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Effects of the 2003 advertising/promotion ban in the United Kingdom on awareness of tobacco marketing: findings from the International Tobacco Control (ITC) Four Country Survey
  1. F Harris1,
  2. A M MacKintosh2,
  3. S Anderson1,
  4. G Hastings1,
  5. R Borland3,
  6. G T Fong4,
  7. D Hammond4,
  8. K M Cummings5,
  9. for the ITC Collaboration
  1. 1The Open University, Milton Keynes, UK
  2. 2University of Stirling, Stirling, UK
  3. 3The Cancer Council Victoria, Carlton, Victoria, Australia
  4. 4University of Waterloo, Waterloo, Ontario, Canada
  5. 5Roswell Park Cancer Institute, Buffalo, New York, USA
  1. Correspondence to:
 Professor Gerard Hastings
 Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA, UK; gerard.hastings{at}


Background: In February 2003, a comprehensive ban on tobacco promotion came into effect in the United Kingdom, which prohibited tobacco marketing through print and broadcast media, billboards, the internet, direct mail, product placement, promotions, free gifts, coupons and sponsorships.

Objective: To investigate the impact of the UK’s comprehensive ban on tobacco promotion on adult smokers’ awareness of tobacco marketing in the UK relative to Canada, the United States and Australia.

Design: A total of 6762 adult smokers participated in two waves of a random digit dialled telephone survey across the four countries. Wave 1 was conducted before the UK ban (October–December 2002) and Wave 2 was conducted after the UK ban (May–September 2003).

Key measures: Awareness of a range of forms of tobacco marketing.

Results: Levels of tobacco promotion awareness declined significantly among smokers in the UK after implementation of the advertising ban. Declines in awareness were greater in those channels regulated by the new law and change in awareness of tobacco promotions was much greater in the UK than the other three countries not affected by the ban. At least in the short term, there was no evidence that the law resulted in greater exposure to tobacco promotions in the few media channels not covered by the law. Notwithstanding the apparent success of the UK advertising ban and the controls in other countries, 9–22% of smokers in the four countries still reported noticing things that promoted smoking “often or very often” at Wave 2.

Conclusions: The UK policy to ban tobacco advertising and promotion has significantly reduced exposure to pro-tobacco marketing influences. These findings support the effectiveness of comprehensive bans on advertising and promotion, as included in the Framework Convention on Tobacco Control.

  • CATI, computer-assisted telephone interview
  • FCTC, Framework Convention on Tobacco Control
  • GLM, general linear model
  • ITC-4, International Tobacco Control Four Country Survey
  • International Tobacco Control Policy Evaluation Survey
  • marketing
  • policy

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  • * Logistic regression analyses were conducted, within each country, to test whether having completed the survey before affected participants’ Wave 2 responses about noticing in specific marketing channels and overall salience of pro-smoking cues. The cohort data were compared with those of the replenishment sample at Wave 2, which comprised a further 1714 adult smokers (517 in Canada, 684 in the USA, 258 in Australia and 255 in the UK). A sample variable was included as an additional covariate, which identified whether a respondent was part of the cohort who had completed surveys at both Waves 1 and 2 or from the replenishment sample who had only completed the Wave 2 survey. The influence of the sample variable was non-significant for all countries for the following variables: adverts on billboards, in newspapers/magazines, on radio, at movies, arts sponsorship, special price, signs, branded clothing, free samples, gift/discount, promotional emails, mobile phone promotions, and websites.In Canada, the USA and Australia, where there was no high profile intervention between Waves 1 and 2, the sample variable was significant for a selection of variables. The cohort participants in Canada were significantly less likely than replenishment participants to report noticing competitions (adjusted OR 0.618, 95% CI 0.459 to 0.832; p  =  0.001), sports sponsorship (adjusted OR 0.561, 95% CI 0.454 to 0.694; p < 0.001) and overall pro-smoking cues (adjusted OR 0.743, 95% CI 0.560 to 0.985; p  =  0.039). Similarly cohort participants in the USA were significantly less likely than replenishment participants to report noticing tobacco adverts on TV (adjusted OR 0.697, 95% CI 0.530 to 0.917; p  =  0.010), and those in Australia were significantly less likely than replenishment participants to report noticing pro-smoking cues (adjusted OR 0.567, 95% CI 0.384 to 0.837; p  =  0.004) and leaflets (adjusted OR 0.302, 95% CI 0.121 to 0.753; p  =  0.010). These findings are consistent with a time-in-sample effect in which awareness measures decline somewhat with time in sample, in the absence of change. However, in the UK, time-in-sample effects were significant in only two cases, and showed a different pattern: cohort participants were significantly more likely than replenishment participants to report noticing store advertisements (adjusted OR 1.398, 95% CI 1.063 to 1.838; p  =  0.017), and direct mail promotions (adjusted OR 1.845, 95% CI 1.804 to 3.139; p  =  0.024).These findings are consistent with interpreting the greater differences in awareness in the UK between Waves 1 and 2 as real trends, not artefacts of the repeated survey.

  • Competing interest statement: There are no competing interests to declare.

  • Ethics approval: The study protocol was cleared for ethics by the Institutional Review Boards or Research Ethics Boards in each of the countries: the University of Waterloo (Canada), Roswell Park Cancer Institute (USA), the University of Illinois-Chicago (USA), the University of Strathclyde (UK), and The Cancer Council Victoria (Australia).