Ute Mons Cancer Prevention Unit & WHO Collaborating Center for Tobacco Control German Cancer Research Center (DKFZ), Heidelberg, Germany

1. Impact of research on tobacco
advertising, promotion and sponsorship
for tobacco control
Ute Mons
Cancer Prevention Unit & WHO Collaborating Center for Tobacco Control
German Cancer Research Center (DKFZ), Heidelberg, Germany
ICO-WHO Symposium on Tobacco Control | December 3, 2018 | Barcelona
@UteMons

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Abteilung
Background

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AbteilungTobacco advertising, promotion and sponsorship (TAPS)
• TAPS = levels 1 and 2
• Integrated levels of marketing and
promotion
• Each level from 1 through 4 represents a broader
and more indirect level of marketing effort
• …but also a more powerful one (efforts at the
stakeholder level can have impact on policies)
• Challenge to goals of tobacco control/
public health
• As direct channels become more restricted, efforts
and resources will be allocated to more indirect
channels
• Importance of monitoring

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Abteilung FCTC on TAPS
Article 13 – Tobacco advertising, promotion and sponsorship
2. Each Party shall, in accordance with its constitution or constitutional principles, undertake a comprehensive ban of
all tobacco advertising, promotion and sponsorship. This shall include […] a comprehensive ban on cross-border
advertising, promotion and sponsorship originating from its territory. In this respect, within the period of five years after
entry into force of this Convention for that Party, each Party shall undertake appropriate […] measures […].
3. A Party that is not in a position to undertake a comprehensive ban due to its constitution or constitutional principles
shall apply restrictions on all tobacco advertising, promotion and sponsorship. […]
4. As a minimum, and in accordance with its constitution or constitutional principles, each Party shall:
a. prohibit all forms of tobacco advertising, promotion and sponsorship that promote a tobacco product by any
means that are false, misleading or deceptive or likely to create an erroneous impression about its characteristics,
health effects, hazards or emissions;
c. restrict the use of direct or indirect incentives that encourage the purchase of tobacco products by the public;
e. undertake a comprehensive ban or, in the case of a Party that is not in a position to undertake a
comprehensive ban due to its constitution or constitutional principles, restrict tobacco advertising, promotion and
sponsorship on radio, television, print media and, as appropriate, other media, such as the internet, within a
period of five years; and
prohibit, or in the case of a Party that is not in a position to prohibit due to its constitution or constitutional
principles restrict, tobacco sponsorship of international events, activities and/or participants therein.
5. Parties are encouraged to implement measures beyond the obligations set out in paragraph 4.

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Abteilung
Scientific evidence

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Abteilung Important assessments of evidence I
NCI Monograph #19, 2008
• Comprehensive synthesis of scientific literature on
media communication in tobacco promotion
• Conclusions (Selection):
• Media communications play a key role in shaping tobacco-related
knowledge, opinions, attitudes, and behaviors among individuals
and within communities
• The total weight of evidence – from multiple types of studies,
conducted by investigators from different disciplines, and using data
from many countries – demonstrates a causal relationship between
tobacco advertising and promotion and increased tobacco use

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Abteilung Important assessments of evidence II
Lovato et al. 2011
• Methods:
• Systematic review on TAPS and smoking initiation, included 19
longitudinal studies with in total >29.000 baseline never-smokers
• Conclusions:
• Longitudinal studies consistently suggest that exposure to
tobacco advertising and promotion is associated with the
likelihood that adolescents will start to smoke
• Based on the strength and specificity of this association,
evidence of a dose-response relationship, the consistency of
findings across numerous observational studies, temporality of
exposure and smoking behaviours observed, as well as the
theoretical plausibility regarding the impact of advertising, we
conclude that tobacco advertising and promotion increases the
likelihood that adolescents will start to smoke

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Abteilung Important assessments of evidence III
Surgeon General Report, 2012
• Comprehensive literature review
• Conclusions (Selection):
• The evidence is sufficient to conclude that there is a causal
relationship between advertising and promotional efforts of the
tobacco companies and the initiation and progression of tobacco
use among young people

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Abteilung Important assessments of evidence IV
NCI Monograph #21, 2016
• Comprehensive literature review
• Conclusions (Selection):
• The weight of the evidence from multiple types of studies done by
researchers from a variety of disciplines and using data from many
countries indicates that a causal relationship exists between
tobacco company marketing activities and tobacco use, including
the uptake and continuation of tobacco use among young people.
• In high-income countries, comprehensive policies to ban the
marketing activities of tobacco companies are effective in reducing
tobacco use, but partial marketing bans have little or no effect

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Abteilung
TAPS regulations

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AbteilungInsufficient implementation of FCTC Art. 13 in Europe
2014

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AbteilungInsufficient implementation of FCTC Art. 13 in Europe
2018

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Abteilung Example: Germany

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Abteilung
• Significant increase
in FCTC policy
implementation
Insufficient implementation of FCTC Art. 13

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Abteilung Intermediate conclusions
• Strong evidence for causal association between tobacco marketing activities and
tobacco use
• Strong evidence for effectiveness of comprehensive policies to ban the marketing
activities of tobacco companies in reducing tobacco use
• Usually high population support for TAPS bans
• Clear requirements through FCTC to implement a comprehensive TAPS ban
• Efforts to harmonize advertising restrictions through EU directives
…and yet:
• Substantial differences in country efforts to undertake a comprehensive TAPS ban
• Insufficient FCTC implementation

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Abteilung
Explanations

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Abteilung Potential explanations
Tobacco
industry
Research
Tobacco control
policies
Scientific
evidence
Political will
Population
support
Goal: To curb
the
tobacco
epidemic
FCTC
implementation
 Poor communication of evidence
 Tobacco industry interference
 Insufficient political will

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AbteilungHow to communicate evidence / public health advocacy
Don’t imagine that if you publish evidence, they will come
• Be proactive, be persistent, be passionate
• Develop networks, found/join alliances
Understand your audience and don’t expect evidence to speak for itself
• Synthesize evidence concisely to minimise its cognitive burden
• Use story-telling and case studies, frame your message
• Know your enemies, anticipate opposition arguments and prepare your responses
Exploit windows of opportunity
• Reach out and present your solution when attention rises to a problem
• Keep up to date with what’s in the news and with the latest published evidence
Understand and accept the real-world policy-making processes
• Find mentors, learn from examples and case studies
• Find allies/partners who are involved, build trust and offer your support
• Don’t make excessive demands – be realistic and prepared to compromise – use criticism wisely

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AbteilungHow to communicate evidence / public health advocacy
• Scientific articles
• Analyses of advertising and documentation
• Scientific evidence factsheets
• Contrasting industry arguments with evidence
• Showing public support
• Mobilization of NGOs and medical associations
• Media advocacy
• Letters to MPs
• Personal communication with MPs

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Abteilung
• To avoid a European tobacco advertising ban in the 1990s the
tobacco industry paid scientists to generate reports stating that
tobacco advertising does not influence tobacco consumption
• Tobacco industry prepared proposals for weak legislation and
disseminated those into European parliament via German MEPs
• Weak self-regulatory measures were proposed to avoid TAPS
restrictions
• Tobacco industry managed to prevent an outdoor advertising ban
in 2016
• To avoid abolition of vending machines, tobacco industry paid
12 million Euro for a youth prevention campaign
Smoking calms you
down
Correct: smokers don‘t need to
worry about their future because
half of them die prematurely
Tobacco industry interference: example Germany

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Abteilung
• German paradox: despite weak tobacco control and prominent tobacco advertising youth
prevalence is declining steadily
• Makes „child framing“ of messages difficult
• Tobacco industry refers to „German model“ when claiming that educational prevention is more
effective than tobacco control
• Philip Morris: “Educational programmes, seen as and proven to be one of the most effective
drivers in discouraging youth smoking and helping smokers quit are proving successful. For
example the German programme “Be Smart – Don’t Start”, forms part of a comprehensive
education programme that has seen youth smoking rates more than halved since 2001”
• Imperial Tobacco: “Germany has a tobacco control strategy with education embedded at its
core, and it delivers proven results“
Tobacco industry interference: example Germany

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Abteilung Popular arguments against TAPS bans I
„A ban on tobacco advertising won’t decrease tobacco use, and youth smoking is
declining already despite outdoor advertising”
- There is compelling evidence that TAPS bans significantly reduce cigarette
consumption
- The decline in youth smoking is a success of regulatory measures, such as tax
increases and a ban of sales to minors
- Initiation is not prevented in many cases, but rather shifted to legal age – opinions
and attitudes towards smoking shaped by earlier exposure to TAPS

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Abteilung Popular arguments against TAPS bans III
„TAPS does not encourage people to start smoking; it’s just about informing
consumers about the products and enticing current smokers to switch brands.”
- There is compelling evidence that smoking
encourages tobacco use among youths

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Abteilung Insufficient political will
• Cultural and historical reasons
• respect for freedom of choice
• no political interference in personal choices
• no public health tradition
• industry-friendliness
• corporatistic policy system with comprehensive
stakeholder engagement
• Fertile ground for tobacco industry arguments
© Paul Cairney

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Abteilung Popular arguments against TAPS bans II
„Cigarettes are a legal product for adults who can make responsible decisions”
- Cigarettes are legal but they are not like any other consumer products
- Many adults are addicted to tobacco

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Abteilung Conclusions
• Evidence on effects of TAPS on smoking and on effectiveness of TAPS bans
is compelling
• Coercive FCTC requirements on TAPS legislation
• …but insufficient translation of evidence into action and insufficient FCTC
implementation in many countries
• Targeted communication/dissemination of evidence needed
• Curbing tobacco industry interference is crucial
• Both can help increasing political will to strengthen tobacco control

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Abteilung
Contact:
u.mons@dkfz.de

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Abteilung Popular arguments against TAPS bans IV
„TAPS bans pave the way for other advertising bans. If we ban tobacco advertising
today, there will be an alcohol advertising ban the next day, and then a marketing ban
for sweet and salty snacks the day after that.”
- In Germany, this argument was already brought forward in discussions about TV
advertising bans for cigarettes in 1975…
- Tobacco is unique in its harmfulness

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Abteilung Scientific evidence on TAPS and TAPS bans
Some preliminary remarks
• Advertising effects are complex and multidimensional
• Difficult to establish control groups (RCTs not possible and observational studies suffer
from confounding bias)
• Some effects are only indirect and/or long-term
• „Background noise“ from other exposures
• No single study design/method can provide the weight of evidence necessary for causal
inferences regarding effects of TAPS and effectiveness of TAPS bans
• While some study designs are superior to others ( conceptual framework of ITC), only a
body of evidence from different methods and designs enable an assessment
• Econometric studies
• Qualitative studies (incl. analyses of media content, tobacco industry documents)
• Psychological studies (experiments)
• Epidemiological studies (esp. prospective, longitudinal)
• Quasi-experimental designs

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Abteilung
• In 2016 a law was proposed to ban outdoor
advertising as of 2020
• Many meetings between tobacco industry
representatives and German ministries to
discuss plans regarding an outdoor
advertising ban
• Law failed because industry-friendly MPs
blocked a parliamentary vote
Tobacco industry interference: example Germany