World No Tobacco Day: How do we end tobacco promotion?

By Linda Bauld

For the past 25 years, the World Health Organisation and its partners have marked World No Tobacco Day. This day provides an opportunity to assess the impact of the world’s leading cause of preventable death — responsible for one in ten deaths globally — and to advocate for effective action to end tobacco smoking. This year, the WHO has selected the theme of banning tobacco advertising, promotion, and sponsorship.

Why does this matter?  Some still believe that active smoking is an adult choice and that the tobacco industry should be able to promote its products in the same way as the producers of other consumer goods. Yet research has shown us that the vast majority of the world’s smokers begin using tobacco as children and that advertising influences uptake as well as continued smoking. Removing all forms of tobacco promotion is a key component of effective tobacco control. For this reason, Article 13 of the Framework Convention on Tobacco Control, the world’s first global public health treaty, requires the 176 jurisdictions that are currently party to the Treaty to introduce comprehensive bans.

What can advertising bans achieve? First, by removing advertising from television, billboards and magazines, for example, we know that the tobacco industry’s ability to deceive consumers about the attractiveness of its product and the ‘health’ benefits of particular forms of tobacco (such as low tar cigarettes or hand-rolled tobacco) is restricted. Secondly, advertising bans (including removing sports sponsorship and point of sale displays) protect children from tobacco marketing, which is important. Although the industry will claim that its marketing is aimed at adults, studies in a number of countries have demonstrated the relationship between exposure to tobacco advertising and smoking in children, with dose effects related to frequency and type of exposure. Finally, research that has examined the impact of voluntary codes to limit tobacco promotion and partial advertising bans has found these to be ineffective. There is no such thing as ‘responsible’ tobacco advertising.

Yet even in developed countries where most forms or tobacco advertising, including point of sale displays, are now banned, one pernicious form of promotion remains. This is tobacco packaging. As government action has removed the ability of the tobacco industry to spend its generous marketing budgets on traditional forms of advertising, companies such as Phillip Morris, British American Tobacco, and Japan International Tobacco have invested in increasingly innovative, attractive, and tailored (aimed at girls and young women, for example) packs. A recent systematic review found 37 studies that examined the potential impact of removing the promotion that branded packaging provides and replacing it with plain or standardised packaging. The studies in the review show that plain packaging would: reduce the appeal of smoking; increase the noticeability of health warnings and messages; and reduce the use of packaging design techniques that mislead consumers about the harmfulness of tobacco products. Some of this research was influential in persuading the Australian government to introduce plain packaging in December 2012, and despite the tobacco industry’s best efforts to derail its introduction through litigation, this policy is now under active consideration in a number of other countries.

Despite the progress made in ending tobacco promotion in some countries, there is still some way to go, particularly in low and middle income countries where smoking rates are still rising.  Today just 6% of the world’s population live in countries where comprehensive tobacco advertising bans are in place. Action is needed to persuade governments who have not yet introduced restrictions — or only have partial bans in place — to end tobacco promotion in their country. A good starting place is to ensure that policymakers understand the weight of evidence underpinning Article 13 of the FCTC, including the role of tobacco packaging in promotion. The research community needs to work with advocates and policy makers to ensure that this evidence is understood and used. It has a powerful role to play in counteracting the ongoing efforts of the tobacco industry to promote a product that kills.

Linda Bauld is Professor of Health Policy at the University of Stirling. She is Deputy Editor of the journal Nicotine and Tobacco Research, Chair of Cancer Research UK’s Tobacco Advisory Group, a visiting professor at the University of Bath and Chair of the NICE Tobacco Harm Reduction Programme Development Group.

To mark this year’s WHO theme of banning tobacco advertising, promotion, and sponsorship, the Nicotine and Tobacco Research’s Editor has selected five articles for further reading. They can be read in full and for free on the journal’s website:

1. Implementation and Research Priorities for FCTC Articles 13 and 16: Tobacco Advertising, Promotion, and Sponsorship and Sales to and by Minors
2. Perceptions of Plain and Branded Cigarette Packaging Among Norwegian Youth and Adults: A Focus Group Study
3. Germany SimSmoke: The Effect of Tobacco Control Policies on Future Smoking Prevalence and Smoking-Attributable Deaths in Germany
4. The Association Between Point-of-Sale Displays and Youth Smoking Susceptibility
5. The Effect of Graphic Cigarette Warning Labels on Smoking Behavior: Evidence from the Canadian Experience

Nicotine & Tobacco Research is one of the world’s few peer-reviewed journals devoted exclusively to the study of nicotine and tobacco. It aims to provide a forum for empirical findings, critical reviews, and conceptual papers on the many aspects of nicotine and tobacco, including research from the biobehavioral, neurobiological, molecular biologic, epidemiological, prevention, and treatment arenas. The journal is published by OUP on behalf of the Society for Research on Nicotine and Tobacco.

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Image credit: Cigarettes. Photo by robeo, iStockphoto.