verbal testimony was given. All 284 written submissions and 163 verbal testimonies were reviewed to identify the number and nature of COIs declared. Only 1% of written submissions and 6% of verbal testimonies provided a COI statement. The amount and nature of information provided in COI declarations varied widely. To ensure transparency in decisions made as a result of public inquiries, governments should require that COIs be declared for all submissions. An explicit standardized guide is needed, with clear parameters about the type of detail needed for these declarations. Processes for dealing with COIs should also be clear in any reports or recommendations that are made from the evidence presented at such inquiries.

Public health actors have expressed concerns over the entry of the tobacco industry into the UK e-cigarette market. It is important to be aware of the tobacco industry's involvement and stated aims for e-cigarettes in the UK, given their historical attempts to divert attention from and escape responsibility for the harms caused by combustible cigarettes. The use of e-cigarettes amongst young people in the UK has remained constant, despite the law prohibiting sales to adolescents and claims by manufacturers and others that they are designed solely as a tool to quit smoking. This study sought to examine how tobacco-related organizations in the UK e-cigarette market frame the use of e-cigarettes. Publicly available materials between September 2015 and June 2023 were collected from four transnational tobacco companies which have invested in the e-cigarette category, and from a UK e-cigarette trade association. A qualitative framing analysis of materials was conducted guided by relevant frameworks from the Commercial Determinants of Health literature. The analysis identified seven framings used by tobacco-related organizations relevant to e-cigarette usage in the UK. These were: co-opting of harm reduction; consumer choice; following the 'evidence'; insufficient evidence; the right kind of regulation; 'us' and 'them' rhetoric and marketing and advertising. By highlighting tobacco-related organizations' e-cigarette framings and contradictions, this study raises awareness of the rhetorical strategies used by the industry which aim to relegitimize tobacco companies in the political and public spheres.

The tobacco and nicotine industry has a long history of endangering the health and wellbeing of individuals, populations and society, including Indigenous peoples, via dubious practices and tactics that continue today. These tactics include generating opposition, fracturing consensus, dehumanizing groups and minimizing the perception of harms from tobacco use. This article offers guidance for people working in health promotion and tobacco control to align with the World Health Organization's Framework Convention on Tobacco Control, which includes Articles on research, monitoring and information exchange regarding the tobacco and nicotine industry. Recommendations are given to resist the tobacco and nicotine industry's narrative in health promotion, research, evaluation and publications. Holding the industry to account provides a further step forward to eliminating tobacco disease and death.

Commercial activity has positive and negative effects on health. Adverse commercial impacts on health are underpinned by corporate power and economic models and policy that prioritize economic growth, rather than a wellbeing economy that prioritizes health, equity and sustainability. Health in all policies (HiAP) aims to ensure that all policies promote health and health equity, using processes including health impact assessment (HIA). We aimed to explore the potential for HiAP and HIA to help address commercial determinants of health and promote a wellbeing economy. We completed a scoping review to identify how HiAP approaches, including HIA, could address commercial determinants, including challenges and implications for practice. This found synergy between the concepts of wellbeing economy and HiAP. However, corporate interests have sometimes co-opted HiAP to influence policy. We found some examples of HIAs of transnational corporations and international trade and investment agreements. We reviewed HIA frameworks for guidance to practitioners on managing corporate influence. This identified little guidance on identifying and managing corporate and other conflicts of interest or managing power differentials between stakeholders. We also mapped wellbeing economy outcomes against health determinants considered in selected HIA frameworks. This found that HIA frameworks with a comprehensive checklist of health determinants prompt consideration of most wellbeing economy outcomes. HIA could support the transition to a wellbeing economy if applied routinely to economic policies, but ideational change is also needed. HIA frameworks should provide guidance on corporate conflicts of interest and power differentials.

Public health researchers have investigated how youth are exposed to and influenced by traditional forms of commercial marketing from health-harming industries. Limited research has investigated youth opinions about the broader marketing and public relations strategies of these industries. This study aimed to understand youth perceptions of the impact and influence of a range of marketing and public relations strategies used by health harming industries. An online qualitative survey was conducted with n = 518, 16- to 24-year-olds living in Victoria, Australia. Participants were asked to consider the broad influence of marketing from health harming industries on youth, including the impacts of social media promotions, corporate social responsibility strategies including sponsorship and political donations, as well as their views on marketing restrictions. Reflexive thematic analysis was used to construct themes from the data. Participants stated that excessive marketing strategies had a significant influence on youth consumption of health harming products. Most felt that social media marketing had the most appeal and influence on youth. Most were critical of these strategies and were supportive of strong restrictions on marketing for health-harming products. However, many participants held more positive views about corporate social responsibility strategies, which they perceived could offset the negative impacts of these industries on health. Increased focus is needed from the public health and health promotion communities to ensure that youth are protected from the influence of the range of marketing strategies that are used by health-harming industries to promote their products and resist regulatory reform.

Cigarettes, alcohol, vaping and gambling products can cause significant harm to children and young people. The industries that make these products employ a range of tactics that aim to normalize their products and resist policy and regulatory reform. This includes 'responsibility' framing, in which parents are often held responsible for educating their children about the risks of these products. However, there has been very little research, which has investigated parents' perceptions of these industries. A qualitatively led online panel survey was conducted with n = 455 Australian parents who had at least one child aged between 11 and 17 years. Participants were asked questions relating to concerns about harmful products; what they talked about with their children; other potential sources of risk information; and who were responsible for protecting young people from these industries. Four themes were constructed. (i) Parents identified that parental influence, peer pressure, social media and advertising influenced children's attitudes towards these products. (ii) They had concerns about the short- and long-term consequences of these products. (iii) Parents actively engaged in educating their children about these products but recognized that it was difficult to counter industry messages. (iv) Parents emphasized the need for a collective approach, advocating for increased information and government regulations, particularly relating to marketing. This study demonstrates that parents are concerned about these industries and do their best to protect their children from harm but recognize that they need more support. Evidence-based education and comprehensive regulations particularly around marketing are needed to de-normalize products and protect young people.

Flavoured oral nicotine pouches, manufactured and marketed by global tobacco companies, such as Philip Morris International (PMI) and British American Tobacco, entered the Australian market in 2024. Despite it being illegal for Australian retailers to sell nicotine pouches, the products have been seized in government enforcement raids of Australian retailers, and have also been promoted to young people by Australian social media influencers. The Australian Federal Government has recognized and expressed concern about the rising profile of nicotine pouches in Australia and the promotion of these products as unproven vaping and smoking cessation aids. Yet to date, there has been no published research on nicotine pouches in Australia. Using focus group and interview data collected in early 2024 as part of Generation Vape, an ongoing Australian national study into adolescent and young adult vaping and smoking, we explored their attitudes to and perceptions of nicotine pouches, including first-hand experiences and drivers of use. The participants perceived an increase in the use and popularity of oral nicotine pouches, including PMI's Zyn brand, for reasons including claimed sport performance enhancement, vaping cessation and as part of partying and clubbing culture. Some participants perceived nicotine pouches to be a 'healthier' alternative to smoking or vaping. It is critical that research on nicotine pouches is collected now to inform public health policy and to prevent the proliferation of a new class of addictive recreational nicotine products in Australia.

Retail food environments influence dietary health, yet efforts to improve them have had limited success. Recruiting informants from the food and beverage retail industry for insider information has been challenging due to the sensitivity of inquiries and proprietary protections. Moreover, which recruitment approaches are successful are seldom disseminated. This paper aimed to bridge this gap by detailing the complexities of recruiting and interviewing four food industry insider groups-independent store owners, corporate chain managers, food and beverage distributors, and sales representatives of major companies-to provide insights and specific guidance for future research. From October 2021 to November 2022, we interviewed 49 industry informants to explore business and commercial practices used in the US food retail sector. Recruitment methods were tailored to each group, and qualitative data were collected through in-person or virtual 'walk-along' interviews with customized interview guides. Across the study, we experienced distinct challenges around participant inaccessibility, hierarchy within corporate chains, skepticism, mistrust and variation in knowledge across industry groups. We detail our response to these challenges through four lessons learned, including persistence and flexibility, the importance of vetting, the value of trust-building measures and adapting the study protocol to new information. Given our success in reaching industry groups and accessing insider information, we provide key recommendations that future researchers can use to engage diverse industry groups and advance efforts to promote healthy food retail.

Gambling sponsorship of professional sport, particularly relating to online wagering, has been a key focus of global regulatory reform efforts to address the normalization of gambling. In Australia, gambling companies and venues (including community clubs and hotels) also sponsor and develop relationships with community (non-professional) sports teams and clubs. In-depth interviews (n = 24) were conducted with senior leaders in community sporting organizations in Australia with an aim of understanding the factors that shape decisions about accepting or refusing gambling sponsorships and partnerships. A reflexive approach to thematic analysis was used to construct three themes from the data. First, participants considered the alignment of values between the sponsor and the community sporting organization. While most stated that gambling and sport should not be aligned through sponsorship, some forms of sponsorship (for example from community clubs) were perceived as less harmful than others (such as online wagering). Second, some thought that while there were ethical ways to engage with gambling sponsors such as not promoting sponsors' products, they were concerned about how gambling sponsorship might have an overall impact on the community. Third, was the impact of gambling sponsorships on the organization's reputation, and balancing this with a need for financial stability. Decisions to accept (or reject) gambling sponsorship were influenced by a range of perceived risks and benefits. Addressing the acceptance of gambling sponsorships among community sporting organizations could involve several approaches to interventions, including regulation, formal policies to guide sponsorship decisions and education about the risks of accepting these sponsorships.

Children's exposure to outlets selling, and outdoor advertisements marketing, unhealthy foods is an important risk factor for obesity. Yet few policies address the food retail and/or outdoor advertising environment, and research about children's perceptions is limited, especially in low- and middle-income countries. We used a participatory, multimodal visual/verbal approach to explore urban-dwelling South African primary school students' perceptions of unhealthy food outlets and outdoor advertisements they encountered on their journeys to school. Forty-one grade 7 students aged 11-14 years participated in drawing and/or photography activities and elicitation discussions. A mixed-methods, triangulated analysis involving the content analysis and extraction of data from research artefacts (33 journey to school drawings and 10 food advertisement photo collages) and thematic analysis of discussion transcripts was conducted. Drawings depicted 175 food outlets, two-thirds (64%) of which sold only unhealthy foods and 125 advertisements, most of which marketed unhealthy food. Unbranded, deep-fried foods prepared and sold by informal traders and independent shops were prominent. Informal and independent traders also sold unhealthy branded foods. Advertisements were primarily for unhealthy foods, especially branded, sugar-sweetened beverages. Participants thought extensive advertising bans, regulation of the sale of unhealthy food to children and other measures were needed to promote children's health in urban contexts. The results point to the need for food system-wide approaches that address multiple commercial determinants of health, including 'big food' advertising, unhealthy food sales by informal and independent traders and programs to address socio-economic influences such as poverty, unemployment and parents' poor work conditions.

There is increasing evidence that commercial determinants impact mental health. Addressing the commercial determinants may therefore be a way of improving population-level mental health. This umbrella review aimed to provide an overview of evidence in this field and identify knowledge gaps. Five databases (MEDLINE, Embase, PsycINFO, Scopus and Cochrane Library) were searched on the 18/19 of July 2022. Eligible papers were systematic reviews published after 31 December 2011. No geographical limits were applied. Eligible interventions were those that targeted the behaviours or products of commercial actors. Ineligible interventions included individual behaviour change interventions, such as those seeking to educate consumers. Included mental health outcomes were anxiety, depression, self-harm and suicide, whilst surrogate outcomes included product consumption. Industry involvement and the quality of included reviews (critical components of A MeaSurement Tool to Assess systematic Reviews - AMSTAR 2) were assessed. A narrative synthesis was used to compare the findings by industry, and a typology of interventions was developed. Eight reviews with mental health outcomes were included, each with multiple methodological weaknesses. There is some evidence that reducing the availability of alcohol or pesticides may lower suicide rates. Despite the known links, no evidence on the mental health impacts of population-level interventions tackling the social media, tobacco, gambling and ultra-processed foods industries were located. All gambling reviews were identified as having links to industry. Future high-quality evaluations of commercial determinants interventions developed specifically with the aim of achieving positive mental health outcomes and/or that evaluate mental health outcomes and are free from industry links are needed. PROSPERO ref. number CRD42022346002.

South Africa has high levels of obesity and overweight, which contribute to non-communicable diseases and are associated with poor diets high in ultra-processed foods. Bundling occurs when two or more products are packaged and sold together, often at a discount and is a marketing strategy for unhealthy foods. Given the paucity of data on bundling of unhealthy foods, this exploratory study sought to document how unhealthy foods are bundled together to be more attractive to consumers in Johannesburg, South Africa. Fifty food outlets were included and compared across two regions. In-store photos were taken of bundles and individual items, and data were captured on the costs of the bundle and of individual components. Descriptive analysis and the contents of the bundles based on the photographs and promotional material were conducted. Almost half of all outlets had more than five bundles and nearly a quarter had bundles targeting children. Most children's meals were burgers, and all had fries as part of the bundle. The average savings per bundle when compared to the combined cost of individual items was R21,39 overall, or 18%. The study demonstrated that unhealthy food bundling is a common practice in food outlets in Johannesburg, often with cost advantages and promotional appeal. Policy options for promoting a favourable food environment include regulating portion sizes of bundles and offering healthy options as part of a bundle. Marketing food to children by bundling unhealthy food with toys is of particular concern and is prohibited in the recently gazetted Regulations Relating to the Labelling and Advertising of Foodstuffs.

Over the last two decades, menstrual health and hygiene have become increasingly common on the global health agenda. While governments and international organizations are adopting measures to make menstrual products more accessible, corporate actors producing them have only been subject to limited scrutiny. Yet, their products and commercial practices raise environmental, health, equity and societal issues, which warrant attention and regulation. As such, commercial disposable menstrual products are largely made up of plastic, sometimes as much as 90%. Menstrual pads and tampons also contain some chemicals, the health impact of which is still unclear. In addition, these products are often sold with high-profit margins, and marketing campaigns to sell such products tend to reinforce shame and secrecy. So far, no global standards exist to regulate menstrual products and manufacturers, and evidence in the field of menstrual health and hygiene is lagging behind. To fill this gap, countries have started to regulate menstrual products and the International Standards Organization is in the process of developing global standards to better regulate the content and labeling of menstrual products. To support the emergence of regulation in this area, this article conceptualizes for the first time a comprehensive framework for the regulation of menstrual product manufacturers. This framework encompasses five complementary measures to regulate the content; labeling; production and waste management; pricing; advertising and marketing of menstrual products. The article also calls for more research to produce evidence and for increased governmental and inter-governmental attention to menstrual product manufacturers.

Taxes on sugar-sweetened beverages (SSBs) in Vanuatu and Fiji are praised for their alignment with the World Health Organization's noncommunicable diseases Best Buy policy recommendations. SSB taxes also intersect with economic, trade and commercial interests as well as complex domestic and international power dynamics. Yet, to date, the role of these broader interests and power dynamics in shaping SSB tax adoption in Vanuatu and Fiji has remained underexamined. Drawing on Bourdieu's forms of capital and triangulating interview (n = 50), document (n = 461) and observational data, this cross-case political economy analysis sought to understand where forms of power reside, how they manifest, and what impact they have on the alignment between SSB tax in Vanuatu and Fiji and national and global goals and priorities. Three interconnected themes emerged from the analysis: the influence of domestic industry actors in a context of shifting fiscal and trade incentives; the pivotal agenda-setting role of pro-tax multisectoral coalitions and the way political instability lent importance to informal policy processes. Findings evidence the varying influence of economic, social, and cultural capitals across the policy cycle and showcase the way in which actors strategically deployed, lost or re-imagined their capitals to secure policy influence. Importantly, cultural capital was essential to leveraging influence across the policy cycle and more inward-facing systems favoured the protection of domestic actors and industries, including their economic capital. From a health perspective, these political forces ultimately culminated in weaker or 'watered down' SSB taxes in both Vanuatu and Fiji.

According to the World Health Organization (WHO), tobacco use causes over 8 million deaths annually including 1.3 million due to second-hand exposure. Furthermore, data from the Tobacco Atlas show that the tobacco industry continues to target new markets in the WHO African region, one of two regions where absolute numbers of smokers continue to increase. Understanding context contributes to policy formulation and implementation ensuring relevance to a country's political economy. Focusing on the WHO African region, this scoping review (i) maps the extent of academic research examining contextual factors on the WHO Framework Convention on Tobacco Control (WHO FCTC) national-level implementation, and (ii) reports on contextual factors impacting the WHO FCTC implementation. Using a stepwise structured approach, we conducted a search across four academic databases, yielding 10 342 articles and 42 were selected for full data extraction. Leichter's four categories of context (situational, structural, cultural and exogenous) and the stages of heuristic policy model guided data extraction. Study findings indicated that situational contextual factors such as the burden of disease or its impact on health can push governments toward policy formulation. Structural contextual factors included political considerations, economic interests, funding, institutional congruence, strength of policy and institutional capacity as important. Cultural contextual factors included the influence of policy entrepreneurs, current social trends and public opinion. Exogenous contextual factors included the WHO FCTC, tobacco industry influence at the national-level and bi-lateral partnerships. Further understanding contextual factors affecting the WHO FCTC national implementation can strengthen policy formulation and align required support with the WHO FCTC Secretariat and other relevant bodies.

Unhealthy commodity industries (UCIs) such as tobacco, alcohol, gambling, ultra-processed food and beverage producers are known to influence policy-making to advance their interests, often to the detriment of public health goals. This study mapped the complex system underpinning UCI's influence on public health policy formulation in the UK and identified potential interventions to shift the system towards being able to better attain public health goals. We conducted a participatory systems mapping workshop with ten experts to build a causal loop diagram (CLD) and identify potential interventions to address UCI's influence on public health policy development. The resulting CLD depicts a highly interconnected and reinforcing system driving UCI's involvement in public health policy formulation across five thematic areas. Among the most connected elements were the 'dominance of market mechanisms', 'perception of partnership as good governance principle', 'industry involvement lending perceived legitimacy to the policy formulation process', 'industry is seen as part of the solution' and 'industry ties to policy-makers'. Participants identified a total of 22 interventions within this system. Analysis of the CLD and interventions identified the potential for two key paradigmatic changes in this complex system: de-normalizing the perception of unhealthy commodity industry actors as legitimate stakeholders in policy formulation; and prioritizing public health and wellbeing objectives over profit and economic gain. In order to shift the system towards better attaining public health goals, interventions should reinforce each other and be supportive of these two key paradigmatic shifts.

This study investigated the prevalence and predictors of misperceptions about the healthiness of alcohol products carrying common health-oriented marketing cues and the relative importance of the type (versus amount) of alcohol consumed in contributing to health risks. Data were from a 2022 cross-sectional national population survey. Australian adults (18-65 years) who consumed alcohol in the past year (n = 1960) reported their agreement with statements that a selection of health-oriented marketing cues meant an alcohol product was 'better for you' and rated the importance of the type and amount of alcohol consumed in causing health risks. The majority of participants misperceived the type of alcohol to be at least as important as the amount in causing health risks (61%) and misperceived at least one health-oriented marketing cue as meaning a product was 'better for you' (75%). Misperceptions about low sugar, calorie and carbohydrate; and preservative-free claims (46-56%) were most common. Misperceptions about natural, organic, vegan, low sugar, low calorie, gluten-free and seltzer cues were less prevalent among older (45-65 years) than young adults (18-24 years, PR = 0.27-0.86). A lower proportion of women (compared to men) held misperceptions about vegan (PR = 0.66) and gluten-free claims (PR = 0.78), but a higher proportion held misperceptions about low sugar claims (PR = 1.13). There were also variations by socioeconomic status, alcohol consumption, education and regional/metropolitan location. Misperceptions about health-oriented marketing of alcohol are widespread. Further regulation of permissible alcohol marketing content is needed, but until then, differences in misperceptions between population segments may inform targeted health promotion efforts.

Unhealthy commodity industries (UCIs) engage in corporate political activity, using diverse practices, including intimidatory tactics, to thwart, delay and dilute regulations that threaten their businesses. While examples of such intimidation exist across multiple sectors, no attempt has been made to synthesize these. Furthermore, much of the literature focuses on intimidation of policy-makers. Less is known about the types of intimidation experienced by advocates and researchers and their responses to this intimidation. This scoping review explores the literature across the tobacco, alcohol and ultra-processed food spaces for instances of intimidation and categorizes them inductively and deductively based on a framework of intimidation types. Similarly, responses to intimidation were mapped onto a pre-existing framework. We found intimidatory tactics towards advocates and researchers in every sector. Public discreditation, followed by legal threats and action, complaints and freedom of information requests were most frequently mentioned and often attributed to UCIs or their third parties. Surveillance, threats of violence, violence, burglary and bribery were less prevalent in the literature and their perpetrators were unknown. Those intimidated reported carrying on as normal, defensive action (changing/adapting work, taking security precautions) or, as was most reported, offensive action (exposing intimidation, correcting misinformation, taking legal action). The similarity of intimidation across sectors suggests that UCIs engage in similar intimidatory tactics regardless of sector. Understanding more about the scale of intimidation and how it impacts the work and wellbeing of those affected is essential, as is learning more about the ways researchers and advocates can effectively pre-empt and respond.

E-cigarette use is increasing rapidly across the world. Governments have begun to tighten regulation principally to prevent uptake by young people and non-smokers. As tobacco industry ownership of the e-cigarette market grows, it is important to be aware of how industry is seeking to influence the regulation of e-cigarettes. Using thematic analysis, this research examines the explicit arguments and implicit tactics used in responses from the tobacco industry and linked organizations to Scotland's 2022 consultation 'Vaping Products-Tightening Rules on Advertising and Promoting'. The themes that emerged in the analysis were compared to tactics and arguments identified in past research on the tobacco industry to look for continuations and divergences. While the research finds continuation of historic arguments and tactics being used in the submissions, it also highlights important novel tactics and framings employed by tobacco industry actors, including incorporating outdated data and calling for UK-wide policy despite this being a devolved issue. Policymakers must remain alert to the strategies being used by the tobacco industry, so they are able to prioritize public health rather than the interests of industries that put profit before health.

Despite growing awareness of the importance of commercial determinants of health (CDoH), there has been limited development or evaluation of educational and practice-focused support for public health professionals. This article reports findings from an action-research approach bringing together people with academic and practice expertise (n = 16) to co-create workshop materials (called 'CDoH Essentials'), test and improve them through five trial workshops and explore their effects. Five English local public health teams co-facilitated the workshops in their organizations, with participants from public health teams and their internal partners (n = 94). Quantitative and qualitative data were collected throughout and analysed to understand: (1) whether the workshops met the expectations of participants, public health and academic observers, and (2) the effects of workshop participation on (a) participants' knowledge, understanding and critical CDoH literacy, and (b) subsequent working practices and attitudes. The co-created CDoH Essentials appeared effective in meeting expectations, improving knowledge and critical CDoH literacy and promoting action on CDoH. The proportion of participants reporting 'little' or 'no' CDoH knowledge fell significantly following the workshop (55.4% vs 2.7%). Participants' increased understanding supported reflection on the implications of the CDoH for their roles and for wider strategy and action. After 3 months, all five settings reported greater consideration of CDoH and had initiated or planned action. CDoH Essentials could be used to galvanize more effective public health action to tackle the CDoH in England and trialled in other public health contexts.