Introduction To say that tobacco advertising stimulates tobacco sales may seem a simple and moderate statement. In reality, tobacco control activists often meet serious opposition in defending this fact. Achieving the restriction or banning of tobacco advertising is one of the fiercest battles to face. Tobacco lobbyists usually assert that advertising does not increase the overall quantity of tobacco sold. Rather, the tobacco industry maintains that advertising merely enhances the market share of a particular brand, without recruiting new smokers. These arguments are not always easy to counter.

This Factsheet gives health advocates the arguments and research data needed to face well-prepared tobacco lobbyists in public debate. The data cited are all presented in reputable scientific journals or congresses. They demonstrate that tobacco advertising entices young people to begin smoking and that restricting or banning advertising has a measurable effect on smoking behaviour. Research on tobacco advertising and consumption It is not possible to conduct a randomized controlled trial to study the effect of an advertising ban. Such a trial would require long-term exposure of one group of people to cigarette advertising, while ensuring that a control group would be completely unexposed. This is neither feasible nor ethical.

Scientists funded by the tobacco industry have argued that in the absence of data from such a trial, it can never be proven that banning tobacco advertising will reduce tobacco consumption. However, most researchers agree that reliable conclusions can be drawn from other types of studies. Three main types of studies have examined the relationship between tobacco advertising and consumption: 1. econometric research on the link between expenditure on advertising and tobacco consumption 2.

research comparing tobacco consumption within a country before and after an ad ban 3. international comparison of trends in tobacco consumption and anti-tobacco measures Econometric research Numerous studies have investigated the relationship between expenditure on tobacco advertising and consumption of tobacco ([1]). Adjustment must be made for important factors such as product price, available income, etc. , to avoid drawing wrong conclusions. As econometric studies look at total expenditure and total consumption, no specific conclusions regarding effects on young people can be drawn.

Most econometric studies have found that increased expenditure on tobacco advertising increases demand for cigarettes, while banning advertising leads to a reduction in tobacco consumption. A recent meta-analysis of 48 econometric studies found that tobacco advertising significantly increased tobacco sales ([2]). Recent reviews by the United States Institute of Medicine ([3]), the United States Department of Health and Human Services ([4]) and the World Health Organisation ([5]) reached the same conclusion. Research within a country before and after an ad ban These studies compare tobacco consumption before and after a complete ban on advertising, controlling for other factors. Although such studies may be complicated by inadequate of data collection or poor implementation of the ban, they have yielded convincing data that a complete ban on advertising makes an important contribution towards reducing smoking prevalence. Selected studies are summarise d in the table below.

Country, year Description of anti-tobacco measures Effect Norway, 1975 Complete ban on advertising and sponsoring, coupled with health warnings, public information and age limits on sales Long-term reduction of smoking prevalence by 9% ([6], [7]) Finland, 1977 Complete ad ban, no smoking in public buildings, age limit on sales, strong public information campaigns Reduction of cigarette consumption of 6. 7% (6) Canada, 1989 Complete ban on advertising and sponsoring, with higher tobacco prices Corrected for price increases, a long-term reduction of smoking prevalence of 4% (6) New Zealand, 1990 Ban on advertising and sponsoring, higher tobacco prices Reduction in tobacco sales of 7. 5%, of which 5. 5% is attributed to ad ban (6) France, 1991 Complete ad ban, limiting smoking in public buildings, removal of tobacco from consumer price index Reduction of smoking prevalence of 7% in 1991-1993 ([8]) International comparison of trends in tobacco consumption and anti-tobacco measures This type of study - known as a cross-sectional time-series analysis - compares trends in tobacco advertising and consumption. An important study commissioned by the New Zealand government examined trends in consumption and advertising in 33 countries during 1970-1986 (3). It demonstrated that the higher the degree of governmental control on tobacco advertising and sponsorship, the larger the annual reduction of tobacco consumption.

Corrections were made to account for differences in income, tobacco prices and public information. A cross-sectional time series analysis in 22 OECD countries for the period 1960-1986 concluded that increasingly strict regulation of advertising causes corresponding reductions in tobacco consumption ([9]). The degree of restriction on tobacco marketing was scored in each country: for example, Iceland, Finland and Norway, countries with a comprehensive ad ban and strong warnings on tobacco products, scored 10, while others with less strict measures, such as a ban only on TV, radio or cinema advertising, had a lower score. On a scale of one to ten, an increase of 1 point was found to translate into a 1. 5% reduction in tobacco consumption. One drawback was that other types of anti-tobacco measures, such as public information campaigns, were not corrected for.

Another study of 22 OECD countries during 1964-1990 came to a different conclusion ([10]). This study suggested that advertising bans have no effect on tobacco consumption. No attempt is made to explain why this conclusion differs so radically with those of other researchers. The tobacco industry often quotes this study when attacking restrictions on advertising. Further discussion of the strategies used by the tobacco industry in opposing restrictions can be found in references [11] and [12]. The effect of tobacco advertising on young people recent review of the available literature concludes that isolated actions have little effect in reducing youth smoking arguing that only in combination with measures like increased health education an advertising ban can be expected to affect adolescent smoking ([13], [14]).

Any advertising ban must be comprehensive, and cover other promotional activities (see next paragraphs). The tobacco industry targets young people in their advertising campaigns, and research has shown that young people are aware of, remember, understand and be receptive to tobacco advertising ([15], [16], [17], [18]). Bans on advertising have an impact on youth norms and attitudes regarding smoking (11). A combination of increases in tobacco prices and a complete advertising ban proved to be more effective than either measure on its own (9). Outdoor advertising Outdoor advertising - for example, billboards or posters - has always been used heavily by the tobacco industry ([19]). Voluntary restrictions on outdoor advertising, such as agreements not to place ads on billboards within a certain distance of schools, have been less than effective.

One study showed that, despite such an agreement, during a six-month period in 1994, tobacco advertising was posted on two-thirds of billboards near schools ([20]). In 1995, tobacco advertising was posted near 40% of the schools ([21]). Other forms of tobacco promotion Not all tobacco promotion takes traditional forms, such as billboard, print or TV advertising. A large proportion takes more subtle forms.

Indeed, the tobacco industry undertakes much more 'indirect' advertising than other industries. Indirect advertising includes: sponsorship of sports or cultural events; displays at points of sale; 'brand stretching', where tobacco brand names are used as part of other product names (e. g. Marlboro Classics clothing); product placement in television and film shows; direct mailings; special sales promotions, etc. Indirect advertising is being used increasingly where direct advertising is not permitted (3, 15, [22]). Studies show that young people are easily attracted by this kind of advertising.

Conclusion convincing body of evidence demonstrates that tobacco advertising plays an important part in encouraging non-smokers to begin smoking. Advertising is a particularly important factor among young people (11). Comprehensive bans on tobacco advertising and promotion can result in a considerable reduction of tobacco consumption on a national level. Laugesen and Meads (9) conclude that where a complete ad ban is coupled with an intensive public information campaign on smoking, a reduction in tobacco consumption of 6% can be achieved. A recent report by the World Bank supports this conclusion ([23]). Prohibition of outdoors advertising is a valuable first step; however, even where a comprehensive ban on advertising and promotion is in place, the tobacco industry will constantly try to find other ways of promoting its products.

Acknowledgement This fact sheet is based on material in a recent report of the Netherlands School of Public Health ([24]). References[1] Redmond WH. (1999) Effect of sales promotion on smoking among US ninth graders. Preventive Medicine, 28 (3), 243-250[2] Andrews RL, Franke GR. (1991). The determinants of cigarette consumption: A meta-analysis.

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Preventing Tobacco Use among young people: A Report of the Surgeon General. Washington, DC: US Government Printing Office. [5] Roemer R. (1993) Legislative action to combat the World Tobacco Epidemic (2 e ed. ).

Geneva: WHO[6] See C, Parsonage M, Anderson R, Duckworth S. (1992) Effect of tobacco advertising on tobacco consumption: A discussion document reviewing the evidence. London: Economics & Operational Research Division, Department of Health[7] Rimpel"a MK, A aro LE, Rimpel"a AH. (1993) The effects of tobacco sales promotion on initiation of smoking: Experiences from Finland and Norway.

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Influence of tobacco marketing and exposure to smokers on adult susceptibility to smoking. Journal of the National Cancer Institute, 87, 1538-1545[17] DiFranza JR et al. (1991). RJR Nabisco's cartoon camel promotes Camel cigarettes to children.

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