Tobacco advertising in communities: associations with race and class

Abstract

Background. Individuals of lower socioeconomic position smoke at higher rates than those of higher socioeconomic position. Because of this disparity, the National Cancer Institute has called for studies of targeted tobacco marketing to clarify mechanisms contributing to higher tobacco use among low-income Americans and other high-risk populations.

Methods. We observed tobacco industry marketing in six Boston area communities (two of high socioeconomic position and four of low position; total of 41 observations) and in selected print publications that circulated in those communities during a 22-month period in 2000–2002.

Results. On average, there were fewer tobacco advertisements in the higher socioeconomic communities, compared to the lower socioeconomic communities (P < 0.001). In the low socioeconomic communities, there were more than three times as many brand advertisements as youth access signs (P = 0.0012). Although brand advertisements outnumbered smoke-free signs, on average, there was no difference in the ratio of brand advertisements to smoke-free signs in low and high socioeconomic communities (P = 0.06).

Conclusions. The tobacco industry is actively present in community settings, particularly in communities with a low socioeconomic profile (SEP). Tobacco control researchers and advocates need to continue to monitor the tobacco industry's behavior at the community level and develop strategies to counter this behavior.

Introduction

The population burden of tobacco falls disproportionately on individuals of lower socioeconomic position, whether defined by educational attainment, occupation, or income [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]. In addition, among adults in the United States, smoking prevalence is highest among 18- to 24-year olds and has remained relatively stable in the past few years, while prevalence has been declining for all other age groups [12]. Not surprisingly, a growing body of evidence demonstrates that the tobacco industry's advertising and promotions strategies are heavily geared toward reaching young adults, socially disadvantaged groups, and various racial/ethnic groups [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29]. Industry strategies include brand creation, advertising imagery, advertising placement, events sponsorships, and promotional items. Because there is solid evidence of an association between exposure to tobacco advertising/promotions and tobacco use behavior [25], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], public health researchers must monitor advertising and promotion efforts by the tobacco industry overall and in relation to population groups among whom smoking prevalence is relatively high. The National Cancer Institute has called for studies of targeted tobacco marketing to clarify mechanisms contributing to higher tobacco use among low-income Americans and other high-risk populations so as to inform development of effective prevention and cessation strategies [53].

One important and understudied question is how the tobacco industry's marketing affects the community-level physical environment. How visible is the tobacco industry in the everyday streetscape and print publications that circulate in community settings? At issue is how the industry's presence might vary for communities of different sociodemographic characteristics and in publications reaching audiences in those communities. We undertook an observational longitudinal study to document selected tobacco industry advertising and promotion strategies in demographically contrasting community settings. We conducted systematic observations of tobacco industry advertising and promotion practices in community commercial districts and in selected print publications that circulate in those communities during a 22-month period.

Our study was conducted following implementation of the Master Settlement Agreement (MSA) [54]. The MSA restricts tobacco industry advertising and promotion practices in specific ways, such as banning of billboards and imposing limitations on events sponsorship. Our study characterizes tobacco industry activity in the wake of the MSA.