The value of studying supply chains for tobacco control.

INTRODUCTION Tobacco control research and advocacy has yet to capitalize on understanding the tobacco industry supply chain. The objective of this narrative review is to expose the processes, actors and supporting industries involved in tobacco production, laying the groundwork to expand the scope of tobacco control beyond the transnational tobacco companies (TTCs). METHODS We reviewed 69 academic articles (2013 to 2019) and five tobacco industry journal issues. RESULTS We identify six major processes in tobacco production: farming, primary processing of the leaf, secondary processing into products such as cigarettes, packaged product, usage by smokers, and decay. Supply chain actors include seed and plant retailers, farmers, leaf processors, wholesalers, brokers and middlemen, manufacturers, retailers, smokers and refuse collectors with considerable variation in intermediate actors by location. Supporting industries supply additives, machinery, packaging, logistics, marketing, and research and development (R&D). CONCLUSIONS This expanded understanding of the supply chain can enable wider appreciation of the various incentives and risks of being involved in the industry, all of which is important information to feed into tobacco control policies. Researchers and campaigners, seeking to design effective policy preventing the expansion of this industry and the health harms it produces, need to look beyond the TTCs to identify under-exploited leverage points along the entire tobacco supply chain.