Population and Economic Analysis of the Penetration and Impact of Anti-smoking Mass Media Messages. United States, 2009 - 2018
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Part 1
Recall of Tobacco Corrective Statements Advertisements and Effects on Health Information-seeking Behavior among Adults - United States 2018
Abstract
Background:
In a 2006 landmark ruling, U.S. District Judge Gladys Kessler instructed tobacco companies to disseminate Corrective Statements (CSs) against their products through media advertisements. Five court-approved messaged were published to address tobacco-related common misperceptions among the public. The objectives of this study are (1) examine the proportion of adults who were exposed to each of the five CSs messages; and to (2) describe the association between exposure to CSs and health-information seeking behavior among the U.S. adult population.
Methods: Data, settings, participants, outcomes, and statistical approach.
Analysis of most recent nationally representative data from the population-based cross-sectional survey of U.S. adults, the Health Information National Trends Survey (HINTS5-Cycle2,2018). Data collection began in January 2018 and concluded in May 2018, and CSs dissemination
took place from November 2017 to March 2018. Statistical significance was defined as a p-value less than 0.05, and all tests were 2-tailed. All data were weighted to be nationally representative.
Results: Key findings.
Exposure to CS was not independently associated with health-information seeking behavior. Among the exposed, those with lower than a high school education sought significantly less health information (70.2%, 95%CI=53.8-86.5) compared to college graduates (93.3%, 95%CI=90.8 - 95.7) (p<0.0002). Females reported higher prevalence of seeking health information 88.4% (95%CI= 85.9– 90.96) compared to males at 75.4% (95%CI =6.3– 83.6) (p<0.0001). Assessing the impact of CS language and advertisement frame on message recall we noted that the majority of respondents reported exposure to Message 1 (Health effects of smoking) estimated at 85.8% (95%CI= 82.9 – 88.6). This was followed by 65.8% (95%CI= 61.1 – 70.5) recalling Message 2 (health effects of secondhand smoke). Our logistic regression analysis revealed that the odds of health information seeking were two times higher in females (Adjusted Odds Ratio [AOR], 2.07; 95%CI=1.59- 2.69); while odds were 2.55 folds higher among those who had a college education (95% CI= 1.26 - 5.21), compared with less than high school education. Compared to white adults, the odds of seeking health information were lower among Blacks (AOR=0.46; 95%CI=0.29 - 0.74) and Hispanics (AOR=0.51; 95%CI= 0.33 - 0.79).
Conclusions: Key message and implications.
This study found that the court ordered national antismoking advertising campaign had different exposure and recall patterns in subgroups depending on the message category. While some messages were easier to recall others, perhaps more technical ones, were less likely to make an impact on participants’ memory and prompt change to health behavior.
Part 2
The Association between Exposure to “The Real Cost” Campaign and Smoking Risk Perceptions, Curiosity, and Quit Intentions among Youths - United States 2018
Abstract
Background:
Tobacco use behaviors are usually established in adolescence, which coincides with the tobacco industry’s targeted marketing age group. In February 2014, the Food and Drug Administration (FDA) launched “The Real Cost” youth tobacco prevention campaign to counter tobacco marketing efforts directed toward children and youth. The objectives of this study were to: (1) describe the association between exposure to “The Real Cost” campaign and tobacco risk perception among U.S. adolescents, (2) to compare smoking curiosity among non-smoking adolescents across different exposure status, and (3) to compare the intention to quit cigarette smoking among current cigarette smokers by exposure status to the campaign.
Methods: Data, settings, participants, outcomes, and statistical approach.
To address these objectives, we analyzed the National Youth Tobacco Survey (NYTS-2018), a nationally representative data set from a cross-sectional survey of U.S. middle school (grades 6–8) and high school (grades 9–12) students. Statistical significance was defined as a P value less than 0.05, and all tests were 2-tailed. Data were weighed to be nationally representative and analyses were performed using STATA version 14.2 to account for specific features of survey design.
Results: Key findings.
Exposure to the FDA’s “The Real Cost” campaign was associated with higher cigarettes risk perceptions among U.S. youth. Estimated exposure to the anti-smoking advertisements was 70.94% (95% CI = 69.4–72.1%). Mean perceived risk among exposed individuals to “The Real Cost” was 91.15% (95% CI = 90.3–92.0%) compared to 85.66% (95% CI = 84.1–87.3%) in unexposed individuals (p < 0.0001). Exposure to the campaign was associated with higher cigarette smoking curiosity among youth who were non-smokers (p < 0.0001). Finally, exposure to tobacco control advertisements was not found to influence intention to quit among youth smokers (p = 0.0009).
Conclusion: Key message and implications.
The FDA’s “The Real Cost” campaign achieved exposure levels that are essential for population-level perceptual changes. The campaign led adolescents to have increased perception of harm towards smoking. However, the campaign’s anti-smoking advertisements were associated with elevated curiosity and perhaps susceptibility to cigarette smoking among adolescents who were non-smokers. Our findings support the messaging strategies implemented by the FDA for “The Real Cost” national tobacco prevention campaigns.
Part 3
Analysis of the Tobacco Industry Cigarette Marketing Expenditures — United States, 2008–2019
Abstract
Background
Anti-tobacco campaigns are undermined by the fact that tobacco marketing outspends public health preventative initiatives. To effectively counter tobacco marketing, the tobacco industry’s retail activity must be monitored and regulated. The objectives of this study were to: (1) perform a 10-year trend analysis of the total combined and print cigarette annual advertising and promotional expenditures by major tobacco companies in the United States during 2009–2018, and (2) contrast the 2018 print media cigarette advertising expenditures against the cost of disseminating anti-tobacco corrective statements in print advertisements incurred by the tobacco companies in the United States.
Methods
We collected information about cigarette marketing expenditures from the Federal Trade Commission Cigarettes reports. All expenditures were adjusted for inflation using the Consumer Price Index Inflation Calculator obtained from the U.S. bureau of labor statistics. Temporal trends during the 2009–2018 period were assessed using joinpoint regression with a level of significance of p < 0.05. The cost of corrective statements published in print were estimated from the cost of a full-page newspaper advertisement with specifications similar to those used for CSs implementation.
Results
During 2009–2018, the total adjusted cigarette marketing expenditures did not experience any significant changes (AAPC = -1.5 confidence interval [CI] = -2.5–0.4; p < 0.05). Expenditure on print advertisements decreased from 0.43% in 2009 to 0.1% in 2018. Absolute dollar amounts on magazine cigarette marketing expenditures decreased from $36.6 million in 2009 to $8.5 million in 2018, a relative decline of 80% (AAPC = -13.5, 95% CI = -26.4–1.7; p < 0.05). The tobacco industry spent approximately $8.5 million on print advertisements in 2018 to market cigarettes. We estimated that it cost $5.5 million to disseminate the corrective statements in print within that same year, totaling 0.06% of what was spent on combined cigarette marketing and promotion in 2018.
Conclusion
Many traditional cigarette advertising categories lost funding in the past decade, however, total marketing expenditure remains unaffected. Tobacco companies respond to marketing regulations by reallocating funds to other less regulated channels. In 2018, most promotional expenditures were spent on various price discounts, which could expose vulnerable, unsuspecting children and youth to cigarette marketing. Finally, the impact of the corrective statements was weakened by delayed implementation, and consumer attention shifted from traditional media to other digital channels.
Dental Public Health
Dental Public Health
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Tác giả
AlDukhail, Shaikha
