In the Journals

Reach of court-ordered antismoking ads ‘suboptimal’ in US population

Approximately half of current smokers in a recent survey reported seeing federal court-ordered antismoking advertisements, but exposure to these advertisements fell short in some U.S. populations, including in those who are at higher risk for tobacco use, researchers reported in JAMA Network Open.

In 2006, Gladys Kessler, a federal judge on the U.S. District Court for the District of Columbia, ruled that tobacco companies had violated the Racketeer Influenced and Corrupt Organizations Act based on evidence indicating the industry misled the general public about the health risks of smoking.

Tobacco companies were subsequently ordered to issue corrective statements about their deceptive practices with regard to the adverse health effects of smoking, among other issues, via paid advertisements in major newspapers, on television, retail point-of-sale displays, cigarette package inserts and on tobacco companies’ corporate websites. The first of these appeared in November 2017.

“To our knowledge, since the dissemination of the corrective advertising campaign, no

assessment has been conducted to evaluate the penetration of these advertisements within the U.S. population. Given the tobacco industry’s history of deceptiveness as well as the skepticism generated by an industry-sponsored public health campaign (albeit a federal court-ordered campaign), an assessment of the population-level penetration of this antismoking advertising campaign is crucial,” the researchers wrote.

Penetration of antismoking messages

For this study, the researchers conducted a nationally representative, population-based, cross-sectional survey of U.S. adults who responded to the 2018 Health Information National Trends Survey (HINTS) 5, Cycle 2, with data collection occurring from January to May 2018 and analysis occurring from December 2018 to April 2019.

In the overall sample of 3,484 respondents, the estimated exposure to the court-ordered antismoking advertisements was 40.6% (95% CI, 37.5-43.7), with the lowest exposure among respondents aged 18 to 34 years (37.4%; 95% CI, 28-46.8), those with a high school education or less (34.5%; 95% CI, 29.3-39.8) and those with an annual household income less than $35,000 (37.5%; 95% CI, 32-42.9).

Among the 450 respondents who were current smokers, 50.5% reported exposure to antismoking advertisements. Similar to data from the overall sample, exposure rates were lowest among those aged 18 to 34 (45.2%; 95% CI, 24.1-66.4). Exposure rates were also lower among Hispanic respondents (42.2%; 95% CI, 18.5-65.9) when compared with white respondents (51.7%; 95% CI, 40.4-63.1).

In the overall sample, reported rates of exposure to antismoking advertisements appeared to increase as the duration of the campaign increased, and exposure rates were highest among those who returned surveys in April or May 2018 (46.8%; 95% CI, 35.5-58.1). Notably, among current smokers, exposure increased from 46.6% (95% CI, 36.2-57.1) for those who returned surveys in February 2018 to 78.3% (95% CI, 64.3-92.2) for those who returned surveys in April or May 2018.

Most respondents who reported seeing antismoking advertisements (70.5%) were exposed to multiple types of antismoking messages, with the most commonly reported messages addressing the health effects of smoking (17.3%).

After multivariable adjustment, the likelihood of exposure to the antismoking advertisements was significantly lower among people with a high school education or less vs. those who had a college or postgraduate degree (adjusted OR = 0.67; 95% CI, 0.48-0.94), whereas the likelihood of exposure was higher among current smokers vs. never smokers (aOR = 1.81; 95% CI, 1.17-2.8).

Looking ahead

Despite the broad scope of the national-level advertising campaign, the reach of these antismoking messages was “suboptimal,” according to the researchers.

“This study offers critical cues for oversight of ongoing and future tobacco industry-sponsored antismoking advertising campaigns. This study also draws attention to the important role that judiciary, along with regulatory agencies, public health agencies and health interest groups, can play in comprehensive tobacco control and prevention,” they wrote. “District Judge Kessler’s landmark ruling could have implications for global tobacco control (if similar efforts are adopted by the judiciary in regions outside the United States) as well as beyond the field of tobacco control and may set a precedent for similar actions in other areas relevant to public health where deceptive industry marketing practices exist.” – by Melissa Foster

Disclosures: The authors report no relevant financial disclosures.

Approximately half of current smokers in a recent survey reported seeing federal court-ordered antismoking advertisements, but exposure to these advertisements fell short in some U.S. populations, including in those who are at higher risk for tobacco use, researchers reported in JAMA Network Open.

In 2006, Gladys Kessler, a federal judge on the U.S. District Court for the District of Columbia, ruled that tobacco companies had violated the Racketeer Influenced and Corrupt Organizations Act based on evidence indicating the industry misled the general public about the health risks of smoking.

Tobacco companies were subsequently ordered to issue corrective statements about their deceptive practices with regard to the adverse health effects of smoking, among other issues, via paid advertisements in major newspapers, on television, retail point-of-sale displays, cigarette package inserts and on tobacco companies’ corporate websites. The first of these appeared in November 2017.

“To our knowledge, since the dissemination of the corrective advertising campaign, no

assessment has been conducted to evaluate the penetration of these advertisements within the U.S. population. Given the tobacco industry’s history of deceptiveness as well as the skepticism generated by an industry-sponsored public health campaign (albeit a federal court-ordered campaign), an assessment of the population-level penetration of this antismoking advertising campaign is crucial,” the researchers wrote.

Penetration of antismoking messages

For this study, the researchers conducted a nationally representative, population-based, cross-sectional survey of U.S. adults who responded to the 2018 Health Information National Trends Survey (HINTS) 5, Cycle 2, with data collection occurring from January to May 2018 and analysis occurring from December 2018 to April 2019.

In the overall sample of 3,484 respondents, the estimated exposure to the court-ordered antismoking advertisements was 40.6% (95% CI, 37.5-43.7), with the lowest exposure among respondents aged 18 to 34 years (37.4%; 95% CI, 28-46.8), those with a high school education or less (34.5%; 95% CI, 29.3-39.8) and those with an annual household income less than $35,000 (37.5%; 95% CI, 32-42.9).

Among the 450 respondents who were current smokers, 50.5% reported exposure to antismoking advertisements. Similar to data from the overall sample, exposure rates were lowest among those aged 18 to 34 (45.2%; 95% CI, 24.1-66.4). Exposure rates were also lower among Hispanic respondents (42.2%; 95% CI, 18.5-65.9) when compared with white respondents (51.7%; 95% CI, 40.4-63.1).

In the overall sample, reported rates of exposure to antismoking advertisements appeared to increase as the duration of the campaign increased, and exposure rates were highest among those who returned surveys in April or May 2018 (46.8%; 95% CI, 35.5-58.1). Notably, among current smokers, exposure increased from 46.6% (95% CI, 36.2-57.1) for those who returned surveys in February 2018 to 78.3% (95% CI, 64.3-92.2) for those who returned surveys in April or May 2018.

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Most respondents who reported seeing antismoking advertisements (70.5%) were exposed to multiple types of antismoking messages, with the most commonly reported messages addressing the health effects of smoking (17.3%).

After multivariable adjustment, the likelihood of exposure to the antismoking advertisements was significantly lower among people with a high school education or less vs. those who had a college or postgraduate degree (adjusted OR = 0.67; 95% CI, 0.48-0.94), whereas the likelihood of exposure was higher among current smokers vs. never smokers (aOR = 1.81; 95% CI, 1.17-2.8).

Looking ahead

Despite the broad scope of the national-level advertising campaign, the reach of these antismoking messages was “suboptimal,” according to the researchers.

“This study offers critical cues for oversight of ongoing and future tobacco industry-sponsored antismoking advertising campaigns. This study also draws attention to the important role that judiciary, along with regulatory agencies, public health agencies and health interest groups, can play in comprehensive tobacco control and prevention,” they wrote. “District Judge Kessler’s landmark ruling could have implications for global tobacco control (if similar efforts are adopted by the judiciary in regions outside the United States) as well as beyond the field of tobacco control and may set a precedent for similar actions in other areas relevant to public health where deceptive industry marketing practices exist.” – by Melissa Foster

Disclosures: The authors report no relevant financial disclosures.