The tobacco epidemic is a global issue that warrants a global response. The World Health Organization Framework Convention on Tobacco Control establishes a wide range of measures to reduce tobacco use worldwide. The 182 countries who have ratified this treaty are required to comprehensively ban tobacco advertising, promotion, and sponsorship. However, implementation and enforcement varies greatly. And, while most bans cover traditional media platforms, such as television, many do not adequately extend to online platforms. Young people spend more time online than any other age group, but little is known about their exposure to such advertisements. This week, ASHES reviews a study by Janni Leung and colleagues that examined the prevalence of adolescent exposure to advertisements for tobacco products on the Internet in 15 countries.
What were the research questions?
What is the cross-national prevalence of adolescent exposure to online tobacco advertisements, and does exposure vary depending on the level of tobacco advertising ban implemented in that country? Is exposure to tobacco advertisements associated with adolescent smoking?
What did the researchers do?
The researchers conducted a secondary data analysis of 111,356 adolescents in 15 countries, using data from the Global Youth Tobacco Survey1. Participants reported their exposure to tobacco advertising on the Internet in the past month and whether they had seen advertisements that looked “fun or cool.” They also reported past-month and lifetime history of smoking. Countries were categorized by the level of tobacco advertising ban implemented: (1) no ban; (2) ban on national television, radio, and print media, and some other direct and/or indirect advertising; (3) ban on all forms of direct and indirect advertising (including online). The researchers estimated the weighted prevalence of exposure to online tobacco advertisements by country. They also compared prevalence rate confidence intervals of exposure to online advertisements for different levels of bans implemented. Finally, they examined the association between smoking status and exposure to online tobacco advertising, by country.
What did they find?
It was common for adolescents to have seen tobacco advertisements on the Internet in the past month — ranging from 18.2% in Cuba to 34.3% in the Czech Republic. Similarly, between 12.3% and 34.4% of adolescents had seen tobacco advertisements online that looked “fun or cool.” Past-month exposure to any online tobacco advertisements, and to those that looked “fun or cool,” was not lower in countries with the strictest advertising bans compared to countries with no advertising bans (see Figure). National exposure prevalence to any online tobacco advertisements, and to those ads that looked “fun or cool,” was not associated with smoking prevalence. However, seeing tobacco advertisements that looked “fun or cool” was associated with past-month smoking.
Figure. Prevalence of past-month adolescent exposure to any online tobacco advertisements and to tobacco advertisements that looked “fun or cool.” Prevalence is stratified by countries’ level of tobacco advertising ban: (1) no ban; (2) ban on national television, radio, and print media and some other direct and/or indirect advertising; (3) ban on all direct and indirect advertising (including online). Bars represent confidence intervals. Confidence intervals that do not overlap represent statistically significant differences. Adapted from Leung et al. 2023. Click image to enlarge.
Why do these findings matter?
Adolescents who are exposed to tobacco advertising are more likely to start smoking. Despite numerous efforts to reduce tobacco advertising, many adolescents are still exposed. Much of this exposure occurs online, even in countries with the strictest advertising bans. This may be partially attributed to the challenges of enforcing bans online, where “digital” borders can be difficult to regulate. Therefore, reducing the prevalence of tobacco advertising likely requires global cooperation. Countries need to work collaboratively to implement strategies that reduce cross-border advertising, which occurs when advertisements created in one country are uploaded or broadcast in another. Furthermore, the digital media environment is constantly and rapidly evolving. Countries must take a proactive approach to periodically updating their laws and regulations around online advertising, including the enforcement and oversight of advertising bans.
Every study has limitations. What are the limitations of this study?
Study data were self-reported. Participants who were exposed to tobacco advertisements may not recall seeing these advertisements, which may result in conservative estimates of exposure. Survey questions may have been interpreted differently by different populations, such as the meaning of “fun or cool” or which products “tobacco” includes.
For more information:
SmokeFreeTeen offers tools and resources for teenagers about quitting and maintaining abstinence from tobacco use. The Centers for Disease Control and Prevention also provides research and tips about cigarettes and how to quit. For additional self-help tools, please visit the BASIS Addiction Resources page.
— Kira Landauer, MPH
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1. The included surveys were conducted between 2013 and 2018. They represent 15 countries in four regions: Americas (Argentina, Costa Rica, Cuba, Ecuador, Panama, Paraguay, Peru), African (Mauritius, Zimbabwe), European (Czech Republic, Turkey), and the Western Pacific (Micronesia, Macao, Papua New Guinea, Samoa).