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The Master Settlement Agreement with the tobacco industry and cigarette advertising in magazines.

BACKGROUND: In 1998, the attorneys general of 46 states signed a Master Settlement Agreement with the four largest tobacco companies in the United States. The agreement prohibits tobacco advertising that targets people younger than 18 years of age. METHODS: We analyzed the trends in expenditures for advertising for 15 specific brands of cigarettes and the exposure of young people to cigarette advertising in 38 magazines between 1995 and 2000. We defined cigarette brands as "youth" brands if they were smoked by more than 5 percent of the smokers in the 8th, 10th, and 12th grades in 1998; all others were considered to be "adult" brands. We classified magazines as youth-oriented magazines if at least 15 percent of their readers or at least 2 million of their readers were 12 to 17 years old. "Reach," a standard measure of exposure to advertising, was defined as the number of young persons who read at least one issue of a magazine containing an advertisement for a particular brand of cigarette during a given year. RESULTS: In 2000 dollars, the overall advertising expenditures for the 15 brands of cigarettes in the 38 magazines were $238.2 million in 1995, $219.3 million in 1998, $291.1 million in 1999, and $216.9 million in 2000. Expenditures for youth brands in youth-oriented magazines were $56.4 million in 1995, $58.5 million in 1998, $67.4 million in 1999, and $59.6 million in 2000. Expenditures for adult brands in youth-oriented magazines were $72.2 million, $82.3 million, $108.6 million, and $67.6 million, respectively. In 2000, magazine advertisements for youth brands of cigarettes reached more than 80 percent of young people in the United States an average of 17 times each. CONCLUSIONS: The Master Settlement Agreement with the tobacco industry appears to have had little effect on cigarette advertising in magazines and on the exposure of young people to these advertisements.

Adolescent↗

Television advertising and children: lessons from policy development.

AIM: To conduct a policy review of the regulations related to food advertising on television aimed at children. DESIGN: The study consisted of documentary analysis of relevant legislation and policy documents related to children's advertising from both industry and non-governmental organisations at a global level and in 20 countries. This was supported with semi-structured telephone interviews with individuals from 11 countries. RESULTS: The initial findings resulted in a listing of regulatory impacts from which we developed a taxonomy of regulatory schemes. There was a tension between the development of legislation to cover this area and the use of voluntary agreements and codes. This tension represents a food industry/civic society split. The food and advertising industries are still engaged in a process of denying the impact of advertising on food choice and children as well as commissioning their own research. Outright bans are unusual, with most countries addressing the situation through voluntary agreements and self-regulation. We found a deep division over the way forward and the role and place of legislation. Policy-makers expressed concerns that national legislation was increasingly less relevant in dealing with broadcast media transmitted from outside national boundaries and therefore not subject to the receiving countries' laws but to the laws of the country from which they were transmitted. CONCLUSIONS: The options for the regulation of advertising targeted at children range from (1) a complete ban on advertising as in the case of Sweden, through (2) partial restrictions on advertising by type of food, target group or limits on the amount of advertisements or times shown, to (3) continuation of self-regulation by the advertising and food industries. There is a global dimension to regulation that needs to be built in, as national frontiers are no barriers to broadcast media and public health nutrition needs to ensure that its concerns are heard and addressed.

Advertising↗

Effects of anti-smoking advertising on youth smoking: a review.

This paper reviews empirical studies, encompassing community trials and field experiments, and evaluates government-funded anti-smoking campaigns, ecologic studies of population impact of anti-smoking advertising, and qualitative studies that have examined the effects of anti-smoking advertising on teenagers. We conclude that anti-smoking advertising appears to have more reliable positive effects on those in pre-adolescence or early adolescence by preventing commencement of smoking. It is unclear whether this is due to developmental differences, or is a reflection of smoking experience, or a combination of the two. In addition, it is evident that social group interactions, through family, peer and cultural contexts, can play an important role in reinforcing, denying, or neutralizing potential effects of anti-smoking advertising. Although there is some research to suggest that advertising genres that graphically depict the health effects of smoking, emphasize social norms against smoking, and portray the tobacco industry as manipulative can positively influence teenagers, these findings are far from consistent. Finally, the effects of anti-smoking advertising on youth smoking can be enhanced by the use of other tobacco control strategies, and may be dampened by tobacco advertising and marketing. Overall, the findings of this review indicate that there is no single "recipe" for anti-smoking advertising that leads to reductions in youth smoking. Anti-smoking advertising can influence youth smoking, but whether it does in the context of individual anti-smoking campaigns needs to be the subject of careful evaluation.

Adolescent↗

When advertising turns "cheeky"!

Portraits typically exhibit leftward posing biases, with people showing more of their left cheek than their right. The current study investigated posing biases in print advertising to determine whether the product advertised affects the posing bias. As the posing bias may be decreasing over time, we also investigated changes in posing biases over a span of more than 100 years. The current investigation coded 2664 advertisements from two time periods; advertisements were coded for target group of advertisement (men, women, both) and posing bias (rightward, leftward, or central). Unlike other studies that typically observe a leftward posing bias, print advertisements exhibit a rightward posing bias, regardless of time-frame. Thus, print advertisements differ greatly from portraits, which may relate to the purpose of advertisements and the role of attractiveness in advertising.

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The social costs of tobacco advertising and promotions.

Recent longitudinal evidence suggests that approximately 34% of all new tobacco experimentation occurs because of tobacco advertising and promotions. Based on this figure, in this paper we estimate the long-term impact on mortality and morbidity, as well as the economic and medical costs associated with smoking that is attributable to cigarette advertising and promotions in the United States. This study used several data sources, including the Teenage Attitudes and Practices Survey (TAPS), the 1993 and 1996 Adolescent California Tobacco Surveys (CTS), and the Food and Drug Administration's estimates of annual illness-related benefits of alternative effectiveness rates of banning tobacco advertising. Our resulting estimates are that in each year between 1988 and 1998, tobacco advertising and promotional activities generated approximately 193000 additional adult smokers who began smoking as adolescents because of advertisements and promotions. That decade of tobacco advertising and promotions will also result in approximately 46400 smoking-attributable deaths per year and 698400 years of potential life lost, which translates into costs of approximately $21.7 billion to $33.3 billion in total medical, productivity, and mortality-related costs. Even accounting for quitting behavior, each year of advertising-attributable smoking increases the number of smokers in the population. We conclude that annual costs can be expected to continue to increase if tobacco advertising and promotional activities are not effectively eliminated. If all tobacco industry advertising and promotional activities were banned for the next 25 years, nearly 60000 smoking-attributable deaths per year could be avoided, saving nearly 900000 life-years, $2.6 billion in excess medical expenses, and between $28 billion and $43 billion in mortality costs.

Adolescent↗

Effects of consumer motives on search behavior using internet advertising.

Past studies on uses and gratifications theory suggested that consumer motives affect how they will use media and media contents. Recent advertising research has extended the theory to study the use of Internet advertising. The current study explores the effects of consumer motives on their search behavior using Internet advertising. The study employed a 2 by 2 between-subjects factorial experiment design. A total of 120 subjects were assigned to an experiment condition that contains an Internet advertisement varying by advertising appeals (i.e., rational vs. emotional) and product involvement levels (high vs. low). Consumer search behavior (measured by the depth, breadth, total amount of search), demographics, and motives were collected by post-experiment questionnaires. Because all three dependent variables measuring search behavior were conceptually related to each other, MANCOVA procedures were employed to examine the moderating effects of consumer motives on the dependent variables in four product involvement-advertising appeal conditions. Results indicated that main effects for product involvements and advertising appeals were statistically significant. Univariate ANOVA also showed that advertising appeals and product involvement levels influenced the total amount of search. Three-way interactions among advertising appeals, product involvement levels, and information motive were also statistically significant. Implications and future research directions are discussed.

Adult↗

Advertising by physicians. Behavior and attitudes.

This article analyzes 380 responses to a systematic sample of 800 physicians in Pennsylvania regarding their advertising behavior and attitudes. The use of advertising is growing despite the fact that most of these physicians are averse to advertising and pessimistic about its effects. Several multivariate techniques are applied to generate a statistical model of the probability that a given physician will advertise. The proportion of physicians who advertise is quite small, and it remains difficult to predict accurately whether a given physician will advertise. Nevertheless, the results suggest several factors that influence the decision. The advertisers are significantly younger than their peers. In addition, advertising is somewhat more prominent among physicians in larger group practices, among primary care physicians, and among those physicians for whom the chief means of reimbursement is the prepayment contract. The research has relevance for health care marketing and for policy analysis concerned with the effects of recent court decisions that remove restrictions on physician advertising.

Adult↗

Does alcohol advertising promote adolescent drinking? Results from a longitudinal assessment.

AIMS: To examine the relationship between exposure to different forms of alcohol advertising and subsequent drinking among US adolescents and assess whether exposure to an alcohol and drug prevention program mitigates any such relationship. DESIGN: Regression models with multiple control variables examined the relationship between exposure to alcohol advertising in grade 8 and grade 9 drinking for two groups of South Dakotan adolescents: (1) seventh-grade non-drinkers (n = 1206) and (2) seventh-grade drinkers (n = 1905). Interactions between the intervention program and the significant advertising predictors were tested. SETTING: Forty-one middle schools in South Dakota, USA. PARTICIPANTS: A total of 3111 seventh-graders followed through grade 9. MEASUREMENTS: Advertising variables were constructed for four types of alcohol advertising-television, in-store displays, magazines and concession stands. Other predictors tested included measures tapping social influences, social bonds, problem behavior, alcohol beliefs, television exposure and demographics. FINDINGS: For seventh-grade non-drinkers, exposure to in-store beer displays predicted drinking onset by grade 9; for seventh-grade drinkers, exposure to magazines with alcohol advertisements and to beer concession stands at sports or music events predicted frequency of grade 9 drinking. Although exposure to television beer advertising had a significant bivariate relationship with alcohol use for grade 7 non-drinkers, it was not a significant predictor of drinking for either group in multivariate analyses. Participation in the prevention program, ALERT Plus, reduced future drinking for both groups and counteracted the effect of in-store beer displays. CONCLUSIONS: Several forms of alcohol advertising predict adolescent drinking; which sources dominate depends on the child's prior experience with alcohol. Alcohol prevention programs and policies should help children counter alcohol advertising from multiple sources and limit exposure to these sources.

Adolescent↗

Perception of foreign cigarettes and their advertising in China: a study of college students from 12 universities.

OBJECTIVE: To examine how deeply foreign cigarette advertising had penetrated the Chinese market when a new ban on cigarette advertising was enacted in February 1995. DESIGN: A survey using self-completion questionnaires administered in college classrooms from November 1994 to March 1995. SETTINGS: Eight universities and four medical schools in three Chinese cities: Beijing, Wenzhou, and Hangzhou. SUBJECTS: 1896 college students who agreed to complete a written questionnaire. The mean age was 21.2 years; 39.5% of respondents were female. RESULTS: Four of the top eight cigarette brands most familiar to the respondents were foreign: Marlboro, 555, Kent, and Hilton. Advertisements for the foreign brands were much more likely to be seen than those for the domestic brands; those for Marlboro were reported most often (29.7%), followed by 555 (21.8%) and Kent (18.1%). Among smokers, Marlboro was the most preferred foreign brand, by 44.2%. The preference for Marlboro was also correlated with smokers having seen its advertisements. Most respondents, 71.8%, believed that cigarette advertising should be banned. CONCLUSIONS: The previous restrictions on cigarette advertising in China failed to prevent a large portion of the population from seeing and understanding the advertisements. Before the 1995 advertising ban took effect, strict limitations on imports of foreign cigarettes notwithstanding, certain highly advertised brands such as Marlboro achieved wide recognition and even consumer preference. Stricter restrictions are suggested as previous ones have failed to achieve their intended effects.

Adolescent↗

[Tobacco advertising and printed mass media in Spain: a fatal attraction].

OBJECTIVE: Tobacco advertising is a powerful factor in encouraging smoking initiation. We analyzed tobacco advertising in written mass media in Spain between 2002 and 2005. METHODS: We performed an annual cross-sectional study of advertisements in the 41 most widely disseminated written mass media (nearly 10 million readers). RESULTS: In the period studied, 37% of the media included tobacco advertising (an average of 4.35 million readers). Only 4% of the media included anti-drug campaigns (an average of 0.27 million readers). Tobacco advertising increased from 2.0 to 4.7% (overall) and from 4.3 to 8.0% (in media allowing tobacco advertising). Four out of every 10 readers and one out of eight Spaniards aged 15 years or older were exposed to tobacco advertising. Fifty-six percent of advertisements included young people. CONCLUSIONS: Tobacco advertising remains prominent in written mass media in Spain and was mainly directed at young people.

Adolescent↗

Assessing storefront tobacco advertising after the billboard ban.

This study examined storefront tobacco advertisements in 11 towns in Illinois from 1999 through 2001 to assess possible changes in these types of advertisements since the master tobacco settlement, which banned tobacco advertisements on billboards. Observers assessed the number of merchant- and industry-made tobacco storefront advertisements in Illinois stores and whether these advertisements were either brand- or price-focused. The relationship between the amount of tobacco advertisements and underage tobacco sales to minors was also explored. Findings indicated no significant relationships between tobacco advertisements and underage tobacco sales. However, industry price advertisements decreased over time because of tobacco price increases resulting from the master settlement, whereas industry brand advertisements increased over time, perhaps in an effort by the tobacco industry to retain sales of their products through brand recognition.

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The attitudes and beliefs of oncology nurse practitioners regarding direct-to-consumer advertising of prescription medications.

PURPOSE/OBJECTIVES: To obtain information about the knowledge and attitudes of oncology nurse practitioners (ONPs) concerning the effect of direct-to-consumer (DTC) advertising of prescription medications on prescribing patterns. DESIGN: Exploratory survey. SETTING: Oncology Nursing Society Nurse Practitioner Special Interest Group members in the United States. SAMPLE: 221 of 376 ONPs completed the survey (58%). METHODS: Researcher-developed 12-question postal survey. MAIN RESEARCH VARIABLES: Knowledge and attitudes of ONPs on DTC advertising effects on prescribing patterns. FINDINGS: The findings were similar to those of previous studies of physicians regarding the number of visits when patients requested DTC-advertised medications. Major differences were the positive attitudes of ONPs toward potentially longer patient visits to explain and educate patients regarding medication requests based on DTC advertising and smaller percentages of ONPs who felt "pressured" to prescribe requested medications. CONCLUSIONS: ONPs have mixed opinions regarding the practice of DTC advertising but do not believe that they are influenced heavily by advertising with regard to prescriptive practices. ONPs consider patient encounters for education purposes as appropriate and include information about requested DTC-advertised medications in their approach to patient care. IMPLICATIONS FOR NURSING: This is an exploratory survey of a specialty group of ONPs. More research is needed to further explore the practice of DTC advertising and potential influences on the prescribing patterns of ONPs. DTC advertising of prescription medications is increasing; ONPs need to increase their knowledge base about the potential for influences of prescriptive practices.

Adult↗

Advertising and alcohol sales: a legal impact study.

According to the single distribution theory increases in the availability of alcoholic beverages in the general population are associated with increases in average consumption and increases in alcohol-related damage. If it can be demonstrated that advertising contributes to availability, perhaps in the form of what has been called social or subjective availability, then advertising could be considered an appropriate target of prevention. A 58-year ban on advertising of alcoholic beverages was lifted in Saskatchewan in 1983. Data on monthly sales of beer, wine and distilled spirits were examined for the years 1981 to 1987. Box-Jenkins time series techniques were used to estimate the statistical relationship between the policy change and volume of sales of alcoholic beverages. The results revealed that sales of beer increased and sales of spirits decreased following the change in legislation that permitted alcohol advertising in Saskatchewan. The main finding is that there was no impact on wine and total alcohol sales from the introduction of alcohol advertising. Alcohol advertising may have produced a substitution effect with respect to beer and spirits, but this was not predicted. This evaluation suggests that alcohol advertising is not a contributory force that influences the overall level of alcohol consumption. The place of advertising in the single distribution theory remains not proven, and the place of advertising as an instrument of public policy with respect to the prevention of alcohol-related damage remains in question.

Advertising↗

Nutritional content of foods advertised during the television programs children watch most.

OBJECTIVES: We sought to code food (nutritional content and food type and eating occasion) and character (cartoon and live action) attributes of food advertisements airing during television programs heavily viewed by children, and to represent and evaluate the nutritional content of advertised foods in terms of the nutrition facts label. METHODS: Food advertisements (n=426) aimed at general and child audiences were coded for food and character attributes. "Nutrition Facts" label data for advertised foods (n=275) were then analyzed. RESULTS: Convenience/fast foods and sweets comprised 83% of advertised foods. Snacktime eating was depicted more often than breakfast, lunch, and dinner combined. Apparent character body size was unrelated to eating behavior. A 2000-calorie diet of foods in the general-audience advertisements would exceed recommended daily values (RDVs) of total fat, saturated fat, and sodium. A similar diet of foods in the child-audience advertisements would exceed the sodium RDV and provide 171 g (nearly 1 cup) of added sugar. CONCLUSIONS: Snack, convenience, and fast foods and sweets continue to dominate food advertisements viewed by children. Advertised foods exceed RDVs of fat, saturated fat, and sodium, yet fail to provide RDVs of fiber and certain vitamins and minerals.

Advertising↗

Pharmaceutical advertising revenue and physician organizations: how much is too much?

OBJECTIVE: To determine if revenue generated from pharmaceutical advertisements in medical journals creates potential financial conflicts of interest for nonprofit physician organizations that own those journals. DESIGN: Convenience sample of six professional medical societies and their respective journals. Calculation of pharmaceutical advertising revenue generated by these journals for their respective professional medical societies. METHODS: Random selection of each journal for one month per quarter in calendar year 1996 and tabulation per edition of the average number of pharmaceutical advertising pages for each journal. OUTCOME MEASURES: Published advertising rates were used to estimate pharmaceutical advertising revenue for calendar year 1996 and compared with each organization's gross revenue and membership dues and assessments, based on Internal Revenue Service documents for the last available fiscal year (1995). RESULTS: Estimated pharmaceutical advertising revenue ranged from $715,000 to $18,630,000. Five organizations raised more than 10% of their gross income (range 2% to 30%) from a single journal's pharmaceutical advertising. Four organizations raised as much or more from pharmaceutical advertising as from members (range 17% to 790%). CONCLUSIONS: Potential financial conflicts of interest arising from pharmaceutical advertisements in medical journals may be substantial. The impact on professional societies' financial independence and behavior is unknown.

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The educational value of consumer-targeted prescription drug print advertising.

BACKGROUND: The case for direct-to-consumer (DTC) prescription drug advertising has often been based on the argument that such promotions can educate the public about medical conditions and associated treatments. Our content analysis of DTC advertising assessed the extent to which such educational efforts have been attempted. METHODS: We collected advertisements appearing in 18 popular magazines from 1989 through 1998. Two coders independently evaluated 320 advertisements encompassing 101 drug brands to determine if information appeared about specific aspects of the medical conditions for which the drug was promoted and about the treatment (mean kappa reliability=0.91). We employed basic descriptive statistics using the advertisement as the unit of analysis and cross-tabulations using the brand as the unit of analysis. RESULTS: Virtually all the advertisements gave the name of the condition treated by the promoted drug, and a majority provided information about the symptoms of that condition. However, few reported details about the condition's precursors or its prevalence; attempts to clarify misconceptions about the condition were also rare. The advertisements seldom provided information about the drug's mechanism of action, its success rate, treatment duration, alternative treatments, and behavioral changes that could enhance the health of affected patients. CONCLUSIONS: Informative advertisements were identified, but most of the promotions provided only a minimal amount of information. Strategies for improving the educational value of DTC advertisements are considered.

Advertising↗

[What messages did the Norwegian tobacco industry communicate to consumers in its advertising?].

BACKGROUND: A Norwegian official report, NOU 2000: 16, Tort liability for the Norwegian tobacco industry, concludes that Norwegian law and judicial practice allows lawsuits against the tobacco industry for damages. A crucial claim in such suits would be that the industry withheld information on health risks and addiction and instead used advertising messages that undermined the information campaigns initiated after the reports on smoking and health from the U.S. Surgeon-General and the Norwegian Board of Health in 1964. This article reports a study of differences in tobacco advertising in Norway before and after 1964. MATERIAL AND METHODS: A total of 1,945 photographs of advertisements in two popular weekly family magazines over the 1955 to 1975 period were stored in a database along with information on date of publication, size, copy and message, presumed target group, and characteristics of persons and situations shown. RESULT: Up until 1964, advertisement space per year in these magazines totalled 100 dm2 (11 sq. feet). The amount of advertising space then increased up until 1973, to 2,033 dm2 (219 sq. feet). The share featuring women went up from 33 in the 1955-64 period to 62% in 1965-75, when 51% of advertisements showed women smoking while 31% showed men smoking. Pre-1964 advertisements primarily contained information to smokers on price, type of tobacco, packaging and country of origin; after 1964 the advertisements developed a more universal appeal associating smoking with various social situations marked by style, well-being and comfort. The tobacco was said to be pure, fresh, mild and natural, and the filter was claimed to have protective properties. INTERPRETATION: It is probable that the cognitive dissonance created by more health information on smoking after 1964, i.e. the necessary motivation to quit, was reduced as a result of strategic changes in the amount and content of advertising.

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Television advertising of foodstuffs potentially detrimental to oral health--a content analysis and comparison of children's and primetime broadcasts.

OBJECTIVES: The study aimed to examine the nature, content and duration of advertisements broadcast during children's television; determine the proportion of advertisements promoting food; identify the potential of the food advertised to be detrimental to oral health; and to compare the nature and content of advertisements aimed at children with those transmitted during evening 'primetime' television. BASIC RESEARCH DESIGN: Children's and primetime television, broadcast on a main independent terrestrial channel in South Wales were video recorded, 237 and 42 hours being analysed in total. RESULTS: Analysis of the recording resulted in a total of 3,236 commercials, of which 2,345 were broadcast during children's television and 891 in primetime. During children's TV, 62.5% of advertising time was devoted to foodstuffs, significantly greater (P< 0.001) than the 18.4% of time spent advertising foods during primetime. Of the time spent advertising foods, during children's television 73.4% was devoted to products deemed potentially detrimental to oral health (primarily high in sugar), compared to 18.6% similarly categorised during evening television. CONCLUSIONS: Commercials for products which have the potential to adversely affect oral health constitute a large proportion of advertising time during children's television. Current codes of the Independent Television Commission governing advertising directed at children should be reviewed.

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