Last updated October 2014
For more detailed discussion concerning the influence of tobacco advertising on children and teenagers, and the effects of advertising bans, refer to Chapter 11, Tobacco advertising and promotion.
Since more than 50% of Australians who have ever smoked have quit,1 and since about half of all regular tobacco users die prematurely due to smoking,2 the tobacco industry will not remain viable unless it recruits new smokers. In the US, the Centers for Disease Control estimated that in the late 1990s, a typical teenager would have been exposed to almost $20 billion worth of advertising promoting tobacco products.3 The study, published in 1999, found that children bought the most heavily advertised tobacco brands and were estimated to be three times more affected by advertising expenditures than adults.3
Major scientific reviews of decades of published research have concluded that tobacco advertising and promotion have directly influenced the uptake of smoking by young people.4–8
A recent systematic review examined articles quantitatively assessing the relationship between media exposure and substance use behaviour (including tobacco, alcohol and illicit drug use) among children and adolescents from 1980 to January 2008. 'Media' covered television, cinema, the Internet, electronic/video games, magazines and music (advertising was excluded). The review identified 42 studies, most based on television or film media, including 24 which examined tobacco use. The majority (88%) of the 24 studies (including 10 longitudinal studies) examining tobacco use reported a statistically significant relationship between increased media exposure and an increase in child and adolescent smoking behaviour (typically ever having tried smoking or age of uptake). Reviewers noted that the evidence supporting the relationship between media and tobacco use was stronger than that for alcohol and illicit drug use.9
In a major review drawing on research published between 1966 and 2005, Di Franza and colleagues concluded that the evidence satisfies all six standard statistical criteria for determining that there is a causal relationship between exposure to tobacco advertising and the uptake of smoking in children.10 These criteria are:
- temporality–children are exposed to tobacco promotion prior to taking up smoking
- exposure–being exposed to advertising increases the risk of smoking over the non-exposed
- dose-response–the more exposed the population to advertising, the greater the likelihood of taking up smoking
- robust and consistent findings–observed across a large number of studies and populations, and controlled for confounding factors
- causality is theoretically and scientifically plausible
- no explanation other than causality fits the factual evidence.
Conversely, while tobacco advertising has been shown to influence youth smoking uptake and prevalence, banning or restricting tobacco advertising and marketing does seem to reduce youth smoking. Research from the UK, for example, examined adolescent smoking intentions and tobacco marketing before and after the implementation of restrictions on advertising through the UK's Tobacco Advertising and Promotion Act between 2003 and 2005.11 The Act included advertising bans on billboards, cinemas and in print media, prohibition of domestic tobacco sponsorship, direct mail and on-pack promotions, and restricted point-of-sale advertising. The authors concluded that restrictions on tobacco advertising can significantly reduce adolescents' smoking intentions by signifying smoking to be less normative and to be socially unacceptable.11
Most forms of tobacco advertising and promotion in Australian states and territories have been incrementally banned since 1973 by federal and state legislation. Over this period, tobacco manufacturers have adapted to restrictions by increasing activity in those areas where promotion was still allowed to occur, most notably during the early 2000s at retail outlets, through events promotions and via upgraded products and packaging. The Internet has also become an important conduit for pro-tobacco messages.12–14 The following sub-sections provide brief discussion about these kinds of promotions; for more detail, refer to Chapter 11, Sections 11.12. Further discussion about smoking imagery in movies, television shows and other popular media (including the Internet) can be found in Section 5.16, and tobacco-control responses to addressing these, in Section 5.29.
5.15.1 Point of sale displays
Cigarettes are the most widely available of all consumer products in Australia, including milk and bread.15
It is evident that the tobacco industry responded to restrictions on advertising at point of sale and elsewhere by attempting to maximise visual impact of products on display.16 Tobacco 'powerwalls', common in the early 2000s, were typically eye catching and brightly lit, forming bold blocks of colour. Australian tobacco companies actively engaged in ensuring that their products received prominence in the retail setting by offering financial and other incentives to retailers17 (see also Chapter 10, Section 10.18.8).
While they may have been intended to encourage existing smokers to select different brands, it is also likely that such displays provided reassurance to current smokers and attracted the attention of potential new young smokers, who are frequent visitors to supermarkets and to milk bars and other convenience stores.16 Australian evidence shows that such displays served as a cue to buy tobacco products and appeared to undermine attempts to quit smoking.18 Australian research has also found that point of sale display advertising may have increased the perception among schoolchildren that cigarettes were easy to obtain, and also influenced students' recall of particular brands.19 In contrast, the vast majority of adult smokers do not appear to make their brand selection at the point of sale.20
A recent US longitudinal survey assessed the smoking behaviour of over 1600 young people aged 11–14 years following baseline measures of exposure to point-of-sale retail tobacco advertising (including pack displays).21 After 12 months, the odds of smoking initiation were significantly higher for adolescents who visited the types of stores containing the most cigarette advertising (such as convenience, liquor and small grocery stores) with at least moderate frequency, and more than doubled for those who visited such stores more frequently. Similar results were seen for adolescents who visited stores where tobacco advertising and displays were assessed through researcher observation, and persisted at the 30-month follow-up.21
See Chapter 11, Section 11.9.2 for details on action in Australia to limit promotion at point of sale.
5.15.2 Event marketing
In Australia12 and overseas,22,23 the tobacco industry has targeted young adults by sponsoring a range of events such as fashion shows, dance parties and music events, often staged in bars and nightclubs. Young adults are of key importance to the industry, providing a pool of experimenters and uncommitted smokers.
Harper and Martin identify several ways in which event marketing is strategically important to the tobacco industry:12
- such events promote brand loyalty
- they may tip the balance between being an experimenter and becoming an addict
- they provide a positive social context in which smoking can occur, serving to reinforce smoking as well as encourage new smokers
- co-sponsorship of events by other youth-oriented brands (such as sports drinks) normalises smoking behaviour
- they actively encourage participants (by offering incentives) to spread the word about the events and bring along more people, thereby extending the industry's reach.
Philip Morris Australia promoted its brand Alpine through young designer fashion shows and dance parties between 2000 and 2002; these events were themed in Alpine colours and included roving cigarette sellers dressed in the Alpine colour way.12 Other events have featured accessories bearing brand logos, new packaging and 'special edition' product configurations, free drinks and discounts on cigarettes. The events have encouraged participants to sign on to an email database, providing the organisers with client contact details and profiles as well as facilitating publicity about future events.12
Although exposure to promotions of this kind predominantly reaches young adults in the first instance, their influence can also be expected to trickle down to younger adolescents, who are keen to emulate adult behaviour.
For further discussion of these kinds of promotional events, see Chapter 11, Section 11.7.
5.15.3 Internet promotions
The global and largely unregulated nature of the Internet provides vast opportunities for the promotion of tobacco use in general, as well as for specific tobacco products. International pro-smoking websites celebrating a smoking culture and lifestyle are easily accessed by young people and feature glamorous and sometimes titillating content.13 US research (2009) tracking home internet usage by young people aged 14–17 years for a month to examine exposure to tobacco- and smoking-related content concluded that many adolescents are consistently exposed to tobacco content on the Internet (both pro-and anti-tobacco as well as unclear/mixed).24 Over half the pages on which tobacco content was found were social networking sites.24 Australian research has found that pro-smoking imagery is easily accessed on the popular video-sharing website 'YouTube'. The authors of this study comment that given the ability for material to be posted anonymously, it is quite conceivable that the tobacco industry could exploit this medium for its own purposes as a way of evading advertising bans.14 For further discussion, refer to Chapter 11, Section 11.6.
In Australia, the Internet has been used to promote events sponsored by tobacco companies (see Section 5.15.2 above), a primary goal being to establish an email database in order to initiate direct marketing.12
Tobacco products can also be bought online from several Australian-based companies. In May 2007 the Ministerial Council on Drug Strategy announced its intention to work towards restricting the advertising and sales of tobacco products over the Internet and banning sales to people aged under 18.25 In 2009, the Australian National Preventative Health Taskforce recommended a ban on internet sales of tobacco products as one of a raft of proposed legislative reforms to address current deficiencies in tobacco regulation included in the National Preventative Health Strategy.26 The Minister for Health and Ageing released the Government's response to the Preventative Health Strategy in 2010, announcing that the Government would legislate to restrict Australian internet advertising of tobacco products.27 This legislation had passed the Australian Senate at the time of writing. For further detail please refer to Chapter 11, Section 11.12.
5.15.4 Anti-smoking advertising by the tobacco industry
Youth smoking prevention activities have been adopted by the tobacco industry internationally, in response to criticism that the industry has an interest in and has actively encouraged young people to smoke. In many countries these activities have taken the form of anti-smoking advertising, placed mainly on television and in magazines.
There is strong evidence that these advertisements have provided a useful public relations service for the tobacco industry, promoting a positive corporate image without threatening its livelihood by reducing intention to smoke.28,29 Analysis of transcripts from US tobacco litigation cases between 1992 and 2002 reveals that while the industry has invested heavily financially in anti-tobacco advertising and other programs, there has only been weak associated industry evaluation of program effectiveness; the focus has tended to be on aspects such as program reach and uptake rather than on any demonstrable effects on youth smoking.30 In fact, industry anti-tobacco advertising may have fostered a more positive attitude towards the tobacco companies among young people,31,32 and may have influenced teenagers in their senior high school years to take up smoking.30 There is also evidence that youth smoking prevention initiatives have been used to bolster the defence strategies of the tobacco industry in the face of increasing tobacco litigation in the US.30 Industry anti-tobacco advertising campaigns are discussed in greater detail in Chapter 10, Section 10.13.3.
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9. Nunez-Smith M, Wolf E, Huang H, Chen P, Lee L, Emanuel E, et al. Media exposure and tobacco, illicit drugs, and alcohol use among children and adolescents: a systematic review. Substance Abuse 2010;31(3):174–92. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20687006
10. DiFranza JR, Wellman RJ, Sargent JD, Weitzman M, Hipple BJ, Winickoff JP, et al. Tobacco promotion and the initiation of tobacco use: assessing the evidence for causality. Pediatrics 2006;117:e1237-48. Available from: http://pediatrics.aappublications.org/cgi/reprint/117/6/e1237
11. Brown A and Moodie C. The influence of tobacco marketing on adolescent smoking intentions via normative beliefs. Health Education Research 2009;24(4):721-33. Available from: http://her.oxfordjournals.org/cgi/content/full/cyp007v1
12. Harper T and Martin J. Under the radar - how the tobacco industry targets youth in Australia. Drug and Alcohol Review 2002;21:387-92. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12537709
13. Ribisl K. The potential of the internet as a medium to encourage and discourage youth tobacco use Tobacco Control 2003;12(suppl.1):i48-59. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/12/suppl_1/i48
14. Freeman B and Chapman S. Is 'YouTube' telling or selling you something? Tobacco content on the YouTube video-sharing website. Tobacco Control 2007;16:207-10. Available from: http://tobaccocontrol.bmj.com http://tobaccocontrol.bmj.com/cgi/reprint/16/3/207
15. Ministerial Council on Drug Strategy and Department of Health and Ageing. National Tobacco Strategy 2004-2009. Canberra: Commonwealth of Australia, 2005. Available from: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/phd-pub-tobacco-tobccstrat2-cnt.htm
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18. Wakefield M, Germain D and Henriksen L. The effect of retail cigarette pack displays on impulse purchase. Addiction 2008;103:322-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18042190
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20. Wakefield M and Germain D. Adult smokers' use of point-of-sale displays to select cigarette brands [Letter]. Australia and New Zealand Journal of Public Health 2006;30:483-4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17073234
21. Henriksen L, Schleicher N, Feighery E and Fortmann S. A longitudinal study of exposure to retail cigarette advertising and smoking initiation. Pediatrics 2010;126(2):232-8. Available from: http://pediatrics.aappublications.org/cgi/reprint/peds.2009-3021v1
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23. Sepe E, Ling P and Glantz S. Smooth moves: tobacco bar and nightclub promotions target young adults. American Journal of Public Health 2002;92:414-19. Available from: http://www.ajph.org/cgi/reprint/92/3/414
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25. Ministerial Council on Drug Strategy. Ministerial Council on Drug Strategy Joint Communique 16 May 2007. Canberra: MCDS, 2007. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/mcds-16may07-communique
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30. Wakefield M, Terry-McElrath Y, Emery S, Saffer H, Chaloupka FJ, Szczypka G, et al. Effect of televised, tobacco company-funded smoking prevention advertising on youth smoking-related beliefs, intentions, and behavior. American Journal of Public Health 2006;96:2154-60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17077405
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