11.1 The merits of banning tobacco advertising

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Tobacco companies have always defended their promotions by claiming that advertising serves only to encourage adult smokers to switch or try new brands.9 This is certainly one important function of tobacco advertising. However, published research shows that tobacco advertising also is associated with an increase in overall tobacco consumption and therefore is an important focus for comprehensive tobacco control.10 Additionally, new smokers, primarily adolescents, enter the cigarette market every day.

The 2000 US Surgeon General's report on reducing tobacco use highlights the influential nature of industry advertising and promotion11:

• Despite the overwhelming evidence of the adverse health effects from tobacco use, efforts to prevent the onset or continuance of tobacco use face the pervasive challenge of promotional activity by the tobacco industry.
• The tobacco industry uses a variety of marketing tools and strategies to influence consumer preference, thereby increasing market share and attracting new consumers.
• Advertising increases consumption of tobacco products by encouraging children or young adults to experiment with tobacco products and initiate regular use, reducing current smokers' motivation to quit and prompting former smokers to resume smoking.
• Among all US manufacturers, the tobacco industry is one of the most intense in marketing its products. Only the automobile industry markets its products more heavily.

11.1.1 Tobacco advertising increases youth smoking

The industry commonly claims that its promotional activities are not intended to influence and have no impact on children. However, numerous, academic reviews have identified tobacco advertising as a key influence on youth to initiate smoking.12-16 Youth exposed to tobacco advertising hold positive attitudes toward tobacco use.15 The industry, however, argues that in the absence of causal proof (that advertising directly induces children to smoke); there is insufficient evidence to justify banning tobacco advertising.

DiFranza and colleagues demonstrated that exposure to tobacco advertising directly causes youth to take up smoking by evaluating the available literature on tobacco promotion against the Bradford Hill criteria, originally developed to explain disease causality.12 Epidemiologists use these stringent criteria to determine whether a causal link (rather than a statistical association) exists between exposure to a risk factor and development of a disease. The researchers found that the body of published evidence supports the criteria for causality: 'First, children are exposed to tobacco promotion before the initiation of tobacco use. Second, exposure increases the risk for initiation. Third, there is a dose-response relationship, with greater exposure resulting in higher risk. Fourth, the association between exposure and increased risk is robust; it is observed with various study methods, in multiple populations, and with various forms of promotion and persists after controlling for other factors. Fifth, scientifically plausible and theoretically based mechanisms whereby promotion could influence initiation exist. Finally, no explanation other than causality can account for the evidence'.12 pe 1245

In 1984, Philip Morris lamented how best to address the decreasing sales of its flagship brand, Marlboro, in Australia: 'The key problem seems to be its lack of appeal to younger smokers and this is the area which needs to be addressed. One possibility might be to concentrate on sampling and promotion as many young smokers have never had any first hand experience with the product'.17 p 1 Again, in 1990, Philip Morris recognised the potential for increased sales among Australia's large youth population, 'given predisposition to try/adopt new brands, this segment represents significant market opportunity'.18 p 16

11.1.2 Marketing to 'over 18s'

When analysing marketing strategies and effects, it is important to avoid arbitrarily drawing the transition of youth to adulthood as a single event that happens on one's 18th birthday. Decisions made by those turning 18 are plainly affected by influences to which they are exposed before turning 18, including advertising. In internal documents the industry acknowledges the importance of capturing the youth market. The tobacco industry actually uses the term 'young adult' to describe the youth market: 'From time to time when describing market categories and target audiences we use references such as young smokers, young market, youth market etc. These terms do not accurately describe what we are talking about. In the future when describing the low-age end of the cigarette business please use the term 'young adult smoker' or 'young adult smoking market.' Please advise all members of your department that these terms should be used in all written materials in the future.'19 p 1

Along with their parent companies abroad, Australian tobacco companies developed a 'youth strategy' that has evolved from unabashed marketing to children in the 1950s20, to denial of this practice from the late 1960s, and eventually to the present day position of concern to show themselves as a socially responsible industry actively campaigning against teenage smoking.21 A core part of this social responsibility is the claim to only market tobacco products to adults aged 18 and over, and to support certain youth tobacco prevention programs. However, as Carter notes: 'It is commonly observed that teens tend to mimic those just older than themselves and strive to establish themselves as independent, and that the industry's youth smoking programs play to those characteristics by emphasising the 'forbidden fruit' aspects of smoking. As years of dedicated research, media circulation demographics, and even common sense dictates, it is impossible to quarantine those under 18 years of age from aspiring to, or participating in, activities designed for those over 18.'21 p iii75

An RJ Reynolds report explains the vital importance of the young smokers: 'Younger adult smokers have been the critical factor in the growth and decline of every major brand and company over the last 50 years. They will continue to be just as important to brands/companies in the future for two simple reasons: The renewal of the market stems almost entirely from 18 year old smokers. No more than 5% of smokers start after age 24. (And) the brand loyalty of 18 year old smokers far outweighs any tendency to switch with age.'22 p 1

11.1.3 Awareness of tobacco marketing

As part of a four-country study on tobacco control in 2003, Australian adult smokers were surveyed about their awareness of tobacco industry advertising.23 The research findings are detailed in Table 11.2. Smokers were most aware of advertisements at retail outlets with almost half of smokers noticing such advertisements. Smokers claimed also to be aware of forms of advertising that had been long banned under Australian legislation. The authors suggested that this could be 'explained by a mixture of promotion in channels where promotion is still allowed (point of sale, on packaging, and sponsorship exemptions), incidental promotions (for example, in movies) and through cross-border advertising (either direct via satellite TV or the internet, or indirectly—for example, broadcast of sporting events such as Grand Prix with lots of promotion on cars and around the track). The substantial awareness of sports sponsorship where exemptions are allowed (for example, Formula One racing) demonstrates the importance of not allowing such exemptions.'23 p iii32 The study suggests that tobacco advertising may remain in a community's collective memory for many years after it has been severely restricted.

11.1.4 Industry arguments to retain tobacco advertising

In addition to its claims that adverting does not influence the uptake of smoking by young people, the tobacco industry uses other 'key messages' when lobbying against advertising bans:

• Companies often cite 'freedom of speech' protection, arguing they have a right to inform consumers about their products. This erroneously implies that cigarette advertisements contain important consumer information and smokers base their decision to smoke by weighing up such information and making an educated choice. Most cigarette advertising has little to no 'information' other than the brand name. This argument also ignores the fact that most smokers commence before they are consenting adults and so by law, are deemed not to be legally sentient. Most smokers are also inadequately informed about the harms of smoking, in part due to historic tobacco industry efforts to discredit health information.24 Tobacco companies have only recently publicly acknowledged that smoking causes disease having 'maintained the stance that smoking had not been proven to be injurious to health through 1999'.25 p i110
• A common industry argument is that tobacco is a legal product therefore it should be legal to advertise. However, in most countries there are precedents for prohibiting the promotion of certain harmful products. Internationally, governments have banned or restricted advertising for other legal products, such as prescription-only pharmaceuticals, guns, explosives and some industrial chemicals.26 Equally, tobacco is not freely sold in Australia; it is illegal to sell cigarettes to children (under age 18).
• As previously described, the industry publicly states that advertising and promotion only serve to encourage brand switching among adult smokers. Clive Turner, when with the UK-based Tobacco Advisory Council, encapsulated the industry position: 'Certainly no tobacco advertising is concerned with encouraging nonsmokers to start or existing smokers to smoke more and it seems blindingly obvious that, unless you are a smoker, tobacco advertising or sponsorship has absolutely no influence whatsoever in persuading or motivating a purchase'.9 p 8 But according to advertising executive Emerson Foote, former CEO of the international advertising group McCann-Erickson, which has handled millions of dollars in tobacco industry accounts: 'The cigarette industry has been artfully maintaining that cigarette advertising has nothing to do with total sales. This is complete and utter nonsense. The industry knows it is nonsense. I am always amused by the suggestion that advertising, a function that has been shown to increase consumption of virtually every other product, somehow miraculously fails to work for tobacco products.'9 p 8

11.1.5 The effects of advertising bans

The effectiveness of advertising bans in reducing tobacco use and 'denormalising' tobacco products are much more plausible reasons for tobacco industry opposition. Regulating advertising and promotion can reduce both the prevalence and initiation of smoking. Based on an analysis of tobacco use before and after the introduction of advertising bans, it is estimated that comprehensive advertising bans reduce smoking initiation by 6 percent and smoking prevalence by 4 percent. A partial ban is likely to only reduce prevalence and initiation by 2 percent.13 Empirical evidence also shows that comprehensive advertising bans reduce tobacco consumption, but incomplete bans have little or no effect because companies transfer expenditure to media in which advertising is still allowed.27 Comprehensive advertising bans are essential to reducing the health burden of tobacco use.