Objective Tobacco control policies gained ground nationwide in 2006, with voters in nine states approving legislation to strengthen clean indoor air policies and increase tobacco excise taxes. Despite having the second lowest cigarette tax rate in the nation, Missouri was unsuccessful in passing its 2006 ballot initiative to raise the tax. An important way to encourage health-related policy change such as increasing tobacco taxes is through media coverage of tobacco issues. We examined how tobacco issues were presented in Missouri's print media leading up to the 2006 election.

Methods This study analysed 1263 articles with tobacco content published in 187 Missouri newspapers in the year before the election. Articles were coded for general and tobacco-related characteristics including article type (news story, editorial, letter to the editor), tobacco control position (pro, neutral, anti) and article theme (economic, health, political).

Results Most articles were news stories (73.6%) and pro-tobacco control (63.8%). The proportion of anti-tobacco control articles increased significantly (χ²=104.9, p<0.001) the month before the election, driven by an increase in economically themed articles. Economic articles were published more often in counties with less voter support for the tax (F=5.68, p<0.01). Finally, tobacco control position varied significantly across article types (χ²=148.3, p<0.01), with letters to the editor being anti-tobacco control most often.

Conclusion The media have a critical role in promoting public health goals and presenting health issues which influences formation of health policies. Tobacco control advocates must consider public opinion, opposition pressure, timing and themes in tobacco-related media coverage when promoting policy change.